1 Scientific RepoRts | 5:10802 | DOi: 10.1038/srep10802 www.nature.com/scientificreports Multisensory attention training for treatment of tinnitus spiegel D. p. 1,2,5 , Linford t. 1 , thompson B. 2,3,* , petoe M. A. 1,4 , Kobayashi K. 1,2 , stinear C. M. 2 & Searchield G. D. 1,2 tinnitus is the conscious perception of sound with no physical sound source. some models of tinnitus pathophysiology suggest that networks associated with attention, memory, distress and multisensory experience are involved in tinnitus perception. the aim of this study was to evaluate whether a multisensory attention training paradigm which used audio, visual, and somatosensory stimulation would reduce tinnitus. eighteen participants with predominantly unilateral chronic tinnitus were randomized between two groups receiving 20 daily sessions of either integration (attempting to reduce salience to tinnitus by binding with multisensory stimuli) or attention diversion (multisensory stimuli opposite side to tinnitus) training. The training resulted in small but statistically signiicant reductions in tinnitus Functional Index and tinnitus severity Numeric scale scores and improved attentional abilities. No statistically signiicant improvements in tinnitus were found between the training groups. This study demonstrated that a short period of multisensory attention training reduced unilateral tinnitus, but directing attention toward or away from the tinnitus side did not diferentiate this efect. Tinnitus is the conscious awareness of sound without an external driving sound. It is believed to arise from an injury to the peripheral auditory system 1 resulting in deaferentation; the lack of normal sen- sory input is thought to trigger a cascade of neuroplastic changes within the subcortical and cortical auditory pathways 2 . here is oten little direct relationship between the subjectively reported severity of tinnitus and the psychoacoustic matches such as loudness and sensation level 3,4 suggesting the involve- ment of processes related to attention, emotion, and memory in tinnitus pathophysiology 5 . Support for this assumption is the observation showing that unilateral tinnitus is associated with a marked attention shit towards the tinnitus ear 6 . Participants with a unilateral tinnitus were able to detect target sounds more accurately in the tinnitus ear than the opposite ear but this did not occur in a simulated tinnitus group 6 . Further support comes from functional imaging studies. Although the evidence is not univocal 7 and many of the methods used are still under development, the majority of recent studies using electro- encephalography (EEG) 8 resting state functional magnetic resonance imaging (fMRI) 9,10 , and positron emission tomography (PET) scans 11 have shown altered brain connectivity in tinnitus patients. As an example, Vanneste et al 8 . showed increased EEG gamma connectivity between the let auditory cortex, let insula, let parahippocampus, and the right dorsolateral prefrontal cortex arguing that these connec- tions may be linked to maintaining consciousness and the enduring attention towards the tinnitus sound. PET in tinnitus patients has revealed increased resting state activity in limbic, frontal and parietal regions and a positive correlation between tinnitus duration and the activity in the right inferior frontal, right ventro-medial prefrontal, and the right posterior cingulate cortices 11 . Multisensory interactions appear to be a ubiquitous property of information processing within the central nervous system. he evidence comes both from behavioural and physiological studies as well as 1 Section of Audiology, School of Population Health, the University of Auckland, 261 Morrin Road, Glenn innes, Auckland, new Zealand. 2 centre for Brain Research, the University of Auckland, 85 Park Road, Grafton, Auckland, new Zealand. 3 Department of Optometry and Vision Science, the University of Auckland, 85 Park Road, Grafton, Auckland, new Zealand. 4 the Bionics institute of Australia, 384-388 Albert Street, Melbourne, Australia. 5 McGill Vision Research, Department of Ophthalmology, McGill University, Montreal, canada. *current address: School of Optometry and Vision Science, University of Waterloo, 200 columbia Street West Waterloo, Ontario, canada. Correspondence and requests for materials should be addressed to G.D.S. (email: g.searchield@auckland.ac.nz) Received: 04 December 2014 Accepted: 23 April 2015 Published: 28 May 2015 opeN