Theoretical Tinnitus Framework: A Neurofunctional Model

Abstract

Subjective tinnitus is the conscious (attended) awareness perception of sound in the absence of an external source and can be classified as an auditory phantom perception. Earlier literature establishes three distinct states of conscious perception as unattended, attended, and attended awareness conscious perception. The current tinnitus development models depend on the role of external events congruently paired with the causal physical events that precipitate the phantom perception. We propose a novel Neurofunctional Tinnitus Model to indicate that the conscious (attended) awareness perception of phantom sound is essential in activating the cognitive-emotional value. The cognitive-emotional value plays a crucial role in governing attention allocation as well as developing annoyance within tinnitus clinical distress. Structurally, the Neurofunctional Tinnitus Model includes the peripheral auditory system, the thalamus, the limbic system, brainstem, basal ganglia, striatum, and the auditory along with prefrontal cortices. Functionally, we assume the model includes presence of continuous or intermittent abnormal signals at the peripheral auditory system or midbrain auditory paths. Depending on the availability of attentional resources, the signals may or may not be perceived. The cognitive valuation process strengthens the lateral-inhibition and noise canceling mechanisms in the mid-brain, which leads to the cessation of sound perception and renders the signal evaluation irrelevant. However, the “sourceless” sound is eventually perceived and can be cognitively interpreted as suspicious or an indication of a disease in which the cortical top-down processes weaken the noise canceling effects. This results in an increase in cognitive and emotional negative reactions such as depression and anxiety. The negative or positive cognitive-emotional feedbacks within the top-down approach may have no relation to the previous experience of the patients. They can also be associated with aversive stimuli similar to abnormal neural activity in generating the phantom sound. Cognitive and emotional reactions depend on general personality biases toward evaluative conditioning combined with a cognitive-emotional negative appraisal of stimuli such as the case of people with present hypochondria. We acknowledge that the projected Neurofunctional Tinnitus Model does not cover all tinnitus variations and patients. To support our model, we present evidence from several studies using neuroimaging, electrophysiology, brain lesion, and behavioral techniques.

Nationwide analysis of the relationships between mental health, body mass index and tinnitus in premenopausal female adults in Korea: 2010–2012 KNHANES

“…According to the signal-detection model 27 , personality traits can manipulate the response criterion placement so that individuals with increased awareness report even very low levels of signal as tinnitus. This theory is in line with the Jastreboff model 17 , 28 . Durai and Searchfield found that personality traits or psychiatric disorders were not likely to cause tinnitus but more likely to affect how individuals with tinnitus were distressed by amplifying symptoms and complaints 26 .…”

Effects of Anxiety Sensitivity and Hearing Loss on Tinnitus Symptom Severity

“…32 33 The current consensus is that tinnitus symptoms have multiple etiologies. 34 As such, tinnitus might be related to not only dysfunction of the inner ear or auditory nerves but also to cognitive distortions of somatic sensations. 6 34 Our findings further support the notion that auditory factors (i.e., hearing loss) are associated with the acoustical symptoms (awareness and loudness), whereas psychological traits (anxiety sensitivity) are linked with the non-auditory symptoms (annoyance, impact on life and tinnitus-related handicap).…”

The characteristics of cognitive impairment in subjective chronic tinnitus

“…These neuroanatomical changes play a specific role in both tinnitusrelated emotional state disorder and cognitive deficits (Araneda et al, 2015;Kraus & Canlon, 2012;Simonetti & Oiticica, 2015;Vanneste et al, 2016). Thus, tinnitus-related emotional state disorder (distress and depression) has exhibited a close relationship with tinnitus and cognitive deficits (Ghodratitoostani et al, 2016;Tegg-Quinn, Bennett, Eikelboom, & Baguley, 2016). At the same time, patients with poor cognitive skills may be more likely to harbor misconception about tinnitus, which in turn may lead to clinical symptoms such as fear, anxiety, insomnia, and other harmful psychological reactions.…”