RP306 - Tinnitus Where? The Role of Perceived Location in the Mechanisms and Management of Tinnitus

Abstract:
The spatial localization of tinnitus, where it is heard, is critical for how tinnitus is separated from other ongoing neural activity. Tinnitus location may be essential for unlocking a sound’s full potential as a therapeutic. The literature indicates that: a tinnitus neural network influenced by the perceived location of tinnitus exists, and that spatial tinnitus masking, game-based auditory training, and multisensory and virtual environments can harness spatial cues to improve tinnitus treatment.  It is concluded that where tinnitus is heard may be equally, if not more, important in tinnitus management than other characteristics such as tinnitus pitch and loudness.

Summary:

Objective:
Critical to our understanding of tinnitus is how it is separated from other ongoing neural activity. The localization, “where”, of auditory events is an essential component of this process. Understanding binaural integration or separation of tinnitus from sound may enable manipulation of the neurophysiology of tinnitus in multiple ways.

Design: A scoping review was undertaken to determine the role of the perceived spatial location of tinnitus on neurophysiology and how this can be manipulated to reduce its perception. 

Results: A tinnitus localization network has been proposed to consist of the auditory cortex, angular gyrus, parahippocampal area, and superior premotor cortex. Several studies have demonstrated that sound localization is impaired in persons with tinnitus, indicative of disruption of attention or neural mechanisms responsible for localization.  The use of an external sound in 3D space to match to perceived tinnitus location has enabled the development of novel tinnitus informational maskers and game-based auditory training paradigms.  Studies using spatially localized avatars for virtual reality cognitive behavioral therapy and multisensory auditory training of tinnitus have demonstrated therapeutic promise. Providing an accurate representation of tinnitus in space may also serve to move tinnitus perception towards that of the normal sound, making tinnitus more “real”.

Conclusion:
The perception of where tinnitus is located may be equally, if not more, important in tinnitus management than other tinnitus characteristics such as pitch and loudness.