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Subjective chronic tinnitus is a prevalent auditory perception characterized by an absence of a corresponding acoustic source. It is often accompanied by hearing deficits and may lead to various psychological problems including sleep disorder, depression and anxiety. To investigate the differential neuronal profile of patients with severe and less severe chronic tinnitus, 34 tinnitus patients were distributed in two groups and their EEG resting state activity was compared. Using standardized Low Resolution Electromagnetic Tomography (sLORETA) a significant and substantial frontal increase in theta wave activity was found in the group with severe tinnitus (p = .013). The correlated severity of depression and anxiety had no influence on the electrophysiological metric. These results support a tinnitus-related global network change in which prefrontal areas are part of a network which exerts a top-down influence on the auditory cortices. The demonstrated slowing of oscillations in the responsible network may constitute a neuronal marker for the prefrontal brain network lacking the capacity to inhibit overexcitation. The magnitude of this influence is linked to the subjective strength of the tinnitus distress.

Zusammenfassung Hintergrund Die Behandlung von Ösophaguskarzinom nach geltendem Standard ist eine Operation, die nach einer neoadjuvanten Chemotherapie (nCT) oder Radiochemotherapie (nCRT) erfolgt. Für Patient*innen mit klinischer Komplettresponse auf eine nCT/nCRT kann eine aktive Überwachung mit einer Operation nur bei Bedarf eine gleichwertige Option in Bezug auf das Überleben darstellen. Fragestellung Identifikation von Faktoren, die Therapiepräferenzen, Beweggründe zur Entscheidungsfindung sowie Befürchtungen/Hoffnungen von EC-Patient*innen hinsichtlich der Wahl der beiden Behandlungsoptionen. Material und Methode Die qualitative Erhebung mit teilstrukturierten Einzelinterviews mit EC-Patient*innen und Expert*inneninterviews mit Ärzt*innen, Pflegekräften und Psychoonkolog*innen. Ergebnisse Die ärztliche Aufklärung stellt bei der Therapiepräferenz eine Entscheidungsgrundlage dar. Hierbei wird nicht nur eine empathische und kompetente Beratung, sondern auch eine konkrete Anweisung bzgl. der Therapiewahl von den behandelnden Ärzt*innen erwartet. Als ein wesentlicher Faktor für die Therapiewahl wird das Alter genannt. Vor allem erhöhtes Komplikationsrisiko während oder nach einer Operation bzw. körperliche Schwäche scheinen für Patient*innen in höherem Alter ein bedeutsamer Grund zu sein, eine Operation nach Bedarf zu bevorzugen. Die Entscheidung für oder gegen eine bestimmte Therapie orientiert sich an Lebenszeit und Lebensqualität der Patient*innen, die immer individuell und unterschiedlich interpretiert wird. Schlussfolgerungen Nach den hier vorliegenden qualitativen Daten ist die sofortige Operation die primäre Behandlungsoption bei Patient*innen mit Ösophaguskarzinom (7 von 11), dennoch sehen einige Patient*innen sehr wohl die Vorteile der alternativen Behandlungsmethode und würden eine Operation nach Bedarf bevorzugen. Die überwiegende Anzahl der Patient*innen (8 von 11) würde an einer RCT teilnehmen und betrachtet die Teilnahme als eine einmalige Chance, eine alternative Behandlungsmethode zu erhalten, eine Operation zu vermeiden und somit ihre Lebensqualität zu verbessern.

Subjective chronic tinnitus consists of a more or less continuous perception of sound in the absence of a corresponding acoustic source, which can lead to various psychological problems like depression, anxiety, attentional deficits and sleep disturbances. The prevalence is 10%-15% of the general population. Various therapy and management options have been proposed, but outcomes vary, and no generally accepted cure exists. In this review, the coherence of the most frequently used aetiological models shall be evaluated, and the efficacy of several treatment options will be discussed. With respect to tinnitus treatments, we focus on controlled studies and meta-analyses. Although there are some therapies that outweigh placebo effects such as cognitive behavioural therapy, neurofeedback or neuromodulation techniques, they mainly target secondary symptoms and not the tinnitus tone itself. Furthermore, positive treatment effects only seem to last for a limited period of time. We conclude that long-lasting combination therapies such as neurofeedback of auditory cortex inhibitory EEG signatures, cognitive therapy and sound-tactile stimulation may provide more efficient outcomes if they target the intensity of the tinnitus tone itself and not only secondary psychological symptoms.

Among embedded measures of performance validity, reaction time parameters appear to be less common. However, their potential may be underestimated. In the German-speaking countries, reaction time is often examined using the Alertness subtest of the Test of Attention Performance (TAP). Several previous studies have examined its suitability for validity assessment. The current study was conceived to examine a variety of reaction time parameters of the TAP Alertness subtest with a sample of 266 Austrian civil forensic patients. Classification results from the Word Memory Test (WMT) were used as an external indicator to distinguish between valid and invalid symptom presentations. Results demonstrated that the WMT fail group performed worse in reaction time as well as its intraindividual variation across trials when compared to the WMT pass group. Receiver operating characteristic analyses revealed areas under the curve of .775–.804. Logistic regression models indicated the parameter intraindividual variation of motor reaction time with warning sound as being the best predictor for invalid test performance. Suggested cut scores yielded a sensitivity of .62 and a specificity of .90, or .45 and .95, respectively, when the accepted false-positive rate was set lower. The results encourage the use of the Alertness subtest as an embedded measure of performance validity.

Objective Low levels of alpha activity (8-13Hz) mirror a state of enhanced responsiveness, whereas high levels of alpha are a state of reduced responsiveness. Tinnitus is accompanied by reduction of alpha activity in the perisylvian regions compared to normal hearing controls. This reduction might be a key mechanism in the chain of reactions leading to tinnitus. We devised a novel spatial filter as an on-line source monitoring method, which can be used to control alpha activity in the primary auditory cortex. In addition, we designed an innovative experimental procedure to enable suppression of visual and somatosensory alpha, facilitating auditory alpha control during alpha neurofeedback. Approach An amplitude-modulated auditory stimulation with 40 Hz modulation frequency and 1000 Hz carrier frequency specifically activates the primary auditory cortex. The topography of 40 Hz oscillation depicts the activity of the auditory cortices. We used this map as a spatial filter, which passes the activity originating from the auditory cortex. To suppress superposition of auditory alpha by somatosensory and visual alpha, we used a continuous tactile jaw-stimulation and visual stimulation protocol to suppress somatosensory alpha of regions adjacent to the auditory cortex and visual alpha for local regulation of auditory alpha activity only. Main results This novel spatial filter for online detection of auditory alpha activity and the usage of multi-sensory stimulation facilitate the appearance of alpha activity from the auditory cortex at the sensor level. Significance The proposed procedure can be used in an EEG-neurofeedback-treatment approach allowing online auditory alpha self-regulation training in patients with chronic tinnitus.