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Deklerck AN, Swinnen F, Keppler H, Dhooge IJM. Changes in Tinnitus Characteristics and Residual Inhibition following Cochlear Implantation: A Prospective Analysis. Brain Sci 2023; 13:1484. [PMID: 37891851 PMCID: PMC10605020 DOI: 10.3390/brainsci13101484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 10/12/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
This study aims to explore the effect of cochlear implantation on tinnitus perception. A prospective study was conducted on 72 adult hearing-impaired patients to evaluate tinnitus perception before and after cochlear implantation, using standardized tinnitus questionnaires (the tinnitus sample case-history questionnaire, tinnitus functional index (TFI), and tinnitus handicap inventory (THI)). A large variety of demographic and hearing- and implant-related data was collected from patient hospital records to explore possible associations with the implantation effect. The prevalence of tinnitus complaints before implantation was 58.3%. The temporary induction or aggravation of tinnitus immediately after surgery was noted in 20% and 46.7% of patients, respectively. When evaluated 3 months after implantation, 60% of tinnitus patients experienced a clinically significant reduction in their complaints; most of the improvements were experienced immediately after activation of the implant. Only the scores for TFI and THI at baseline were found to be significantly correlated with a reduction in TFI scores after implantation. In 80% of tinnitus patients, the tinnitus remained suppressed for some time after taking off the device. The large subset of patients with residual inhibition supports the involvement of central pathophysiological processes in implantation effects on tinnitus, which are explored in this paper.
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Affiliation(s)
- Ann Nancy Deklerck
- Department of Otorhinolaryngology, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium;
| | - Freya Swinnen
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium; (F.S.); (H.K.)
- Department of Otorhinolaryngology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Hannah Keppler
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium; (F.S.); (H.K.)
- Department of Otorhinolaryngology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Ingeborg Johanna Maria Dhooge
- Department of Otorhinolaryngology, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium;
- Department of Otorhinolaryngology, Ghent University Hospital, 9000 Ghent, Belgium
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Rasmussen KD, West NC, Bille M, Cayé-Thomasen P. Tinnitus suppression in a prospective cohort of 45 cochlear implant recipients: occurrence, degree and correlates. Eur Arch Otorhinolaryngol 2023; 280:4073-4082. [PMID: 37099145 DOI: 10.1007/s00405-023-07921-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/08/2023] [Indexed: 04/27/2023]
Abstract
OBJECTIVE To determine tinnitus prevalence and severity in a cohort of unselected first-time cochlear implant (CI) recipients whose primary motive for CI was sensorineural hearing loss (SNHL), and to evaluate the effect of CI on tinnitus after cochlear implantation. METHODS Prospective longitudinal study of 45 adult CI recipients with moderate to profound SNHL. Patients completed the Danish version of the Tinnitus Handicap Inventory (THI) and a visual analogue scale (VAS) for tinnitus burden before implantation, 4 months after implantation and 14 months after implantation. RESULTS The study included 45 patients, of which 29 (64%) had pre-implant tinnitus. Median THI score (IQR) significantly decreased from 20 (34) to 12 (24) at first follow-up (p < 0.05) and to 6 points (17) at second follow-up (p < 0.001). Median VAS (IQR) for tinnitus burden decreased from 33 (62) to 17 (40; p = 0.228) and 12 (27, p < 0.05) at the first and second follow-ups, respectively. Tinnitus was totally suppressed in 19% of patients, improved in 48%, remained unchanged in 19% and worsened in 6%. 2 patients reported new tinnitus. At the second follow-up, 74% of patients had slight or no tinnitus handicap, 16% had mild handicaps, 6% had moderate handicaps, and 3% had severe handicaps. High pre-implant THI and VAS scores correlated with greater decrease in THI scores over time. CONCLUSION 64% of the patients with SNHL had pre-implant tinnitus, which was decreased 4 and 14 months after implantation. Overall, 68% of patients with tinnitus improved their tinnitus handicap after CI. Patients with higher THI and VAS scores had a larger decline and the highest benefits in terms of tinnitus handicap improvement. The study findings demonstrate that the majority of patients with moderate to profound SNHL eligible for cochlear implantation benefit from complete or partial tinnitus suppression and improved quality of life after implantation.
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Affiliation(s)
- Kasper Dyre Rasmussen
- Department of Otorhinolaryngology Head and Neck Surgery and Audiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark.
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Niels Cramer West
- Department of Otorhinolaryngology Head and Neck Surgery and Audiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Michael Bille
- Department of Otorhinolaryngology Head and Neck Surgery and Audiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Per Cayé-Thomasen
- Department of Otorhinolaryngology Head and Neck Surgery and Audiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Potier M, Gallego S, Fournier P, Marx M, Noreña A. Amplification of the poorer ear by StereoBiCROS in case of asymmetric sensorineural hearing loss: effect on tinnitus. Front Neurosci 2023; 17:1141096. [PMID: 37304020 PMCID: PMC10248029 DOI: 10.3389/fnins.2023.1141096] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 04/12/2023] [Indexed: 06/13/2023] Open
Abstract
Tinnitus is prevalent among patients suffering from Single-Sided Deafness (SSD) and Asymmetrical Hearing Loss (AHL). In addition to bothersome tinnitus in the poorer ear, these patients also report issues with understanding speech in noise and sound localization. The conventional treatment options offered to these patients to improve auditory abilities are cochlear implantation, bone conduction devices or Contralateral Routing Of Signal (CROS) hearing aids. It was recently found that the benefit of cochlear implantation for tinnitus associated with AHL/SSD was greater than the other two approaches. It is conceivable that the lack of stimulation provided to the poorer ear in these last approaches explains their modest impact on tinnitus perception. A new technology that combines the ability to reroute the sound from the poorer ear to the good ear (CROS system) while still stimulating the poorer ear with conventional sound amplification has recently been developed: the StereoBiCROS system. The aim of this study was to investigate the effects of this new device on tinnitus. Twelve AHL and two SSD patients aged 70.7 ± 7.9 years with tinnitus were fitted with bilateral hearing aids that included 3 programs: Stereophonic, BiCROS and StereoBiCROS (CROS + bilateral amplification). The short-and long-term effect of the approach on tinnitus was assessed using a tinnitus Loudness Visual Analog Scale (VAS) and the Tinnitus Handicap Inventory (THI), respectively. Both the VAS and the THI were used before and one month after the hearing aid fitting. Of the 14 patients who used their hearing aids daily (12.6 ± 1.6 h per day) the StereoBiCROS program was the most used program (81.8 ± 20.5% of the time). The average THI total score decreased from 47 (± 22) to 15 (± 16) (p = 0.002) and the VAS-Loudness score decreased from 7 (± 1) to 2 (± 2) (p < 0.001) after the one-month trial period. In conclusion, StereoBiCROS stimulation strategy seems to offer an effective alternative to reduce tinnitus handicap and loudness for patients with AHL/SSD and tinnitus. This effect may be driven by sound amplification of the poorer ear.
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Affiliation(s)
- Morgan Potier
- CNRS UMR, Laboratoire de Neurosciences Cognitives, Aix-Marseille–Université Centre Saint-Charles, Marseille, France
- Laboratoire d’Audiologie Clinique, Narbonne, France
| | - Stéphane Gallego
- CNRS UMR, Laboratoire de Neurosciences Cognitives, Aix-Marseille–Université Centre Saint-Charles, Marseille, France
- Institut des Sciences et Technologies de Réadaptation, Université de Lyon, Lyon, France
| | - Philippe Fournier
- CNRS UMR, Laboratoire de Neurosciences Cognitives, Aix-Marseille–Université Centre Saint-Charles, Marseille, France
- Département de réadaptation, Faculté de Médecine, Université Laval, Quebec, QC, Canada
| | - Mathieu Marx
- CNRS UMR, Centre de Recherche Cerveau et Cognition (CERCO), Université Paul Sabatier, Toulouse, France
| | - Arnaud Noreña
- CNRS UMR, Laboratoire de Neurosciences Cognitives, Aix-Marseille–Université Centre Saint-Charles, Marseille, France
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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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Assouly K, Smit AL, Stegeman I. Effect of electrical stimulation with a cochlear implant on tinnitus impact: protocol of an individual patient data meta-analysis. BMJ Open 2022; 12:e063432. [PMID: 35715189 PMCID: PMC9208004 DOI: 10.1136/bmjopen-2022-063432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/31/2022] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Tinnitus is the perception of sound without an external stimulus, often experienced as a ringing, buzzing sound. While several studies have shown a reduction in tinnitus distress following cochlear implantation, others showed an increase or no change after implantation. At this stage, clinicians have little certainty when counselling their patients prior to implantation regarding tinnitus post-implantation. To help clinicians to counsel cochlear implant (CI) candidates on the risk of developing or improving tinnitus after implantation, we aim to assess the effect of electrical stimulation with a CI on tinnitus impact for individual adult patients with tinnitus. We will also apply prediction models to individual patient data (IPD) of clinical trials to find predictive factors of the effect of electrical stimulation on tinnitus impact. METHOD AND ANALYSIS The IPD meta-analysis is a follow-up project of the systematic review on cochlear implantation in patients with tinnitus as a primary complaint. First, the systematic searches will be updated to date. Methodological quality of eligible studies will be assessed using the Risk of Bias In Non-randomised Studies of Intervention tool (ROBINS-I). Based on a data-sharing agreement, authors of the eligible studies will be invited to share their deidentified and complete IPD. The primary outcome is the effect of electrical stimulation with a CI on tinnitus impact 1 month or more post-implantation. IPD meta-analysis will be used to assess the primary outcome, while differentiating the tinnitus impact questionnaires. Second, linear regression analyses will be used to model the effect of electrical stimulation on tinnitus impact based on relevant predictors. ETHICS AND DISSEMINATION The Medical Research Involving Human Subject Act does not apply, and ethical approval is not required. The study results will be made accessible to the public in a peer-review open access journal. PROSPERO REGISTRATION NUMBER CRD42022319367, review ongoing.
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Affiliation(s)
- Kelly Assouly
- Department of Otorhinolaryngology and Head & Neck Surgery, UMC Utrecht, Utrecht, The Netherlands
- UMC Utrecht Brain Center, UMC Utrecht, Utrecht, The Netherlands
- Cochlear Technology Centre Belgium, Mechelen, Belgium
| | - Adriana L Smit
- Department of Otorhinolaryngology and Head & Neck Surgery, UMC Utrecht, Utrecht, The Netherlands
- UMC Utrecht Brain Center, UMC Utrecht, Utrecht, The Netherlands
| | - Inge Stegeman
- Department of Otorhinolaryngology and Head & Neck Surgery, UMC Utrecht, Utrecht, The Netherlands
- UMC Utrecht Brain Center, UMC Utrecht, Utrecht, The Netherlands
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Chen SL, Chan KC, Hu CY, Fang HY, Wu CM. Experience of adult cochlear implantation at a tertiary hospital. J Chin Med Assoc 2022; 85:469-477. [PMID: 35019869 DOI: 10.1097/jcma.0000000000000690] [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: 11/26/2022] Open
Abstract
BACKGROUND The prevalence of adult cochlear implant (CI) surgery is increasing. However, the relevant adult CI data in Taiwan are insufficient due to the relatively small number of adult implant patients. The two main factors hindering adult implantation are the high cost of the surgery itself and inadequate knowledge regarding the effectiveness of CI for hearing and suppression of tinnitus. Here, we present data regarding adult CI outcomes from a single tertiary hospital. METHODS A total of 116 consecutive adult CI recipients (≥18 years old) who completed at least 12 months of speech perception tests (words and sentences) between January 1999 and December 2020 were enrolled in this retrospective population-based cohort study. Thirty patients completed speech perception (words and sentences) testing as well as three questionnaires relating to quality of life, and 71 completed full tinnitus suppression studies. Subjects' pre- and post-CI questionnaires were evaluated to assess overall CI outcome. RESULTS For auditory evaluation, the scores of easy sentences (ES), difficult sentences (DS), and phonetically balanced (PB) word recognition tests reached a plateau at 3 months post-CI (p = 0.005, 0.001, and 0.004, respectively) in most subjects. The post-CI scores of bodily pain, mental health, and social role functioning were significantly higher than corresponding pre-CI scores on the SF-36 Health Survey-Taiwan version (p = 0.036, 0.019, and 0.002, respectively). Furthermore, the post-CI scores of basic sound perception, speech production, and advanced sound perception were significantly higher than the corresponding pre-CI scores on the Nijmegen Cochlear Implant Questionnaire (p < 0.001, 0.013, and <0.001, respectively). Self-esteem was significantly correlated with the Categories of Auditory Performance scale and Speech Intelligibility Rating scale at 3, 6, and 9 months post-CI. CI improved tinnitus in approximately 65.1% of 71 adults. Based on the Tinnitus Handicap Inventory, 66.7% of patients were in grade 3-5 before surgery. However, after CI, only 34.4% of patients remained in THI grade 3-5. CONCLUSION This study confirmed that CI can improve speech perception (words and sentences), physical health, mental health, social interaction, and self-esteem in adult patients with profound hearing loss. CI also significantly alleviated tinnitus. The outcomes of ES, DS, and PB tests at 3 months post-CI were non-inferior to other longer post-CI periods and could be utilized as references for recovery and evaluation of prognosis.
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Affiliation(s)
- Shih-Lung Chen
- Department of Otorhinolaryngology & Head and Neck Surgery, Chang Gung Memorial Hospital-Linkou, Taoyuan, Taiwan, ROC
- School of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Kai-Chieh Chan
- Department of Otorhinolaryngology & Head and Neck Surgery, Chang Gung Memorial Hospital-Linkou, Taoyuan, Taiwan, ROC
- School of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Chih-Yu Hu
- Department of Otorhinolaryngology & Head and Neck Surgery, Chang Gung Memorial Hospital-Linkou, Taoyuan, Taiwan, ROC
- School of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Hsuan-Yeh Fang
- School of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
- Department of Otorhinolaryngology & Head and Neck Surgery, Hsinchu Mackey Memorial Hospital, Hsinchu, Taiwan, ROC
| | - Che-Ming Wu
- Department of Otorhinolaryngology & Head and Neck Surgery, Chang Gung Memorial Hospital-Linkou, Taoyuan, Taiwan, ROC
- School of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
- Department of Otorhinolaryngology & Head and Neck Surgery, New Taipei Municipal TuCheng Hospital (Built and Operated by Chang Gung Medical Foundation), New Taipei City, Taiwan, ROC
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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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Abstract
OBJECTIVE Explore patient characteristics associated with tinnitus improvement after cochlear implantation. STUDY DESIGN Retrospective cohort. SETTING Tertiary referral. PATIENTS Adults with bilateral severe-to-profound hearing loss and tinnitus. INTERVENTIONS Unilateral cochlear implantation. RESULTS From 1996 to 2018, 358 patients endorsed pre-implant tinnitus and had ascertainable tinnitus status at 1-year. Clinically significant improvement in Tinnitus Handicap Inventory (THI) (reduction by at least 7-points) was observed in 262 (73.2%) patients, of whom 155 (59.2%) reported complete resolution. Of the 24 characteristics explored, four were identified as independent predictors of improved tinnitus in logistic regression models. In a multivariable model including identified independent predictors, each 10-percentage point increase in baseline hearing in noise test was associated with an 14% reduction in odds of tinnitus resolution or clinically significant improvement (odds ratio [OR] 0.86, 95% confidence limits [CL] 0.77, 0.96) and preoperative use of a hearing aid in the contralateral ear was associated with a 72% reduction (OR 0.28; 95% CL 0.11, 0.73). Each 10-point increase in baseline Hearing Handicap Inventory for Adults (HHI) score was associated with a 28% increase in odds of tinnitus improvement (OR 1.28; 95% CL 1.07, 1.54). Higher baseline burden of tinnitus was associated with higher odds of tinnitus improvement (OR 1.21 per 10-point THI increase, 95% CL 1.04, 1.40). CONCLUSIONS Worse residual hearing and higher baseline hearing and tinnitus handicap are associated with higher odds of tinnitus improvement. Expectations of patients seeking reduced tinnitus burden following cochlear implantation should be managed by counselling regarding odds of tinnitus improvement compared to those with similar residual hearing and tinnitus burden.
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Opperman E, le Roux T, Masenge A, Eikelboom RH. The effect of tinnitus on hearing-related quality of life outcomes in adult cochlear implant recipients. Int J Audiol 2020; 60:246-254. [PMID: 33100038 DOI: 10.1080/14992027.2020.1828633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To describe the effect of tinnitus distress on the hearing-related quality of life (QoL) outcomes over time in adult cochlear implant (CI) recipients. DESIGN A retrospective, longitudinal study of adult CI recipients was conducted. Hearing-related QoL and tinnitus distress were assessed using the Abbreviated Profile of Hearing Aid Benefit (APHAB) and the Tinnitus Reaction Questionnaire (TRQ) preoperatively and at 6-months, 12-months and >24-month postoperatively. The association between tinnitus distress and hearing-related QoL outcomes over time was investigated. Furthermore, 13 potential predictive factors were identified from the retrospective dataset. Multiple regression analyses were performed to identify variables that influence hearing-related QoL outcomes over time. STUDY SAMPLE The study sample included 210 adult (≥18 years) CI recipients implanted between 2001 and 2017. RESULTS Lower tinnitus distress and younger age at implantation were significant predictors of better hearing-related QoL in adult CI recipients. A significant reduction in tinnitus distress up to two years post-implantation was found, as well as greater tinnitus distress correlating with poorer hearing-related QoL outcomes. CONCLUSION Tinnitus distress negatively affects the hearing-related QoL outcomes of adult CI recipients. Tinnitus distress and age at implantation were found to be significant predictors of hearing-related QoL when controlling for other predictive factors.
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Affiliation(s)
- Elmien Opperman
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Hatfield, South Africa
| | - Talita le Roux
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Hatfield, South Africa
| | - Andries Masenge
- Department of Statistics, University of Pretoria, Hatfield, South Africa
| | - Robert H Eikelboom
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Hatfield, South Africa.,Ear Science Institute Australia, Subiaco, Australia.,Ear Sciences Centre, Medical School, The University of Western Australia, Nedlands, Australia
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Sarac ET, Ozbal Batuk M, Batuk IT, Okuyucu S. Effects of Cochlear Implantation on Tinnitus and Depression. ORL J Otorhinolaryngol Relat Spec 2020; 82:209-215. [PMID: 32594084 DOI: 10.1159/000508137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 04/21/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Tinnitus is prevalent in 66-88% of cochlear implant users. The reason for this high prevalence is that hearing impairment is the most common cause of tinnitus. OBJECTIVE This study aims to determine the effect of cochlear implant and to compare the severity of tinnitus and depression in adult cochlear implant users with tinnitus. METHODS Patients diagnosed with tinnitus filled out the Tinnitus Handicap Inventory and the Beck Depression Inventory during CI candidate evaluation. The audiological follow-up in the present study included only patients suffering from tinnitus before the cochlear implant surgery. This study included only patients who had tinnitus handicap inventory and Beck Depression Inventory clinical records pre- and postoperatively, including 23 adult cochlear implant users (13 males and 10 females) aged 18-76 years. RESULTS AND CONCLUSION There was a statistically significant decrease in the severity of tinnitus and depression after cochlear implant. As the participants' tinnitus level and grade decreased, their depression levels also decreased. Depression levels decreased after the use of a cochlear implant compared to before cochlear implantation. Cochlear implantation is currently used only for hearing restoration. However, cochlear implantation may be used in rehabilitation for tinnitus in patients with severe hearing loss and in tinnitus patients. In addition cochlear implantation can be a depression rehabilitation method by reducing tinnitus.
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Affiliation(s)
- Elif Tugba Sarac
- Ear-Nose-Throat-Audiology Department, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey,
| | - Merve Ozbal Batuk
- Audiology Department, Faculty of Health Science, Hacettepe University, Ankara, Turkey
| | - Isa Tuncay Batuk
- Audiology Department, Faculty of Health Science, Hacettepe University, Ankara, Turkey
| | - Semsettin Okuyucu
- Ear-Nose-Throat Department, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
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Ramakers GGJ, van Zanten GA, Thomeer HGXM, Stokroos RJ, Heymans MW, Stegeman I. Development and internal validation of a multivariable prediction model for tinnitus recovery following unilateral cochlear implantation: a cross-sectional retrospective study. BMJ Open 2018; 8:e021068. [PMID: 29895652 PMCID: PMC6009556 DOI: 10.1136/bmjopen-2017-021068] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To develop and internally validate a prediction model for tinnitus recovery following unilateral cochlear implantation. DESIGN A cross-sectional retrospective study. SETTING A questionnaire concerning tinnitus was sent to patients with bilateral severe to profound hearing loss, who underwent unilateral cochlear implantation at the University Medical Center Utrecht, the Netherlands, between 1 January 2006 and 31 December 2015. PARTICIPANTS Of 137 included patients, 87 patients experienced tinnitus preoperatively. Data of these 87 patients were used to develop the prediction model. PRIMARY AND SECONDARY OUTCOME MEASURES The outcome of the prediction model was tinnitus recovery. Investigated predictors were: age, gender, duration of deafness, preoperative hearing performance, tinnitus duration, severity and localisation, follow-up duration, localisation of cochlear implant (CI) compared with tinnitus side, surgical approach, insertion depth of the electrode, CI brand and difference in hearing threshold following cochlear implantation. Multivariable backward logistic regression was performed. Missing data were handled using multiple imputation. The performance of the model was assessed by the calibrative and discriminative ability of the model. The prediction model was internally validated using bootstrapping techniques. RESULTS The tinnitus recovery rate was 40%. A lower preoperative Consonant-Vowel-Consonant (CVC) score, unilateral localisation of tinnitus and larger deterioration of residual hearing at 250 Hz revealed to be relevant predictors for tinnitus recovery. The area under the receiver operating characteristics curve (AUC) of the initial model was 0.722 (IQR: 0.703-0.729). After internal validation of this prediction model, the AUC decreased to 0.696 (IQR: 0.667-0.700). CONCLUSION AND RELEVANCE Lower preoperative CVC score, unilateral localisation of tinnitus and larger deterioration of residual hearing at 250 Hz were significant predictors for tinnitus recovery following unilateral cochlear implantation. The performance of the model developed in this retrospective study is promising. However, before clinical use of the model, the conduction of a larger prospective study is recommended.
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Affiliation(s)
- Geerte G J Ramakers
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gijsbert A van Zanten
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hans G X M Thomeer
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Robert J Stokroos
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martijn W Heymans
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Inge Stegeman
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
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Simon F, Hempel JM. [Extended applications for cochlear implantation]. MMW Fortschr Med 2018; 160:51-53. [PMID: 29721870 DOI: 10.1007/s15006-018-0485-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Florian Simon
- Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde, Klinikum der Universität München, Marchioninistr. 15, D-81377, München, Deutschland.
| | - John-Martin Hempel
- Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde, Klinikum der Universität München, Marchioninistr. 15, D-81377, München, Deutschland
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13
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Tinnitus, depression, and suicidal ideation in adults: A nationally representative general population sample. J Psychiatr Res 2018; 98:124-132. [PMID: 29406247 DOI: 10.1016/j.jpsychires.2018.01.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 01/09/2018] [Accepted: 01/09/2018] [Indexed: 11/24/2022]
Abstract
Tinnitus is strongly associated with psychiatric symptoms, including depression and suicidality. We aimed to further investigate the association of tinnitus with depressive mood and/or suicidal ideation, and explore the shared risk factors for these within a representative sample of the adult general population. We also investigated potential mediation pathways among tinnitus, suicidal ideation, depression, shared risk factors, and perceived stress levels. We analysed data from 28,930 adults (aged ≥19 years) from the fourth and fifth Korea National Health and Nutrition Examination Surveys (KNHANES) conducted from 2008 to 2012 in South Korea. We investigated the presence and severity of tinnitus, depressive mood, suicidal ideation, perceived usual stress level, and socioeconomic and health-related variables. We conducted logistic regression and mediation analyses. Tinnitus and its severity were significantly associated with depressive mood and suicidal ideation. Tinnitus, depressive mood, and suicidal ideation shared common socioeconomic and health-related risk factors. Tinnitus significantly mediated the association of shared risk factors for depressive mood and suicidal ideation. Perceived usual stress level mediates the association of tinnitus with depressive mood and suicidal ideation. The correlation of perceived usual stress levels with depression and suicidal ideation was also mediated by tinnitus. Our findings implicate that tinnitus may contribute substantially to the development of depressive symptom and suicidal ideation in adults via apparent interactions with shared risk factors and stress levels.
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Hoppe U, Hesse G. Hearing aids: indications, technology, adaptation, and quality control. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2017; 16:Doc08. [PMID: 29279726 PMCID: PMC5738937 DOI: 10.3205/cto000147] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Hearing loss can be caused by a number of different pathological conditions. Some of them can be successfully treated, mainly by surgery, depending on the individual's disease process. However, the treatment of chronic sensorineural hearing loss with damaged cochlear structures usually needs hearing rehabilitation by means of technical amplification. During the last two decades tremendous improvements in hearing aid technology led to a higher quality of the hearing rehabilitation process. For example, due to sophisticated signal processing acoustic feedback could be reduced and hence open fitting options are available even for more subjects with higher degrees of hearing loss. In particular for high-frequency hearing loss, the use of open fitting is an option. Both the users' acceptance and the perceived sound quality were significantly increased by open fittings. However, we are still faced with a low level of readiness in many hearing impaired subjects to accept acoustic amplification. Since ENT specialists play a key-role in hearing aid provision, they should promote early hearing aid rehabilitation and include this in the counselling even in subjects with mild and moderate hearing loss. Recent investigations demonstrated the benefit of early hearing aid use in this group of patients since this may help to reduce subsequent damages as auditory deprivation, social isolation, development of dementia, and cognitive decline. For subjects with tinnitus, hearing aids may also support masking by environmental sounds and enhance cortical inhibition. The present paper describes the latest developments of hearing aid technology and the current state of the art for amplification modalities. Implications for both hearing aid indication and provision are discussed.
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Affiliation(s)
- Ulrich Hoppe
- Section of Audiology, Department of Otolaryngology, Head and Neck Surgery, University of Erlangen, Germany
| | - Gerhard Hesse
- Tinnitus Department, Hospital of Bad Arolsen, University of Witten-Herdecke, Germany
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15
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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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