Cochlear Implants as a Treatment Option for Unilateral Hearing Loss, Severe Tinnitus and Hyperacusis

Abstract

Tinnitus is an incapacitating condition commonly affecting cochlear implant (CI) candidates. The aim of this clinical study is to assess the long-term effects of CI treatment in patients with severe-to-profound, sensorineural, unilateral hearing loss (UHL) and incapacitating tinnitus. We performed a prospective Cochlear™ company-sponsored multicentre study in five Spanish centres. Sixteen patients with UHL and incapacitating tinnitus, which was indicated by a Tinnitus Handicap Inventory (THI) score >58%, received a Nucleus® CI in their deaf ear. The study design includes repeated within-subject measures on hearing, tinnitus, hyperacusis and quality of life up to 12 months after initial CI fitting. In addition to hearing loss and tinnitus, all patients suffered from hyperacusis. Most patients had a sudden hearing loss and received a CI within 2 years after their hearing loss. Preliminary 6-month, post-CI activation data of 13 subjects showed that the majority of patients perceived a subjective benefit from CI treatment, which was assessed using the THI, a Visual Analogue Scale of tinnitus loudness/annoyance and the Speech, Spatial and Qualities of Hearing Scale. Preliminary 12-month data of 7 subjects showed that most patients also perceived a degree of relief from their hyperacusis. One patient showed no improvements in any of the applied scales, which could be explained by partial insertion of the electrode due to obstruction of the cochlea by otosclerosis. In conclusion, CI can successfully be used in the treatment of UHL patients with accompanying severe tinnitus and hyperacusis. Implantation resulted in hearing benefits and a durable relief from tinnitus and hyperacusis in the majority of patients. These findings support the hypothesis that pathophysiological mechanisms after peripheral sensorineural hearing loss are at least partly reversible when hearing is restored with a CI.

Cochlear Implantation of Bilaterally Deafened Patients with Tinnitus Induces Sustained Decrease of Tinnitus-Related Distress

“…There are three main reasons for this: the first is varying sample size (from 1 to 26); the second is using different follow-up times (from 1 to 24 months) (18, 19); and the third is that despite recent recommendations to measure tinnitus-related distress before and after CI (10), the methods and the domains vary extremely from study to study (20). Furthermore, the design of clinical trials is often retrospective and the patients included have various types of hearing impairment (21–23). Moreover, the methods of treatment are frequently dissimilar and include unilateral hearing impairment treated with unilateral CI to bilateral hearing impairment treated with bilateral CI.…”

Clinical Interventions for Hyperacusis in Adults: A Scoping Review to Assess the Current Position and Determine Priorities for Research

“…Records were predominantly reporting studies from the USA, UK, Australia, India, South Korea, and European countries. Of the included records, 23 were case studies [ 19 , 25 – 27 , 34 – 38 , 40 – 43 , 49 – 58 ], seven were cohort studies [ 28 , 29 , 39 , 44 , 46 , 59 , 60 ], five were RCTs [ 18 , 20 , 21 , 30 , 47 ], four were Nonrandomised Controlled Trials [ 22 , 23 , 31 , 48 ], and four were retrospective studies [ 24 , 32 , 33 , 45 ].…”

“…Of these studies, nine (53%) were case studies and only two (12%) were RCTs ( Table 2 ). Equally, 16 studies [ 34 – 37 , 40 , 44 , 45 , 47 , 49 – 54 , 58 , 59 ] included patients reporting hyperacusis as part of a set of symptoms, the most common of which were tinnitus, hearing loss, vertigo, or aural fullness. The remaining 11 studies included patients reporting hyperacusis as a secondary complaint to tinnitus [ 20 , 26 – 28 , 30 – 33 , 48 ] and/or hearing loss [ 29 , 46 ].…”

“…Fourteen studies [ 26 – 28 , 31 – 33 , 44 , 45 , 47 , 48 , 51 , 52 , 54 , 57 ] did not provide a working definition of hyperacusis. Across the remaining studies, common terminologies were used to define hyperacusis, with four main themes identified ( Figure 2 ).…”

“…Of the remaining 21 studies [ 18 , 19 , 22 – 27 , 30 – 34 , 37 , 38 , 40 , 44 , 45 , 48 , 58 , 60 ], audiometric measures (Loudness Discomfort Levels (LDLs), Maximum Comfort Levels (MCLs), and Dynamic Range (DR)) and patient self-reported measurement tools (Baltimore questionnaire (VAS) [ 61 ], Sound Hypersensitivity Questionnaire [ 62 ], Hyperacusis Questionnaire (HQ) [ 63 ], Hyperacusis test (12-item) [ 38 ], a non-validated Hyperacusis Questionnaire adapted from Geraüschüberempfindlichkeit (GÜF [ 64 ]) [ 60 ], and Tinnitus Retraining Therapy (TRT) assessment interview [ 65 ]) were reported to assess hyperacusis. Most commonly reported were LDLs, the HQ and TRT assessment interview.…”