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Abstract
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.
Highlights
Tinnitus is the perception of a phantom sound, such as a pure tone, ringing, buzzing, or other noise, without external acoustic stimulation
Recent findings on tinnitus distress suggested that the distress-related higher mental effort for attention control may arise primarily from focusing on self-referred emotional signals that were triggered by a network consisting of the amygdala, the anterior cingulate cortex, the insula, and the parahippocampal area (Vanneste et al, 2010)
The current paper aims to show the effects of tinnitus duration on the control of visual attention and the effects of Heidelberg Neuro-Music Therapy (HNMT) on the visual attention network in tinnitus patients
Summary
Tinnitus is the perception of a phantom sound, such as a pure tone, ringing, buzzing, or other noise, without external acoustic stimulation. Husain et al (2015) observed that tinnitus patients’ attention networks showed more activation during visual than auditory tasks These findings suggested a need for rising engagement of the attention system in tinnitus patients while focusing on visual stimuli. It is unclear, whether these perceptual changes arose immediately with the tinnitus onset or whether they were gradually provoked by the persisting tinnitus percept. Selective attention in the visual domain and the respective brain responses can be measured by a Continuous Performance Task (CPT) which requires sustained attention to a sequence of visual stimuli (Hester et al, 2004) In this context, reaction time (RT) and error rates for responses can be measured to assess effects of a musical intervention (Guo et al, 2015). 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
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