A Scoping Review of the Role of Attention in Tinnitus Management

Abstract

There is strong evidence that attention plays an important role in tinnitus perception, but less is known about its role in treating tinnitus. This review scoped the literature for evidence of the role attention plays in tinnitus therapy and catalogued the methods employed, clinical outcomes, and the degree to which interventions for tinnitus were supported. The research question was “what role does attention play in the management or treatment of tinnitus.” To identify relevant studies, database searches of Scopus (keywords) PsychArticle (title and abstract), CINAHL complete (title and abstract), and PubMed (title and abstract) were performed in March/April 2024 using the following search terms: [tinnitus] and [attention] and [treatment] or [therapy] or [management]. After the removal of duplicates, 494 articles were identified. After exclusions, and additions from references, 38 articles were included in the review. Treatments were classified into five types: electrical/magnetic stimulation, psychological, sound therapy, music therapy, and perceptual training. Sound therapy and perceptual training were identified as having the most evidence for their benefit via an attention mechanism. A model of sound and perceptual training in alleviating tinnitus through an attention pathway is presented.

Keywords

tinnitus - attention - therapy - treatment - management

Authors' Contributions

G.D.S. undertook all literature searching, initial thematic allocation and draft writing, and editing. P.J.S. and A.B. contributed equally, reviewing thematic allocation and editing the manuscript.

Publication History

Article published online:
06 March 2025

• References

• 1 De Ridder D, Schlee W, Vanneste S. et al. Tinnitus and tinnitus disorder: theoretical and operational definitions (an international multidisciplinary proposal). Prog Brain Res 2021; 260: 1-25
• 2 Gudwani S, Munjal SK, Panda NK, Kohli A. Association of chronic subjective tinnitus with neuro- cognitive performance. Int Tinnitus J 2017; 21 (02) 90-97
• 3 Jacobson GP, Calder JA, Newman CW, Peterson EL, Wharton JA, Ahmad BK. Electrophysiological indices of selective auditory attention in subjects with and without tinnitus. Hear Res 1996; 97 (1–2): 66-74
• 4 Stevens C, Walker G, Boyer M, Gallagher M. Severe tinnitus and its effect on selective and divided attention. Int J Audiol 2007; 46 (05) 208-216
• 5 Singh D. An Assessment of Attention in Tinnitus Patients: A Selective Attention Paradigm. Auckland, New Zealand: The University of Auckland; 2006
• 6 Matsushima JI, Sakai N, Kumagai M. et al. Improved selective attention and word perception in tinnitus patients treated with electrical stimulation. Int Tinnitus J 1996; 2 (02) 115-122
• 7 Busse M, Low YF, Corona-Strauss FI, Delb W, Strauss DJ. . Neurofeedback by Neural Correlates of Auditory Selective Attention as Possible Application for Tinnitus Therapies. 30th Annual International IEEE EMBS Conference; August 20–24, 2008 ; Vancouver, British Columbia, Canada 2008;5136–5139
• 8 Knobel KAB, Sanchez TG. Influence of silence and attention on tinnitus perception. Otolaryngol Head Neck Surg 2008; 138 (01) 18-22
• 9 Attias J, Furman V, Shemesh Z, Bresloff I. Impaired brain processing in noise-induced tinnitus patients as measured by auditory and visual event-related potentials. Ear Hear 1996; 17 (04) 327-333
• 10 Kaltenbach JA. The dorsal cochlear nucleus as a participant in the auditory, attentional and emotional components of tinnitus. Hear Res 2006; 216-217: 224-234
• 11 Manchaiah V, Londero A, Deshpande AK. et al. Online discussions about tinnitus: What can we learn from natural language processing of reddit posts?. Am J Audiol 2022; 31 (3S): 993-1002
• 12 Heeren A, Maurage P, Perrot H. et al. Tinnitus specifically alters the top-down executive control sub-component of attention: evidence from the Attention Network Task. Behav Brain Res 2014; 269: 147-154
• 13 Jastreboff PJ. Phantom auditory perception (tinnitus): mechanisms of generation and perception. Neurosci Res 1990; 8 (04) 221-254
• 14 Kaltenbach JA. The dorsal cochlear nucleus as a contributor to tinnitus: mechanisms underlying the induction of hyperactivity. In: Langguth B, Hajak G, Kleinjung T, Cacace A, Møller AR. eds Progress in Brain Research. 166. Amsterdam, The Netherlands: Elsevier, (B. V.); 2007: 89-106
• 15 Searchfield GD, Kobayashi K, Sanders M. An adaptation level theory of tinnitus audibility. Front Syst Neurosci 2012; 6: 46
• 16 Lima DO, Araújo AMGD, Branco-Barreiro FCA, Carneiro CDS, Almeida LNA, Rosa MRDD. Auditory attention in individuals with tinnitus. Braz J Otorhinolaryngol 2020; 86 (04) 461-467
• 17 Tegg-Quinn S, Bennett RJ, Eikelboom RH, Baguley DM. The impact of tinnitus upon cognition in adults: a systematic review. Int J Audiol 2016; 55 (10) 533-540
• 18 Du H, Feng X, Qian X. et al. Recent-onset and persistent tinnitus: uncovering the differences in brain activities using resting-state functional magnetic resonance imaging technologies. Front Neurosci 2022; 16: 976095
• 19 Newman CW, Wharton JA, Jacobson GP. Self-focused and somatic attention in patients with tinnitus. J Am Acad Audiol 1997; 8 (03) 143-149
• 20 Brozoski T, Wisner K, Randall M, Caspary D. Chronic sound-induced tinnitus and auditory attention in animals. Neuroscience 2019; 407: 200-212
• 21 Lockwood AH, Salvi RJ, Coad ML, Towsley ML, Wack DS, Murphy BW. The functional neuroanatomy of tinnitus: evidence for limbic system links and neural plasticity. Neurology 1998; 50 (01) 114-120
• 22 Mirz F, Pedersen B, Ishizu K. et al. Positron emission tomography of cortical centers of tinnitus. Hear Res 1999; 134 (1–2): 133-144
• 23 Schmidt SA, Carpenter-Thompson J, Husain FT. Connectivity of precuneus to the default mode and dorsal attention networks: a possible invariant marker of long-term tinnitus. Neuroimage Clin 2017; 16: 196-204
• 24 Burton H, Wineland A, Bhattacharya M, Nicklaus J, Garcia KS, Piccirillo JF. Altered networks in bothersome tinnitus: a functional connectivity study. BMC Neurosci 2012; 13: 3
• 25 Vossel S, Geng JJ, Fink GR. Dorsal and ventral attention systems: distinct neural circuits but collaborative roles. Neuroscientist 2014; 20 (02) 150-159
• 26 Husain FT, Pajor NM, Smith JF. et al. Discrimination task reveals differences in neural bases of tinnitus and hearing impairment. PLoS One 2011; 6 (10) e26639
• 27 Trevis KJ, Tailby C, Grayden DB, McLachlan NM, Jackson GD, Wilson SJ. Identification of a neurocognitive mechanism underpinning awareness of chronic tinnitus. Sci Rep 2017; 7 (01) 15220
• 28 Marks E, Smith P, McKenna L. Living with tinnitus and the health care journey: an interpretative phenomenological analysis. Br J Health Psychol 2019; 24 (02) 250-264
• 29 Thompson DM, Hall DA, Walker DM, Hoare DJ. Psychological therapy for people with tinnitus: a scoping review of treatment components. Ear Hear 2017; 38 (02) 149-158
• 30 Henry JA. Directed attention and habituation: two concepts critical to tinnitus management. Am J Audiol 2023; 32 (02) 274-281
• 31 Hoare DJ, Kowalkowski VL, Hall DA. Effects of frequency discrimination training on tinnitus: results from two randomised controlled trials. J Assoc Res Otolaryngol 2012; 13 (04) 543-559
• 32 Arefi HN, Jarollahi F, Mohsen SM, Jalaie S. The role of attention modulation and its neurophysiological mechanisms in tinnitus management: a review. Auditory and Vestibular Research 2024
• 33 Fu D, Weber C, Yang G. et al. What can computational models learn from human selective attention? A review from an audiovisual unimodal and crossmodal perspective. Front Integr Nuerosci 2020; 14: 10
• 34 Price CN, Moncrieff D. Defining the role of attention in hierarchical auditory processing. Audiology Res 2021; 11 (01) 112-128
• 35 Shinn-Cunningham BG. Object-based auditory and visual attention. Trends Cogn Sci 2008; 12 (05) 182-186
• 36 Arksey H, O'Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol 2005; 8 (01) 19-32
• 37 Richter GT, Mennemeier M, Bartel T. et al. Repetitive transcranial magnetic stimulation for tinnitus: a case study. Laryngoscope 2006; 116 (10) 1867-1872
• 38 Seydel C, Haupt H, Szczepek AJ, Klapp BF, Mazurek B. Long-term improvement in tinnitus after modified tinnitus retraining therapy enhanced by a variety of psychological approaches. Audiol Neurootol 2010; 15 (02) 69-80
• 39 James GA, Thostenson JD, Brown G. et al. Neural activity during attentional conflict predicts reduction in tinnitus perception following rTMS. Brain Stimul 2017; 10 (05) 934-943
• 40 Smith JA, Mennemeier M, Bartel T. et al. Repetitive transcranial magnetic stimulation for tinnitus: a pilot study. Laryngoscope 2007; 117 (03) 529-534
• 41 Busse M, Low YF, Corona-Strauss FI, Delb W, Strauss DJ. , Eds. Neurofeedback by neural correlates of auditory selective attention as possible application for tinnitus therapies. Proceedings of the 30th Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBS'08 - “Personalized Healthcare through Technology”; 2008
• 42 Henry JL, Wilson PH. The psychological management of tinnitus: comparison of a combined cognitive educational program, education alone and a waiting-list control. Int Tinnitus J 1996; 2: 9-20
• 43 Kallogjeri D, Piccirillo JF, Spitznagel Jr E. et al. Cognitive training for adults with bothersome tinnitus: a randomized clinical trial. JAMA Otolaryngol Head Neck Surg 2017; 143 (05) 443-451
• 44 Roland LT, Lenze EJ, Hardin FM. et al. Effects of mindfulness based stress reduction therapy on subjective bother and neural connectivity in chronic tinnitus. Otolaryngol Head Neck Surg 2015; 152 (05) 919-926
• 45 Schecklmann M, Weber FC, Lehner A, Langguth B, Schoisswohl S. Cognitive behavioral group therapy for chronic tinnitus in a German tertiary clinical real-world setting. Int J Environ Res Public Health 2023; 20 (06) 4982
• 46 Walter U, Pennig S, Kottmann T, Bleckmann L, Röschmann-Doose K, Schlee W. Randomized controlled trial of a smartphone-based cognitive behavioral therapy for chronic tinnitus. PLOS Digit Health 2023; 2 (09) e0000337
• 47 Zimmerman B, Finnegan M, Paul S. et al. Functional brain changes during mindfulness-based cognitive therapy associated with tinnitus severity. Front Neurosci 2019; 13: 747
• 48 McKenna L, Marks EM, Vogt F. Mindfulness-based cognitive therapy for chronic tinnitus: evaluation of benefits in a large sample of patients attending a tinnitus clinic. Ear Hear 2018; 39 (02) 359-366
• 49 Alonso-Valerdi LM, Ibarra-Zárate DI, Torres-Torres AS, Zolezzi DM, Naal-Ruiz NE, Argüello-García J. Comparative analysis of acoustic therapies for tinnitus treatment based on auditory event-related potentials. Front Neurosci 2023; 17: 1059096
• 50 Chen Q, Lv H, Wang Z. et al. Pretreatment intranetwork connectivity can predict the outcomes in idiopathic tinnitus patients treated with sound therapy. Hum Brain Mapp 2021; 42 (14) 4762-4776
• 51 Chen Q, Lv H, Wang Z. et al. Brain structural and functional reorganization in tinnitus patients without hearing loss after sound therapy: a preliminary longitudinal study. Front Neurosci 2021; 15: 573858
• 52 Durai M, Doborjeh Z, Sanders PJ, Vajsakovic D, Wendt A, Searchfield GD. Behavioral outcomes and neural network modeling of a novel, putative, recategorization sound therapy. Brain Sci 2021; 11 (05) 554
• 53 Durai M, Searchfield GD. A mixed-methods trial of broad band noise and nature sounds for tinnitus therapy: group and individual responses modeled under the adaptation level theory of tinnitus. Front Aging Neurosci 2017; 9: 44
• 54 Hesser H, Pereswetoff-Morath CE, Andersson G. Consequences of controlling background sounds: the effect of experiential avoidance on tinnitus interference. Rehabil Psychol 2009; 54 (04) 381-389
• 55 Joergensen ML, Hyvärinen P, Caporali S, Dau T. The short and long-term effect of sound therapy on visual attention in chronic tinnitus patients. Audiology Res 2022; 12 (05) 493-507
• 56 Lv H, Liu C, Wang Z. et al. Altered functional connectivity of the thalamus in tinnitus patients is correlated with symptom alleviation after sound therapy. Brain Imaging Behav 2020; 14 (06) 2668-2678
• 57 Lv H, Liu J, Chen Q. et al. Brain effective connectivity analysis facilitates the treatment outcome expectation of sound therapy in patients with tinnitus. IEEE Trans Neural Syst Rehabil Eng 2023; PP;
• 58 Simonetti P, Ono CR, Godoi Carneiro C. et al. Evaluating the efficacy of hearing aids for tinnitus therapy - a Positron emission tomography study. Brain Res 2022; 1775: 147728
• 59 Simonetti P, Vasconcelos LG, Oiticica J. Effect of fractal tones on the improvement of tinnitus handicap inventory functional scores among chronic tinnitus patients: an open-label pilot study. Int Arch Otorhinolaryngol 2018; 22 (04) 387-394
• 60 Boecking B, Rausch L, Psatha S. et al. Hearing therapy improves tinnitus-related distress in mildly distressed patients with chronic tinnitus and mild-to-moderate hearing loss: a randomized-controlled cross-over design. J Clin Med 2022; 11 (07) 1764
• 61 Krick CM, Argstatter H, Grapp M, Plinkert PK, Reith W. Heidelberg neuro-music therapy restores attention-related activity in the angular gyrus in chronic tinnitus patients. Front Neurosci 2017; 11 (JUL): 418
• 62 Low YF, Argstatter H, Bolay HV, Strauss DJ. Evaluation of a compact tinnitus therapy by electrophysiological tinnitus decompensation measures. Annu Int Conf IEEE Eng Med Biol Soc 2008; 2008: 5132-5135
• 63 Rodríguez-León IG, Alonso-Valerdi LM, Salido-Ruiz RA, Román-Godínez I, Ibarra-Zarate DI, Torres-Ramos S. Effect of auditory discrimination therapy on attentional processes of tinnitus patients. Sensors (Basel) 2022; 22 (03) 937
• 64 Searchfield GD, Morrison-Low J, Wise K. Object identification and attention training for treating tinnitus. Prog Brain Res 2007; 166: 441-460
• 65 Wise K, Kobayashi K, Searchfield GD. Feasibility study of a game integrating assessment and therapy of tinnitus. J Neurosci Methods 2015; 249: 1-7
• 66 Spiegel DP, Linford T, Thompson B. et al. Multisensory attention training for treatment of tinnitus. Sci Rep 2015; 5: 10802
• 67 Emadi M, Moossavi A, Akbari M, Jalaie S, Toufan R, Testing A. Testing a hypothesis: tinnitus control by enhancing physiological inhibition. Indian J Otolaryngol Head Neck Surg 2022; 74 (Suppl. 03) 4212-4217
• 68 Wise K, Kobayashi K, Magnusson J, Welch D, Searchfield GD. Randomized controlled trial of a perceptual training game for tinnitus therapy. Games Health J 2016; 5 (02) 141-149
• 69 Makar SK. Tinnitus treatment: an experimental study. Egypt J Otolaryngol 2024; 40 (01) 38
• 70 Searchfield GD, Spiegel DP, Poppe TNER. et al. A proof-of-concept study comparing tinnitus and neural connectivity changes following multisensory perceptual training with and without a low-dose of fluoxetine. Int J Neurosci 2021; 131 (05) 433-444
• 71 Hoare DJ, Van Labeke N, McCormack A. et al. Gameplay as a source of intrinsic motivation in a randomized controlled trial of auditory training for tinnitus. PLoS One 2014; 9 (09) e107430
• 72 Rodenbough J. . Comprehensive Attention Battery. User and Technical Manual. Version 5.0. Neuropsych Works. Inc; 2003
• 73 Leaver AM, Chen YJ, Parrish TB. Focal tDCS of auditory cortex in chronic tinnitus: A randomized controlled mechanistic trial. Clin Neurophysiol 2024; 158: 79-91
• 74 Burton-Harris LJ, Sanders PJ, Searchfield GD. An implementation science systematic review of neurophysiological evidence indicates the tinnitus core network as a therapeutic target. Front Audiol Otol 2023; 1: 1311186