1. Applications of
auditory training
in tinnitus
Prof Deb Hall

2. Some basic facts
‘Ringing’ or ‘whistling’ in the ears
7% of the UK adult population have consulted
their doctor about tinnitus
2.5% have sought specialist advice from an
otologist with regard to tinnitus
National Study of Hearing (Davis, 1995)

3. The tinnitus triangle
Perceptual
characteristics
Pitch and
loudness
Psychological Individual
reactions personality
Cognitive and ‘Susceptibility’
emotional characteristics
responses

4. Management goals
Perceptual Mask the
Habituate
characteristics percept
to the
percept
Pitch and
loudness
Change
reaction Psychological Individual
to the reactions personality
percept
Cognitions and ‘Susceptibility’
emotional characteristics
response

5. New management goal
Can
treatment Perceptual
change characteristics
the
percept Pitch and
itself? loudness
Psychological Individual
reactions personality
Cognitions and ‘Susceptibility’
emotional characteristics
response

6. A neurophysiological mechanism for
tinnitus ?
Chronic tinnitus can result from a maladaptive
response to deafness
Deprivation is known to alter the balance of
neural activity in the central auditory pathway
Over-representation
of the frequency at
the edge of the
high-frequency
hearing loss
Eggermont, Roberts, 2004. TINs 28(6):676-682

7. A neurophysiological mechanism for
treatment ?
“The over-representation of the lesion-edge in
patients with sensorineural hearing loss may be
the representation of tinnitus”
“In patients with hearing loss, an enriched
acoustic environment can minimise or reverse
the cortical reorganisation changes secondary
to hearing impairment.”
Herraiz et al. 2009. Eur Arch Otorhinolaryngol 266:9-16

8. Auditory training expands the topographic
representation of the stimulus
naïve
8 kHz
2.5 kHz
trained
Stimulus and training task
2.5 kHz frequency discrimination
using tones roved in level over a
12 dB range
Duration
Several weeks
Recanzone, Schreiner & Merzenich 1993. J Neuroscience 13(1):87-103

9. Auditory training reduces receptive fields
for neurons tuned to the stimulus
40 dB above threshold
trained
naïve
10 dB above threshold
Q10 dB Q40 dB
Q value = center frequency / bandwidth of the tuning
curve 10/40 dB above threshold
Recanzone, Schreiner & Merzenich 1993. J Neuroscience 13(1):87-103

10. Benefit of auditory training associated with
cortical expansion
Frequency discrimination performance correlated
with topographic expansion, not change in
receptive field
Some form of temporal code might provide
additional information to support frequency
discrimination
Recanzone, Schreiner & Merzenich 1993. J Neuroscience 13(1):87-103

11. A neurophysiological mechanism for
treatment ?
“The over-representation of the lesion-edge in
patients with sensorineural hearing loss may be
the representation of tinnitus”
“In patients with hearing loss, an enriched
acoustic environment can minimise or reverse
the cortical reorganisation changes secondary
to hearing impairment.”
“We can consider that auditory rehabilitation
can have some positive effect on tinnitus
management”
Herraiz et al. 2009. Eur Arch Otorhinolaryngol 266:9-16

12. Principles of auditory training
Training can ‘retune’ the receptive properties of
neurons within the tinnitus-generating network
and allocate them to a network supporting the
representation of the trained frequency
Training is expected to expand the topographic
representation of the trained frequencies (and
shrink the representation of the neighbouring
cortical zones)
Herraiz et al. 2009. Eur Arch Otorhinolaryngol 266:9-16

13. Preliminary training study
10=unbearable
10=unbearable
1
1 4
4
0=none
0=none
close to far from weeks
TI pitch TI pitch
Flor et al., 2004. Applied Psychophysiology& Biofeedback 29(2): 113-120

14. General discussion
What hurdles would have to be overcome to
translate this form of intervention into the
clinical setting?
Credability of the rationale for applying auditory
rehabilitation methods in tinnitus
What is the necessary evidence base for its efficacy?
How might this form of treatment be received by
clinicians?
How acceptable might it be with patients?