Exam 1 (Models of Tinnitus)

Question 1

what is the limbic system

Answer 1

Functions → emotion, long-term memory, and other aspects of behavior
Amygdala → important in a person’s emotional response to sounds

Question 2

Functions → emotion, long-term memory, and other aspects of behavior

Answer 2

limbic system

Question 3

important in a person’s emotional response to sounds

Answer 3

Amygdala

Question 4

what is the autonomic system

Answer 4

Function → controls vital bodily functions like homeostasis (maintenance of bodily stability)
Activated when we hear potentially dangerous sounds

Question 5

Activated when we hear potentially dangerous sounds

Answer 5

ANS

Question 6

define tinnitus

Answer 6

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)

Question 7

perception of sound (must be heard) & involuntary (not produced intentionally)

Answer 7

tinnitus

Question 8

maintenance of bodily stability

Answer 8

homeostasis

Question 9

what are tinnitus models

Answer 9

conceptual frameworks that aim to explain the overall phenomenon of tinnitus including its generation, perception and associated distress

Question 10

what is the significance of tinnitus models

Answer 10

Offer explanations for various tinnitus-related phenomena
Integrate findings from multiple research domains
Guides research & clinical approaches

Question 11

what is the basis of neurophysiological models

Answer 11

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

Question 12

3 proposed mechanisms for how tinnitus is coded in the auditory cortex

Answer 12

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.

Question 13

what are examples of neurophysiological models

Answer 13

maladaptive plasticity
role of HL in tinnitus perception
central gain
Jasterboff’s model

Question 14

describe maladaptive plasticity and how it leads to tinnitus

Answer 14

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

Question 15

how does HL lead to tinnitus perception

Answer 15

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

Question 16

what is central gain

Answer 16

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

Question 17

central gain and how it leads to the perception of tinnitus

Answer 17

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

Question 18

what is a limitation to central gain

Answer 18

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

Question 19

what is Jasterboff’s model

Answer 19

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

Question 20

key components in Jasterboff’s model

Answer 20

Limbic system → highlights the emotional processing that is attached to the sound of the tinnitus
Sympathetic autonomic nervous system
Reticular formation → awareness?

Question 21

focuses on the non-auditory systems

Answer 21

jasterboff’s model

Question 22

Foundation for TRT (tinnitus retraining therapy)
Explains why some with hearing loss do not experience tinnitus

Answer 22

jasterboff’s

Question 23

what is the tiger in the room in jasterboff’s model

Answer 23

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

Question 24

limitations of neurophysiological models

Answer 24

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

Question 25

focus of neurophysiological models

Answer 25

These models emphasize the brain's neural mechanisms, explaining tinnitus as a result of changes in the auditory system or brain function.

Question 26

They focus on how abnormal neural activity or maladaptive changes in auditory pathways contribute to the sensation of tinnitus.

Answer 26

neurophysiological models

Question 27

key concepts of neurophysiological models

Answer 27

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.

Question 28

what is the goal of neurophysiological models

Answer 28

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).

Question 29

Distinction between the tinnitus and the reaction to the tinnitus

Answer 29

psychological/cognitive models

Question 30

Symptoms associated with tinnitus

Answer 30

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.

Question 31

iimpact of tinnitus

Answer 31

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

Question 32

perception vs reactions

Answer 32

characteristics of tinnitus sound itself How the tinnitus sounds impact of tinnitus on their life Their reaction to the sounds

Question 33

what is the vicious cycle of tinnitus

Answer 33

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

Question 34

describe the vicious cycle of tinnitus

Answer 34

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.

Question 35

what is habituation

Answer 35

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

Question 36

Decrease in response to a benign stimulus when that stimulus is presented repeatedly

Answer 36

habituation

Question 37

Factors preventing habituation

Answer 37

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

Question 38

Treatment Strategies for hallam's model

Answer 38

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

Question 39

bothersome tinnitus is a failure to habituate

Answer 39

hallams model

Question 40

what is the evidence for hallam's habituation model

Answer 40

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

Question 41

Hallam’s habituation model core principles,

Answer 41

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

Question 42

McKenna cognitive behavioral model of tinnitus

Answer 42

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

Question 43

Key Difference B/W Neurophysiological & Psychological Models

Answer 43

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.

Question 44

focus of psychological models

Answer 44

These models explore tinnitus from a cognitive, emotional, and behavioral perspective, looking at how perception, attention, and emotional responses contribute to tinnitus perception.

Question 45

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.

Answer 45

psychological models

Question 46

key concepts of psychological models

Answer 46

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.

Question 47

goal of psychological models

Answer 47

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.

Question 48

describe Hallam's habituation model

Answer 48

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

Question 49

McKenna cognitive behavioral model of tinnitus

Answer 49

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

Question 50

what are safety seeking behaviors

Answer 50

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

Question 51

Selective attention can distort how tinnitus is perceived; explaining catastrophic descriptions of tinnitus

Answer 51

true

Question 52

describe cognitive behavioral model of tinnitus

Answer 52

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

Question 53

Differences between tinnitus perception and tinnitus reaction

Answer 53

Perception → characteristics of tinnitus sound itself How the tinnitus sounds Reactions → impact of tinnitus on their life Their reaction to the sounds

Question 54

CBM differences from other models

Answer 54

Greater emphasis is placed on vigilance and orientation to tinnitus rather than a failure to habituate

Question 55

differences bw mckenna's model and habituation model (hallam)

Answer 55

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

Question 56

provides a frame of reference for understanding and treating a variety of disorders, which involves the subconscious part of the brain

Answer 56

neurophysiological model

Question 57

In the absence of a cure for each PT with annoying tinnitus, ______ approaches to the struggle of sufferers remains the core of therapeutic strategies

Answer 57

psychological

Question 58

Diverse psychological models reflect the varied needs of tinnitus patients, rejecting the “one-size fits all” approach

Answer 58

true