Tinnitus And Its Effects On Concentration

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Man sitting at a desk struggling to concentrate

Many tinnitus patients are not fully aware of the extensive impact that the condition may have on their overall well-being. The severity of tinnitus often correlates with the intensity of other symptoms, including mild cognitive impairment. So what leads tinnitus sufferers to also experience emotional distress, sleep issues, and cognitive deficits such as depression and anxiety? In this article, we’ll delve deeper into the interplay between hearing loss, tinnitus, and mild cognitive dysfunction. We’ll also highlight key research that explores the connection between moderate to severe tinnitus and cognitive health.

How Tinnitus Causes Changes In Brain Networks

Diagram of the brain's neural network

A review of studies evaluating brain morphology in chronic tinnitus patients sought to better understand the pathophysiology of the disorder. Because much is still unknown about the precise mechanism behind the development of tinnitus, there is still a lot that must be learned about what structures of the brain are involved and how the peripheral and central pathways in the nervous system interact with tinnitus symptoms. To date, the results of these studies are largely contradictory and ambiguous, and fail to shed clear light on the way the tinnitus group experiences brain function changes and changes to mental health.

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What studies can agree upon is the presence of neurological changes or abnormalities in patients with tinnitus. These findings suggest that tinnitus affects different areas of cognitive function, which may include auditory processing and general cognitive function. Chronic tinnitus can impact emotions, stress and anxiety, sleep, and concentration ability, which are all typically attributed to the involvement of the central nervous system. Neural correlates have been found through neuroimaging, which has revealed the role of brain structures within the auditory system and tinnitus. Tinnitus, then, can be linked directly to changes in the neural activity of patients with tinnitus, including central pathways associated with non auditory areas of the brain, such as the front parietal, anterior cingulate cortex, anterior insula, amygdala, hippocampus, and parahippocampal area. These areas of the brain involve awareness, attention, stress, emotion, memory, and cognition, suggesting that there are some neural correlates between brain health and tinnitus, even if they are not well understood.

To develop treatment for poor cognitive performance in tinnitus patients, more evidence based research is likely needed. Until that occurs, the best course of action is typically to address hearing loss and tinnitus.

The Consequences Of Tinnitus And Tinnitus Severity On Cognition: A Review Of The Behavioral Evidence

Man sitting down holding his head in his hand

In one review, outcomes suggested that there may be a link to impaired working memory, executive functioning, and selective attention; the evidence is quite limited, however, and it is not yet certain about whether chronic tinnitus and cognitive impairment are definitively linked. The study review determined that the claims that tinnitus interferes with sustained or alerting attention, or that tinnitus severity is directly correlated with cognitive performance were not supported. The language put forth by some studies was the source of concern with the reviews, as the term “concentration” is difficult to measure, and therefore the impact of tinnitus severity on cognitive abilities is difficult to quantify or determine. The study instead measured chronic tinnitus and its effects on memory and attention, in order to develop a clinical inference. The review did not find definitive evidence that chronic tinnitus was linked to cognitive dysfunction–at least in the areas of memory and attention.

Is It True That Tinnitus Impairs Cognitive Efficiency?

The notion of chronic tinnitus impairing cognitive efficiency is not unusual; after all, the statement is one of the conditions evaluated to determine tinnitus severity in patients. In these assessments, many tinnitus patients have suggested that their cognitive processing is impaired as a result of their tinnitus symptoms. Another study separated participants into two groups: clinical patients with tinnitus and non-clinical patients. Participants reported more cognitive failures when they had been diagnosed with tinnitus than those without symptoms.

While this may seem to be conclusive, it is far from a definitive link. One evaluation even suggested that tinnitus was associated with improved cognitive performance and improved speech perception. This study was unusual, as hearing loss has routinely been associated with reductions in cognitive processing. Nevertheless, non-hispanic elderly people in one review were found to have better cognitive performance than an age-matched control group.

Still other studies have found a correlation between tinnitus and cognitive decline, including reduced concentration and executive control, decreased processing speed, and impaired short-term memory. These are significant changes, leading many to regard the tinnitus group as being at greater risk of developing cognitive issues. Some researchers have suggested that tinnitus and hearing loss are too often conflated, leading researchers to determine that tinnitus is linked to difficulty with auditory memory and other significant differences in cognitive health because it is frequently accompanied by hearing loss, which has been shown to have a significant positive correlation with cognitive decline.

Does Tinnitus Cause Mental Exhaustion?

Stressed man holding his glasses in his hand

While tinnitus may initially seem to be an ear issue alone, hearing ringing in the ears and experiencing hearing loss had more wide-reaching effects. Interpreting and processing sounds occurs within the brain, which means that disorders of hearing, including both hearing loss and tinnitus can be related to working memory, cognitive function, and far more. MRIs in one study determined that tinnitus effects can be found within a region of the brain called the precuneus, or a connection between two networks within the brain. These networks are the dorsal attention network, which is related to attention, and the default mode network, which is related to the “background” functions of the brain when a person is at rest. Patients with chronic tinnitus were found to have a stronger connection to the dorsal attention network than the default, suggesting that patient’s brains are not able to fully experience a resting stage. This can lend some insight as to why patients with more severe tinnitus may experience concentration difficulties.

Counting Stroop Task (Selective And Executive Attention)

The Counting Stroop Task was originally designed as a functional magnetic resonance imaging (fMRI) task to help identify the different brain regions. During the counting Stroop, subjects press a button to indicate the number of words on a screen (between one and four), regardless of the meaning of the words. Tinnitus patients consistently showed slower reaction times during the Stroop task, suggesting that the tinnitus effect includes decreases in the ability to accurately or rapidly complete cognitive processes. Future studies are necessary to determine how significant these links are, and whether hearing impairment is also involved.

Tinnitus And Work Productivity

Diagram of work productivity

Tinnitus impacts as much as 10% of the population, and negatively impacts the quality of life of 2% of the population. Quality of life is decreased through the onset of anxiety and depression, insomnia, concentration difficulties, and poor psychological well-being. Studies show that work productivity and overall performance can be negatively impacted as a result of these experiences, which means that hearing impairment impacts far more than simple listening.

Expenses related to the management of tinnitus include different medical costs, including those required for visits to a specialist, medication, and medical devices. There are also indirect costs that can be racked up, such as travel expenses, recommended activity costs (think meditation apps or classes, etc.), costs for family members, and even loss of income that comes about as a result of symptoms’s impact on working ability. Tinnitus can even be the cause of work-related disability, requiring compensation payments, making it costly for employers as well as employees. One investigation into tinnitus effects found that the VA, for instance, spent 1.2 billion USD on compensation related to tinnitus for veterans.

Despite the prevalence of tinnitus among veterans and the cost of those symptoms for the VA, one study found that nearly half of respondents did not discuss their tinnitus symptoms with employers or even coworkers, out of fear that their condition would not be understood or recognized. This demonstrates some of the difficulty tinnitus patients can face when trying to receive the appropriate medical assistance and accommodations to truly address their tinnitus management efforts. Hearing loss is also frequently targeted when tinnitus is addressed.

Do Individuals With Tinnitus Have A Higher Risk Of Dementia?

Silhouette of a head made out of puzzle pieces

As previously discussed, although there are distinct links to anxiety and depression and other issues and tinnitus, the risk of dementia when tinnitus is present is far more difficult to parse through. One study evaluated early-onset dementia among tinnitus patients. Cognitive tests determined that the neuroplastic changes found within the central auditory structures were tied to tinnitus, which can be linked to cognitive impairment. That being said, that same cognitive impairment can be directly linked to hearing loss, as many studies have fairly conclusively determined. Nevertheless, the one study determined that pre-existing tinnitus was associated with an almost 70% increased risk of early-onset dementia. As a result of conclusions like these, doctors have called for greater awareness of and more intensive screening for tinnitus as a means of identifying dementia risk. Early detection and treatment of tinnitus could help reduce the likelihood of developing issues like communication disorders, depressive symptoms, and even dementia.

Why Do Researchers Think That Tinnitus May Interfere With Memory?

The role of tinnitus and hearing loss in many other issues is well defined, and one increasing area of concern is memory. It is commonly believed that tinnitus patients may experience difficulty maintaining attention and memory, but the links remain unclear. Mild cognitive impairment is defined as an intermediate decline in cognitive ability in elderly individuals, and patients with mild cognitive impairment are at greater risk of developing dementia. Hearing levels and tinnitus severity, specifically, were significant predictors of mild cognitive impairment.

The hippocampus plays an important role in tinnitus, as it is responsible for updating auditory memory and maintaining some degree of cognitive function. Hearing loss is frequently a comorbidity of tinnitus, and when tinnitus is present, auditory processing and cognitive function can be impaired. Because hearing loss is already linked to issues with memory and cognitive health, and some components of the brain share common resources with tinnitus (think attention and memory function), some have concluded that seeing significantly slower reaction times and other issues with task relevant stimuli indicates the negative impact tinnitus has on cognitive health.

Evidence Synthesis: Effects Of Tinnitus On Working Memory

One review quantified the links between tinnitus and different types of cognitive performance. Results demonstrated an association between tinnitus and poor executive function, processing speed, short-term memory, and learning and retrieval abilities. While these may not be precisely linked to dementia, they are indicators of cognitive health, suggesting that there is a significant difference between the minds of those with tinnitus and those with normal hearing and without changes to the auditory cortex. Cognitive abilities are a serious interest within tinnitus research, which includes working memory.

Tinnitus And Sustained Attention

Woman working on her laptop

Tinnitus patients reported that their ability to concentrate and sustain attention was significantly impaired by their tinnitus symptoms in one study, suggesting that having normal hearing may mean having a greater ability to sustain attention and concentrate. Because the annoyance of tinnitus interferes with cognitive capacity, there were group differences in everyday life between tinnitus patients and those with normal hearing. Another study found a positive correlation between total Tinnitus Handicap Inventory (THI) scores, Visual Analog Scale (VAS), and Sustained Auditory Attention Ability Test (SAAAT) scores, suggesting that when tinnitus impacts different areas of life as reported by a tinnitus questionnaire, sustained attention is increasingly difficult to accomplish, leading to some degree of cognitive dysfunction.

The Stop Signal Task (Response Inhibition)

The Stop Signal Task evaluates an individual’s ability to exercise cognitive control. This particular task is designed to measure response inhibition that is directly related to shifts in environmental demands. While cognitive dysfunction is frequently reported among tinnitus patients, Stop Signal Task assessments determined that tinnitus affects impulse control very little or not at all. There was no significant correlation between phantom sounds and response inhibition.

Vigilance Task (Sustained Attention)

The Vigilance Task is another evaluation tool used to evaluate attention ability. The presence of chronic tinnitus indicated a significant effect on attention, as participants demonstrated a slower reaction time during the task. Control groups consistently scored higher on attention tasks than those who reported hearing phantom sounds.

Evidence Synthesis: Cognitive Performance In Those Reporting Concentration Or Memory Difficulties

Although there are numerous studies evaluating tinnitus related cognitive impairment, and some of those studies suggested significant correlations between tinnitus and loss of cognitive function–especially relating to working memory and attention–others found no compelling evidence between tinnitus symptoms and communication disorders and other issues, instead suggesting that age related hearing loss and other hearing loss types were more likely to blame. More studies are needed to determine whether both tinnitus and hearing loss are likely to have an effect on cognitive health, or chronic tinnitus and hearing loss separately impact cognition.

The Importance Of Tinnitus Management

As the studies above indicate, tinnitus negatively impacts numerous aspects of a patient’s life. Clinical management, tinnitus treatment strategies, and lifestyle changes can all help mitigate the effects both tinnitus and hearing loss have on general and cognitive health, and increase quality of life, even when symptoms remain present.

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