RP210 - Resonating Echoes: Tinnitus and fMRI Findings in Veterans and Service Members with and without PTSD

Thursday, April 18, 2024

4:00 PM – 4:30 PM EST

Location: A402-403

Earn 0.05 CEUs

Instructional Level: Intermediate

Lead Presenter(s)

Quintin Hecht, AuD

Research Audiologist
Hearing Center of Excellence, Defense Health Agency
Cibolo, Texas

Disclosure(s): No financial or nonfinancial relationships to disclose.

PDF Slides

Contributor(s)

JM

John Moring, PhD, PhD

Assistant Professor
The University of Texas Health Science Center at San Antonio
The University of Texas Health Science Center at San Antonio
San Antonio, Texas

Disclosure(s): No financial or nonfinancial relationships to disclose.
AF

Andrew Fallon, AuD

Disclosure(s): No financial or nonfinancial relationships to disclose.
SL

Suheily Lovelace

Disclosure(s): No financial or nonfinancial relationships to disclose.
FH

Fatima Husain, PhD

Disclosure(s): No financial or nonfinancial relationships to disclose.
CE

Carlos Esquivel, MD

Disclosure(s): No financial or nonfinancial relationships to disclose.
SY

Stacey Young-McCaughan, PhD

Disclosure(s): No financial or nonfinancial relationships to disclose.
PF

Peter Fox, MD

Disclosure(s): No financial or nonfinancial relationships to disclose.
CF

Crystal Franklin, MS

Disclosure(s): No financial or nonfinancial relationships to disclose.
AF

Amanda Flores

Disclosure(s): No financial or nonfinancial relationships to disclose.
Alan L. Peterson, PhD, PhD

Professor
University of Texas Health Science Center at San Antonio
University of Texas Health Science Center at San Antonio, Texas

Disclosure(s): No financial or nonfinancial relationships to disclose.

Abstract: Tinnitus and posttraumatic stress disorder (PTSD) remain highly prevalent among U.S. military service members and veterans. The literature describes these two conditions as highly comorbid with an array of overlapping symptoms. The goal of this study is to characterize tinnitus symptomatically, audiologically, and neurobiologically in participants with tinnitus only and in those with both tinnitus and PTSD. We administered questionnaires, comprehensive audiologic evaluations, tinnitus assessments, and resting-state functional magnetic resonance imaging (rs-fMRI) to study participants. This presentation will discuss the study’s background, methodology, and preliminary findings among participants with tinnitus only and among those with both tinnitus and PTSD.

Summary:

Introduction: Tinnitus and posttraumatic stress disorder (PTSD) are reported respectively as the first and fourth most prevalent service-connected disabilities by the Veterans Benefits Administration (VBA, 2022). The literature describes these two conditions as highly comorbid, presenting with an array of overlapping symptoms such as difficulty sleeping, concentration issues, avoidance, and irritability. Vanasse et al. (2019) found the auditory system to be the most implicated brain network among individuals with combat-related PTSD, while previous neuroimaging studies have indicated the role of the auditory system in tinnitus (De Ridder et al., 2014; Hussain, 2016; Lv et al., 2017). Individuals with both tinnitus and PTSD have demonstrated worse functional outcomes compared to those with tinnitus only (Fagelson & Smith, 2016). Unfortunately, trauma-focused therapy has been unsuccessful in treating many of these individuals, underscoring the need to better understand the underlying mechanisms and develop new treatments. This presentation aims to characterize tinnitus symptomatically, audiologically, and neurobiologically.

Methods: This is a prospective, non-randomized, observational study. Participants were screened to determine group assignment: Healthy Controls (HC), Tinnitus Only (TO), PTSD Only (PO), Tinnitus and PTSD (T&P). Tympanometry, otoacoustic emissions, pure-tone and speech audiometry, and loudness discomfort levels were completed on all participants. Participants with tinnitus completed questionnaires, pitch matching, and loudness matching measures. All participants underwent resting-state functional magnetic resonance imaging (rs- fMRI).

Results: To date, audiologic data have been collected from 42 participants, including 19 participants in the TO group and 12 participants in the T&P group. Rs-fMRI data were analyzed using Independent Components Analysis (ICA) on 8 participants from the TO group and 8 participants from the T&P group. Participants completed the Tinnitus and Hearing Healthcare History (THHH) Form, the Tinnitus Functional Index (TFI), and the Tinnitus Acceptance Questionnaire (TAQ). Descriptive, inferential, and non-inferential statistics were calculated. Wilcoxon Mann Whitney analysis was performed and Bonferroni adjustments were applied to correct for multiple comparisons. Compared to the TO group, the T&P group had significantly higher THHH tinnitus loudness and annoyance ratings (p < 0.0125). TFI scores were also significantly higher and TAQ scores significantly lower for the T&P group (vs. TO group, p < 0.0125). Rs-fMRI ICA yielded three components showing significant differences in the visual, frontoparietal, and cerebellar regions between T&P and TO groups. The T&P group demonstrated greater functional connectivity in left superior temporal gyrus and right postcentral gyrus, while the TO group demonstrated greater functional connectivity in the cerebellum.

Conclusions: Preliminary findings indicate that compared to tinnitus alone, comorbid PTSD and tinnitus results in (1) higher perceived loudness and annoyance and (2) more severe impact on quality of life and lower acceptance of tinnitus. In the T&P group, greater functional connectivity of the superior temporal gyrus in the auditory network with the somatosensory cortex may represent a combined effect specific to comorbid PTSD and tinnitus. These findings provide preliminary evidence that a different phenotype exists when tinnitus and PTSD co-occur, compared to tinnitus alone, which may help to explain sub-optimal therapeutic outcomes in those with PTSD and tinnitus.
Learning Objectives:
describe the methodology employed in this study.
describe the audiologic similarities observed among participants with tinnitus only and participants with both tinnitus and PTSD.
describe the audiologic differences observed among participants with tinnitus only and participants with both tinnitus and PTSD.