Functional MRI outperforms CBT, seems promising for treatment of chronic severe tinnitus: Study

The researchers found a greater reduction in tinnitus distress with real-time fMRI neurofeedback therapy than the current standard treatment of CBT.

Chronic tinnitus is common, but no evidence-based universal cure exists, and currently available therapeutic options are of inconsistent benefit or limited efficacy.

Cognitive behavioural therapy is the current standard treatment for the condition, intending to reduce distress and debilitating impact caused by tinnitus by having patients focus on "realistic and positive thoughts," but it doesn't address tinnitus' "auditory percept" – that is, what previous research has indicated is excessive activation in the auditory cortex. Preliminary evidence has suggested that real-time functional MRI neurofeedback therapy may be more effective.

Against the above background, Nicolas Gninenko, PhD, of École Polytechnique Fédérale de Lausanne in Switzerland, and colleagues aimed to compare the efficacy of real-time fMRI neurofeedback against CBT for reducing chronic tinnitus distress.

The prospective controlled trial included 43 individuals with chronic severe tinnitus. They were randomized between 2017 to 2021 to receive either CBT for 10 weekly group sessions (22 participants) or individual real-time fMRI neurofeedback for 15 weekly sessions (21 participants).

The team assessed changes in the Tinnitus Handicap Inventory (THI) score (range, 0–100) from baseline to 6 or 12 months. Secondary outcomes were patient responses to four quality-of-life questionnaires (Pittsburgh Sleep Quality Index, Beck Depression Inventory, State-Trait Anxiety Inventory, and World Health Organization Disability Assessment Schedule).

The study led to the following findings:

• The fMRI group showed a greater reduction in THI scores compared with the CBT group at both six months (mean score change, −28.21 points ± 18.66 vs −12.09 points ± 18.86) and 12 months (mean score change, −30 points ± 25.44 vs −4 points ± 17.2).
• Compared with baseline, the fMRI group showed improved sleep (mean score, 8.62 points ± 4.59 vs 7.25 points ± 3.61) and trait anxiety (mean score, 44 points ± 11.5 vs 39.84 points ± 10.5) at 1 month and improved depression (mean score, 13.71 points ± 9.27 vs 6.53 points ± 5.17) and general functioning (mean score, 24.91 points ± 17.05 vs 13.06 points ± 10.1) at six months.
• No difference in these metrics over time was observed for the CBT group.

The findings showed that patients with severe chronic tinnitus who underwent real-time functional MRI neurofeedback therapy showed decreased tinnitus burden 6 months after the intervention compared with patients who received group cognitive behavioural therapy.

According to the authors, the results are encouraging, but more research is needed.

"Despite the promising study results, fMRI neurofeedback is limited by its technical complexity and associated costs," they concluded.

"However, given the absence of efficient therapeutic options today and significant morbidity of severe chronic tinnitus, there may be a place for fMRI neurofeedback therapy for highly affected patients."

Reference:

Gninenko N, Trznadel S, Daskalou D, Gramatica L, Vanoy J, Voruz F, Robyn CL, Spadazzi A, Yulzari A, Sitaram R, Van De Ville D, Senn P, Haller S. Functional MRI Neurofeedback Outperforms Cognitive Behavioral Therapy for Reducing Tinnitus Distress: A Prospective Randomized Clinical Trial. Radiology. 2024 Feb;310(2):e231143. doi: 10.1148/radiol.231143. PMID: 38349241.