Changes in the Resting-State Cortical Oscillatory Activity 6 Months After Modified Tinnitus Retraining Therapy

Abstract

Although tinnitus retraining therapy (TRT) based on Jastreboff’s classical neurophysiological model is efficacious in most patients, its effects on the cortical activity changes responsible for the improvement of tinnitus are still unclear. In this study, we compared pre- and post-TRT resting-state quantitative electroencephalography (rs-qEEG) findings to identify power changes that could explain TRT-induced improvements. Thirty-seven patients with severe tinnitus were enrolled in the study, and rs-qEEG data recorded before the initial TRT sessions and 6 months after TRT were compared. In addition, associations between the changes in qEEG and percentage improvements in Tinnitus Handicap Inventory (THI) scores and numeric rating scale (NRS) scores of tinnitus loudness and tinnitus perception were examined. The mean THI score decreased significantly 6 months after the initial TRT session. Also, significant improvements were observed 6 months after the initial TRT session compared with the pre-treatment scores in NRS loudness, distress, and perception. As compared with the pre-TRT status, post-TRT 6 months status showed significantly decreased powers in the left primary and secondary auditory cortices for the gamma frequency band. Changes in the alpha 1 frequency band power in the right insula and orbitofrontal cortex (OFC) appeared to be positively correlated with the percentage changes in NRS distress. These results suggested that TRT improved tinnitus-related distress by reducing the power of the top-down autonomic response modulator or peripheral physiological responses to emotional experiences. That is, TRT induced habituation via modulation of functional connections between the auditory system and the limbic and autonomic nervous systems. Our results confer additional basis for understanding the neurophysiological model and the newly suggested integrative model of tinnitus by De Ridder et al. (2014) in the context of the long-term efficacy of TRT.

Cortical Oscillatory Signatures Reveal the Prerequisites for Tinnitus Perception: A Comparison of Subjects With Sudden Sensorineural Hearing Loss With and Without Tinnitus

“…We performed qEEG data acquisition and pre-processing procedures according to a previously reported protocol (Kim et al, 2016;Song et al, 2017;Han et al, 2018;Vanneste et al, 2018b;Lee et al, 2019). Prior to EEG recording, we instructed the enrolled patients not to drink alcohol for 24 h and to avoid caffeine on the day of recording to exclude alcoholinduced changes in the EEG signal (Korucuoglu et al, 2016) and caffeine-induced reductions in alpha and beta power (Siepmann and Kirch, 2002).…”

“…Non-pulsatile tinnitus is a common otologic symptom characterized by conscious auditory perception in the absence of an external stimulus. This is often called a "phantom sound" because there is no corresponding genuine physical source of the sound (Vanneste et al, 2018b;Lee et al, 2019;Han et al, 2020). Although the exact mechanism of tinnitus has yet to be elucidated, peripheral auditory deafferentation has been suggested as the most important factor in increased spontaneous neuronal firing in the central auditory system and cortical maladaptive plasticity between auditory and non-auditory brain regions, leading to the development of tinnitus (Eggermont and Roberts, 2012;Elgoyhen et al, 2015).…”

Single-Session of Combined tDCS-TMS May Increase Therapeutic Effects in Subjects With Tinnitus

“…The therapeutic effect of each treatment group was assessed using four questionnaires: tinnitus handicap inventory (THI), visual analog scales (VAS) of tinnitus intensity (loudness), distress (annoyance), and perception (awareness) (38,39). Subjects completed the four questionnaires both before and after treatment.…”

The effects of sound therapy in tinnitus are characterized by altered limbic and auditory networks

“…Extensive means of treating tinnitus have been developed, which include medications ( von Boetticher, 2011 ; Bhatt et al , 2016 ), counselling and cognitive behaviour therapy, transcranial magnetic stimulation ( Kreuzer et al , 2017 ; Formánek et al , 2018 ), transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS) ( Bae et al , 2020 ), tinnitus retraining therapy ( Scherer et al , 2014 ; Kim et al , 2016 ; Lee et al , 2019 ), relaxation therapy, hearing aids ( Searchfield et al , 2010 ) and sound therapy ( Hall et al , 2015 ; Langguth, 2015 ; Blakley, 2016 ; Plein et al , 2016 ; Makar et al , 2017 ). According to the clinical practice guidelines of tinnitus, sound therapy is one of the recommended treatments ( Tunkel et al , 2014 ) and is used as a standard treatment in the UK ( Baguley et al , 2013 ).…”