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11Th Tinnitus Research Initiative (TRI)

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ID: 100 Abstract Submissions Keywords: fMRI, distress, Bayesian brain, nucleus accumbens, free energy principle Predictive-brain mechanisms of phantom perception pathology Jeffrey Hullfish1, Ian Abenes1, Silvia Kovacs2, Stefan Sunaert2, Dirk De Ridder3, Sven Vanneste1 1University of Texas at Dallas, United States of America; 2Catholic University of Leuven, Belgium; 3University of Otago, New Zealand; Among recent innovations in tinnitus research, the application of Bayesian brain theory has proven especially promising, treating phantom perception as part of the brain’s strategy to resolve the uncertainty resulting from sensory deafferentation. The involvement of reward-processing regions such as nucleus accumbens is however an unresolved paradox in tinnitus, a disorder that features a neutral percept and presents with distressful symptoms in roughly one in five cases. Here, I specifically examine the role of nucleus accumbens in cases of chronic, distressful tinnitus. I present two separate experiments to this end: (1) a within-subjects, block-design fMRI experiment comparing patients’ responses to auditory stimuli at their tinnitus frequency versus control-frequency stimuli; (2) a resting-state fMRI experiment comparing tinnitus patients to healthy controls. While nucleus accumbens is reportedly involved in processing both positive and negative affect, I show that its involvement in cases of distressful tinnitus is dissociable from the effect of tinnitus-related distress itself, which correlates instead with functional connectivity in subgenual anterior cingulate cortex and the amygdala. I conclude that the tinnitus percept is merely an incidental byproduct of the large-scale neuroplastic changes made to resolve the persistent negative reward prediction error that results from hearing loss, per Bayesian brain theory. Tinnitus-related distress is likely a learned reaction to that percept specifically and not related to the broader error resolution mechanism, thus eliminating the apparent paradox of nucleus accumbens’ role in tinnitus pathology. ID: 102 Abstract Submissions Keywords: dynamic connectivity, distress, sLORETA, EEG, tinnitus Distress-dependent temporal binding of regions encoding disorder-specific and disorder-general behavioral manifestations of phantom percepts Anusha Mohan1, Dirk De Ridder2, Sven Vanneste1 1University of Texas at Dallas, United States of America; 2University of Otago, New Zealand; Background: Tinnitus is the perception of a phantom sound in the absence of an external auditory stimulus characterized by a specific sensory component i.e. loudness and a non-specific affective component i.e. distress. Tinnitus is hypothesized to be a maladaptive compensation to a prediction error generated between compromised bottom-up information and top-down prediction of the upcoming stimulus. Although a wealth of information is available about the relationship between these behavioral correlates and changes in static functional connectivity (FC), its relationship with dynamic changes in network connectivity is yet unexplored. Objective: The aim of the current study is to investigate changes in the flexibility and specificity of time-varying functional connectivity in tinnitus and its relation to loudness and distress. Methods: We calculate a measure called temporal variability of functional connectivity from the source-localized resting state EEG of 151 tinnitus patients and 125 controls using an overlapping and non-overlapping sliding window. Results and discussion: In low distressed patients, no relationship between temporal variability and loudness or distress was observed, demonstrating a resilience in temporal binding. However, highly distressed patients exhibited increased temporal variability in FC with increasing loudness percept in the primary auditory cortex and parahippocampus and a decreased temporal variability in FC and increasing distress percept in the parahippocampus. Conclusion: Thus, in tinnitus, the sensory specific component exhibited increased variability in FC, possibly related to a Bayesian search for updating deafferentation-based missing information, whereas the decreased variability in the parahippocampus related to the non-specific distress possibly reflecting a more hard-wired, i.e. less adaptive, contextual processing. ID: 103 / Session 20: 1 Abstract Submissions Keywords: Innovation, Tinnitus, Research design, Yachting Throwing the ball further: What tinnitus research can learn from Team New Zealand’s winning of yachting’s Americas Cup. Grant Donald Searchfield The University of Auckland, New Zealand; Winning yachting’s Americas cup and curing tinnitus are no small feats. Both were goals of Emirates Team New Zealand's (ETNZ) principal, and founder of the Tinnitus Research Initiative, Matteo de Nora. The first goal was achieved in 2017 after many years of trying; the later goal remains unattained. Tinnitus research may not seem to share much in common with yachting, but in order to win the world’s oldest sporting trophy ETNZ faced financial, technical and methodological issues not dissimilar to the challenges we face in tinnitus research. ETNZs victory was not based on incremental improvements in design and performance, but instead a philosophy of “throwing the ball out as far as we can and see if we can get to it”. While scientific method and funders favor safe, or proven, research we may miss opportunities to rapidly advance our field if we do not take risks. This talk will use ETNZ as a sporting analogy for how we can change the tinnitus research space by emboldening researchers to take greater risks. Four themes for success will be explored; innovation, risk, persistence and people. ID: 104 / Session 3: 1 Abstract Submissions Keywords: Tinnitus, cognitive behavioral therapy, treatment, hyperacusis Efficacy of treatment for tinnitus based on cognitive behavioral therapy in an inpatient setting: a 10-year retrospective outcome analysis Daniele R. Nolan1, Andres R. Schneeberger1,2,3, Christian G. Huber2, Rahul Gupta1 1Psychiatrische Dienste Graubünden, Switzerland; 2Universitäre Psychiatrische Kliniken Basel, Switzerland; 3Albert Einstein College of Medicine, New York City, USA; ABSTRACT AIM: Tinnitus is a phenomenon with a high prevalence in the general population, leading to high levels of suffering. It is a symptom that can present itself comorbidly with a variety of psychiatric and medical illnesses. We established a treatment of tinnitus, which is based on a multimodal approach including a specific cognitive-behavioral therapy (CBT) method in an inpatient setting. This approach includes education on tinnitus, applying coping strategies and techniques of relaxation, directed attention and music therapy. We aim to evaluate the efficacy of this treatment approach. MATERIAL / METHODS: We included retrospective data of 268 patients that underwent tinnitus treatment throughout the ten- year existence of the treatment program. We assessed routine clinical data pre and post treatment with parameters concerning tinnitus-distress, hyperacusis and psychological well-being. To determine these variables we used validated instruments including the Tinnitus Questionnaire (TQ), Questionnaire on hypersensitivity to sound (QHS), Brief Symptom Inventory (BSI) and the Beck Depression Inventory (BDI). Questionnaires were implemented before and after the treatment program. RESULTS: Patients showed highly significant reduction in all of the implemented questionnaires. Reduction of TQ, the primary outcome measure, was 15.39 points (SD 21.88) from 35.72 to 20.32 (p<0.001). The QHS showed a reduction from 18.98 down to 12.26, which equals 6.72 points (SD 8.23; p<0.001). Moreover, psychological strain was also reduced with high significance, as illustrated in reduction of BSI and BDI with all examined subsets; reduction in BSI from 49.63 to 25.21 points (24.41, SD 26.88; p<0.001) and BDI from 16.89 to 9.41 points (7.47, SD 8.76; p<0.001). DISCUSSION: The multimodal treatment program for tinnitus, including a specific CBT method proves to be a highly effective means of significantly reducing not only tinnitus and hyperacusis, but also distress related to tinnitus. It also offers patients preservation of symptom reduction. Furthermore it also enables considerable reduction of concomitant psychiatric symptoms such as depression. CONCLUSIONS: Our results underline the necessity of intensive and multimodal approaches to the treatment of tinnitus. ID: 105 / Session 1: 1 Abstract Submissions Keywords: vagus nerve A Prospective Randomized Double-blind Controlled Clinical Study Using Vagus-Nerve Stimulation Paired with Tones for the Treatment of Tinnitus Richard S Tyler1, Tony Cacace2, Michael Seidman3, ,Christina Stocking4, Sven Vanneste5, Brent Tarver6 1University of Iowa, United States of America; 2Department of Communication Sciences & Disorders, Wayne State University, Detroit, MI, USA.; 3Oto-HNS University of Central Florida and Director of Skull base/Neurotologic Surgery Florida Hospital; 4Communicative Disorders and Sciences, University at Buffalo, Buffalo, NY, USA.; 5Lab for Clinical and Integrative Neuroscience, School for Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA.; 6MicroTransponder, Inc., 2802 Flintrock Trace, Suite 225, Austin, TX, USA.; Introduction: Chronic tinnitus is a debilitating condition that significantly interferes with quality of life of the individual. Several counseling and sound-based therapies have been developed to help some patients manage
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