Clarke, N.A.
(2021)
An investigation into the relationship between tinnitus distress and cognitive performance.
PhD thesis, University of Nottingham.
Abstract
Chronic subjective tinnitus (herein referred toas tinnitus) is the conscious perception of sound in the absence of an external sound source. It is very common and a significant proportion of those who experience it find their tinnitus percept distressing. Cognitive task performance has been suggested to be poorer for people with subjective tinnitus, however, research on this topic to date has yielded inconsistent findings. This thesis contributes to understanding of the role of cognitive performance in subjective tinnitus through three studies.
The first study presents a comprehensive systematic review and meta-analyses of associations between cognitive performance and subjective tinnitus. The meta-analyses pooled data from a total of 1,863participants, and found that subjective tinnitus was negatively associated with various domains of cognitive performance, but particularly for executive functions. It also highlighted potential confounding factors in primary research on this topic, such as the unconsidered influence of hearing loss.
The second study presents experimental data from an investigation into performance for core executive functions in a large sample of participants with distressing, non-distressing, and no tinnitus(n=139).Participant groups undertook a battery of cognitive tasks that tapped core executive functions, then between-group differences were analysed. Analyses initially suggested that executive performance was poorer for groups with both distressing tinnitus and non-distressing, but observed that prima facie evidence from the study was confounded, and precluded an independent association between tinnitus distress and poorer cognitive performance being inferred. Furthermore, confounding through methodological practises from previous research within the wider literature was highlighted.
Additionally, advanced analyses and modelling of this experimental data demonstrated independent associations between executive functions and distressing tinnitus. However, the analyses also demonstrated that this is generally not the case for non-distressing tinnitus. Furthermore, non-distressing tinnitus was independently associated with improved performance for certain executive functions relative to the other groups, which suggested a causal role for executive functioning in distressing tinnitus.
Building on these insights, the third study proposed a conceptual model of tinnitus distress (the Executive Disruption Modelor EDM), and an accompanying structural causal model (SCM). The EDM provides a novel conceptualisation in positing that the tinnitus percept is not the subject of focus for an attentional spotlight, but instead intrudes into conscious awareness because of inherent and/or disrupted executive abilities and causally contributes to distress.
Application of the SCM provided preliminary validation of the EDMin an independent dataset. Factor analysis was used to obtain latent measures of executive functioning that facilitated consistent estimates of a relationship between poorer executive functioning and greater tinnitus distress in both datasets.
The research presented in this thesis contributes new knowledge to the relationship between cognitive performance and distress related to subjective tinnitus through comprehensive evidence synthesis, primary research and model development, and subsequent application and validation. This offers consistency, both in terms of implicated cognitive domains and size of effect. The thesis presents novel theoretical and methodological insights into research on this topic with practical applications for cognitive research into tinnitus, related interventions for tinnitus distress, and potential clinical applications.
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