Automatic identification of tinnitus malingering based on overt and covert behavioral responses during psychoacoustic testing

Abstract

Tinnitus, or ringing in the ears, is a prevalent condition that imposes a substantial health and financial burden on the patient and to society. The diagnosis of tinnitus, like pain, relies on patient self-report, which can complicate the distinction between actual and fraudulent claims. Here, we combined tablet-based self-directed hearing assessments with neural network classifiers to automatically differentiate participants with tinnitus (N = 24) from a malingering cohort, who were instructed to feign an imagined tinnitus percept (N = 28). We identified clear differences between the groups, both in their overt reporting of tinnitus features, but also covert differences in their fingertip movement trajectories on the tablet surface as they performed the reporting assay. Using only 10 min of data, we achieved 81% accuracy classifying patients and malingerers (ROC AUC = 0.88) with leave-one-out cross validation. Quantitative, automated measurements of tinnitus salience could improve clinical outcome assays and more accurately determine tinnitus incidence.

The human pupil and face encode sound affect and provide objective signatures of tinnitus and auditory hypersensitivity disorders

“…A major goal for research on sensory disorders is to identify and refine a set of objective measurements – akin to what tumor imaging and biopsy data provide for oncologists or EEG measures of epileptiform activity provide to neurologists – that inform future care providers about the subtype and severity of the sensory disorder, the likelihood to benefit from a particular treatment, or whether they have demonstrated an improvement subsequent to treatment. While some measurements have been developed to identify whether an individual has tinnitus, they are insensitive to severity and lifestyle burden 39,58,59 . Here, we found that pupil dilation and facial reactions both demonstrated a correlation with symptom severity, though it was not clear whether these measures were redundant, nor how accurately they could predict an individual’s self-reported severity.…”

“…There are no objective measurements for the severity of tinnitus and sound sensitivity disorders. Instead, assessments rely on subjective self-report questionnaires, which can introduce vulnerabilities for malingering and false disability claims 39 and offer less insight into the underlying causes and potential treatments. Here, we hypothesized that involuntary autonomic and behavioral responses may have untapped potential as non-invasive, objective markers of tinnitus and sound sensitivity severity that are relatively easily to implement in laboratory and clinical settings.…”