Cortical reorganization in recent-onset tinnitus patients by the Heidelberg Model of Music Therapy.
Pathophysiology and treatment of tinnitus still are fields of intensive research. The neuroscientifically motivated Heidelberg Model of Music Therapy, previously developed by the German Center for Music Therapy Research, Heidelberg, Germany, was applied to explore its effects on individual distress and on brain structures. This therapy is a compact and fast application of nine consecutive 50-min sessions of individualized therapy implemented over 1 week. Clinical improvement and long-term effects over several years have previously been published. However, the underlying neural basis of the therapy's success has not yet been explored. In the current study, the therapy was applied to acute tinnitus patients (TG) and healthy active controls (AC). Non-treated patients were also included as passive controls (PTC). As predicted, the therapeutic intervention led to a significant decrease of tinnitus-related distress in TG compared to PTC. Before and after the study week, high-resolution MRT scans were obtained for each subject. Assessment by repeated measures design for several groups (Two-Way ANOVA) revealed structural gray matter (GM) increase in TG compared to PTC, comprising clusters in precuneus, medial superior frontal areas, and in the auditory cortex. This pattern was further applied as mask for general GM changes as induced by the therapy week. The therapy-like procedure in AC also elicited similar GM increases in precuneus and frontal regions. Comparison between structural effects in TG vs. AC was calculated within the mask for general GM changes to obtain specific effects in tinnitus patients, yielding GM increase in right Heschl's gyrus, right Rolandic operculum, and medial superior frontal regions. In line with recent findings on the crucial role of the auditory cortex in maintaining tinnitus-related distress, a causative relation between the therapy-related GM alterations in auditory areas and the long-lasting therapy effects can be assumed.
Department for Neuroradiology, Saarland University Hospital Homburg, Germany.
Christoph M
CM
Krick
German Center for Music Therapy Research (Victor Dulger Institute) DZM Heidelberg, Germany.
Miriam
M
Grapp
Department for Neuroradiology, Saarland University Hospital Homburg, Germany.
Jonas
J
Daneshvar-Talebi
Department for Neuroradiology, Saarland University Hospital Homburg, Germany.
Wolfgang
W
Reith
Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital for Ear, Nose, and Throat, University of Heidelberg Heidelberg, Germany.
Peter K
PK
Plinkert
Music Therapy Tinnitus Outpatient Department, German Center for Music Therapy Research (Victor Dulger Institute) DZM Heidelberg, Germany.
Hans Volker
HV
Bolay
Heidelberg Model of Music Therapy; MRI; auditory cortex; brain plasticity; cerebral reorganization; gray matter; tinnitus; voxel-based morphometry (VBM)