title: The neuropsychiatry of tinnitus: a circuit-based approach to the causes and treatments available.
abstract: Patients presenting with tinnitus commonly have neuropsychiatric symptoms with which physicians need to be familiar. We provide an overview of tinnitus, including its types and pathophysiology. We discuss how recent methods such as transcranial magnetic stimulation, positron emission tomography, MRI, magnetoencephalography and quantitative EEG improve our understanding of the pathophysiology of tinnitus and connect tinnitus to the neuropsychiatric symptoms. We then explain why treatment of the tinnitus patient falls within the purview of neuropsychiatry. Psychiatric problems such as depression, anxiety and personality disorders are discussed. We also discuss how stress, headache, cognitive processing speed and sleep disturbance are associated with tinnitus. Finally, we provide a brief overview of treatment options and discuss the efficacy of various medications, including benzodiazepines, antidepressants, antipsychotics and mood-stabilising agents, and various non-pharmacological treatment options, such as cognitive behavioural therapy, habituation therapy and acupuncture. We also discuss how brain stimulation therapies are being developed for the treatment of tinnitus. In conclusion, a review of the literature demonstrates the varied neuropsychiatric manifestations of tinnitus. Imaging studies help to explain the mechanism of the association. However, more research is needed to elucidate the neurocircuitry underlying the association.
authors.affiliation: Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Mia T
authors.initials: MT
authors.lastname: Minen
authors.affiliation: Harvard Medical School, Boston, Massachusetts, USA Departments of Neurology and Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Joan
authors.initials: J
authors.lastname: Camprodon
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Romy
authors.initials: R
authors.lastname: Nehme
authors.affiliation: Harvard Medical School, Boston, Massachusetts, USA Departments of Neurology and Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA Massachusetts Eye Ear Infirmary, Boston, Massachusetts, USA.
authors.forename: Zeina
authors.initials: Z
authors.lastname: Chemali
mesh_terms: D001306:Auditory Pathways / Q000503:physiopathology*; D001521:Behavior Therapy; D001921:Brain / Q000503:physiopathology*; D006801:Humans; D001523:Mental Disorders / Q000150:complications; D008959:Models, Neurological; D059906:Neuroimaging; D011619:Psychotropic Drugs / Q000627:therapeutic use; D014012:Tinnitus / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy; D050781:Transcranial Magnetic Stimulation
chemical_list: D011619:Psychotropic Drugs
keywords: Behavioural Disorder; Cognition; Neurootology; Neuropsychiatry; Neuroradiology