Expanding the biological basis of tinnitus: crossmodal origins and the role of neuroplasticity.

Tinnitus is most often initiated by modality specific otopathologic disturbances affecting peripheral and central auditory pathways. However, there is growing evidence indicating that the anatomical location generating tinnitus occurs at sites different from the initial pathology. Support for this notion is found in individuals where tinnitus can be triggered or modulated by inputs from other sensory modalities or sensorimotor systems (somatosensory, somatomotor, visual-motor). The use of functional imaging methods combined with psychophysics, detailed physical examinations and questionnaire-based assessments has reinforced and validated these observations. Available data suggest that tinnitus-related crossmodal interactions are more common than previously anticipated. This communication reviews these advancements and suggests that a relatively broad multimodal network of neurons is involved in generating and sustaining the tinnitus perception in some forms of the disorder. Also implicated as part of the tinnitus experience are interactions within large-scale neural networks subserving attention, cognition, and emotion. Incorporating this knowledge into contemporary psychophysiological models will help facilitate the conceptualization of this phantom perception in a more comprehensive manner.