Attentional Bias in Patients with Decompensated Tinnitus: Prima Facie Evidence from Event-Related Potentials

What Do Mismatch Negativity (MMN) Responses Tell Us About Tinnitus?

Due to the heterogeneous causes, symptoms and associated comorbidities with tinnitus, there remains an unmet need for a clear biomarker of tinnitus presence. Previous research has suggested a "final pathway" of tinnitus presence, which occurs regardless of the specific mechanisms that resulted in alterations of auditory predictions and, eventually, tinnitus perception. Predictive inference mechanisms have been proposed as the possible basis for this final unifying pathway. A commonly used measure of prediction violation is mismatch negativity (MMN), an electrical potential generated in response to most stimuli that violate an established regularity. This narrative review discusses 16 studies comparing MMN between tinnitus and non-tinnitus groups. Methods varied considerably, including type of deviant, type of paradigm and carrier frequency. A minority of studies matched groups for age, sex and hearing, with few measuring hyperacusis. Frequency deviants were the most widely studied; at frequencies remote from tinnitus, MMN was consistently smaller in tinnitus groups, though hyperacusis or altered distress or attention could not be ruled out as explanatory factors. Few studies have used tinnitus-related frequencies; these showed larger MMN to upward frequency deviants above the tinnitus frequency, and larger MMN to upward intensity deviants at or close to the tinnitus frequency. However, the latter appears a correlate of hyperacusis rather than tinnitus, and tinnitus groups without hyperacusis instead show larger MMN to downward intensity deviants than controls. Other factors that affect MMN amplitudes included age, attention, and the specific characteristics of the range of stimuli across a particular experiment paradigm. As such, MMN cannot presently be considered a specific biomarker of tinnitus, but showed potential to objectively characterise a number of auditory processing traits relevant to tinnitus and hyperacusis.

Electrophysiological auditory measures to identify potential cortical markers of tinnitus

Tinnitus, or the perception of a sound in the absence of an external acoustic stimulus, is a common condition that cannot yet be objectively diagnosed. Current diagnostic tests of tinnitus consist of case history and behavioral measures that rely on subjective responses. This study examined electrophysiological measures, specifically the auditory late response (ALR), mismatch negativity (MMN), and P300 as potential neural biomarkers of tinnitus in both a tinnitus and non-tinnitus control group while utilizing the pitch-matched tinnitus frequencies as the test stimuli. Results of this study found differences in MMN amplitudes and area under the curve, and in P300 topographic maps between tinnitus and control subjects. The differences in MMN responses across groups suggest that dysfunctional processing of acoustic stimuli located near the tinnitus frequency in individuals with tinnitus manifests as soon as 200 ms after initial onset of the stimulus. In addition, results from a global field power analysis and differences in spatial distributions on topographical maps indicate that deficits persist through higher levels of cortical processing. A secondary goal of this study was to determine if electrophysiological measures correlated with reported tinnitus severity on questionnaires. This analysis indicated that P2 latency was a significant predictor of Tinnitus Reaction Questionnaire, Tinnitus Handicap Inventory, and percent of the time participant's tinnitus was considered bothersome, suggesting that this measure could potentially be used to assess the efficacy of treatment programs for tinnitus.

Deep learning-based electroencephalic diagnosis of tinnitus symptom

Tinnitus is a neuropathological phenomenon caused by the recognition of external sound that does not actually exist. Existing diagnostic methods for tinnitus are rather subjective and complicated medical examination procedures. The present study aimed to diagnose tinnitus using deep learning analysis of electroencephalographic (EEG) signals while patients performed auditory cognitive tasks. We found that, during an active oddball task, patients with tinnitus could be identified with an area under the curve of 0.886 through a deep learning model (EEGNet) using EEG signals. Furthermore, using broadband (0.5 to 50 Hz) EEG signals, an analysis of the EEGNet convolutional kernel feature maps revealed that alpha activity might play a crucial role in identifying patients with tinnitus. A subsequent time-frequency analysis of the EEG signals indicated that the tinnitus group had significantly reduced pre-stimulus alpha activity compared with the healthy group. These differences were observed in both the active and passive oddball tasks. Only the target stimuli during the active oddball task yielded significantly higher evoked theta activity in the healthy group compared with the tinnitus group. Our findings suggest that task-relevant EEG features can be considered as a neural signature of tinnitus symptoms and support the feasibility of EEG-based deep-learning approach for the diagnosis of tinnitus.

Systematic review and meta-analysis on the effect of continuous subjective tinnitus on attention and habituation

Background

Attention and habituation are two domains known to play key roles in the perception and maintenance of tinnitus. The heterogeneous nature of tinnitus and the methodologies adopted by various studies make it difficult to generalize findings. The current review aims at assessing and synthesizing evidence on the possible roles of attention and habituation in continuous subjective tinnitus.

Methodology

The literature search included five databases (PubMed, Scopus, Web of Sciences, CINAHL and ProQuest) that resulted in 1,293 articles, published by July 2019. Studies on attention and/or habituation in individuals with tinnitus using either behavioural or electrophysiological tests were included in the review after a quality assessment.

Results

Seventeen studies on attention in tinnitus were included in the narrative synthesis. Two meta-analyses were performed to assess the role of attention in tinnitus using a behavioural methodology (z = 4.06; p < 0.0001) and P300 amplitude (z = 2.70; p = 0.007) with 531 participants. With respect to habituation, the review indicates the lack of quality articles for habituation inclusion in the narrative synthesis.

Conclusions

The review highlights that selective domains of attention were consistently impaired in individuals with tinnitus. Habituation, on the other hand, needs further exploration.

Aberrant Frequency Related Change-Detection Activity in Chronic Tinnitus

Tinnitus is the perception of sound without the occurrence of an acoustic event. The deficit in auditory sensory or echoic memory may be the cause of the perception of tinnitus. This study considered the mismatch negativity (MMN) to investigate the potential difference between and within groups of persons with normal hearing (NH) and tinnitus. Using an auditory multi-feature paradigm to elicit the MMN, this study considered the MMN peak amplitude at two central frequencies for two MMN subcomponents. These central frequencies were 1 and 5 kHz, which the latter was closer to the perceived tinnitus frequency in the group with tinnitus. The deviants were higher frequency, lower frequency, higher intensity, lower intensity, duration, location (left), location (right), and gap. The pure tone audiometry (PTA) test and distortion product otoacoustic emissions (DPOAE) test showed no meaningful difference between the two groups. For the frontal subcomponent, the mean amplitudes of the MMN peak for the two groups illustrated less negative meaningful MMN peak amplitudes in the group of persons with tinnitus. For the supratemporal component at 5 kHz central frequency, amplitudes were lower for the group of persons with tinnitus, whereas for the central frequency of 1 kHz, most deviants exhibited meaningful differences. Additionally, within-group comparisons indicated that mean amplitudes for both groups were more negative at the central frequency of 1 kHz for the frontal MMN subcomponent. In comparison, the supratemporal component illustrated a lower peak amplitude at 5 kHz central frequency in the group of persons with tinnitus and no difference in the NH group, which is a unique observation of this study. Results of the between-groups are in accordance with previous studies and within-group comparisons consider the probability of decreasing the change detection capability of the brain. The results of this study indicate that increasing the frequency of the stimuli close to the tinnitus perceived frequencies decreases the prediction error, including the prediction error of the silence. Such a decrease may cause the prediction error of the spontaneous neural activity in the auditory pathway to exceed the silence prediction error, and as a result, increases the probability of occurrence of tinnitus in higher frequencies according to the predictive coding model.

Eyes and Ears: Cross-Modal Interference of Tinnitus on Visual Processing

The visual processing capacity of tinnitus patients is worse than normal controls, indicating cross-modal interference. However, the mechanism underlying the tinnitus-modulated visual processing is largely unclear. In order to explore the influence of tinnitus on visual processing, this study used a signal recognition paradigm to observe whether the tinnitus group would display a significantly longer reaction time in processing the letter symbols (Experiment 1) and emotional faces (Experiment 2) than the control group. Signal detection and signal recognition, which reflect the perceptual and conceptual aspects of visual processing respectively, were manipulated individually in different conditions to identify the pattern of the cross-modal interference of tinnitus. The results showed that the tinnitus group required a significantly prolonged reaction time in detecting and recognizing the letter symbols and emotional faces than the control group; meanwhile, no between-group difference was detected in signal encoding. In addition, any gender- and distress-modulated effects of processing were not found, suggesting the universality of the present findings. Finally, follow-up studies would be needed to explore the neural mechanism behind the decline in speed of visual processing. The positive emotional bias in tinnitus patients also needs to be further verified and discussed.

Highlights:

- The bottom-up visual processing speed is decreased in tinnitus patients.

- Tinnitus primarily interferes with the detection of the visual signals in individuals.

Heidelberg Neuro-Music Therapy Restores Attention-Related Activity in the Angular Gyrus in Chronic Tinnitus Patients

Background: Tinnitus is the perception of a phantom sound without external acoustic stimulation. Recent tinnitus research suggests a relationship between attention processes and tinnitus-related distress. It has been found that too much focus on tinnitus comes at the expense of the visual domain. The angular gyrus (AG) seems to play a crucial role in switching attention to the most salient stimulus. This study aims to evaluate the involvement of the AG during visual attention tasks in tinnitus sufferers treated with Heidelberg Neuro-Music Therapy (HNMT), an intervention that has been shown to reduce tinnitus-related distress. Methods: Thirty-three patients with chronic tinnitus, 45 patients with recent-onset tinnitus, and 35 healthy controls were tested. A fraction of these (21/21/22) were treated with the "compact" version of the HNMT lasting 1 week with intense treatments, while non-treated participants were included as passive controls. Visual attention was evaluated during functional Magnet-Resonance Imaging (fMRI) by a visual Continous Performance Task (CPT) using letter-based alarm cues ("O" and "X") appearing in a sequence of neutral letters, "A" through "H." Participants were instructed to respond via button press only if the letter "O" was followed by the letter "X" (GO condition), but not to respond if a neutral letter appeared instead (NOGO condition). All participants underwent two fMRI sessions, before and after a 1-week study period. Results: The CPT results revealed a relationship between error rates and tinnitus duration at baseline whereby the occurrence of erroneous "GO omissions" and the reaction time increased with tinnitus duration. Patients with chronic tinnitus who were treated with HNMT had decreasing error rates (fewer GO omissions) compared to treated recent-onset patients. fMRI analyses confirmed greater activation of the AG during CPT in chronic patients after HNMT treatment compared to treated recent-onset patients. Conclusions: Our findings suggest that HNMT treatment helps shift the attention from the auditory phantom percept toward visual cues in chronic tinnitus patients and that this shift in attention may involve the AG.