Auditory capacity of the better-hearing ear in asymmetric hearing loss

PURPOSE

Our aim was to investigate the course of the hearing capacity of the better-hearing ear in single-sided deafness (SSD) and asymmetric hearing loss (AHL) over time, in a multicenter study.

METHODS

We included 2086 pure-tone audiograms from 323 patients with SSD and AHL from four hospitals and 156 private practice otorhinolaryngologists. We collected: age, gender, etiology, duration of deafness, treatment with CI, number and monosyllabic speech recognition, numerical rating scale (NRS) of tinnitus intensity, and the tinnitus questionnaire according to Goebel and Hiller. We compared the pure tone audiogram of the better-hearing ear in patients with SSD with age- and gender-controlled hearing thresholds from ISO 7029:2017.

RESULTS

First, individuals with SSD showed a significantly higher hearing threshold from 0.125 to 8 kHz in the better-hearing ear compared to the ISO 7029:2017. The duration of deafness of the poorer-hearing ear showed no relationship with the hearing threshold of the better-hearing ear. The hearing threshold was significantly higher in typically bilaterally presenting etiologies (chronic otitis media, otosclerosis, and congenital hearing loss), except for Menière's disease. Second, subjects that developed AHL did so in 5.19 ± 5.91 years and showed significant reduction in monosyllabic word and number recognition.

CONCLUSIONS

Individuals with SSD show significantly poorer hearing in the better-hearing ear than individuals with NH from the ISO 7029:2017. In clinical practice, we should, therefore, inform our SSD patients that their disease is accompanied by a reduced hearing capacity on the contralateral side, especially in certain etiologies.

Tinnitus suppression by means of cochlear implantation: does it affect cognition?

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.

Surgical labyrinthectomy in the treatment of unilateral Meniere disease: a Belgian retrospective study

PURPOSE

Meniere's disease (MD) is a disabling condition with symptoms, such as hearing loss, dizziness, and tinnitus. Surgery is the last resort option for managing MD when other treatments are not effective. Surgical labyrinthectomy (SL) is less commonly performed than vestibular neurectomy or chemical labyrinthectomy. We sought to assess the efficacy and safety of the SL procedure.

METHODS

A retrospective study was carried out involving a cohort of 25 patients with disabling and drug-resistant MD, who underwent SL performed by the same surgeon at University Hospital UCL Namur between 2009 and 2019. All patients considered their hearing non-functional and requested a radical therapeutic option. We compared subjective and objective measures before and after surgery, retrieved from patient medical records.

RESULTS

The difference between the Dizziness Handicap Inventory scores before and after surgery was statistically significant (p < 0.01). 81% of patients being satisfied with surgery. No post-operative complications occurred. Following SL, 14 patients evolved well, both subjectively and clinically, without any further vestibular workup required, which was offered to the other patients. All had a total deafness on the operated side, as expected, while four benefited from multidisciplinary rehabilitation because of persistent tinnitus. The scientific literature on this topic was reviewed, compared, and discussed.

CONCLUSIONS

Based on our results, SL represents an efficient and safe approach to achieve vestibular deafferentation in patients with unilateral, disabling, and treatment-resistant MD, with non-functional hearing.

Challenges in the use of Venous Sinus Stenting in the Treatment of Idiopathic Intracranial Hypertension and Pulsatile Tinnitus

Although numerous case series and meta-analyses have shown the efficacy of venous sinus stenting (VSS) in the treatment of idiopathic intracranial hypertension and idiopathic intracranial hypertension-associated pulsatile tinnitus, there remain numerous challenges to be resolved. There is no widespread agreement on candidacy; pressure gradient and failed medical treatment are common indications, but not all clinicians require medical refractoriness as a criterion. Venous manometry, venography, and cerebral angiography are essential tools for patient assessment, but again disagreements exist regarding the best, or most appropriate, diagnostic imaging choice. Challenges with the VSS technique also exist, such as stent choice and deployment. There are considerations regarding postprocedural balloon angioplasty and pharmacologic treatment, but there is insufficient evidence to formalize postoperative decision making. Although complications of VSS are relatively rare, they include in-stent stenosis, hemorrhage, and subdural hematoma, and the learning curve for VSS presents specific challenges in navigating venous anatomy, emphasizing the need for wider availability of high-quality training. Recurrence of symptoms, particularly stent-adjacent stenosis, poses challenges, and although restenting and cerebrospinal fluid-diverting procedures are options, there is a need for clearer criteria for retreatment strategies. Despite these challenges, when comparing VSS with traditional cerebrospinal fluid-diverting procedures, VSS emerges as a favorable option, with strong clinical outcomes, lower complication rates, and cost-effectiveness. Further research is necessary to refine techniques and indications and address specific aspects of VSS to overcome these challenges.

Benefits of unilateral cochlear implantation in adults with asymmetric hearing loss: Audiologic and patient-related outcome measures

PURPOSE

To investigate the benefits of cochlear implantation in adults with single-sided deafness (SSD) and asymmetric hearing loss (AHL).

STUDY DESIGN

Prospective within-subjects repeated-measures.

SETTING

Two tertiary cochlear implant centers.

PATIENTS

Fourteen adults with severe-to-profound sensorineural hearing loss in the worse hearing ear and up to moderate SNHL in the better hearing ear.

INTERVENTION

Cochlear implantation in the worse hearing ear.

MAIN OUTCOME MEASURES

Consonant-nucleus-consonant (CNC) test, AzBio sentence test in noise, and lateralization testing were conducted preoperatively and at 3-, 6-, and 12-months post-activation. Patient-related outcomes were measured using the Speech, Spatial, and Qualities of Hearing Scale and Glasgow Benefit Inventory. Tinnitus Handicap Inventory was administered to subjects with tinnitus.

RESULTS

Mean length of hearing loss in the worse hearing ear was 3.5 years. The mean CNC change scores from baseline were 54.8, 55.9, and 58.9 percentage points at 3-, 6-, and 12-months (p < 0.001). AzBio sentence test in noise demonstrated improved scores in all spatial configurations, although statistically significant in S0N0 (speech front, noise front) only. Lateralization testing showed significant improvement of 22.9, 24.5, and 24.0 percentage points at 3-, 6-, and 12 months post-activation (p = 0.002). All patient-related outcome measures revealed significant improvement.

CONCLUSION

This study demonstrates improved speech perception in noise, sound lateralization, quality of life, and reduction in tinnitus perception in adults with SSD/AHL who undergo cochlear implantation. Our results add to the growing body of evidence that cochlear implant should be offered to this population.

A Transcanal Endoscopic Approach for Management of Pulsatile Tinnitus due to High-Riding Dehiscent Jugular Bulb

Pulsatile tinnitus (PT) caused by a high-riding dehiscence jugular bulb (HDJB) is a rare but treatable otology disease. There are several managements include transcatheter endovascular coil embolization, transvenous stent-assisted coil embolization, or resurfacing the dehiscent bony wall of high jugular bulb under the use of microscope. Among those options, surgical resurfacing of HDJB might be an effective and safe choice with less destruction. However, previous studies approached middle ear cavity via microscope can only provide a lateral, indirect view, while resurfacing the vessel through a transcanal endoscopic ear surgery (TEES) approach may give surgeon a direct and easy way to manage HDJB. In this report, we presented a case of 40-year-old woman with HDJB and shared our clinical consideration and reasoning of the surgical management of PT via a transtympanic approach by TEES rather than a transmastoid approach.

Stereotactic radiosurgery for Koos grade IV vestibular schwannoma: a systematic review and meta-analysis

BACKGROUND

Stereotactic radiosurgery (SRS) is a well-established treatment option for Koos stage I-III vestibular schwannomas (VS), often used as the first line of treatment or after subtotal resection. However, the optimal treatment for Koos-IV VS remains unclear. Therefore, our study aimed to evaluate the effectiveness of SRS as a primary treatment for large VS classified as Koos-IV.

METHODS

A systematic search was performed on December 28th, 2022, based on PubMed, Web of Science, and Scopus according to the PRISMA statement. The review was updated on September 7th, 2023. The risk of bias was assessed using the NIH Quality Assessment Tool. The R software (ver. 4.3.2) was used for all quantitative analyses and preparation of the forest plots. Publication bias and sensitivity analysis were performed to evaluate the reliability of the obtained results.

RESULTS

Among 2941 screened records, ten studies (1398 patients) have been included in quantitative synthesis. The overall tumor control rate was 90.7% (95%CI 86.3-94.4). Kaplan-Meier estimates of tumor control at 2, 6, and 10 years were 96.0% (95% CI 92.9-97.6%), 88.8% (95% CI 86.9-89.8%), and 84.5% (95% CI, 81.2-85.8%), respectively. The overall hearing preservation rate was 56.5% (95%CI 37-75.1). Kaplan-Meier estimates of hearing preservation rate at 2, 6, and 10 years were 77.1% (95% CI 67.9-82.5%), 53.5% (95% CI 44.2-58.5%), and 38.1% (95% CI 23.4-40.7%), respectively. The overall facial nerve preservation rate was 100% (95%CI 99.9-100.0). The overall trigeminal neuropathy rate reached 5.7% (95%CI 2.9-9.2). The overall rate of new-onset hydrocephalus was 5.6% (95%CI 3-9). The overall rates of worsening or new-onset tinnitus and vertigo were 6.8% (95%CI 4.2-10.0) and 9.1% (95%CI 2.1-19.6) respectively. No publication bias was detected according to the used methods.

CONCLUSIONS

Our systematic review and meta-analysis demonstrated a high overall tumor control rate, excellent facial nerve preservation, and low incidence of new-onset or worsened tinnitus and vertigo. However, several drawbacks associated with SRS should be noted, such as the presence of post-SRS hydrocephalus risk, mediocre long-term hearing preservation, and the lack of immediate tumor decompression. Nevertheless, the use of SRS may be beneficial in appropriately selected cases of Koos-IV VS. Moreover, further prospective studies directly comparing SRS with surgery are necessary to determine the optimal treatment for large VS and verify our results on a higher level of evidence. Registration and protocol: CRD42023389856.

Resurfacing Dehiscence(s) Without Reducing Diverticulum Effectively Silences Pulsatile Tinnitus: Novel Surgical Techniques for Diverticulum and Intraoperative Microphone Monitoring

OBJECTIVE

To emphasize the surgical importance of addressing dehiscence over diverticulum in resolving pulsatile tinnitus (PT) in patients with sigmoid sinus wall anomalies (SSWAs) and investigate anatomical differences.

STUDY DESIGN

Retrospective data analysis.

SETTING

Multi-institutional tertiary university medical centers.

PATIENTS

Fifty participants (dehiscence/diverticulum, 29:21 cases) with SSWA-associated PT were included in the study. All 21 diverticulum participants underwent surgical intervention.

INTERVENTIONS

1) Surgical intervention with novel techniques monitored by intraoperative microphone. 2) Radiologic and ophthalmologic imaging methods.

MAIN OUTCOME MEASURES

Quantitative and qualitative preoperative and postoperative alterations of PT and anatomical differences between dehiscence and diverticulum.

RESULTS

Addressing dehiscence overlying diverticulum and sigmoid sinus wall dehiscences significantly reduced visual analog score and Tinnitus Handicap Inventory ( p < 0.01). Sinus wall reconstruction led to substantial PT sound intensity reduction in the frequency range of 20 to 1000 Hz and 20 to 500 Hz (paired-sample t test, p < 0.01). Diploic vein analysis showed a significant positive correlation in 85.7% of the diverticulum cohort compared with the dehiscence cohort ( p < 0.01). Eight percent of the participants exhibited papilledema, which was limited to the dehiscence cohort.

CONCLUSION

1) Effective reduction of PT can be achieved by addressing all dehiscences, including those overlying the diverticulum, without the need to exclude the diverticulum. 2) Diploic vein may involve in the formation of diverticulum, and loss of dura mater and vascular wall thickness are observed at the SSWA locations.

Transmastoid Surgery for Superior Canal Dehiscence: Prospective Longitudinal Objective and Patient-Reported Audiovestibular Outcomes

OBJECTIVE

We assess symptom control, reversal and stability of objective third-window indicators, and hearing and balance function after transmastoid superior canal dehiscence plugging. To do this, we combine patient self-assessment questionnaires with auditory and vestibular test data collected at a preoperative and multiple postoperative visits.

STUDY DESIGN

Prospective cohort study.

SETTING

Tertiary referral center.

PATIENTS

Patients who underwent transmastoid plugging for superior canal dehiscence from 2012 to 2020.

INTERVENTIONS

Plugging of the superior semicircular canal using the transmastoid approach.

MAIN OUTCOME MEASURES

Patients were evaluated preoperatively, 3-month postoperative, and at yearly follow-ups (up to 8 yr postoperative). Self-assessment questionnaires included Autophony Index, Dizziness Handicap Inventory, Tinnitus Handicap Inventory, and Hearing Handicap Inventory. Objective tests included audiometry, cervical vestibular evoked myogenic potential, ocular vestibular evoked myogenic potential, and video head impulse test.

RESULTS

There was a statistically significant improvement in Autophony Index and Hearing Handicap Inventory total scores from the preoperative evaluation to 1 year postoperative. Dizziness Handicap Inventory and Tinnitus Handicap Inventory total scores also improved but statistically insignificant. Cervical and ocular vestibular evoked myogenic potential amplitudes and low-frequency air-bone gap showed statically significant reversal of the third-window effect preoperative versus 1 year postoperative. Video head impulse test of the superior semicircular canal revealed cases of pathological function preoperative with postoperative recovery. Results were stable over time.

CONCLUSIONS

Superior canal dehiscence repair resolves symptoms of autophony and improves hearing disability. Objective third-window indicators reverse and show long-term stability. Auditory and vestibular function is preserved postoperative, even superior semicircular canal function may be normal. Data suggest that surgical outcomes should not be evaluated until 1 year postoperative.

Cerebral Venous Thrombosis and Persistent Pulsatile Tinnitus After Sigmoid Sinus Resurfacing Surgery

We report a case with rare complication of cerebral venous thrombosis, as well as an incomplete response, after sigmoid sinus resurfacing surgery for pulsatile tinnitus (PT). A 24-year-old female patient with PT originating from the sigmoid sinus underwent sigmoid sinus resurfacing surgery. The tinnitus was immediately resolved, but it recurred with headache 5 days after surgery. A cerebral venous thrombosis was identified and treated, but PT persisted, although its frequency and loudness decreased. Sigmoid sinus resurfacing surgery is a safe and effective method to treat PT, but in some patients, it can cause serious complications and/or persistent tinnitus. In our patient, factors such as changes in blood viscosity due to warfarin intake or increased blood flow due to weight loss may have influenced the persistence of the tinnitus. It is important to identify the various associated factors and the weight of each of these factors to provide more tailored treatment of PT for individual patients in the future and to reduce complications and increase the effectiveness of sigmoid sinus resurfacing surgery.

Temporomandibular joint herniation into the external auditory canal presenting as clicking tinnitus: A case report

BACKGROUND

Herniation of the temporomandibular joint (TMJ) into the external auditory canal (EAC) due to a bony defect in the EAC is rare. Such bony defects can be secondary to inflammation, neoplasm, trauma. In rare instances, TMJ herniation can occur when the Huschke foramen is constantly exposed. TMJ herniation can induce clicking tinnitus, otalgia, conductive hearing loss, and otorrhea, but can also present with no symptoms. This study reports a case of TMJ herniation.

CLINICAL PRESENTATION

A male patient presented with clicking tinnitus that had developed 3 years ago. Dome-shaped soft tissue was found on the anterior EAC wall, which protruded and depressed with mouth movement. The patient underwent surgical reconstruction of the bony defect with titanium mesh, and the symptoms resolved after surgery.

CONCLUSION

This case highlights the importance of surgical reconstruction of a bony defect in the EAC using appropriate materials.

Tympanostomy tube placement for intractable Meniere's disease in the elderly

BACKGROUND

The treatment of refractory elderly Meniere's disease is a challenge.

AIM

To investigate the efficacy of tympanostomy tube placement in elderly patients with Meniere's disease.

METHODS

31 patients over 60 years old with Meniere's disease who had failed medical treatment and underwent tympanostomy tube placement. Vertigo control, hearing level, tinnitus, and ear fullness were recorded and analyzed preoperatively and postoperatively.

RESULTS

All patients completed a 6-month follow-up. At 6 months postoperatively,complete control, substantial control and limited control of vertigo were achieved in 10 (32%), 13 (42%), and 6 (19%) patients respectively. Two patients (6%) reported no substantial improvement. Twelve patients completed a 2-year follow-up. At 2 years postoperatively, complete control, substantial control and limited control of vertigo were achieved in 3 (25%), 5 (42%), and 1 (8%) patients respectively. Three (25%) patients showed no significant improvement in vertigo. The majority of patients reported significant improvement in the functional level scale, the Dizziness Handicap Inventory scores, and ear fullness at 6 months and 2 years postoperatively.

CONCLUSIONS AND SIGNIFICANCE

Tympanostomy tube placement may reduce vertigo attacks and improved the quality of life in elderly patients with Meniere's disease.

Abnormal Rhomboid Lip and Choroid Plexus Should be Valued in Microvascular Decompression for Vestibulocochlear Diseases

BACKGROUND

Surgical outcomes for functional vestibulocochlear diseases vary, and the influencing factors are not fully understood. The role of a rhomboid lip (RL) and choroid plexus (CP) in microvascular decompression (MVD) of the vestibulocochlear nerve has not been studied. This study aims to evaluate the surgical efficacy of MVD for vestibulocochlear diseases, with and without addressing the RL and CP, to enhance our understanding of their etiology.

METHODS

A total of 15 patients who underwent MVD for the vestibulocochlear nerve between 2013 and 2022 were retrospectively identified and followed up. The patients were classified into 4 categories: vestibular paroxysmia (VP), benign positional paroxysmal vertigo (BPPV), and Meniere disease (MD). The fourth was a "tinnitus" group. The relief of symptoms, recurrence, satisfaction after surgery, available relevant imaging studies, and intraoperative observation data were evaluated.

RESULTS

Following MVD, 6 of the 7 patients in the VP group, the 1 patient in the BPPV group, and 1 of 2 patients in the MD group were completely relieved of vertigo. The seventh VP patient showed significant improvement. The 5 patients in the "tinnitus" group remained unchanged. Retrospectively, 4 patients from the VP, BPPV, and MD groups who underwent RL incision and CP excision were also free of vertigo, although vascular compression was not confirmed in these cases.

CONCLUSIONS

MVD is generally considered a useful treatment for VP and could also be effective in managing recurrent vertigo caused by BPPV and MD. Our results highlight the potential role of an abnormal RL and CP in the development of vertigo symptoms. Patients presenting with "tinnitus" require further investigation and might not be suitable for MVD.

Therapeutic Effect of Tympanoplasty on Patients with Chronic Otitis Media with Tinnitus and Influencing Factors

Objective

This research was conducted to investigate the therapeutic effects of tympanoplasty on patients with chronic otitis media with tinnitus and analyze the possible influencing factors for patient prognosis.

Methods

This is a pre-post control group study, 86 patients with chronic otitis media were included as the subjects and enrolled into tinnitus group (n = 46) and the non-tinnitus group (n = 40). All patients underwent tympanoplasty under microscope or ear endoscopy. A tinnitus severity and efficacy assessment scale was employed for the evaluation of the severity of tinnitus among the subjects. In addition, tinnitus handicap inventory (THI) was utilized to evaluate disease alleviation.

Results

Before treatment, the proportions of the patients with tinnitus at grades I, II, III, IV, and V amounted to 15.22%, 32.61%, 21.74%, 17.39%, and 13.04%, respectively, while they were 30.43%, 45.65%, 13.04%, 8.71%, and 2.17%, respectively 3 months after treatment (P < .05). THI scores for the patients in the tinnitus group before and 3 months after treatment amounted to 17.96 ± 3.66 and 16.21 ± 3.29, respectively (P < .05). After treatment, the air conduction (AC) and bone conduction (BC) thresholds and air-bone gap (ABG) of the two groups apparently declined (P < .05). No statistical significance was detected in the differences in disease classification, disease courses, and whether an electric drill was used among the patients between effective and invalid groups (P > .05).

Conclusion

To some extent, tympanoplasty alleviated tinnitus among patients with chronic otitis media and promoted the restoration of hearing. Hence, it is worthy of application in clinical treatment.

A Rare Cause of Red Tympanic Membrane: Jugular Bulb Diverticulum

SIGNIFICANCE STATEMENT

Pulsatile tinnitus with erythematous tympanic membrane mass suggests vascular pathologies such as dural arteriovenous fistula, glomus tympanicum, or aberrant carotid artery. Jugular bulb aneurysmatic diverticulum is rare but should be suspected in a case with the presence of aneurysm in other organs. An imaging study is mandatory to confirm the diagnosis. Patient must avoid digging ear as it can cause profuse bleeding. Treatment option can be open surgery or endovascular treatment.

Endovascular occlusion of a persistent stapedial artery prior to stapedotomy: a novel approach

BACKGROUND

The stapedial artery is an embryonic artery that transiently supplies the cranial vasculature of the human embryo. Postnatal persistence of the stapedial artery may cause conductive hearing loss and pulsatile tinnitus due to its course through the middle ear. We describe a patient with a persistent stapedial artery (PSA) managed by endovascular coil occlusion prior to stapedotomy.

METHODS

A 48-year-old woman presented with left-sided conductive hearing loss and pulsatile tinnitus. Ten years earlier the patient had undergone explorative tympanoplasty, which was aborted due to a large PSA. Digital subtraction angiography was performed to confirm the anatomy and endovascular occlusion of the proximal PSA was achieved by deployment of coils.

RESULTS

The pulsatile tinnitus improved immediately after the procedure. The size of the artery subsequently decreased and surgery could be performed with only a minor intraoperative bleeding. Successful stapedotomy resulted in postoperative normalization of her hearing with some minor residual tinnitus.

CONCLUSION

Endovascular coil occlusion of a PSA is feasible and safe in patients with favorable anatomy and facilitates middle ear surgery. It decreases the size of the artery and minimizes the risk of intraoperative bleeding in patients with a large PSA. The future role of this novel technique in the management of patients with PSA-related conductive hearing loss and pulsatile tinnitus remains to be determined.

Cochlear Implantation for Unilateral and Asymmetric Hearing Loss: Long-Term Subjective Benefit

OBJECTIVES

Assess the long-term patterns of perceived tinnitus severity and subjective benefit for adult cochlear implant (CI) users with asymmetric or unilateral hearing loss (AHL or UHL).

METHODS

Forty adults underwent cochlear implantation as part of a prospective clinical trial assessing the outcomes of CI use in cases of AHL (n = 20) and UHL (n = 20). Subjective measures included the Tinnitus Handicap Inventory (THI), the Speech, Spatial, & Qualities of Hearing Scale (SSQ), and the Abbreviated Profile of Hearing Aid Benefit (APHAB). Responses were obtained preoperatively and at routine intervals out to 5 years post-activation.

RESULTS

For subjective benefit, participants with AHL and UHL reported a significant improvement as compared to preoperative abilities, which was maintained with long-term CI use. For perceived tinnitus severity, participants with AHL and UHL reported a significant reduction with CI use as compared to preoperative perceptions. The perceived tinnitus severity significantly differed for the AHL and UHL cohorts over time. This pattern of results is likely influenced by the worse perceived severity levels for the UHL cohort preoperatively and the fluctuating perceived severity levels for some participants in the AHL cohort post-activation.

CONCLUSION

Adults with AHL and UHL report an early, significant reduction in perceived tinnitus severity and improvement in quality of life with CI use that is generally maintained with long-term device use. Questionnaires such as the THI, SSQ, and APHAB may contribute to a more holistic assessment of the benefits of cochlear implantation in this population.

LEVEL OF EVIDENCE

2 Laryngoscope, 133:2792-2797, 2023.

Cochlear implantation in single-sided deafness: a single-center experience of 138 cases

OBJECTIVES

Assess the outcomes in patients who underwent cochlear implant (CI) for single-sided deafness (SSD).

METHODS

All patients affected by SSD who underwent CI at Gruppo Otologico, Piacenza, from October 2012 to May 2022 with at least 6 months of follow-up were selected in the study group. The analysis included subjective and objective measures performed pre-operative and up to 24 months after surgery. Hearing threshold on both sides was evaluated with a weighted four-frequency average (PTA [0.5 kHz + 1 kHz + 2 kHz + 4 kHz]/4) on pure tone audiometry and speech audiometry (Speech Discrimination Score, SDS). The Speech Spatial and Qualities of Hearing scale (SSQ Questionnaire) for binaural hearing benefits and sound localization, the Tinnitus Handicap Inventory Questionnaire (THI) and Dizziness Handicap Inventory Questionnaire (DHI) were used for subjective assessment.

RESULTS

Data from 138 patients, 69 males and 69 females, (mean age 49 years, range 17-77 years) underwent CI for SSD were examined. Single-sided hearing deprivation average before undergoing CI surgery was 2.5 years (range 3 months-35 years). There was a significant reduction of THI and DHI scores compared to pre-operative scores alongside a referred improvement in social, physical, and emotional well-being through the SSQ questionnaire.

CONCLUSIONS

To the best of our knowledge, this paper descried the largest cohort of SSD who underwent CI in a single institution. According to our findings CI in patients affected by SSD represents a valuable tool for an overall improvement of tinnitus and dizziness but also quality of life, after at least 6 months of follow-up. Further studies are desirable to improve rehabilitation pathways and possibly set new standards of care of this condition.

Blood Flow Velocity: a Decision Tool for Stenting Indication in Venous Pulsatile Tinnitus

BACKGROUND AND PURPOSE

Lateral sinus stenosis is the most common cause of venous pulsatile tinnitus (VPT). Stenting is an effective treatment after demonstration of a trans-stenotic pressure gradient; however, pressure measurement has many technical limitations. In 2018, a study showed that a combined approach with intravascular velocity measurement could be effective in identifying most appropriate candidates for stenting. The aim of the present study was to evaluate a new strategy using this biomarker for the indication of stenting even without a significant pressure gradient.

MATERIAL AND METHODS

Consecutive patients with disabling VPT were included from 2016 to 2019 and analyzed retrospectively. Intrasinusal pressures were measured and blood flow velocities (with a dual-sensor guidewire) were used for the indication of stenting independent of the pressure gradient. We evaluated the clinical outcome after stenting based on this new biomarker.

RESULTS

A total of 41 patients were treated according to this strategy. At last follow-up (mean = 30.2 months), 32/33 patients (97%) treated by stenting showed complete resolution or a significant decrease in VPT intensity. The use of velocity as the threshold for indicating stenting identified 8 patients (24%) missed by the pressure gradient. Their clinical outcome after stenting was excellent and no complications occurred.

CONCLUSION

Measurement of sinus blood flow velocity provides a hemodynamic explanation of disease and may be a better tool than pressure gradient for the indication of stenting in VPT.

Cochlear Implants for Single-Sided Deafness: Quality of Life, Daily Usage, and Duration of Deafness

OBJECTIVE

To report our experience for adults undergoing cochlear implantation (CI) for single-sided deafness (SSD).

METHODS

This is a retrospective case series for adults with SSD who underwent CI between January 2013 and May 2021 at our institution. CNC and AzBio speech recognition scores, Tinnitus Handicap Inventory (THI), Speech, Spatial, and Qualities of Hearing Scale (SSQ12), datalogging, and the Cochlear Implant Quality of Life (CIQOL)-10 Global measure were utilized.

RESULTS

Sixty-six adults underwent CI for SSD (median 51.3 years, range 20.0-74.3 years), and 57 (86.4%) remained device users at last follow-up. Compared to pre-operative performance, device users demonstrated significant improvement in speech recognition scores and achieved peak performance at six months post-activation for CNC (8.0% increased to 45.6%, p < 0.0001) and AzBio in quiet (12.2% increased to 59.5%, p < 0.0001). THI was decreased at 6 months post-implantation (58.1-14.6, p < 0.0001), with 77% of patients reporting improved or resolved tinnitus. Patients demonstrated improved SSQ12 scores as well as the disease-specific CIQOL-10 Global questionnaire. Duration of deafness was not associated with significant differences in speech recognition performance. Average daily wear time was positively associated with CNC and AzBio scores as well as post-operative CIQOL-10 scores.

CONCLUSIONS

Herein we present the largest cohort of adult CI recipients with SSD with data on speech recognition scores, tinnitus measures, and SSQ12. Novel insights regarding the correlation of datalogging, duration of deafness, and CI-specific quality of life (CIQOL-10) metrics are discussed. Data continue to support CI as an efficacious treatment option for SSD.

LEVEL OF EVIDENCE

4 Laryngoscope, 133:2362-2370, 2023.

Early effects of very early cochlear implant activation on tinnitus

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.

Radiographic Sigmoid Sinus Wall Abnormalities and Pulsatile Tinnitus: A Case-Control Study

OBJECTIVE

Compare incidence of sigmoid sinus wall abnormalities (SSWAs) and other radiographic abnormalities in patients with pulsatile tinnitus (PT) versus controls.

STUDY DESIGN

Retrospective case-control.

SETTING

Tertiary referral center.

PATIENTS

Adults with PT and high-resolution computed tomography imaging were compared with adults undergoing cochlear implant workup including high-resolution computed tomography imaging.

MAIN OUTCOME MEASURES

Incidence of SSWA in PT cohort (n = 141) compared with control (n = 149, n = 298 ears). Secondary outcome measures included differences in demographics and in other radiographic abnormalities between cohorts.

RESULTS

Patients with PT had a higher incidence of SSWA (34% versus 9%, p < 0.001) and superior canal dehiscence (23% versus 12%, p = 0.017) than controls. Spearman product component correlations demonstrated that ipsilateral PT was weakly associated with SSWA ( r = 0.354, p < 0.001). When SSWA was present in the PT cohort (n = 48 patients, n = 59 ears), in 31 cases (64.6%), the SSWA correlated with PT laterality (e.g., left SSWA, left PT); in 12 (25.0%), SSWA partially correlated with PT laterality (e.g., bilateral SSWA, right PT); and in 5 (10.4%), the SSWA did not correlate with PT laterality (e.g., right SSWA, left PT).

CONCLUSIONS

For our patients with both PT and SSWA, the SSWA is likely a contributing factor in approximately 65% of cases. For a third of patients with PT and concomitant SSWA, the association between the two is either not causative or not solely causative. Surgeons counseling patients with PT and SSWA may be optimistic overall regarding sigmoid resurfacing procedures but must appreciate the possibility of treatment failure, likely because of untreated comorbid conditions.

Surgical interventions for Ménière's disease

BACKGROUND

Ménière's disease is a condition that causes recurrent episodes of vertigo, associated with hearing loss and tinnitus. First-line treatments often involve dietary or lifestyle changes, medication or local (intratympanic) treatments. However, surgery may also be considered for people with persistent or severe symptoms. The efficacy of different surgical interventions at preventing vertigo attacks, and their associated symptoms, is currently unclear.

OBJECTIVES

To evaluate the benefits and harms of surgical interventions versus placebo or no treatment in people with Ménière's disease.

SEARCH METHODS

The Cochrane ENT Information Specialist searched the Cochrane ENT Register; Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid Embase; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 14 September 2022.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) and quasi-RCTs in adults with definite or probable Ménière's disease comparing ventilation tubes, endolymphatic sac surgery, semi-circular canal plugging/obliteration, vestibular nerve section or labyrinthectomy with either placebo (sham surgery) or no treatment. We excluded studies with follow-up of less than three months, or with a cross-over design (unless data from the first phase of the study could be identified).  DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcomes were: 1) improvement in vertigo (assessed as a dichotomous outcome - improved or not improved), 2) change in vertigo (assessed as a continuous outcome, with a score on a numerical scale) and 3) serious adverse events. Our secondary outcomes were: 4) disease-specific health-related quality of life, 5) change in hearing, 6) change in tinnitus and 7) other adverse effects. We considered outcomes reported at three time points: 3 to < 6 months, 6 to ≤ 12 months and > 12 months. We used GRADE to assess the certainty of evidence for each outcome.  MAIN RESULTS: We included two studies with a total of 178 participants. One evaluated ventilation tubes compared to no treatment, the other evaluated endolymphatic sac decompression compared to sham surgery.  Ventilation tubes We included a single RCT of 148 participants with definite Ménière's disease. It was conducted in a single centre in Japan from 2010 to 2013. Participants either received ventilation tubes with standard medical treatment, or standard medical treatment alone, and were followed up for two years. Some data were reported on the number of participants in whom vertigo resolved, and the effect of the intervention on hearing. Our other primary and secondary outcomes were not reported in this study. This is a single, small study and for all outcomes the certainty of evidence was low or very low. We are unable to draw meaningful conclusions from the numerical results. Endolymphatic sac decompression We also included one RCT of 30 participants that compared endolymphatic sac decompression with sham surgery. This was a single-centre study conducted in Denmark during the 1980s. Follow-up was predominantly conducted at one year, but additional follow-up continued for up to nine years in some participants. Some data were reported on hearing and vertigo (both improvement in vertigo and change in vertigo), but our other outcomes of interest were not reported. Again, this is a single, very small study and we rated the certainty of the evidence as very low for all outcomes. We are therefore unable to draw meaningful conclusions from the numerical results.  AUTHORS' CONCLUSIONS: We are unable to draw clear conclusions about the efficacy of these surgical interventions for Ménière's disease. We identified evidence for only two of our five proposed comparisons, and we assessed all the evidence as low- or very low-certainty. This means that we have very low confidence that the effects reported are accurate estimates of the true effect of these interventions. Many of the outcomes that we planned to assess were not reported by the studies, such as the impact on quality of life, and adverse effects of the interventions. Consensus on the appropriate outcomes to measure in studies of Ménière's disease is needed (i.e. a core outcome set) in order to guide future studies in this area and enable meta-analyses of the results. This must include appropriate consideration of the potential harms of treatment, as well as the benefits.

Cochlear Implantation After Intralabyrinthine Schwannoma Microsurgical Resection

ABSTRACT

Cochlear implantation after microsurgical resection of intralabyrinthine schwannomas has shown promising results in a limited number of small studies with safe and favorable outcomes. Cochlear implantation is a mainstream treatment for advanced bilateral sensorineural hearing loss and, more recently, has been applied to patients with single-sided deafness.The case presented is a 66-year-old gentleman with a history of progressive right-sided sensorineural hearing loss and bothersome tinnitus with a right intralabyrinthine schwannoma involving the semicircular canals, vestibule, and basal turn of the cochlea. The authors describe concomitant cochlear implantation after microsurgical resection of an intralabyrinthine schwannoma. Intralabyrinthine schwannomas represent an uncommon subtype of benign tumors arising from the terminal branches of the vestibulocochlear nerve. Symptoms often include sensorineural hearing loss, dizziness, and tinnitus, and in this location, symptoms often arise at a small tumor size. In this featured case, we present a patient who underwent gross total tumor resection and cochlear implantation for hearing rehabilitation and treatment of tinnitus. Six months after surgery, the patient achieved good device performance, scoring 46% on consonant-nucleus-consonant word testing and 66% on AzBio sentence testing, and subjective improvement in his tinnitus.

Single-Sided Deafness: Emotional and Social Handicap, Impact on Health Status and Quality of Life, Functional Hearing, and the Effects of Cochlear Implantation

OBJECTIVE

To evaluate the functional and subjective outcomes in individuals with single-sided deafness (SSD) treated with a cochlear implant (CI).

METHODS

Eighty-one adult CI users with SSD participated in this study. Functional assessments consisted of speech in noise testing and localization. Subjective assessments consisted of the Speech Spatial Quality of Hearing Scale, the Tinnitus Reaction Questionnaire, the Abbreviated Profile of Hearing Aid Benefit questionnaire, the Hearing Handicap Inventory for Adults questionnaire, and the Glasgow Health Status Inventory and the Glasgow Benefit Inventory questionnaires.

RESULTS

SSD has remarkable consequences on quality of life (QoL) and imposes a substantial emotional and social handicap on the individuals. Self-reported QoL improved after CI with tinnitus intrusion significantly reduced as early as 3 months post-CI. A significant improvement was seen in all speech understanding in noise configurations. Localization ability significantly improved with CI on.

CONCLUSION

Our findings demonstrate that SSD reduces social and psychological QoL and imposes a remarkable level of handicap as per general and specific self-assessments tool. CI provided a significant improvement in function including speech understanding in noise and localization ability, as well as improved QoL and reduced tinnitus significantly in both the early and long terms.

Audiovestibular symptoms and facial nerve function comparing microsurgery versus SRS for vestibular schwannomas: a systematic review and meta-analysis

OBJECTIVE

Surgery and radiosurgery represent the most common treatment options for vestibular schwannoma. A systematic review and meta-analysis were conducted to compare the outcomes of surgery versus stereotactic radiosurgery (SRS).

METHODS

The Cochrane library, PubMed, Embase, and clinicaltrials.gov were searched through 01/2021 to find all studies on surgical and stereotactic procedures performed to treat vestibular schwannoma. Using a random-effects model, pooled odds ratios (OR) and their 95% confidence intervals (CI) comparing post- to pre-intervention were derived for pre-post studies, and pooled incidence of adverse events post-intervention were calculated for case series and stratified by intervention type.

RESULTS

Twenty-one studies (18 pre-post design; three case series) with 987 patients were included in the final analysis. Comparing post- to pre-intervention, both surgery (OR: 3.52, 95%CI 2.13, 5.81) and SRS (OR: 3.30, 95%CI 1.39, 7.80) resulted in greater odds of hearing loss, lower odds of dizziness (surgery OR: 0.10; 95%CI 0.02, 0.47 vs. SRS OR: 0.22; 95%CI 0.05, 0.99), and tinnitus (surgery OR: 0.23; 95%CI 0.00, 37.9; two studies vs. SRS OR: 0.11; 95%CI 0.01, 1.07; one study). Pooled incidence of facial symmetry loss was larger post-surgery (14.3%, 95%CI 6.8%, 22.7%) than post-SRS (7%, 95%CI 1%, 36%). Tumor control was larger in the surgery (94%, 95%CI 83%, 98%) than the SRS group (80%, 95%CI 31%, 97%) for small-to-medium size tumors.

CONCLUSION

Both surgery and SRS resulted in similar odds of hearing loss and similar improvements in dizziness and tinnitus among patients with vestibular schwannoma; however, facial symmetry loss appeared higher post-surgery.

Cochlear Implantation for Patients with a Vestibular Schwannoma: Effect on Tinnitus Handicap

Background:

Tinnitus is a common symptom among individuals with a vestibular schwannoma. In recent years, cochlear implantation, often combined with tumor resection, is an increasingly used option in the management of these patients. The existing literature does not account well for the effect of treatment on tinnitus burden. Thus, this paper reports the effect of cochlear implantation on tinnitus in a cohort of vestibular schwannoma patients.

Methods:

Individuals with vestibular schwannoma undergoing cochlear implantation were retrospectively reviewed for tinnitus burden, as evaluated by the Tinnitus Handicap Inventory, administered before and after implantation. The outcome measures were total Tinnitus Handicap Inventory score and scores from each of the Tinnitus Handicap Inventory subdomains (functional, emotional, and catastrophic). In addition, the existing literature on tinnitus in cochlear implanted vestibular schwannoma patients was reviewed.

Results:

Tumor management consisted of simultaneous resection (77%), previous resection (9%), observation (9%) and radiation (5%). Complete Tinnitus Handicap Inventory evaluation was available for 17 patients. After implantation, the median THI_total changed from 18 to 10 (P = .0006), the subdomain THI_functional from 10 to 3 (P = .006), the THI_emotional from 3 to 0 (P = .023) and the THI_catastrophic from 6 to 1 (P = .004). In the scarcely reported tinnitus outcomes in the literature, most but not all cases experienced a decrease in tinnitus.

Conclusions:

The tinnitus burden is significantly reduced by cochlear implantation in individuals with a vestibular schwannoma. This agrees with findings for other etiologies indicating cochlear implantation and supports the eligibility for hearing rehabilitation with a cochlear implant for this specific group of patients.

Analysis of Revision Surgery Following Surgical Reconstruction of the Sigmoid Sinus Wall in Patients with Pulsatile Tinnitus

Background:

To explore potential causes leading to the failure of the surgical reconstruction of sigmoid sinus wall in patients with pulsatile tinnitus.

Methods:

This study retrospectively analyzed pulsatile tinnitus patients with sigmoid sinus wall dehiscence and/or sigmoid sinus diverticulum, who underwent revision surgeries following the surgical reconstruction of the sigmoid sinus wall.

Results:

A total of 7 pulsatile tinnitus patients were included. After the first surgery, 5 of 7 patients showed varying degrees of remission in pulsatile tinnitus, but pulsatile tinnitus gradually recurred. The other 2 patients experienced no change in pulsatile tinnitus. Images after the first surgeries revealed that the surgical failure of Patients 1-5 was caused by incompleted elimination of sigmoid sinus wall dehiscence and sigmoid sinus diverticulum. Following revision surgeries, they all acquired great or complete resolution of pulsatile tinnitus. In Patient 6, an abnormal diploic vein entering the sigmoid sinus was overlooked during the first surgery for repairing sigmoid sinus wall dehiscence. As soon as the diploic vein was blocked during the revision surgery, the patient’s pulsatile tinnitus was alleviated significantly. Patient 7 had a recurrence of pulsatile tinnitus after transient improvement following the first surgery, and still experienced no change in pulsatile tinnitus after the revision surgery. However, after venous sinus stenting in the stenosis of transverse-sigmoid sinus junction, she got complete resolution of pulsatile tinnitus. It suggested that the unresolved stenosis of the venous sinus was the cause of the surgical failure.

Conclusions:

Both sigmoid sinus diverticulum and sigmoid sinus wall dehiscence are recommended to be resolved during surgery. Abnormal diploic veins and venous sinus stenosis are potential causes of pulsatile tinnitus.

Surgical Management of Intractable Meniere's Disease

Meniere's Disease (MD) is an inner ear disorder characterized by spontaneous recurrent vertigo, fluctuating sensorineural hearing loss, aural fullness and low-pitch tinnitus. Therapeutic management of MD includes dietary restriction and medical therapy. A minority of cases is characterized by frequent vertigo attacks, progressive hearing loss and persistent tinnitus even through the continuous medical treatments; this condition is called intractable MD and requires a therapeutic escalation from non-invasive medical treatment to surgical intervention. Invasive procedures include endolymphatic sac surgery, vestibular nerve section and labyrinthectomy. These procedures have a very high success rate on symptom control but may have a severe impact on the hearing function. However, the simultaneous combined approach of demolitive surgery and cochlear implantation may be a valid approach to treat symptoms of intractable MD and preserve hearing function. In the present study, we review current literature focusing on intractable MD to describe and discuss advantages and disadvantages of established and newly proposed surgical treatments for intractable MD.

[Analysis of intraoperative EABR characteristics and postoperative efficacy of cochlear implant in patients with tinnitus]

Objective:To investigate the characteristics of intraoperative electrically stimulated auditory brainstem responses（EABR） in patients with neural deafness and tinnitus, and to analyze the inhibitory effect of cochlear implantation on tinnitus and its correlation with auditory evoked potential. Methods:Twenty-eight adult patients with neuronal deafness accompanied by tinnitus who underwent cochlear implant surgery in the Peking Union Medical College Hospital from 2014 to 2015 were selected, and 10 age-matched patients without tinnitus with the same age were selected as the control group. Preoperative audiology, imaging and tinnitus history of the patients were retrospectively analyzed. During the operation, EABR were used to detect the auditory central functions at all levels, and the electrophysiological characteristics of the two groups were analyzed. The tinnitus handicap inventory（THI） was used to evaluate the severity of tinnitus before and after surgery, and the correlation between EABR results and THI score was analyzed. Results:There were no postoperative complications such as facial paralysis, cerebrospinal fluid leakage, meningitis, etc. , and electroacoustic reactions were observed in all 38 patients. The results of intraoperative EABR showed that there were significant differences in Ⅲ wave amplitude, Ⅴ wave amplitude and Ⅴ wave latency between tinnitus group and control group（P<0.05）. The mean C value of （162.78± 24.57）CL and the mean intraoperative EABR threshold of （158.62± 10.31） CL were collected in the two groups 12 months after starting the machine, and there was a significant correlation according to linear correlation analysis（r=0.903, P<0.01）. The total THI scores of 28 tinnitus patients were 65.00±14.93, 55.00±15.93 and 36.00±21.02 at three time points before, 1 day after and 1 year after cochlear implantation, respectively. The scores of 1 year after cochlear implantation were significantly different by ANOVA（P<0.05）, but there was no statistically significant difference 1 day after operation（P>0.05）. There was significant correlation between the intraoperative EABR wave Ⅲ amplitude and the linear correlation analysis of THI changes 1 year after operation（r=0.873, P<0.05）. Conclusion:There is significant difference in intraoperative EABR between patients with neural deafness accompanied with tinnitus and patients without tinnitus. Cochlear electrical stimulation has a good inhibitory effect on tinnitus, and intraoperative EABR can be used as a objective assessment tool for cochlear implant to inhibit tinnitus.

Transtemporal Sigmoid Sinus Decompression: A Novel Surgical Procedure for the Treatment of Idiopathic Pulsatile Tinnitus

OBJECTIVE

Idiopathic pulsatile tinnitus (IPT) is associated with high patient morbidity although treatment methods remain unsatisfactory. In the present study, the transtemporal sigmoid sinus decompression is used in the treatment of idiopathic pulsatile tinnitus.

STUDY DESIGN

Retrospective case study.

SETTING

Tertiary referral center.

PATIENTS

From 2005 to 2020, 287 patients presented with a complaint of pulsatile tinnitus. After exclusion criteria, 25 patients were diagnosed with IPT. Those patients underwent treatment and were included in a retrospective study.

INTERVENTIONS

Following failed conservative therapies, the primary author performed a transtemporal sigmoid sinus decompression surgery on the patients under general anesthesia.

MAIN OUTCOME MEASURES

Long-term resolution of IPT was measured using the Tinnitus Handicap Inventory (THI). Outcome measurements were taken preoperatively, immediately postoperatively, three months postoperatively, and the status of all 25 patients is known at the time of this study.

RESULTS

Transtemporal sigmoid sinus decompression was performed on 25 patients (mean age: 51.7 years, 80.0% female). Out of the 25 patients, 23 (92.0%) patients experienced complete resolution of their IPT. Statistically significant differences based on preoperative THI (mean THI: 4.19) were evident immediately after surgery (mean THI: 1.31; p < 0.001), at 3 months postoperatively (mean THI: 1.19; p < 0.001), and over a mean follow-up time of 68.7 months (range, 3-168 months) (mean THI: 1.38; p < 0.001). Out of the two patients considered unsuccessful, Case 21 experienced a partial resolution. No major postoperative complications occurred.

CONCLUSIONS

Transtemporal sigmoid sinus decompression is a safe and effective surgical procedure demonstrated to give near total resolution in properly selected patients and provides long-term relief for patients with IPT.

[Tinnitus and depression after cochlear implantation in adult sensorineural deafness]

Objective:The aim of this study is to investigate the changes and correlation of tinnitus and depression in adult patients with severe deafness after cochlear implantation. Methods:A total of 166 adult patients who underwent cochlear implantation（CI） were retrospectively selected as the research objects. All patients were investigated by Chinese Version of the Tinnitus Handicap Inventory（THI-C） and Chinese Version of the Beck Depression Inventory-Ⅱ（BDI-Ⅱ-C） before and after operation, and the improvement of tinnitus after operation was observed THI-C and BDI-Ⅱ-C scores before and after operation and the correlation between them. Results:Re-examination at 6 months after CI showed that the evaluation grade of tinnitus disability before and after the operation decreased significantly（Z=-9.478, P<0.001）, and the THI-C score （t=69.128, P<0.001）, and BDI-Ⅱ-C score （t=58.531，P<0.01）were significantly reduced. Spearman correlation analysis showed that there was a significant positive correlation between THI-C and BDI-Ⅱ-C scores before and after operation, aswell as the improvement of THI-C score and BDI-Ⅱ-C score（rpreoperative=0.763, rpostoperative=0.741, rdifference=0.741, all P<0.001）. Conclusion:Cochlear implantation can significantly improve tinnitus and depression in adult patients with sensorineural hearing loss. With the improvement of tinnitus, the depressive state of patients can be alleviated accordingly.

Neurosurgical Causes of Pulsatile Tinnitus: Contemporary Update

Traditionally in the domain of the otolaryngologist, pulsatile tinnitus (PT) has become increasingly relevant to neurosurgeons. PT may prove to be a harbinger of life-threatening pathology; however, often, it is a marker of a more benign process. Irrespectively, the neurosurgeon should be familiar with the many potential etiologies of this unique and challenging patient population. In this review, we discuss the myriad causes of PT, categorized by pulse-phase rhythmicity.

Multiphysics coupling numerical simulation of flow-diverting stents in the treatment of patients with pulsatile tinnitus

Patients with pulsatile tinnitus (PT) have unstable treatment effects after resurfacing surgery. Flow-diverting stents (FDS) are proposed as a potential method for the treatment of PT, but the therapeutic effect is not clear. This study aimed to investigate the efficacy of FDS in the treatment of patients with PT induced by sigmoid sinus diverticulum (SSD) and sigmoid sinus wall dehiscence (SSWD). In addition, we aimed to explore the treatment mechanism of PT. Transient-state multiphysics coupling numerical simulation method based on computed tomography angiography of five patients was used to clarify the biomechanical and acoustic states before and after FDS placement. FDS was placed to prevent the blood flow from impacting the vessel wall in the SSD and SSWD areas. Low blood flow velocity (<0.0391 m/s), high relative residence time (>10 Pa^-1 ), and low wall shear stress of SSD might lead to thrombosis after FDS placement. The average pressure on the SSWD area of each patient decreased by 13.77%, 18.82%, 29.23%, 19.03%, and 11.20%. The average displacement of the vessel wall on the SSWD area showed acute pulsation and decreased by 15.29%, 14.64%, 30.22%, 41.03%, and 21.28%. The average sound pressure level at the tympanum decreased by 14.01%, 9.33%, 17.66%, 18.88%, and 25.18%, respectively. In brief, FDS was placed to avoid blood flow impacting vessels and reduce the vibration of vessels in the short term, thereby attenuating the degree of PT. The long-term prognosis was that the SSWD area was blocked after SSD thrombosis. Therefore, FDS might be an effective method for the treatment of PT induced by SSD and SSWD. This study would provide a theoretical basis for the treatment of PT and an exploration of FDS design in the treatment of PT.

The Effect of Cochlear Implantation on Tinnitus and Quality of Life: A Systematic Review and Meta-analysis

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.

Cochlear implantation for tinnitus in adults with bilateral hearing loss: protocol of a randomised controlled trial

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.

Hemodynamic study on the different therapeutic effects of SSWD resurfacing surgery on patients with pulsatile tinnitus

Sigmoid sinus wall anomalies (SSWA) are a common pathophysiology of pulsatile tinnitus (PT) and usually treated by sigmoid sinus wall dehiscence (SSWD) resurfacing surgery. However, symptoms of tinnitus remain unrelieved after surgery in some patients with PT, and even new tinnitus appears. The cause of the difference in therapeutic effects is unclear. In this study, eight patient-specific SSWA geometric models were reconstructed on the basis of computed tomography angiography, including four cases of postoperative rehabilitation (group 1, 1-4 cases) and four cases of non-rehabilitation (group 2, 5-8 cases). Transient-state computational fluid dynamics (CFD) was performed to clarify the SS blood flow pattern and hemodynamic states. The wall pressure distribution on SSWA area, pressure difference, and flow pattern in SS were calculated to evaluate the hemodynamic changes of rehabilitation and non-rehabilitation patients before and after surgery. The difference of hemodynamics between these patients was statistically analyzed. The accuracy of CFD simulation was evaluated by cross validating the numerical and particle image velocimetry experimental results. Results showed that the SSWA area in patients with PT was loaded with high pressure. No difference was found in the hemodynamic characteristics between the two groups pre- and postoperation. When the average pressure (P_avg) and time-average P_avg (TAP_avg) on the SSWA area were studied, the TAP_avg difference pre- and postoperation between the two groups was found significant (p = 0.0021). The TAP_avg difference had a negative change in postoperative rehabilitation patients (case 1, -44.49 Pa vs. case 2, -15.85 Pa vs. case 3, -25.88 Pa vs. case 4, -16.58 Pa). The postoperative TAP_avg of non-rehabilitation patients was higher than the preoperative one (case 5, 24.70 Pa vs. case 6, 28.56 Pa vs. case 7, 5.81 Pa vs. case 8, 13.04 Pa). The velocity streamlines in the SS with rehabilitation became smoother and more regular than that without rehabilitation. By contrast, the velocity streamlines in SS without rehabilitation showed increased twisting and curling. No difference was found in time-average volume-averaged vorticity (TAV_avgV) between the two groups. Therefore, the high pressure of the vessel wall on SSWA area was one of the causes of PT. The variation of SSWA wall pressure difference before and after PT was the cause of the difference in therapeutic effects after SSWD resurfacing surgery. In patients with SSWA, disordered blood flow in SS was another cause of PT. SSWD repair may relieve tinnitus to some extent, but blood flow disorders may still arise.

Carhart Notch-A Prognostic Factor in Surgery for Otosclerosis

OBJECTIVE

Otosclerosis is an underlying disease of the bony labyrinth. This disorder, occurring only within the area of a person's temporal bone, is characterized by a progressive hearing loss and tinnitus.

MATERIAL AND METHODS

The study looked for the answer to the question of whether the presence or absence of Carhart notch in the presurgical tonal audiogram affects the final outcome of the otosclerosis surgery.

RESULTS

The analysis included 140 patients operated on for the first time due to otosclerosis between 2010 and 2016. The study group consisted of 107 women aged from 19 to 62 (average age: 40.33) and 33 men aged 27 to 59 (average age: 38.23). Analysis showed a statistically better result of stapedotomy in patients without the notch than in the same procedure in patients with the notch present. The opposite situation occurred in the case of stapedectomy.

CONCLUSION

(1) The presence of a refraction of the bone conduction curve with a depth of 10 to 20 dB at a frequency of 2000 Hz (the so-called Carhart notch) in the presurgical tonal audiogram is an unfavorable prognostic factor in relation to closing the cochlear reserve and improving bone conduction after the stapedotomy. (2) Regardless of the presence or absence of Carhart notch in the presurgical tonal audiogram, stapedotomy is the procedure with the highest efficiency in the treatment of otosclerosis.

Systematic Review of Temporal Bone-Resurfacing Techniques for Pulsatile Tinnitus Associated with Vascular Wall Anomalies

OBJECTIVE

To systematically review literature evidence on temporal bone-resurfacing techniques for pulsatile tinnitus (PT) associated with vascular wall anomalies.

DATA SOURCES

We searched PubMed, Embase, and the Cochrane Database. The period covered was from 1962 to 2018.

REVIEW METHODS

We included studies in all languages that reported resurfacing outcomes for patients with PT and radiographic evidence or direct visualization of sigmoid sinus wall anomaly, jugular bulb wall anomaly, or dehiscent or aberrant internal carotid artery.

RESULTS

Of 954 citations retrieved in database searches and 5 citations retrieved from reference lists, 20 studies with a total of 141 resurfacing cases involving 138 patients were included. Resurfacing outcomes for arterial sources of PT showed 3 of 5 cases (60%) with complete resolution and 2 (40%) with partial resolution. Jugular bulb sources of PT showed 11 of 14 cases (79%) with complete resolution and 1 (7%) with partial resolution. Sigmoid sinus sources of PT showed 91 of 121 cases (75%) with complete resolution and 12 (10%) with partial resolution. Symptoms occurred more in females and on the right side. Most cases (94%) used hard-density materials for resurfacing. Material density did not appear to be associated with resurfacing outcomes. Use of autologous materials was associated with improved outcomes for arterial sources resurfacing. Major complications involving sigmoid sinus thrombosis or compression were reported in 4% of cases without long-term morbidity or mortality.

CONCLUSIONS

Resurfacing surgery is likely effective and well tolerated for select patients with PT associated with various vascular wall anomalies.

Development and internal validation of a multivariable prediction model for tinnitus recovery following unilateral cochlear implantation: a cross-sectional retrospective study

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.

Cochlear implantation for single-sided deafness and tinnitus suppression

OBJECTIVE

To quantify the potential effectiveness of cochlear implantation for tinnitus suppression in patients with single-sided deafness using the Tinnitus Handicap Inventory.

METHODS

The study included 12 patients with unilateral tinnitus who were undergoing cochlear implantation for single-sided deafness. The Tinnitus Handicap Inventory was administered at the patient's cochlear implant candidacy evaluation appointment prior to implantation and every cochlear implant follow-up appointment, except activation, following implantation. Patient demographics and speech recognition scores were also retrospectively recorded using the electronic medical record.

RESULTS

A significant reduction was found when comparing Tinnitus Handicap Inventory score preoperatively (61.2±27.5) to the Tinnitus Handicap Inventory score after three months of cochlear implant use (24.6±28.2, p=0.004) and the Tinnitus Handicap Inventory score beyond 6months of CI use (13.3±18.9, p=0.008). Further, 45% of patients reported total tinnitus suppression. Mean CNC word recognition score improved from 2.9% (SD 9.4) pre-operatively to 40.8% (SD 31.7) by 6months post-activation, which was significantly improved from pre-operative scores (p=0.008).

CONCLUSION

The present data is in agreement with previously published studies that have shown an improvement in tinnitus following cochlear implantation for the large majority of patients with single-sided deafness.

Occult infratemporal fossa neurofibroma presenting with persistent unilateral tinnitus and middle ear effusion: More than meets the eye

Herein, we present the case of a previously healthy 54year-old female who developed several weeks of unilateral tinnitus and aural fullness. She subsequently underwent unilateral pressure equalization tube placement at an outside institution after exam demonstrated a middle ear effusion, conductive hearing loss and normal nasopharyngoscopy. Ultimately, an MRI revealed an occult mass in the infratemporal fossa (ITF), which was successfully removed via an endoscopic transnasal ITF approach. Following resection of a histopathologically confirmed benign neurofibroma, she reported complete resolution of her symptoms. The antiquated diagnostic algorithm of unilateral effusion suggests that normal nasopharyngscopy successfully "rules out" a causative neoplastic process; however, Eustachian tube occlusion by occult skull base lesions may be missed without further investigation. This case highlights the need for additional radiological investigation of unexplained unilateral persistent middle ear effusion in the setting of normal nasopharyngoscopy.

Sigmoid Sinus Wall Reconstruction for Pulsatile Tinnitus Caused by Sigmoid Sinus Wall Dehiscence: A Single-Center Experience

OBJECTIVE

To evaluate clinical characteristics and present surgical outcomes of PT caused by sigmoid sinus wall dehiscence (SSWD).

METHODS

This study retrospectively reviewed 34 patients with PT who were diagnosed with SSWD in our institution between December 2008 and July 2013. Among them, 27 patients underwent sigmoid sinus wall reconstruction (surgery group) and 7 patients refused surgery (non-surgery group). Preoperative data were obtained from the patients' medical records. All patients were followed up regularly for at least 25 months. Preoperative and postoperative computed tomography angiography (CTA) images were compared. Student's t-tests were used to compare age, body mass index (BMI) and preoperative Tinnitus Handicap Inventory (THI) scores between the surgery and the non-surgery groups and to compare pre- and follow-up THI scores.

RESULTS

There was no significant difference in age, body mass index, or preoperative THI scores between groups. Following surgery, 14 patients had complete resolution, 5 had partial resolution, 7 experienced no change and PT was aggravated in 1 patient. The difference between preoperative and postoperative THI scores was significant. No severe complications were found postoperatively. Comparison of the preoperative and postoperative CTA images revealed that remnant unrepaired dehiscences were the cause of unsatisfactory outcomes following surgery. In the non-surgery group, PT remained largely unchanged.

CONCLUSIONS

Sigmoid sinus wall reconstruction is an effective and safe treatment for PT caused by SSWD. It is imperative that all regions of the dehiscence are sufficiently exposed and resurfaced during surgery.

Pulsatile Tinnitus Cured by Mastoidectomy

Tinnitus of venous origin is a rare occurrence. It represents roughly half of cases of vascular tinnitus. The choice of treatment is not easy, even when the diagnosis is certain. Reassurance of the patient is often sufficient. Nevertheless, a surgical treatment is sometimes performed — usually ligature of the internal jugular vein. We present the case of a patient with a right venous pulsatile tinnitus and a history of 5 years of ineffective medical and surgical treatments. Ligature of the internal jugular vein was not chosen in this case: a computed tomographic scan showed filled mastoid cells, and mastoidectomy was performed instead. The tinnitus disappeared immediately after surgery and has not recurred during a 2-year follow-up. The bilateral preoperative sensorineural and conductive hearing loss also disappeared. Pulsatile tinnitus of venous origin is usually treated with ligature of the internal jugular vein. Mastoidectomy is an interesting alternative in selected cases.

The effects of cochlear implantation in Japanese single-sided deafness patients: five case reports

CONCLUSION

Cochlear implantation (CI) for Japanese single-sided deafness patients resulted in improved speech perception, increased sound localization accuracy, and reduced tinnitus handicap.

OBJECTIVES

This study reports results for five adult SSD cases with CI, focusing on the benefits they obtained in terms of speech recognition, sound localization, and tinnitus handicap.

METHODS

Five Japanese patients meeting the eligibility criteria were included in this study. All patients were implanted with a fully inserted MED-EL Concerto FLEX28® implant (MED-EL, Innsbruck, Austria). Speech perception outcomes in noise, as well as sound localization and tinnitus disturbance, were assessed pre-surgically and at 1, 3, 6, and 12 months after CI activation.

RESULTS

The Japanese monosyllable test score in noise improved gradually after implantation. In some cases, speech perception ability appeared unstable, particularly in the first 1-6 months after implantation. The sound localization ability showed marked improvement in all cases, with the disturbance to daily life caused by tinnitus also decreasing in all cases from the early post-operative period.

Occult Pulsatile Tinnitus in Association with a Prominent Vein of Hypoglossal Canal: Two Case Reports

The pathway of the vein of hypoglossal canal has not been mentioned in venous origin pulsatile tinnitus. We wished to clarify the possible complications related to this venous variant. We described 2 rare cases of troublesome pulsatile tinnitus associated with prominent vein of hypoglossal canal, which communicates with the jugular bulb and the marginal sinus. Both cases were successfully treated by positioning a stent across the vein of hypoglossal canal and jugular bulb. The 2 present clinical cases represent the first report of such a condition. The therapeutic decision-making is discussed in relation to the persistent pulsatile tinnitus and the etiopathologic hypothesis put forward.