Cochlear implantation for single-sided deafness and tinnitus suppression

A Consensus to Revise the Minimum Speech Test Battery-Version 3

PURPOSE

The Minimum Speech Test Battery (MSTB) for adults was introduced in 1996 (Nilsson et al., 1996) and subsequently updated in 2011 (Advanced-Bionics et al., 2011). The MSTB has been widely used by clinicians as a guide for cochlear implant (CI) candidacy evaluations and to document post-operative speech recognition performance. Due to changes in candidacy over the past 10 years, a revision to the MSTB was needed.

METHOD

In 2022, the Institute for Cochlear Implant Training (ICIT) recruited a panel of expert CI audiologists to update and revise the MSTB. This panel utilized a modified Delphi consensus process to revise the test battery and to improve its applicability considering recent changes in CI care.

RESULTS

This resulted in the MTSB-Version 3 (MSTB-3), which includes test protocols for identifying not only traditional CI candidates but also possible candidates for electric-acoustic stimulation and patients with single-sided deafness and asymmetric hearing loss. The MSTB-3 provides information that supplements the earlier versions of the MSTB, such as recommendations of when to refer patients for a CI, recommended patient-reported outcome measures, considerations regarding the use of cognitive screeners, and sample report templates for clinical documentation of pre- and post-operative care. Electronic versions of test stimuli, along with all the materials described above, will be available to clinicians via the ICIT website.

CONCLUSION

The goal of the MSTB-3 is to be an evidence-based test battery that will facilitate a streamlined standard of care for adult CI candidates and recipients that will be widely used by CI clinicians.

The effect of cochlear implantation on tinnitus in patients with post lingual bilateral profound hearing loss

INTRODUCTION

In this study we investigated the effect of cochlear implantation on tinnitus in patients with post lingual bilateral profound hearing loss.

METHODS

In this retrospective study, 66 post-lingual deaf patients over 18 years old who referred for cochlear implantation and complained of tinnitus were included. Patients were divided into two groups with residual hearing (in frequency 250-500 Hz) and without residual hearing. All data including age, gender, type of implants, type of surgery, cause of the disease, and information on the THI score before cochlear implantation, one month after cochlear implantation and one year after cochlear implantation was recorded and analyzed.

RESULTS

Nine patients had residual hearing, while 57 patients did not. After one month and one year, in both groups, the mean THI score has decreased significantly (p-value = 0.001), but there was no significant difference in the mean THI score before surgery and one month and one year after surgery between two groups with and without residual hearing. There was no significant difference in tinnitus severity according to THI-grade between two groups. Also there was no significant difference in THI score and the cause of the hearing loss, type and insertion method of implantation, one month and one year after the surgery between two groups.

CONCLUSION

According to our results, the was no significant correlation between residual hearing and tinnitus score before surgery, one month and one year after the surgery.

Recent advances in Otology: Current landscape and future direction

Hearing is an essential sensation, and its deterioration leads to a significant decrease in the quality of life. Thus, great efforts have been made by otologists to preserve and recover hearing. Our knowledge regarding the field of otology has progressed with advances in technology, and otologists have sought to develop novel approaches in the field of otologic surgery to achieve higher hearing recovery or preservation rates. This requires knowledge regarding the anatomy of the temporal bone and the physiology of hearing. Basic research in the field of otology has progressed with advances in molecular biology and genetics. This review summarizes the current views and recent advances in the field of otology and otologic surgery, especially from the viewpoint of young Japanese clinician-scientists, and presents the perspectives and future directions for several topics in the field of otology. This review will aid next-generation researchers in understanding the recent advances and future challenges in the field of otology.

Clinical experience with the Nurotron™ cochlear implant in a Spanish-speaking postlingual population: Clinical safety and audiological results

OBJECTIVE

to assess clinical safety and postoperative audiological outcomes in postlingual deafness Spanish speaking patients, who underwent surgery with Nurotron™ cochlear implant.

MATERIAL AND METHODS

Retrospective descriptive case series study. We performed follow-up of complications and audiological measurements before and after cochlear implantation. Patients with bilateral severe to profound sensorineural hearing loss or patients with unilateral deafness with/without tinnitus were included. Repeated-measures within-subjects for assess pure tone thresholds and speech performance (bilingual test) with a detailed monitoring to establish security or adverse effects were performed. Analysis of variance tests, repetitive measures, were used for statistical analysis.

RESULTS

31 patients were included, 17 (54.8%) men and 14 (45.2%) women. Mean age at the time of surgery was 49.82 ± 18.8 years. The mean follow-up of the group was 31.56 ± 9.57 months (minimum = 19.6 months and maximum = 52.50 months). As major complication one patient (3.23%) had a hard failure that required removal and re-implantation. 25.8% of the patients presented minor complications, the most frequent being vertigo/unsteadiness in 22.6%. The mean of language discrimination (free field at 65 dB SPL) was 62.19% ± 16.66; being 69.82% ± 7.35 in the group of severe to profound bilateral sensorineural hearing loss. A statistically significant reduction was observed in patients with tinnitus, assessed using the visual analogue scale, preoperative = 7.2 ± 1,6 vs postoperative (18months postoperative) = 1.7 ± 1.3 (p < .001).

CONCLUSIONS

The Nurotron™ cochlear implant shows satisfactory audiological results, in accordance with what has been reported in the literature. Minor complications were similar to previous studies, but the percentage of hard failure should continue to be observed, which was higher than other reports with comparable follow-up.

Masked Speech Perception with Bone Conduction Device, Contralateral Routing of Signals Hearing Aid, and Cochlear Implant Use in Adults with Single-Sided Deafness: A Prospective Hearing Device Comparison using a Unified Testing Framework

INTRODUCTION

For the treatment of single-sided deafness (SSD), common treatment choices include a contralateral routing of signals (CROS) hearing aid, a bone conduction device (BCD), and a cochlear implant (CI). The primary aim of this study was to compare speech understanding in noise and binaural benefits in adults with postlingual SSD between preoperative unaided baseline, preoperative CROS and BCD trial devices, and CI, following recommendations from a consensus protocol. In addition, we investigated the effect of masker type on speech understanding.

METHODS

This was a prospective study with twelve participants. Binaural effects of head shadow, squelch, summation, and spatial release from masking were assessed by measuring speech reception thresholds (SRTs) in five different spatial target-masker configurations using two different maskers: two-talker babble (TTB), and speech-shaped noise (SSN). Preoperatively, participants were assessed unaided and with CROS and BCD trial devices. After cochlear implantation, participants were assessed at 1, 3, and 6 months post-activation.

RESULTS

For TTB, significant improvements in SRT with a CI relative to preoperatively unaided were found in all spatial configurations. With CI at 6 months, median benefits were 7.8 dB in SSSDNAH and 5.1 dB in S0NAH (head shadow), 3.4 dB in S0N0 (summation), and 4.6 dB in S0NSSD and 5.1 dB in SAHNSSD (squelch). CROS yielded a significant head shadow benefit of 2.4 dB in SSSDNAH and a significant deterioration in squelch of 2.5 dB in S0NSSD and SAHNSSD, but no summation effect. With BCD, there was a significant summation benefit of 1.5 dB, but no head shadow nor squelch effect. For SSN, significant improvements in SRT with CI compared to preoperatively unaided were found in three spatial configurations. Median benefits with CI at 6 months were: 8.5 dB in SSSDNAH and 4.6 dB in S0NAH (head shadow), 1.4 dB in S0N0 (summation), but no squelch. CROS showed a significant head shadow benefit of 1.7 dB in SSSDNAH, but no summation effect, and a significant deterioration in squelch of 2.9 dB in S0NSSD and 3.2 dB in SAHNSSD. With BCD, no binaural effect was obtained. Longitudinally, we found significant head shadow benefits with a CI in SSSDNAH in both maskers at all postoperative intervals and in S0NAH at 3 and 6 months post-activation.

CONCLUSION

With a CI, a clear benefit for masked speech perception was observed for all binaural effects. Benefits with CROS and BCD were more limited. CROS usage was detrimental to the squelch effect.

Influence of listening environment on usage patterns in cochlear implant patients with single-sided deafness

OBJECTIVE

To compare cochlear implant (CI) data logging of patients with single-sided deafness (SSD) and bilateral sensorineural hearing loss (biSNHL) in various acoustic environments and study the implications of data logging on auditory performance.

STUDY DESIGN

Retrospective case control study.

METHODS

Adult CI patients with SSD or biSNHL from 2010 to 2021 with usage data collected at 3-, 6-, and 12-months following device activation were identified. The CI listening environment was defined as speech in noise, speech in quiet, quiet, music or noise. Auditory performance was measured using the CNC word, AzBio sentence tests and the Tinnitus Handicap Index (THI).

RESULTS

60 adults with SSD or biSNHL were included. CI patients with biSNHL wore their devices more than those with SSD at 3-months post-activation (11.18 versus 8.97 hours/day, p = 0.04), though there were no significant differences at 6-12 months. Device usage was highest in the speech in quiet environment. In SSD CI users, there was a positive correlation (p = 0.03) between device use and CNC scores at 12-months and an improvement in THI scores at 12-months (p = 0.0004).

CONCLUSIONS

CI users with SSD and biSNHL have comparable duration of device usage at longer follow-up periods with greatest device usage recorded in speech in quiet environments.

Cochlear Implants for Single-Sided Deafness: Quality of Life, Daily Usage, and Duration of Deafness

OBJECTIVE

To report our experience for adults undergoing cochlear implantation (CI) for single-sided deafness (SSD).

METHODS

This is a retrospective case series for adults with SSD who underwent CI between January 2013 and May 2021 at our institution. CNC and AzBio speech recognition scores, Tinnitus Handicap Inventory (THI), Speech, Spatial, and Qualities of Hearing Scale (SSQ12), datalogging, and the Cochlear Implant Quality of Life (CIQOL)-10 Global measure were utilized.

RESULTS

Sixty-six adults underwent CI for SSD (median 51.3 years, range 20.0-74.3 years), and 57 (86.4%) remained device users at last follow-up. Compared to pre-operative performance, device users demonstrated significant improvement in speech recognition scores and achieved peak performance at six months post-activation for CNC (8.0% increased to 45.6%, p < 0.0001) and AzBio in quiet (12.2% increased to 59.5%, p < 0.0001). THI was decreased at 6 months post-implantation (58.1-14.6, p < 0.0001), with 77% of patients reporting improved or resolved tinnitus. Patients demonstrated improved SSQ12 scores as well as the disease-specific CIQOL-10 Global questionnaire. Duration of deafness was not associated with significant differences in speech recognition performance. Average daily wear time was positively associated with CNC and AzBio scores as well as post-operative CIQOL-10 scores.

CONCLUSIONS

Herein we present the largest cohort of adult CI recipients with SSD with data on speech recognition scores, tinnitus measures, and SSQ12. Novel insights regarding the correlation of datalogging, duration of deafness, and CI-specific quality of life (CIQOL-10) metrics are discussed. Data continue to support CI as an efficacious treatment option for SSD.

LEVEL OF EVIDENCE

4 Laryngoscope, 133:2362-2370, 2023.

Cochlear Implantation Outcomes in Adults With Single-Sided Deafness: A Systematic Review and Meta-analysis

OBJECTIVE

To assess spatial hearing, tinnitus, and quality-of-life outcomes in adults with single-sided deafness (SSD) who underwent cochlear implantation.

DATABASES REVIEWED

PubMed, MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus databases were searched from January 2008 to September 2021 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

METHODS

Studies reporting spatial hearing, tinnitus, and quality-of-life outcomes in adult cochlear implant (CI) recipients (≥18 yr old) with SSD were evaluated. Study characteristics, demographic data, spatial hearing (speech recognition in noise, sound source localization), tinnitus (severity, loudness), and quality-of-life outcomes were collected.

RESULTS

From an initial search of 1,147 articles, 36 studies that evaluated CI use in 796 unique adults with SSD (51.3 ± 12.4 yr of age at time of implantation) were included. The mean duration of deafness was 6.2 ± 9.6 years. There was evidence of improvement for speech recognition in noise using different target-to-masker spatial configurations, with the largest benefit observed for target-to-masker configurations assessing head shadow (mean, 1.87-6.2 dB signal-to-noise ratio). Sound source localization, quantified as root-mean-squared error, improved with CI use (mean difference [MD], -25.3 degrees; 95% confidence interval [95% CI], -35.9 to -14.6 degrees; p < 0.001). Also, CI users reported a significant reduction in tinnitus severity as measured with the Tinnitus Handicap Inventory (MD, -29.97; 95% CI, -43.9 to -16.1; p < 0.001) and an improvement in spatial hearing abilities as measured with the Spatial, Speech, and Qualities of Hearing questionnaire (MD, 2.3; 95% CI, 1.7 to 2.8; p < 0.001).

CONCLUSIONS

Cochlear implantation and CI use consistently offer improvements in speech recognition in noise, sound source localization, tinnitus, and perceived quality of life in adults with SSD.

Cochlear Implantation in Adults With Single-Sided Deafness: A Systematic Review and Meta-analysis

OBJECTIVE

To determine the clinical outcomes of adult patients with single-sided deafness (SSD) undergoing ipsilateral cochlear implantation.

DATA SOURCE

An electronic search of Medline and Embase articles.

REVIEW METHODS

A systematic review was performed with a search strategy developed by a licensed librarian to identify studies of adult patients with SSD who underwent ipsilateral cochlear implantation. Articles were managed in Covidence and evaluated by 2 independent reviewers. Risk of bias was assessed and data were extracted, including patient demographics, etiology of deafness, duration of deafness, and postoperative change in speech recognition, tinnitus, sound localization, and quality of life (QoL). A meta-analysis was performed, and pooled mean differences were calculated for each outcome of interest via random effects models by each outcome, as well as subgroup analyses by the individual clinical score used.

RESULTS

Of 2309 studies identified, 185 full texts were evaluated, and 50 were ultimately included involving 674 patients. Speech perception scores in quiet and noise, tinnitus control, sound localization, and QoL all significantly improved after implantation. Pooled outcomes demonstrated score improvements in speech perception (standardized mean difference [SMD], 2.8 [95% CI, 2.16-3.43]), QoL (SMD, 0.68 [95% CI, 0.45-0.91]), sound localization (SMD, -1.13 [95% CI, -1.68 to -0.57]), and tinnitus score reduction (SMD, -1.32 [95% CI, -1.85 to -0.80]).

CONCLUSIONS

Cochlear implantation in adults with SSD results in significant improvements in speech perception, tinnitus control, sound localization, and QoL.

LEVEL OF EVIDENCE: 2

Twelve-Month Outcomes of Simultaneous Translabyrinthine Resection and Cochlear Implantation

OBJECTIVE

Audiometric outcomes at 12 months following simultaneous translabyrinthine (TL) resection of vestibular schwannoma (VS) and cochlear implantation (CI).

STUDY DESIGN

Prospective cohort study.

SETTING

Tertiary referral center.

METHODS

Adult patients undergoing TL resection of sporadic, unilateral VS ≤ 2 cm were prospectively enrolled. Preoperative testing included binaural AZBio in noise and quiet and unilateral Consonant-Nucleus-Consonant (CNC). Tinnitus Handicap Index (THI) and Speech, Spatial, and Qualities of Hearing (SSQ) questionnaires were also completed. Patients underwent TL resection with simultaneous CI. The preoperative test battery was repeated at 1, 3, 6, and 12 months after activation. Statistical analysis was performed to characterize short-term outcomes (preoperative to 3 months), longer-term outcomes (3-12 months), and overall changes during the preoperative to 12-month period.

RESULTS

AZBio, CNC, and THI improved at 3 months with no significant changes thereafter and showed durable improvement at 12 months compared to preoperative testing. While SSQ did not improve at 12 months, a subset of patients showed either recovery or improvement of SSQ-spatial subscores. Patients with cerebellopontine angle tumors had poorer performance, although the impact of tumor size and location could not be deduced based on the small sample size.

CONCLUSION

Patients undergoing simultaneous CI and TL resection of VS had durable improvements in speech perception and tinnitus severity 12 months following surgery. Subjective improvements in localization were not observed. Additional studies are needed to determine which VS patients are optimal candidates for CI.

Effects of auditory rehabilitation with cochlear implant on tinnitus prevalence and distress, health-related quality of life, subjective hearing and psychological comorbidities: Comparative analysis of patients with asymmetric hearing loss (AHL), double-sided (bilateral) deafness (DSD), and single-sided (unilateral) deafness (SSD)

Introduction

Auditory rehabilitation with a cochlear implant (CI), in many cases, positively impacts tinnitus. However, it is unclear if the tinnitus-related benefit of CI is equal for patients with various indications for CI. Therefore, this study aimed to determine differences in tinnitus prevalence and distress, health-related quality of life, subjective hearing, perceived stress, and psychological comorbidities between patients diagnosed with asymmetric hearing loss (AHL), single-sided (unilateral) deafness (SSD), and double-sided (bilateral) deafness (DSD) before and six months after cochlear implantation.

Methods

One hundred-one CI candidates were included in this prospective study (39 AHL patients, 23 DSD patients, and 39 SSD patients). The patients completed questionnaires measuring tinnitus distress, health-related quality of life, subjective hearing, perceived stress, and psychological comorbidities before and 6 months after CI.

Results

The prevalence of tinnitus in the entire cohort (80.2% before CI) decreased 6 months after CI to 71.3%. The DSD group had the lowest tinnitus prevalence at both time points. The degree of tinnitus-induced distress decreased significantly in all three groups after CI. Differences in quality of life, subjective hearing, and psychological comorbidities between the groups at the study onset disappeared after CI. Significant correlations existed between anxiety, depression, and tinnitus distress in AHL and SSD but not in DSD patients before and after CI.

Discussion

Our results demonstrate significant differences between the three groups of CI candidates, which might affect the implantation outcome. These differences suggest a need for personalized psychological counseling during the auditory rehabilitation process, focusing on anxiety and depressive symptoms for SSD and AHL patients.

Short- and Long-Term Effect of Cochlear Implantation on Disabling Tinnitus in Single-Sided Deafness Patients: A Systematic Review

Patients with single-sided deafness can experience an ipsilateral disabling tinnitus that has a major impact on individuals’ social communication and quality of life. Cochlear implants appear to be superior to conventional treatments to alleviate tinnitus in single-sided deafness. We conducted a systematic review to evaluate the effectiveness of cochlear implants in single-sided deafness with disabling tinnitus when conventional treatments fail to alleviate tinnitus (PROSPERO ID: CRD42022353292). All published studies in PubMed/MEDLINE and SCOPUS databases until December 2021 were included. A total of 474 records were retrieved, 31 studies were included and were divided into two categories according to whether tinnitus was assessed as a primary complaint or not. In all studies, cochlear implantation, evaluated using subjective validated tools, succeeded in reducing tinnitus significantly. Objective evaluation tools were less likely to be used but showed similar results. A short-(3 months) and long-(up to 72 months) term tinnitus suppression was reported. When the cochlear implant is disactivated, complete residual tinnitus inhibition was reported to persist up to 24 h. The results followed a similar pattern in studies where tinnitus was assesed as a primary complaint or not. In conclusion, the present review confirmed the effectiveness of cochlear implantation in sustainably reducing disabling tinnitus in single-sided deafness patients.

(Even Off-Label) Cochlear Implantation in Single-Sided Deafness and Asymmetric Hearing Loss Results in Measurable Objective and Subjective Benefit

OBJECTIVE

To quantify objective and subjective outcomes in cochlear implant (CI) recipients with asymmetric hearing loss, including single-sided deafness (SSD) whose candidacy was determined on an ear-specific basis when word recognition was 50% or less.

STUDY DESIGN

Retrospective case review.

SETTING

Tertiary referral center.

BACKGROUND

The effectiveness of CI in cases of SSD and asymmetric hearing loss (AHL) has been described in terms of tinnitus suppression, improved speech recognition in quiet and noise, enhanced localization ability, and improved quality of life. However, CI is not yet routinely offered as a top option or standard of care for these individuals. Recent Food and Drug Administration (FDA) labeling limits aided word recognition in the ear to be implanted to only 5% in cases of AHL/SSD, which is significantly poorer than 40 to 50%, which is often referenced in cases of bilateral hearing loss. Anecdotal experience suggests that patients with much better preoperative word recognition than 5% can benefit from CI.

METHODS

We conducted a retrospective chart review of all adult CI candidates, with one ear exhibiting consonant-nucleus-consonant (CNC) word recognition scores at least 50% and one ear not meeting CI candidacy (i.e., CNC word recognition >50%). Outcome variables of interest included word and sentence recognition and subjective handicap questionnaires (hearing, tinnitus, dizziness) and the Speech Spatial Qualities questionnaire.

RESULTS

Statistically and clinically significant improvement in speech understanding (word, sentence, sentence in noise) was noted for both the SSD and AHL groups in the implanted ear. There were statistically and clinically significant subjective improvements noted for both groups on the Hearing Handicap Inventory, the Tinnitus Handicap Inventory, and the Speech Spatial Qualities questionnaire by 1 month after activation. There were no significant differences between the AHL and SSD groups on either objective or subjective measures of the implanted ear. Individual word understanding improved for the majority of recipients across both groups and is not dependent on meeting the FDA criteria of less than 5%.

CONCLUSIONS

Cochlear implantation is a viable option with measurable objective and perceived benefits for recipients with preoperative aided CNC word scores exceeding current FDA labeling. There is no significant difference between the AHL and SSD groups, suggesting that candidacy and outcome expectations should be set based on the ear to be implanted alone, without regard for the ability of the better hearing ear.

American Cochlear Implant Alliance Task Force Guidelines for Clinical Assessment and Management of Adult Cochlear Implantation for Single-Sided Deafness

The indications for cochlear implantation have expanded to include individuals with profound sensorineural hearing loss in the impaired ear and normal hearing (NH) in the contralateral ear, known as single-sided deafness (SSD). There are additional considerations for the clinical assessment and management of adult cochlear implant candidates and recipients with SSD as compared to conventional cochlear implant candidates with bilateral moderate to profound sensorineural hearing loss. The present report reviews the current evidence relevant to the assessment and management of adults with SSD. A systematic review was also conducted on published studies that investigated outcomes of cochlear implant use on measures of speech recognition in quiet and noise, sound source localization, tinnitus perception, and quality of life for this patient population. Expert consensus and systematic review of the current literature were combined to provide guidance for the clinical assessment and management of adults with SSD.

Effects of hearing aids in patients with unilateral tinnitus with acquired ipsilateral sensorineural hearing loss

OBJECTIVES

To evaluate the effectiveness of sound therapy using hearing aids in patients experiencing tinnitus with acquired unilateral sensorineural hearing loss.

METHODS

A total of 97 patients with unilateral tinnitus with acquired ipsilateral sensorineural hearing loss were included. Evaluation involved self-report questionnaires administered at entry, 3 months after treatment, and 1 year after treatment.

RESULTS

The mean Tinnitus Handicap Inventory score before treatment decreased significantly (p < 0.01) at 3 months (50.0 ± 24.5-12.7 ± 16.2), and 1 year (53.3 ± 25.5-8.79 ± 13.9), after treatment. Moreover, the visual analog scale score decreased significantly at 3 months (loudness, 69.6 ± 21.9-29.1 ± 27.2; annoyance, 71.1 ± 24.7-22.7 ± 25.5) and 1 year (loudness, 69.8 ± 22.0-21.1 ± 26.1; annoyance, 72.7 ± 25.6-19.4 ± 27.6). Approximately 80-90% of patients noticed improvements in tinnitus annoyance and loudness, as determined by their responses to the questionnaires of subjective symptom improvement.

CONCLUSIONS

Hearing aids are remarkably effective for patients with unilateral tinnitus with acquired ipsilateral sensorineural hearing loss.

Guidelines for Best Practice in the Audiological Management of Adults Using Bimodal Hearing Configurations

Clinics are treating a growing number of patients with greater amounts of residual hearing. These patients often benefit from a bimodal hearing configuration in which acoustic input from a hearing aid on 1 ear is combined with electrical stimulation from a cochlear implant on the other ear. The current guidelines aim to review the literature and provide best practice recommendations for the evaluation and treatment of individuals with bilateral sensorineural hearing loss who may benefit from bimodal hearing configurations. Specifically, the guidelines review: benefits of bimodal listening, preoperative and postoperative cochlear implant evaluation and programming, bimodal hearing aid fitting, contralateral routing of signal considerations, bimodal treatment for tinnitus, and aural rehabilitation recommendations.

Speech perception abilities of adult cochlear implant listeners with single-sided deafness vs. bilateral hearing loss

OBJECTIVES

The purpose of this study was to compare the speech perception abilities in adult cochlear implant recipients implanted for bilateral sensorineural hearing loss (BSNHL) with those implanted for single-sided deafness (SSD).

DESIGN

A total of 12 adults with BSNHL and 12 adults with SSD participated. Each participant completed a battery of speech perception measures including monosyllabic words, sentences, and consonant recognition.

RESULTS

Cochlear implant users with BSNHL performed higher on word and sentence recognition. Consonant recognition scores showed higher performance for CI listeners with BSNHL for voicing and manner, but not for place or articulation.

CONCLUSIONS

Results of this study suggest that adults with SSD may have lower speech perception abilities with their cochlear implant when compared to adults implanted for BSNHL.

Conversations in Cochlear Implantation: The Inner Ear Therapy of Today

As biomolecular approaches for hearing restoration in profound sensorineural hearing loss evolve, they will be applied in conjunction with or instead of cochlear implants. An understanding of the current state-of-the-art of this technology, including its advantages, disadvantages, and its potential for delivering and interacting with biomolecular hearing restoration approaches, is helpful for designing modern hearing-restoration strategies. Cochlear implants (CI) have evolved over the last four decades to restore hearing more effectively, in more people, with diverse indications. This evolution has been driven by advances in technology, surgery, and healthcare delivery. Here, we offer a practical treatise on the state of cochlear implantation directed towards developing the next generation of inner ear therapeutics. We aim to capture and distill conversations ongoing in CI research, development, and clinical management. In this review, we discuss successes and physiological constraints of hearing with an implant, common surgical approaches and electrode arrays, new indications and outcome measures for implantation, and barriers to CI utilization. Additionally, we compare cochlear implantation with biomolecular and pharmacological approaches, consider strategies to combine these approaches, and identify unmet medical needs with cochlear implants. The strengths and weaknesses of modern implantation highlighted here can mark opportunities for continued progress or improvement in the design and delivery of the next generation of inner ear therapeutics.

Tinnitus suppression with electrical stimulation in adults: long-term follow-up

Objectives

To investigate the long-term effects of cochlear implants as a treatment for patients with severe to profound neurosensory loss associated with severe tinnitus.

Methods

Prospective study in 17 adult patients with severe to profound sensorineural hearing loss associated with severe tinnitus, indicated with a Tinnitus Handicap Inventory (THI) score ≥ 58%, and hyperacusis. Measures were made on hearing, tinnitus, hyperacusis and quality of life up to 5 years after activation of the sound processor of the cochlear implant. It was evaluated by using the disyllabic test, THI, visual analogue scale and Glasgow Benefit Inventory questionnaire.

Results

60 months after cochlear implantation, improvements in loudness and discomfort of tinnitus, speech discrimination and hyperacusis were observed. Subjects perceive an important subjective benefit upon receiving the cochlear implant.

Conclusions

Cochlear implants can be used as treatment for patients with severe to profound sensorineural hearing loss associated with severe tinnitus and hyperacusis with long-term benefits on quality of life and lasting relief of tinnitus.

Electrical stimulation of the cochlea for treatment of chronic disabling tinnitus: an open-label trial towards the development of an implantable device

Background

Chronic tinnitus affects millions of people globally and constitutes the most commonly compensated disability among military service members in the United States. Existing treatment options largely surround helping patients cope with their disease as opposed to directly suppressing tinnitus perception. The current study investigated the efficacy of electrical stimulation of the cochlea on chronic disabling tinnitus.

Methods

In this single-arm, open-label clinical trial, 22 adult subjects with severe-range asymmetric or unilateral non-pulsatile tinnitus underwent electrical stimulation of the cochlea through use of an extra-cochlear electrode positioned on the cochlear promontory. Each subject underwent 3 stimulation treatments over 3 weeks at 7-day intervals. Tinnitus severity was determined by Tinnitus Handicap Inventory (THI), Tinnitus Functional Index (TFI), and Tinnitus Visual Analog Scale (VAS). Inclusion criteria required subjects have no worse than moderate sensorineural hearing loss determined by pre-enrollment audiometric testing. The primary outcome was nadir post-treatment THI scores, obtained at seven timepoints following electrical stimulation, with clinically significant improvement defined as a decrease of  ≥ 7.

Results

All 22 (100%) subjects experienced clinically significant improvement in the THI during the study period with a mean decrease in scores of − 31 (95% CI − 38 to − 25) from a baseline of 48. Twenty (91%) experienced clinically significant improvement detectable on at least two of the three tinnitus survey instruments and 17 (77%) experienced clinically significant improvement detectable on all three survey instruments (i.e., THI, TFI, and VAS). Eight (36%) subjects reported either complete (THI of 0; n  = 3) or near-complete (THI 1–4; n  = 5) suppression of their tinnitus following a stimulation session. Thirteen (59%) subjects reported a nadir following stimulation at or below the threshold for “no or slight handicap” on the THI (≤ 16). No adverse events were observed.

Conclusions

These findings establish the foundation for the development of an extra-cochlear implantable device that delivers electrical stimulation to the cochlea for the treatment of disabling tinnitus. For patients considering device implantation, trans-tympanic cochlear promontory stimulation can facilitate patient selection.

Trial Registration ClinicalTrials.gov Identifier: NCT03759834. URL: https://clinicaltrials.gov/ct2/show/NCT03759834

Supplementary Information

The online version contains supplementary material available at 10.1186/s12967-022-03271-4.

Speech Perception Performance Growth and Benchmark Score Achievement After Cochlear Implantation for Single-Sided Deafness

OBJECTIVES

Compare speech perception performance growth and benchmark score achievement among adult cochlear implant (CI) recipients with single-sided deafness (SSD) versus bilateral moderate to profound hearing loss.

STUDY DESIGN

Retrospective matched cohort analysis.

SETTING

Tertiary referral center.

PATIENTS

Adults with SSD or bilateral moderate to profound hearing sensorineural hearing loss who underwent cochlear implantation from 2014 to 2019.

INTERVENTIONS

Cochlear implantation.

MAIN OUTCOME MEASURES

Time-to-benchmark speech perception score (CNC, AzBio in quiet) and speech performance within first postoperative year.

RESULTS

Thirty-three SSD patients were matched to 66 bilateral hearing loss patients (referent cohort) for duration of deafness and preoperative ipsilateral CNC scores. Although SSD patients were more likely to achieve benchmark CNC scores more quickly compared with matched referents, this difference did not reach statistical significance (HR 1.72; 95% CI 0.78-3.82; p = 0.18). AzBio scores showed similar trends (HR 1.40; 95% CI 0.66-2.98; p = 0.38). At last follow-up, the SSD cohort had lower CNC (median 54% vs. 62%; p = 0.019) and AzBio scores (median 72% vs. 84%; p = 0.029) compared to the referent cohort.

CONCLUSIONS

No significant difference in speech perception performance growth (i.e., time-to-benchmark speech perception score) was identified between SSD and bilateral hearing loss CI recipients, although patients with bilateral hearing loss achieved higher scores in the implanted ear within the first year of follow-up.

Impact of Duration of Deafness on Speech Perception in Single-Sided Deafness Cochlear Implantation in Adults

OBJECTIVE

To evaluate the impact of prolonged auditory deprivation on speech perception outcomes in adult acquired single-sided deafness (SSD) cochlear implant (CI) recipients.

STUDY DESIGN

Retrospective case series.

SETTING

Tertiary care academic center.

PATIENTS

Acquired SSD in adults with and without prolonged duration of deafness (defined as >10 yr) who underwent CI between 2014 and 2019.

INTERVENTIONS

CI.

MAIN OUTCOME MEASURES

Consonant-nucleus-consonant (CNC) and AzBio in quiet scores within first year of follow-up.

RESULTS

A total of 35 adult patients with SSD were evaluated, with a median overall duration of deafness of 2.4 years (interquartile range [IQR] 1.2-6.0 yr): seven patients with prolonged auditory deprivation (median 18 yr, IQR 15-28) were compared with 28 SSD patients with duration of deafness less than 10 years (median 1.7 yr, IQR 1.1-3.2). At last follow-up, the median CNC scores were 39% (IQR 31-64) and 54% (IQR 46-64) for the prolonged and shorter duration of deafness cohorts, respectively (p = 0.3). The median AzBio scores were 66% (IQR 65-68) and 72% (IQR 60-82) for the prolonged and shorter duration of deafness cohorts, respectively (p = 0.6). In a separate analysis evaluating duration of deafness as a continuous variable across all 35 patients, Spearman correlation coefficients for associations of duration of deafness with most recent CNC and AzBio scores were -0.02 (p = 0.9) and 0.02 (p = 0.9), respectively.

CONCLUSIONS

Adult CI recipients with acquired SSD, with and without prolonged auditory deprivation, demonstrated comparable speech perception scores. Prolonged duration of deafness alone should not preclude a motivated SSD patient from undergoing cochlear implantation.

Rehabilitation for unilateral deafness - Narrative review comparing a novel bone conduction solution with existing options

Patients with single sided deafness (SSD) struggle with sound localization and speech in noise. Existing treatment options include contralateral routing of signal (CROS) systems, percutaneous bone conduction hearing devices (BCHDs), passive transcutaneous BCHDs, active BCHDs, and cochlear implants. Implanted devices provide benefits in speech in noise compared to CROS devices. Percutaneous BCHDs transmit sound efficiently but have aesthetic drawbacks and skin complications. Scalp attenuation impacts passive transcutaneous BCHD performance. Active BCHDs overcome these issues and provide benefits for speech in noise. Cochlear implantation is the only existing option that restores binaural input but introduces electrical rather than acoustic stimuli to the deaf ear. Active BCHDs have been designed to maintain efficient sound transmission and avoid chronic skin irritation and cosmetic concerns that may occur with percutaneous BCHDs. Cochlear implantation may be a superior option for recently deafened SSD patients, though this requires further study. The duration of deafness, patient age and comorbidities, and a shared decision-making model among patients, surgeons, and audiologists should be considered in device selection. The aim of this manuscript is to review available devices, discuss surgical considerations for implantable devices, review available published results for speech in noise and sound quality with each device, and provide an overview to guide shared decision making for patients and providers. This review consolidates available literature and reviews experience with a newer active transcutaneous active BCHD available for use in the SSD population.

Evolution in Surgical Treatment of Vestibular Schwannomas

Purpose of Review

Management of vestibular schwannomas (VSs) is multimodal and include watchful observation, radiation treatment, and surgery. Over the past decades, a shift in treatment strategy toward radiation treatment has gradually displaced surgery from the main treatment option for VS. In recent years, however, surgery has been further refined by developments of microsurgical and endoscopic techniques and advances in intraoperative application of neuroprotective drugs. This article presents outcomes of modern surgical treatment of VS in the era of radiosurgery and reviews recent published advancements relevant to VS management.

Recent Findings

Following VS surgery, excellent tumor resection rates and cranial nerve outcomes were achieved in a consecutive series of 572 adult patients with mean postoperative follow up of 4 years. Innovations in surgical technique include endoscopic technique as additional tool to microsurgery, exploration of semi-sitting position for large tumors, and intraoperative use of vasoactive agents as neuroprotective strategy.

Summary

Despite great developments in radiation treatment of VS, surgery remains the key solution for the majority of the cases in order to achieve cure of the disease, long-term tumor control, and preservation of cranial nerve function at long-term.

Cochlear Implantation in Adults With Single-sided Deafness: Outcomes and Device Use

OBJECTIVE

To describe our experience with adults undergoing cochlear implantation (CI) for treatment of single-sided deafness (SSD).

STUDY DESIGN

Retrospective case review.

SETTING

Tertiary referral center.

PATIENTS

Fifty-three adults with SSD.

INTERVENTIONS

Unilateral CI.

MAIN OUTCOME MEASURES

Speech perception testing in quiet and noise, tinnitus suppression, and device usage from datalogs.

RESULTS

The mean age at CI was 53.2 years (SD 11.9). The mean duration of deafness was 4.0 years (SD 7.8). The most common etiology was idiopathic sudden SNHL (50%). Word recognition improved from 8.7% (SD 15) preoperatively to 61.8% (SD 20) at a mean follow-up of 3.3 years (SD 1.8) (p < 0.0001). Adaptive speech recognition testing in the "binaural with CI" condition (speech directed toward the front and noise toward the normal hearing ear) revealed a significant improvement by 2.6-dB SNR compared to the preoperative unaided condition (p = 0.0002) and by 3.6-dB SNR compared to when a device to route sound to the contralateral side was used (p < 0.0001). Tinnitus suppression was reported to be complete in 23 patients (43%) and improved in 20 patients (38%) while the device was on. The addition of the CI did not lead to a decrement in hearing performance in any spatial configuration. Device usage averaged 8.7 (SD 3.7) hours/day.

CONCLUSIONS

Cochlear implantation in adult SSD patients can suppress tinnitus and achieve speech perception outcomes comparable with CI in conventional candidates. Modest improvements in spatial hearing were also observed and primarily attributable to the head shadow effect. Careful patient selection and counseling regarding potential benefits are important to optimize outcomes.

Early Outcomes of Simultaneous Translabyrinthine Resection and Cochlear Implantation

OBJECTIVES/HYPOTHESIS

Hearing rehabilitation after translabyrinthine resection of a vestibular schwannoma (VS) has largely been based on the transfer of acoustic stimulus to the contralateral ear, typically through a contralateral routing of signal hearing aid or bone-anchored hearing aid (BAHA). Cochlear implant, either as a subsequent surgery or simultaneously, has become a more common treatment option; however, there is still relatively limited data available on its success. The purpose of this study is to evaluate the early outcomes of simultaneous cochlear implantation in patients with sporadic VS undergoing translabyrinthine resection.

STUDY DESIGN

Prospective, nonrandomized study.

METHODS

A prospective study of nonrandomized patients was completed at a tertiary care neurotology center. Audiologic outcomes, primarily based on AzBIO in quiet and background noise, as well as consonant-nucleus-consonant (CNC) testing of the affected ears were utilized. Tinnitus, dizziness, and spatial hearing questionnaries were also completed. Audiologic outcomes and questionnaires were compared between the pre- and postoperative groups.

RESULTS

Ten patients were included in the study with 3 month follow-up data. There was statistically significant improvement in AzBO with +10 and +5 signal to noise ratio and in quiet, as well as in CNC testing (P < .05). There was a significant improvement in Tinnitus Handicap Inventory between the two groups.

CONCLUSIONS

Simultaneous cochlear implantation is a viable treatment for hearing loss after translabyrinthine approach to VS. These patients have improved hearing in background noise and tinnitus compared to their preoperative state. Further prognostic data are required to determine which patients are the best candidates.

LEVEL OF EVIDENCE

4 Laryngoscope, 131:E2312-E2317, 2021.

Prospective Multicentric Follow-up Study of Cochlear Implantation in Adults With Single-Sided Deafness: Tinnitus and Audiological Outcomes

Objective:

This study investigated the audiological and tinnitus outcomes of cochlear implantation (CI) in adults with single-sided deafness (SSD) and tinnitus.

Study Design:

Multicentered prospective, non-randomized intervention study.

Setting:

Six French CI centers.

Patients:

Twenty-six patients with SSD and incapacitating tinnitus (Tinnitus Handicap Inventory [THI] >58) underwent cochlear implantation.

Interventions:

First, CIs delivered only masking white noise stimulation for 1 month and then standard CI stimulation.

Main Outcome Measures:

Before and after CI surgery, patients completed the THI, Tinnitus Reaction Questionnaire (TRQ), Subjective Tinnitus Severity Scale (STSS), and two visual analogue scales quantifying tinnitus loudness and annoyance. Speech perception in spatialized noise was tested at 13 months.

Results:

The first month of white noise stimulation triggered a significant improvement in THI scores (72 ± 9 to 55 ± 20, p < 0.05). No change was observed for the other measures. After 1 year of standard CI stimulation, 23 patients (92%) reported a significant improvement in tinnitus. This improvement started 1 to 2 months after CI and exceeded 40% improvement for 14 patients (54%). Average speech-in-noise perception after 1 year significantly improved for the 23 patients who completed these measures.

Conclusions:

CI is efficacious to reduce the handicap of patient with SSD and incapacitating tinnitus, leading to a decrease in reported tinnitus and partial restoration of binaural hearing abilities.

What Makes Tinnitus Loud?

INTRODUCTION

Tinnitus loudness is a subjective measure, and it does not directly reflect either tinnitus severity or the impact on daily life. Nevertheless, loud tinnitus may be the most frequent clinical complaint of tinnitus patients. Factors contributing to the loudness of the phantom sound have rarely been studied. We evaluated both matched and self-rated loudness in a large sample of patients with tinnitus and analyzed the influencing factors among demographic, hearing, and tinnitus characteristics.

METHODS

Two hundred ninety-nine patients with chronic tinnitus were enrolled. We evaluated the matched loudness, minimal masking level (MML), and visual analog scale (VAS) loudness. Stepwise multiple regression analyses were performed for each loudness measure using independent variables of age, sex, time since tinnitus onset, tinnitus laterality, pure-tone average, tinnitus pitch, tinnitus handicap inventory (THI) score, VAS annoyance, disturbance and daily tinnitus duration, and depression score. We calculated bivariate correlations between each loudness measure and all independent variables.

RESULTS

The psychoacoustic loudness measures (matched loudness and MML) were highly correlated and were affected by the hearing deficit and tinnitus pitch (Pearson r > 0.5 for pure tone averages, and r > 0.3 for tinnitus pitch for both variables, p < 0.05), whereas the subjective measurement (VAS loudness) exhibited little to no correlation with the other two measures and was related to psycho-emotional factors such as the THI score, VAS variables, and depression (Pearson r > 0.6 for VAS annoyance, r > 0.4 for VAS daily duration and disturbance and THI score, r > 0.3 for the depression score, p < 0.05).

CONCLUSION

The matched tinnitus loudness and MML values were influenced principally by the extent of hearing loss and related factors, suggesting that rehabilitation using hearing aids could help reduce perception of tinnitus loudness. A psycho-emotional approach might more effectively lessen self-perceived loudness.

Single-sided deafness: Bone conduction devices or cochlear implantation? A systematic review with meta-analysis

OBJECTIVES

To perform a systematic review with meta-analysis of the studies published on the efficacy of bone conduction devices and cochlear implantation in single-sided deafness, through the evaluation of speech discrimination in noise, sound localization and tinnitus suppression. As a secondary outcome, patient satisfaction is also assessed.

DESIGN

A systematic search in PubMed, Embase and CENTRAL was conducted, including all articles written in English and published in the last 10 years. The outcomes selected were speech perception in noise, sound localization, tinnitus intensity and, secondarily, quality of life assessment. Studies that met prospectively defined criteria were subjected to random effects meta-analyses. The review protocol is registered on PROSPERO with number CRD42019121444.

RESULTS

Nineteen articles reporting a total of 210 patients (95 patients with bone conduction devices and 115 in the cochlear implantation group) were included. The meta-analysis identifies statistically significant benefits in cochlear implantation for sound localization, tinnitus suppression, in global quality of life assessment and in 2 of the 3 subscales of quality of life assessment (ease of communication and reverberation). Bone conduction devices are better regarding speech discrimination in noise and background noise quality of life assessment.

CONCLUSION

Cochlear implants effectively offer better results in 2 of the 3 evaluated parameters, being a very valid option. Bone conduction devices should continue to be considered in the treatment of these patients because, in addition to allowing better discrimination in noise, patient satisfaction is greater in environments with background noise.

Cochlear implantation for patients with tinnitus - A systematic review

BACKGROUND

Cochlear implantation (CI) is used in patients with severe-to-profound hearing loss when hearing aids provide limited or no benefit for speech perception. Studies on this topic reported tinnitus reduction as a common side effect of the electrical activation after cochlear implantation. So far, it is unclear what the effect is when patients do receive their implant primarily because of tinnitus complaints.

OBJECTIVES

To assess the effectiveness of the electrical stimulation with a cochlear implant in patients with tinnitus as a primary complaint, by systematically reviewing the literature.

METHODS

Two independent authors identified studies, extracted data and assessed risk of bias of included studies. Original studies reporting outcomes of electrical stimulation by cochlear implantation for primarily tinnitus (defined as severe or incapacitating distress levels) were included, if they reported a follow-up of at least three months. The pre- and post-implantation tinnitus distress scores on single and/or multi-item questionnaires of the included studies were extracted.

RESULTS

In total, 4091 unique articles were retrieved. After screening titles, abstracts and full texts, we included seven prospective cohort studies (105 subjects in total, range: 10-26). All studies had considerable risks of bias. All tinnitus patients in the included studies had asymmetrical hearing loss or single-sided deafness. A statistically significant tinnitus distress improvement based on tinnitus questionnaire scores was found in every study.

CONCLUSION

Our systematic review reveals that electrical stimulation by cochlear implants in patients with a primary complaint of tinnitus has a positive impact on tinnitus distress. Nevertheless, only small sample sizes were found and studies showed considerable risks of bias.^a.

The case for cochlear implantation in unilateral and asymmetric sensorineural hearing loss

PURPOSE OF REVIEW

Cochlear implants have been used to treat bilateral deafness for over 40 years. A more recent development has been the application of this technology toward single-sided deafness (SSD) and asymmetric hearing loss (AHL), culminating in the Food and Drug Administration (FDA) approval in the United States for this indication in July of 2019. This review examines the recent literature on cochlear implants for SSD and AHL, focusing on speech perception, sound localization, tinnitus, and quality of life.

RECENT FINDINGS

There is an expanding body of literature supporting the use of cochlear implant in SSD/AHL patients. The cochlear implant offers a unique rehabilitation option for this subset of patients as it potentially restores binaural hearing (direct stimulation of both ears). A review of the literature reveals significant improvements with the cochlear implant in speech perception in quiet and noise, sound localization, tinnitus, and quality of life. In addition, these improvements appear to be greater than what conventional options such as a contralateral routing of signal (CROS) hearing aid and bone conduction device (BCD) are able to achieve.

SUMMARY

Cochlear implants offer additional benefits over previously available options of CROS and BCDs and have recently been approved by the FDA for use in patient with SSD/AHL. Given the growing body of literature demonstrating the benefit of cochlear implant over other devices, it is important to offer cochlear implant as an option to these patients.

[Hearing rehabilitation using a cochlear implant - a way of reducing tinnitus in the elderly]

BACKGROUND

Tinnitus is a common symptom of severe hearing loss or deafness especially in older people. Hearing rehabilitation for these patients is usually only possible with a cochlear implant (CI). In recent years, an increasing number of old and very old patients have been treated with a CI. The aim of this study was to examine the influence of hearing rehabilitation with a CI on the tinnitus of older people.

MATERIALS AND METHODS

In this prospective study 34 patients between the age of 65 and 86 were included, who were unilaterally treated with a CI for the first time. 16 patients (47.1 %) had tinnitus preoperatively. At three time points (preoperative, on initial fitting and six months postoperatively), tinnitus severity was assessed in addition to speech discrimination in patients with tinnitus using the mini-tinnitus questionnaire (Mini-TF12).

RESULTS

Six month postoperatively we found a highly significant improvement of speech discrimination (preoperatively 11.5 ± 17.4, six-month visit 54.4 ± 28.1 %, p = 0.001) that was accompanied by a highly significant reduction in tinnitus severity according to Mini-TF12 scores (preoperatively 6.9 ± 6.5, six-month visit 4.3 ± 3.3, p = 0.001).

CONCLUSIONS

Hearing rehabilitation by means of CI leads to a highly significant reduction of tinnitus severity of pre-operatively existing tinnitus in the elderly.

Current Device-based Clinical Treatments for Tinnitus

Device-based clinical treatments for tinnitus are predominantly sound based and include ear-level sound generators, hearing aids, cochlear implants, and tinnitus treatment devices. They are intended for patients with bothersome tinnitus. Bothersome tinnitus is characterized by problems with sleep, concentration, and mood. Most people with bothersome tinnitus have hearing loss and would benefit from amplification; however, not all patients are willing to use hearing aids. Tinnitus treatment devices are available to assist those who are not good candidates for amplification, and include devices used while sleeping and devices used for specified periods during the day.

New Medical Device and Therapeutic Approvals in Otolaryngology: State of the Art Review of 2019

OBJECTIVE

To review new devices and drugs relevant to otolaryngology-head and neck surgery that were approved by the US Food and Drug Administration (FDA) in 2019.

DATA SOURCES

Approval notifications for 2019 were extracted from the ENT (ear, nose, and throat) and general and plastic surgery sections of the FDA's medical devices and therapeutics listings.

REVIEW METHODS

New therapeutics and medical devices identified from the query were analyzed by members of the American Academy of Otolaryngology-Head and Neck Surgery's Medical Devices and Drugs Committee. Technologies were assessed by 2 independent reviewers to ascertain relevance to otolaryngology, prioritized, and classified to subspecialty field with critical review based on extant scientific literature.

CONCLUSIONS

Query of the FDA drug and device database returned 105 ENT devices (50 cleared, 55 with premarket approval, and 0 de novo), 543 general and plastic surgery devices (372 cleared, 170 with premarket approval, and 1 de novo), and 46 new otolaryngology-relevant drug approvals that occurred in 2019. Advances spanned all subspecialty areas with otology predominating, primarily due to hearing-related technologies. While scientific evidence was available for all new devices, there was significant heterogeneity in rigor of supporting scientific data.

IMPLICATIONS FOR PRACTICE

Technological and pharmaceutical innovation is an important catalyst for advances in the surgical specialties. Familiarity with new devices and therapeutics in otolaryngology-head and neck surgery ensures that clinicians keep abreast of developments with potential to improve prevailing standards of care.

Core Rehabilitation Outcome Set for Single Sided Deafness (CROSSSD) study: protocol for an international consensus on outcome measures for single sided deafness interventions using a modified Delphi survey

BACKGROUND

Single-sided deafness (SSD) describes the presence of a unilateral severe to profound sensorineural hearing loss. SSD disrupts spatial hearing and understanding speech in background noise. It has functional, psychological and social consequences. Potential options for rehabilitation include hearing aids and auditory implants. Benefits and harms of these interventions are documented inconsistently in the literature, using a variety of outcomes ranging from tests of speech perception to quality of life questionnaires. It is therefore difficult to compare interventions when rehabilitating SSD. The Core Rehabilitation Outcome Set for Single Sided Deafness (CROSSSD) study is an international initiative that aims to develop a minimum set of core outcomes for use in future trials of SSD interventions.

METHODS/DESIGN

The CROSSSD study adopts an international two-round online modified Delphi survey followed by a stakeholder consensus meeting to identify a patient-centred core outcome domain set for SSD based on what is considered critical and important for assessing whether an intervention for SSD has worked.

DISCUSSION

The resulting core outcome domain set will act as a minimum standard for reporting in future clinical trials and could have further applications in guiding the use of outcome measures in clinical practice. Standardisation will facilitate comparison of research findings.

Corticostriatal functional connectivity of bothersome tinnitus in single-sided deafness

Subjective tinnitus is an auditory phantom perceptual disorder without an objective biomarker. Bothersome tinnitus in single-sided deafness (SSD) is particularly challenging to treat because the deaf ear can no longer be stimulated by acoustic means. We contrasted an SSD cohort with bothersome tinnitus (TIN; N = 15) against an SSD cohort with no or non-bothersome tinnitus (NO TIN; N = 15) using resting-state functional magnetic resonance imaging (fMRI). All study participants had normal hearing in one ear and severe or profound hearing loss in the other. We evaluated corticostriatal functional connectivity differences by placing seeds in the caudate nucleus and Heschl’s Gyrus (HG) of both hemispheres. The TIN cohort showed increased functional connectivity between the left caudate and left HG, and left and right HG and the left caudate. Within the TIN cohort, functional connectivity between the right caudate and cuneus was correlated with the Tinnitus Functional Index (TFI) relaxation subscale. And, functional connectivity between the right caudate and superior lateral occipital cortex, and the right caudate and anterior supramarginal gyrus were correlated with the TFI control subscale. These findings support a striatal gating model of tinnitus and suggest tinnitus biomarkers to monitor treatment response and to target specific brain areas for innovative neuromodulation therapies.

Hearing Preservation and Speech Outcomes After Cochlear Implantation in Meniere's Disease

OBJECTIVES/HYPOTHESIS

To evaluate speech perception outcomes and hearing preservation after cochlear implantation in patients with Meniere's disease (MD).

STUDY DESIGN

Retrospective chart review.

METHODS

Fifty-one adult patients, accounting for a total of 63 implants, with MD treated at a tertiary care center were included in the study. Patients with unaided preoperative air-conduction thresholds ≤80 dB at 250 Hz were included in hearing preservation analyses. The primary outcome measure was Consonant-Nucleus-Consonant (CNC) score. Hearing preservation was assessed as follows: 1) maintenance of functional hearing, defined as a postoperative unaided air-conduction threshold ≤80 dB at 250 Hz and 2) low-frequency pure-tone average (LFPTA) shift.

RESULTS

Speech perception scores improved significantly postimplantation; specifically, the CNC mean score was 9% preoperatively and increased to 57% by 1 year postoperatively (P < .001). Eighteen ears were included in hearing preservation analysis; the mean preoperative LFPTA was 65 dB (standard deviation [SD] = 10). The mean postoperative LFPTA at activation was 93 dB (SD = 21), and at 1 year was 102 dB (SD = 11). Twenty-seven percent of patients achieved short-term functional hearing preservation, whereas the longer-term outcomes were less favorable (11%).

CONCLUSIONS

Speech perception scores improve after implantation in patients with MD. Hearing preservation is possible in patients with MD, albeit at lower rates than reported non-MD populations. Our data suggest that there can be degradation in acoustic hearing over time.

LEVEL OF EVIDENCE

4 Laryngoscope, 2019.

Quantifying tinnitus suppression in cochlear implantation using tinnitus interval-limited tracking

OBJECTIVES

Quantify the effects of cochlear implants (CI) on tinnitus suppression in patients with previous cochlear implantation using a novel audiologic sequence: Tinnitus Interval Limited Tracking (TILT).

STUDY DESIGN

Prospective cohort study.

METHODS

Consecutive patients with tinnitus and previous cochlear implantation for profound hearing loss underwent an audiologic testing sequence called TILT. Patients rated tinnitus severity using the validated Tinnitus Handicap Inventory (THI) as well as a visual analog scale at baseline and in a variety of audiologic scenarios. Changes in tinnitus severity between scenarios allow for the isolation of the effects of masking and electrical stimulation on the reduction of tinnitus.

RESULTS

Twenty patients were enrolled, 10 of whom have tinnitus with average THI 30.2 (standard deviation 22.6). Patients had an acute decrease in tinnitus severity when their CIs were turned on, even in the absence of noise in a soundproof booth. This effect reversed once the CIs were turned off. This effect was greater in magnitude than with masking that occurred with the presentation of soft speech. Acute tinnitus severity trended toward improvement with increased level of presented speech. Degree of improvement was not correlated with THI.

CONCLUSION

Acute tinnitus suppression in patients using CIs is multifactorial. Masking plays a role; however, it cannot sufficiently account for the totality of symptom improvement experienced by CI patients. Quantifiable tinnitus suppression observed when a CI is turned on, even in the absence of audiologic stimulation, suggests that electrical stimulation is involved in the mechanism of symptom improvement in these patients.

LEVEL OF EVIDENCE

4 Laryngoscope, 130: 2047-2052, 2020.

Age-related hearing loss and tinnitus, dementia risk, and auditory amplification outcomes

Age-related hearing loss (ARHL) or presbycusis, as the third leading cause of chronic disability in older adults, has been shown to be associated with predisposing cognitive impairment and dementia. Tinnitus is also a chronic auditory disorder demonstrating a growth rate with increasing age. Recent evidence stands for the link between bothersome tinnitus and impairments in various aspects of cognitive function. Both ARHL and age-related tinnitus affect mental health and contribute to developing anxiety, stress, and depression. The present review is a comprehensive multidisciplinary study on diverse interactions among ARHL, tinnitus, and cognitive decline in older adults. This review incorporates the latest evidence in prevalence and risk factors of ARHL and tinnitus, the neural substrates of tinnitus-related cognitive impairments, hypothesized mechanisms concerning the association between ARHL and increased risk of dementia, hearing amplification outcomes in cases with ARHL and cognitive decline, and preliminary findings on the link between ARHL and cognitive impairment in animal studies. Given extensive evidence that demonstrates advantages of using auditory amplification in the alleviation of hearing handicap, depression, and tinnitus, and the improvement of cognition, social communication, and quality of life, regular hearing screening programs for identification and management of midlife hearing loss and tinnitus is strongly recommended.

A Prospective Randomized Crossover Study in Single Sided Deafness on the New Non-Invasive Adhesive Bone Conduction Hearing System

BACKGROUND

Recently, an adhesive bone conduction hearing system has been developed for conductive hearing loss or single-sided deafness (SSD). In SSD cases, this device may be a good solution for patients who are unsuitable for, or who do not wish to undergo, bone conduction implant or cochlear implant surgery. The study aimed to investigate the hearing outcomes with the adhesive hearing system in SSD.

PURPOSE OF THE STUDY

The study aimed to investigate the hearing outcomes with the adhesive hearing system in SSD.

METHODS

A randomized crossover study was conducted in 17 SSD participants, using CROS (contralateral routing of signals) hearing aid as a control. Following outcome measurements were administered after a two-week trial: 1) Speech, Spatial and Qualities scale, Audio Processor Satisfaction Questionnaire, and a custom-made questionnaire about the use of the system, 2) sound localization, 3) speech perception in noise.

RESULTS

70% of the SSD subjects reported that the adhesive hearing system was partially useful or better. Using the APSQ, the adhesive test device was evaluated equally as the control device. Sound localization improved with the adhesive test device and deteriorated with the control device. There was no improvement in speech perception in noise measured with the adhesive test device. Speech perception in noise (SSSDNNH) with the control device improved significantly.

CONCLUSION

To the best of our knowledge, this is the first study to report on the outcomes of the new adhesive system. Users' satisfaction of the adhesive hearing system was found to be comparable to the control device. Since the hearing outcomes vary highly between patients, trials with applicable hearing systems are recommended in SSD patients.

Evaluating the Long-Term Hearing Outcomes of Cochlear Implant Users With Single-Sided Deafness

OBJECTIVES

To investigate the long-term outcomes of cochlear implantation in individuals with single-sided deafness (SSD) in terms of speech perception, subjective hearing performance, and sound localization.

METHODS

Thirty-four subjects with SSD were recruited across two large cochlear implant (CI) centers (Antwerp, Belgium and Perth, Australia). The long-term hearing outcomes (between 4 and 10 years of CI use) were evaluated using speech in noise tests, a subjective hearing performance questionnaire (Speech, Spatial and Qualities Questionnaire [SSQ12]), and sound localization tests.

RESULTS

Statistically significant improvements were observed in speech perception in noise and sound localization results postoperatively with the use of a CI in comparison to preoperative measurements. Subjective hearing abilities also significantly improved after long-term CI use.

CONCLUSION

Access to binaural hearing is important for subjects with SSD. CI users with SSD experience long-term benefits in speech understanding, sound localization, and quality of life.

The Influence of Cochlear Implantation on Tinnitus in Patients with Single-Sided Deafness: A Systematic Review

Objectives

This systematic review provides an overview of the available studies (published by January 29, 2018) with descriptive data analysis about the influence of cochlear implantation on tinnitus in patients with single-sided deafness (SSD).

Data Sources

PubMed, EMBASE, Web of Science, Cochrane Library, and Google Scholar.

Review Methods

Original studies about the influence of cochlear implantation on tinnitus, measured with different tinnitus questionnaires or visual analog scale, in patients with SSD were included. The pre- and postimplantation tinnitus scores of the included studies were extracted for the further systematic review.

Results

The systematic search yielded 1028 studies. After evaluating titles, abstracts, and full texts, 1011 of these were dismissed. From the remaining 17 studies, 4 showed a low directness of evidence or high risk of bias and were therefore excluded. Due to the nature of cochlear implantation in SSD, only cohort studies and no randomized trials exist, which limits the evaluation in a systematic review. Generally, the mean tinnitus questionnaire scores decreased after cochlear implantation in these 13 studies with a total of 153 patients. The most widely used tinnitus questionnaire was the Tinnitus Handicap Inventory. In these studies, 34.2% of patients demonstrated complete suppression, 53.7% an improvement, 7.3% a stable value, and 4.9% an increase of tinnitus, and none of the patients reported an induction of tinnitus.

Conclusion

This review shows a clear improvement of tinnitus complaints after cochlear implantation in patients with SSD. Therefore, tinnitus might be considered as an additional indication for cochlear implantation in SSD.

One-Year Results for Patients with Unilateral Hearing Loss and Accompanying Severe Tinnitus and Hyperacusis Treated with a Cochlear Implant

OBJECTIVE

To show that patients with unilateral hearing loss (UHL), with one ear fulfilling cochlear implant (CI) indication criteria, and an additional severe tinnitus handicap can be treated effectively with a CI.

METHOD

A prospective multi-centre study was conducted in five Spanish centres. Sixteen adult patients with UHL and a mean Tinnitus Handicap Inventory (THI) score of at least 58 were implanted. The study design included repeated within-subject measures of quality of life (Health Utility Index Mark 3 [HUI3]), tinnitus (THI, Visual Analogue Scale [VAS] on tinnitus loudness), hearing (Speech, Spatial, and Qualities of Hearing Scale- [SSQ]), and hyperacusis (Test de Hipersensibilidad al Sonido [THS]) up to 12 months after the initial CI fitting.

RESULTS

Group data showed significant subjective benefit from CI treatment: the preoperative HUI3 total utility score of 0.45 went up to 0.57 at 6 months and 0.63 at 12 months; the preoperative THI total score of 75 decreased to 40 at 6 months and 35 at 12 months. The preoperative tinnitus loudness VAS score of 8.2 decreased to 2.4 at 6 months and 2.2 at 12 months with the implant "On" and to 6.7 at 6 months and 6.5 at 12 months with the implant "Off." The preoperative THS total score of 26 decreased to 17 at 12 months. The preoperative SSQ total score of 4.2 increased to 5.1 at 6 months and 6.3 at 12 months. No unanticipated adverse events were reported during the study period. At 12 months after CI activation all subjects (except 1 subject who used the device 6 days a week) wore their devices all day and every day. The primary reason for CI use was split evenly between tinnitus suppression (n = 6) and both hearing and tinnitus (n = 6).

CONCLUSION

A CI should be considered as a treatment option in patients with UHL and a concomitant severe tinnitus handicap. However, appropriate counselling of candidates on the anticipated risks, benefits, and limitations that are inherent to cochlear implantation is imperative.

Postoperative Tinnitus After Vestibular Schwannoma Surgery Depends on Preoperative Tinnitus and Both Pre- and Postoperative Hearing Function

Objective

Tinnitus is one of the most common symptoms before and/or after the surgical removal of a vestibular schwannoma (VS) affecting almost half of the patients. Although there is increasing evidence for the association of hearing impairment and VS-associated tinnitus, the effect of hearing deterioration due to surgery and its relation to the postoperative tinnitus (postTN) is poorly investigated. This knowledge, however, might (i) enlighten the pathophysiology of VS-associated tinnitus (i.e., peripheral or central origin) and (ii) improve preoperative patient counseling. The aim of this study was to understand the predisposition factors for a postTN in relation to hearing outcome after surgery.

Methods

This retrospective study analyzed the presence of tinnitus in 208 patients with unilateral VS before and after surgical removal. A binomial logistic regression was performed to ascertain the effect of pre- and postoperative hearing as well as age, gender, tumor side, and size, and intraoperative cochlear nerve resection (CNR) on the likelihood of postoperative VS-associated tinnitus.

Results

Preoperative tinnitus was the strongest predictor of postTN. In addition, deterioration of functional hearing was increasing, while functional deafferentation (i.e., postoperative hearing loss) of non-functional hearing was reducing the risk of postTN. At the same time, patients with no preoperative tinnitus but complete hearing loss had the lowest risk to suffer from postTN. Patient age, gender, tumor side, and size as well as CNR played a subordinate role.

Conclusion

While the presence of preoperative tinnitus was the strongest predictor of postTN, there is a distinct relationship between hearing outcome and postTN depending on the preoperative situation. Functional or anatomical deafferentation due to surgical tumor removal does not prevent postTN per se.