ISSN 1612-3352

Editors in Chief

Prof. Dr. Claus F. Claussen, Neurootological Research Institute of the Research Society for Smell, Taste, Hearing and Equilibrium Disorders at Bad Kissingen (4-G-F). Bad Kissingen, Germany.
Dr. med. Julia M. Bergmann,
Dr. med. Guillermo O. Bertora,
Otoneuroophthalmological Neurophysiology,
Buenos Aires, Argentina.

Production Managers

Dr. med. Julia M. Bergmann,
Dr. med. Guillermo O. Bertora,
Otoneuroophthalmological Neurophysiology,
Buenos Aires, Argentina.

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Final Common Pathway for Tinnitus: Theoretical and Clinical Implications of Neuroanatomical Substrates


A final common pathway (FCP) for tinnitus has been hypothesized since 1989 for
all clinical types of tinnitus, particularly subjective idiopathic tinnitus (SIT) of the severe disabling
type. This was intended to explain the transformation-transition of the sensation of an
aberrant auditory sensation—tinnitus (i.e., the sensory component)—to one of affect (i.e., the
emotional-behavioral component) or, conversely, that an emotional-behavioral stimulus (affect)
can result in the clinical manifestation of a sensation (a sensory stimulus). Understanding
the pathophysiology of this transformation is fundamental for the diagnosis of tinnitus and the
treatment of the patient, and it presents a dilemma to basic science, neuroscience, and clinical
medicine. Clinically, tinnitus is not a unitary symptom; it constitutes many clinical types; can
have its origin in the auditory or nonauditory systems and in the peripheral or central nervous
system; and may be clinically manifest or subclinical. Accumulating evidence is presented to
support the original hypothesis of an FCP. The resolution of this dilemma involves sensory
processing (i.e., the integration, identification, and understanding of the ongoing, underlying,
simultaneous, multiple associated brain function processes not only from one sensory modality
but from multiple sensory modalities accompanying and associated with an FCP). In the
FCP, the predominant brain function process is that of the sensory–affect transformation of a
sensation and its conscious awareness by the affected patient. The neuroanatomical substrates
identified in 1989 in tinnitus patients (reported originally in 1991 and published in 1995) are
presented as a common framework for the hypothesis of an FCP. They further the understanding
of the clinical heterogeneity of the tinnitus symptom, clinically manifest as multiple brain
functions associated with the clinical course of tinnitus patients, particularly those with SIT.
The FCP provides a model for tinnitus theory, diagnosis, and treatment.
The FCP is not a tinnitus theory. Specifically, it is a hypothesis that attempts to explain how
an aberrant auditory sensory stimulus becomes transformed into one of affect and somatomotor
response. The neuroanatomical substrates of the FCP provide a basis for the identification
of the involved neurocircuitries and neurochemistries. The physiology and biochemistry
underlying the neuroanatomical substrates of the FCP provide a basis for translation for tinnitus
diagnosis and treatment.
The neuroanatomical substrates of the FCP are presented as algorithms of (1) components of
a sensation (i.e., sensory, affect, and psychomotor), a translation from basic sensory physiology
for tinnitus; (2) clinically manifest biophysiological brain functions and underlying processes
associated with the tinnitus; (3) a model for investigation of metabolic-electrophysiological correlates for tinnitus; (4) the basis for an integrated theory of tinnitus and brain function (i.e.,
tinnitus dyssynchrony-synchrony theory; (5) a model for the identification of underlying neurocircuitries
and neurochemistries involved in brain for the sensory–affect transformation of an
aberrant auditory stimulus (tinnitus); (6) a model for the selection-introduction of innovative
therapies attempting tinnitus relief; and (7) its clinical translation for objective monitoring systems
for the determination of the efficacy of modalities of therapy attempting tinnitus relief.
The hypothesis of the FCP for tinnitus and the identified neuroanatomical substrates, when
viewed in terms of the physiology of sensory processing, is considered to be expanded and
broader in its application for all sensations, normal or aberrant.



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