Elsevier

Medical Hypotheses

Volume 77, Issue 2, August 2011, Pages 216-219
Medical Hypotheses

Is tinnitus an acoasm?

https://doi.org/10.1016/j.mehy.2011.04.016Get rights and content

Abstract

Tinnitus and unspecific auditory hallucinations generally known as acoasms arise from identical or at least similar cerebral structures. Both phenomena can be interpreted as signs of an over activation of neuronal networks. Several pieces of evidence to underline this hypothesis as well as its implications are discussed. It is even speculated that both clinical entities might profit from treatment strategies that are normally employed for treatment of the other.

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.

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