Investigating the Efficacy of an Individualized Alpha/Delta Neurofeedback Protocol in the Treatment of Chronic Tinnitus

Dominik Güntensperger, Christian Thüring, Tobias Kleinjung, Patrick Neff, Martin Meyer, Dominik Güntensperger, Christian Thüring, Tobias Kleinjung, Patrick Neff, Martin Meyer

Abstract

First attempts have demonstrated that the application of alpha/delta neurofeedback in the treatment of chronic tinnitus leads to a reduction of symptoms at the group level. However, recent research also suggests that chronic tinnitus is a decidedly heterogeneous phenomenon, one that requires treatment of distinct subgroups or even on an individual level. Thus, the purpose of this study was to evaluate an individually adjusted alpha/delta neurofeedback protocol. Following previous studies, the delta band fixed between 3 and 4 Hz was chosen as the frequency for inhibition. However, unlike the previous studies, the frequency range for the rewarded alpha band was not fixed between 8 and 12 Hz but rather individually determined according to each patient's specific alpha peak frequency (IAF). Twenty-six chronic tinnitus patients participated in 15 weekly neurofeedback training sessions and extensive pre- and post-tests, as well as follow-up testing 3 and 6 months after training. The main outcome measures were tinnitus-related distress measured with the Tinnitus Handicap Inventory (THI) and Tinnitus Questionnaire (TQ), tinnitus loudness, and pre- and post-training resting-state EEG activity in trained frequency bands. In Results, the neurofeedback protocol led to a significant reduction of tinnitus-related distress and tinnitus loudness. While distress remained on a low level even 6 months after the completion of training, loudness returned to baseline levels in the follow-up period. In addition, resting-state EEG activity showed an increase in the trained alpha/delta ratio over the course of the training. This ratio increase was related to training-induced changes of tinnitus-related distress as measured with TQ, mainly due to increases in the alpha frequency range. In sum, this study confirms the alpha/delta neurofeedback as a suitable option for the treatment of chronic tinnitus and represents a first step towards the development of individual neurofeedback protocols. This clinical trial was registered online at ClinicalTrials.gov (NCT02383147) and kofam.ch (SNCTP000001313).

Figures

Figure 1
Figure 1
Barplots showing tinnitus-related symptoms before (t1), 1 week after (t2), 3 months after (t3), and 6 months after (t4) neurofeedback training. Error bars represent ±1 standard error for within-subject designs according to Morey [60]. THI scores (a) showed significant decreases from t1 to t2, and differences between t1 and the two follow-up time points were significant. TQ scores (b) were significantly higher before (t1) than after the neurofeedback intervention (t2-t4). For tinnitus loudness (c), a significant decrease between t1 and t2 was found followed by a significant increase to t4.
Figure 2
Figure 2
Barplots showing the alpha/delta power ratio over the four electrodes used for training in measurements before (t1), 1 week after (t2), and 3 months after (t3) the neurofeedback intervention. Error bars represent ±1 standard error for within-subject designs according to Morey [60]. The alpha/delta ratio of EEG-NT (a) did not vary significantly over time. The ratio of EEG-WT (b) increased significantly over the course of the training, between t1 and t2, followed by a nonsignificant decrease to t3.
Figure 3
Figure 3
Scatterplots of difference scores (t2-t1) of EEG-NT resting-state data ((a, d, g) alpha/delta ratio; (b, e, h) rewarded individual alpha band power; (c, f, i) inhibited delta band power) and tinnitus-related symptoms ((a–c) THI; (d–f) TQ; (g–i) tinnitus loudness). The plots show the fitted regression lines with 95% confidence intervals. No correlations were found to be statistically significant.
Figure 4
Figure 4
Scatterplots of difference scores (t2-t1) of EEG-WT resting-state data ((a, d, g) alpha/delta ratio; (b, e, h) rewarded individual alpha band power; (c, f, i) inhibited delta band power) and tinnitus-related symptoms ((a–c) THI; (d–f) TQ; (g–i) tinnitus loudness). The plots show the fitted regression lines with 95% confidence intervals. The correlation between IAF and TQ difference scores is statistically significant (p > .05).

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