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Applications of
auditory training
in tinnitus
Prof Deb Hall
Some basic facts


                ‘Ringing’ or ‘whistling’ in the ears
                7% of the UK adult population have...
The tinnitus triangle


                   Perceptual
                   characteristics

                   Pitch and
   ...
Management goals


                                Perceptual                   Mask the
           Habituate
            ...
New management goal

  Can
  treatment        Perceptual
  change           characteristics
  the
  percept          Pitch...
A neurophysiological mechanism for
            tinnitus ?

               Chronic tinnitus can result from a maladaptive
 ...
A neurophysiological mechanism for
             treatment ?

                “The over-representation of the lesion-edge i...
Auditory training expands the topographic
               representation of the stimulus
                                  ...
Auditory training reduces receptive fields
            for neurons tuned to the stimulus


                            40 ...
Benefit of auditory training associated with
            cortical expansion




           Frequency discrimination perfor...
A neurophysiological mechanism for
             treatment ?

                “The over-representation of the lesion-edge i...
Principles of auditory training


                Training can ‘retune’ the receptive properties of
                neuron...
Preliminary training study



                                                  10=unbearable
        10=unbearable




  ...
General discussion

 What hurdles would have to be overcome to
 translate this form of intervention into the
 clinical set...
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Applications of Auditory Training in Tinnitus

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Transcript of "Applications of Auditory Training in Tinnitus"

  1. 1. Applications of auditory training in tinnitus Prof Deb Hall
  2. 2. Some basic facts ‘Ringing’ or ‘whistling’ in the ears 7% of the UK adult population have consulted their doctor about tinnitus 2.5% have sought specialist advice from an otologist with regard to tinnitus National Study of Hearing (Davis, 1995)
  3. 3. The tinnitus triangle Perceptual characteristics Pitch and loudness Psychological Individual reactions personality Cognitive and ‘Susceptibility’ emotional characteristics responses
  4. 4. Management goals Perceptual Mask the Habituate characteristics percept to the percept Pitch and loudness Change reaction Psychological Individual to the reactions personality percept Cognitions and ‘Susceptibility’ emotional characteristics response
  5. 5. New management goal Can treatment Perceptual change characteristics the percept Pitch and itself? loudness Psychological Individual reactions personality Cognitions and ‘Susceptibility’ emotional characteristics response
  6. 6. A neurophysiological mechanism for tinnitus ? Chronic tinnitus can result from a maladaptive response to deafness Deprivation is known to alter the balance of neural activity in the central auditory pathway Over-representation of the frequency at the edge of the high-frequency hearing loss Eggermont, Roberts, 2004. TINs 28(6):676-682
  7. 7. A neurophysiological mechanism for treatment ? “The over-representation of the lesion-edge in patients with sensorineural hearing loss may be the representation of tinnitus” “In patients with hearing loss, an enriched acoustic environment can minimise or reverse the cortical reorganisation changes secondary to hearing impairment.” Herraiz et al. 2009. Eur Arch Otorhinolaryngol 266:9-16
  8. 8. Auditory training expands the topographic representation of the stimulus naïve 8 kHz 2.5 kHz trained Stimulus and training task 2.5 kHz frequency discrimination using tones roved in level over a 12 dB range Duration Several weeks Recanzone, Schreiner & Merzenich 1993. J Neuroscience 13(1):87-103
  9. 9. Auditory training reduces receptive fields for neurons tuned to the stimulus 40 dB above threshold trained naïve 10 dB above threshold Q10 dB Q40 dB Q value = center frequency / bandwidth of the tuning curve 10/40 dB above threshold Recanzone, Schreiner & Merzenich 1993. J Neuroscience 13(1):87-103
  10. 10. Benefit of auditory training associated with cortical expansion Frequency discrimination performance correlated with topographic expansion, not change in receptive field Some form of temporal code might provide additional information to support frequency discrimination Recanzone, Schreiner & Merzenich 1993. J Neuroscience 13(1):87-103
  11. 11. A neurophysiological mechanism for treatment ? “The over-representation of the lesion-edge in patients with sensorineural hearing loss may be the representation of tinnitus” “In patients with hearing loss, an enriched acoustic environment can minimise or reverse the cortical reorganisation changes secondary to hearing impairment.” “We can consider that auditory rehabilitation can have some positive effect on tinnitus management” Herraiz et al. 2009. Eur Arch Otorhinolaryngol 266:9-16
  12. 12. Principles of auditory training Training can ‘retune’ the receptive properties of neurons within the tinnitus-generating network and allocate them to a network supporting the representation of the trained frequency Training is expected to expand the topographic representation of the trained frequencies (and shrink the representation of the neighbouring cortical zones) Herraiz et al. 2009. Eur Arch Otorhinolaryngol 266:9-16
  13. 13. Preliminary training study 10=unbearable 10=unbearable 1 1 4 4 0=none 0=none close to far from weeks TI pitch TI pitch Flor et al., 2004. Applied Psychophysiology& Biofeedback 29(2): 113-120
  14. 14. General discussion What hurdles would have to be overcome to translate this form of intervention into the clinical setting? Credability of the rationale for applying auditory rehabilitation methods in tinnitus What is the necessary evidence base for its efficacy? How might this form of treatment be received by clinicians? How acceptable might it be with patients?
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