Tinnitus after Simultaneous and Sequential Bilateral Cochlear Implantation

Changes in Tinnitus Characteristics and Residual Inhibition following Cochlear Implantation: A Prospective Analysis

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.

Effects of auditory rehabilitation with cochlear implant on tinnitus prevalence and distress, health-related quality of life, subjective hearing and psychological comorbidities: Comparative analysis of patients with asymmetric hearing loss (AHL), double-sided (bilateral) deafness (DSD), and single-sided (unilateral) deafness (SSD)

Introduction

Auditory rehabilitation with a cochlear implant (CI), in many cases, positively impacts tinnitus. However, it is unclear if the tinnitus-related benefit of CI is equal for patients with various indications for CI. Therefore, this study aimed to determine differences in tinnitus prevalence and distress, health-related quality of life, subjective hearing, perceived stress, and psychological comorbidities between patients diagnosed with asymmetric hearing loss (AHL), single-sided (unilateral) deafness (SSD), and double-sided (bilateral) deafness (DSD) before and six months after cochlear implantation.

Methods

One hundred-one CI candidates were included in this prospective study (39 AHL patients, 23 DSD patients, and 39 SSD patients). The patients completed questionnaires measuring tinnitus distress, health-related quality of life, subjective hearing, perceived stress, and psychological comorbidities before and 6 months after CI.

Results

The prevalence of tinnitus in the entire cohort (80.2% before CI) decreased 6 months after CI to 71.3%. The DSD group had the lowest tinnitus prevalence at both time points. The degree of tinnitus-induced distress decreased significantly in all three groups after CI. Differences in quality of life, subjective hearing, and psychological comorbidities between the groups at the study onset disappeared after CI. Significant correlations existed between anxiety, depression, and tinnitus distress in AHL and SSD but not in DSD patients before and after CI.

Discussion

Our results demonstrate significant differences between the three groups of CI candidates, which might affect the implantation outcome. These differences suggest a need for personalized psychological counseling during the auditory rehabilitation process, focusing on anxiety and depressive symptoms for SSD and AHL patients.

Analysis of a Cochlear Implant Database: Changes in Tinnitus Prevalence and Distress After Cochlear Implantation

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.

Sustained reduction of tinnitus several years after sequential cochlear implantation

OBJECTIVE

This study aimed to explore the short- and long-term effects of a second cochlear implant (CI-2) on the reduction of tinnitus annoyance and tinnitus handicap.

DESIGN

In a combined retrospective and prospective cohort study, tinnitus annoyance was measured before receiving the CI-2 (Pre), more than two years after (Post1) and more than seven years after (Post2), using the Tinnitus Handicap Inventory (THI), the Visual Analog Scale for the assessment of perceived tinnitus loudness (VAS-L) and annoyance (VAS-A), and a self-report questionnaire.

STUDY SAMPLE

Twenty sequentially bilaterally implanted adults with bothersome tinnitus.

RESULTS

CI-2 implantation resulted in a statistically significant reduction of tinnitus handicap from severe at Pre to mild at Post1 (THI mean score reduced from 61.3 [SD = 19.4] to 29.3 [SD = 23.5]). The reduction in tinnitus annoyance was statistically significant from Pre to Post 2 (VAS-A reduced from 7.1 [SD = 1.5] to 3.4 [SD = 2.2]). The reduction in tinnitus loudness was not statistically significant.

CONCLUSIONS

The provision of a CI-2 for severely and profoundly hearing-impaired individuals with bothersome tinnitus is an effective method of providing long-term tinnitus relief.

Restoration of Deafferentation Reduces Tinnitus, Anxiety, and Depression: A Retrospective Study on Cochlear Implant Patients

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.

Prospective study on health-related quality of life in patients before and after cochlear implantation

Purpose

Assessing cochlear implant (CI)-associated patient outcomes is a focus of implant research. Most studies have analyzed outcomes retrospectively with low patient numbers and few measurement time points. In addition, standardized CI-specific health-related quality of life (HRQoL) instruments have not been used. To address this, we prospectively assessed HRQoL in patients before and after implantation.

Methods

We assessed HRQoL using the Nijmegen Cochlear Implant Questionnaire (NCIQ), Abbreviated Profile of Hearing Aid Benefit (APHAB), Hearing Participation Scale (HPS), and the Visual Analogue Scale (VAS) in 100 deaf or severely hearing-impaired patients (57 unilaterally deaf and 43 bilaterally deaf) before and 3, 6, and 12 months after cochlear implantation. We compared the results of unilaterally and bilaterally hearing-impaired patients and patients with or without a hearing aid. Principal component (PCA) and exploratory factor analyses (EFA) were also conducted.

Results

The NCIQ measured improvements in all 6 domains after CI and correlated well with other QoL instruments. The PCA revealed that the NCIQ can be better explained by physical, physical advanced, and socio-psychological components. The APHAB score ameliorated over time, except for the background noise domain. The overall HPS score improved over time, but the hearing handicap subscore significantly decreased. Sociodemographic influences on the questionnaire scores were relatively weak.

Conclusion

Assessing HRQoL is essential for quantifying the patient outcome after CI. NCIQ scores in our patient cohort showed improved HRQoL in all domains and we recommend that the NCIQ be used as a first-line questionnaire for assessing QoL in hearing-impaired patients after CI.

Cochlear implant and tinnitus-a meta-analysis

Introduction

Tinnitus is a frequent symptom in cochlear implant patients, often reported as persistent and disabling in implant candidates. Tinnitus is rarely considered in the preoperative evaluation of patients who are eligible for cochlear implantation. Many studies have shown that a cochlear implant leads to a significant change in the perception of tinnitus.

Objective

To identify evidence in the scientific literature indicating that cochlear implant in eligible patients with tinnitus can improve tinnitus perception.

Methods

One hundred forty articles were found from nine databases, and 20 articles from the gray literature mentioned the relationship between cochlear implant and tinnitus perception in patients eligible for cochlear implant. The PICOS (population, intervention, comparison, and outcome) strategy, was used to define the eligibility criteria. The studies that met the inclusion criteria for this second step were included in a qualitative synthesis, and each type of study was analyzed using the Joanna Briggs Institute critical appraisal checklist for quasi-experimental studies and the Joanna Briggs Institute critical appraisal checklist for randomized clinical trials.

Results

The full texts of 11 articles were read, and 6 studies were selected for the meta-analysis. The total sample size in the evaluated articles was 136 patients with tinnitus who were eligible for cochlear implantation.

Conclusions

Taken together, these findings support the feasibility of cochlear implantation to reduce the perception of tinnitus, thus providing a new perspective in the treatment of tinnitus in patients with hearing loss who are candidates for cochlear implantation.

Sound therapy for cochlear implant users with tinnitus

OBJECTIVE

Despite the positive effect of a cochlear implant (CI) on tinnitus in many patients, tinnitus remains a problem for a significant proportion of CI users. We investigated the acceptability and effect of sound therapy (a combination of natural background sounds and one concise tinnitus counselling session) on tinnitus and speech perception in CI users who still experienced tinnitus during CI use.

DESIGN AND STUDY SAMPLE

Thirty-two CI users (32-78 years) participated in phase 1: a test at the clinic to evaluate six background sounds provided by the sound processor. Eighteen out of the 32 CI users participated in phase 2: an optional take-home evaluation of 2 weeks without sound therapy, followed by 5 weeks with sound therapy, ending with an evaluation visit.

RESULTS

Thirty subjects (93.8%) found at least one background sound acceptable. In phase 2, a small improvement with sound therapy was found for tinnitus loudness, annoyance, and intrusiveness. 50% of the subjects subjectively reported benefit of sound therapy. Especially the sense of control on their tinnitus was highly appreciated. No detrimental effect on speech perception was observed.

CONCLUSION

The background sounds were acceptable and provided tinnitus relief in some CI users with tinnitus during CI use.

Quantifying tinnitus suppression in cochlear implantation using tinnitus interval-limited tracking

OBJECTIVES

Quantify the effects of cochlear implants (CI) on tinnitus suppression in patients with previous cochlear implantation using a novel audiologic sequence: Tinnitus Interval Limited Tracking (TILT).

STUDY DESIGN

Prospective cohort study.

METHODS

Consecutive patients with tinnitus and previous cochlear implantation for profound hearing loss underwent an audiologic testing sequence called TILT. Patients rated tinnitus severity using the validated Tinnitus Handicap Inventory (THI) as well as a visual analog scale at baseline and in a variety of audiologic scenarios. Changes in tinnitus severity between scenarios allow for the isolation of the effects of masking and electrical stimulation on the reduction of tinnitus.

RESULTS

Twenty patients were enrolled, 10 of whom have tinnitus with average THI 30.2 (standard deviation 22.6). Patients had an acute decrease in tinnitus severity when their CIs were turned on, even in the absence of noise in a soundproof booth. This effect reversed once the CIs were turned off. This effect was greater in magnitude than with masking that occurred with the presentation of soft speech. Acute tinnitus severity trended toward improvement with increased level of presented speech. Degree of improvement was not correlated with THI.

CONCLUSION

Acute tinnitus suppression in patients using CIs is multifactorial. Masking plays a role; however, it cannot sufficiently account for the totality of symptom improvement experienced by CI patients. Quantifiable tinnitus suppression observed when a CI is turned on, even in the absence of audiologic stimulation, suggests that electrical stimulation is involved in the mechanism of symptom improvement in these patients.

LEVEL OF EVIDENCE

4 Laryngoscope, 130: 2047-2052, 2020.

Age-related hearing loss and tinnitus, dementia risk, and auditory amplification outcomes

Age-related hearing loss (ARHL) or presbycusis, as the third leading cause of chronic disability in older adults, has been shown to be associated with predisposing cognitive impairment and dementia. Tinnitus is also a chronic auditory disorder demonstrating a growth rate with increasing age. Recent evidence stands for the link between bothersome tinnitus and impairments in various aspects of cognitive function. Both ARHL and age-related tinnitus affect mental health and contribute to developing anxiety, stress, and depression. The present review is a comprehensive multidisciplinary study on diverse interactions among ARHL, tinnitus, and cognitive decline in older adults. This review incorporates the latest evidence in prevalence and risk factors of ARHL and tinnitus, the neural substrates of tinnitus-related cognitive impairments, hypothesized mechanisms concerning the association between ARHL and increased risk of dementia, hearing amplification outcomes in cases with ARHL and cognitive decline, and preliminary findings on the link between ARHL and cognitive impairment in animal studies. Given extensive evidence that demonstrates advantages of using auditory amplification in the alleviation of hearing handicap, depression, and tinnitus, and the improvement of cognition, social communication, and quality of life, regular hearing screening programs for identification and management of midlife hearing loss and tinnitus is strongly recommended.

Expanding unilateral cochlear implantation criteria for adults with bilateral acquired severe sensorineural hearing loss

Objectives

To report on a retrospective cohort study on the effects of expanding inclusion criteria for application of cochlear implants (CIs) on the performance 1-year post-implantation.

Methods

Based on pre-implantation audiometric thresholds and aided speech recognition scores, the data of 164 CI recipients were divided into a group of patients that fulfilled conservative criteria (mean hearing loss at 0.5, 1 and 2 kHz > 85 dB HL and phoneme scores with hearing aids < 30%), and the remaining group of patients that felt outside this conservative criterion. Speech recognition scores (in quiet) and quality of life (using the NCIQ) of both groups, measured at 1-year post-implantation, were compared.

Results

The group that felt outside the conservative criterion showed a higher phoneme score at 1-year post-implantation compared to the conservative group, suggesting that relaxed criteria have a positive influence on the speech recognition results with CI. With respect to quality of life, both groups significantly improved 1-year post-implantation. The conservative group showed a higher benefit on the advanced perception domain of the NCIQ. Based on their worse pre-implantation hearing, this was expected.

Conclusions

The data suggest that relaxation of CI indication positively affects the speech recognition performance of patients with severe hearing loss. Both groups of patients showed a positive effect of CI on the quality of life. This benefit relates to communication skills and the subjective day-to-day functioning in society.

No Difference in Behavioral and Self-Reported Outcomes for Simultaneous and Sequential Bilateral Cochlear Implantation: Evidence From a Multicenter Randomized Controlled Trial

Objective: The primary aim of this study was to longitudinally compare the behavioral and self-reported outcomes of simultaneous bilateral cochlear implantation (simBiCI) and sequential BiCI (seqBiCI) in adults with severe-to-profound postlingual sensorineural hearing loss. Design: This study is a multicenter randomized controlled trial with a 4-year follow-up period after the first moment of implantation. Participants were allocated by randomization to receive bilateral cochlear implants (CIs) either, simultaneously (simBiCI group) or sequentially with an inter-implant interval of 2 years (UCI/seqBiCI group). All sequential patients where encouraged to use their hearing aid on the non-implanted ear over of the first 2 years. Patients were followed-up on an annual basis. The primary outcome was speech perception in noise coming from a source directly in front of the patient. Other behavioral outcome measures were speech intelligibility-in-noise from spatially separated sources, localization and speech perception in quiet. Self-reported outcome measures encompassed questionnaires on quality of life, quality of hearing and tinnitus. All outcome measures were analyzed longitudinally using a linear or logistic regression analysis with an autoregressive residual covariance matrix (generalized estimating equations type). Results: Nineteen participants were randomly allocated to the simBiCI group and 19 participants to the UCI/seqBiCI group. Three participants in the UCI/seqBiCI group did not proceed with their second implantation and were therefore unavailable for follow-up. Both study groups performed equally well on speech perception in noise from a source directly in front of the patient longitudinally. During all 4 years of follow-up the UCI/seqBiCI group performed significantly worse compared to the simBiCI group on spatial speech perception in noise in the best performance situation (8.70 dB [3.96 - 13.44], p < 0.001) and localization abilities (largest difference 60 degrees configuration: -44.45% [-52.15 - -36.74], p < 0.0001). Furthermore, during all years of follow-up, the UCI/seqBiCI group performed significantly worse on quality of hearing and quality of life questionnaires. The years of unilateral CI use were the reason for the inferior results in the UCI/SeqBiCI group. One year after receiving CI2, the UCI/seqBiCI group performance did not statistically differ from the performance of the simBiCI group on all these outcomes. Furthermore, no longitudinal differences were seen in tinnitus burden prevalence between groups. Finally, the complications that occurred during this trial were infection, dysfunction of CI, facial nerve palsy, tinnitus and vertigo. Conclusion: This randomized controlled trial on bilaterally severely hearing impaired participants found a significantly worse longitudinal performance of UCI/seqBiCI compared to simBiCI on multiple behavioral and self-reported outcomes regarding speech perception in noise and localization abilities. This difference is associated with the inferior performance of the UCI/seqBiCI participants during the years of unilateral CI use. After receiving the second CI however, the performance of the UCI/seqBiCI group did not significantly differ from the simBiCI group. Trial Registration: Dutch Trial Register NTR1722.