Georg-August-University, Georg-Elias-Mueller-Institute of Psychology, Department of Clinical Psychology and Psychotherapy, Gosslerstrasse 14, 37073 Goettingen, Germany.
Hear Res. 2013 Jan;295:87-99. doi: 10.1016/j.heares.2012.03.003. Epub 2012 Mar 14.
Chronic tinnitus affects approximately 5% of the population. Severe distress due to the phantom noise is experienced by 20% of the tinnitus patients. This distress cannot be predicted by psychoacoustic features of the tinnitus. It is commonly assumed that negative cognitive emotional evaluation of the tinnitus and its expected consequences is a major factor that determines the impact of tinnitus-related distress. Models of tinnitus distress and recently conducted research propose differences in limbic, frontal and parietal processing between highly and low distressed tinnitus patients. An experimental paradigm using verbal material to stimulate cognitive emotional processing of tinnitus-related information was conducted. Age and sex matched highly (n = 16) and low (n = 16) distressed tinnitus patients and healthy controls (n = 16) underwent functional magnetic resonance imaging (fMRI) while sentences with neutral, negative or tinnitus-related content were presented. A random effects group analysis was performed on the basis of the general linear model. Tinnitus patients showed stronger activations to tinnitus-related sentences in comparison to neutral sentences than healthy controls in various limbic/emotion processing areas, such as the anterior cingulate cortex, midcingulate cortex, posterior cingulate cortex, retrosplenial cortex and insula and also in frontal areas. Highly and low distressed tinnitus patients differed in terms of activation of the left middle frontal gyrus. A connectivity analysis and correlational analysis between the predictors of the general linear model of relevant contrasts and tinnitus-related distress further supported the idea of a fronto-parietal-cingulate network, which seems to be more active in highly distressed tinnitus patients. This network may present an aspecific distress network. Based on the findings the left middle frontal gyrus and the right medial frontal gyrus are suggested as target regions for neuromodulatory approaches in the treatment of tinnitus. For future studies we recommend the use of idiosyncratic stimulus material.
慢性耳鸣影响约 5%的人群。20%的耳鸣患者会因幻听而感到严重困扰。这种困扰无法通过耳鸣的心理声学特征来预测。人们普遍认为，对耳鸣及其预期后果的消极认知情绪评估是决定耳鸣相关困扰影响的一个主要因素。耳鸣困扰模型和最近的研究提出，在边缘系统、额叶和顶叶处理方面，高度和低度困扰的耳鸣患者存在差异。使用言语材料刺激与耳鸣相关信息的认知情绪处理的实验范式已经开展。年龄和性别匹配的高度（n=16）和低度（n=16）困扰的耳鸣患者和健康对照组（n=16）在进行功能性磁共振成像（fMRI）时接受了中性、负面或与耳鸣相关内容的句子的刺激。基于一般线性模型，对随机效应组进行了分析。与健康对照组相比，耳鸣患者在各种边缘/情绪处理区域（如前扣带回皮质、中扣带回皮质、后扣带回皮质、后扣带回皮质、后扣带回皮质和岛叶）以及额叶区域对与耳鸣相关的句子的反应更强烈，而不是中性句子。高度和低度困扰的耳鸣患者在左额中回的激活方面存在差异。对相关对比的一般线性模型的预测因子的连通性分析和相关性分析进一步支持了一个额顶扣带回网络的想法，该网络在高度困扰的耳鸣患者中似乎更为活跃。该网络可能代表一种非特异性的困扰网络。基于这些发现，建议将左额中回和右额内侧回作为治疗耳鸣的神经调节方法的靶区。对于未来的研究，我们建议使用独特的刺激材料。
