A proof-of-concept study comparing tinnitus and neural connectivity changes following multisensory perceptual training with and without a low-dose of fluoxetine

Impact of short-term tinnitus treatment on cognitive function and neural synchronization

We aimed to evaluate the impact of short-term tinnitus treatment on cognitive function and identify the effects of various treatment combinations on cognitive and tinnitus outcomes. A non-randomized prospective study was conducted with 32 tinnitus patients at a tertiary university hospital between May 2022 and May 2024. Patients received treatments, including neuromodulation, diuretics, gabapentin, selective serotonin reuptake inhibitors (SSRI), anxiolytics, muscle relaxants, hearing aids, and counseling. Cognitive function and tinnitus distress were assessed using the Mini-Mental State Examination (MMSE) and Tinnitus Handicap Inventory (THI) at baseline and 1 month after treatment. Quantitative electroencephalogram (qEEG) recordings were analyzed to evaluate changes in neural synchronization using phase-locking value (PLV). Strong correlations were also observed between baseline MMSE and changes in MMSE post-treatment (r = -0.796, p < 0.01) and between tinnitus loudness perception and changes in MMSE (r = 0.458, p < 0.01). After Bonferroni correction, muscle relaxants (p = 0.017) and neuromodulation (p = 0.007) showed significant negative effects on cognitive function, while anxiolytics demonstrated a tendency for negative effects (p = 0.052). Additionally, neither baseline tinnitus loudness nor changes in loudness perception (ΔVAS for loudness) were significantly correlated with ΔTHI after Bonferroni correction (p > 0.05). qEEG analysis showed increased PLV in prefrontal-limbic and parietal-occipital connections in patients with improved THI as well as increased PLV in temporal-limbic connections in patients with improved MMSE scores, indicating enhanced neural synchronization and cognitive resource reorganization. These findings underscore the need for careful consideration of cognitive effects when selecting tinnitus treatments and highlight the importance of targeted multimodal interventions to address both tinnitus distress and cognitive function.

A Scoping Review of the Role of Attention in Tinnitus Management

There is strong evidence that attention plays an important role in tinnitus perception, but less is known about its role in treating tinnitus. This review scoped the literature for evidence of the role attention plays in tinnitus therapy and catalogued the methods employed, clinical outcomes, and the degree to which interventions for tinnitus were supported. The research question was "what role does attention play in the management or treatment of tinnitus." To identify relevant studies, database searches of Scopus (keywords) PsychArticle (title and abstract), CINAHL complete (title and abstract), and PubMed (title and abstract) were performed in March/April 2024 using the following search terms: [tinnitus] and [attention] and [treatment] or [therapy] or [management]. After the removal of duplicates, 494 articles were identified. After exclusions, and additions from references, 38 articles were included in the review. Treatments were classified into five types: electrical/magnetic stimulation, psychological, sound therapy, music therapy, and perceptual training. Sound therapy and perceptual training were identified as having the most evidence for their benefit via an attention mechanism. A model of sound and perceptual training in alleviating tinnitus through an attention pathway is presented.

A scoping review of tinnitus research undertaken by New Zealand researchers: Aotearoa-an international hotspot for tinnitus innovation and collaboration

Tinnitus is a very common oto-neurological disorder of the perception of sound when no sound is present. To improve understanding of the scope, strengths and weaknesses of New Zealand tinnitus research, a critical scoping review was undertaken. The aim was to help develop priorities for future research. A review of the literature was undertaken using a 6-stage scoping review framework of Scopus and Pub Med were searched in May 2023 with the combination of following key word [Tinnitus] and country of affiliation [New Zealand]. The search of PubMed resulted in 198 articles and that of Scopus 337 articles. After initial consideration of title relevance to the study (165 from PubMed and 196 from Scopus) removal of duplicates and after reading the articles and adding from references, 208 studies were chosen for charting of data. Nine themes were identified and described: A. Epidemiology; B. Models; C. Studies in animals; D. Mechanisms; E. Assessment and prognosis; F. Pharmacotherapy; G. Neuromodulation; H. Sensory therapies; I. Clinical practice. An urgent priority for future tinnitus research in NZ must be to address the absence of cultural and ethnic diversity in participants and consideration of traditional knowledge.

A scoping review of the spatial perception of tinnitus and a guideline for the minimum reporting of tinnitus location

Tinnitus spatial localisation is an essential attribute of tinnitus perception and how it is separated from other ongoing neural activity. A scoping review was undertaken to determine how tinnitus localisation is reported, the role of the perceived spatial location of tinnitus on neurophysiology and if sound presented spatially can change tinnitus perception. Following reading of the full-text articles and including articles from reference lists, 46 articles were included for review. Six themes emerged from the results. 1. Where tinnitus was localised. 2. The effects of tinnitus on localisation. 3. The mechanisms underpinning tinnitus spatial location. 4. Masking. 5. Auditory training. 6. Multisensory training and virtual reality (VR). Tinnitus is much more complex than the often-used description of 'ringing in the ears'. Tinnitus can be heard anywhere in and around the head. Spatial sound presentation and perceptual training approaches may disrupt spatial selective attention to tinnitus and appear as changes in some of the neural networks involved in sound localisation. Where tinnitus is heard is a critical aspect of its perception, but its report, even in studies purporting to study localisation, is too general. A matrix for standardised minimum reporting of tinnitus location is recommended.

Auditory training for tinnitus treatment: a scoping review

OBJECTIVES

Our study aimed to verify the evidence of auditory training employed in the audiological treatment of tinnitus in adults and older adults.

METHODS

Scoping review based on a search for articles in journals available in MEDLINE (PubMed), Embase (Elsevier), LILACS (BVS), and Cochrane Library. Titles and abstracts of the retrieved articles were assessed by peers, following the eligibility criteria; they were afterward read in full text, and the references were hand searched in the results found. Studies' level of evidence was classified into very high (Level A+), high (Level A), moderate (Level B), limited (Level C), low (Level D), or very low (Level D-) based on the Critically Appraised Topics.

RESULTS

2160 records were identified in the searching stage and 15 studies were eligible for data extraction. Study design, sample characterization, auditory training tasks, sound stimuli, outcome measures, and results were extracted. Frequency discrimination training was the most frequent strategy, followed by auditory attentional skills training and multisensory training. Almost all studies with daily auditory training sessions reported significant benefits demonstrated in at least one outcome measure. Studies that used auditory discrimination training and attentional auditory skill stimulation to treat tinnitus obtained quality evidence levels ranging from limited to high (C‒A) and studies that applied multisensory training or attentional training combined with counseling and passive listening in tinnitus patients reached a high-quality evidence level (A).

CONCLUSION

Recent studies had higher levels of evidence and considered attentional factors and multisensory pathways in auditory training strategies.

Recent Updates on Tinnitus Management

In this comprehensive review, we discuss recent updates on tinnitus evaluation and treatment. Tinnitus evaluation commences with comprehensive medical history taking and audiological evaluation, which can provide valuable insight into the nature and extent of auditory disturbances. Additionally, tinnitus evaluation includes investigation of psychosomatic comorbidities to determine the intricate interplay between psychological factors and tinnitus perception. Various therapeutic approaches are available to minimize the burden of tinnitus. Cognitive behavioral therapy reshapes negative thought patterns and behaviors that are closely associated with tinnitus-induced distress. Acceptance and commitment therapy fosters mindfulness and value-aligned actions to address emotional effects. Tinnitus retraining therapy combines counseling and sound therapy for habituation. Tailor-made notched music therapy offers customized auditory experiences for symptom relief. Hearing aids and cochlear implants compensate for hearing loss and associated stress. Both neuromodulation and neurofeedback may be potentially useful. The role of pharmacotherapy and dietary supplements remains uncertain. Physiotherapy and head-neck manipulation relieve tinnitus associated with orofacial factors. Virtual reality, smartphone applications, and photobiomodulation may serve as novel therapeutic avenues. Although promising interventions are available, further research is warranted to confirm their effectiveness and long-term effects.

Application of auditory mismatch negativity in tinnitus patients based on high-resolution electroencephalogram signals

Objective

The purpose of this study was to investigate the significance of mismatch negativity (MMN) by comparing high-resolution electroencephalogram signals from tinnitus patients and healthy controls.

Methods

The study included eight subjects with chronic subjective idiopathic tinnitus and seven healthy controls. Participants with clinical speech (512-2,000 Hz) hearing thresholds less than 25 dB HL and with negative Hospital Anxiety and Depression Scale scores were included in the study. The E-Prime 2.0 software and a 256-electrode EGI Net Station system were used to evoke and record the MMN signal, and the amplitude and latency parameters of the MMN responses were compared between the two groups.

Results

From 150 ms, there was a significant difference between the amplitude of standard stimulation and deviation stimulation, and the event-related potential amplitude under deviation stimulation in the tinnitus patient group was significantly different from that in the healthy group. The MMN amplitude of the FCz electrode was statistically significantly lower in the tinnitus patients compared to healthy controls.

Conclusion

MMN has application value in the evaluation of abnormal electrical activity in the auditory pathway, and electroencephalograms are feasible for follow-up monitoring after acoustic therapy.

A State-of-Art Review of Digital Technologies for the Next Generation of Tinnitus Therapeutics

Background: Digital processing has enabled the development of several generations of technology for tinnitus therapy. The first digital generation was comprised of digital Hearing Aids (HAs) and personal digital music players implementing already established sound-based therapies, as well as text based information on the internet. In the second generation Smart-phone applications (apps) alone or in conjunction with HAs resulted in more therapy options for users to select from. The 3rd generation of digital tinnitus technologies began with the emergence of many novel, largely neurophysiologically-inspired, treatment theories that drove development of processing; enabled through HAs, apps, the internet and stand-alone devices. We are now of the cusp of a 4th generation that will incorporate physiological sensors, multiple transducers and AI to personalize therapies. Aim: To review technologies that will enable the next generations of digital therapies for tinnitus. Methods: A "state-of-the-art" review was undertaken to answer the question: what digital technology could be applied to tinnitus therapy in the next 10 years? Google Scholar and PubMed were searched for the 10-year period 2011-2021. The search strategy used the following key words: "tinnitus" and ["HA," "personalized therapy," "AI" (and "methods" or "applications"), "Virtual reality," "Games," "Sensors" and "Transducers"], and "Hearables." Snowballing was used to expand the search from the identified papers. The results of the review were cataloged and organized into themes. Results: This paper identified digital technologies and research on the development of smart therapies for tinnitus. AI methods that could have tinnitus applications are identified and discussed. The potential of personalized treatments and the benefits of being able to gather data in ecologically valid settings are outlined. Conclusions: There is a huge scope for the application of digital technology to tinnitus therapy, but the uncertain mechanisms underpinning tinnitus present a challenge and many posited therapeutic approaches may not be successful. Personalized AI modeling based on biometric measures obtained through various sensor types, and assessments of individual psychology and lifestyles should result in the development of smart therapy platforms for tinnitus.

Emerging Topics in the Behavioral Neuroscience of Tinnitus

This volume has highlighted the many recent advances in tinnitus theory, models, diagnostics, therapies, and therapeutics. But tinnitus knowledge is far from complete. In this chapter, contributors to the Behavioral Neuroscience of Tinnitus consider emerging topics and areas of research needed in light of recent findings. New research avenues and methods to explore are discussed. Issues pertaining to current assessment, treatment, and research methods are outlined, along with recommendations on new avenues to explore with research.

Sense and Sensibility: A Review of the Behavioral Neuroscience of Tinnitus Sound Therapy and a New Typology

Tinnitus Sound Therapy is not a single strategy. It consists of many different sound types, targeting many different mechanisms. Therapies that use sound to cover, reduce attention to, or facilitate habituation of tinnitus are among the most common tinnitus treatment paradigms. Recent history has seen a proliferation of sound therapies, but they have each been criticized for having limited empirical support. In this review, Sound Therapy's modern history will be described, and a typology will be introduced and discussed in light of current behavioral neuroscience research. It will be argued that contributing factors to the limited evidence for the efficacy of Sound Therapy are its diversity, plural modes of action, and absence of a clear typology. Despite gaps in understanding the efficacy of sound's effects on tinnitus, there is compelling evidence for its multiple, but related, neurophysiological mechanisms. Evidence suggests that sound may reduce tinnitus through its presence, context, reaction, and potentially adaptation. This review provides insights into the neurocognitive basis of these tinnitus Sound Therapy modes. It concludes that a unifying classification is needed to secure and advance arguments in favor of Sound Therapy.