(PS4-85) Correlations of Tinnitus and PTSD in Veterans and Service Members: An Auditory and Neuroimaging Study

Abstract Text:

Introduction: Tinnitus and posttraumatic stress disorder (PTSD) are the first and sixth most common service-connected disabilities within the Veterans Benefits Administration, respectively. Those with both PTSD and tinnitus are functionally worse-off, compared to those with tinnitus and any other psychiatric condition, such as depression or anxiety. We have found significant associations among PTSD symptoms and domains of tinnitus-related distress. Neurobiologically, we have showed considerable overlap of connectivity among resting-state networks between those with both tinnitus and PTSD and those with only tinnitus, including the auditory (AUD), default mode (DMN), sensorimotor (SM), and auditory executive (AE) networks. This study aims to further investigate the unique and shared characteristics between PTSD and tinnitus at the symptom and neurobiological levels, using resting-state fMRI (rs-fMRI) as a biomarker of these disorders. We also aim to clarify whether PTSD may disrupt audiological functioning and serves to exaccerbate tinnitus-related distress.

Methods: Participants included 61 active duty military personnel and veterans with tinnitus-only (TO, n = 25), tinnitus and PTSD (T&P, n = 16), and healthy controls (HC, n = 20). All participants provided rs-fMRI scans and audiometric assessments. For those with tinnitus, individuals completed the Tinnitus Functional Index (TFI) and the Tinnitus Acceptance Questionnaire (TAQ), and visual analogue scales (VAS) of tinnitus loudness and annoyance. For those with PTSD, diagnosis was confirmed via the Clinician Administered PTSD Scale for the DSM-5 (CAPS-5).

Results: Hearing thresholds were significantly worse for those with tinnitus (TO & T+P) versus HC. The T+P group reported significantly greater functional impairment due to their tinnitus, as measured by the TFI, t(36) = 3.85, p < .001, perceived their tinnitus as more annoying, as measured by the annoyance VAS, t(39) = 3.07, p < .01, and had less acceptance of their tinnitus, as measured by the TAQ, t(39) = 4.35, p < .001, compared to the TO group, after correcting for multiple comparisons. Neuroimaging results indicated greater FC in the TO group, compared to HC, within the AUD (insula), DMN (precuneus and thalamus), SM (cuneus), and the AE network (thalamus). Greater functional connectivity (FC) in the T+P group compared to the TO and HC groups was found within AUD (middle temporal gyrus and precuneus), DMN (superior parietal lobule, culmen, postcentral gyrus, posterior cingulate, and medial frontal gyrus), SM; (cerebellar lingual and cingulate gyrus), and the AE networks (medial frontal gyrus).

Conclusions: Study findings suggest that PTSD, a trauma disorder, serves to exacerbate tinnitus distress. Moreover, individuals with PTSD are more likely to endorse less tinnitus-acceptance, which may service as a barrier to successful management of their tinnitus. Mindfulness-based interventions may improve acceptance and decrease tinnitus distress. Neuroimaging results show effects of tinnitus when compared to healthy controls across several resting-state networks. The DMN appears to have more regions of increased FC when PTSD co-occurs with tinnitus, representing possible targets for therapeutic intervention.