Chapter 9

The Jastreboff neurophysiological

model

Having reviewed potential physiological mechanisms of tinnitus, Jastreboff (1990)

­presented a neurophysiological model of tinnitus. This was based on the tenet that, in
addition to the classical auditory system pathways, other central neural pathways are
involved in the emergence and maintenance of tinnitus. In particular, the limbic system,
sympathetic autonomic nervous system and reticular formation are pivotal to the
hypothesis. Jastreboff proposed that signal recognition and classification circuits are
involved in persistent tinnitus as neural networks that become tuned to the tinnitus sig-
nal, even when that signal is of low intensity or intermittent. Peripheral processes might
indeed be involved in the generation of tinnitus-related activity, but bearing in mind the
findings of Heller and Bergman (1953), it was not necessary for an auditory system
dysfunction to be present for tinnitus to be perceived. This Jastreboff ‘neurophysiologi-
cal model’ was published in diagrammatic form in 1996 and in slightly more detailed
form in 1999 (Figure 9.1).
It was noted that after a short period of awareness of tinnitus-related activity, a process
of habituation generally occurs so that the activity is no longer consciously perceived.
However, in cases where there is some ‘negative emotional reinforcement’, described as
fear, anxiety or tension, then limbic system and sympathetic autonomic activation cause
the activity to be enhanced and perception persists. The distinction between the percep-
tion and the behavioural and emotional reaction to tinnitus was implicit, as was the poten-
tial for a feedback loop between these processes. The Jastreboff neurophysiological
model suggests that, in tinnitus, the links between these elements of the central nervous
system are governed by classical conditioning or associative learning (Schwartz et al.,
2002). Although not described in detail by Jastreboff, these processes are based on
Aristotle’s third principle of contiguity. This states that if two or more experiences occur
together frequently enough then eventually one occurring on its own will evoke memory
of the other(s). The most famous examples of this are Pavlov’s experiments (1927), in
which a neutral stimulus (a bell ringing) was presented to dogs at the same time as they

Tinnitus: A Multidisciplinary Approach, Second Edition. David Baguley, Gerhard Andersson,

Don McFerran and Laurence McKenna.
© 2013 David Baguley, Gerhard Andersson, Don McFerran and Laurence McKenna.
Published 2013 by Blackwell Publishing Ltd.
 The Jastreboff neurophysiological model  111

Perception & evaluation

Auditory & other cortical areas

Detection Emotional associations

Subcortical Limbic system

Source Annoyance
Cochlea Autonomic nervous system

Auditory & other cortical areas

Perception & evaluation (consciousness, memory, attention)

Auditory
Limbic system Reactions
Subconscious
Emotions
Detection/processing

Auditory periphery Autonomic nervous system

Source

Figure 9.1  Diagrammatic representations of the Jastreboff neurophysiological model of

tinnitus. Arrows denote interrelations between different functional areas.

were given another stimulus (food) which naturally produced salivation. After a while the
dogs salivated when the bell was rung even if no food was present. The presentation of
food was the natural or unconditioned stimulus; the bell ringing was the neutral stimulus
or conditioned stimulus; the salivation without the presence of food was the conditioned
reflex. Jastreboff (1999) suggested that tinnitus becomes a problem when it becomes
associated with negative experiences, though he did not clearly elaborate upon what
­comprises the unconditioned stimulus, the conditioned stimulus and the conditioned
response in that process. Although the negative experience may be a change within the
auditory system, it may also be an unrelated stressful event such as bereavement, relation-
ship difficulties or work problems. Indeed, Jastreboff (1999) suggested that in the m
­ ajority
of cases of tinnitus the emergence is not related to auditory system change. Negative
information or beliefs about tinnitus can supply negative reinforcement, which, via the
limbic system, stimulates the sympathetic arm of the autonomic nervous system, releas-
ing catecholamines and producing a fight or flight response. Because this autonomic
response is unpleasant, it in turn acts as further negative reinforcement.
112 Tinnitus

There are several points within the auditory, reactive and emotional systems where
feedback can occur. One of the main feedback pathways occurs in the lower part of
the model (Figure 9.1) between the auditory subconscious, the limbic system and the
autonomic nervous system. This lower loop operates at a pre-conscious level. An
upper feedback loop also involves the limbic system and the autonomic nervous
system, but in addition incorporates higher cortical centres and hence operates at a
conscious level. Jastreboff (1999) suggested that the lower loop is dominant in most
people who have severe tinnitus. The neurophysiological model hypothesis also
suggests that once the central feedback loops have become established the auditory
periphery becomes relatively unimportant. There is evidence to support this as section
of the auditory nerve fails to control severe established tinnitus in up to 50% of cases
(see Chapter 13).
Jastreboff et al. (1996) used this neurophysiological model to develop a treatment
­strategy called tinnitus retraining therapy (see Chapter 14), but has subsequently agreed
that tinnitus retraining therapy is not the only treatment that is congruent with the neuro-
physiological model. The model itself has been criticised for being oversimplistic
(Andersson, 2002a), but this is perhaps to miss the point: within that simplicity lies the
ease of communication to patients and indeed to nonspecialist clinicians.
The assertions made in the Jastreboff neurophysiological model are also not as well
supported as sometimes claimed. For example, it is not clear that tinnitus can be likened
to a tone to which the patient is classically conditioned. Further, the role of the limbic
system in tinnitus distress might seem hard to contest, but imaging research has not been
fully consistent with this theory (Chapter 6). Indeed, from a learning psychology point of
view, there is much left to explain within the neurophysiological model, such as the
­temporal properties and actual instances when aversive reactions have become condi-
tioned (McKenna, 2004). Personal attributes such as experience and personality are
­marginalised in the Jastreboff neurophysiological model, and this does not fit well with
­observations in the clinic.
Given that tinnitus is not viewed as an unconditioned stimulus for unconditioned
­aversive reactions (which it might very well be, for example, as a sign of becoming deaf),
there is a missing link to explain, namely, how a tone without meaning (i.e. tinnitus)
becomes paired with an unconditioned aversive stimulus. Here, the Jastreboff model takes
a tautological approach and does not explain why tinnitus becomes bothersome. Indeed,
it might not be classical conditioning that takes place but rather ‘evaluative conditioning’
(De Houwer et al., 2001) (see Chapter 8). Evaluative conditioning refers to changes in the
liking of a stimulus because the stimulus has been paired with other, positive or negative,
stimuli. In evaluative conditioning studies, a neutral stimulus is paired with an affective
stimulus and changes in the valence of the neutral stimulus are measured. Interestingly,
unlike most forms of Pavlovian conditioning, evaluative conditioning is highly resistant
to extinction.
Despite the many criticisms that have been levelled against the Jastreboff neurophysi-
ological model of tinnitus its basic principles are still used by many, perhaps the majority,
of tinnitus clinicians worldwide, more than two decades after its publication. It is diffi-
cult to overemphasise the improvements in tinnitus management that developed as a
result of this work.
 The Jastreboff neurophysiological model  113

Summary

The Jastreboff neurophysiological model of tinnitus undoubtedly represented one of the

major turning points in our understanding of tinnitus and helped to provide a useful
management strategy. It relegated the cochlea to a minor role in tinnitus distress and gave
much greater importance to the role of the brain and autonomic nervous system. It highlighted
emotional processing as the major factor in generating tinnitus distress and promoted
habituation as the means of reducing that distress. In many respects these are features that
are shared by psychological models of tinnitus. The neurophysiological model, however,
differed from the psychological models in that it regarded the sub­conscious processing of
auditory information as being more important than conscious evaluation of the symptom in
most patients. The treatment strategy that developed from this model, tinnitus retraining
therapy, is discussed in Chapter 14.