Background
The scientific understanding of tinnitus and its etiology have
transitioned from thinking of tinnitus as solely a peripheral auditory
problem to an increasing awareness that cortical networks may play a
critical role in tinnitus percept or bother. With this change, studies that
seek to use structural brain imaging techniques to better characterize
tinnitus patients have become more common. These studies include using
voxel-based morphometry (VBM) to determine if there are differences in
regional gray matter volume in individuals who suffer from tinnitus and
those who do not. However, studies using VBM in patients with tinnitus have
produced inconsistent and sometimes contradictory results.
Objective
This paper is a systematic review of all of the studies to date that
have used VBM to study regional gray matter volume in people with tinnitus,
and explores ways in which methodological differences in these studies may
account for their heterogeneous results. We also aim to provide guidance on
how to conduct future studies using VBM to produce more reproducible results
to further our understanding of disease processes such as tinnitus.
Methods
Studies about tinnitus and VBM were searched for using PubMed and
Embase. These returned 15 and 25 results respectively. Of these, nine met
the study criteria and were included for review. An additional 5 studies
were identified in the literature as pertinent to the topic at hand and were
added to the review, for a total of 13 studies.
Results
There was significant heterogeneity among the studies in several
areas, including inclusion and exclusion criteria, software programs, and
statistical analysis. We were not able to find publicly shared data or code
for any study.
Discussion
The differences in study design, software analysis, and statistical
methodology make direct comparisons between the different studies difficult.
Especially problematic are the differences in the inclusion and exclusion
criteria of the study, and the statistical design of the studies, both of
which could radically alter findings. Thus, heterogeneity has complicated
efforts to explore the etiology of tinnitus using structural MRI.
Conclusion
There is a pressing need to standardize the use of VBM when
evaluating tinnitus patients. While some heterogeneity is expected given the
rapid advances in the field, more can be done to ensure that there is
internal validity between studies.