Correlation Analysis of the Tinnitus Handicap Inventory and Distress Network in Chronic Tinnitus: An EEG Study

Abstract

Tinnitus is a common disorder with a considerable amount of distress that affects the patient`s daily life. No objective tools were approved for measuring tinnitus distress. It can be estimated only by subjective scales and questionnaires, albeit, the Electroencephalography (EEG) studies have reported some alterations regarding tinnitus distress network. This study aimed to investigate the correlation between Tinnitus Handicap Inventory (THI) and the recorded EEG data. Methods: A total of 33 chronic tinnitus cases (9 females) with the mean age of 42.67 years were recruited. Their THI scores were collected, and a 3-minute EEG recorded with eye closed at resting-state. The correlation analysis was performed on THI scores and the current density in the selected Region of Interests (ROIs) concerning the distress network for the eight frequency bands. The patients grouped depending on the THI cutoff point of 56 into low and high THI groups, and then the groups were compared for source analysis and functional connectivity between ROIs using standardized low-resolution brain electromagnetic tomography. Results: A significant positive correlation was seen between THI scores and the electrical activity in the Anterior Cingulate Cortex (ACC), the prefrontal cortex, and the parahippocampus for an alpha band (P<0.05) and in the ACC for beta (P<0.01). Source analysis showed significant differences with increased activity in the high THI group for alpha, beta and gamma bands. Functional connectivity was also elevated in the high THI group between the ROIs in alpha and beta bands. Conclusion: THI can be a useful tool for measuring tinnitus distress, and it has a high correlation with EEG data.

Electrophysiological correlates of focused attention on low- and high-distressed tinnitus

“…both are variable subjective sensations caused by peripheral lesions, the patients also share a psychological profile characterized by increased tendency to depression and anxiety [ 41 ]) implicate a common neural foundation resulting from the presence of chronic and unpleasant symptoms. At first glance, in the case of alpha rhythm, our results do not appear consistent with either previous evidence on troublesome tinnitus [ 56 , 59 , 65 ] or the literature on chronic pain (see: [ 117 ] for a review) which both suggest elevated rather than reduced activity within this band at rest. Chronic high tinnitus-related distress is supposed to be apparent during the resting state due to the absence of any stimulus presentation and the fact that it is hard to keep attention away from persistent and annoying sound.…”

“…In this case it could be more similar to the condition, explored in the present study, when patients are requested to focus on the own body (a legitimate therapeutic technique to achieve a state of relaxed, calm mind). When we take into account the resembles between both these states, our results in the alpha frequency band (increased activity under the BFC relative to the TFC) are congruent with previous findings [ 56 , 59 , 65 ].…”

“…We found increased gamma (30–40 Hz) power over the right anterior area in the TFC relative to the BFC in all patients but especially in bothersome tinnitus sufferers ( Fig 3 , S3 and S4 Tables). Gamma activity associated with tinnitus-related distress has been relatively well documented [ 46 , 66 , 67 , 120 ], however, comparable number of evidence failed to demonstrate any relationship [ 56 , 59 , 65 , 121 ]. Since in our study in the HD group the between-condition difference in gamma power was found only in one cluster (and also the high and low distress tinnitus groups did not substantially different in the activity within this frequency band) it is hard to explain increased gamma, observed in the TFC, in terms of tinnitus-related distress.…”

“…Bothersome tinnitus also co-occurred with increased synchronization in the high alpha (10.5–12.5 Hz) band in the para-hippocampal gyrus, amygdala, and middle temporal gyrus; there was also decreased current source density in this band in the posterior cingulate and precuneus [ 59 ]. Previous studies have demonstrated that distress caused by tinnitus involves the global fronto-parieto-cingulate network [ 63 , 64 ] and is related to the alpha and beta bands in the anterior cingulate and ventromedial prefrontal/orbitofrontal cortices [ 54 , 56 , 59 , 65 ] or gamma activity in the auditory cortex or insula [ 46 , 66 , 67 ]. The subcallosal/ventromedial prefrontal area and the amygdala are considered as the structures forming the “noise-cancellation” system thought to underlie long-term habituation to tinnitus [ 40 ].…”

Too Blind to See the Elephant? Why Neuroscientists Ought to Be Interested in Tinnitus

“…The list of studies that demonstrate a close relationship of distress and tinnitus is increasing (Boecking et al 2021 ; Durai et al 2018 ; Elarbed et al 2021 ; Park et al 2020 ; van Munster et al 2020 ). Numerous studies document altered evoked or resting state BOLD fMRI or EEG activity in tinnitus patients, particularly in those brain regions or networks that are involved in attention, distress, and memory functions (Kandeepan et al 2019 ; Mohsen et al 2019 ; Pattyn et al 2016 ; Vanneste et al 2021 ; Yoo et al 2021 ). The strong contribution of distress culminates in evidence that insomnia, hearing distress, and anxiety are the best predictors of tinnitus severity, and are indeed stronger predictors than any demographic factors (Beukes et al 2021 ; Crönlein et al 2016 ).…”