Is tinnitus an acoasm?
Section snippets
Hypothesis in brief
Tinnitus is defined as a sound in the ear(s) and/or head without external origin and is a serious health concern for millions worldwide. Although it is recommended in the literature to carefully differentiate tinnitus from unspecific auditory hallucinations (=acoasms), the disturbances caused by tinnitus as well as second rank auditory hallucinations might be etiopathogenetically more similar than it was supposed until now. The underlying pathophysiology has been localized within the
Background
Auditory hallucinations occupy, along with delusional beliefs, the centre stage of active or “positive” psychotic clinical psychopathology [1]. Auditory hallucinations comprise the most common symptoms of schizophrenia followed by visual hallucinations, and then by tactile and olfactory or gustatory hallucinations [2]. With respect to a gender specific differentiation males show more negative symptoms and cognitive deficits, with greater structural brain and neurophysiologic abnormalities,
Evaluation of the hypothesis
Tinnitus patients tend to suffer more often from psychiatric co morbidity as anxiety disorders, depression, somatoform disorders and even schizophrenia [23], [24]. It was hypothesized that co morbidity with special emphasis on mental disorders or psychopathological symptoms (such as DSM-IV diagnoses or ranking on the SCL-90R score and other psychometric scales) and a high level of dysfunctional cognitions in relation to the symptom complex of tinnitus have a negative effect on the prognosis and
Diagnostic implication of the hypothesis
In a previous hypothesis by the authors it was suggested that auditory hallucinations might be an “outcry of the brain” as a kind of counter regulation of the brain in reaction to the supposed dopamine imbalance in different brain regions, in this respect the over activation of neuronal networks could be interpreted as a kind of repair mechanism of the brain [29]. Based on this hypothesis, a MEG study was conducted that could show that the quality of hallucinations (first or second rank)
Therapeutic implications of the hypothesis
Therapeutic parallels in the treatment of tinnitus and psychiatric disorders such as anxiety, depression and schizophrenia are not completely new but mainly refer to “off-label” use of different medication regimens.
Up to now the therapeutic “gold standard” in the treatment of tinnitus focused on the use of steroids [10]. Changes and thereby new treatment options within the context of the HPA-axis dysfunction and also unspecific activation or deactivation of different cerebral regions have also
Conflict of interest
None declared.
References (41)
- et al.
Uncontrollable voices and their relationship to gating deficits in schizophrenia
Schizophr Res
(2008) - et al.
Correlation with semantic fluency and change over time in adolescent onset psychosis
Psychiatry Res
(2010) Psychological aspects of tinnitus and the application of cognitive-behavioral therapy
Clin Psychol Rev
(2002)- et al.
Changes in spontaneous neural activity immediately after an acoustic trauma: implications for neural correlates of tinnitus
Hear Res
(2003) - et al.
Relationship between tinnitus severity and psychiatric disorders
Psychosomatics
(2006) - et al.
Endophenotypes in schizophrenia: a selective review
Schizophr Res
(2009) - et al.
Differential neuropsychological patterns of frontal- and temporal-lobe dysfunction in patients with schizophrenia
Schizophr Res
(2001) - et al.
Auditory hallucinations in schizophrenia - outcry of a diseased brain?
Med Hypotheses
(2009) - et al.
Neural activity underlying tinnitus generation: results from PET and fMRI
Hear Res
(2009) - et al.
The sound of stress: blunted cortisol reactivity to psychosocial stress in tinnitus sufferers
Neurosci Lett
(2007)
The combined dexamethasone-CRH test before and after repetitive transcranial magnetic stimulation (rTMS) in major depression
Psychoneuroendocrinology
Sulpiride plus hydroxyzine decrease tinnitus perception
Auris Nasus Larynx
Deep transcranial magnetic stimulation for the treatment of auditory hallucinations: a preliminary open-label study
Ann Gen Psychiatry
First-rank symptoms as a diagnostic clue to multiple personality disorder
Am J Psychiatry
Tinnitus: models and mechanisms
Hear Res
Current perspectives on tinnitus
Arch Dis Child
’’Ringing in the ears’’: narrative review of tinnitus and its impact
Biol Res Nurs
Risk factors for tinnitus in a population of older adults: the blue mountains hearing study
Ear Hear
The functional neuroanatomy of tinnitus: evidence for limbic system links and neural plasticity
Neurology
Managing tinnitus: a comparison of different approaches to tinnitus management training
Br J Audiol
Cited by (3)
The schizoictal syndrome
2012, Medical HypothesesCitation Excerpt :The induction of seizures would be endogenous repair mechanisms against desynchronizing neuronal activity. Even in the context of psychosis there are alternating phases of desynchronization with synchronization in form of either global diminished activity or distinct psychotic symptoms [15,16,22]. There might be two different explanatory approaches within the context of an intrinsic repair model with synchronization as a compensation for primary desynchronization:
Auditory phenomena as differential diagnostics to tinnitus
2021, Laryngo- Rhino- Otologie