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

Tinnitus reduction after active bone-conduction implantation in patients with single-sided deafness: a prospective multicenter study

PURPOSE

Single-sided deafness (SSD) presents significant challenges for patients, including compromised sound localization, reduced speech recognition, and often, tinnitus. These issues are typically addressed using interventions such as cochlear implantation (CI) and bone conduction implant (BCI). However, evidence regarding the efficacy of BCI in reducing tinnitus in SSD patients remains limited. This study explored the ability of a novel active transcutaneous BCI (Bonebridge BCI602) to alleviate tinnitus in SSD patients.

STUDY DESIGN

Prospective cohort multicenter study.

SETTING

Tertiary referral hospitals.

METHODS

A prospective multicenter study of 30 SSD patients was conducted. The patients were divided into two groups: those with (n = 19) and without (n = 11) tinnitus. Audiometric assessments, subjective questionnaires including the Abbreviated Profile of Hearing Aid Benefit (APHAB) and the Bern Benefit in Single-Sided Deafness (BBSS), and tinnitus evaluations with the Tinnitus Handicap Inventory (THI) and tinnitogram were conducted before and after BCI surgery.

RESULTS

THI scores after surgery were significantly reduced in SSD patients with tinnitus. Subjective satisfaction improved in both the tinnitus and non-tinnitus groups; however, the former group exhibited a significantly greater improvement in the APHAB questionnaire score. According to tinnitograms, the loudness of tinnitus decreased, particularly in patients with ipsilateral tinnitus. Patients with residual hearing had greater reductions in their THI scores. However, three patients without residual hearing had a relative worsening of tinnitus after surgery.

CONCLUSION

The Bonebridge BCI602 effectively reduced tinnitus in SSD patients, particularly in those with residual hearing. Subjective satisfaction improved in both the tinnitus and non-tinnitus groups. These findings demonstrate the therapeutic potential of BCI for managing SSD and associated tinnitus.

The Benefits of Cochlear Implantation for Adults: A Systematic Umbrella Review

OBJECTIVES

The uptake of cochlear implants among adults who could benefit (based on pure-tone audiometry) in developed countries is estimated to be less than 10%. Concerns about potential surgical complications, fear of losing residual hearing, and limited awareness about the benefits of this intervention contribute to the low adoption rate. To enhance quality of life and improve the uptake of cochlear implants, it is essential to have a clear understanding of their benefits.

DESIGN

This umbrella review aims to summarize the major benefits of cochlear implant usage in adults, by synthesizing findings from published review articles. A comprehensive search of databases including MEDLINE, EMBASE, PsycINFO, and Google Scholar, was conducted. The search was limited to English-language review articles published between 1990 and 2022, focusing on cochlear implant outcomes in at least 5 adults (aged ≥18 years). Two independent reviewers screened titles, abstracts, and full-text articles, and conducted a quality assessment using the Joanna Briggs Checklist for Systematic Reviews and Research Syntheses.

RESULTS

Forty-two articles were included in this review. There were 15 systematic reviews with meta-analysis, 25 systematic reviews without meta-analysis, and 2 systematic scoping reviews. All 42 articles underwent quality assessment using the Joanna Briggs Institute Checklist for Systematic Reviews and Research Syntheses, of which 40% (n = 17) satisfied 9 out of 11 quality criteria. This umbrella review shows that cochlear implants are associated with improvements in speech perception and recognition as well as improved quality of life and cognition. These benefits are observed in a significant proportion of adults undergoing the procedure, highlighting its effectiveness as a viable intervention for individuals with severe to profound hearing loss.

CONCLUSIONS

The potential benefits of cochlear implantation appear to outweigh the risks and complications associated with the procedure. It is recommended that adults with severe to profound hearing loss in particular, engage in informed discussions with healthcare professionals to consider cochlear implantation as a viable treatment option.

The Chronological Evolution of Cochlear Implant Contraindications: A Comprehensive Review

Cochlear implantation has emerged as a transformative intervention in addressing profound hearing loss, offering a paradigm shift in auditory rehabilitation for individuals with restricted auditory function. Throughout its history, the understanding of contraindications for cochlear implant (CI) surgery has evolved significantly. This review comprehensively analyzes the chronological advancements in the understanding of CI contraindications, examining studies conducted from historical timelines to the present. Recent research has revealed significant developments in the field, prompting a reevaluation of established criteria and resulting in expanded indications for CI. The chronological evolution of contraindications underscores the transformative nature of the field, offering potential improvements in outcomes and enhancing the quality of life for individuals with profound hearing loss. In conclusion, this narrative review emphasizes the dynamic nature of the field, where the reevaluation of contraindications has created new opportunities and broader indications for CI. The emerging prospects, including improved outcomes and enhanced quality of life, hold promise for individuals with profound hearing loss.

The impact of cochlear implantation on quality of life and psychological status in single-sided deafness or asymmetric hearing loss with tinnitus and influencing factors of implantation intention: a preliminary study

PURPOSE

The current study aims to explore the therapeutic effect of cochlear implants (CIs) on tinnitus in patients with single-sided deafness or asymmetric hearing loss (SSD/AHL) as well as the improvement of tinnitus-related quality of life and psychological status. In addition, we also explored whether the levels of quality of life and psychological status was related to the patient's implantation intention.

METHODS

Seven patients decided to receive cochlear implantation. Before and after implantation, they completed the Visual Analogue Scale (VAS) and the Tinnitus Questionnaire (TQ) to assess tinnitus severity, the Speech, Spatial and Qualities of Hearing Scale (SSQ), and the Medical Outcomes Study Short Form 36 Health Survey Questionnaire (SF-36) to assess the quality of life, the Simplified Coping Style Questionnaire (SCSQ) to assess psychological status. The other 8 SSD patients refused cochlear implantation. Their scores of the above questionnaires were compared with those of patients received implantation.

RESULTS

Six months after cochlear implantations, the tinnitus perception, loudness, and annoyance significantly decreased compared to that before implantation. In terms of quality of life and physiological status, no statistically significant changes were detected in SSQ, SF-36, and SCSQ measurements. The score of annoyance subcategory of VAS and all subcategories of SSQ of patients refused implantation were better than those of implanted patients before implantation.

CONCLUSIONS

These results suggest that CIs can significantly reduce tinnitus severity. Patients refused implantation had better status in the annoyance of VAS and all subcategories of SSQ scores than those received implantation.

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

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.

Hearing outcomes in children with single sided deafness: Our experience at a tertiary paediatric otorhinolaryngology unit

INTRODUCTION

Hearing rehabilitation options for single sided deafness (SSD) include contralateral routing of sound (CROS) aids and bone conduction devices (BCDs). This study aimed to review the management of children with SSD at our tertiary paediatric otolaryngology unit over the last 15 years.

MATERIAL AND METHODS

A retrospective cohort study was performed. Primary hearing outcomes were measured using the Children's Home Inventory for Listening Difficulties (CHILD) questionnaire score and secondary hearing outcomes were measured using hearing thresholds for speech in noise. Outcomes were measured pre and post bone conduction device (BCD) trial.

RESULTS

49 patients with SSD were identified. 20 children had trial of a BCD. 16 patients had pre- and post- BCD trial CHILD scores available for analysis. There was a statistically significant improvement in CHILD scores and speech in noise testing at +5 dB and +0 dB following amplification with a BCD. The mean use of BCD was 1.3 h per day.

DISCUSSION

We have described the management of children with SSD in our unit. This study demonstrated a statistically significant benefit of BCD use on hearing outcomes. However, device compliance is low suggesting hearing advice choice in the population is complex and further research is warranted.