Cortical reorganization in recent-onset tinnitus patients by the Heidelberg Model of Music Therapy

Abstract

Pathophysiology and treatment of tinnitus still are fields of intensive research. The neuroscientifically motivated Heidelberg Model of Music Therapy, previously developed by the German Center for Music Therapy Research, Heidelberg, Germany, was applied to explore its effects on individual distress and on brain structures. This therapy is a compact and fast application of nine consecutive 50-min sessions of individualized therapy implemented over 1 week. Clinical improvement and long-term effects over several years have previously been published. However, the underlying neural basis of the therapy's success has not yet been explored. In the current study, the therapy was applied to acute tinnitus patients (TG) and healthy active controls (AC). Non-treated patients were also included as passive controls (PTC). As predicted, the therapeutic intervention led to a significant decrease of tinnitus-related distress in TG compared to PTC. Before and after the study week, high-resolution MRT scans were obtained for each subject. Assessment by repeated measures design for several groups (Two-Way ANOVA) revealed structural gray matter (GM) increase in TG compared to PTC, comprising clusters in precuneus, medial superior frontal areas, and in the auditory cortex. This pattern was further applied as mask for general GM changes as induced by the therapy week. The therapy-like procedure in AC also elicited similar GM increases in precuneus and frontal regions. Comparison between structural effects in TG vs. AC was calculated within the mask for general GM changes to obtain specific effects in tinnitus patients, yielding GM increase in right Heschl's gyrus, right Rolandic operculum, and medial superior frontal regions. In line with recent findings on the crucial role of the auditory cortex in maintaining tinnitus-related distress, a causative relation between the therapy-related GM alterations in auditory areas and the long-lasting therapy effects can be assumed.

A methodological assessment of studies that use voxel-based morphometry to study neural changes in tinnitus patients

“…Three of the studies that used controls had controls with hearing loss and with normal hearing (Allan et al 2016, Boyen et al 2013, Husain et al 2011). The other seven studies used a single control group in their VBM study (Krick et al 2015, Landgrebe et al 2009, Leaver et al, 2011, Leaver et al 2012, Mahoney et al 2011, Melcher et al 2013, Mühlau et al 2005).…”

“…Five of the studies excluded those individuals who had psychiatric disease (Husain et al 2011, Krick et al 2015, Landgrebe et al 2009, Shecklmann et al 2012, Vanneste et al 2015). Four of the studies did not allow for any type of hearing loss (Landgrebe et al 2009, Melcher et al 2013, Mühlau et al 2006, Schecklmann et al 2013).…”

“…This process left nine studies that addressed VBM and tinnitus. Upon further review, we identified one additional article (Leaver et al, 2011) that did not appear in the search, but was cited in the VBM/tinnitus literature; reviewers also pointed us to three additional papers (Allan et al 2016, Krick et al 2015, Mahoney et al 2011). In total, 13 articles met the selection criteria of the study.…”

Tinnitusu olan bireylerde müzik terapisinin yaşam kalitesi üzerine etkisi

“…Çalışmamızda müzik terapisi ile, tinnitus hastalarının tinnitustan duydukları rahatsızlık düzeyi ve yaşam kalitesi üzerinde iyileşme sağlanmıştır. Bu sonuç, metodolojik farklılıklar göstermekle birlikte, literatür ile uyumludur [15,16,[20][21][22][23][24]. Argstatter ve ark.…”

“…Krick ve ark. 50 tinnitus hastasında, her biri 50 dakikalık dokuz ardışık seans şeklinde 1 hafta boyunca uygulanan bireyselleştirilmiş tedavi olan Heidelberg Müzik terapi modeli ile; hem tinnitustan rahatsızlık düzeyinde hızlı bir kliniksel iyileşme elde etmiş hem de tinnitustan rahatsızlıkla ilişkili olduğu düşünülen beyin bölgeleri üzerinde spesifik terapi etkisi olduğunu saptamışlardır [24].…”