Exam 1 (Models of Tinnitus) Flashcards
what is the limbic system
Functions → emotion, long-term memory, and other aspects of behavior
Amygdala → important in a person’s emotional response to sounds
Functions → emotion, long-term memory, and other aspects of behavior
limbic system
important in a person’s emotional response to sounds
Amygdala
what is the autonomic system
Function → controls vital bodily functions like homeostasis (maintenance of bodily stability)
Activated when we hear potentially dangerous sounds
Activated when we hear potentially dangerous sounds
ANS
define tinnitus
Phantom auditory perception → perception of sounds without corresponding acoustic or mechanical correlates in the cochlea
Tinnitus is the perception of sound (must be heard) & involuntary (not produced intentionally)
perception of sound (must be heard) & involuntary (not produced intentionally)
tinnitus
maintenance of bodily stability
homeostasis
what are tinnitus models
conceptual frameworks that aim to explain the overall phenomenon of tinnitus including its generation, perception and associated distress
what is the significance of tinnitus models
Offer explanations for various tinnitus-related phenomena
Integrate findings from multiple research domains
Guides research & clinical approaches
what is the basis of neurophysiological models
Biological basis of tinnitus in the auditory system
Focuses on different anatomical or physiological aspects; none are definitely proven
Consensus → tinnitus results from perception of abnormal activity
3 proposed mechanisms for how tinnitus is coded in the auditory cortex
Increased spontaneous activity fed by increase or decrease in activity.
Cross-fiber correlation with normal or increased spontaneous activity.
More fibers with similar best frequency following hearing loss–induced auditory plasticity.
what are examples of neurophysiological models
maladaptive plasticity
role of HL in tinnitus perception
central gain
Jasterboff’s model
describe maladaptive plasticity and how it leads to tinnitus
Tinnitus is thought to result from maladaptive plasticity in the CNS in response to HL or other unknown causes
In response to causes, mechanisms that keep the nervous system in balance (homeostasis) leads to changes that result in the perception of tinnitus
Neurophysiological models have logically nominated the increase in spontaneous activity as a mechanism of tinnitus
increases spontaneous activity to compensate because it compensates for the decrease in the auditory input; hyperactivity heard by the cortex is the tinnitus sound
when plasticity can lead to side effects, then it is maladaptive; you tried to help and fix something but messed it up
how does HL lead to tinnitus perception
HL leads to input to the auditory system decrease
The brain then attempts to maintain homeostasis through compensation for reduced input due to the HL
Compensation → increasing neural gain and sensitivity in the auditory system
Increase in gain leads to higher spontaneous neural activity even without acoustic simulation
Increased spontaneous activity is proposed as the key mechanism for tinnitus perception
Changes in neural activity are likely transmitted to and represented in the auditory cortex
what is central gain
Compensatory increase in the central auditory activity in response to the loss of sensory input
Tinnitus occurs due to central gain which is the brain reaction to auditory deprivation
Explains why when you cut the auditory nerve and the brain still hears the tinnitus
central gain and how it leads to the perception of tinnitus
Auditory deprivation and central gain plus altered spontaneous neural activity leads to tinnitus
There is a decrease in auditory input, neurons become more excitable (hyperactivity) doing more than they need due, and this leads to the tinnitus perception
what is a limitation to central gain
need to have hearing loss to explain this but there are cases where they do not have HL
why is the brain compensating and resulting in tinnitus?
explains why those with hL can have tinnitus but not why those with no HL has the tinnitus
can not explain why those with HL do not have tinnitus
what is Jasterboff’s model
Focuses on the interaction between auditory and non-auditory systems & based on general neurophysiology & behavioral neuroscience
Hypothesis → many systemas in the brain are involved in tinnitus with auditory system playing a secondary role
key components in Jasterboff’s model
Limbic system → highlights the emotional processing that is attached to the sound of the tinnitus
Sympathetic autonomic nervous system
Reticular formation → awareness?
focuses on the non-auditory systems
jasterboff’s model
Foundation for TRT (tinnitus retraining therapy)
Explains why some with hearing loss do not experience tinnitus
jasterboff’s
what is the tiger in the room in jasterboff’s model
Focusing on the tinnitus increases the arousal (stress; anxiety) making it harder to ignore it making the limbic system involved in those PTs with emotional reactions
brought a tiger into the classroom and it sits in the corner and tells us not to worry about it it hasn’t eaten anyone in a couple of weeks you should be fine
saying that you know that the tiger is threatening and it could jump at anyone but no matter how hard you try to listen to the lecture, your brain is occupied by the tiger in the room you cannot do anything else
same with tinnitus, brain is preoccupied with it because it perceives it as negative, dangerous, threatening
limitations of neurophysiological models
They can explain how HL can lead to tinnitus but NOT why not everyone with HL gets tinnitus
It cannot explain observations of PTs whose alleviation occurred after the auditory nerve was cut
Evidence supports theory that there are multiple possible mechanisms for tinnitus generation occurring at all levels of the auditory pathways but much remains to be discovered
focus of neurophysiological models
These models emphasize the brain’s neural mechanisms, explaining tinnitus as a result of changes in the auditory system or brain function.
They focus on how abnormal neural activity or maladaptive changes in auditory pathways contribute to the sensation of tinnitus.
neurophysiological models
key concepts of neurophysiological models
Theories include abnormal spontaneous firing of neurons, increased gain (hyperactivity) in auditory pathways, or maladaptive plasticity. The most well-known is the Neurophysiological Model of Tinnitus by Jastreboff, which proposes that tinnitus involves changes in the auditory, limbic, and autonomic nervous systems.
what is the goal of neurophysiological models
Neurophysiological treatments target the auditory system directly (e.g., sound therapy) or work to reduce abnormal neural firing through methods like neuromodulation or tinnitus retraining therapy (TRT).
Distinction between the tinnitus and the reaction to the tinnitus
psychological/cognitive models
Symptoms associated with tinnitus
Insomnia → prevalent in those with bothersome tinnitus
Loss of concentration → interferes with cognitive functioning, attention & concentration
Low mood & irritability
Anxiety → annual societal costs of tinnitus to be £2.7 billion.
Clinical depression → The relationship between tinnitus and depression is likely bidirectional; tinnitus can exacerbate depression, and depression may make tinnitus more challenging to manage, potentially worsening the condition.
iimpact of tinnitus
Chronic tinnitus may severely disrupt quality of life in some individuals
Characteristics of tinnitus doesn’t directly influence its psychological impact on PTs
For example, no correlation between if the tinnitus is louder there is more anxiety etc.
how brain and structure is reacting to lack of auditory information and how tinnitus is generated
perception vs reactions
characteristics of tinnitus sound itself
How the tinnitus sounds
impact of tinnitus on their life
Their reaction to the sounds
what is the vicious cycle of tinnitus
describes how tinnitus can become increasingly bothersome and distressing due to the interaction between attention, emotional responses, and cognitive reactions. This cycle often explains why tinnitus becomes more prominent and distressing over time.
It can trigger anxiety which reinforces tinnitus perception which creates a feedback loop leading to increased arousal and emotional distress
describe the vicious cycle of tinnitus
First notice the sound of tinnitus, brain interprets this new or unusual sound as significant causing you to pay more attention to it. This increased attention makes it seem louder or more intrusive causing negative emotions (anxiety, frustration, fear etc.). This emotional stress activates the limbic (emotional) and autonomic (fight or flight) systems leading to increase in arousal/stress which leads to more intense tinnitus perception.
what is habituation
learning process where the brain treats constant presence of tinnitus as a non-threatening stimulus leading to gradual decrease in both awareness and distress caused by the noise
Decrease in response to a benign stimulus when that stimulus is presented repeatedly
habituation
Factors preventing habituation
High levels of arousal: Stress or anxiety can increase the awareness of tinnitus, making it more difficult to ignore.
Sudden onset of tinnitus: The abruptness can make it more difficult for the brain to adapt.
Intense or unpredictable tinnitus: Loud or varying tinnitus sounds are harder to adapt to and can prevent habituation.
when they go to bed everything is more quiet and they notice it is louder but here it is not related to the quiet environment or not
Emotional significance: If tinnitus is associated with strong negative emotions, it can become more difficult to habituate.
Neural pathway damage: Damage to the neural pathways involved in habituation can interfere with the normal habituation process.
Dishabituation: Psychological changes or shifts in a person’s mental state can lead to a re-awareness of the tinnitus sound that was previously habituated, disrupting the habituation process.
there was tinnitus, they habituated but now there are psychological changes that reintroduce the stimulus and they become aware of it
being aware of a stim that the person dishabituated to previously and dealing with it as a new stimulus
Treatment Strategies for hallam’s model
focused on maintaing low arousal to facilitate habituation
Relaxation therapy → lower autonomic arousal and interrupt the feedback loop
Formal cognitive therapy → Alters emotional responses to tinnitus, reducing perceived distress and aiding habituation
bothersome tinnitus is a failure to habituate
hallams model
what is the evidence for hallam’s habituation model
Many with tinnitus do not complain
many of pt who complain about it learn to ignore it over time distress decreases over time
Tinnitus distress usually decreases over time
when you first notice it, gives anxiety distress etc. but then the brain learns it isnt a big deal and stress decreases
No relationship between tinnitus loudness and distress levels, highlighting significant individual psychological adaptation.
if it is soft or loud has nothing to do with the stress level
Individuals grow more tolerant of tinnitus even if it doesn’t go away
even if it is chronic and always there, they learn to ignore it
tells us there is something different bw those who can live with it and ignore it and those who have it but cannot ignore it and complain
Hallam’s habituation model core principles,
Proposed tinnitus may occur without auditory dysfuntion, potentially triggered by psychological factors
Can happen with or without HL
Tinnitus is influenced by CNS’s ability to selectively inhibit unnecessary sensory input
tinnitus is loud and clear a you cannot ignore it because the CNS cannot inhibit the sensory information
Disruptions in the selective inhibition, especially during high arousal states, can make tinnitus more prominant
McKenna cognitive behavioral model of tinnitus
Emphasizes that tinnitus distress often stems more from an individual’s reactions and perceptions of the sound rather than the auditory signal itself
How the person thinks about their tinnitus is the primary driver of their stress
Serves as a foundation for CBT aiming to break the cycle of distress through therapeutic techniques
Key Difference B/W Neurophysiological & Psychological Models
Neurophysiological models view tinnitus mainly as an issue of brain and auditory system dysfunction, whereas psychological models focus on the way tinnitus is perceived, processed, and reacted to psychologically and emotionally.
focus of psychological models
These models explore tinnitus from a cognitive, emotional, and behavioral perspective, looking at how perception, attention, and emotional responses contribute to tinnitus perception.
They are based on the idea that tinnitus becomes problematic when individuals focus on it or react emotionally to it, often leading to distress and worsening of symptoms.
psychological models
key concepts of psychological models
These models involve processes like attention (how much a person focuses on tinnitus), cognitive appraisal (beliefs about tinnitus), and emotional responses. The Fear-Avoidance Model, for instance, explains that individuals may avoid activities due to fear that it will worsen their tinnitus, which in turn heightens distress.
goal of psychological models
Treatments focus on managing psychological responses to tinnitus, often using cognitive-behavioral therapy (CBT), mindfulness, or acceptance and commitment therapy (ACT) to reduce the impact of tinnitus on daily life.
describe Hallam’s habituation model
Proposed tinnitus may occur without auditory dysfuntion, potentially triggered by psychological factors
Can happen with or without HL
Tinnitus is influenced by CNS’s ability to selectively inhibit unnecessary sensory input
tinnitus is loud and clear a you cannot ignore it because the CNS cannot inhibit the sensory information
Disruptions in the selective inhibition, especially during high arousal states, can make tinnitus more prominant
McKenna cognitive behavioral model of tinnitus
Emphasizes that tinnitus distress often stems more from an individual’s reactions and perceptions of the sound rather than the auditory signal itself
How the person thinks about their tinnitus is the primary driver of their stress
Serves as a foundation for CBT aiming to break the cycle of distress through therapeutic techniques
what are safety seeking behaviors
avoidance or suppression that can provide short-term relief but prevents long-term adaptation
Want to run away from the problem & try to push the thoughts down
This works short-term but long-term it reduces the habituation because you are trying to pretend that it isn’t there
Can lead to chronic tinnitus because you get stuck in the loop
Selective attention can distort how tinnitus is perceived; explaining catastrophic descriptions of tinnitus
true
describe cognitive behavioral model of tinnitus
Negative interpretations of tinnitus increase physiological arousal and selective attention
Leads to greater awareness of tinnitus which can cause anxiety and low mood
Due to increased attention the tinnitus is noticed more which creates the cycle reinforcing the negative interpretation
triggered by abnormal activity, person is aware of tinnitus and hears ti, once they hear it they react to it (neg emotions because brain is thinking of it as a threat), because you are thinking about it it leads to arousal (more focused on it), as a result you pay more attention to it, increases more neg thoughts about it and creates a cycle that intensifies the emotion about it
Differences between tinnitus perception and tinnitus reaction
Perception → characteristics of tinnitus sound itself
How the tinnitus sounds
Reactions → impact of tinnitus on their life
Their reaction to the sounds
CBM differences from other models
Greater emphasis is placed on vigilance and orientation to tinnitus rather than a failure to habituate
differences bw mckenna’s model and habituation model (hallam)
Mckenna’s model focuses on the impact of negative thoughts and cognitive distortions on tinnitus distress (distress influences how individuals react to the tinnitus; reaction to the stimulus itself) while the Habituation model focuses on the brain’s natural ability to tune out the tinnitus sound over time
provides a frame of reference for understanding and treating a variety of disorders, which involves the subconscious part of the brain
neurophysiological model
In the absence of a cure for each PT with annoying tinnitus, ______ approaches to the struggle of sufferers remains the core of therapeutic strategies
psychological
Diverse psychological models reflect the varied needs of tinnitus patients, rejecting the “one-size fits all” approach
true
