Tinnitus-on the interplay between emotion and cognition.

Subjective tinnitus (hereafter tinnitus) is often considered and studied as a perceptual phenomenon. Accordingly, various abnormalities in the area of cognitive processing have been reported in patients with tinnitus. At the same time, the disorder is characterized by considerable emotional distress, which is associated with a high comorbidity of affective disorders. Here, we aim to outline the close link between cognition and emotion, and how current research from the field of cognitive neuroscience examines the processing and acquisition of emotional stimuli. The emotional valence of stimuli can be acquired after brief exposure to learning, leading from neutral to appetitive or aversive evaluation. In contrast to neutral stimuli, emotional stimuli attract attention very early (about 100 ms) during processing, leading to deeper processing and corresponding memory effects. The involved subcortical and cortical network encompasses limbic and sensory areas. In particular, prefrontal regions are involved in the acquisition and evaluation of emotional stimuli as also shown in studies of patients with affect disorders. The interplay of cognitive and emotional processes seems to be central to the development, maintenance, and treatment of tinnitus.

Effect of simulated acute bilateral severe conductive hearing loss on static balance function in healthy subjects: a prospective observational pilot study.

PURPOSE: Maintaining static balance is a process coordinated by central integration of visual, vestibular and somatosensory information. Whether or not hearing and spatial acoustic information contributes to the maintenance of static postural balance is unclear. METHODS: A prospective observational pilot study was performed. Twenty-five normal hearing adults (68% female; 19-31 years) underwent a computerized dynamic posturography test battery including the Sensory Organization Test (SOT), the Motor Control Test (MCT), and the Adaptation Test (ADT). The balance tests were performed two times, in a randomized sequence without or with acute hearing loss. Earplugs (sound insulation 37 dB) or headphones with white noise (sound volume 75 dB) induced the conductive hearing loss. Hence, all participants passed through four sequences of the balance test battery. A repeated-measures analysis of variance (ANOVA) was used to analyze the results. RESULTS: The ANOVA revealed no difference for any SOT and ADT subtest without hearing loss and simulated hearing loss (either earplugs or headphones; all p > 0.05). The ANOVA showed no longer latencies with simulated hearing loss compared to no hearing loss in both experiments with one exception: the reaction of the right foot during large forward translation was longer with hearing loss than without hearing loss in both experiments (p = 0.025). CONCLUSIONS: Overall, a simulated acute conductive bilateral moderate or severe hearing loss did not disturb the static balance function in normal hearing younger adults in this first small pilot study.

Creating safe environments: optimal acoustic alarming of laypeople in fire prevention.

Hazards like fires occur regularly and can cost people's lives. Optimal auditory alarm signals enable laypeople to recognise dangers and to protect themselves. Existing fire alarm sound research focuses on alarm sounds and voice alerts presented singularly. We explored a combination of both and aimed to identify alarm signals that work optimally in everyday life. Thus, we conducted two online experiments: In Study 1 (N = 379), we tested eight alarm sounds regarding their typicality, their familiarity, their arousal, their valence, and their dominance. Siren-like alarm sounds were the most effective. In Study 2 (N = 206), we combined the four most effective alarm sounds with a voice alert. The voice alert reinforced ambiguity reduction, action motivation, and action intention. Hence, we suggest using alarm sounds with siren-like patterns. They should be combined with a voice alert to foster a quick and specific (target task-oriented) reaction.Practitioner summary: Warning laypeople is of great importance in time-critical hazards. In two remote testing studies (NTotal = 585), auditory alarm sounds with siren-like patterns resulted in the most distinct and emotional perception. Combining the alarm sound with a voice alert adds meaning to the alarm and fosters action intention.Abbreviations: DIN: Deutsches Institut für Normung [German Institute for Standardization]; ISO: International Organization for Standardization; Mixed MANOVA: mixed measures multivariate analysis of variance; rmMANOVA: repeated measures multivariate analysis of variance.

[Tinnitus-on the interplay between emotion and cognition. German version]. / Tinnitus im Wechselspiel zwischen Emotion und Kognition.

Subjective tinnitus (hereafter tinnitus) is often considered and studied as a perceptual phenomenon. Accordingly, various abnormalities in the area of cognitive processing have been reported in patients with tinnitus. At the same time, the disorder is characterized by considerable emotional distress, which is associated with a high comorbidity of affective disorders. Here, we aim to outline the close link between cognition and emotion, and how current research from the field of cognitive neuroscience examines the processing and acquisition of emotional stimuli. The emotional valence of stimuli can be acquired after brief exposure to learning, leading from neutral to appetitive or aversive evaluation. In contrast to neutral stimuli, emotional stimuli attract attention very early (about 100 ms) during processing, leading to deeper processing and corresponding memory effects. The involved subcortical and cortical network encompasses limbic and sensory areas. In particular, prefrontal regions are involved in the acquisition and evaluation of emotional stimuli as also shown in studies of patients with affect disorders. The interplay of cognitive and emotional processes seems to be central to the development, maintenance, and treatment of tinnitus.

The Jena Voice Learning and Memory Test (JVLMT): A standardized tool for assessing the ability to learn and recognize voices.

The ability to recognize someone's voice spans a broad spectrum with phonagnosia on the low end and super-recognition at the high end. Yet there is no standardized test to measure an individual's ability of learning and recognizing newly learned voices with samples of speech-like phonetic variability. We have developed the Jena Voice Learning and Memory Test (JVLMT), a 22-min test based on item response theory and applicable across languages. The JVLMT consists of three phases in which participants (1) become familiarized with eight speakers, (2) revise the learned voices, and (3) perform a 3AFC recognition task, using pseudo-sentences devoid of semantic content. Acoustic (dis)similarity analyses were used to create items with various levels of difficulty. Test scores are based on 22 items which had been selected and validated based on two online studies with 232 and 454 participants, respectively. Mean accuracy in the JVLMT is 0.51 (SD = .18) with an empirical (marginal) reliability of 0.66. Correlational analyses showed high and moderate convergent validity with the Bangor Voice Matching Test (BVMT) and Glasgow Voice Memory Test (GVMT), respectively, and high discriminant validity with a digit span test. Four participants with potential super recognition abilities and seven participants with potential phonagnosia were identified who performed at least 2 SDs above or below the mean, respectively. The JVLMT is a promising research and diagnostic screening tool to detect both impairments in voice recognition and super-recognition abilities.

[Tinnitus]. / Tinnitus.

Tinnitus is a highly prevalent symptom and a common reason for seeing an otolaryngologist. Since tinnitus can go hand in hand with hearing loss, the step-by-step clarification of hearing loss is one of the essential ENT examinations for tinnitus sufferers. The anamnesis and medical history are relevant, since a multidimensional interaction with the tinnitus can be important for the treatment, especially in the case of a psychological comorbidity. In the vast majority of patients, no causal factor can be found. In the absence of external stimuli, phantom perceptions of tones or noises are held responsible for subjective tinnitus, which probably arises from pathological changes of the auditory pathway, but also in non-auditory cortical structures. In the case of acute tinnitus, a comprehensive audiological assessment is needed, and if the hearing threshold is normal, counseling is the priority. The patient must be informed about the nature of these benign symptoms. So far, there is no acute therapy that has been proven to increase the probability of healing, i.e. the disappearance of the acute tinnitus. Only if the hearing threshold descended, for instance in case of sudden idiopathic hearing loss, therapy of the underlying disease can also lead to improvement or healing of the acute tinnitus. Counseling for chronic tinnitus with high burden is also about reducing exaggerated expectations of healing that cannot be fulfilled. The training of habituation strategies is important. The standard of therapy for chronic tinnitus with psychological strain represents cognitive behavioral therapy for dealing with the tinnitus in a beneficial way. Tinnitus is a symptom of a very heterogeneous group of patients. In the future, it is to be hoped that digital applications and interventions in particular will be evaluated in quality-controlled clinical studies in order to be able to further personalize patient therapy.

[The ENT patients' perspective on otorhinolaryngology, head and neck surgery - a Germany-wide survey]. / Die Perspektive der Patienten auf die HNO-Heilkunde ­ eine deutschlandweite Befragung.

BACKGROUND: Patient orientation in the decision-making process for the best treatment, but patient participation in research projects, are more required. METHODS: In a multi-center prospective cross-sectional study, ENT patients completed a layman-friendly questionnaire with questions on patient orientation, evidence-based medicine, need for research, and health literacy. The survey was performed during an ENT awareness week in June 2021 in 27 ENT practices, 18 ENT clinics and 14 university ENT departments. RESULTS: 2023 patient responses (46% female; 49% 46-75 years old; 40% in ENT practice) were evaluated. The most commonly reported ENT diseases were sensory disorders (16.8%), or tumors (12.7%), Shared decision-making was the favored process for treatment decisions (43.5%). Sufficient time to talk was cited as the most important element of the relationship (15.8%). Most participants felt well informed about treatment steps (42.4%). For electronic searches, general search engines were primarily used (50.3%). Three-quarters of participants (73.7%) had never participated in a study before. About two-thirds (62.8%) could not imagine doing so in the future. Factors such as gender, age, schooling, or location of the survey were associated with different response behaviors. DISCUSSION: The desire for patient orientation is also high among ENT patients and frequently implemented by ENT doctors in practice and clinic. Especially, patients with lower education level should be more involved in the planning of studies in order to provide opportunities for participation in accordance with the recommendations of the funding institutions.

Tinnitus and Influencing Comorbidities. / Tinnitus und beeinflussende Komorbiditäten.

Numerous studies show that impairments in chronic tinnitus are closely connected with psychosomatic and other concomitant symptoms. This overview summarizes some of these studies. Beyond hearing loss, individual interactions of medical and psychosocial stress factors as well as resources are of central importance. Tinnitus related distress reflects a large number of intercorrelated, psychosomatic influences - such as personality traits, stress reactivity and depression or anxiety - which can be accompanied by cognitive difficulties and should be conceptualized and assessed within a vulnerability-stress-reaction model. Superordinate factors such as age, gender or education level can increase vulnerability to stress. Therefore, diagnosis and therapy of chronic tinnitus be individualised, multidimensional and interdisciplinary. Multimodal psychosomatic therapy approaches aim to address individually constellated medical, audiological and psychological influences in order to sustainably increase the quality of life of those affected. Counselling in the first contact is also indispensable for diagnosis and therapy.

Tinnitus and Multimodal Cortical Interaction. / Tinnitus und multimodale kortikale Interaktion.

The term of subjective tinnitus is used to describe a perceived noise without an external sound source. Therefore, it seems to be obvious that tinnitus can be understood as purely auditory, sensory problem. From a clinical point of view, however, this is a very inadequate description, as there are significant comorbidities associated with chronic tinnitus. Neurophysiological investigations with different imaging techniques give a very similar picture, because not only the auditory system is affected in chronic tinnitus patients, but also a widely ramified subcortical and cortical network. In addition to auditory processing systems, networks consisting of frontal and parietal regions are particularly disturbed. For this reason, some authors conceptualize tinnitus as a network disorder rather than a disorder of a circumscribed system. These findings and this concept suggest that tinnitus must be diagnosed and treated in a multidisciplinary and multimodal manner.

Continual rehabilitation motivation of patients with postparalytic facial nerve syndrome.

PURPOSE: To evaluate the continued rehabilitation motivation in patients with postparalytic facial synkinesis (PFS). METHODS: In this single-center cross-sectional survey, the multidimensional patient questionnaire for assessment of rehabilitation motivation (PAREMO-20) was used to assess the rehabilitation motivation. Associations Sunnybrook and Stennert index grading, Facial Clinimetric Evaluation (FaCE) survey, general quality of life (SF-36), Liebowitz Social Anxiety Scale (LSAS), Patient Health Questionnaire (PHQ)-9, technology commitment and affinity, and interest in further therapy were analyzed. RESULTS: 69 adults with PFS (73% women; median age: 54 years) answered the survey. In comparison to prior treatment forms, there was a significant higher future interest in computer-based home facial training (p < 0.0001). For PAREMO Psychological burden subscore, SF36 Emotional role was the highest negative correlative factor (p < 0.0001). For PAREMO Physical burden subscore, SF-36 General health was the highest negative correlative factor (p = 0.018). Working (p = 0.033) and permanent relationship (p = 0.029) were the only independent factors correlated to PAREMO Social Support Subscore. Higher positive impacts of technology affinity was inversely correlated to PAREMO Knowledge subscore (p = 0.017). Lower SF-36 Role physical subscore p = 0.045) and a lower SF-36 General health (p = 0.013) were correlated to a higher PAREMO Skepticism subscore. CONCLUSIONS: Patients with PFS seem to have a high facial motor and non-motor psychosocial impairment even after several facial therapies. Rehabilitation-related motivation increases with both, higher facial motor and non-motor dysfunction. Social and emotional dysfunction are drivers to be interested in innovative digital therapy forms.

Improving the assessment of functional impairment in tinnitus sufferers: validation of the German version of the Tinnitus Functional Index using a confirmatory factor analysis.

OBJECTIVES: Chronic tinnitus negatively impacts daily functioning. To specifically assess this impairment, the Tinnitus Functional Index (TFI) was developed. The current study investigated the hierarchical, eight-factorial structure for the German TFI and examined its psychometric properties. DESIGN: In an online assessment, the TFI and other validated health-related measurements were completed. Confirmatory factor analysis (CFA) was conducted to investigate the factorial structure by testing two competing models: (1) a general factor model, and (2) a hierarchical second-order factor model. STUDY SAMPLE: 316 research volunteers (59.8% female) with low to moderate tinnitus distress were included. RESULTS: CFA revealed an insufficient fit of the data to the general factor model. For the hierarchical second-order factor model, an acceptable model fit was shown (χ2/df ratio = 2.74, RMSEA = 0.07, SRMR = 0.05, CFI = 0.95, TLI = 0.95). Correlational analyses between the TFI and measures assessing tinnitus distress, depression, sleeping difficulties, subjective well-being, and personality dimensions indicated high convergent and moderate discriminant validity. Internal consistency reliability was excellent. CONCLUSIONS: The results confirm the hierarchical, eight-factorial structure of the German TFI. The TFI is a promising inventory that should be used on a regular basis.HighlightsThe results of our study confirm the hierarchical eight-factorial structure of the German TFI.Confirmatory factor analysis revealed an acceptable model fit of the data.Convergent validity of the German TFI was high.Discriminant validity of the German TFI was moderate.The German TFI is a reliable questionnaire to assess tinnitus functional impairment.

Ratings of Emotional Expressions in Static and Dynamic Facial Recordings Before and After Upper Face Botulinum Injections-An Observational Prospective Study.

BACKGROUND: Botulinum toxin A (BTX), a neurotoxin widely used for facial aesthetics, causes dose-dependent muscle paralysis. It was hypothesized that treatment of mimic muscles with BTX might have a positive impact on emotional expression in static images (photographs), but a negative impact in dynamic recordings (videos). OBJECTIVES: The aim of this study was to compare of emotional expression recorded in photographs and videos before and after treatment with BTX. METHODS: Twenty healthy women (mean age, 45 years) received a dose of 19 mouse units of XEOMIN (Merz, Frankfurt am Main, Germany) into the procerus, occipitofrontalis, and orbicularis oculi muscles. Photographs and videos of the participants' faces with neutral and happy expressions were recorded before treatment and 2 weeks later. Recordings were rated by naive raters blind to the conditions and in balanced order. RESULTS: Videos were generally rated as more pleasant, arousing, attractive, and genuine than photographs (all Ps > 0.001). This was especially the case for videos with neutral expression (P = 0.003). Independent of presentation mode and facial expression, women were rated as more attractive after BTX treatment (P = 0.03). CONCLUSIONS: In contrast to the hypothesis, the reduced mobility had no detectable negative impact on dynamic emotional expression, but videos received more positive ratings, particularly for neutral expressions. It is thus recommended to assess emotional expression with dynamic recordings to evaluate the effects of treatment with BTX. BTX seems to improve perceived attractiveness, although the cause of this effect remains unclear.

One Step Closer towards a Reliable Tinnitus Pitch-Match Frequency Determination Using Repetitive Recursive Matching.

INTRODUCTION: The determination of the tinnitus pitch-match (PM) frequency is not straightforward but an important audiological assessment recommended for clinical and research purposes. We evaluated repetitive recursive matching using an iPod-based matching procedure as a method to estimate a patient's PM frequency without audiometric equipment. METHODS: One hundred and seventeen patients with chronic tonal tinnitus (uni- and bilateral tinnitus) measured their tinnitus in 10 sessions using a self-administered automated iPod-based procedure comprising a recursive 2 interval forced-choice test. RESULTS: Mean SD of the PM frequency of all participants across sessions was 0.41 octaves. The internal consistency measured by Cronbach's α was very high (0.8->0.95). As an example, 7 PMs obtained excellent internal consistency (α = 0.93). The exclusion of the first and/or second session led to more definite PMs with a decreased SD. Outliers were identified by PMs departing 2 SDs (i.e., 0.94 octaves) from the mean variability (n = 5). CONCLUSION: Repetitive recursive matching together with recommendations for the exclusion of initial and redundant sessions as well as outlier identification and treatment can enable a reliable estimation of the PM frequency.

Deaf signers outperform hearing non-signers in recognizing happy facial expressions.

The use of signs as a major means for communication affects other functions such as spatial processing. Intriguingly, this is true even for functions which are less obviously linked to language processing. Speakers using signs outperform non-signers in face recognition tasks, potentially as a result of a lifelong focus on the mouth region for speechreading. On this background, we hypothesized that the processing of emotional faces is altered in persons using mostly signs for communication (henceforth named deaf signers). While for the recognition of happiness the mouth region is more crucial, the eye region matters more for recognizing anger. Using morphed faces, we created facial composites in which either the upper or lower half of an emotional face was kept neutral while the other half varied in intensity of the expressed emotion, being either happy or angry. As expected, deaf signers were more accurate at recognizing happy faces than non-signers. The reverse effect was found for angry faces. These differences between groups were most pronounced for facial expressions of low intensities. We conclude that the lifelong focus on the mouth region in deaf signers leads to more sensitive processing of happy faces, especially when expressions are relatively subtle.

Tolerability of facial electrostimulation in healthy adults and patients with facial synkinesis.

PURPOSE: To evaluate optimal stimulation parameters with regard to discomfort and tolerability for transcutaneous electrostimulation of facial muscles in healthy participants and patients with postparetic facial synkinesis. METHODS: Two prospective studies were performed. First, single pulse monophasic stimulation with rectangular pulses was compared to triangular pulses in 48 healthy controls. Second, 30 healthy controls were compared to 30 patients with postparetic facial synkinesis with rectangular pulse form. Motor twitch threshold, tolerability threshold, and discomfort were assessed using a numeric rating scale at both thresholds. RESULTS: Discomfort at motor threshold was significantly lower for rectangular than for triangular pulses. Average motor and tolerability thresholds were higher for patients than for healthy participants. Discomfort at motor threshold was significantly lower for healthy controls compared to patients. Major side effects were not seen. CONCLUSIONS: Surface electrostimulation for selective functional and tolerable facial muscle contractions in patients with postparetic facial synkinesis is feasible.

The causal role of prefrontal hemispheric asymmetry in valence processing of words - Insights from a combined cTBS-MEG study.

Hemispheric asymmetries play an important role in multiple cerebral functions. Asymmetries in prefrontal cortex (PFC) function have been suggested to regulate emotional processing in that right-hemispheric dominance biases towards negative affect, whereas left PFC dominance favors positive affect. This study used transcranial magnetic stimulation to test the causal role of prefrontal asymmetries in the processing of emotional stimuli. To experimentally induce hemispheric asymmetries, 21 healthy volunteers underwent two separate sessions of inhibitory continuous theta burst stimulation (cTBS) to the left versus right dorsolateral prefrontal cortex. Each stimulation was followed by magnetoencephalographic (MEG) recordings of event-related fields elicited by visually presented emotional words in a silent reading task and a subsequent behavioral emotion categorization task. The asymmetry manipulation influenced valence processing of words in early, mid-latency and late time intervals in right occipitotemporal and parietal brain regions. Left-sided cTBS (inducing right-hemispheric dominance) consistently resulted in enhanced brain responses to negative words, while right-sided cTBS (inducing left-hemispheric dominance) enhanced responses to positive words. On a behavioral level, right-hemispheric dominance resulted in more categorization matches of negative compared to positive words, while left-hemispheric dominance resulted in reverse effects. These results provide direct evidence that bottom-up valence processing is influenced by prefrontal hemispheric asymmetry.

[Tinnitracks - First results of a user survey]. / Tinnitracks ­ Erste Ergebnisse einer Anwenderbefragung.

BACKGROUND: The treatment of chronic tinnitus poses still a challenge for clinicians and researchers alike. Since a couple of years, the tailor-made notched music training (TMNMT) has been proposed as a new method in which the frequency of tonal tinnitus is been filtered from the spectrum of individually chosen music. Today, some smartphone-based apps are available for the patients, i. e. Tinnitracks. METHODS: During spring 2018, in total 457 ENT-physicians have been consulted by e-mail in respect of effectiveness and compatibility by using Tinnitracks. The data were collected centrally, were arcsin transformed and analysed by single factor ANOVA, t-tests were used for further analyses of effects. RESULTS: In total, 117 (25.6 %) of all consulted ENT-physicians participated in the survey. On average, TMNMT has been used for 1.26 years in the offices. With respect to loudness, frequency, and comfort of the tinnitus significant effects were found, which came forth by less reporting of negative in comparison of equal or better effects. Significant differences between "equal" and "better" as a positive effect of the therapy were not found. DISCUSSION: The effectiveness of Tinnitracks has not been investigated. Our survey demonstrated that Tinnitracks did not influence negatively the loudness or discomfort of the tinnitus, its frequency was not influenced significantly. Negative effects were statistically not significant. Thus, a therapy with Tinnitracks could not be recommended yet.

Emotion regulation and trait anxiety are predicted by the microstructure of fibers between amygdala and prefrontal cortex.

Diffusion tensor imaging revealed that trait anxiety predicts the microstructural properties of a prespecified fiber tract between the amygdala and the perigenual anterior cingulate cortex. Besides this particular pathway, it is likely that other pathways are also affected. We investigated white matter differences in persons featuring an anxious or a nonanxious personality, taking into account all potential pathway connections between amygdala and anxiety-related regions of the prefrontal cortex (PFC). Diffusion-weighted images, measures of trait anxiety and of reappraisal use (an effective emotion-regulation style), were collected in 48 females. With probabilistic tractography, pathways between the amygdala and the dorsolateral PFC, dorsomedial PFC, ventromedial PFC, and orbitofrontal cortex (OFC) were delineated. The resulting network showed a direct ventral connection between amygdala and PFC and a second limbic connection following the fornix and the anterior limb of the internal capsule. Reappraisal use predicted the microstructure of pathways to all calculated PFC regions in the left hemisphere, indicating stronger pathways for persons with high reappraisal use. Trait anxiety predicted the microstructure in pathways to the ventromedial PFC and OFC, indexing weaker connections in trait-anxious persons. These effects appeared in the right hemisphere, supporting lateralization and top-down inhibition theories of emotion processing. Whereas a specific microstructure is associated with an anxious personality, a different structure subserves emotion regulation. Both are part of a broad fiber tract network between amygdala and PFC.

Change of speech fundamental frequency explains the satisfaction with voice in response to testosterone therapy in female-to-male gender dysphoric individuals.

Previous studies demonstrated that there is a significant change in speaking fundamental frequency after testosterone therapy in female-to-male gender dysphoric individuals. It is yet an open question how the satisfaction with voice alteration can be predicted because until now it is not clear whether a testosterone therapy is sufficiently effective. The aim of the current study was not only to measure satisfaction with voice, but additionally to detect factors that predict or explain satisfaction with voice after testosterone therapy. Therefore, nine female-to-male gender dysphoric individuals were examined during the first year of testosterone treatment at different points of time. The patients underwent several voice analyses within 1 year and had to fill out several questionnaires concerning their voice, depressive symptoms, quality of life and voice handicap index. Multiple regression analyses were performed to find the factors that explained satisfaction with altered voice after 1 year. The difference of voice frequency in semitones before the treatment and after 1 year is the only significant predictor for satisfaction after 1 year (B = 0.442; SE = 0.049) and more important than the absolute fundamental frequency.