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Background: Tinnitus can cause considerable psychological distress among patients, particularly if comorbidities occur. Despite a strong relationship between tinnitus-related distress and depression, the underlying mechanisms represent a long-standing question. By investigating the co-development of tinnitus-related distress and depressiveness throughout therapy, we capture the dynamic interplay of both conditions and uncover underlying common features mediating their link., Methods: Large datasets from two different day clinics in Germany have been analyzed using a regularization method for predictor selection (analysis 1) and latent growth curve modeling (LCM; analysis 2). Tinnitus-related distress was assessed using the Tinnitus Questionnaire (TQ). All patients have been experiencing chronic subjective tinnitus with a minimum mean severity level of TQ grade 2. Treatment at both day clinics involved tinnitus management according to clinical guidelines with minor idiosyncratic differences. Analysis 1 was performed on a dataset of 500 patients who received the Jena Interdisciplinary Treatment for Tinnitus (JITT) for 5 consecutive days between 2013 and 2017. Analysis 2 was performed on a second dataset, which included 1016 patients treated at the Tinnitus Center of the Charité Universitätsmedizin Berlin for 7 days between 2011 and 2015., Results: Here, we show a substantial bidirectional relationship between tinnitus-related distress and depression severity while emphasizing the role of somatic symptoms and perceived stress in the experience and maintenance of tinnitus awareness. The LCM provides adequate model fit (CFI = 0.993, SRMR = 0.016)., Conclusions: Our results indicate enhanced therapy success in depression when tinnitus-related distress is addressed and vice versa. The combined treatment of tinnitus and depression is proposed for future treatment strategies., Competing Interests: Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Objective : e-Health or web-based systems in the field of tinnitus have gained increasing interest. Cognitive behavioral therapy (CBT) delivered via the internet is currently witnessing a surge in both attention and offerings. This systematic review analyzed the efficacy and sustainability of internet-based therapies aimed at reducing tinnitus distress and comorbidities such as anxiety, depression, and sleep disorders. The review exclusively considered randomized controlled trials (RCTs) in which trained personnel were actively involved during intervention. Methods : Utilizing search terms such as tinnitus, internet-based therapy, and e-Health therapy, we identified 155 studies, from which 37 RCTs were carefully examined for data availability. Primary outcome measures included treatment effects for tinnitus distress (Tinnitus Questionnaire and other questionnaires) and handicap (Tinnitus Handicap Inventory), while secondary outcomes encompassed depression, anxiety, and sleep problems. Meta-analyses were conducted employing random-effect models. A study effect model was applied, yielding a singular effect size for each sample. The effect sizes were examined for influences of various moderators. Results : We found a statistically significant large effect size for improvement in tinnitus distress ( d = 0.83; [confidence interval 0.61-1.06] with total n = 450 for the experimental group and total n = 504 or the controls), while the reduction of tinnitus handicap was smaller (moderate effect size d = 0.59; [0.44-0.73]). Less strong but still significant effects resulted for depression, anxiety, and insomnia. Most of the long-term outcomes remained stable. As moderators, the risk of bias (RoB) and the severity of tinnitus manifestations were identified. Conclusions : Internet-based therapy provides a valuable avenue for initial therapeutic contact, as supporting component in tinnitus treatment if accompanied by therapists. The heterogeneous quality with high drop-out rates or partly high RoB and the wide range of interventions (counseling, eCBT, mindfulness) might be considered as a limiting factor for a first-line management in tinnitus. So far, the use of e-Health is dependent on availability or user preferences.

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., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

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 ( N Total = 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.

High-resolution facial surface electromyography (HR-sEMG) is suited to discriminate between different facial movements. Whether HR-sEMG also allows a discrimination among the six basic emotions of facial expression is unclear. 36 healthy participants (53% female, 18-67 years) were included for four sessions. Electromyograms were recorded from both sides of the face using a muscle-position oriented electrode application (Fridlund scheme) and by a landmark-oriented, muscle unrelated symmetrical electrode arrangement (Kuramoto scheme) simultaneously on the face. In each session, participants expressed the six basic emotions in response to standardized facial images expressing the corresponding emotions. This was repeated once on the same day. Both sessions were repeated two weeks later to assess repetition effects. HR-sEMG characteristics showed systematic regional distribution patterns of emotional muscle activation for both schemes with very low interindividual variability. Statistical discrimination between the different HR-sEMG patterns was good for both schemes for most but not all basic emotions (ranging from p > 0.05 to mostly p < 0.001) when using HR-sEMG of the entire face. When using information only from the lower face, the Kuramoto scheme allowed a more reliable discrimination of all six emotions (all p < 0.001). A landmark-oriented HR-sEMG recording allows specific discrimination of facial muscle activity patterns during basic emotional expressions., (© 2023. The Author(s).)

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., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

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., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

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., (© 2023. The Author(s).)

Practicing mindfulness is associated with stress reduction and with positive effects in the context of learning and teaching. Although effects on student populations have been studied extensively, there are few studies implementing mindfulness exercises in university courses directly. For this reason, we aimed to investigate whether the use of a brief mindfulness exercise in regular university courses, guided by the lecturers, is feasible and has immediate effects on the students' mental states. We conducted a preregistered multicenter study with one observational arm, following an ABAB design. In total, N = 325 students from 19 different university courses were included at baseline and n = 101 students at post measurement. Students were recruited by N = 14 lecturers located in six different universities in Germany. Lecturers started their courses either by guiding a brief mindfulness exercise (intervention condition) or as they regularly would, with no such exercise (control condition). In both conditions, the mental states of students and lecturers were assessed. Over the semester, n = 1193 weekly observations from students and n = 160 observations from lecturers were collected. Intervention effects were analyzed with linear mixed-effects models. The brief mindfulness exercise, compared to no such exercise, was associated with lower stress composite scores, higher presence composite scores, higher motivation for the courses, as well as better mood in students. Effects persisted throughout a respective course session. Lecturers also reported positive effects of instructing mindfulness. Implementing a brief mindfulness exercise in regular university teaching sessions is feasible and has positive effects on both students and lecturers., (© 2023. The Author(s).)

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., Competing Interests: Die Autorinnen geben an, dass kein Interessenkonflikt besteht., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

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., Competing Interests: Die Autorinnen geben an, dass kein Interessenkonflikt besteht., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

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., (© 2022. The Author(s).)

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., Competing Interests: Erklärung zu finanziellen Interessen Forschungsförderung erhalten: nein; Honorar/geldwerten Vorteil für Referententätigkeit erhalten: nein; Bezahlter Berater/interner Schulungsreferent/Gehaltsempfänger: nein; Patent/Geschäftsanteile/Aktien (Autor/Partner, Ehepartner, Kinder) an im Bereich der Medizin aktiven Firma: nein; Patent/Geschäftsanteile/Aktien (Autor/Partner, Ehepartner, Kinder) an zu Sponsoren dieser Fortbildung bzw. durch die Fortbildung in ihren Geschäftsinteressen berührten Firma: nein Erklärung zu nichtfinanziellen Interessen O. Guntinas-Lichius: Dt. HNO-Gesellschaft; J. Prengel und C. Dobel geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Tinnitus pathophysiology has been associated with an atypical cortical network that involves functional changes in auditory and non-auditory areas. Numerous resting-state studies have replicated a tinnitus brain network to be significantly different from healthy-controls. Yet it is still unknown whether the cortical reorganization is attributed to the tinnitus frequency specifically or if it is frequency-irrelevant. Employing magnetoencephalography (MEG), the current study aimed to identify frequency-specific activity patterns by using an individual tinnitus tone (TT) and a 500 Hz-control tone (CT) as auditory stimuli, across 54 tinnitus patients. MEG data were analyzed in a data-driven approach employing a whole-head model in source space and in sources' functional connectivity. Compared to the CT, the event related source space analysis revealed a statistically significant response to TT involving fronto-parietal regions. The CT mainly involved typical auditory activation-related regions. A comparison of the cortical responses to a healthy control group that underwent the same paradigm rejected the alternative interpretation that the frequency-specific activation differences were due to the higher frequency of the TT. Overall, the results suggest frequency-specificity of tinnitus-related cortical patterns. In line with previous studies, we demonstrated a tinnitus-frequency specific network comprising left fronto-temporal, fronto-parietal and tempo-parietal junctions., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Despite the fact that chronic diseases usually occur together with a spectrum of possible comorbidities that may differ strongly between patients, they are classically still viewed as distinct disease entities and, consequently, are often treated with uniform therapies. Unfortunately, such an approach does not take into account that different combinations of symptoms and comorbidities may result from different pathological (e.g., environmental, genetic, dietary, etc.) factors, which require specific and individualised therapeutic strategies. In this opinion paper, we aim to put forward a more differentiated, systems medicine approach to disease and patient treatment. To elaborate on this concept, we focus on the interplay of tinnitus, depression, and chronic pain. In our view, these conditions can be characterised by a variety of phenotypes composed of variable sets of symptoms and biomarkers, rather than distinct disease entities. The knowledge of the interplay of such symptoms and biomarkers will provide the key to a deeper, mechanistic understanding of disease pathologies. This paves the way for prediction and prevention of disease pathways, including more personalised and effective treatment strategies.

Tinnitus treatment, diagnosis and management across Europe varies significantly. The lack of national clinical guidelines for tinnitus management in most European countries and the absence of a common language across all disciplines involved is reflected in the diversification of healthcare practices. Interprofessional Training for Tinnitus Researchers and Clinicians (Tin-TRAC) is an Erasmus+ project that aims to develop common educational ground in the form of an e-Learning platform, co-created by patients, researchers and clinicians, which is able to unify tinnitus diagnosis and treatment strategies across Europe. A pan-European thematic educational platform integrating the best practices and latest research achievements with regard to tinnitus diagnosis and management has the potential to act as a facilitator of the reduction of interdisciplinary and interregional practice diversification. A detailed analysis of the educational needs of clinicians and researchers across disciplines will be followed by the co-creative development of the curriculum. Reusable learning objects will incorporate the training contents and will be integrated in an open e-Learning platform. Tin-TRAC envisions that its output will answer the need to create a common language across the clinicians and researchers of different disciplines that are involved in tinnitus management, and reduce patients' prolonged suffering, non-adherence and endless referral trajectories.

Background and Objective: Despite the availability of successful treatment approaches for chronic tinnitus, it has proven difficult to predict who profits from treatment and it is still an open question if it is possible at all. We tried to overcome methodological shortcomings and to predict treatment outcome indicated by questionnaires measuring tinnitus distress., Methods: This is an observational, prospective cohort study. Lasso and post-selection inference methods were used to predict treatment outcome in patients suffering from chronic tinnitus (N = 747). Patients were treated for five consecutive days in an interdisciplinary setting according to guidelines., Results: Early change, i.e. a positive response after the screening day, as well as change due to treatment was predicted by several psychopathological variables, but also tinnitus-related factors. Female gender as an example was a predictor for change due to treatment. In general, therapy success both for early change and change due to treatment cannot be predicted satisfactorily as indicated by a high mean cross-validation error (for early change: 9.83, for change due to treatment: 14.40). Analyzing sub-groups separated by tinnitus severity to reduce heterogeneity did not improve the situation and for patients with high tinnitus severity no predictors at all could be reported (cross-validated error: 11.62 for the low quartile, 13.38 for the low-medium quartile, and 15.61 for the medium-high quartile)., Conclusion: Several psychopathological and tinnitus-related variables predicted early and long-term change. Nevertheless, also overcoming methodological shortcomings to predict treatment success did not lead to satisfactory results, but rather emphasizes the high heterogeneity of chronic tinnitus., (Copyright © 2022 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Chronic tinnitus is a commonly occurring symptom of the auditory system. Epidemiological studies assume a lifetime prevalence in men and women of 3.5% for chronic tinnitus requiring treatment. Almost 25% of all Germans have experienced at least one episode of tinnitus. No causal therapy is yet available, but numerous treatment strategies are being pursued. Rigorous scientific assessment of these procedures is essential., Methods: For this exhaustive revision of the German clinical practice guideline, the literature in the medical databases PubMed and Cochrane Library, including existing guidelines from various countries, was systematically searched using keywords on the topic of chronic tinnitus. On the basis of the revised guideline, a separate guideline was written in language accessible to patients., Results: Chronic tinnitus is often associated with hearing loss, but the mental distress caused by the ear noise is another crucial element. Apart from expert counseling, the recommended treatment comprises psychotherapeutic interventions, particularly cognitive behavioral therapy (with effect sizes of 0.54 to 0.91 for reduction of the tinnitus-related distress), and measures to improve the hearing. There is insufficient evidence regarding the effects of drug treatment, sound and music therapy, and neuromodulation (magnetic stimulation or electrostimulation)., Conclusion: Alongside thorough and sound diagnosis and counseling, the principal treatment options for chronic tinnitus are specific cognitive behavioral therapy and expert psychotherapeutic interventions on an individual or group basis. Future-preferably interdisciplinary-research should evaluate the long-term effects of the treatment options, with particular attention to psychosomatic comorbidity.

Objectives: (1) To determine which psychosocial aspects predict tinnitus-related distress in a large self-reported dataset of patients with chronic tinnitus, and (2) to identify underlying constructs by means of factor analysis., Methods: A cohort of 1958 patients of the Charité Tinnitus Center, Berlin completed a large questionnaire battery that comprised sociodemographic data, tinnitus-related distress, general psychological stress experience, emotional symptoms, and somatic complaints. To identify a construct of "tinnitus-related distress", significant predictive items were grouped using factor analysis., Results: For the prediction of tinnitus-related distress (linear regression model with R 2 = 0.7), depressive fatigue symptoms (concentration, sleep, rumination, joy decreased), the experience of emotional strain, somatization tendencies (pain experience, doctor contacts), and age appeared to play a role. The factor analysis revealed five factors: "stress", "pain experience", "fatigue", "autonomy", and low "educational level"., Conclusions: Tinnitus-related distress is predicted by psychological and sociodemographic indices. Relevant factors seem to be depressive exhaustion with somatic expressions such as sleep and concentration problems, somatization, general psychological stress, and reduced activity, in addition to higher age.

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 (χ 2 /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.

To determine treatment and outcome in a tertiary multidisciplinary facial nerve center, a retrospective observational study was performed of all patients referred between 2007 and 2018. Facial grading with the Stennert index, the Facial Clinimetric Evaluation (FaCE) scale, and the Facial Disability Index (FDI) were used for outcome evaluation; 1220 patients (58.4% female, median age: 50 years; chronic palsy: 42.8%) were included. Patients with acute and chronic facial palsy were treated in the center for a median of 3.6 months and 10.8 months, respectively. Dominant treatment in the acute phase was glucocorticoids ± acyclovir (47.2%), followed by a significant improvement of all outcome measures ( p < 0.001). Facial EMG biofeedback training (21.3%) and botulinum toxin injections (11%) dominated the treatment in the chronic phase, all leading to highly significant improvements according to facial grading, FDI, and FaCE ( p < 0.001). Upper eyelid weight (3.8%) and hypoglossal-facial-nerve jump suture (2.5%) were the leading surgical methods, followed by improvement of facial motor function ( p < 0.001) and facial-specific quality of life (FDI, FaCE; p < 0.05). A standardized multidisciplinary team approach in a facial nerve center leads to improved facial and emotional function in patients with acute or chronic facial palsy.

Learning from errors as the main mechanism for motor adaptation has two fundamental prerequisites: a mismatch between the intended and performed movement and the ability to adapt motor actions. Many neurological patients are limited in their ability to transfer an altered motor representation into motor action due to a compromised motor pathway. Studies that have investigated the effects of a sustained and unresolvable mismatch over multiple days found changes in brain processing that seem to optimize the potential for motor learning (increased drive for motor adaptation and a weakening of the current implementation of motor programs). However, it remains unclear whether the observed effects can be induced experimentally and more important after shorter periods. Here, we used task-based and resting-state fMRI to investigate whether the known pattern of cortical adaptations due to a sustained mismatch can be induced experimentally by a short (20 min), but unresolvable, sensory-motor mismatch by impaired facial movements in healthy participants by transient facial tapping. Similar to long-term mismatch, we found plastic changes in a network that includes the striatal, cerebellar and somatosensory brain areas. However, in contrast to long-term mismatch, we did not find the involvement of the cerebral motor cortex. The lack of the involvement of the motor cortex can be interpreted both as an effect of time and also as an effect of the lack of a reduction in the motor error. The similar effects of long-term and short-term mismatch on other parts of the sensory-motor network suggest that the brain-state caused by long-term mismatch can be (at least partly) induced by short-term mismatch. Further studies should investigate whether short-term mismatch interventions can be used as therapeutic strategy to induce an altered brain-state that increase the potential for motor learning., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Klingner, Kattlun, Krolopp, Jochmann, Volk, Brodoehl, Guntinas-Lichius, Witte and Dobel.)

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., (© 2021. The Author(s).)

Background: There is no current standard for facial synkinesis rehabilitation programs. The benefit and stability of effect of an intensified 10-day facial training combining electromyography and visual biofeedback training was evaluated. Methods: Fifty-four patients (77.8% female; median age: 49.5 years) with post-paralytic facial synkinesis (median time to onset of paralysis: 31.1 months) were included in retrospective longitudinal study between January 2013 and June 2016. Facial function was assesses at baseline (T0), first days of training (T1), last day of training (T2), and follow-up visit (T3) at a median time of 6 months later using the House-Brackmann (HB) facial nerve grading system, Stennert index (SI), Facial Nerve Grading System 2.0 (FNGS 2.0), and Sunnybrook Facial Grading System (SFGS). Pairwise comparisons between the time points with post-hoc Bonferroni correction were performed. Results: No significant changes of the gradings and subscores were seen between T0 and T1 (all p > 0.01). The 10-day combined and intensified feedback training between T1 and T2 improved facial symmetry and decreased synkinetic activity. Facial grading with the FNGS 2.0 or the SFGS were most suited to depict the training effect. FNGS 2.0, regional score, FNGS 2.0, synkinesis score, and FNGS 2.0 total score improved significantly (all p ≤ 0.0001). Both, the FNGS 2.0 and the SFGS showed the strongest improvement in the nasolabial fold/zygomatic and the oral region. Neither the age of the patient ( r = 0.168; p = 0.224), the gender ( r = 0.126; p = 0.363) nor the length of the interval between onset of the palsy and training start ( r = 0.011; p = 0.886) correlated with the changes of the SFGS between T1 and T2. The results remained stable between T2 and T3 without any further significant change. Conclusion: Intensified daily combined electromyography and visual biofeedback training over 10 days was effective in patients with facial synkinesis and benefits were stable 6 months after therapy., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Volk, Roediger, Geißler, Kuttenreich, Klingner, Dobel and Guntinas-Lichius.)

Objectives/hypothesis: To evaluate the role of body dysmorphic disorder (BDD) in patients with postparalytic facial nerve syndrome with synkinesis (PFS)., Study Design: A single-center retrospective cohort study., Methods: A total of 221 adults (74% women; median age: 44 years; median duration since onset of facial palsy: 1.6 years) were included. To diagnose BDD, the BDD Munich Module was used. Associations with House-Brackmann grading, Stennert index grading, Facial Clinimetric Evaluation (FaCE) survey, Facial Disability Index (FDI), general quality of life (SF-36), Beck Depression Inventory (BDI), and the Liebowitz Social Anxiety Scale (LSAS) was analyzed., Results: A total of 59 patients (27%) were classified as patients with BDD. Significant associations were found between the diagnosis of BDD and female gender and lower FDI, FaCE, and SF-36 scores and higher BDI and LSAS scores. Multivariate analysis revealed BDI, FaCE total score, and FaCE social function subscore as independent factors associated with BDD., Conclusion: BDD was a relevant diagnosis in patients with PFS. A higher BDD level was associated with general and facial-specific quality of life and more psychosocial disabilities. Optimal treatment of PFS has to include these nonmotor dysfunctions., Level of Evidence: 3 Laryngoscope, 131:E2518-E2524, 2021., (© 2021 The Authors. The Laryngoscope published by Wiley Periodicals LLC on behalf of The American Laryngological, Rhinological and Otological Society, Inc.)

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., (© 2020 The Aesthetic Society. Reprints and permission: journals.permissions@oup.com.)

While tinnitus is known to compromise the perception of speech, it is unclear if the same holds for extralinguistic speaker information. Furthermore, research with simple tone stimuli showed that unilateral tinnitus binds spatial attention, thereby impeding the detection of auditory changes in the non-affected ear. Using dichotic listening tasks, we tested left-ear tinnitus patients and control patients for their ability to ignore speech and speaker information in the task-irrelevant ear. To this end they heard vowel-consonant-vowel (VCV) syllables simultaneously spoken by gender-ambiguous voices in one ear and male or female voices in the contralateral ear. They selectively attended to speech (Exp. 1) or speaker (Exp. 2) information in a designated target ear, by classifying either the consonant (/b/ or /g/) in VCV syllables or voice gender (male or female) while ignoring distractor voices in the other ear. While performance was comparable across groups in the gender task, tinnitus patients responded slower than controls in the consonant task, with no effect of target ear. This suggests that tinnitus hampers phonetic perception in speech, while preserving the processing of extralinguistic speaker information. These findings support the growing evidence for speech perception impairments in tinnitus., (© 2021 Elsevier B.V. All rights reserved.)

Tinnitus assessment is a precursor for individualized treatment and outcome measurement. In the recent years, several studies proposed two-alternative forced choice (2AFC) recursive matching as a method to determine tinnitus pitch-match frequency in a standardized reliable manner. Currently, pure tones are used as comparison stimuli to assess pitch-match frequency. In this study, we investigated the psychometric quality of the method comparing different sound types. We measured 20 chronic tinnitus patients in 2 runs on 3 days. To assess pitch-match frequency, we used 2AFC recursive matching and compared results between pure tones and narrow band noise (NBN). Test-retest reliability between runs and across sound types was high (α>0.9) and increased across days. Perceived matching difficulty and time to completion decreased over repetitions. Importantly, the difference of matched frequencies (DMF) between runs was significantly less for NBN. When patients matched the spectral bandwidth of a test tone to their tinnitus, consistency was high (α=0.86) and no patient indicated continuously a pure tone. In conclusion, we recommend using NBN sounds in 2AFC recursive matching to assess pitch-match frequency as a standardized reliable method. Such a procedure could be offered as smartphone-based application to monitor tinnitus symptomatology for individualized assessment and treatment outcome., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Purpose In their letter, Meister et al. (2020) appropriately point to a potential influence of stimulus type, arguing cochlear implant (CI) users may have the ability to use timbre cues only for complex stimuli such as sentences but not for brief stimuli such as vowel-consonant-vowel or single words. While we cannot exclude this possibility on the basis of Skuk et al. (2020) alone, we hold that there is a strong need to consider type of social signal (e.g., gender, age, emotion, speaker identity) to assess the profile of preserved and impaired aspects of voice processing in CI users. We discuss directions for further research to systematically consider interactive effects of stimulus type and social signal. In our view, this is crucial to understand and enhance nonverbal vocal perception skills that are relevant to successful communication with a CI.

Purpose Using naturalistic synthesized speech, we determined the relative importance of acoustic cues in voice gender and age perception in cochlear implant (CI) users. Method We investigated 28 CI users' abilities to utilize fundamental frequency (F0) and timbre in perceiving voice gender (Experiment 1) and vocal age (Experiment 2). Parameter-specific voice morphing was used to selectively control acoustic cues (F0; time; timbre, i.e., formant frequencies, spectral-level information, and aperiodicity, as defined in TANDEM-STRAIGHT) in voice stimuli. Individual differences in CI users' performance were quantified via deviations from the mean performance of 19 normal-hearing (NH) listeners. Results CI users' gender perception seemed exclusively based on F0, whereas NH listeners efficiently used timbre. For age perception, timbre was more informative than F0 for both groups, with minor contributions of temporal cues. While a few CI users performed comparable to NH listeners overall, others were at chance. Separate analyses confirmed that even high-performing CI users classified gender almost exclusively based on F0. While high performers could discriminate age in male and female voices, low performers were close to chance overall but used F0 as a misleading cue to age (classifying female voices as young and male voices as old). Satisfaction with CI generally correlated with performance in age perception. Conclusions We confirmed that CI users' gender classification is mainly based on F0. However, high performers could make reasonable usage of timbre cues in age perception. Overall, parameter-specific morphing can serve to objectively assess individual profiles of CI users' abilities to perceive nonverbal social-communicative vocal signals.

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.

Affective pictures are widely used in studies of human emotions. The objects or scenes shown in affective pictures play a pivotal role in eliciting particular emotions. However, affective processing can also be mediated by low-level perceptual features, such as local brightness contrast, color or the spatial frequency profile. In the present study, we asked whether image properties that reflect global image structure and image composition affect the rating of affective pictures. We focused on 13 global image properties that were previously associated with the esthetic evaluation of visual stimuli, and determined their predictive power for the ratings of five affective picture datasets (IAPS, GAPED, NAPS, DIRTI, and OASIS). First, we used an SVM-RBF classifier to predict high and low ratings for valence and arousal, respectively, and achieved a classification accuracy of 58-76% in this binary decision task. Second, a multiple linear regression analysis revealed that the individual image properties account for between 6 and 20% of the variance in the subjective ratings for valence and arousal. The predictive power of the image properties varies for the different datasets and type of ratings. Ratings tend to share similar sets of predictors if they correlate positively with each other. In conclusion, we obtained evidence from non-linear and linear analyses that affective pictures evoke emotions not only by what they show, but they also differ by how they show it. Whether the human visual system actually uses these perceptive cues for emotional processing remains to be investigated., (Copyright © 2020 Redies, Grebenkina, Mohseni, Kaduhm and Dobel.)

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.

Background: To evaluate the face-specific quality of life after hypoglossal-facial jump nerve suture for patients with long-term facial paralysis. Methods: A single-center retrospective cohort study was performed. Forty-one adults (46% women; median age: 55 years) received a hypoglossal-facial jump nerve suture. Sunnybrook and eFACE grading was performed before surgery and at a median time of 42 months after surgery. The Facial Clinimetric Evaluation (FaCE) survey and the Facial Disability Index (FDI) were used to quantify face-specific quality of life after surgery. Results: Hypoglossal-facial jump nerve suture was successful in all cases without tongue dysfunction. After surgery, the median FaCE Total score was 60 and the median FDI Total score was 76.3. Most Sunnybrook and eFACE grading subscores improved significantly after surgery. Younger age was the only consistent independent predictor for better FaCE outcome. Additional upper eyelid weight loading further improved the FaCE Eye comfort subscore. Sunnybrook grading showed a better correlation to FaCE assessment than the eFACE. Neither Sunnybrook nor eFACE grading correlated to the FDI assessment. Conclusion: The hypoglossal-facial jump nerve suture is a good option for nerve transfer to reanimate the facial muscles to improve facial motor function and face-specific quality of life., (Copyright © 2020 Volk, Geitner, Geißler, Thielker, Raslan, Mothes, Dobel and Guntinas-Lichius.)

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., (© 2020 S. Karger AG, Basel.)

Tinnitus describes the perception of a sound without external source and is characterized by high comorbidity, e.g. depression. In many studies, tinnitus patients were compared to healthy controls while a comorbid psychiatric diagnosis was an exclusion criterion. Consequently, patients with severe tinnitus and psychiatric comorbidity were often neglected. In the current study, we tried to fill this gap and compared four groups including two control groups: (1) chronic tinnitus patients with mild tinnitus distress (N = 37), (2) chronic tinnitus patients with severe tinnitus distress (N = 24), (3) patients suffering from depression, but no tinnitus (major depressive disorder, MDD; N = 23) and (4) healthy controls (N = 42). We assessed their clinical profile with clinical questionnaires concerning anxiety, depression and somatoform symptoms. Data were analyzed with a canonical discriminant analysis resulting in two factors. Factor 1 was called general psychopathology, because most questionnaires loaded highly on it. Regarding this factor, patients with severe tinnitus distress and MDD controls were impaired equally strong. Patients with mild tinnitus distress were more strongly affected than healthy controls. Both tinnitus groups reached higher values than the two control groups with regard to factor 2, called somatization. These results stress the presence of significant general psychopathology even in mild tinnitus., (Copyright © 2019 Elsevier B.V. All rights reserved.)

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., Competing Interests: Die Autoren versichern, dass die Arbeit ohne eine Unterstützung durch die Tinnitracks anbietende Firma Sonormed, Hamburg, erfolgte. Die Forschung von Autor #2 zu Tinnitus wird durch die Deutsche Forschungsgemeinschaft unterstützt (Do 711/7–1). Die Forschung von Autor #1 wird vom Deutschen Berufsverband der HNO-Ärzte e. V. unterstützt., (© Georg Thieme Verlag KG Stuttgart · New York.)

The present study used resting state MEG whole-head recordings to identify how chronic tonal tinnitus relates to altered functional connectivity of brain's intrinsic cortical networks. Resting state MEG activity of 40 chronic tinnitus patients and 40 matched human controls was compared identifying significant alterations in intrinsic networks of the tinnitus population. Directed functional connectivity of the resting brain, at a whole cortex level, was estimated by means of a statistical comparison of the estimated phase Transfer Entropy (pTE) between the time-series of cortical activations, as reconstructed by LORETA. As pTE identifies the direction of the information flow, a detailed analysis of the connectivity differences between tinnitus patients and controls was possible. Results indicate that the group of tinnitus patients show increased connectivity from right dorsal prefrontal to right medial temporal areas. Our results go beyond previous findings by indicating that the role of the left para-hippocampal area is dictated by a modulation from dmPFC; a region that is part of the dorsal attention network (DAN), as well as implicated in the regulation of emotional processing. Additionally, this whole cortex analysis showed a crucial role of the left inferior parietal cortex, which modulated the activity of the right superior temporal gyrus, providing new hypotheses for the role of this area within the context of current tinnitus models. Overall, these maladaptive alterations of the structure of intrinsic cortical networks show a decrease in efficiency and small worldness of the resting state network of tinnitus patients, which is correlated to tinnitus distress.

Previous neuroimaging studies have shown that sounds can be discriminated due to living-related or man-made-related characteristics and involve different brain regions. However, these studies have mainly provided source space analyses, which offer simple maps of activated brain regions but do not explain how regions of a distributed system are functionally organized under a specific task. In the present study, we aimed to further examine the functional connectivity of the auditory processing pathway across different categories of non-speech sounds in healthy adults, by means of MEG. Our analyses demonstrated significant activation and interconnection differences between living and man-made object sounds, in the prefrontal areas, anterior-superior temporal gyrus (aSTG), posterior cingulate cortex (PCC), and supramarginal gyrus (SMG), occurring within 80-120 ms post-stimulus interval. Current findings replicated previous ones, in that other regions beyond the auditory cortex are involved during auditory processing. According to the functional connectivity analysis, differential brain networks across the categories exist, which proposes that sound category discrimination processing relies on distinct cortical networks, a notion that has been strongly argued in the literature also in relation to the visual system., (Copyright © 2019 Salvari, Paraskevopoulos, Chalas, Müller, Wollbrink, Dobel, Korth and Pantev.)

Chronic tinnitus, a symptom of high prevalence, is a persistent hearing sensation in the absence of an external sound source. Recent electrophysiological studies indicate that tinnitus generation is to a high degree the result of maladaptive plasticity in the central auditory pathway. The pitch of the tinnitus sensation can be assessed by performing a pitch matching procedure. In the most frequent "tonal tinnitus" type pure tones are used as test stimuli. However, in the case of tonal tinnitus not a single malfunctioning neuron, but rather a population of neighbouring neurons is involved in the generation process of tinnitus and patients typically perceive their tinnitus as a sound having a prominent centre frequency with some spectral extent. Thus, the question arises, why not to use narrow band noise (NBN) instead of pure tones as test stimuli in pitch matching procedures? To investigate this, we first evaluated the pitch matching performance of healthy subjects. In a recursive two alternative choice testing, driven by a computer based automated procedure, the subjects were asked to match the pitch of two sounds. In a crosswise design, NBNs and pure tones were used both as target and as test stimuli. We were able to show that across all four possible combinations the pitch matching performance was least favourable when a sinusoidal sound had to be matched to an NBN target. Even though matching two sinusoidal sounds results in the lowest error, considering that the tinnitus percept typically includes some spectral extent, an NBN should be preferably used as a test stimulus against a pure tone., (Copyright © 2019 The Authors. Published by Elsevier B.V. All rights reserved.)

Recent electrophysiological evidence suggests a rapid acquisition of novel speaker representations during intentional voice learning. We investigated effects of learning intention on voice recognition, using a variant of the directed forgetting paradigm. In an old/new recognition task following voice learning, we compared performance and event-related brain potentials (ERPs) for studied voices, half of which had been prompted to be remembered (TBR) or forgotten (TBF). Furthermore, to assess incidental encoding of episodic information, participants indicated for each recognized test voice the ear of presentation during study. During study, TBR voices elicited more positive ERPs than TBF voices (from ∼250 ms), possibly reflecting deeper voice encoding. In parallel, subsequent recognition performance was higher for TBR than for TBF voices. Importantly, above-chance recognition for both learning conditions nevertheless suggested a degree of non-intentional voice learning. In a surprise episodic memory test for voice location, above-chance performance was observed for TBR voices only, suggesting that episodic memory for ear of presentation depended on intentional voice encoding. At test, a left posterior ERP OLD/NEW effect for both TBR and TBF voices (from ∼500 ms) reflected recognition of studied voices under both encoding conditions. By contrast, a right frontal ERP OLD/NEW effect for TBF voices only (from ∼800 ms) possibly reflected additional elaborative retrieval processes. Overall, we show that ERPs are sensitive 1) to strategic voice encoding during study (from ∼250 ms), and 2) to voice recognition at test (from ∼500 ms), with the specific pattern of ERP OLD/NEW effects partly depending on previous encoding intention., (Copyright © 2019 Elsevier B.V. All rights reserved.)

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., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Chronic tinnitus has been associated with brain structural changes in both the auditory system as well as limbic system. While there is considerable inconsistency across brain structural findings, growing evidence suggests that distress and other non-auditory symptoms modulate effects. In this study we addressed this issue, testing the hypothesis that limbic changes in tinnitus relate to both disease-related distress as well as co-morbid psychopathology. We obtained high-resolution structural magnetic resonance imaging (MRI) scans from a total of 125 subjects: 59 patients with bilateral chronic tinnitus (29 with a co-morbid psychiatric condition, 30 without), 40 healthy controls and 26 psychiatric controls with depression/anxiety disorders (without tinnitus). Voxel-based morphometry with the CAT12 software package was used to analyse data. First, we analysed data based on a 2 × 2 factorial design (tinnitus; psychiatric co-morbidity), showing trend-level effects for tinnitus in ROI analyses of the anterior cingulate cortex and superior/transverse temporal gyri, and for voxel-based analysis in the left parahippocampal cortex. Multiple regression analyses showed that the parahippocampal finding was mostly predicted by tinnitus rather than (dimensional) psychopathology ratings. Comparing only low-distress tinnitus patients (independent of co-morbid conditions) with healthy controls also showed reduced left parahippocampal grey matter. Our findings demonstrate that depression and anxiety (not only subjective distress) are major modulators of brain structural effects in tinnitus, calling for a stronger consideration of psychopathology in future neurobiological and clinical studies of tinnitus., (Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.)

Faces of one's own-age group are easier to recognize than other-age faces. Using behavioral measures and EEG, we studied whether an own-age bias (OAB) also exists in voice memory. Young (19 - 26 years) and old (60-75 years) participants studied young (18-25 years) and old (60-77 years) unfamiliar voices from short sentences. Subsequently, they classified studied and novel voices as "old" (i.e. studied) or "new", from the same sentences. Recognition performance was higher in young compared to old participants, and for old compared to young voices, with no OAB. At the same time, we found evidence for higher distinctiveness of old compared to young voices, both in terms of acoustic measures and subjective ratings (independent of rater age). Analyses of event-related brain potentials (ERPs) indicated more negative-going deflections (400-1000ms) for old compared to young voices in young participants. In old participants, we observed a reversed OLD/NEW memory effect, with overall more positive amplitudes for novel compared to studied old (but not young) voices (400-1000ms). Time-frequency analyses revealed less beta power (16-26Hz) for young compared to old voices at left anterior sites, and also reduced beta power for correctly recognized studied (compared to novel) voices at left posterior sites (300-900ms). These findings could suggest an engagement of cortical areas during stimulus-specific recollection from about 300ms, in a task that emphasized the analysis of individual acoustic features., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

At the interface between scene perception and speech production, we investigated how rapidly action scenes can activate semantic and lexical information. Experiment 1 examined how complex action-scene primes, presented for 150 ms, 100 ms, or 50 ms and subsequently masked, influenced the speed with which immediately following action-picture targets are named. Prime and target actions were either identical, showed the same action with different actors and environments, or were unrelated. Relative to unrelated primes, identical and same-action primes facilitated naming the target action, even when presented for 50 ms. In Experiment 2, neutral primes assessed the direction of effects. Identical and same-action scenes induced facilitation but unrelated actions induced interference. In Experiment 3, written verbs were used as targets for naming, preceded by action primes. When target verbs denoted the prime action, clear facilitation was obtained. In contrast, interference was observed when target verbs were phonologically similar, but otherwise unrelated, to the names of prime actions. This is clear evidence for word-form activation by masked action scenes. Masked action pictures thus provide conceptual information that is detailed enough to facilitate apprehension and naming of immediately following scenes. Masked actions even activate their word-form information-as is evident when targets are words. We thus show how language production can be primed with briefly flashed masked action scenes, in answer to long-standing questions in scene processing.

Tinnitus describes the subjective perception of a sound despite the absence of external stimulation. Being a sensory symptom the majority of studies focusses on the auditory pathway. In the recent years, a series of studies suggested a crucial involvement of the limbic system in the manifestation and development of chronic tinnitus. Regarding cognitive symptoms, several reviews addressed the presence of cognitive impairments in tinnitus as well and concluded that attention and memory processes are affected. Despite the importance for social communication and the reliance on a highly functional auditory system, speech comprehension remains a largely neglected field in tinnitus research. This is why we review here the existing literature on speech and language functions in tinnitus patients. Reviewed studies suggest that speech comprehension is impaired in patients with tinnitus, especially in the presence of competing noise. This is even the case in tinnitus patients with normal hearing thresholds. Additionally, speech comprehension measures seem independent of other measures such as tinnitus severity and perceived tinnitus loudness. According to the majority of authors, the speech comprehension difficulties arise as a result of central processes or dysfunctional neuroplasticity.

Objective: Considering the heterogeneity of the symptoms shown by patients suffering from chronic tinnitus, there are surprisingly few interdisciplinary treatments available, and mostly available only for inpatients. In order to provide an interdisciplinary treatment, we developed a day care concept in which each patient was treated by an ENT doctor, a cognitive behavioral therapist, a specialist for medical rehabilitation and an audiologist (Jena Interdisciplinary Treatment for Tinnitus, JITT). The aim of this study was to observe the changes of tinnitus related distress due to interdisciplinary day care treatment and to determine which factors mediate this change. Subjects and Methods: Tinnitus annoyance was measured using the Tinnitus Questionnaire on 308 patients with chronic tinnitus. They were treated in the day care unit over five consecutive days between July 2013 and December 2014. Data were collected before treatment when screened (T0), at the beginning (T1) and at the end of the 5 day treatment (T2), as well as 20 days (T3) and 6 months after treatment (T4). Results: Overall, tinnitus annoyance improved significantly from the screening day to the beginning of treatment, and to a much larger degree from the beginning to the end of treatment. The treatment outcome remained stable 6 months after treatment. Patients with the following symptoms displayed higher tinnitus annoyance at T0: dizziness at tinnitus onset, tinnitus sound could not be masked with background noise, tinnitus worsening during physical stress, comorbid psychiatric diagnosis, higher age and higher hearing loss. Loudness of tinnitus perceived in the right ear correlated with tinnitus annoyance significantly. Demographic, tinnitus and strain variables could only explain 12.8% of the variance of the change in tinnitus annoyance from T0 to T4. Out of 39 predictors, the only significant ones were "sick leave 6 months before treatment" and "tinnitus annoyance at T0." Conclusion: The newly developed JITT represents a valuable treatment for chronic tinnitus patients with improvement remaining stable for at least 6 months after treatment. Using a large number of variables did not allow predicting treatment outcome which underlines the heterogeneity of tinnitus.