Psychological and neurobiological mechanisms underpinning chronic tinnitus

© 2017 Dr. Krysta Jannaya Callander-TrevisChronic tinnitus, the phenomenon of a ringing, buzzing or hissing type sound in the ears or head is a prevalent health condition affecting 10-15% of the general population (Henry, Dennis, & Schechter, 2005a). It can have significant negative effects on an individual’s health and wellbeing and is associated with significant economic burden (Maes, Cima, Vlaeyen, Anteunis, & Joore, 2013; Tyler & Baker, 1983). At present, there is no cure for chronic tinnitus, likely due to the lack of consensus regarding the mechanisms maintaining the presence or impact of chronic tinnitus on individuals experiencing this condition. This thesis aimed to determine if psychological factors, and associated neural networks, could be maintaining awareness of the tinnitus sound and the severity of its impact. To achieve this objective, four studies were conducted utilising meta-analytic, questionnaire, cognitive and neuroimaging techniques. The first study comprehensively and systematically reviewed current literature regarding the psychological functioning of adults with chronic tinnitus. Results suggest that a heterogeneous array of psychological functions may be involved in the experience of chronic tinnitus, particularly emotional and cognitive functions, with meta-analyses providing consistent evidence for a role of reduced emotional wellbeing in both the presence and impact of chronic tinnitus. Study 2 and 3 further investigated the role of emotional and cognitive factors respectively in chronic tinnitus. Specifically, Study 2 investigated possible interactions between psychological factors and the vicious cycle of hypervigilance to the tinnitus sound in a heterogeneous community sample of 81 adults with chronic tinnitus. While analyses replicated the presence of the vicious cycle, this was conditional on the experience of depressive symptoms. Study 3 aimed to determine the contribution of cognitive functioning to chronic tinnitus. Compared to healthy-hearing individuals (n=26) people with chronic tinnitus (n=26) showed significant impairments in cognitive control, inhibitory control and increased symptoms of depression, with depressive symptoms and cognitive control successfully discriminating between people with and without chronic tinnitus. Combined, these studies suggest that disruption of specific large-scale neurocognitive networks proposed to underpin a range of psychological and cognitive symptoms; particularly those associated with depression may also underpin chronic tinnitus. As such, the final study of this thesis investigated the functioning of our stable neurocognitive networks, specifically the cognitive control network, in people with chronic tinnitus (n=15) and matched controls (n=15). While both groups successfully engaged the cognitive control network, the chronic tinnitus group exhibited subtle disruptions to a core node of this network, namely the right middle frontal gyrus, revealing both attenuated activation during cognitive engagement. This region also showed decreased connectivity with a node of the salience network, the right anterior insula, and increased connectivity with nodes of the autobiographical memory network, namely left posterior cingulate cortex and left medial prefrontal cortex. Together, the results of this thesis identify a failure in the process of attention-switching and the associated neurocognitive networks as a core mechanism underpinning the persistent awareness and pervasive impact of chronic tinnitus. This provides a novel framework, the Attention-Switching Model, for investigating both the experience of tinnitus, and potential treatments to help people with chronic tinnitus