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Olze H, Vater J, Gröschel M, Szczepek AJ. [Cochlear implant and tinnitus]. HNO 2023; 71:693-701. [PMID: 37815555 DOI: 10.1007/s00106-023-01376-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2023] [Indexed: 10/11/2023]
Abstract
Cochlear implant (CI) treatment is now established as a successful standard of care for auditory rehabilitation of profoundly deaf or severe hearing loss patients. CI candidates with tinnitus also benefit from improved health-related quality of life (HRQoL) and tinnitus burden. Current CI indications include bilateral (double-sided) profound hearing loss and deafness (DSD), unilateral (single-sided) deafness (SSD), and asymmetric hearing loss (AHL). The new and expanded indications for cochlear implants result in different healthcare situations, which may also be associated with differences in tinnitus burden before and after CI treatment. In this article, we discuss the prevalence of tinnitus in different patient groups and the influence of CI on tinnitus prevalence and severity in these groups. In addition, further therapeutic options for tinnitus suppression based on the CI principle are presented, including the development of an anti-tinnitus implant (proof of concept).
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Affiliation(s)
- Heidi Olze
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.
| | - Jana Vater
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - Moritz Gröschel
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - Agnieszka J Szczepek
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland
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2
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Deklerck AN, Swinnen F, Keppler H, Dhooge IJM. Changes in Tinnitus Characteristics and Residual Inhibition following Cochlear Implantation: A Prospective Analysis. Brain Sci 2023; 13:1484. [PMID: 37891851 PMCID: PMC10605020 DOI: 10.3390/brainsci13101484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 10/12/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
This study aims to explore the effect of cochlear implantation on tinnitus perception. A prospective study was conducted on 72 adult hearing-impaired patients to evaluate tinnitus perception before and after cochlear implantation, using standardized tinnitus questionnaires (the tinnitus sample case-history questionnaire, tinnitus functional index (TFI), and tinnitus handicap inventory (THI)). A large variety of demographic and hearing- and implant-related data was collected from patient hospital records to explore possible associations with the implantation effect. The prevalence of tinnitus complaints before implantation was 58.3%. The temporary induction or aggravation of tinnitus immediately after surgery was noted in 20% and 46.7% of patients, respectively. When evaluated 3 months after implantation, 60% of tinnitus patients experienced a clinically significant reduction in their complaints; most of the improvements were experienced immediately after activation of the implant. Only the scores for TFI and THI at baseline were found to be significantly correlated with a reduction in TFI scores after implantation. In 80% of tinnitus patients, the tinnitus remained suppressed for some time after taking off the device. The large subset of patients with residual inhibition supports the involvement of central pathophysiological processes in implantation effects on tinnitus, which are explored in this paper.
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Affiliation(s)
- Ann Nancy Deklerck
- Department of Otorhinolaryngology, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium;
| | - Freya Swinnen
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium; (F.S.); (H.K.)
- Department of Otorhinolaryngology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Hannah Keppler
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium; (F.S.); (H.K.)
- Department of Otorhinolaryngology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Ingeborg Johanna Maria Dhooge
- Department of Otorhinolaryngology, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium;
- Department of Otorhinolaryngology, Ghent University Hospital, 9000 Ghent, Belgium
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3
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Rasmussen KD, West NC, Bille M, Cayé-Thomasen P. Tinnitus suppression in a prospective cohort of 45 cochlear implant recipients: occurrence, degree and correlates. Eur Arch Otorhinolaryngol 2023; 280:4073-4082. [PMID: 37099145 DOI: 10.1007/s00405-023-07921-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/08/2023] [Indexed: 04/27/2023]
Abstract
OBJECTIVE To determine tinnitus prevalence and severity in a cohort of unselected first-time cochlear implant (CI) recipients whose primary motive for CI was sensorineural hearing loss (SNHL), and to evaluate the effect of CI on tinnitus after cochlear implantation. METHODS Prospective longitudinal study of 45 adult CI recipients with moderate to profound SNHL. Patients completed the Danish version of the Tinnitus Handicap Inventory (THI) and a visual analogue scale (VAS) for tinnitus burden before implantation, 4 months after implantation and 14 months after implantation. RESULTS The study included 45 patients, of which 29 (64%) had pre-implant tinnitus. Median THI score (IQR) significantly decreased from 20 (34) to 12 (24) at first follow-up (p < 0.05) and to 6 points (17) at second follow-up (p < 0.001). Median VAS (IQR) for tinnitus burden decreased from 33 (62) to 17 (40; p = 0.228) and 12 (27, p < 0.05) at the first and second follow-ups, respectively. Tinnitus was totally suppressed in 19% of patients, improved in 48%, remained unchanged in 19% and worsened in 6%. 2 patients reported new tinnitus. At the second follow-up, 74% of patients had slight or no tinnitus handicap, 16% had mild handicaps, 6% had moderate handicaps, and 3% had severe handicaps. High pre-implant THI and VAS scores correlated with greater decrease in THI scores over time. CONCLUSION 64% of the patients with SNHL had pre-implant tinnitus, which was decreased 4 and 14 months after implantation. Overall, 68% of patients with tinnitus improved their tinnitus handicap after CI. Patients with higher THI and VAS scores had a larger decline and the highest benefits in terms of tinnitus handicap improvement. The study findings demonstrate that the majority of patients with moderate to profound SNHL eligible for cochlear implantation benefit from complete or partial tinnitus suppression and improved quality of life after implantation.
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Affiliation(s)
- Kasper Dyre Rasmussen
- Department of Otorhinolaryngology Head and Neck Surgery and Audiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark.
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Niels Cramer West
- Department of Otorhinolaryngology Head and Neck Surgery and Audiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Michael Bille
- Department of Otorhinolaryngology Head and Neck Surgery and Audiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Per Cayé-Thomasen
- Department of Otorhinolaryngology Head and Neck Surgery and Audiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Chau IY, Li SYH, Shiao AS, Islam AS, Coelho DH. Early effects of very early cochlear implant activation on tinnitus. J Chin Med Assoc 2023; 86:850-853. [PMID: 37481759 DOI: 10.1097/jcma.0000000000000968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND Cochlear implantation (CI) has long been the standard of care for patients with severe-to-profound hearing impairment. Yet the benefits of CI extend far beyond speech understanding, with mounting recent literature supporting its role in tinnitus abatement. However, those studies have uniformly analyzed the effects of tinnitus after the traditional 3-4 weeks waiting period between CI surgery and device activation. As many clinics are shifting these waiting intervals to become shorter (in some cases within 24 hours, little is known about tinnitus abatement very early in the postoperative period. The aim of this study was to compare preoperative and postoperative tinnitus handicaps in this unique but growing population of very early-activated patients. METHODS Twenty-seven adults with severe-to-profound hearing impairment with chronic tinnitus (>6 months) were included. Patients with concomitant psychiatric disorders were excluded. All patients were implanted with the same array and were switched on within 24 hours after the surgery. Tinnitus Handicap Inventory (THI) was recorded preoperatively, immediately after activation at 24 hours postoperatively, at 1 week, 2 weeks, and I month after activation. Wilcoxon signed-rank test was used to compare values between preoperative assessment and respective fitting sessions. RESULTS Mean THI 24 hours after implantation increased in comparison to that assessed preoperatively (77.6 vs 72.5, p = 0.001). By 1 week after surgery, the THI had decreased to 54.9 ( p < 0.001). This trend continued and was statistically significant at 2 weeks (36.0, p < 0.001) and 1 month (28.5, p < 0.001). CONCLUSION On average, most patients with tinnitus will note a significant improvement in their tinnitus handicap when activated within 24 hours of CI. However, tinnitus does increase between surgery and 24 hours, most likely reflecting not only intracochlear changes, but modulation of the entire auditory pathway. Following this early rise, the tinnitus continues to abate over the following month. Patients with tinnitus may benefit from early activation, although should be counseled that they may experience an exacerbation during the very early postoperative period.
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Affiliation(s)
- Ivy Yenwen Chau
- Department of Otolaryngology, Cheng Hsin General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | | | - An-Suey Shiao
- Department of Otolaryngology, Cheng Hsin General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Albina S Islam
- Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Daniel H Coelho
- Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
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Huang Z, Chen S, Zhang G, Almadhor A, Li R, Li M, Abbas M, Nguyen Le B, Zhang J, Huang Y. Nanocatalysts as fast and powerful medical intervention: Bridging cochlear implant therapies and advanced modelling using Hidden Markov Models (HMMs) for effective treatment of infections. ENVIRONMENTAL RESEARCH 2023:116285. [PMID: 37301496 DOI: 10.1016/j.envres.2023.116285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 05/23/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023]
Abstract
As human population growth and waste from technologically advanced industries threaten to destabilise our delicate ecological equilibrium, the global spotlight intensifies on environmental contamination and climate-related changes. These challenges extend beyond our external environment and have significant effects on our internal ecosystems. The inner ear, which is responsible for balance and auditory perception, is a prime example. When these sensory mechanisms are impaired, disorders such as deafness can develop. Traditional treatment methods, including systemic antibiotics, are frequently ineffective due to inadequate inner ear penetration. Conventional techniques for administering substances to the inner ear fail to obtain adequate concentrations as well. In this context, cochlear implants laden with nanocatalysts emerge as a promising strategy for the targeted treatment of inner ear infections. Coated with biocompatible nanoparticles containing specific nanocatalysts, these implants can degrade or neutralise contaminants linked to inner ear infections. This method enables the controlled release of nanocatalysts directly at the infection site, thereby maximising therapeutic efficacy and minimising adverse effects. In vivo and in vitro studies have demonstrated that these implants are effective at eliminating infections, reducing inflammation, and fostering tissue regeneration in the ear. This study investigates the application of hidden Markov models (HMMs) to nanocatalyst-loaded cochlear implants. The HMM is trained on surgical phases in order to accurately identify the various phases associated with implant utilisation. This facilitates the precision placement of surgical instruments within the ear, with a location accuracy between 91% and 95% and a standard deviation between 1% and 5% for both sites. In conclusion, nanocatalysts serve as potent medicinal instruments, bridging cochlear implant therapies and advanced modelling utilising hidden Markov models for the effective treatment of inner ear infections. Cochlear implants loaded with nanocatalysts offer a promising method to combat inner ear infections and enhance patient outcomes by addressing the limitations of conventional treatments.
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Electrical Determinants of Tinnitus Extinction in a Cochlear Implant Patient. Otol Neurotol 2023; 44:e8-e12. [PMID: 36509436 DOI: 10.1097/mao.0000000000003735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
HYPOTHESIS Electrical tinnitus suppression by cochlear implants requires stimulation of a subset of neural elements in the cochlea. BACKGROUND Tinnitus is the phantom perception of sound in the ears and is a known correlate of hearing loss. Cochlear implants restore hearing and are known to lessen or extinguish tinnitus. The amount of electrical charge required and the number and location of electrodes required to extinguish tinnitus with a cochlear implant are factors that remain poorly understood. METHODS In a subject with single-sided deafness, with tinnitus in the deaf ear, we enabled single electrodes and groups of electrodes along the cochlea and increased the current until tinnitus was diminished or extinguished. We recorded the subject's perception of these changes using loudness scaling of both the electrical stimuli and the tinnitus. RESULTS Tinnitus could be extinguished with individual electrodes and more effectively extinguished by activating a greater number of electrodes. Tinnitus suppression and loudness growth of the electrical stimuli were imperfectly correlated. CONCLUSION Tinnitus suppression in this cochlear implant patient was achieved by electrically stimulating multiple distinct portions of the cochlea, and the cochlear neural substrate for tinnitus suppression may be distinct from that for auditory perception.
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Alzahrani L, Sereda M, Chamouton CS, Haider H, Dewey RS, Hoare DJ. Experience of tinnitus in adults who have severe-to-profound hearing loss: A scoping review. Front Neurol 2022; 13:1004059. [DOI: 10.3389/fneur.2022.1004059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundTinnitus is defined as the subjective perception of sound in the absence of an external stimulus, and tinnitus disorder becomes relevant when it is associated with emotional distress, cognitive dysfunction, and/or autonomic arousal. Hearing loss is recognized as the main risk factor for the pathogenesis of tinnitus. However, clinical guidelines for tinnitus disorder provide little direction for those who have severe-to-profound hearing loss including those who are pre-lingually Deaf. The aim of this scoping review was to catalogue what is known from the existing literature regarding the experience and management of tinnitus in adults who have a severe-to-profound hearing loss.SummaryA scoping review was conducted following the Preferred Reporting Item for Systematic Reviews and Meta-analysis extension for Scoping Reviews. Records were included if they reported an evaluation of tinnitus in adults who had severe-to-profound hearing loss. The online databases Ovid (MEDLINE, EMBASE and PsycINFO), CINAHL, ProQuest, Scopus, and Google Scholar were searched using the search terms ‘tinnitus’ (as a MESH term) and ‘deaf’ OR ‘profound hearing loss. Thirty-five records met the inclusion criteria for this review and were cataloged according to three major themes: Impact of tinnitus in deaf adults; Primary treatment of tinnitus in deaf adults; and Cochlear implant studies where tinnitus was a secondary outcome. Tinnitus symptom severity was assessed before and after intervention using tinnitus validated questionnaires in 29 records, with six further records using other assessment tools to measure tinnitus severity. Participants using cochlear implants were included in 30 studies. Medication, repetitive transcranial magnetic stimulation (rTMS), electrical promontory stimulation, and behavioral self-control therapy were each reported in single records.Key messagesThis scoping review cataloged the experience, assessment, and treatment of tinnitus in adults who have severe-to-profound hearing loss. It is shown that there is very limited research reported in this field. Although this review included many records, most focused on the provision of cochlear implants for severe-to-profound hearing loss, with assessment and measurement of tinnitus as a baseline or secondary outcome. Largely missing in the literature are empirical studies that seek firstly to understand the nature of the experience of tinnitus by people with no or little residual access to external sound.
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Holder JT, Holcomb MA, Snapp H, Labadie RF, Vroegop J, Rocca C, Elgandy MS, Dunn C, Gifford RH. Guidelines for Best Practice in the Audiological Management of Adults Using Bimodal Hearing Configurations. OTOLOGY & NEUROTOLOGY OPEN 2022; 2:e011. [PMID: 36274668 PMCID: PMC9581116 DOI: 10.1097/ono.0000000000000011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
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.
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Affiliation(s)
| | | | | | | | | | - Christine Rocca
- Guy’s and St. Thomas’ Hearing Implant Centre, London, United Kingdom
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Yuen E, Ma C, Nguyen SA, Meyer TA, Lambert PR. The Effect of Cochlear Implantation on Tinnitus and Quality of Life: A Systematic Review and Meta-analysis. Otol Neurotol 2021; 42:1113-1122. [PMID: 33973951 DOI: 10.1097/mao.0000000000003172] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To ascertain the effect of cochlear implantation (CI) on tinnitus and quality of life. DATABASES SOURCES PubMed, Scopus, Web of Science, and Cochrane Library were searched through August 21, 2020. Search strategies used a combination of subject headings (e.g., MeSH in PubMed) and keywords for the following two concepts: cochlear implantation and tinnitus. STUDY SELECTION English articles reporting on pre-intervention tinnitus-related patient-reported outcome measures (e.g., Tinnitus Handicap Inventory [THI], Tinnitus Questionnaire [TQ], Visual Analogue Scale [VAS] for loudness) and quality of life measures (e.g., Nijmegen Cochlear Implantation Questionnaire [NCIQ] and Hospital Anxiety and Depression Scale [HADS]) for CI recipients were included. DATA EXTRACTION Demographics, baseline, and follow-up data. DATA SYNTHESIS Total of 27 articles reporting on 1,285 patients (mean age 54.5 years, range 14-81) were included. Meta-analysis of all tinnitus-related measures demonstrated improvement following implantation, with a mean difference of -23.2 [95% CI: -28.8 to -17.7], -12.6 [95% CI: -17.5 to -7.8], and -4.5 [95% CI: -5.5 to -3.4] (p < 0.05 for all) for THI, TQ, and VAS, respectively. NCIQ increased by 12.2 points [95% CI: 8.2-16.2] (p < 0.05), indicating improved quality of life among CI recipients. Psychological comorbidities were also ameliorated, as evidenced by reductions in HADS depression (-1.7 [95% CI: -2.4 to -0.9]) and anxiety (-1.3 [95% CI: -2.1 to -0.5]) (p < 0.05 for both) scores. CONCLUSION Following CI, patients reported significant improvement in tinnitus via several validated questionnaires. Additional benefits include improved quality of life and reduction in psychological comorbidities.
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Affiliation(s)
- Erick Yuen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
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Chen M, Min S, Zhang C, Hu X, Li S. Using Extracochlear Multichannel Electrical Stimulation to Relieve Tinnitus and Reverse Tinnitus-Related Auditory-Somatosensory Plasticity in the Cochlear Nucleus. Neuromodulation 2021; 25:1338-1350. [PMID: 34346133 DOI: 10.1111/ner.13506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/15/2021] [Accepted: 06/29/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Tinnitus has no reliable cure but may be significantly relieved by the usage of cochlear implants. However, not all tinnitus patients necessitate cochlear implantation that can impair hearing. This study was to investigate whether a novel extracochlear electrical stimulation (EES) strategy could relieve tinnitus of guinea pigs without hearing impairment, and the roles of auditory-somatosensory plasticity in the cochlear nucleus in the tinnitus relief. MATERIALS AND METHODS We used a novel four-electrode extracochlear implant to electrically stimulate the cochlea of tinnitus guinea pigs. Tinnitus was assessed by the gap-prepulse inhibition of the acoustic startle reflex (GPIAS) ratios and the tinnitus index. The plasticity of auditory and somatosensory innervation in the different subdivisions of cochlear nucleus was evaluated by immunostaining of vesicular glutamate transporter 1 (VGLUT1) and VGLUT2, respectively. RESULTS The EES induced significant decreases of GPIAS ratios and the tinnitus index of tinnitus guinea pigs, indicating reductions of tinnitus behavioral manifestations. Meanwhile, the EES reversed the abnormal auditory-somatosensory innervation in the cochlear nucleus of tinnitus animals but did not change the hearing and the numbers of inner hair cell synapses. CONCLUSIONS This study demonstrated that the novel EES strategy could effectively relieve tinnitus without impairment to hearing and cochlear structure of tinnitus animals. The reversal of tinnitus-related auditory-somatosensory plasticity in the cochlear nucleus was correlated with the tinnitus relief induced by the EES.
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Affiliation(s)
- Min Chen
- ENT Institute and Department of Otolaryngology & Head-Neck Surgery, Eye & ENT Hospital of Fudan University, Shanghai, 200031, China.,NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, 200031, China
| | - Shiyao Min
- ENT Institute and Department of Otolaryngology & Head-Neck Surgery, Eye & ENT Hospital of Fudan University, Shanghai, 200031, China.,NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, 200031, China
| | - Chen Zhang
- ENT Institute and Department of Otolaryngology & Head-Neck Surgery, Eye & ENT Hospital of Fudan University, Shanghai, 200031, China.,NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, 200031, China
| | - Xuerui Hu
- ENT Institute and Department of Otolaryngology & Head-Neck Surgery, Eye & ENT Hospital of Fudan University, Shanghai, 200031, China.,NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, 200031, China
| | - Shufeng Li
- ENT Institute and Department of Otolaryngology & Head-Neck Surgery, Eye & ENT Hospital of Fudan University, Shanghai, 200031, China.,NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, 200031, China
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Assouly KKS, van Heteren JAA, Stokroos RJ, Stegeman I, Smit AL. Cochlear implantation for patients with tinnitus - A systematic review. PROGRESS IN BRAIN RESEARCH 2020; 260:27-50. [PMID: 33637223 DOI: 10.1016/bs.pbr.2020.06.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
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.
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Affiliation(s)
- Kelly K S Assouly
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Clinical and Experimental Neuroscience, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands; Cochlear Technology Center, Mechelen, Belgium.
| | - Jan A A van Heteren
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Clinical and Experimental Neuroscience, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Robert J Stokroos
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Clinical and Experimental Neuroscience, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Inge Stegeman
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Clinical and Experimental Neuroscience, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Adriana L Smit
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Clinical and Experimental Neuroscience, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
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Kloostra FJJ, de Kleine E, Free RH, Hofman R, Van Dijk P. Changes in Tinnitus by Cochlear Implantation: A Parametric Study of the Effect of Single-Electrode Stimulation. Audiol Neurootol 2020; 26:140-148. [PMID: 32894830 DOI: 10.1159/000509202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 05/29/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION While cochlear implantation may have a positive effect on tinnitus, it is not effective in reducing tinnitus in all patients. This may be due to different patients requiring different strategies of electrical stimulation in order to obtain a positive effect on tinnitus. It is, therefore, important to identify the most effective stimulation strategies to reduce tinnitus. The simplest possible strategy is stimulation by only one electrode. In this study, we investigated tinnitus suppression by electrical stimulation via a single electrode of the cochlear implant. METHODS We performed a listening experiment in 19 adult participants, who had received a unilateral cochlear implant (CI) because of severe bilateral hearing loss. All of these patients had indicated that they suffered from tinnitus. During a 300-s interval, patients listened to blocks of single-electrode stimulation and rated the loudness of the stimulus and any effects on their tinnitus. The 300-s interval included a block of single-electrode stimulation (duration 120 s). In consecutive intervals, the stimulus differed in its cochlear location (basal or apical), its pulse rate (720 or 725 Hz, 1,200 Hz, and 2,400 or 2,320 Hz), and amplitude (just above threshold or equivalent to moderate loudness). Thus, 2 × 3 × 2 = 12 stimulus conditions were tested in each participant, and each condition was presented only once. During the experiment, the participants promptly rated the loudness of the stimuli and the loudness of their tinnitus on a Visual Analogue Scale (10-point VAS). RESULTS Significantly more tinnitus reduction was observed with stimuli at a moderate intensity level (30%) compared to stimuli at near-threshold level (18%) (χ2 [1, N = 222] = 14.115, p < 0.01). No significant differences in tinnitus levels resulted from the different pulse rates and stimulation sites. Eight participants reported an increase of tinnitus loudness under at least one stimulus condition. Changes in tinnitus loudness were generally minor, and never exceeded 3 points on the VAS. The overall effect of cochlear implantation on tinnitus, that is, the effect with full-array stimulation, was not correlated with the effectiveness of the single-electrode stimulation on tinnitus. CONCLUSION In conclusion, the effect of single-electrode stimulation on tinnitus is relatively insignificant in comparison to the effect of full-array stimulation. However, in some individual cases, sustained single-electrode stimulation may be beneficial for tinnitus management.
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Affiliation(s)
- Francka J J Kloostra
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Groningen, Groningen, The Netherlands, .,Graduate School of Medical Sciences, Behavioural and Cognitive Neurosciences, University of Groningen, Groningen, The Netherlands,
| | - Emile de Kleine
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Groningen, Groningen, The Netherlands.,Graduate School of Medical Sciences, Behavioural and Cognitive Neurosciences, University of Groningen, Groningen, The Netherlands
| | - Rolien H Free
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Groningen, Groningen, The Netherlands.,Graduate School of Medical Sciences, Behavioural and Cognitive Neurosciences, University of Groningen, Groningen, The Netherlands
| | - Rutger Hofman
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Groningen, Groningen, The Netherlands.,Graduate School of Medical Sciences, Behavioural and Cognitive Neurosciences, University of Groningen, Groningen, The Netherlands
| | - Pim Van Dijk
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Groningen, Groningen, The Netherlands.,Graduate School of Medical Sciences, Behavioural and Cognitive Neurosciences, University of Groningen, Groningen, The Netherlands
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Hsieh WH, Huang WT, Lin HC. Investigation of the effect of cochlear implantation on tinnitus, and its associated factors. Acta Otolaryngol 2020; 140:497-500. [PMID: 32186232 DOI: 10.1080/00016489.2020.1736338] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Many studies have focused on the suppressive effects of cochlear implants (CIs) on loudness of tinnitus.Aims/objective: This study aimed to examine the effects of CIs and their activation on changes in loudness and tinnitus and explore other factors associated with this effect.Material and methods: We recruited 26 CI recipients according to specific criteria. Participants asked to complete tinnitus questionnaires, while the CI was kept on and at 30 min after the CI was turned off. Tinnitus improvement after CI was tested using Wilcoxon signed rank tests, and correlation was tested using Spearman's rank correlation coefficients and multiple linear regression.Results: After CI, tinnitus reduced from 62% to 46%. Total and partial reduction in tinnitus was seen in 76% subjects with pre-CI tinnitus. However, 6% of the subjects had tinnitus since birth, and none showed worsening tinnitus. The average THI score while the CI on was significantly lower than that CI off.Conclusions: Post-CI tinnitus improvement was seen in 76% of those with pre-CI tinnitus; however, the low risk of new or aggravating tinnitus should be considered, and reasonable expectations for tinnitus reduction should be built into the pre-CI assessment.
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Affiliation(s)
- Wen-Hui Hsieh
- Department of Audiology and Speech Language Pathology, Mackay Medical College, Taipei, Taiwan
| | - Wen-Ting Huang
- Department of Speech and Hearing Disorders and Sciences, National Taipei College of Nursing Taipei, Taiwan
| | - Hung-Ching Lin
- Department of Audiology and Speech Language Pathology, Mackay Medical College, Taipei, Taiwan
- Department of Otolaryngology, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, Mackay Medical College, Taipei, Taiwan
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Predicting Postoperative Cochlear Implant Performance Using Supervised Machine Learning. Otol Neurotol 2020; 41:e1013-e1023. [DOI: 10.1097/mao.0000000000002710] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Mallen JR, Chiu J, Marquis H, Ottochian A, Perez E, Kuo CL, Otto S, Ryan T, Roberts DS. Quantifying tinnitus suppression in cochlear implantation using tinnitus interval-limited tracking. Laryngoscope 2019; 130:2047-2052. [PMID: 31800110 DOI: 10.1002/lary.28414] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 09/26/2019] [Accepted: 10/23/2019] [Indexed: 12/20/2022]
Abstract
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.
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Affiliation(s)
- Jonathan R Mallen
- Department of Surgery, Division of Otolaryngology, University of Connecticut Health, Farmington, Connecticut
| | - Jerlon Chiu
- University of Connecticut Medical School, University of Connecticut Health, Farmington, Connecticut
| | - Hillary Marquis
- Department of Audiology, University of Connecticut Health, Farmington, Connecticut
| | - Amanda Ottochian
- Department of Audiology, University of Connecticut Health, Farmington, Connecticut
| | - Erin Perez
- Department of Audiology, University of Connecticut Health, Farmington, Connecticut
| | - Chia-Ling Kuo
- Connecticut Institute for Clinical and Translational Science, University of Connecticut Health, Farmington, Connecticut
| | - Steve Otto
- House Clinic and House Ear Institute, Los Angeles, California, U.S.A
| | - Tessa Ryan
- Department of Surgery, Division of Otolaryngology, University of Connecticut Health, Farmington, Connecticut
| | - Daniel S Roberts
- Department of Surgery, Division of Otolaryngology, University of Connecticut Health, Farmington, Connecticut
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Kloostra F, Verbist J, Hofman R, Free R, Arnold R, van Dijk P. A Prospective Study of the Effect of Cochlear Implantation on Tinnitus. Audiol Neurootol 2019; 23:356-363. [DOI: 10.1159/000495132] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 10/31/2018] [Indexed: 11/19/2022] Open
Abstract
Previous studies have shown diverse and sometimes even contrary results concerning the effect of cochlear implantation on tinnitus and the factors that can influence this effect. The aim of this prospective questionnaire study was to determine the effects of cochlear implantation on tinnitus and explore which factors can influence the effect of cochlear implantation on tinnitus. Forty-four of the patients implanted in our hospital returned 2 questionnaire packages, i.e., one before the cochlear implantation and one 6 months after implantation. Before implantation, 66% of the patients experienced tinnitus. This study shows that cochlear implantation could help to reduce tinnitus and the tinnitus handicap in at least 28% of the patients with preoperative tinnitus. In 72% of the patients the tinnitus remained after implantation. None of the patients developed tinnitus after implantation. A shorter duration of tinnitus prior to implantation, a more fluctuating type of tinnitus, a higher tinnitus handicap prior to implantation, and a round-window surgical approach might have a positive influence on the effect of cochlear implantation on tinnitus, but further research is necessary to confirm these findings.
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Van Eeckhoutte M, Spirrov D, Wouters J, Francart T. Objective Binaural Loudness Balancing Based on 40-Hz Auditory Steady-State Responses. Part II: Asymmetric and Bimodal Hearing. Trends Hear 2018; 22:2331216518805363. [PMID: 30334496 PMCID: PMC6196612 DOI: 10.1177/2331216518805363] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
In Part I, we investigated 40-Hz auditory steady-state response (ASSR) amplitudes for the use of objective loudness balancing across the ears for normal-hearing participants and found median across-ear ratios in ASSR amplitudes close to 1. In this part, we further investigated whether the ASSR can be used to estimate binaural loudness balance for listeners with asymmetric hearing, for whom binaural loudness balancing is of particular interest. We tested participants with asymmetric hearing and participants with bimodal hearing, who hear with electrical stimulation through a cochlear implant (CI) in one ear and with acoustical stimulation in the other ear. Behavioral loudness balancing was performed at different percentages of the dynamic range. Acoustical carrier frequencies were 500, 1000, or 2000 Hz, and CI channels were stimulated in apical or middle regions in the cochlea. For both groups, the ASSR amplitudes at balanced loudness levels were similar for the two ears, with median ratios between left and right ear stimulation close to 1. However, individual variability was observed. For participants with asymmetric hearing loss, the difference between the behavioral balanced levels and the ASSR-predicted balanced levels was smaller than 10 dB in 50% and 56% of cases, for 500 Hz and 2000 Hz, respectively. For bimodal listeners, these percentages were 89% and 60%. Apical CI channels yielded significantly better results (median difference near 0 dB) than middle CI channels, which had a median difference of −7.25 dB.
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Affiliation(s)
| | | | - Jan Wouters
- 1 ExpORL, Department of Neurosciences, KU Leuven, Belgium
| | - Tom Francart
- 1 ExpORL, Department of Neurosciences, KU Leuven, Belgium
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Ramakers GGJ, van Zanten GA, Thomeer HGXM, Stokroos RJ, Heymans MW, Stegeman I. Development and internal validation of a multivariable prediction model for tinnitus recovery following unilateral cochlear implantation: a cross-sectional retrospective study. BMJ Open 2018; 8:e021068. [PMID: 29895652 PMCID: PMC6009556 DOI: 10.1136/bmjopen-2017-021068] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To develop and internally validate a prediction model for tinnitus recovery following unilateral cochlear implantation. DESIGN A cross-sectional retrospective study. SETTING A questionnaire concerning tinnitus was sent to patients with bilateral severe to profound hearing loss, who underwent unilateral cochlear implantation at the University Medical Center Utrecht, the Netherlands, between 1 January 2006 and 31 December 2015. PARTICIPANTS Of 137 included patients, 87 patients experienced tinnitus preoperatively. Data of these 87 patients were used to develop the prediction model. PRIMARY AND SECONDARY OUTCOME MEASURES The outcome of the prediction model was tinnitus recovery. Investigated predictors were: age, gender, duration of deafness, preoperative hearing performance, tinnitus duration, severity and localisation, follow-up duration, localisation of cochlear implant (CI) compared with tinnitus side, surgical approach, insertion depth of the electrode, CI brand and difference in hearing threshold following cochlear implantation. Multivariable backward logistic regression was performed. Missing data were handled using multiple imputation. The performance of the model was assessed by the calibrative and discriminative ability of the model. The prediction model was internally validated using bootstrapping techniques. RESULTS The tinnitus recovery rate was 40%. A lower preoperative Consonant-Vowel-Consonant (CVC) score, unilateral localisation of tinnitus and larger deterioration of residual hearing at 250 Hz revealed to be relevant predictors for tinnitus recovery. The area under the receiver operating characteristics curve (AUC) of the initial model was 0.722 (IQR: 0.703-0.729). After internal validation of this prediction model, the AUC decreased to 0.696 (IQR: 0.667-0.700). CONCLUSION AND RELEVANCE Lower preoperative CVC score, unilateral localisation of tinnitus and larger deterioration of residual hearing at 250 Hz were significant predictors for tinnitus recovery following unilateral cochlear implantation. The performance of the model developed in this retrospective study is promising. However, before clinical use of the model, the conduction of a larger prospective study is recommended.
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Affiliation(s)
- Geerte G J Ramakers
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gijsbert A van Zanten
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hans G X M Thomeer
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Robert J Stokroos
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martijn W Heymans
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Inge Stegeman
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
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Wang Q, Li JN, Lei GX, Chen DS, Wang WZ, Chen AT, Mong MD, Li S, Jiao QS, Yang SM. Interaction of tinnitus suppression and hearing ability after cochlear implantation. Acta Otolaryngol 2017. [PMID: 28641038 DOI: 10.1080/00016489.2017.1336283] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To study the postoperative impact of cochlear implants (CIs) on tinnitus, as well as the impact of tinnitus on speech recognition with CI switched on. METHODS Fifty-two postlingual deafened CI recipients (21 males and 31 females) were assessed using an established Tinnitus Characteristics Questionnaire and Tinnitus Handicap Inventory (THI) before and after cochlear implantation. The tinnitus loudness was investigated when CI was switched on and off in CI recipients with persistent tinnitus. The relation between tinnitus loudness and recipients' satisfaction of cochlear implantation was analyzed by the visual analogue scale (VAS) score. RESULTS With CI 'OFF', 42 CI recipients experienced tinnitus postimplant ipsilaterally and 44 contralaterally. Tinnitus was totally suppressed ipsilateral to the CI with CI 'ON' in 42.9%, partially suppressed in 42.9%, unchanged in 11.9% and aggravated in 2.4%. Tinnitus was totally suppressed contralaterally with CI 'ON' in 31.8% of CI recipients, partially suppressed in 47.7%, unchanged in 20.5%. Pearson correlation analysis showed that tinnitus loudness and the results of cochlear implant patients satisfaction was negatively correlated (r = .674, p < .001). CONCLUSION The study suggests six-month CI activation can be effective for suppressing tinnitus. The tinnitus loudness may affect patients' satisfaction with the use of CI.
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Affiliation(s)
- Qian Wang
- Auditory Implantation Center, Department of Otolaryngology & Head and Neck Surgery, Beijing Key Laboratory of Hearing Impairment Prevention and Treatment, Key Laboratory of Hearing Impairment Science, Ministry of Education, Chinese PLA General Hospital, Beijing, P.R. China
| | - Jia-Nan Li
- Auditory Implantation Center, Department of Otolaryngology & Head and Neck Surgery, Beijing Key Laboratory of Hearing Impairment Prevention and Treatment, Key Laboratory of Hearing Impairment Science, Ministry of Education, Chinese PLA General Hospital, Beijing, P.R. China
| | - Guan-Xiong Lei
- Auditory Implantation Center, Department of Otolaryngology & Head and Neck Surgery, Beijing Key Laboratory of Hearing Impairment Prevention and Treatment, Key Laboratory of Hearing Impairment Science, Ministry of Education, Chinese PLA General Hospital, Beijing, P.R. China
| | - Dai-Shi Chen
- Auditory Implantation Center, Department of Otolaryngology & Head and Neck Surgery, Beijing Key Laboratory of Hearing Impairment Prevention and Treatment, Key Laboratory of Hearing Impairment Science, Ministry of Education, Chinese PLA General Hospital, Beijing, P.R. China
| | - Wei-Ze Wang
- Auditory Implantation Center, Department of Otolaryngology & Head and Neck Surgery, Beijing Key Laboratory of Hearing Impairment Prevention and Treatment, Key Laboratory of Hearing Impairment Science, Ministry of Education, Chinese PLA General Hospital, Beijing, P.R. China
| | - Ai-Ting Chen
- Auditory Implantation Center, Department of Otolaryngology & Head and Neck Surgery, Beijing Key Laboratory of Hearing Impairment Prevention and Treatment, Key Laboratory of Hearing Impairment Science, Ministry of Education, Chinese PLA General Hospital, Beijing, P.R. China
| | - Meng-Di Mong
- Auditory Implantation Center, Department of Otolaryngology & Head and Neck Surgery, Beijing Key Laboratory of Hearing Impairment Prevention and Treatment, Key Laboratory of Hearing Impairment Science, Ministry of Education, Chinese PLA General Hospital, Beijing, P.R. China
| | - Sun Li
- Auditory Implantation Center, Department of Otolaryngology & Head and Neck Surgery, Beijing Key Laboratory of Hearing Impairment Prevention and Treatment, Key Laboratory of Hearing Impairment Science, Ministry of Education, Chinese PLA General Hospital, Beijing, P.R. China
| | - Qing-Shan Jiao
- Auditory Implantation Center, Department of Otolaryngology & Head and Neck Surgery, Beijing Key Laboratory of Hearing Impairment Prevention and Treatment, Key Laboratory of Hearing Impairment Science, Ministry of Education, Chinese PLA General Hospital, Beijing, P.R. China
| | - Shi-Ming Yang
- Auditory Implantation Center, Department of Otolaryngology & Head and Neck Surgery, Beijing Key Laboratory of Hearing Impairment Prevention and Treatment, Key Laboratory of Hearing Impairment Science, Ministry of Education, Chinese PLA General Hospital, Beijing, P.R. China
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Knopke S, Szczepek AJ, Häussler SM, Gräbel S, Olze H. Cochlear Implantation of Bilaterally Deafened Patients with Tinnitus Induces Sustained Decrease of Tinnitus-Related Distress. Front Neurol 2017; 8:158. [PMID: 28487670 PMCID: PMC5403821 DOI: 10.3389/fneur.2017.00158] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 04/04/2017] [Indexed: 11/24/2022] Open
Abstract
Objective Tinnitus is a common symptom of hearing impairment. Patients who are bilaterally hard of hearing are often affected by tinnitus. However, they cannot undergo any of the standard tinnitus therapies, since they rely on hearing. Cochlear implantation (CI) used to treat severe hearing disabilities, such as bilateral hearing loss, was also shown to reduce tinnitus. Our goal was to determine if CI induces sustained reduction of tinnitus. We performed prospective, longitudinal analyses of tinnitus-related distress in a uniform group of bilaterally deafened patients after CI. Patients and Methods The homogenous sample consisted of 41 patients who met the inclusion criteria and were consecutively included in this study. The impact of unilateral CI on tinnitus-related distress, health-related quality of life (HRQoL), and hearing abilities was studied with validated instruments. The follow-up appointments were scheduled at 6, 12, and 24 months after CI surgery. During the appointments, hearing abilities were estimated with monosyllabic Freiburg test, whereas the tinnitus-related distress, the HRQoL, and the subjective hearing were measured with standard questionnaires [Tinnitus Questionnaire (TQ), Nijmegen Cochlear Implantation Questionnaire, and Oldenburg Inventory, respectively]. Results Tinnitus-related distress decreased significantly from the mean TQ score of 35.0 (SD = 19.6) prior to surgery to the mean TQ = 27.54 (SD = 20.0) 6 months after surgery and remained sustained low until the end of follow-up period. In addition, CI significantly improved the hearing abilities and the HRQoL of all patients. Conclusion The results from our prospective study suggest that in a homogenous sample of bilaterally deafened, implanted patients who report having tinnitus prior to surgery, CI alone not only improves the hearing abilities but also significantly reduces the tinnitus-related distress and improves the HRQoL in a sustained way.
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Affiliation(s)
- Steffen Knopke
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité - University Hospital Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Agnieszka J Szczepek
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité - University Hospital Berlin, Campus Charité Mitte, Berlin, Germany
| | - Sophia Marie Häussler
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité - University Hospital Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Stefan Gräbel
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité - University Hospital Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Heidi Olze
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité - University Hospital Berlin, Campus Virchow-Klinikum, Berlin, Germany
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Servais JJ, Hörmann K, Wallhäusser-Franke E. Unilateral Cochlear Implantation Reduces Tinnitus Loudness in Bimodal Hearing: A Prospective Study. Front Neurol 2017; 8:60. [PMID: 28326059 PMCID: PMC5339283 DOI: 10.3389/fneur.2017.00060] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 02/10/2017] [Indexed: 11/13/2022] Open
Abstract
Perceptive and receptive aspects of subjective tinnitus like loudness and tinnitus-related distress are partly independent. The high percentage of hearing loss in individuals with tinnitus suggests causality of hearing impairment particularly for the tinnitus percept, leading to the hypothesis that restoration of auditory input has a larger effect on tinnitus loudness than on tinnitus-related distress. Furthermore, it is assumed that high levels of depression or anxiety prevent reductions of tinnitus loudness and distress following restoration of activity in the cochlea. This prospective study investigated the influence of unilateral cochlear implant (CI) on tinnitus in 19 postlingually deafened adults during 6 months following implantation. All had bimodal provision with the other ear being continuously supported by a hearing aid. On the day before CI implantation (T1, T2), and at about 3 and 6 months postsurgery (T3, T4), participants were questioned about their current tinnitus. Loudness was rated on a Numeric Rating Scale, distress was assessed by the TQ12 Tinnitus Questionnaire, and depression and anxiety were recorded with the Hospital Anxiety and Depression Scale. At T2, 79% experienced tinnitus, one participant developed tinnitus after implantation. Following implantation, tinnitus loudness was reduced significantly by 42%, while reductions in tinnitus-related distress (−24%), depression (−20%), and anxiety (−20%) did not attain statistical significance. Significant correlations existed between tinnitus measures, and between postimplantation tinnitus-related distress and anxiety and depression scores. Moreover, improvement of hearing in the CI ear was significantly correlated with reduction in tinnitus loudness. A new aspect of this study is the particular influence of CI provision on perceptive aspects of preexisting tinnitus (hypothesis 1), with the effect size regarding postimplant reduction of perceived tinnitus loudness (1.40) being much larger than effect sizes on the reduction of tinnitus-related distress (0.38), depression (0.53), and anxiety (0.53). Contrary to expectation both tinnitus measures reduce even in the majority of CI recipients with increased levels of anxiety or depression. This suggests that reduction of the tinnitus signal by restoring activity in the cochlea cannot be entirely compensated for by central tinnitus mechanisms and results in a reduction of perceptive and less so of reactive aspects of subjective tinnitus.
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Affiliation(s)
- Jérôme J Servais
- Department of Otorhinolaryngology, Cochlear Implant Centre, University Medicine Mannheim , Mannheim , Germany
| | - Karl Hörmann
- Department of Otorhinolaryngology, Cochlear Implant Centre, University Medicine Mannheim, Mannheim, Germany; Audiology, Medical Faculty Mannheim, Department of Otorhinolaryngology, Heidelberg University, Mannheim, Germany
| | - Elisabeth Wallhäusser-Franke
- Audiology, Medical Faculty Mannheim, Department of Otorhinolaryngology, Heidelberg University , Mannheim , Germany
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Effect of Direct Stimulation of the Cochleovestibular Nerve on Tinnitus: A Long-Term Follow-Up Study. World Neurosurg 2017; 98:571-577. [PMID: 27867121 DOI: 10.1016/j.wneu.2016.11.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 11/06/2016] [Accepted: 11/07/2016] [Indexed: 10/20/2022]
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Greenberg D, Meerton L, Graham J, Vickers D. Developing an assessment approach for perceptual changes to tinnitus sound characteristics for adult cochlear implant recipients. Int J Audiol 2016; 55:392-404. [PMID: 27146518 DOI: 10.3109/14992027.2016.1172391] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To investigate the impact of cochlear implantation on tinnitus suppression, characteristics, localization, and duration. DESIGN A cochlear implant (CI) recipient-focused postal questionnaire survey. STUDY SAMPLE The questionnaire was posted, with consent, to 100 adults who had received a unilateral CI at the RNTNEH between 1988 and 1999. All adults spoke English as their first language and were postlingually deafened. Sixty-eight adults (38 female, 29 male, one unspecified) aged 31-80 years (mean 61 years) completed and returned the questionnaire without interview. RESULTS With the processor 'ON', CI recipients experienced total or partial suppression of tinnitus ipsilateral to their CI in 57% of cases, and in 43% where tinnitus was perceived contralateral to the CI. The percentage of CI recipients who experienced high tone tinnitus was reduced from 60% pre-implant to 29% post-implant with the processor 'ON' while pulsatile tinnitus was reduced from 38% pre-implant to 13% post-implant. CIs were also found to reduce the tonal complexity and duration, and change the source localization of tinnitus post-implantation. CONCLUSIONS Perceptual changes to tinnitus can take place post-implantation. Changes can occur within the four categories explored: tinnitus suppression, characteristics, localization, and duration of awareness per day.
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Affiliation(s)
| | - Leah Meerton
- b Royal National Throat , Nose & Ear Hospital , London , UK
| | - John Graham
- b Royal National Throat , Nose & Ear Hospital , London , UK
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Knopke S, Gräbel S, Förster-Ruhrmann U, Mazurek B, Szczepek AJ, Olze H. Impact of cochlear implantation on quality of life and mental comorbidity in patients aged 80 years. Laryngoscope 2016; 126:2811-2816. [DOI: 10.1002/lary.25993] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 02/10/2016] [Accepted: 02/29/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Steffen Knopke
- Department of Otorhinolaryngology, Head and Neck Surgery; Campus Virchow-Klinikum, Charité-University Medical Center Berlin; Berlin Germany
| | - Stefan Gräbel
- Department of Otorhinolaryngology, Head and Neck Surgery; Campus Virchow-Klinikum, Charité-University Medical Center Berlin; Berlin Germany
| | - Ulrike Förster-Ruhrmann
- Department of Otorhinolaryngology, Head and Neck Surgery; Campus Virchow-Klinikum, Charité-University Medical Center Berlin; Berlin Germany
| | - Birgit Mazurek
- Tinnitus Center, Campus Charité Mitte; Charité-University Medical Center Berlin; Berlin Germany
| | - Agnieszka J. Szczepek
- Tinnitus Center, Campus Charité Mitte; Charité-University Medical Center Berlin; Berlin Germany
| | - Heidi Olze
- Department of Otorhinolaryngology, Head and Neck Surgery; Campus Virchow-Klinikum, Charité-University Medical Center Berlin; Berlin Germany
- Department of Otorhinolaryngology, Head and Neck Surgery; Charité-University Medical Center Berlin; Berlin Germany
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Mulders WHAM, Spencer TC, Robertson D. Effects of pulsatile electrical stimulation of the round window on central hyperactivity after cochlear trauma in guinea pig. Hear Res 2016; 335:128-137. [PMID: 26970475 DOI: 10.1016/j.heares.2016.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 02/09/2016] [Accepted: 03/03/2016] [Indexed: 11/17/2022]
Abstract
Partial hearing loss induced by acoustic trauma has been shown in animal models to result in an increased spontaneous firing rate in central auditory structures. This so-called hyperactivity has been suggested to be involved in the generation of tinnitus, a phantom auditory sensation. Although there is no universal cure for tinnitus, electrical stimulation of the cochlea, as achieved by a cochlear implant, can result in significant reduction of the tinnitus percept. However, the mechanism by which this tinnitus suppression occurs is as yet unknown and furthermore cochlear implantation may not be an optimal treatment option for tinnitus sufferers who are not profoundly deaf. A better understanding of the mechanism of tinnitus suppression by electrical stimulation of the cochlea, may lead to the development of more specialised devices for those for whom a cochlear implant is not appropriate. This study aimed to investigate the effects of electrical stimulation in the form of brief biphasic shocks delivered to the round window of the cochlea on the spontaneous firing rates of hyperactive inferior colliculus neurons following acoustic trauma in guinea pigs. Effects during the stimulation itself included both inhibition and excitation but spontaneous firing was suppressed for up to hundreds of ms after the cessation of the shock train in all sampled hyperactive neurons. Pharmacological block of olivocochlear efferent action on outer hair cells did not eliminate the prolonged suppression observed in inferior colliculus neurons, and it is therefore likely that activation of the afferent pathways is responsible for the central effects observed.
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Affiliation(s)
- W H A M Mulders
- The Auditory Laboratory, School of Anatomy, Physiology and Human Biology, The University of Western Australia, 35 Stirling Highway, Crawley WA 6009, Australia.
| | - T C Spencer
- The Auditory Laboratory, School of Anatomy, Physiology and Human Biology, The University of Western Australia, 35 Stirling Highway, Crawley WA 6009, Australia
| | - D Robertson
- The Auditory Laboratory, School of Anatomy, Physiology and Human Biology, The University of Western Australia, 35 Stirling Highway, Crawley WA 6009, Australia
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Abstract
The cochlear implant became a very successful method of hearing rehabilitation for patients with profound sensorineural hearing loss. The benefits of the CI extend beyond the medical success and positively influence social and psychosocial areas, reflected by an improved HRQoL. Furthermore, variety of studies demonstrated that the tinnitus severity improves in 46-95 % of cases following the cochlear implantation. However, the parameters investigated in such studies are not always standardized or addressed by validated questionnaires, which explains the high outcome variation between the studies. The relationships between HRQoL and tinnitus distress before and after cochlear implantation have not been well studied. Nevertheless, it is believed that the improvement in HRQoL following CI affects particularly tinnitus.However, an existing tinnitus can also worsen or occur for the first time after the surgery. Since neither tinnitus frequency nor tinnitus loudness correlate with the tinnitus-induced distress, the measurement of HRQoL, distress factors, stress reactions and psychiatric comorbidities appears to be the meaningful assessment of positive or negative effects of CI on tinnitus.Initial studies demonstrated that also patients with unilateral hearing loss may benefit from CI supply, as shown by an improvement in HRQoL and reduction of tinnitus-induced distress. For those patients, who despite CI implantation experience severe tinnitus, there is an option of tinnitus-specific CI-fitting and tinnitus-specific therapy with psychosomatic and psychological approaches, and- in addition- a treatment of possible mental comorbidities.
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van Zon A, Smulders YE, Ramakers GGJ, Stegeman I, Smit AL, Van Zanten GA, Stokroos RJ, Hendrice N, Free RH, Maat B, Frijns JHM, Mylanus EAM, Huinck WJ, Topsakal V, Tange RA, Grolman W. Effect of unilateral and simultaneous bilateral cochlear implantation on tinnitus: A Prospective Study. Laryngoscope 2015; 126:956-61. [DOI: 10.1002/lary.25493] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 05/20/2015] [Accepted: 06/16/2015] [Indexed: 01/16/2023]
Affiliation(s)
- Alice van Zon
- Department of Otorhinolaryngology and Head and Neck Surgery; Brain Center Rudolf Magnus, University Medical Center Utrecht; Utrecht
| | - Yvette E. Smulders
- Department of Otorhinolaryngology and Head and Neck Surgery; Brain Center Rudolf Magnus, University Medical Center Utrecht; Utrecht
| | - Geerte G. J. Ramakers
- Department of Otorhinolaryngology and Head and Neck Surgery; Brain Center Rudolf Magnus, University Medical Center Utrecht; Utrecht
| | - Inge Stegeman
- Department of Otorhinolaryngology and Head and Neck Surgery; Brain Center Rudolf Magnus, University Medical Center Utrecht; Utrecht
| | - Adriana L. Smit
- Department of Otorhinolaryngology and Head and Neck Surgery; Brain Center Rudolf Magnus, University Medical Center Utrecht; Utrecht
| | - Gijsbert A. Van Zanten
- Department of Otorhinolaryngology and Head and Neck Surgery; Brain Center Rudolf Magnus, University Medical Center Utrecht; Utrecht
| | - Robert J. Stokroos
- Department of Otorhinolaryngology; Maastricht University Medical Center; Maastricht
| | - Nadia Hendrice
- Department of Otorhinolaryngology; Maastricht University Medical Center; Maastricht
| | - Rolien H. Free
- Department of Otorhinolaryngology; Graduate School of Medical Sciences, Research School of Behavioral and Cognitive Neurosciences, University Medical Center Groningen; Groningen
| | - Bert Maat
- Department of Otorhinolaryngology; Graduate School of Medical Sciences, Research School of Behavioral and Cognitive Neurosciences, University Medical Center Groningen; Groningen
| | - Johan H. M. Frijns
- Department of Otorhinolaryngology; Leiden Institute for Brain and Cognition, Leiden University Medical Center; Leiden
| | - Emmanuel A. M. Mylanus
- Department of Otorhinolaryngology; Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center; Nijmegen the Netherlands
| | - Wendy J. Huinck
- Department of Otorhinolaryngology; Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center; Nijmegen the Netherlands
| | - Vedat Topsakal
- Department of Otorhinolaryngology and Head and Neck Surgery; Brain Center Rudolf Magnus, University Medical Center Utrecht; Utrecht
| | - Rinze A. Tange
- Department of Otorhinolaryngology and Head and Neck Surgery; Brain Center Rudolf Magnus, University Medical Center Utrecht; Utrecht
| | - Wilko Grolman
- Department of Otorhinolaryngology and Head and Neck Surgery; Brain Center Rudolf Magnus, University Medical Center Utrecht; Utrecht
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Ramakers GGJ, van Zon A, Stegeman I, Grolman W. The effect of cochlear implantation on tinnitus in patients with bilateral hearing loss: A systematic review. Laryngoscope 2015; 125:2584-92. [DOI: 10.1002/lary.25370] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/31/2015] [Accepted: 04/14/2015] [Indexed: 01/18/2023]
Affiliation(s)
- Geerte G. J. Ramakers
- Department of Otorhinolaryngology-Head and Neck Surgery; University Medical Center Utrecht; Utrecht the Netherlands
- Brain Center Rudolf Magnus, University Medical Center Utrecht; Utrecht the Netherlands
| | - Alice van Zon
- Department of Otorhinolaryngology-Head and Neck Surgery; University Medical Center Utrecht; Utrecht the Netherlands
- Brain Center Rudolf Magnus, University Medical Center Utrecht; Utrecht the Netherlands
| | - Inge Stegeman
- Department of Otorhinolaryngology-Head and Neck Surgery; University Medical Center Utrecht; Utrecht the Netherlands
- Brain Center Rudolf Magnus, University Medical Center Utrecht; Utrecht the Netherlands
| | - Wilko Grolman
- Department of Otorhinolaryngology-Head and Neck Surgery; University Medical Center Utrecht; Utrecht the Netherlands
- Brain Center Rudolf Magnus, University Medical Center Utrecht; Utrecht the Netherlands
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Shurkhay VA, Aleksandrova EV, Potapov AA, Goryainov SA. The current state of the brain-computer interface problem. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2015; 79:97-104. [PMID: 25945382 DOI: 10.17116/neiro201579197-104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
It was only 40 years ago that the first PC appeared. Over this period, rather short in historical terms, we have witnessed the revolutionary changes in lives of individuals and the entire society. Computer technologies are tightly connected with any field, either directly or indirectly. We can currently claim that computers are manifold superior to a human mind in terms of a number of parameters; however, machines lack the key feature: they are incapable of independent thinking (like a human). However, the key to successful development of humankind is collaboration between the brain and the computer rather than competition. Such collaboration when a computer broadens, supplements, or replaces some brain functions is known as the brain-computer interface. Our review focuses on real-life implementation of this collaboration.
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Affiliation(s)
- V A Shurkhay
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | - A A Potapov
- Burdenko Neurosurgical Institute, Moscow, Russia
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Kloostra FJ, Arnold R, Hofman R, Van Dijk P. Changes in Tinnitus after Cochlear Implantation and Its Relation with Psychological Functioning. Audiol Neurootol 2014; 20:81-9. [DOI: 10.1159/000365959] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 07/17/2014] [Indexed: 11/19/2022] Open
Abstract
This study retrospectively assessed the prevalence of tinnitus in cochlear implant patients and the changes after implantation in 212 patients implanted between 2000 and 2009. Patients were included at least 6 months after implantation and received 2 sets of questionnaires, one about the situation before implantation and one about the situation after implantation. Mostly standardized questionnaires assessed tinnitus handicap (Tinnitus Handicap Inventory, THI, and Tinnitus Handicap Questionnaire, THQ), tinnitus characteristics, hearing loss (Abbreviated Profile of Hearing Aid Benefit) and anxiety/depression (Hospital Anxiety and Depression Scale). Of the approached patients, 117 completed the full sets of questionnaires and 35 completed a short version. Preoperative tinnitus was reported by 51.3% of these patients, of which 55.6% reported a reduction or cessation of their tinnitus after implantation. However, 8.2% of the patients with tinnitus reported a postoperative deterioration of their tinnitus. In addition, among the patients without preoperative tinnitus, 19.6% reported the start of tinnitus after implantation. The self-reported change of tinnitus correlated with the pre- and postoperative scores on the THI and THQ. The THQ showed slightly more changes in scores after cochlear implantation compared to the THI. Overall hearing handicap and feelings of anxiety and depression decreased after implantation. In conclusion, tinnitus is reduced after cochlear implantation in an important part of the patients, but in a small part implantation has a negative effect on tinnitus. When tinnitus starts after implantation, the tinnitus handicap is mild.
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Offutt SJ, Ryan KJ, Konop AE, Lim HH. Suppression and facilitation of auditory neurons through coordinated acoustic and midbrain stimulation: investigating a deep brain stimulator for tinnitus. J Neural Eng 2014; 11:066001. [PMID: 25307351 PMCID: PMC4244264 DOI: 10.1088/1741-2560/11/6/066001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The inferior colliculus (IC) is the primary processing center of auditory information in the midbrain and is one site of tinnitus-related activity. One potential option for suppressing the tinnitus percept is through deep brain stimulation via the auditory midbrain implant (AMI), which is designed for hearing restoration and is already being implanted in deaf patients who also have tinnitus. However, to assess the feasibility of AMI stimulation for tinnitus treatment we first need to characterize the functional connectivity within the IC. Previous studies have suggested modulatory projections from the dorsal cortex of the IC (ICD) to the central nucleus of the IC (ICC), though the functional properties of these projections need to be determined. APPROACH In this study, we investigated the effects of electrical stimulation of the ICD on acoustic-driven activity within the ICC in ketamine-anesthetized guinea pigs. MAIN RESULTS We observed ICD stimulation induces both suppressive and facilitatory changes across ICC that can occur immediately during stimulation and remain after stimulation. Additionally, ICD stimulation paired with broadband noise stimulation at a specific delay can induce greater suppressive than facilitatory effects, especially when stimulating in more rostral and medial ICD locations. SIGNIFICANCE These findings demonstrate that ICD stimulation can induce specific types of plastic changes in ICC activity, which may be relevant for treating tinnitus. By using the AMI with electrode sites positioned with the ICD and the ICC, the modulatory effects of ICD stimulation can be tested directly in tinnitus patients.
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Affiliation(s)
- Sarah J. Offutt
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, USA
| | - Kellie J. Ryan
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, USA
| | - Alexander E. Konop
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, USA
| | - Hubert H. Lim
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, USA
- Institute for Translational Neuroscience, University of Minnesota, Minneapolis, USA
- Department of Otolaryngology, Head and Neck Surgery, University of Minnesota, Minneapolis, USA
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Henry JA, Roberts LE, Caspary DM, Theodoroff SM, Salvi RJ. Underlying mechanisms of tinnitus: review and clinical implications. J Am Acad Audiol 2014; 25:5-22; quiz 126. [PMID: 24622858 PMCID: PMC5063499 DOI: 10.3766/jaaa.25.1.2] [Citation(s) in RCA: 151] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The study of tinnitus mechanisms has increased tenfold in the last decade. The common denominator for all of these studies is the goal of elucidating the underlying neural mechanisms of tinnitus with the ultimate purpose of finding a cure. While these basic science findings may not be immediately applicable to the clinician who works directly with patients to assist them in managing their reactions to tinnitus, a clear understanding of these findings is needed to develop the most effective procedures for alleviating tinnitus. PURPOSE The goal of this review is to provide audiologists and other health-care professionals with a basic understanding of the neurophysiological changes in the auditory system likely to be responsible for tinnitus. RESULTS It is increasingly clear that tinnitus is a pathology involving neuroplastic changes in central auditory structures that take place when the brain is deprived of its normal input by pathology in the cochlea. Cochlear pathology is not always expressed in the audiogram but may be detected by more sensitive measures. Neural changes can occur at the level of synapses between inner hair cells and the auditory nerve and within multiple levels of the central auditory pathway. Long-term maintenance of tinnitus is likely a function of a complex network of structures involving central auditory and nonauditory systems. CONCLUSIONS Patients often have expectations that a treatment exists to cure their tinnitus. They should be made aware that research is increasing to discover such a cure and that their reactions to tinnitus can be mitigated through the use of evidence-based behavioral interventions.
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Affiliation(s)
- James A. Henry
- VA RR&D National Center for Rehabilitative Auditory Research (NCRAR), VA Medical Center, Portland, OR
- Department of Otolaryngology/Head and Neck Surgery, Oregon Health and Science University, Portland, OR
| | - Larry E. Roberts
- Department of Psychology, Neuroscience, and Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - Donald M. Caspary
- Pharmacology Department, Southern Illinois University School of Medicine, Springfield, IL
| | - Sarah M. Theodoroff
- VA RR&D National Center for Rehabilitative Auditory Research (NCRAR), VA Medical Center, Portland, OR
- Department of Otolaryngology/Head and Neck Surgery, Oregon Health and Science University, Portland, OR
| | - Richard J. Salvi
- Center for Hearing and Deafness, University of Buffalo, Buffalo, NY
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Punte AK, Vermeire K, Hofkens A, De Bodt M, De Ridder D, Van de Heyning P. Cochlear implantation as a durable tinnitus treatment in single-sided deafness. Cochlear Implants Int 2013; 12 Suppl 1:S26-9. [DOI: 10.1179/146701011x13001035752336] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Kleine Punte A, De Ridder D, Van de Heyning P. On the necessity of full length electrical cochlear stimulation to suppress severe tinnitus in single-sided deafness. Hear Res 2013; 295:24-9. [PMID: 23418635 DOI: 10.1016/j.heares.2012.08.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Extra Benefit of a Second Cochlear Implant With Respect to Health-Related Quality of Life and Tinnitus. Otol Neurotol 2012; 33:1169-75. [DOI: 10.1097/mao.0b013e31825e799f] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Engineer ND, Rosellini WM, Tyler RS. Willingness to Accept and Pay for Implantable Tinnitus Treatments: A Survey. Neuromodulation 2012; 16:154-62. [DOI: 10.1111/j.1525-1403.2012.00487.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstracts of the British Society of Audiology annual conference (incorporating the Experimental and Clinical Short papers meetings). Int J Audiol 2012. [DOI: 10.3109/14992027.2012.653103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kompis M, Pelizzone M, Dillier N, Allum J, DeMin N, Senn P. Tinnitus before and 6 Months after Cochlear Implantation. ACTA ACUST UNITED AC 2012; 17:161-8. [DOI: 10.1159/000335126] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Accepted: 11/15/2011] [Indexed: 11/19/2022]
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Noreña AJ. Stimulating the Auditory System to Treat Tinnitus: From Alleviating the Symptoms to Addressing the Causes. SPRINGER HANDBOOK OF AUDITORY RESEARCH 2012. [DOI: 10.1007/978-1-4614-3728-4_10] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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Olze H, Szczepek AJ, Haupt H, Zirke N, Graebel S, Mazurek B. The Impact of Cochlear Implantation on Tinnitus, Stress and Quality of Life in Postlingually Deafened Patients. ACTA ACUST UNITED AC 2012; 17:2-11. [PMID: 21540584 DOI: 10.1159/000323847] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Accepted: 12/15/2010] [Indexed: 11/19/2022]
Affiliation(s)
- Heidi Olze
- Department of Otorhinolaryngology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
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Soleymani T, Pieton D, Pezeshkian P, Miller P, Gorgulho AA, Pouratian N, De Salles AAF. Surgical approaches to tinnitus treatment: A review and novel approaches. Surg Neurol Int 2011; 2:154. [PMID: 22140639 PMCID: PMC3228384 DOI: 10.4103/2152-7806.86834] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Accepted: 08/30/2011] [Indexed: 11/21/2022] Open
Abstract
Background: Tinnitus, a profoundly widespread auditory disorder, is characterized by the perception of sound in the absence of external stimulation. The aim of this work is to review the various surgical treatment options for tinnitus, targeting the various disruption sites along the auditory pathway, as well as to indicate novel neuromodulatory techniques as a mode of tinnitus control. Methods: A comprehensive analysis was conducted on published clinical and basic neuroscience research examining the pathophysiology and treatment options of tinnitus. Results: Stereotactic radiosurgery methods and microvascular decompressions are indicated for tinnitus caused by underlying pathologies such as vestibular schwannomas or neurovascular conflicts of the vestibulocochlear nerve at the level of the brainstem. However, subsequent hearing loss and secondary tinnitus may occur. In patients with subjective tinnitus and concomitant sensorineural hearing loss, cochlear implantation is indicated. Surgical ablation of the cochlea, vestibulocochlear nerve, or dorsal cochlear nucleus, though previously suggested in earlier literature as viable treatment options for tinnitus, has been shown to be ineffective and contraindicated. Recently, emerging research has shown the neuromodulatory capacity of the somatosensory system at the level of the trigeminal nerve on the auditory pathway through its inputs at various nuclei in the central auditory pathway. Conclusion: Tinnitus remains to be a difficult disorder to treat despite the many surgical interventions aimed at eliminating the aberrant neuronal activity in the auditory system. A promising novel neuromodulatory approach using the trigeminal system to control such a bothersome and difficult-to-treat disorder deserves further investigation and controlled clinical trials.
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Affiliation(s)
- Teo Soleymani
- School of Medicine, University of California at Irvine, Irvine, CA, USA
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Fioretti A, Eibenstein A, Fusetti M. New trends in tinnitus management. Open Neurol J 2011; 5:12-7. [PMID: 21541237 PMCID: PMC3085173 DOI: 10.2174/1874205x01105010012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Revised: 11/11/2010] [Accepted: 12/02/2010] [Indexed: 11/22/2022] Open
Abstract
Tinnitus is a perception of sound in absence of sound stimulation. Tinnitus in many cases cannot be eliminated by conventional medical treatment with drugs or surgery. Some people who begin to notice tinnitus, whether spontaneous or induced by noise, trauma or other insult, will experience spontaneous resolution, but many patients will have persistent tinnitus. For some of them, tinnitus sensation will be joined by tinnitus suffering, with many adverse effects like anxiety, depression and sleep disorders. For these tinnitus sufferers the psychological and acoustic approach proposed by the Tinnitus Retraining Therapy and Acoustic Desensitization Protocol may be helpful. Periodically new treatments are suggested like low-frequency repetitive transcranial magnetic stimulation and sequential phase shift sound cancellation treatment based on the frequency and loudness matching of the tinnitus. The aim of this work is to review modern considerations for the treatment of tinnitus.
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Masgoret Palau E, Merán Gil JL, Moreno Vidal C, Falcón González JC, Artiles Cabrera O, Ramos Macías Á. Acúfeno e implante coclear. Experiencia preliminar. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2010; 61:405-11. [DOI: 10.1016/j.otorri.2010.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Revised: 07/02/2010] [Accepted: 07/05/2010] [Indexed: 10/19/2022]
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Hörgeräte, implantierbare Hörgeräte und Cochlear implants in der Therapie des chronischen Tinnitus. HNO 2010; 58:1004-12. [DOI: 10.1007/s00106-010-2181-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Pan T, Tyler RS, Ji H, Coelho C, Gehringer AK, Gogel SA. Changes in the tinnitus handicap questionnaire after cochlear implantation. Am J Audiol 2010; 18:144-51. [PMID: 19949236 DOI: 10.1044/1059-0889(2009/07-0042)] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To determine (a) changes in the Tinnitus Handicap Questionnaire (THQ) for patients using cochlear implants, (b) differences between patients who receive total or partial relief, and (c) identifiable characteristics of those who report tinnitus after implantation. METHOD Pre- and postoperatively, 244 adults were administered the THQ when they reported tinnitus. RESULTS Of the 153 patients who had tinnitus preoperatively, 94 (61%) patients reported total suppression and 59 (39%) reported a partial reduction. In 91 patients who did not have tinnitus before implantation, 11 (12%) reported tinnitus postimplantation. The THQ score decreased from 41% preimplant to 30% postimplant. The largest reductions involved social handicap and hearing. Patients with a more severe hearing loss might be more likely to experience an exacerbation of their tinnitus. We were not able to clearly identify differences between patients who received total or partial relief and the characteristics of patients who reported tinnitus after implantation. Those who acquired tinnitus had the shortest duration hearing loss (5.6 years) and were the oldest (63 years). The average THQ score of patients getting tinnitus was 29%. CONCLUSIONS Most tinnitus patients benefit from receiving a cochlear implant.
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Affiliation(s)
- Tao Pan
- University of Iowa, Iowa City, and Peking University Third Hospital, Beijing, People’s Republic of China
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Masgoret Palau E, Merán Gil JL, Moreno Vidal C, Falcón González JC, Artiles Cabrera O, Ramos Macías Á. Tinnitus and cochlear implantation. Preliminary experience. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2010. [DOI: 10.1016/s2173-5735(10)70075-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Chadha NK, Gordon KA, James AL, Papsin BC. Tinnitus is prevalent in children with cochlear implants. Int J Pediatr Otorhinolaryngol 2009; 73:671-5. [PMID: 19185357 DOI: 10.1016/j.ijporl.2008.12.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Revised: 12/22/2008] [Accepted: 12/23/2008] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To explore the prevalence and the perceived impact of tinnitus in children using cochlear implants. METHOD Cross-sectional study of implanted children attending a cochlear implant family event organized annually by our academic tertiary pediatric care center. Children were interviewed together with their parents, using open-questioning and structured interview qualitative methodologies. The main outcome measures were the prevalence of tinnitus and any impact of these symptoms. RESULTS 40 children (age range: 3-15, mean: 7 years) and their families were interviewed. These included unilateral implantees (n=21), and bilateral implantees (n=19) whose two procedures were simultaneous (n=6), within 6-12 months (n=3), or >2 years apart (n=10). Tinnitus was reported by 38% (n=15). Tinnitus occurred most commonly in the implanted ear, when the implants were not in use (e.g. in bed at night). The children were generally untroubled by the tinnitus, although two reported difficulty sleeping. Tinnitus was most frequent in children aged 6-8 years (8/17, 47%), and in bilateral implantees with an inter-procedure delay of at least 2 years (6/10, 60%). Tinnitus was least reported in those implanted bilaterally simultaneously (1/6, 17%), and in those 5 years old or younger (3/11, 27%). No obvious relationship was identified between the prevalence of tinnitus and the etiology of deafness, age of implantation, or time elapsed since implantation. CONCLUSIONS To our knowledge this is the first study to report the widespread prevalence of tinnitus in implanted children. Further work, particularly examining the effect of inter-implant delay on tinnitus in bilateral implantees, may contribute to our understanding of the neuronal plasticity after implantation.
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Affiliation(s)
- Neil K Chadha
- Department of Otolaryngology, The Hospital for Sick Children, Toronto, Ontario, Canada.
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