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Labree B, Sereda M, Cullington H, Johnson S, Church P, Dunster J, Hoare DJ. Evaluation of factors predicting tinnitus outcomes following cochlear implantation: Protocol for a prospective quasi-experimental study. PLoS One 2024; 19:e0302790. [PMID: 38885210 PMCID: PMC11182524 DOI: 10.1371/journal.pone.0302790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/10/2024] [Indexed: 06/20/2024] Open
Abstract
Cochlear implantation is an effective intervention to restore useful aspects of hearing function in adults with severe-to-profound hearing loss. Tinnitus, the perception of sound in the absence of an external source, is common in people with severe-to-profound hearing loss. Existing evidence suggests cochlear implantation may be effective in reducing the negative impact of tinnitus in this population. However, this is contradicted by data suggesting that up to half of cochlear implant recipients experience tinnitus, and that some of these patients who did not have tinnitus before cochlear implantation experience it after surgery or cochlear implant activation. Most evidence on the effects of cochlear implantation on tinnitus comes from secondary data in cochlear implant studies primarily concerned with hearing-related outcomes. Hence, the quality of the evidence for effects on tinnitus is low and not suitable to inform clinical recommendations or decision-making. This study will systematically collect data on tinnitus and tinnitus-related outcomes from patients at multiple points during the cochlear implant pathway to characterise changes in tinnitus. This will improve our understanding of the effects of cochlear implantation for tinnitus in adults with severe to profound hearing loss and inform the design of clinical trials of cochlear implantation for tinnitus.
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Affiliation(s)
- Bas Labree
- NIHR Nottingham Biomedical Research Centre, Nottingham, United Kingdom
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Magdalena Sereda
- NIHR Nottingham Biomedical Research Centre, Nottingham, United Kingdom
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Helen Cullington
- Auditory Implant Service, University of Southampton, Southampton, United Kingdom
| | - Susan Johnson
- Nottingham Auditory Implant Programme, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Paige Church
- NIHR Nottingham Biomedical Research Centre, Nottingham, United Kingdom
- NIHR Clinical Research Network (CRN) East Midlands, Nottingham Health Science Partners, Nottingham, United Kingdom
| | | | - Derek J. Hoare
- NIHR Nottingham Biomedical Research Centre, Nottingham, United Kingdom
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
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The Relationship Between Sleep Traits and Tinnitus in UK Biobank: A Population-Based Cohort Study. Ear Hear 2023; 44:53-60. [PMID: 36194023 DOI: 10.1097/aud.0000000000001273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Understanding the association between sleep traits and tinnitus could help prevent and provide appropriate interventions against tinnitus. Therefore, this study aimed to assess the relationship between different sleep patterns and tinnitus. DESIGN A cross-sectional analysis using baseline data (2006-2010, n = 168,064) by logistic regressions was conducted to evaluate the association between sleep traits (including the overall health sleep score and five sleep behaviors) and the occurrence (yes/no), frequency (constant/transient), and severity (upsetting/not upsetting) of tinnitus. Further, a prospective analysis of participants without tinnitus at baseline (n = 9581) was performed, who had been followed-up for 7 years (2012-2019), to assess the association between new-onset tinnitus and sleep characteristics. Moreover, a subgroup analysis was also carried out to estimate the differences in sex by dividing the participants into male and female groups. A sensitivity analysis was also conducted by excluding ear-related diseases to avoid their confounding effects on tinnitus (n = 102,159). RESULTS In the cross-sectional analysis, participants with "current tinnitus" (OR: 1.13, 95% CI: 1.04-1.22, p = 0.004) had a higher risk of having a poor overall healthy sleep score and unhealthy sleep behaviors such as short sleep durations (OR: 1.09, 95% CI: 1.04-1.14, p < 0.001), late chronotypes (OR: 1.09, 95% CI: 1.05-1.13, p < 0.001), and sleeplessness (OR: 1.16, 95% CI: 1.11-1.22, p < 0.001) than those participants who "did not have current tinnitus." However, this trend was not obvious between "constant tinnitus" and "transient tinnitus." When considering the severity of tinnitus, the risk of "upsetting tinnitus" was obviously higher if participants had lower overall healthy sleep scores (OR: 1.31, 95% CI: 1.13-1.53, p < 0.001). Additionally, short sleep duration (OR: 1.22, 95% CI: 1.12-1.33, p < 0.001), late chronotypes (OR: 1.13, 95% CI: 1.04-1.22, p = 0.003), and sleeplessness (OR: 1.43, 95% CI: 1.29-1.59, p < 0.001) showed positive correlations with "upsetting tinnitus." In the prospective analysis, sleeplessness presented a consistently significant association with "upsetting tinnitus" (RR: 2.28, p = 0.001). Consistent results were observed in the sex subgroup analysis, where a much more pronounced trend was identified in females compared with the males. The results of the sensitivity analysis were consistent with those of the cross-sectional and prospective analyses. CONCLUSIONS Different types of sleep disturbance may be associated with the occurrence and severity of tinnitus; therefore, precise interventions for different types of sleep disturbance, particularly sleeplessness, may help in the prevention and treatment of tinnitus.
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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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Abdelmonem AA, Salah H, Mostafa HA, ElMonem NAA, Khalil DM, Youssef RS, Fahiem RA. Assessment of Behavioral Problems in Children Pre- and Post-Cochlear Implant: An Egyptian Study. Psychiatry Investig 2022; 19:763-769. [PMID: 36202112 PMCID: PMC9536882 DOI: 10.30773/pi.2022.0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/02/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The present study aimed to detect the behavioral problems pre- and post-cochlear implantation in comparison to normal hearing group to be able to manage these problems to get more benefit from using cochlear implants. METHODS A case-control study included 53 children was done. They were divided into 2 groups, the control group included 28 healthy volunteers with normal hearing and the case group included 25 children with severe to profound hearing loss, fitted for cochlear implantation. The Arabic Child Behavior Checklist (CBCL) was used to detect different behavioral problems in both groups. Case group children were followed up and reassessed again by CBCL 3 months later after cochlear implantation. RESULTS There were highly significant differences regarding total scores of internalizing and externalizing domains of empirically based CBCL between the control group and the case group after cochlear implants (p=0.001). There were non-significant differences in children within case group (pre- and post-cochlear implantation) regarding emotional and behavioral problems on both empirically based and Diagnostic and Statistical Manual of Mental Disorders-based CBCL. CONCLUSION For better results, it is necessary to include a specialist of psychosomatic medicine in the cochlear rehabilitation teamwork.
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Affiliation(s)
- Ahmed Ali Abdelmonem
- Department of Phoniatrics, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Hisham Salah
- Department of Psychiatry, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Heba Ashour Mostafa
- Department of Phoniatrics, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Noha A Abd ElMonem
- Department of Neurology, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Doaa Mahmoud Khalil
- Department of Public Health and Community, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Rabie Sayed Youssef
- Department of Otorhinolaryngology, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Reham Ahmed Fahiem
- Department of Medical Studies for Children, Faculty of Postgraduate Childhood Studies, Ain Shams University, Cairo, Egypt
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Assouly KKS, Arts RAGJ, Graham PL, van Dijk B, James CJ. Influence of tinnitus annoyance on hearing-related quality of life in cochlear implant recipients. Sci Rep 2022; 12:14423. [PMID: 36002556 PMCID: PMC9402917 DOI: 10.1038/s41598-022-18823-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 08/19/2022] [Indexed: 01/10/2023] Open
Abstract
Tinnitus is a common symptom in cochlear implant (CI) recipients. There is no clear evidence of the influence of tinnitus on hearing-related quality of life (QoL) in this population. The aim of this study was to assess the relationship between hearing-related QoL measured by the Speech, Spatial and Qualities of Hearing scale (SSQ12) and tinnitus annoyance or perceived change in tinnitus annoyance after cochlear implantation. The study sample consisted of 2322 implanted adults across France, Germany, Ireland, Italy, the Netherlands, Sweden and the United Kingdom. Information relating to QoL measured using the SSQ12 and tinnitus annoyance and change in tinnitus annoyance, assessed using single-item questions, were collected one or more years post-implantation. The relationship between SSQ12 score and tinnitus annoyance or change in tinnitus annoyance was analysed using linear models adjusted for age and unilateral versus bilateral implants. Tukey pairwise tests were used to compare mean SSQ12 scores across levels of tinnitus annoyance and changes. Tinnitus prevalence was 33.9% post-implantation. Recipients with tinnitus had a significantly lower SSQ12 score than recipients without tinnitus. SSQ scores varied significantly with tinnitus annoyance, age and unilateral versus bilateral implants. Overall, CI recipients who experienced less bothersome tinnitus reported better hearing-related QoL. Healthcare professionals should be aware of the influence of tinnitus on CI recipients’ hearing to manage patient expectations.
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Affiliation(s)
- Kelly K S Assouly
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. .,University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands. .,Cochlear Technology Centre Belgium, Mechelen, Belgium.
| | | | - Petra L Graham
- School of Mathematical and Physical Sciences, Macquarie University, North Ryde, NSW, Australia
| | - Bas van Dijk
- Cochlear Technology Centre Belgium, Mechelen, Belgium
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Assouly KKS, Smit AL, Eikelboom RH, Sucher C, Atlas M, Stokroos RJ, Stegeman I. Analysis of a Cochlear Implant Database: Changes in Tinnitus Prevalence and Distress After Cochlear Implantation. Trends Hear 2022; 26:23312165221128431. [PMID: 36154765 PMCID: PMC9515522 DOI: 10.1177/23312165221128431] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The aim of this study was to estimate the prevalence and distress of tinnitus
pre- and post-cochlear implantation in patients with bilateral severe to
profound hearing loss. In this retrospective study, we included patients from a
cochlear implant clinic in Perth, Western Australia. Pre- and post-cochlear
implantation data from 300 implant recipients were collected on self-reported
presence of tinnitus, tinnitus distress using the Tinnitus Reaction
Questionnaire (TRQ), hearing-related quality of life using the Abbreviated
Profile of Hearing Aid Benefit (APHAB), and consonant-nucleus vowel-consonant
(CNC) word recognition test scores. Retrospectively, patients were grouped into
those with or without tinnitus, and the grade of tinnitus distress. The
potential factors associated with post-implantation changes in the presence of
tinnitus and its distress were evaluated. Tinnitus prevalence was 55.8%
pre-operatively and 44.3% post-implantation with a median TRQ score respectively
of 12.0 (IQR: 1.0–28.0) and 3.5 (IQR: 0.0–16.2) points. Among the 96 patients
experiencing tinnitus pre-implantation, 14.6% patients experienced moderate to
catastrophic tinnitus distress pre-implantation compared to 6.3%
post-implantation. To conclude, the pre- and post-implantation median TRQ score
for the cohort population showed that tinnitus was a “slight” handicap. Tinnitus
prevalence and its associated tinnitus distress decreased post-implantation.
Patients with tinnitus post-implantation were significantly younger and had less
severe pre-implantation hearing loss in the non-implanted ear than patients
without tinnitus. Further research is needed to understand the factors
influencing changes in tinnitus.
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Affiliation(s)
- Kelly K S Assouly
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.,UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Cochlear Technology Centre, Mechelen, Belgium
| | - Adriana L Smit
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.,UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Robert H Eikelboom
- 104182Ear Science Institute Australia, Subiaco, Western Australia.,Centre for Ear Sciences, Medical School, The University of Western Australia, Nedlands, Western Australia.,Department of Speech Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa.,Curtin Medical School, Curtin University, Bentley, Western Australia
| | - Cathy Sucher
- 104182Ear Science Institute Australia, Subiaco, Western Australia.,Centre for Ear Sciences, Medical School, The University of Western Australia, Nedlands, Western Australia
| | - Marcus Atlas
- 104182Ear Science Institute Australia, Subiaco, Western Australia.,Centre for Ear Sciences, Medical School, The University of Western Australia, Nedlands, Western Australia
| | - Robert J Stokroos
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.,UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Inge Stegeman
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.,UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands.,Epidemiology and Data Science, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Associations Between Hearing Health and Well-Being in Unilateral Hearing Impairment. ACTA ACUST UNITED AC 2021; 42:520-530. [DOI: 10.1097/aud.0000000000000969] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Smith SS, Kitterick PT, Scutt P, Baguley DM, Pierzycki RH. An exploration of psychological symptom-based phenotyping of adult cochlear implant users with and without tinnitus using a machine learning approach. PROGRESS IN BRAIN RESEARCH 2020; 260:283-300. [PMID: 33637224 DOI: 10.1016/bs.pbr.2020.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The identification of phenotypes within populations with troublesome tinnitus is an important step towards individualizing tinnitus treatments to achieve optimal outcomes. However, previous application of clustering algorithms has called into question the existence of distinct tinnitus-related phenotypes. In this study, we attempted to characterize patients' symptom-based phenotypes as subpopulations in a Gaussian mixture model (GMM), and subsequently performed a comparison with tinnitus reporting. We were able to effectively evaluate the statistical models using cross-validation to establish the number of phenotypes in the cohort, or a lack thereof. We examined a cohort of adult cochlear implant (CI) users, a patient group for which a relation between psychological symptoms (anxiety, depression, or insomnia) and trouble tinnitus has previously been shown. Accordingly, individual item scores on the Hospital Anxiety and Depression Scale (HADS; 14 items) and the Insomnia Severity Index (ISI; 7 items) were selected as features for training the GMM. The resulting model indicated four symptom-based subpopulations, some primarily linked to one major symptom (e.g., anxiety), and others linked to varying severity across all three symptoms. The presence of tinnitus was self-reported and tinnitus-related handicap was characterized using the Tinnitus Handicap Inventory. Specific symptom profiles were found to be significantly associated with CI users' tinnitus characteristics. GMMs are a promising machine learning tool for identifying psychological symptom-based phenotypes, which may be relevant to determining appropriate tinnitus treatment.
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Affiliation(s)
- Samuel S Smith
- Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom.
| | - Pádraig T Kitterick
- Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom; National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, University of Nottingham, Ropewalk House, Nottingham, United Kingdom; Nottingham University Hospitals NHS Trust, Queens Medical Centre, Nottingham, United Kingdom
| | - Polly Scutt
- Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom; National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, University of Nottingham, Ropewalk House, Nottingham, United Kingdom
| | - David M Baguley
- Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom; National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, University of Nottingham, Ropewalk House, Nottingham, United Kingdom; Nottingham University Hospitals NHS Trust, Queens Medical Centre, Nottingham, United Kingdom
| | - Robert H Pierzycki
- Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom; National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, University of Nottingham, Ropewalk House, Nottingham, United Kingdom
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van Heteren JAA, Arts RAGJ, Killian MJP, Assouly KKS, van de Wauw C, Stokroos RJ, Smit AL, George ELJ. Sound therapy for cochlear implant users with tinnitus. Int J Audiol 2020; 60:374-384. [PMID: 33074733 DOI: 10.1080/14992027.2020.1832266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Despite the positive effect of a cochlear implant (CI) on tinnitus in many patients, tinnitus remains a problem for a significant proportion of CI users. We investigated the acceptability and effect of sound therapy (a combination of natural background sounds and one concise tinnitus counselling session) on tinnitus and speech perception in CI users who still experienced tinnitus during CI use. DESIGN AND STUDY SAMPLE Thirty-two CI users (32-78 years) participated in phase 1: a test at the clinic to evaluate six background sounds provided by the sound processor. Eighteen out of the 32 CI users participated in phase 2: an optional take-home evaluation of 2 weeks without sound therapy, followed by 5 weeks with sound therapy, ending with an evaluation visit. RESULTS Thirty subjects (93.8%) found at least one background sound acceptable. In phase 2, a small improvement with sound therapy was found for tinnitus loudness, annoyance, and intrusiveness. 50% of the subjects subjectively reported benefit of sound therapy. Especially the sense of control on their tinnitus was highly appreciated. No detrimental effect on speech perception was observed. CONCLUSION The background sounds were acceptable and provided tinnitus relief in some CI users with tinnitus during CI use.
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Affiliation(s)
- 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
| | | | | | - 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.,Technology Centre, Cochlear Technology Centre, Mechelen, Belgium
| | - Cynthia van de Wauw
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, 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
| | - 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
| | - Erwin L J George
- Department of Otorhinolaryngology and Head & Neck Surgery, Maastricht University Medical Center, MHeNS School for Mental Health and Neuroscience, Maastricht, The Netherlands
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Abstract
OBJECTIVE Determine the prevalence of clinical insomnia and its associations with anxiety, depression, and tinnitus in adult cochlear implant (CI) users. DESIGN Self-reported information on tinnitus, sleep, and demographic variables was collected from adult CI users (n = 127). Tinnitus presence, its persistence, related emotional distress, and difficulties with sleep were assessed using questions from the UK Biobank study (www.ukbiobank.ac.uk). Tinnitus-related handicap was assessed using the Tinnitus Handicap Inventory. Clinical insomnia symptoms were characterized using the Insomnia Severity Index (ISI), and clinical anxiety and depression symptoms using the Hospital Anxiety and Depression Scale (HADS). Regression models were used to compare the data from CI users with and without tinnitus, and to test the associations between clinical insomnia, anxiety, depression and tinnitus handicap. RESULTS About a half (53%) of CI users reported tinnitus, of whom 54% described it as persistent, 41% as emotionally distressing and 73% reported having difficulties with sleep based on the UK Biobank questions. The ISI suggested that clinically abnormal insomnia symptoms were more likely to occur with tinnitus (odds ratio [OR] = 2.60, 95% confidence interval 1.04 to 6.45; p = 0.040) and were found in 41% of CI users with tinnitus. Post-hoc exploratory analyses on the ISI suggested that CI users with tinnitus experienced greater levels of difficulty falling asleep, lower satisfaction with sleep patterns, greater interference of sleep problems with daily activities, and a greater impact on their quality of life. The HADS scores suggested that those with tinnitus were also more likely to have clinically abnormal anxiety (42%; OR = 3.50, 95% confidence interval 1.49 to 8.22; p = 0.004) and depression symptoms (14%; OR = 6.18, 95% confidence interval 1.17 to 32.82; p = 0.032). The clinical insomnia observed in CI users with tinnitus was associated with tinnitus handicap (p = 0.028), and the levels of clinical anxiety (p = 0.012) and depression (p < 0.001). CONCLUSIONS Clinically abnormal insomnia symptoms are prevalent, potentially affecting over 40% of CI users with tinnitus. The associations between clinical insomnia, anxiety, and depression symptoms, and tinnitus-related handicap suggest that all of these symptoms should be considered when assessing the tinnitus-related burden and its impact on the quality of life after cochlear implantation. The present findings also have potential implications for the clinical management of CI recipients with tinnitus, in whom it may be advisable to monitor sleep problems so that they can be addressed where appropriate. Further research is needed to investigate the mechanisms and causal links behind insomnia and tinnitus-related symptoms in this population. Future studies should also investigate the feasibility and effectiveness of night time use of CIs to alleviate tinnitus-related insomnia. The potential impact of insomnia on the quality of life of CI users with tinnitus highlights the importance of including sleep measures in future evaluations of the effectiveness of cochlear implantation for the alleviation of tinnitus.
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Lu J, Zhang L, Lu Y, Su M, Li X, Liu J, Zhang H, Nasir K, Masoudi FA, Krumholz HM, Li J, Zheng X. Secondary prevention of cardiovascular disease in China. Heart 2020; 106:1349-1356. [PMID: 31980439 DOI: 10.1136/heartjnl-2019-315884] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 12/06/2019] [Accepted: 01/05/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE We aimed to estimate the current use of secondary prevention drugs and identify its associated individual characteristics among those with established cardiovascular diseases (CVDs) in the communities of China. METHODS We studied 2 613 035 participants aged 35-75 years from 8577 communities in 31 provinces in the China Patient-Centered Evaluative Assessment of Cardiac Events Million Persons Project, a government-funded public health programme conducted from 2014 to 2018. Participants self-reported their history of ischaemic heart disease (IHD) or ischaemic stroke (IS) and medication use in an interview. Multivariable mixed models with a logit link function and community-specific random intercepts were fitted to assess the associations of individual characteristics with the reported use of secondary prevention therapies. RESULTS Among 2 613 035 participants, 2.9% (74 830) reported a history of IHD and/or IS, among whom the reported use rate either antiplatelet drugs or statins was 34.2% (31.5% antiplatelet drugs, 11.0% statins and 8.3% both). Among the 1 530 408 population subgroups, which were defined by all possible permutations of 16 individual characteristics, reported use of secondary prevention drugs varied substantially (8.4%-60.6%). In the multivariable analysis, younger people, women, current smokers, current drinkers, people without hypertension or diabetes and those with established CVD for more than 2 years were less likely to report taking antiplatelet drugs or statins. CONCLUSIONS The current use of secondary prevention drugs in China is suboptimal and varies substantially across population subgroups. Our study identifies target populations for scalable, tailored interventions to improve secondary prevention of CVD.
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Affiliation(s)
- Jiapeng Lu
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lihua Zhang
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuan Lu
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Heaven, Connecticut, USA
| | - Meng Su
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xi Li
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiamin Liu
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haibo Zhang
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Khurram Nasir
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Heaven, Connecticut, USA
| | - Frederick A Masoudi
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Heaven, Connecticut, USA
| | - Jing Li
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xin Zheng
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Pierzycki RH, Corner C, Fielden CA, Kitterick PT. Effects of Tinnitus on Cochlear Implant Programming. Trends Hear 2019; 23:2331216519836624. [PMID: 30880643 PMCID: PMC6423681 DOI: 10.1177/2331216519836624] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Clinical observations suggest that tinnitus may interfere with programming
cochlear implants (CIs), the process of optimizing the transmission of acoustic
information to support speech perception with a CI. Despite tinnitus being
highly prevalent among CI users, its effects and impact on CI programming are
obscure. This study characterized the nature, time-course, and impact of
tinnitus effects encountered by audiologists and patients during programming
appointments. Semistructured interviews with six CI audiologists were analyzed
thematically to identify tinnitus effects on programming and related coping
strategies. Cross-sectional surveys with 67 adult CI patients with tinnitus and
20 CI audiologists in the United Kingdom examined the prevalence and time-course
of those effects. Programming parameters established at CI activation
appointments of 10 patients with tinnitus were compared with those of 10
patients without tinnitus. On average, 80% of audiologists and 45% of patients
reported that tinnitus makes measurements of threshold (T) levels more difficult
because patients confuse their tinnitus with CI stimulation. Difficulties
appeared most common at CI activation appointments, at which T levels were
significantly higher in patients with tinnitus. On average, 26% of patients
reported being afraid of “loud” CI stimulation worsening tinnitus, affecting
measurements of loudest comfortable (C) stimulation levels, and 34% of
audiologists reported observing similar effects. Patients and audiologists
reported that tinnitus makes programming appointments more difficult and
tiresome for patients. The findings suggest that specific programming strategies
may be needed during CI programming with tinnitus, but further research is
required to assess the potential impact on outcomes including speech
perception.
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Affiliation(s)
- Robert H Pierzycki
- 1 National Institute for Health Research Nottingham Biomedical Research Centre, UK.,2 Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, UK
| | - Charlotte Corner
- 1 National Institute for Health Research Nottingham Biomedical Research Centre, UK.,2 Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, UK
| | - Claire A Fielden
- 1 National Institute for Health Research Nottingham Biomedical Research Centre, UK.,3 Nottingham University Hospitals National Health Service Trust, Queen's Medical Centre, UK
| | - Pádraig T Kitterick
- 1 National Institute for Health Research Nottingham Biomedical Research Centre, UK.,2 Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, UK.,3 Nottingham University Hospitals National Health Service Trust, Queen's Medical Centre, UK
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Ramos Macías A, Falcón-González JC, Manrique Rodríguez M, Morera Pérez C, García-Ibáñez L, Cenjor Español C, Coudert-Koall C, Killian M. One-Year Results for Patients with Unilateral Hearing Loss and Accompanying Severe Tinnitus and Hyperacusis Treated with a Cochlear Implant. Audiol Neurootol 2018; 23:8-19. [PMID: 29929187 DOI: 10.1159/000488755] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 03/23/2018] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE To show that patients with unilateral hearing loss (UHL), with one ear fulfilling cochlear implant (CI) indication criteria, and an additional severe tinnitus handicap can be treated effectively with a CI. METHOD A prospective multi-centre study was conducted in five Spanish centres. Sixteen adult patients with UHL and a mean Tinnitus Handicap Inventory (THI) score of at least 58 were implanted. The study design included repeated within-subject measures of quality of life (Health Utility Index Mark 3 [HUI3]), tinnitus (THI, Visual Analogue Scale [VAS] on tinnitus loudness), hearing (Speech, Spatial, and Qualities of Hearing Scale- [SSQ]), and hyperacusis (Test de Hipersensibilidad al Sonido [THS]) up to 12 months after the initial CI fitting. RESULTS Group data showed significant subjective benefit from CI treatment: the preoperative HUI3 total utility score of 0.45 went up to 0.57 at 6 months and 0.63 at 12 months; the preoperative THI total score of 75 decreased to 40 at 6 months and 35 at 12 months. The preoperative tinnitus loudness VAS score of 8.2 decreased to 2.4 at 6 months and 2.2 at 12 months with the implant "On" and to 6.7 at 6 months and 6.5 at 12 months with the implant "Off." The preoperative THS total score of 26 decreased to 17 at 12 months. The preoperative SSQ total score of 4.2 increased to 5.1 at 6 months and 6.3 at 12 months. No unanticipated adverse events were reported during the study period. At 12 months after CI activation all subjects (except 1 subject who used the device 6 days a week) wore their devices all day and every day. The primary reason for CI use was split evenly between tinnitus suppression (n = 6) and both hearing and tinnitus (n = 6). CONCLUSION A CI should be considered as a treatment option in patients with UHL and a concomitant severe tinnitus handicap. However, appropriate counselling of candidates on the anticipated risks, benefits, and limitations that are inherent to cochlear implantation is imperative.
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Affiliation(s)
- Angel Ramos Macías
- Unidad de Hipoacusia, Servicio de Otorrinolaringología, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas, Spain
| | - Juan Carlos Falcón-González
- Unidad de Hipoacusia, Servicio de Otorrinolaringología, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas, Spain
| | | | | | - Luis García-Ibáñez
- Servicio de Otorrinolaringología, Instituto de Otologia Garcia Ibanez, Barcelona, Spain
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14
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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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