Tinnitus specifically alters the top-down executive control sub-component of attention: Evidence from the Attention Network Task

•Impairment in attentional processes may be involved in tinnitus.•Tinnitus patients (compared to controls) performed the Attention Network Test.•A specific deficit for executive control of attention was observed.•This deficit correlated with years of tinnitus duration and the frequency of coping strategies. Tinnitus can be defined as the perception of noxious disabling internal sounds in the absence of external stimulation. While most individuals with tinnitus show some habituation to these internal sounds, many of them experience significant daily life impairments. There is now convincing evidence that impairment in attentional processes may be involved in tinnitus, particularly by hampering the habituation mechanism related to the prefrontal cortex activity. However, it is thus still unclear whether this deficit is an alteration of alerting and orienting attentional abilities, or the consequence of more general alteration in the executive control of attention. In the present study, 20 tinnitus patients were compared to 20 matched healthy controls using the Attention Network Test, to clarify which attentional networks, among alerting, orienting, and executive networks, show differences between the groups. The results showed that patients with tinnitus do not present a general attentional deficit but rather a specific deficit for top-down executive control of attention. This deficit was highly correlated with patient characteristics of years of tinnitus duration and the frequency of coping strategies employed to alleviate tinnitus distress in daily life. These findings are discussed in terms of recent neurobiological models suggesting that prefrontal cortex activity might especially be related to tinnitus habituation. Therapeutic perspectives focusing both on rehabilitation of the executive control of attention and neuromodulation are also discussed.