Tinnitus impairs cognitive efficiency

Many people who complain of tinnitus say that the noises impair their mental concentration. This complaint was investigated by self-report (primarily the Cognitive Failures Questionnaire) and by means of five cognitive tasks, four presented via laptop computer and one given manually. The tasks measured performance under single- and dual-task conditions and included tests of sustained attention, reaction time, verbal fluency and immediate and delayed memory. Two groups of outpatients attending audiological clinics (tinnitus, n = 43; hearing impairment, n = 17) were compared with non-clinical volunteers (n = 32). The results replicated earlier findings that tinnitus outpatients report significantly more everyday cognitive failures than do controls. The tinnitus group responded significantly more slowly than the two control groups on the variable fore-period reaction time task under dual-task conditions. In general, comparisons between the groups on other tasks showed equivalent performance, but both clinical groups performed more poorly than non-clinical controls on verbal fluency. We conclude that cognitive inefficiency in tinnitus participants is related to the control of attentional processes, consistent with our earlier theoretical speculation about the nature of tinnitus complaint and with published findings on the effects of chronic pain on cognitive processes.     

儿童变应性鼻炎对认知功能及情绪的影响

目的探讨儿童变应性鼻炎(AR)对认知功能及情绪的影响,并探索影响认知的危险因素。方法选择该院2018年1月—2020年8月被诊断为AR的患儿223例,并招募220例年龄、性别、受教育程度相匹配的健康体检儿童作为对照组,受试人群均接受神经心理测试：蒙特利尔认知测评量表(MoCA)、言语流畅性、数字广度、木块图、儿童社交焦虑量表(SASC)、儿童抑郁障碍自评量表(DSRSC)。结果AR患儿MoCA、言语流畅性、数字广度、木块图得分均较低(P < 0.05);SASC、DSRSC得分均较高(P < 0.05)。AR组的MoCA得分与SASC、DSRSC及AR严重程度呈负相关(r=-0.346、-0.432、-0.479,P < 0.01)。结论AR患儿的整体认知及言语、记忆、执行功能均受损,并合并焦虑抑郁,较高水平的焦虑、抑郁及中重度鼻炎是影响认知的危险因素。     

Bottom-up driven speechreading in a speechreading expert: the case of AA (JK023)

OBJECTIVE: This case study tested the threshold hypothesis (R?nnberg et al., 1998), which states that superior speechreading skill is possible only if high-order cognitive functions, such as capacious verbal working memory, enable efficient strategies. DESIGN: In a case study, a speechreading expert (AA) was tested on a number of speechreading and cognitive tasks and compared with control groups (z scores). Sentence-based speechreading tests, a word-decoding test, and a phoneme identification task were used to assess speechreading skill at different analytical levels. The cognitive test battery used included tasks of working memory (e.g., reading span), inference-making, phonological processing (e.g., rhyme-judgment), and central-executive functions (verbal fluency, Stroop task). RESULTS: Contrary to previous cases of extreme speechreading skill, AA excels on both low-order (phoneme identification: z = +2.83) and high-order (sentence-based: z = +8.12 and word-decoding: z = +4.21) speechreading tasks. AA does not display superior verbal inference-making ability (sentence-completion task: z = -0.36). Neither does he possess a superior working memory (reading span: z = +0.80). However, AA outperforms the controls on two measures of executive retrieval functions, the semantic (z = +3.77) and phonological verbal fluency tasks (z = +3.55). CONCLUSIONS: The performance profile is inconsistent with the threshold hypothesis. Extreme speechreading accuracy can be obtained in ways other than via well-developed high-order cognitive functions. It is suggested that AA's extreme speechreading skill, which capitalizes on low-order functions in combination with efficient central executive functions, is due to early onset of hearing impairment.     

Tinnitus and its effect on working memory and attention.

PURPOSE: In 2 experiments, the assumption that continual orienting to tinnitus uses cognitive resources was investigated. It was hypothesized that differences in performance of tinnitus and control groups would manifest during demanding or unfamiliar tasks that required strategic, controlled processing and that reduced performance was not related solely to levels of anxiety. METHOD: Nineteen participants with chronic, moderate tinnitus-matched with a control group for age, education, and verbal IQ-completed auditory verbal working-memory and visual divided-attention tasks, with task order counterbalanced across participants. RESULTS: As hypothesized, reading span of the tinnitus group was significantly shorter than that of the control group (Task 1). In Task 2, the tinnitus group recorded slower reaction times and poorer accuracy in the most demanding dual task context. Covariate analyses revealed that differences in task performance were not attributable to anxiety scale scores. CONCLUSIONS: Complaints of the distracting effects of tinnitus have a basis in performance test outcomes. Future research should investigate effects of severe tinnitus and possible effects of hearing loss. At the level of theory development, results from this study suggest that tinnitus affects cognition to the extent that it reduces cognitive capacity needed to perform tasks that require voluntary, conscious, effortful, and strategic control.     

Personality traits predict and moderate the outcome of Internet-based cognitive behavioural therapy for chronic tinnitus

Objective: The aim of this study is to investigate whether the Big Five personality traits predict the outcome of Internet-based cognitive behavioural therapy (ICBT) and whether they moderate the outcome between ICBT and face-to-face group cognitive behavioural therapy (GCBT). Design: This study investigated the Big Five personality traits as predictors and moderators of the outcome (tinnitus handicap) in a trial comparing ICBT and GCBT for chronic tinnitus. Study sample: N?=?84 patients with chronic tinnitus were randomised to either ICBT (n?=?41) or GCBT (n?=?43). Results: A multilevel model for discontinuous change was performed. Higher scores on the “openness” scale of the Big Five Personality Inventory (BFI-10) predicted a lower tinnitus handicap (Tinnitus Handicap Inventory, THI) at post-treatment in ICBT (p?p?p?p?p?Conclusions: ICBT might be the preferred treatment choice for tinnitus patients being open towards new experiences. Moreover, ICBT requires autonomous work and self-motivation by the patient in order to have an impact.     

Objective assessment of subjective tinnitus through contralateral suppression of otoacoustic emissions by white noise; suggested cut-off points

Objective: Normative otoacoustic emission (OAE) suppression values are currently lacking and the role of cochlear efferent innervation in tinnitus is controversial. The aim of this study was to investigate the association between tinnitus and medial olivocochlear bundle (MOCB) malfunction. Potential suppression amplitude cut-off criteria that could differentiate participants with tinnitus from those without were sought. Design: Mean suppression amplitudes of transient evoked OAEs and distortion product OAEs by contralateral white noise (50 dBSL) were recorded. Six mean suppression amplitudes criteria were validated as possible cut-off points. Study sample: The population consisted of normal hearing (n?=?78) or presbycusic adults (n?=?19) with tinnitus or without (n?=?28 and 13, respectively) chronic tinnitus (in total, n?=?138 78 females/60males, aged 49?±?14 years). Results: Participants with mean suppression values lower than 0.5–1 dBSPL seem to present a high probability to report tinnitus (specificity 88–97%). On the other hand, participants with mean suppression values larger than 2–2.5dBSPL seem to present a high probability of the absence of tinnitus (sensitivity 87–99%). Correlations were stronger among participants with bilateral presence or absence of tinnitus. Conclusions: This study seem to confirm an association between tinnitus and low suppression amplitudes (<1 dBSPL), which might evolve into an objective examination tool, supplementary to conventional audiological testing.     

The role of cognition in tinnitus

CONCLUSIONS: The role of cognition in tinnitus is difficult to ignore. First, tinnitus is likely to disrupt cognitive functioning, and there are some indications that tinnitus patients have impaired capacity to perform certain cognitive tasks. Second, evidence is emerging that tinnitus patients show cognitive bias in the way they handle information. Such information processing style suggests either depressive functioning, or anxious vigilance, or both. Finally, self-report measures of tinnitus distress all require conscious recollection of how tinnitus is perceived and the consequences of tinnitus. Such reports necessitate cognitive capacity. OBJECTIVES: To review the literature on the interface between cognitive function and tinnitus, with special regard to the role of different levels of information processing. MATERIALS AND METHODS: A selective systematic literature search was conducted using the search engines of Medline and Psychological Abstracts, and by hand search of conference proceedings. RESULTS: There are yet relatively few published studies on cognitive functioning in tinnitus patients. Most research has been conducted by a few separate research groups. However, the available studies clearly implicate an important role of cognitive processes at different levels from basic cognitive function to more conscious appraisal of the consequences of tinnitus. Finally, a tentative model of the road from tinnitus generation to annoyance via cognitive function is suggested.     

声刺激联合认知行为治疗慢性耳鸣的初步探讨

目的 探讨声刺激联合认知行为治疗(CBT)对慢性耳鸣的临床疗效。方法 本研究将49例慢性耳鸣患者按照随机数字表法分为干预组(25例)和对照组(24例),所有患者均行声音刺激1个月。干预组患者同时接受持续1个月的个体化的CBT,对照组患者不接受个体化CBT。所有患者在治疗前和治疗后30 d均需填写问卷,包括耳鸣残疾评估量表(THI)、焦虑自评量表(SAS)及匹兹堡睡眠质量指数(PSQI)。结果 两组患者均完成临床试验。治疗1个月后观察,对照组患者THI、SAS、PSQI的平均值分别下降15.58、15.46、4.96,干预组患者THI、SAS、PSQI的平均值分别下降40.52、41.76、7.72, 差异具有统计学意义(P＜0.05);且干预组患者THI、SAS、PSQI的得分均明显低于对照组。结论 声音刺激和CBT可以预测治疗效果,声音刺激联合CBT的治疗效果优于单独的声音刺激。性别、年龄和听力障碍是耳鸣最相关的危险因素。     

What do diagnostic test data tell us about differences in the profiles of children diagnosed with reading disability or language impairments?

A detailed evaluation of a child's strengths and weaknesses allows for a valid and reliable diagnosis of reading disability for the selection of optimal intervention practices. Using archival data from a clinic that specialized in the diagnosis of reading disabilities, we compared the performance of 60 children diagnosed with specific reading disability (SRD) and 31 children with language impairments and reading disability (LIRD) on measures of cognitive reasoning, verbal ability, phonological manipulation, rapid serial naming, and phonological memory. While the SRD and LIRD groups did not differ in their phonological processing, children with LIRD performed significantly below their peers with SRD on thinking ability and verbal ability measures. Rapid naming skills served as current predictors of text reading fluency and verbal ability skills served as concurrent predictors of reading comprehension in both groups. These findings highlight the need for reading diagnosticians to conduct comprehensive evaluations using a range of cognitive and language processes to ensure the most accurate and specific diagnoses of children with reading disabilities.Learning outcomes: Readers will be able to (a) describe general characteristics of reading disabilities, (b) differentiate features of two learning disabilities, specific reading disability and language impairments and reading disability, and (c) identify key clinical issues and approaches for identification, diagnosis, and intervention of these two diagnostic profiles.     

Electric field-navigated transcranial magnetic stimulation for chronic tinnitus: a randomized,placebo-controlled study

Objective: Repetitive transcranial magnetic stimulation (rTMS) may alleviate tinnitus. We evaluated effects of electric field (E-field) navigated rTMS targeted according to tinnitus pitch. No controlled studies have investigated anatomically accurate E-field-rTMS for tinnitus. Design: Effects of E-field-rTMS were evaluated in a prospective randomised placebo-controlled 6-month follow-up study on parallel groups. Patients received 10 sessions of 1?Hz rTMS or placebo targeted to the left auditory cortex corresponding to tonotopic representation of tinnitus pitch. Effects were evaluated immediately after treatment and at 1, 3 and 6 months. Primary outcome measures were visual analogue scores (VAS 0–100) for tinnitus intensity, annoyance and distress, and the Tinnitus Handicap Inventory (THI). Study sample: Thirty-nine patients (mean age 50.3 years). Results: The mean tinnitus intensity (F₃?=?15.7, p?F₃?=?8.8, p?=?0.0002), distress (F₃?=?9.1, p?=?0.0002) and THI scores (F₄?=?13.8, p?p?=?0.082 and p?=?0.065). Conclusions: Despite the significant effects of rTMS on tinnitus, differences between active and placebo groups remained non-significant, due to large placebo-effect and wide inter-individual variation.     

Assessment of hyperacusis with a newly produced Japanese version of the Khalfa hyperacusis questionnaire

Objectives: The purpose of this study was to determine the validity and reliability of a Japanese version of the Khalfa hyperacusis questionnaire (KHQ) and proposed a threshold KHQ score for classifying hyperacusis.

Methods: In total, 112 patients with hyperacusis (group A) and 103 patients without hyperacusis (group B). The patients in group A were further classified into the following subgroups: subjects with hyperacusis as their chief complaint (n?=?26, group A1) and subjects with hyperacusis accompanied by chief complaints of tinnitus and/or hearing loss (n?=?86, group A2).

Results: The average total questionnaire score for patients in group A was 11.8?±?9.7, which was statistically significantly higher than that of patients in group B, 5.7?±?4.8. Cronbach’s coefficients for internal consistency were high for the total score (0.92). The average total scores for groups A1 and A2 were 18.1?±?11.1 and 9.9?±?8.4, respectively, and the difference between the groups was statistically significant.

Conclusions: We developed a Japanese version of the KHQ. It showed high reliability and validity; suggesting its usefulness in clinical practice. We propose that a total KHQ score of 16 is an appropriate cutoff for classifying hyperacusis     

The impact of tinnitus on cognitive performance in normal-hearing individuals

Objective: The aim of this study was to investigate whether the previously reported differences in cognitive performance as assessed using a Stroop paradigm between individuals with and without tinnitus is present in normal-hearing individuals. Design: Participants completed audiometric evaluation, a visual Stroop test, as well as the Swedish version of the hospital anxiety and depression scale (HADS) questionnaire. In addition individuals with tinnitus participated in a short interview regarding tinnitus characteristics as well as a follow up data collection of the tinnitus questionnaire (TQ). Study sample: Forty individuals participated in this study. Twenty had tinnitus (tinnitus group) and 20 had not (control group). The groups were age- and sex-matched and all participants had normal hearing thresholds (20 dB HL or better). Results: No differences in terms of cognitive performances were found between individuals with tinnitus compared to individuals without tinnitus. Conclusion: In contrast to previous studies of hearing-impaired subjects with tinnitus, the results of the present found no signs of cognitive interference in normal-hearing subjects with tinnitus when assessed using intensive short duration tasks.     

Cognitive tinnitus sensitization: Behavioral and neurophysiological aspects of tinnitus centralization

Objective Acquired centralized tinnitus (ACT) is the most frequent type of chronic tinnitus. We introduce a cognitive neurophysiological ACT hypothesis based on centralized cognitive sensitization processes.

Material and Methods Published cognitive sensitization processes were reviewed using PubMed. Furthermore, a Cochrane analysis was performed.

Results Patients frequently perceive tinnitus as being extremely loud although audiological tinnitus-matching measures reveal that its loudness levels are low. An important principle of central tinnitus processing is that individual tinnitus appraisal is directly linked to neuronal networks in the brain responsible for the production of emotions and cognitions. Cognitive processes may be associated with a reduction in the tinnitus cognition threshold, resulting in hypersensitivity of cognition. The underlying mechanism is known as sensitization and is suggested to be a specific learning process.

Conclusions ACT may be associated with a specific learning process allowing increased tinnitus awareness and continuous appraisal. The underlying mechanism, the cognitive tinnitus sensitization process, is associated with a decrease in the tinnitus cognition threshold. The sensitization contributes to the extremely loud cognition of the tinnitus signal. The associated audiological cognitive discrepancy can be used clinically and diagnostically to identify patients for cognitive testing. The sensitization model does not require tinnitus hyperactivity.     

Severe tinnitus and its effect on selective and divided attention

The effect of chronic, severe tinnitus on two visual tasks was investigated. A general depletion of resources hypothesis states that overall performance would be impaired in a tinnitus group relative to a control group whereas a controlled processing hypothesis states that only tasks that are demanding, requiring strategic processes, are affected. Eleven participants who had experienced severe tinnitus for more than two years comprised the tinnitus group. A control group was matched for age and verbal IQ. Levels of anxiety, depression, and high frequency average hearing level were treated as covariates. Tasks consisted of the say-word (easy) and say-color (demanding) conditions of the Stroop task, a single (baseline) reaction time (RT) task, and dual tasks involving word reading or category naming while performing a concurrent RT task. Results supported the general depletion of resources hypothesis: RT of the tinnitus group was slower in both conditions of the Stroop task, and in the word reading and category naming conditions of the dual task. Differences were not attributable to high frequency average hearing level, anxiety, or depression.     

Severe tinnitus and its effect on selective and divided attention

The effect of chronic, severe tinnitus on two visual tasks was investigated. A general depletion of resources hypothesis states that overall performance would be impaired in a tinnitus group relative to a control group whereas a controlled processing hypothesis states that only tasks that are demanding, requiring strategic processes, are affected. Eleven participants who had experienced severe tinnitus for more than two years comprised the tinnitus group. A control group was matched for age and verbal IQ. Levels of anxiety, depression, and high frequency average hearing level were treated as covariates. Tasks consisted of the say-word (easy) and say-color (demanding) conditions of the Stroop task, a single (baseline) reaction time (RT) task, and dual tasks involving word reading or category naming while performing a concurrent RT task. Results supported the general depletion of resources hypothesis: RT of the tinnitus group was slower in both conditions of the Stroop task, and in the word reading and category naming conditions of the dual task. Differences were not attributable to high frequency average hearing level, anxiety, or depression.     

Distortion product otoacoustic emissions in tinnitus patients

Tinnitus is a symptom that affects a great number of patients. Its diagnosis, treatment, and follow-up are difficult, owing to its subjectivity. The authors propose the use of distortion product otoacoustic emissions (DPOAEs) in tinnitus evaluation. They studied three groups: controls, having no complaint of tinnitus and normal hearing; group 1, presenting tinnitus and normal audiometry; and group 2, presenting tinnitus and sensorineural hearing loss. The results showed 3.6% of DPOAE alterations in the control group, 18.8% in group 1, and 61.3% in group 2. This study shows a correlation between DPOAE alterations and tinnitus complaint, but many patients with tinnitus do not present with DPOAE alterations. The authors conclude that DPOAEs constitute a useful audiological method for evaluating patients complaining of tinnitus.     

Process evaluation of Internet-based cognitive behavioural therapy for adults with tinnitus in the context of a randomised control trial

Objective: The research objective was to identify processes that could either facilitate or hinder clinical implementation of an Internet-based cognitive behavioural therapy intervention for tinnitus in the UK. This was done by exploring the research context, the intervention components and the factors that contributed to the outcomes obtained. Design: This study investigated eight processes including the recruitment strategies, reach, research context, treatment dose delivered and received, implementation fidelity, barriers to implementation and effectiveness of the intervention. Study sample: Of the 169 registered participants, 146 were randomly assigned to the experimental or control groups (23 were excluded). The mean age was 55.57 years with an average tinnitus duration of 11.63 years. Results: The intended sample of people with distressing tinnitus who were underserved with evidence-based tinnitus interventions was reached. The full guided intervention was delivered. The recommended modules were read more than the optional modules. Intervention components such as the easily readable format and the benefits of the applied relaxation programme facilitated significant positive post-intervention outcomes. Barriers hampering the intervention application included time pressures and low self-motivation. Conclusions: Results of this process evaluation together with the outcome data can be used to facilitate translating this research into clinical practice.     

Differences in the suppression of distortion product otoacoustic emissions by contralateral white noise between patients with acute or chronic tinnitus

Objective: The mechanisms underlying the shift from acute tinnitus to chronic remain obscure. An association between tinnitus and medial olivocochlear bundle (MOCB) reflex dysfunction has been hypothesised by several studies. The differences between participants with acute and chronic tinnitus have not yet been investigated. Design: Participants were examined with distortion product otoacoustic emissions (DPOAEs) suppression elicited by contralateral white noise. They were compared in terms of frequency regions with non-recordable DPOAEs, suppression amplitudes and the presence of DPOAE enhancement. Study sample: Eighteen participants with acute tinnitus, 40 age-matched adults with chronic tinnitus and 17 controls were included. All participants (aged 34.7?±?9.6years; mean?±?Standard deviation) had normal hearing. Tinnitus was bilateral in 22 participants and unilateral in 36. Results: Ears with chronic tinnitus presented significantly lower DPOAE suppression amplitudes than ears with acute tinnitus (p?p?p?=?0.0002, respectively). Non-recordable DPOAEs were significantly more frequent in the chronic than in the acute tinnitus and control groups (p?Conclusions: The differences between study groups indicate that when tinnitus becomes chronic, DPOAEs suppression presents changes that might reveal corresponding steps in tinnitus pathophysiology. Treatment implications are discussed.