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Original Investigation
January 19, 2017

Cognitive Training for Adults With Bothersome TinnitusA Randomized Clinical Trial

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
  • 2Statistics Editor, JAMA Otolaryngology–Head & Neck Surgery
  • 3Editor, JAMA Otolaryngology–Head & Neck Surgery
  • 4Department of Mathematics, Washington University in St Louis, St Louis, Missouri
  • 5Department of Psychology, Washington University in St Louis, St Louis, Missouri
  • 6AbbVie Clinical Pharmacology Research Unit, Global Pharmaceutical R&D, Grayslake, Illinois
  • 7Case Western Reserve University School of Medicine, Cleveland, Ohio
  • 8Mallinckrodt Institute of Radiology, Washington University School of Medicine in St Louis, St Louis, Missouri
  • 9Department of Neurology, Washington University School of Medicine in St Louis, St Louis, Missouri
  • 10Department of Pediatrics, Washington University School of Medicine in St Louis, St Louis, Missouri
  • 11Department of Neuroscience, Washington University School of Medicine in St Louis, St Louis, Missouri
  • 12Department of Psychiatry, Washington University School of Medicine in St Louis, St Louis, Missouri
JAMA Otolaryngol Head Neck Surg. Published online January 19, 2017. doi:10.1001/jamaoto.2016.3779
Key Points

Question  Can patients with severe, bothersome tinnitus benefit from a computer-based, cognitive training rehabilitation program?

Findings  Of the 40 individuals with tinnitus enrolled in this randomized clinical trial, patients who used the training program endorsed improvements in domains of tinnitus perception, attention, memory, and concentration, but no significant differences in behavioral measures were observed between these patients and individuals who did not use the training program. Neuroimaging changes in brain systems responsible for attention and cognitive control were observed in patients who used the training program.

Meaning  Cognitive training programs, which purport to exploit the brain’s capacity for neuroplasticity, might have a role in the future treatment of patients with tinnitus.

Abstract

Importance  Individuals with tinnitus have poorer working memory, slower processing speeds and reaction times, and deficiencies in selective attention, all of which interfere with readiness and performance. Brain Fitness Program–Tinnitus (BFP-T) is a cognitive training program specially designed to exploit neuroplasticity for preservation and expansion of cognitive health in adults with tinnitus.

Objective  To evaluate the effect of the BFP-T on tinnitus.

Design, Setting, and Participants  This open-label, intention-to-treat randomized clinical trial prescreened 191 patients with tinnitus and 64 healthy controls (HCs) from June 1, 2012, through October 31, 2013. Participants were 40 adults with bothersome tinnitus for more than 6 months and 20 age-matched HCs. Patients with tinnitus were randomized to a BFP-T or non–BFP-T control group. The BFP-T was completed online, and assessments were completed at Washington University School of Medicine.

Interventions  Participants in the intervention group were required to complete the BFP-T online 1 hour per day 5 days per week for 8 weeks. Tinnitus assessment, neuroimaging, and cognitive testing were completed at baseline and 8 weeks later. The HCs underwent neuroimaging and cognitive assessments.

Main Outcomes and Measures  The primary outcome measure was the change in Tinnitus Handicap Inventory (THI) score. Behavioral measures, neuroimaging, and cognitive tests were performed before and after the intervention.

Results  A total of 40 patients with tinnitus and 20 HCs participated in the study (median [range] age, 56 [35-64] years in the BFP-T group, 52 [24-64] years in the non–BFP-T group, and 50 [30-64] years in the HC group; 13 [65%] in the BFP-T group, 14 [70%] in the non–BFP-T group, and 13 [65%] in the HC group were males; and 16 [80%] in the BFP-T group, 16 [80%] in the non–BFP-T group, and 15 [75%] in the HC group were white). There was a reduction in the THI score in the BFP-T group (median, 7; range, −16 to 64) and non–BFP-T group (median, 11; range, −6 to 26), but this reduction was not significantly different between the 2 groups (median difference, 0; 95% CI, −10 to 8). There was no difference in cognitive test scores and other behavioral measures. There was a significant difference between baseline and follow-up in functional connectivity in cognitive control regions in the BFP-T group but not in HCs or individuals with untreated tinnitus. Of the 20 patients in the BFP-T group, 10 (50%) self-reported improvement attributable to the intervention, and 6 (30%) reported to be much improved in the domains of tinnitus, memory, attention, and concentration.

Conclusions and Relevance  These findings suggest that the computer-based cognitive training program is associated with self-reported changes in attention, memory, and perception of tinnitus. A possible mechanistic explanation for these changes could be neuroplastic changes in key brain systems involved in cognitive control. Cognitive training programs might have a role in the future treatment of patients with tinnitus.

Trial Registration  clinicaltrials.gov Identifier: NCT01458821

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