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van Genuchten S, Gilles A, Mertens G, Andries E, Cardon E, Van Rompaey V, Lammers M, Vanderveken OM, Jacquemin L. Tinnitus suppression by means of cochlear implantation: does it affect cognition? Eur Arch Otorhinolaryngol 2024; 281:2281-2291. [PMID: 38052757 DOI: 10.1007/s00405-023-08339-5] [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: 09/11/2023] [Accepted: 11/06/2023] [Indexed: 12/07/2023]
Abstract
PURPOSE Recent literature suggests that tinnitus can impact cognition, but results were varied due to a diversity in investigated aspects of cognition and utilized tests, as well as the possible influence of confounding factors. The purpose of this study was to assess the impact of tinnitus loudness on cognition by use of a within-subjects design in patients with a cochlear implant (CI). In this population, tinnitus loudness can be modulated by switching the CI on or off as CI is known to highly suppress tinnitus. METHODS A total of 18 CI users completed two versions of the Repeatable Battery for Assessment of Neuropsychological Status for Hearing Impaired individuals (RBANS-H), once in unaided condition and once in best aided condition. Tinnitus suppression was defined as a difference in score on a visual-analogue scale (VAS) of at least one point out of ten between these two conditions. RESULTS No significant differences in RBANS-H scores were found between the suppression and no suppression group, nor for the suppression group alone. No significant correlations between tinnitus loudness and RBANS-H were found, neither for the suppression group alone, nor for the group as a whole. CONCLUSION The current study shows no significant effect of tinnitus loudness on cognition, which contradicts previous literature. This discrepancy could be explained by the use of a within-subjects design, which controls for confounding factors. Future research should include a larger and more diverse study sample to draw definitive conclusions on this topic.
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Affiliation(s)
- Sarah van Genuchten
- Department of Education, Health and Social Work, University College Ghent, Ghent, Belgium
| | - Annick Gilles
- Department of Education, Health and Social Work, University College Ghent, Ghent, Belgium.
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.
| | - Griet Mertens
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Ellen Andries
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Emilie Cardon
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Marc Lammers
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Olivier M Vanderveken
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Laure Jacquemin
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
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Kim H, Choo OS, Ha J, Yang J, Jang JH, Park HY, Choung YH. Objective and subjective efficacy of hearing aids in patients with mild-to-moderate unilateral hearing loss: a prospective study. Eur Arch Otorhinolaryngol 2024; 281:1671-1681. [PMID: 37803218 DOI: 10.1007/s00405-023-08255-8] [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: 03/22/2023] [Accepted: 09/20/2023] [Indexed: 10/08/2023]
Abstract
PURPOSE In patients with unilateral sensorineural hearing loss (USNHL), we explored both objective functional audiological gains and subjective satisfaction, indicating when a unilateral hearing aid is valuable. METHODS Thirty-seven patients with mild-to-moderate USNHL (mean pure-tone thresholds between 25 and 70 dB) were prescribed unilateral hearing aids. Functional gain, the aided speech discrimination score (SDS), the Hearing in Noise Test (HINT) score, and the sound localization test score were collected, and a questionnaire (the Hearing Handicap Inventory for the Elderly, HHIE) completed after 1, 2, and 3 months of hearing aid use. We classified the participants as having 'no handicap' (HHIE < 17), 'mild-to-moderate handicap' (17-42), and 'significant handicap' (> 42). RESULTS The decrease in handicap afforded by unilateral hearing aids was largest in the 'significant handicap' group (the HHIE total score fell from 59.1 to 37.2; P = 0.007). There were no between-group differences in either functional gain or the aided SDS. Only the 'significant handicap' group evidenced an improved HINT score; the composite signal-to-noise ratio (SNR) fell from - 1.5 to - 2.2 dB [S/N] (P = 0.023). The HHIE usefully indicated when a hearing aid alleviated the discomfort of USNHL; patients with unaided HHIE scores ≥ 20 evidenced significant decreases in the composite SNR (- 1.7 to - 2.0 dB [S/N]; P = 0.045). CONCLUSIONS When considering whether to prescribe a unilateral hearing aid for patients with mild-to-moderate USNHL, it is helpful to use the HHIE to evaluate discomfort. If the total score is ≥ 20, a hearing aid is appropriate.
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Affiliation(s)
- Hantai Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Konyang University College of Medicine, Daejeon, 35365, Republic of Korea
| | - Oak-Sung Choo
- Department of Otorhinolaryngology-Head and Neck Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, 07441, Republic of Korea
| | - Jungho Ha
- Department of Otolaryngology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, Gyeonggi-do, 16499, Republic of Korea
| | - Jisun Yang
- Department of Otolaryngology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, Gyeonggi-do, 16499, Republic of Korea
| | - Jeong Hun Jang
- Department of Otolaryngology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, Gyeonggi-do, 16499, Republic of Korea
| | - Hun Yi Park
- Department of Otolaryngology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, Gyeonggi-do, 16499, Republic of Korea
| | - Yun-Hoon Choung
- Department of Otolaryngology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, Gyeonggi-do, 16499, Republic of Korea.
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Arndt S, Findeis L, Wesarg T, Aschendorff A, Speck I, Ketterer MC, Rauch AK. Long-Term Outcome of Cochlear Implantation in Children With Congenital, Perilingual, and Postlingual Single-Sided Deafness. Ear Hear 2024; 45:316-328. [PMID: 37726884 DOI: 10.1097/aud.0000000000001426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
OBJECTIVES We investigated the long-term outcomes of children with single-sided deafness (SSD) after cochlear implant (CI) surgery, during and after rehabilitation, and compared the results of children with congenital, perilingual, and postlingual SSD. We evaluated the impact of SSD at age at onset and duration of deafness on their performance. DESIGN Thirty-six children with SSD treated with CI participated in the study: 20 had congenital, seven perilingual (defined: >0 to 4 years), and nine had postlingual deafness (defined as >4 years of age). Their outcome with CI were measured on both subjective and objective scales: duration of device use, speech intelligibility in noise and in quiet, bilateral hearing and localization ability, quality of life and hearing, presence and loudness of tinnitus, and hearing ability of the better hearing ear. RESULTS After a mean follow-up time of 4.75 years, 32 of the 36 children used their CI on a regular basis. The remaining four children were nonusers. These children had congenital SSD and were older than three years at the time of CI surgery. Overall, for congenital/perilingual and postlingual SSD, speech intelligibility in noise and the Speech, Spatial and Qualities of Hearing Scale (SSQ) speech subscore were significantly improved, as were their subjective and objective localization ability and hearing-related quality of life. Children with postlingual SSD benefited from the CI with regard to speech intelligibility, SSQ speech/spatial/total score, and localization error, and children with congenital SSD showed better results with a short duration of deafness of less than 3 years compared with those with a longer deafness period. CONCLUSIONS Cochlear implantation is a successful treatment for children with congenital/perilingual or postlingual SSD. Results largely differed with respect to the onset and duration of deafness, and better outcomes were achieved by children with postlingual SSD and with a short duration of deafness. Our data also confirmed that children with congenital SSD should be implanted with a CI within three years of age.
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Affiliation(s)
- Susan Arndt
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
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Park KW, Kullar P, Malhotra C, Stankovic KM. Current and Emerging Therapies for Chronic Subjective Tinnitus. J Clin Med 2023; 12:6555. [PMID: 37892692 PMCID: PMC10607630 DOI: 10.3390/jcm12206555] [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: 09/07/2023] [Revised: 10/13/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
IMPORTANCE Chronic subjective tinnitus, the perception of sound without an external source for longer than six months, may be a greatly debilitating condition for some people, and is associated with psychiatric comorbidities and high healthcare costs. Current treatments are not beneficial for all patients and there is a large need for new therapies for tinnitus. OBSERVATIONS Unlike rarer cases of objective tinnitus, chronic subjective tinnitus often has no obvious etiology and a diverse pathophysiology. In the absence of objective testing, diagnosis is heavily based on clinical assessment. Management strategies include hearing aids, sound masking, tinnitus retraining therapy, cognitive behavioral therapy, and emerging therapies including transcranial magnetic stimulation and electrical stimulation. CONCLUSIONS AND RELEVANCE Although current treatments are limited, emerging diagnostics and treatments provide promising avenues for the management of tinnitus symptoms.
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Affiliation(s)
- Ki Wan Park
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, 801 Welch Rd., Palo Alto, CA 94305, USA
| | - Peter Kullar
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, 801 Welch Rd., Palo Alto, CA 94305, USA
| | - Charvi Malhotra
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, 801 Welch Rd., Palo Alto, CA 94305, USA
| | - Konstantina M. Stankovic
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, 801 Welch Rd., Palo Alto, CA 94305, USA
- Department of Neurosurgery, Stanford University School of Medicine, 453 Quarry Rd., Palo Alto, CA 94305, USA
- Wu Tsai Neurosciences Institute, Stanford University, 290 Jane Stanford Way, Stanford, CA 94305, USA
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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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Daher GS, Kocharyan A, Dillon MT, Carlson ML. Cochlear Implantation Outcomes in Adults With Single-Sided Deafness: A Systematic Review and Meta-analysis. Otol Neurotol 2023; 44:297-309. [PMID: 36791341 DOI: 10.1097/mao.0000000000003833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
OBJECTIVE To assess spatial hearing, tinnitus, and quality-of-life outcomes in adults with single-sided deafness (SSD) who underwent cochlear implantation. DATABASES REVIEWED PubMed, MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus databases were searched from January 2008 to September 2021 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. METHODS Studies reporting spatial hearing, tinnitus, and quality-of-life outcomes in adult cochlear implant (CI) recipients (≥18 yr old) with SSD were evaluated. Study characteristics, demographic data, spatial hearing (speech recognition in noise, sound source localization), tinnitus (severity, loudness), and quality-of-life outcomes were collected. RESULTS From an initial search of 1,147 articles, 36 studies that evaluated CI use in 796 unique adults with SSD (51.3 ± 12.4 yr of age at time of implantation) were included. The mean duration of deafness was 6.2 ± 9.6 years. There was evidence of improvement for speech recognition in noise using different target-to-masker spatial configurations, with the largest benefit observed for target-to-masker configurations assessing head shadow (mean, 1.87-6.2 dB signal-to-noise ratio). Sound source localization, quantified as root-mean-squared error, improved with CI use (mean difference [MD], -25.3 degrees; 95% confidence interval [95% CI], -35.9 to -14.6 degrees; p < 0.001). Also, CI users reported a significant reduction in tinnitus severity as measured with the Tinnitus Handicap Inventory (MD, -29.97; 95% CI, -43.9 to -16.1; p < 0.001) and an improvement in spatial hearing abilities as measured with the Spatial, Speech, and Qualities of Hearing questionnaire (MD, 2.3; 95% CI, 1.7 to 2.8; p < 0.001). CONCLUSIONS Cochlear implantation and CI use consistently offer improvements in speech recognition in noise, sound source localization, tinnitus, and perceived quality of life in adults with SSD.
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Affiliation(s)
- Ghazal S Daher
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Armine Kocharyan
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Margaret T Dillon
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Matthew L Carlson
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
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Chen S, Du M, Wang Y, Li Y, Tong B, Qiu J, Wu F, Liu Y. State of the art: non-invasive electrical stimulation for the treatment of chronic tinnitus. Ther Adv Chronic Dis 2023; 14:20406223221148061. [PMID: 36860934 PMCID: PMC9969452 DOI: 10.1177/20406223221148061] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 12/13/2022] [Indexed: 01/19/2023] Open
Abstract
Subjective tinnitus is the perception of sound in the absence of external stimulation. Neuromodulation is a novel method with promising properties for application in tinnitus management. This study sought to review the types of non-invasive electrical stimulation in tinnitus to provide the foothold for further research. PubMed, EMBASE, and Cochrane databases were searched for studies on the modulation of tinnitus by non-invasive electrical stimulation. Among the four forms of non-invasive electrical modulation, transcranial direct current stimulation, transcranial random noise stimulation, and transauricular vagus nerve stimulation yielded promising results, whereas the effect of transcranial alternating current stimulation in the treatment of tinnitus has not been confirmed. Non-invasive electrical stimulation can effectively suppress tinnitus perception in some patients. However, the heterogeneity in parameter settings leads to scattered and poorly replicated findings. Further high-quality studies are needed to identify optimal parameters to develop more acceptable protocols for tinnitus modulation.
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Affiliation(s)
- Shanwen Chen
- Department of Otorhinolaryngology–Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China
| | - Maoshan Du
- Department of Otorhinolaryngology–Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China
| | - Yang Wang
- Department of Otorhinolaryngology–Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China
| | - Yifan Li
- Department of Otorhinolaryngology–Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China
| | - Busheng Tong
- Department of Otorhinolaryngology–Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China
| | - Jianxin Qiu
- Department of Otorhinolaryngology–Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China
| | - Feihu Wu
- Department of Otorhinolaryngology–Head and Neck Surgery, The First Affiliated Hospital of Anhui University of Chinese Medicine, 117 Meishan Road, Hefei 230031, Anhui, P.R. China
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Idriss SA, Reynard P, Marx M, Mainguy A, Joly CA, Ionescu EC, Assouly KKS, Thai-Van H. Short- and Long-Term Effect of Cochlear Implantation on Disabling Tinnitus in Single-Sided Deafness Patients: A Systematic Review. J Clin Med 2022; 11:jcm11195664. [PMID: 36233532 PMCID: PMC9572534 DOI: 10.3390/jcm11195664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 09/12/2022] [Accepted: 09/20/2022] [Indexed: 11/16/2022] Open
Abstract
Patients with single-sided deafness can experience an ipsilateral disabling tinnitus that has a major impact on individuals’ social communication and quality of life. Cochlear implants appear to be superior to conventional treatments to alleviate tinnitus in single-sided deafness. We conducted a systematic review to evaluate the effectiveness of cochlear implants in single-sided deafness with disabling tinnitus when conventional treatments fail to alleviate tinnitus (PROSPERO ID: CRD42022353292). All published studies in PubMed/MEDLINE and SCOPUS databases until December 2021 were included. A total of 474 records were retrieved, 31 studies were included and were divided into two categories according to whether tinnitus was assessed as a primary complaint or not. In all studies, cochlear implantation, evaluated using subjective validated tools, succeeded in reducing tinnitus significantly. Objective evaluation tools were less likely to be used but showed similar results. A short-(3 months) and long-(up to 72 months) term tinnitus suppression was reported. When the cochlear implant is disactivated, complete residual tinnitus inhibition was reported to persist up to 24 h. The results followed a similar pattern in studies where tinnitus was assesed as a primary complaint or not. In conclusion, the present review confirmed the effectiveness of cochlear implantation in sustainably reducing disabling tinnitus in single-sided deafness patients.
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Affiliation(s)
- Samar A. Idriss
- Department of Audiology and Otoneurological Evaluation, Edouard Herriot Hospital, Hospices Civils de Lyon, 69002 Lyon, France
- Department of Otorhinolaryngology and Head and Neck Surgery, Eye and Ear University Hospital, Holy Spirit University of Kaslik, Beirut 1202, Lebanon
| | - Pierre Reynard
- Department of Audiology and Otoneurological Evaluation, Edouard Herriot Hospital, Hospices Civils de Lyon, 69002 Lyon, France
- Institut de l’Audition, Institut Pasteur, University of Paris, INSERM, 75012 Paris, France
- Faculty of Medicine, University Claude Bernard Lyon 1, 69100 Villeurbanne, France
| | - Mathieu Marx
- Department of Otology, Otoneurology and Pediatric Otolaryngology, Pierre-Paul Riquet Hospital, Toulouse Purpan University Hospital, 31300 Toulouse, France
- Brain and Cognition Laboratory, UMR 5549, Toulouse III University, 31062 Toulouse, France
| | - Albane Mainguy
- National Commission for the Evaluation of Medical Devices and Health Technologies, Haute Autorité de Santé, 93210 La Plaine St Denis, France
| | - Charles-Alexandre Joly
- Department of Audiology and Otoneurological Evaluation, Edouard Herriot Hospital, Hospices Civils de Lyon, 69002 Lyon, France
- Institut de l’Audition, Institut Pasteur, University of Paris, INSERM, 75012 Paris, France
- Faculty of Medicine, University Claude Bernard Lyon 1, 69100 Villeurbanne, France
| | - Eugen Constant Ionescu
- Department of Audiology and Otoneurological Evaluation, Edouard Herriot Hospital, Hospices Civils de Lyon, 69002 Lyon, France
- Institut de l’Audition, Institut Pasteur, University of Paris, INSERM, 75012 Paris, France
| | - Kelly K. S. Assouly
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
- UMC Utrecht Brain Center, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
- Cochlear Technology Centre, 2800 Mechelen, Belgium
| | - Hung Thai-Van
- Department of Audiology and Otoneurological Evaluation, Edouard Herriot Hospital, Hospices Civils de Lyon, 69002 Lyon, France
- Institut de l’Audition, Institut Pasteur, University of Paris, INSERM, 75012 Paris, France
- Faculty of Medicine, University Claude Bernard Lyon 1, 69100 Villeurbanne, France
- National Commission for the Evaluation of Medical Devices and Health Technologies, Haute Autorité de Santé, 93210 La Plaine St Denis, France
- Correspondence:
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(Even Off-Label) Cochlear Implantation in Single-Sided Deafness and Asymmetric Hearing Loss Results in Measurable Objective and Subjective Benefit. Otol Neurotol 2022; 43:e895-e902. [PMID: 35970168 DOI: 10.1097/mao.0000000000003623] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To quantify objective and subjective outcomes in cochlear implant (CI) recipients with asymmetric hearing loss, including single-sided deafness (SSD) whose candidacy was determined on an ear-specific basis when word recognition was 50% or less. STUDY DESIGN Retrospective case review. SETTING Tertiary referral center. BACKGROUND The effectiveness of CI in cases of SSD and asymmetric hearing loss (AHL) has been described in terms of tinnitus suppression, improved speech recognition in quiet and noise, enhanced localization ability, and improved quality of life. However, CI is not yet routinely offered as a top option or standard of care for these individuals. Recent Food and Drug Administration (FDA) labeling limits aided word recognition in the ear to be implanted to only 5% in cases of AHL/SSD, which is significantly poorer than 40 to 50%, which is often referenced in cases of bilateral hearing loss. Anecdotal experience suggests that patients with much better preoperative word recognition than 5% can benefit from CI. METHODS We conducted a retrospective chart review of all adult CI candidates, with one ear exhibiting consonant-nucleus-consonant (CNC) word recognition scores at least 50% and one ear not meeting CI candidacy (i.e., CNC word recognition >50%). Outcome variables of interest included word and sentence recognition and subjective handicap questionnaires (hearing, tinnitus, dizziness) and the Speech Spatial Qualities questionnaire. RESULTS Statistically and clinically significant improvement in speech understanding (word, sentence, sentence in noise) was noted for both the SSD and AHL groups in the implanted ear. There were statistically and clinically significant subjective improvements noted for both groups on the Hearing Handicap Inventory, the Tinnitus Handicap Inventory, and the Speech Spatial Qualities questionnaire by 1 month after activation. There were no significant differences between the AHL and SSD groups on either objective or subjective measures of the implanted ear. Individual word understanding improved for the majority of recipients across both groups and is not dependent on meeting the FDA criteria of less than 5%. CONCLUSIONS Cochlear implantation is a viable option with measurable objective and perceived benefits for recipients with preoperative aided CNC word scores exceeding current FDA labeling. There is no significant difference between the AHL and SSD groups, suggesting that candidacy and outcome expectations should be set based on the ear to be implanted alone, without regard for the ability of the better hearing ear.
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American Cochlear Implant Alliance Task Force Guidelines for Clinical Assessment and Management of Adult Cochlear Implantation for Single-Sided Deafness. Ear Hear 2022; 43:1605-1619. [PMID: 35994570 PMCID: PMC9592177 DOI: 10.1097/aud.0000000000001260] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The indications for cochlear implantation have expanded to include individuals with profound sensorineural hearing loss in the impaired ear and normal hearing (NH) in the contralateral ear, known as single-sided deafness (SSD). There are additional considerations for the clinical assessment and management of adult cochlear implant candidates and recipients with SSD as compared to conventional cochlear implant candidates with bilateral moderate to profound sensorineural hearing loss. The present report reviews the current evidence relevant to the assessment and management of adults with SSD. A systematic review was also conducted on published studies that investigated outcomes of cochlear implant use on measures of speech recognition in quiet and noise, sound source localization, tinnitus perception, and quality of life for this patient population. Expert consensus and systematic review of the current literature were combined to provide guidance for the clinical assessment and management of adults with SSD.
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Comparison of Speech Test Outcomes After Cochlear Implantation in Patients With and Without Asymmetric Hearing Loss. Otol Neurotol 2022; 43:559-566. [PMID: 35261377 DOI: 10.1097/mao.0000000000003515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Determine whether asymmetric hearing loss (AHL) affects postoperative speech outcomes in cochlear implant (CI) patients. STUDY DESIGN Retrospective cohort study. SETTING Tertiary care hospital. PATIENTS Adult English-speaking patients with unilateral CIs implanted between 2014 and 2018 were stratified into NonAHL and AHL groups based on preoperative AzBio scores in quiet from the nonimplanted ear (0-50% vs. 51-100%, respectively). INTERVENTIONS CI surgery in the poorer performing ear. MAIN OUTCOME MEASURES Postoperative consonant-nucleusconsonant (CNC) word and AzBio sentence test scores in quiet and/or noise at +5 dB signal-to-noise ratio (SNR). RESULTS Of 512 patients, 33 non-AHL and 27 AHL patients were included. Average ages were 65.6 and 63.6 years, respectively. As expected, preoperative AzBio scores in quiet from the nonimplanted ear were higher in the AHL group (95% confidence interval [95%CI]: 66.4-76.4%) than the non-AHL group at baseline (95%CI: 12.3-23.6%). In both cohorts, AzBio scores in quiet from the implanted ear improved from baseline, with 24-month scores (95%CI: 73.8 - 84.9%) being higher than preoperative scores (95%CI: 13.2-23.1%). There were also significant differences in AzBio scores in quiet between cohorts overall (p = 0.0120) on mixed model analysis, with the AHL group performing ∼6.4% better than the non-AHL group; however, differences were not significant when scores were stratified by time. In addition, there were no significant differences in CNC in quiet and AzBio scores in noise at +5 dB SNR between cohorts (p = 0.1786 and p = 0.6215, respectively). CONCLUSIONS After CI, patients with AHL can achieve scores on word and sentence tests at least comparable to traditional CI candidates, supporting the expansion of CI candidacy to include patients with AHL.
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Conversations in Cochlear Implantation: The Inner Ear Therapy of Today. Biomolecules 2022; 12:biom12050649. [PMID: 35625577 PMCID: PMC9138212 DOI: 10.3390/biom12050649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 02/01/2023] Open
Abstract
As biomolecular approaches for hearing restoration in profound sensorineural hearing loss evolve, they will be applied in conjunction with or instead of cochlear implants. An understanding of the current state-of-the-art of this technology, including its advantages, disadvantages, and its potential for delivering and interacting with biomolecular hearing restoration approaches, is helpful for designing modern hearing-restoration strategies. Cochlear implants (CI) have evolved over the last four decades to restore hearing more effectively, in more people, with diverse indications. This evolution has been driven by advances in technology, surgery, and healthcare delivery. Here, we offer a practical treatise on the state of cochlear implantation directed towards developing the next generation of inner ear therapeutics. We aim to capture and distill conversations ongoing in CI research, development, and clinical management. In this review, we discuss successes and physiological constraints of hearing with an implant, common surgical approaches and electrode arrays, new indications and outcome measures for implantation, and barriers to CI utilization. Additionally, we compare cochlear implantation with biomolecular and pharmacological approaches, consider strategies to combine these approaches, and identify unmet medical needs with cochlear implants. The strengths and weaknesses of modern implantation highlighted here can mark opportunities for continued progress or improvement in the design and delivery of the next generation of inner ear therapeutics.
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Speech Perception Performance Growth and Benchmark Score Achievement After Cochlear Implantation for Single-Sided Deafness. Otol Neurotol 2022; 43:e64-e71. [PMID: 34889843 DOI: 10.1097/mao.0000000000003407] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Compare speech perception performance growth and benchmark score achievement among adult cochlear implant (CI) recipients with single-sided deafness (SSD) versus bilateral moderate to profound hearing loss. STUDY DESIGN Retrospective matched cohort analysis. SETTING Tertiary referral center. PATIENTS Adults with SSD or bilateral moderate to profound hearing sensorineural hearing loss who underwent cochlear implantation from 2014 to 2019. INTERVENTIONS Cochlear implantation. MAIN OUTCOME MEASURES Time-to-benchmark speech perception score (CNC, AzBio in quiet) and speech performance within first postoperative year. RESULTS Thirty-three SSD patients were matched to 66 bilateral hearing loss patients (referent cohort) for duration of deafness and preoperative ipsilateral CNC scores. Although SSD patients were more likely to achieve benchmark CNC scores more quickly compared with matched referents, this difference did not reach statistical significance (HR 1.72; 95% CI 0.78-3.82; p = 0.18). AzBio scores showed similar trends (HR 1.40; 95% CI 0.66-2.98; p = 0.38). At last follow-up, the SSD cohort had lower CNC (median 54% vs. 62%; p = 0.019) and AzBio scores (median 72% vs. 84%; p = 0.029) compared to the referent cohort. CONCLUSIONS No significant difference in speech perception performance growth (i.e., time-to-benchmark speech perception score) was identified between SSD and bilateral hearing loss CI recipients, although patients with bilateral hearing loss achieved higher scores in the implanted ear within the first year of follow-up.
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Impact of Duration of Deafness on Speech Perception in Single-Sided Deafness Cochlear Implantation in Adults. Otol Neurotol 2022; 43:e45-e49. [PMID: 34889841 DOI: 10.1097/mao.0000000000003357] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the impact of prolonged auditory deprivation on speech perception outcomes in adult acquired single-sided deafness (SSD) cochlear implant (CI) recipients. STUDY DESIGN Retrospective case series. SETTING Tertiary care academic center. PATIENTS Acquired SSD in adults with and without prolonged duration of deafness (defined as >10 yr) who underwent CI between 2014 and 2019. INTERVENTIONS CI. MAIN OUTCOME MEASURES Consonant-nucleus-consonant (CNC) and AzBio in quiet scores within first year of follow-up. RESULTS A total of 35 adult patients with SSD were evaluated, with a median overall duration of deafness of 2.4 years (interquartile range [IQR] 1.2-6.0 yr): seven patients with prolonged auditory deprivation (median 18 yr, IQR 15-28) were compared with 28 SSD patients with duration of deafness less than 10 years (median 1.7 yr, IQR 1.1-3.2). At last follow-up, the median CNC scores were 39% (IQR 31-64) and 54% (IQR 46-64) for the prolonged and shorter duration of deafness cohorts, respectively (p = 0.3). The median AzBio scores were 66% (IQR 65-68) and 72% (IQR 60-82) for the prolonged and shorter duration of deafness cohorts, respectively (p = 0.6). In a separate analysis evaluating duration of deafness as a continuous variable across all 35 patients, Spearman correlation coefficients for associations of duration of deafness with most recent CNC and AzBio scores were -0.02 (p = 0.9) and 0.02 (p = 0.9), respectively. CONCLUSIONS Adult CI recipients with acquired SSD, with and without prolonged auditory deprivation, demonstrated comparable speech perception scores. Prolonged duration of deafness alone should not preclude a motivated SSD patient from undergoing cochlear implantation.
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Yu S, Yu H, Wang X, Du B. The efficacy of acoustic therapy versus oral medication for chronic tinnitus: A meta-analysis. Am J Otolaryngol 2021; 42:103116. [PMID: 34293623 DOI: 10.1016/j.amjoto.2021.103116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/20/2021] [Accepted: 06/13/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To compare the efficacy of acoustic therapy (AT) and drug therapy (DT) for chronic tinnitus. METHODS We searched Pubmed, ScienceDirect, Chinese Journal Full-text Database (CNKI), Wanfang Database, Chinese Biomedical Literature Database (CBM), Embase, and Cochrane Library from the establishment of the database to December 2019. Meta-analysis was performed on the Tinnitus Handicap Inventory (THI) score and Visual Analogue Scale (VAS) with included literature using Revman 5.3 software. RESULTS A total of 18 documents were included, including 16 Chinese documents and 2 English documents, with 1774 patients (including 962 patients treated with AT and 812 patients treated with DT). The effect of AT (by the number of cases or ears) is better than that of DT (P < 0.05). After treatment, the THI value of AT was more evident than that of DT (WMD = -4.25, (-13.24, -5.29)). And the VAS value of AT was significantly lower than that of DT (WMD = -0.73, (-1.31, -0.15)). CONCLUSION Compared with DT, AT can significantly improve the efficacy of tinnitus and reduce the symptoms of tinnitus patients. Clinically, it can vigorously promote the application value of treating tinnitus by sound.
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Peters JPM, van Heteren JAA, Wendrich AW, van Zanten GA, Grolman W, Stokroos RJ, Smit AL. Short-term outcomes of cochlear implantation for single-sided deafness compared to bone conduction devices and contralateral routing of sound hearing aids-Results of a Randomised controlled trial (CINGLE-trial). PLoS One 2021; 16:e0257447. [PMID: 34644322 PMCID: PMC8513831 DOI: 10.1371/journal.pone.0257447] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 08/22/2021] [Indexed: 02/06/2023] Open
Abstract
Single-sided deafness (SSD) leads to difficulties with speech perception in noise, sound localisation, and sometimes tinnitus. Current treatments (Contralateral Routing of Sound hearing aids (CROS) and Bone Conduction Devices (BCD)) do not sufficiently overcome these problems. Cochlear implants (CIs) may help. Our aim was to evaluate these treatments in a Randomised Controlled Trial (RCT). Adult SSD patients were randomised using a web-based randomisation tool into one of three groups: CI; trial period of 'first BCD, then CROS'; trial period of 'first CROS, then BCD'. After these trial periods, patients opted for BCD, CROS, or No treatment. The primary outcome was speech perception in noise (directed from the front (S0N0)). Secondary outcomes were speech perception in noise with speech directed to the poor ear and noise to the better ear (SpeNbe) and vice versa (SbeNpe), sound localisation, tinnitus burden, and disease-specific quality of life (QoL). We described results at baseline (unaided situation) and 3 and 6 months after device activation. 120 patients were randomised. Seven patients did not receive the allocated intervention. The number of patients per group after allocation was: CI (n = 28), BCD (n = 25), CROS (n = 34), and No treatment (n = 26). In S0N0, the CI group performed significantly better when compared to baseline, and when compared to the other groups. In SpeNbe, there was an advantage for all treatment groups compared to baseline. However, in SbeNpe, BCD and CROS groups performed worse compared to baseline, whereas the CI group improved. Only in the CI group sound localisation improved and tinnitus burden decreased. In general, all treatment groups improved on disease-specific QoL compared to baseline. This RCT demonstrates that cochlear implantation for SSD leads to improved speech perception in noise, sound localisation, tinnitus burden, and QoL after 3 and 6 months of follow-up. For most outcome measures, CI outperformed BCD and CROS. Trial registration: Netherlands Trial Register (www.trialregister.nl): NTR4580, CINGLE-trial.
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Affiliation(s)
- Jeroen P. M. Peters
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jan A. A. van Heteren
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anne W. Wendrich
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gijsbert A. van Zanten
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - 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, The Netherlands
| | - 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, The Netherlands
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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: 16] [Impact Index Per Article: 5.3] [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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Totten DJ, Manzoor NF, Perkins EL, Cass ND, Bennett ML, Haynes DS. Management of vestibular dysfunction and hearing loss in intralabyrinthine schwannomas. Am J Otolaryngol 2021; 42:102984. [PMID: 33610925 DOI: 10.1016/j.amjoto.2021.102984] [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: 02/05/2021] [Accepted: 02/14/2021] [Indexed: 12/29/2022]
Abstract
PURPOSE Intralabyrinthine schwannomas (ILS) are rare, benign, slow-growing tumors arising from schwann cells of the cochlear or vestibular nerves within the bony labyrinth. This study provides insight into the management of this rare tumor through a large case series. MATERIALS AND METHODS After Institutional Review Board approval, a retrospective chart review was performed of all ILS patients treated at our institution between 2007 and 2019. RESULTS 20 patients (9 male, 11 female) with ILS were managed at our institution. The right ear was affected in 9 patients (45%) and the left in 11 (55%). Subjective hearing loss was endorsed by all 20 patients. Average pure tone average at presentation was 72 dB nHL. Nine tumors (45%) were intravestibular, 6 (30%) were intracochlear, 4 (20%) were transmodiolar and 1 (5%) was intravestibulocochlear. Hearings aids were used in 3 patients (15%), BiCROS in 2 (10%), CI in 2 (10%), and bone conduction implant in 1 (5%). Vestibular rehabilitation was pursued in 5 patients. Surgical excision was performed for one patient (5%) via translabyrinthine approach due to intractable vertigo. No patients received radiotherapy or intratympanic gentamicin injections. CONCLUSION ILS presents a diagnostic and management challenge given the similarity of symptoms with other disorders and limited treatment options. Hearing loss may be managed on a case-by-case basis according to patient symptoms while vestibular loss may be mitigated with vestibular therapy. Surgical excision may be considered in patients with intractable vertigo, severe hearing loss with concurrent CI placement, or in other case-by-case situations.
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Restoration of Deafferentation Reduces Tinnitus, Anxiety, and Depression: A Retrospective Study on Cochlear Implant Patients. Neural Plast 2021; 2021:6678863. [PMID: 34257641 PMCID: PMC8253627 DOI: 10.1155/2021/6678863] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 05/07/2021] [Accepted: 06/15/2021] [Indexed: 12/20/2022] Open
Abstract
Patients with profound bilateral deafness (BD) are prone to suffering from tinnitus, which further leads to psychological comorbidities and makes it more difficult for patients to communicate with people. This study was aimed at investigating the effect of cochlear implants (CIs) on tinnitus distress and psychological comorbidities in patients with profound BD. This multicenter retrospective study reviewed 51 patients with severe postlingual BD who underwent cochlear implantation; 49 patients underwent unilateral cochlear implantation, and 2 patients underwent bilateral cochlear implantation. The patients were asked to complete all the questionnaires, including the tinnitus handicap inventory (THI), the visual analog scale (VAS) score, the Hospital Anxiety and Depression Scale Questionnaire (HADS), the Categories of Auditory Performance (CAP), and the Speech Intelligibility Rating (SIR), at least 4 months after implantation when the CI was on or off, in approximately May-June 2019. In our study, 94% (48/51) of BD patients suffered from tinnitus before CI, and 77% (37/48) of them suffered from bilateral tinnitus. In addition, 50.9% (26/51) of the CI patients were suffering from anxiety, 52.9% (27/51) of them were suffering from depression (score ≥ 8), and 66.7% (34/51) (27/51) of them were suffering from anxiety or depression. Cochlear implantation could reduce tinnitus more obviously when the CI was on than when the CI was off. Cochlear implantation also reduced anxiety/depression severity. There were significantly positive correlations between tinnitus severity and anxiety/depression severity before and after surgery. Moreover, hearing improvement is positively correlated with reduction level of tinnitus, the better hearing, and the lesser severity of tinnitus. Thus, along with effective restoration of deafferentation, cochlear implantation shows positive therapeutic effects on tinnitus and psychological comorbidities, providing a reference for future clinical and research work.
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Assouly K, Smit AL, Stegeman I, Rhebergen KS, van Dijk B, Stokroos R. Cochlear implantation for tinnitus in adults with bilateral hearing loss: protocol of a randomised controlled trial. BMJ Open 2021; 11:e043288. [PMID: 34006544 PMCID: PMC8130732 DOI: 10.1136/bmjopen-2020-043288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Tinnitus is the perception of sound without an external stimulus, often experienced as a ringing or buzzing sound. Subjective tinnitus is assumed to origin from changes in neural activity caused by reduced or lack of auditory input, for instance due to hearing loss. Since auditory deprivation is thought to be one of the causes of tinnitus, increasing the auditory input by cochlear implantation might be a possible treatment. In studies assessing cochlear implantation for patients with hearing loss, tinnitus relief was seen as a secondary outcome. Therefore, we will assess the effect of cochlear implantation in patients with primarily tinnitus complaints. METHOD AND ANALYSIS In this randomised controlled trial starting in January 2021 at the ENT department of the UMC Utrecht (the Netherlands), patients with a primary complaint of tinnitus will be included. Fifty patients (Tinnitus Functional Index (TFI) >32, Beck's Depression Index <19, pure tone average at 0.5, 1, 2 and 4 kHz: bilateral threshold between 50 and ≤75 dB) will be randomised towards cochlear implantation or no intervention. Primary outcome of the study is tinnitus burden as measured by the TFI. Outcomes of interest are tinnitus severity, hearing performances (tinnitus pitch and loudness, speech perception), quality of life, depression and patient-related changes. Outcomes will be evaluated prior to implantation and at 3 and 6 months after the surgery. The control group will receive questionnaires at 3 and 6 months after randomisation. We expect a significant difference between the cochlear implant recipients and the control group for tinnitus burden. ETHICS AND DISSEMINATION This research protocol was approved by the Institutional Review Board of the University Medical Center (UMC) Utrecht (NL70319.041.19, V5.0, January 2021). The trial results will be made accessible to the public in a peer-review journal. TRIAL REGISTRATION NUMBER Trial registration number NL8693; Pre-results.
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Affiliation(s)
- Kelly Assouly
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Cochlear Technology Centre, Mechelen, Belgium
| | - Adriana L Smit
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Inge Stegeman
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Koenraad S Rhebergen
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Robert Stokroos
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
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22
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Effectiveness of tinnitus therapy using a mobile application. Eur Arch Otorhinolaryngol 2021; 279:1257-1267. [PMID: 33783597 PMCID: PMC8897355 DOI: 10.1007/s00405-021-06767-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 03/17/2021] [Indexed: 12/16/2022]
Abstract
Background The World Health Organization reports that the number of tinnitus sufferers is increasing year on year. Given the common use of mobile devices and the availability of applications designed to support patients in tinnitus therapy and reduce tinnitus severity, patients seeking help are likely to try this form of support. The aim of this study was to evaluate the effectiveness of a mobile application in tinnitus sound therapy, in this case ReSound Tinnitus Relief™.
Methods The study involved 52 patients hospitalized for tinnitus. All participants used the free ReSound Tinnitus Relief application for 6 months. The application is based on sound therapy. Patients were advised to use the application for at least 30 min per day, the sounds should not completely mask the tinnitus, and they should be listened to via a loudspeaker. The effects of the therapy were evaluated by means of standardized questionnaires for tinnitus severity: the Tinnitus Handicap Inventory and the Tinnitus Functional Index. Results The study showed a reduction in tinnitus severity as measured by both questionnaires. The general severity decreased after the first 3 months and again in the following 3 months of using the application. In both questionnaires the biggest changes were observed in the subscales of emotions. Conclusions Results obtained here from standardized questionnaires indicate that the tested application may contribute to tinnitus reduction. However, it is advisable to conduct further research on the applicability of such technology in medical practice.
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Benefits of Binaural Integration in Cochlear Implant Patients with Single-Sided Deafness and Residual Hearing in the Implanted Ear. Life (Basel) 2021; 11:life11030265. [PMID: 33806937 PMCID: PMC8005038 DOI: 10.3390/life11030265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/15/2021] [Accepted: 03/22/2021] [Indexed: 01/19/2023] Open
Abstract
The purpose of the study is to gauge the benefits of binaural integration effects (redundancy and squelch) due to preserved low-frequency residual hearing in the implanted ear of cochlear implant users with single-sided deafness. There were 11 cochlear implant users (age 18-61 years old) who had preserved low-frequency hearing in the implanted ear; they had a normal hearing or mild hearing loss in the contralateral ear. Patients were tested with monosyllabic words, under different spatial locations of speech and noise and with the cochlear implant activated and deactivated, in two listening configurations-one in which low frequencies in the implanted ear were masked and another in which they were unmasked. We also investigated how cochlear implant benefit due to binaural integration depended on unaided sound localization ability. Patients benefited from the binaural integration effects of redundancy and squelch only in the unmasked condition. Pearson correlations between binaural integration effects and unaided sound localization error showed significance only for squelch (r = -0.67; p = 0.02). Hearing preservation after cochlear implantation has considerable benefits because the preserved low-frequency hearing in the implanted ear contributes to binaural integration, presumably through the preserved temporal fine structure.
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Katiri R, Hall DA, Killan CF, Smith S, Prayuenyong P, Kitterick PT. Systematic review of outcome domains and instruments used in designs of clinical trials for interventions that seek to restore bilateral and binaural hearing in adults with unilateral severe to profound sensorineural hearing loss ('single-sided deafness'). Trials 2021; 22:220. [PMID: 33743802 PMCID: PMC7981927 DOI: 10.1186/s13063-021-05160-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 02/27/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND This systematic review aimed to identify, compare and contrast outcome domains and outcome instruments reported in studies investigating interventions that seek to restore bilateral (two-sided) and/or binaural (both ears) hearing in adults with single-sided deafness (SSD). Findings can inform the development of evidence-based guidance to facilitate design decisions for confirmatory trials. METHODS Records were identified by searching MEDLINE, EMBASE, PubMed, CINAHL, ClinicalTrials.gov, ISRCTN, CENTRAL, WHO ICTRP and the NIHR UK clinical trials gateway. The search included records published from 1946 to March 2020. Included studies were those as follows: (a) recruiting adults aged 18 years or older diagnosed with SSD of average threshold severity worse than 70 dB HL in the worse-hearing ear and normal (or near-normal) hearing in the better-hearing ear, (b) evaluating interventions to restore bilateral and/or binaural hearing and (c) enrolling those adults in a controlled trial, before-and-after study or cross-over study. Studies that fell just short of the participant eligibility criteria were included in a separate sensitivity analysis. RESULTS Ninety-six studies were included (72 full inclusion, 24 sensitivity analysis). For fully included studies, 37 exclusively evaluated interventions to re-establish bilateral hearing and 29 exclusively evaluated interventions to restore binaural hearing. Overall, 520 outcome domains were identified (350 primary and 170 secondary). Speech-related outcome domains were the most common (74% of studies), followed by spatial-related domains (60% of studies). A total of 344 unique outcome instruments were reported. Speech-related outcome domains were measured by 73 different instruments and spatial-related domains by 43 different instruments. There was considerable variability in duration of follow-up, ranging from acute (baseline) testing to 10 years after the intervention. The sensitivity analysis identified no additional outcome domains. CONCLUSIONS This review identified large variability in the reporting of outcome domains and instruments in studies evaluating the therapeutic benefits and harms of SSD interventions. Reports frequently omitted information on what domains the study intended to assess, and on what instruments were used to measure which domains. TRIAL REGISTRATION The systematic review protocol is registered on PROSPERO (International Prospective Register of Systematic Reviews): Registration Number CRD42018084274 . Registered on 13 March 2018, last revised on 7th of May 2019.
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Affiliation(s)
- Roulla Katiri
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre (BRC), Ropewalk House, 113 The Ropewalk, Nottingham, NG1 5DU UK
- Department of Audiology, Mater Misericordiae University Hospital, Dublin, D07 R2WY Ireland
- Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, NG7 2UH UK
| | - Deborah A. Hall
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre (BRC), Ropewalk House, 113 The Ropewalk, Nottingham, NG1 5DU UK
- Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, NG7 2UH UK
- University of Nottingham Malaysia, Jalan Broga, 43500 Semenyih, Selangor Darul Ehsan Malaysia
| | - Catherine F. Killan
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre (BRC), Ropewalk House, 113 The Ropewalk, Nottingham, NG1 5DU UK
- Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, NG7 2UH UK
- Yorkshire Auditory Implant Service, Bradford Teaching Hospitals Foundation NHS Trust, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ UK
| | - Sandra Smith
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre (BRC), Ropewalk House, 113 The Ropewalk, Nottingham, NG1 5DU UK
- Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, NG7 2UH UK
| | - Pattarawadee Prayuenyong
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre (BRC), Ropewalk House, 113 The Ropewalk, Nottingham, NG1 5DU UK
- Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, NG7 2UH UK
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Pádraig T. Kitterick
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre (BRC), Ropewalk House, 113 The Ropewalk, Nottingham, NG1 5DU UK
- Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, NG7 2UH UK
- Nottingham University Hospitals NHS Trust, Queen’s Medical Centre, Derby Road, Nottingham, NG7 2UH UK
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Zhang J, Firestone E, Elattma A. Animal Models of Tinnitus Treatment: Cochlear and Brain Stimulation. Curr Top Behav Neurosci 2021; 51:83-129. [PMID: 34282563 DOI: 10.1007/7854_2021_227] [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] [Indexed: 12/24/2022]
Abstract
Neuromodulation, via stimulation of a variety of peripheral and central structures, is used to suppress tinnitus. However, investigative limitations in humans due to ethical reasons have made it difficult to decipher the mechanisms underlying treatment-induced tinnitus relief, so a number of animal models have arisen to address these unknowns. This chapter reviews animal models of cochlear and brain stimulation and assesses their modulatory effects on behavioral evidence of tinnitus and its related neural correlates. When a structure is stimulated, localized modulation, often presenting as downregulation of spontaneous neuronal spike firing rate, bursting and neurosynchrony, occurs within the brain area. Through anatomical projections and transmitter pathways, the interventions activate both auditory- and non-auditory structures by taking bottom-up ascending and top-down descending modes to influence their target brain structures. Furthermore, it is the brain oscillations that cochlear or brain stimulation evoke and connect the prefrontal cortex, striatal systems, and other limbic structures to refresh neural networks and relieve auditory, attentive, conscious, as well as emotional reactive aspects of tinnitus. This oscillatory neural network connectivity is achieved via the thalamocorticothalamic circuitry including the lemniscal and non-lemniscal auditory brain structures. Beyond existing technologies, the review also reveals opportunities for developing advanced animal models using new modalities to achieve precision neuromodulation and tinnitus abatement, such as optogenetic cochlear and/or brain stimulation.
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Affiliation(s)
- Jinsheng Zhang
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA. .,Department of Communication Sciences and Disorders, Wayne State University College of Liberal Arts and Sciences, Detroit, MI, USA.
| | - Ethan Firestone
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Ahmed Elattma
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA
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Lee HJ, Smieja D, Polonenko MJ, Cushing SL, Papsin BC, Gordon KA. Consistent and chronic cochlear implant use partially reverses cortical effects of single sided deafness in children. Sci Rep 2020; 10:21526. [PMID: 33298987 PMCID: PMC7726152 DOI: 10.1038/s41598-020-78371-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 11/10/2020] [Indexed: 01/09/2023] Open
Abstract
Potentially neuroprotective effects of CI use were studied in 22 children with single sided deafness (SSD). Auditory-evoked EEG confirmed strengthened representation of the intact ear in the ipsilateral auditory cortex at initial CI activation in children with early-onset SSD (n = 15) and late-onset SSD occurring suddenly in later childhood/adolescence (n = 7). In early-onset SSD, representation of the hearing ear decreased with chronic CI experience and expected lateralization to the contralateral auditory cortex from the CI increased with longer daily CI use. In late-onset SSD, abnormally high activity from the intact ear in the ipsilateral cortex reduced, but responses from the deaf ear weakened despite CI use. Results suggest that: (1) cortical reorganization driven by unilateral hearing can occur throughout childhood; (2) chronic and consistent CI use can partially reverse these effects; and (3) CI use may not protect children with late-onset SSD from ongoing deterioration of pathways from the deaf ear.
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Affiliation(s)
- Hyo-Jeong Lee
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Rm 6D08, 555 University Ave, Toronto, ON, M5G 1X8, Canada
- Department of Communication Disorders, Hospital for Sick Children, Toronto, ON, Canada
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Daniel Smieja
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Rm 6D08, 555 University Ave, Toronto, ON, M5G 1X8, Canada
- Department of Communication Disorders, Hospital for Sick Children, Toronto, ON, Canada
| | - Melissa Jane Polonenko
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Rm 6D08, 555 University Ave, Toronto, ON, M5G 1X8, Canada
- Department of Communication Disorders, Hospital for Sick Children, Toronto, ON, Canada
| | - Sharon Lynn Cushing
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Rm 6D08, 555 University Ave, Toronto, ON, M5G 1X8, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, Toronto, ON, Canada
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Blake Croll Papsin
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Rm 6D08, 555 University Ave, Toronto, ON, M5G 1X8, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, Toronto, ON, Canada
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Karen Ann Gordon
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Rm 6D08, 555 University Ave, Toronto, ON, M5G 1X8, Canada.
- Department of Communication Disorders, Hospital for Sick Children, Toronto, ON, Canada.
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, Toronto, ON, Canada.
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada.
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Marx M, Mosnier I, Vincent C, Bonne NX, Bakhos D, Lescanne E, Flament J, Bernardeschi D, Sterkers O, Fraysse B, Lepage B, Godey B, Schmerber S, Uziel A, Mondain M, Venail F, Deguine O. Treatment choice in single-sided deafness and asymmetric hearing loss. A prospective, multicentre cohort study on 155 patients. Clin Otolaryngol 2020; 46:736-743. [PMID: 33236413 DOI: 10.1111/coa.13672] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 10/29/2020] [Accepted: 11/08/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To describe the treatment choice in a cohort of subjects with single-sided deafness (SSD) and asymmetric hearing loss (AHL). To assess the reliability of the treatment trials. DESIGN In this national, multicentre, prospective study, the choice of subjects was made after two consecutive trials of Contralateral Routing Of the Signal (CROS) hearing aids and a Bone Conduction Device (BCD) on a headband. Subjects could proceed with one of these two options, opt for cochlear implantation or decline all treatments. SETTING Seven tertiary university hospitals. PARTICIPANTS One hundred fifty-five subjects with SSD or AHL fulfilling the candidacy criteria for cochlear implantation, with or without associated tinnitus. MAIN OUTCOME MEASURES After the two trials, the number of subjects choosing each option was described. Repeated assessments of both generic and auditory-specific quality of life were conducted, as well as hearing assessments (speech recognition in noise and horizontal localization). RESULTS CROS was chosen by 75 subjects, followed by cochlear implantation (n = 51), BCD (n = 18) and abstention (n = 11). Patients who opted for cochlear implantation had a poorer quality of life (P = .03). The improvement of quality of life indices after each trial was significantly associated with the final treatment choice (P = .008 for generic indices, P = .002 for auditory-specific indices). The follow-up showed that this improvement had been overestimated in the CROS group, with a long-term retention rate of 52.5%. CONCLUSIONS More than one third of SSD/AHL subjects are unsatisfied after CROS and BCD trials. Repeated quality of life assessments help counselling the patient for his/her treatment choice.
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Affiliation(s)
- Mathieu Marx
- Service d'Otologie, Otoneurologie et ORL Pédiatrique, Hôpital Pierre-Paul Riquet, CHU Toulouse Purpan, France.,Brain & Cognition Research Centre, UMR 5549, Université Toulouse III, France
| | - Isabelle Mosnier
- AP-HP, GHU Pitié-Salpêtrière, Service ORL, Otologie, Implants Auditifs et Chirurgie de la Base du Crâne, Paris, France
| | | | | | - David Bakhos
- Service d'ORL, Hôpital Bretonneau, CHU Tours, Tours, France
| | | | - Jonathan Flament
- AP-HP, GHU Pitié-Salpêtrière, Service ORL, Otologie, Implants Auditifs et Chirurgie de la Base du Crâne, Paris, France.,Laboratoire Audika, Paris, France
| | - Daniele Bernardeschi
- AP-HP, GHU Pitié-Salpêtrière, Service ORL, Otologie, Implants Auditifs et Chirurgie de la Base du Crâne, Paris, France
| | - Olivier Sterkers
- AP-HP, GHU Pitié-Salpêtrière, Service ORL, Otologie, Implants Auditifs et Chirurgie de la Base du Crâne, Paris, France
| | - Bernard Fraysse
- Service d'Otologie, Otoneurologie et ORL Pédiatrique, Hôpital Pierre-Paul Riquet, CHU Toulouse Purpan, France
| | - Benoit Lepage
- Unité de Soutien Méthodologique à la Recherche, Faculté de Médecine, Université de Toulouse, Toulouse, France
| | - Benoit Godey
- Service d'ORL, Hôpital Pontchaillou, CHU Rennes, Rennes, France
| | | | - Alain Uziel
- Service d'ORL, Hôpital Gui de Chauliac, CHU Montpellier, Montpellier, France
| | - Michel Mondain
- Service d'ORL, Hôpital Gui de Chauliac, CHU Montpellier, Montpellier, France
| | - Frédéric Venail
- Service d'ORL, Hôpital Gui de Chauliac, CHU Montpellier, Montpellier, France
| | - Olivier Deguine
- Service d'Otologie, Otoneurologie et ORL Pédiatrique, Hôpital Pierre-Paul Riquet, CHU Toulouse Purpan, France.,Brain & Cognition Research Centre, UMR 5549, Université Toulouse III, France
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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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Bojrab D, Hong RS. The case for cochlear implantation in unilateral and asymmetric sensorineural hearing loss. Curr Opin Otolaryngol Head Neck Surg 2020; 28:329-334. [PMID: 32841959 DOI: 10.1097/moo.0000000000000656] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Cochlear implants have been used to treat bilateral deafness for over 40 years. A more recent development has been the application of this technology toward single-sided deafness (SSD) and asymmetric hearing loss (AHL), culminating in the Food and Drug Administration (FDA) approval in the United States for this indication in July of 2019. This review examines the recent literature on cochlear implants for SSD and AHL, focusing on speech perception, sound localization, tinnitus, and quality of life. RECENT FINDINGS There is an expanding body of literature supporting the use of cochlear implant in SSD/AHL patients. The cochlear implant offers a unique rehabilitation option for this subset of patients as it potentially restores binaural hearing (direct stimulation of both ears). A review of the literature reveals significant improvements with the cochlear implant in speech perception in quiet and noise, sound localization, tinnitus, and quality of life. In addition, these improvements appear to be greater than what conventional options such as a contralateral routing of signal (CROS) hearing aid and bone conduction device (BCD) are able to achieve. SUMMARY Cochlear implants offer additional benefits over previously available options of CROS and BCDs and have recently been approved by the FDA for use in patient with SSD/AHL. Given the growing body of literature demonstrating the benefit of cochlear implant over other devices, it is important to offer cochlear implant as an option to these patients.
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Affiliation(s)
| | - Robert S Hong
- Michigan Ear Institute, Farmington Hills.,Department of Otolaryngology-Head & Neck Surgery, Wayne State University, Detroit, Michigan, USA
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