Laurence McKenna

The role of cognition in tinnitus

Conclusions: The role of cognition in tinnitus is difficult to ignore. First, tinnitus is likely to disrupt cognitive functioning, and there are some indications that tinnitus patients have impaired capacity to perform certain cognitive tasks. Second, evidence is emerging that tinnitus patients show cognitive bias in the way they handle information. Such information processing style suggests either depressive functioning, or anxious vigilance, or both. Finally, self-report measures of tinnitus distress all require conscious recollection of how tinnitus is perceived and the consequences of tinnitus. Such reports necessitate cognitive capacity. Objectives: To review the literature on the interface between cognitive function and tinnitus, with special regard to the role of different levels of information processing. Materials and methods: A selective systematic literature search was conducted using the search engines of Medline and Psychological Abstracts, and by hand search of conference proceedings. Results: There are yet relatively few published studies on cognitive functioning in tinnitus patients. Most research has been conducted by a few separate research groups. However, the available studies clearly implicate an important role of cognitive processes at different levels from basic cognitive function to more conscious appraisal of the consequences of tinnitus. Finally, a tentative model of the road from tinnitus generation to annoyance via cognitive function is suggested.

Tinnitus Masking and Depression

In this pilot study 30 patients with annoying tinnitus completed tinnitus matching and the Beck Depression Inventory (BDI). A cluster analysis revealed three clusters of patients. Cluster one had relatively low depression and average results on tinnitus parameters. Cluster two displayed high depression scores and lower results on tinnitus parameters. The last small cluster had high depression scores and high results on tinnitus and hearing parameters. A curvilinear regression showed a U-shaped relation between the BDI and minimal masking level. The results are interpreted according to a diathesis stress model, in which a vulnerable person might develop tinnitus distress following a comparatively low degree of tinnitus and a more stress-tolerant person might bear higher degrees of tinnitus before seeking help. As a conclusion this may have implications for what treatment to recommend and most certainly should be accounted for in the assessment of patients.

Models of tinnitus suffering and treatment compared and contrasted

This paper discusses the two main approaches to tinnitus management: the ‘psychological’ approach that seeks to understand and treat tinnitus within a cognitive behavioural model, and the ‘neurophysiological’ approach that suggests that tinnitus distress can be understood within a classical conditioning paradigm. Both models, and their corresponding approaches to therapy, have strong followings, and this has given rise to debate about their relative merits. However, there is some confusion among practitioners over points of similarity and differences between the two approaches. The psychological model proposes that autonomic nervous system (ANS) arousal is involved, but highlights the importance of cognitive processes in the tinnitus experience. The neurophysiological model also contends that ANS and brain processes play a fundamental role in the perception of tinnitus; it suggests that tinnitus becomes problematic because it becomes associated with something negative. This model stresses the importance of unconscious conditioning over conscious cognitive processes. Both models represent a major departure from an earlier focus on cochlear mechanisms. Both propose that habituation is a key process in attenuating tinnitus distress. There is an overlap in the evidence cited in support of each model but they differ in the emphasis they give to the role of cognition and classical conditioning within the process of tinnitus perception, suffering and treatment. This difference indicates that they derive from different philosophical traditions. The similarities and differences between the models and the theories underpinning them are discussed. Questions concerning the models are raised. The need for more evidence in support of the habituation hypothesis is discussed. The relevance of the classical conditioning paradigm, and therefore the neurophysiological model, to the human experience of tinnitus is questioned. In questioning the psychological approach, the need for a more elaborate cognitive model is highlighted. The models need stronger experimental support than they currently enjoy, but either of them provides a more clinically relevant account of tinnitus than the older cochlear models. They have both led to practitioners offering at least some help to people for whom tinnitus is problematic. However, neither gives a complete picture, and a more comprehensive model of tinnitus that seeks to elucidate the mind‐body interaction is still needed.

Sound therapy for tinnitus – sacred cow or idol worship?: An investigation of the evidence

Sound therapy is widely used as an ingredient in the treatment of people with tinnitus. This paper examines the evidence concerning sound therapy. A literature search was carried out in order to identify papers that distinguish the effects of sound therapy from the effects of other elements in tinnitus therapy. Few papers allow this distinction. The evidence from those papers that do identify sound therapy as a separate component of treatment indicates that sound therapy without counselling offers no benefit to patients with tinnitus but that counselling alone is of benefit. The evidence concerning whether sound therapy results in additional benefit to that offered by the psychological component of tinnitus therapy is mixed but overall it suggests that sound therapy results in little or no extra benefit. It is likely that when sound therapy does benefit people with tinnitus this effect is mediated by psychological factors.

Caffeine abstinence: an ineffective and potentially distressing tinnitus therapy.

Abstract The effect of phased caffeine withdrawal and abstention on tinnitus severity was assessed using a pseudo-randomized, double-blinded, placebo-controlled crossover trial of 30 days duration. Sixty-six volunteers who experienced tinnitus and who usually consumed at least 150 mg/day of caffeine participated. The intervention was a direct replacement of usual caffeinated tea/coffee with double-blinded supplies, under one of two conditions. Condition 1: Maintenance followed by phased withdrawal. Condition 2: Phased withdrawal followed by reintroduction and maintenance. Tinnitus severity was measured by the total score of the Tinnitus Questionnaire on Days 1, 15, and 30. Secondary measures included twice daily self-rated symptoms relevant to tinnitus and caffeine withdrawal. Caffeine had no effect on tinnitus severity, the mean difference between caffeinated and decaffeinated days being –0.04 (95% confidence interval –1.99 to 1.93), p=0.97. Significant acute adverse symptoms of caffeine withdrawal were observed. No evidence was found to justify caffeine abstinence as a therapy to alleviate tinnitus, but acute effects of caffeine withdrawal might add to the burden of tinnitus. Sumario Se evaluó el efecto del retiro paulatino y la abstención de la cafeína sobre la severidad del acufeno mediante un ensayo clínico de 30 días, pseudo-aleatorio, doble ciego, con control de placebo y transversal. Participaron sesenta y seis voluntarios que experimentaban acufeno y que usualmente consumían al menos 150 mg/día de cafeína. La intervención fue un reemplazo directo de café y/o té cafeinado con suministros doble ciego bajo una de estas dos condiciones: Condición 1. Mantenimiento seguido de retiro paulatino. Condición 2. Retiro paulatino seguido de reintroducción y mantenimiento. La severidad del acufeno fue medida mediante la puntuación total del cuestionario de acufeno en los días 1, 15 y 30. Dentro de las mediciones secundarias se incluyó una autoevaluación de los síntomas relativos al acufeno y a la abstención de cafeína. La cafeína no tuvo efecto en la severidad del acufeno. La diferencia media entre los días con cafeína y sin ella fue de -0.04 (intervalo de confianza del 95% -1.99 a 1.93), P=0.97. Se observaron efectos adversos agudos significativos por la abstención de cafeína. No se encontró evidencia que justificara la abstinencia de cafeína como tratamiento para aliviar el acufeno, pero los efectos agudos del retiro de la cafeína puede agregarse a la carga del acufeno.

Contributions of Clinical Psychology in Audiology: Hearing Impairment and Tinnitus

In audiological medicine, the problems of hearing loss and tinnitus (ringing or buzzing in the ear) sometimes lead to psychological problems for the patients. This paper describes these conditions and the contribution of clinical psychology to their management. Although psychological treatments have been found to be effective in controlled studies, few clinical psychologists work in the field of audiology. The contribution of clinical psychology to the field of audiological medicine is promising. This area of work represents a fruitful new field for clinical psychologists.