Prefrontal Cortex Based Sex Differences in Tinnitus Perception: Same Tinnitus Intensity, Same Tinnitus Distress, Different Mood

Abstract

BackgroundTinnitus refers to auditory phantom sensation. It is estimated that for 2% of the population this auditory phantom percept severely affects the quality of life, due to tinnitus related distress. Although the overall distress levels do not differ between sexes in tinnitus, females are more influenced by distress than males. Typically, pain, sleep, and depression are perceived as significantly more severe by female tinnitus patients. Studies on gender differences in emotional regulation indicate that females with high depressive symptoms show greater attention to emotion, and use less anti-rumination emotional repair strategies than males.MethodologyThe objective of this study was to verify whether the activity and connectivity of the resting brain is different for male and female tinnitus patients using resting-state EEG.ConclusionsFemales had a higher mean score than male tinnitus patients on the BDI–II. Female tinnitus patients differ from male tinnitus patients in the orbitofrontal cortex (OFC) extending to the frontopolar cortex in beta1 and beta2. The OFC is important for emotional processing of sounds. Increased functional alpha connectivity is found between the OFC, insula, subgenual anterior cingulate (sgACC), parahippocampal (PHC) areas and the auditory cortex in females. Our data suggest increased functional connectivity that binds tinnitus-related auditory cortex activity to auditory emotion-related areas via the PHC-sgACC connections resulting in a more depressive state even though the tinnitus intensity and tinnitus-related distress are not different from men. Comparing male tinnitus patients to a control group of males significant differences could be found for beta3 in the posterior cingulate cortex (PCC). The PCC might be related to cognitive and memory-related aspects of the tinnitus percept. Our results propose that sex influences in tinnitus research cannot be ignored and should be taken into account in functional imaging studies related to tinnitus.

The influence of psychological factors on tinnitus severity

“…This finding is in line with an earlier study that demonstrated a gender effect on tinnitus-related handicap [8]. Moreover, female patients with the same TQ scores like male patients displayed higher Beck Depression Inventory scores and differed in their oscillatory brain activity in the orbitofrontal cortex [36]. The gender influence on the relationship between TQ scores and emotional aspects reflects probably gender differences in emotional regulation [37] and should be considered in further research.…”

The impact of tinnitus on adult Nigerians: health related Quality of Life assessment of sufferers using the Hospital Anxiety and Depression Scale (HADS) and the RAND-36 item health survey 1.0 questionnaire

“…differences in coping with stress demonstrating that repeated exposure to stress causes women to be more vulnerable than men 32 , hence would mean that women assess their tinnitus related comorbidities more intensively than men. To buttress this, Vanneste et al 33 using continuous scalp electroencephalographic (EEG) recordings and low-resolution electromyographic tomography (sLORETA) demonstrated differences in the activity of the prefrontal cortex between males and females in response to stress. They reported higher depression scores in women but did not find gender differences in tinnitus distress and tinnitus intensity.…”

Altered top-down cognitive control and auditory processing in tinnitus: evidences from auditory and visual spatial stroop

“…Since the dlPFC is involved in the regulation of emotions (Fregni et al, 2006;Ochsner et al, 2012), it is also probably influenced by emotional states. On the one hand, the dlPFC, with the ACC, the anterior insula and the amygdala, is part of the distress network activated during auditory stimulation in tinnitus patients (Vanneste et al, 2010b;Vanneste, et al, 2012;De Ridder et al, 2013). On the other hand, the dlPFC is connected to parts of the limbic system, such as the ventromedial prefrontal cortex (vmPFC), which are altered in tinnitus (Mülhau et al, 2006;Leaver et al, 2011;Seydell-Greenwald et al, 2012).…”