Cochlear Implants as a Treatment of Tinnitus

I found this article on the Net:

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

1. Geerte G J Ramakers1,2,
2. Gijsbert A van Zanten1,2,
3. Hans G X M Thomeer1,2,
4. Robert J Stokroos1,2,
5. Martijn W Heymans3,
6. Inge Stegeman1,2

Author affiliations

1. Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
2. g.g.j.ramakers-2@umcutrecht.nl

Abstract
Objective To develop and internally validate a prediction model for tinnitus recovery following unilateral cochlear implantation.

Design A cross-sectional retrospective study.

Setting A questionnaire concerning tinnitus was sent to patients with bilateral severe to profound hearing loss, who underwent unilateral cochlear implantation at the University Medical Center Utrecht, the Netherlands, between 1 January 2006 and 31 December 2015.

Participants Of 137 included patients, 87 patients experienced tinnitus preoperatively. Data of these 87 patients were used to develop the prediction model.

Primary and secondary outcome measures The outcome of the prediction model was tinnitus recovery. Investigated predictors were: age, gender, duration of deafness, preoperative hearing performance, tinnitus duration, severity and localisation, follow-up duration, localisation of cochlear implant (CI) compared with tinnitus side, surgical approach, insertion depth of the electrode, CI brand and difference in hearing threshold following cochlear implantation. Multivariable backward logistic regression was performed. Missing data were handled using multiple imputation. The performance of the model was assessed by the calibrative and discriminative ability of the model. The prediction model was internally validated using bootstrapping techniques.

Results The tinnitus recovery rate was 40%. A lower preoperative Consonant-Vowel-Consonant (CVC) score, unilateral localisation of tinnitus and larger deterioration of residual hearing at 250 Hz revealed to be relevant predictors for tinnitus recovery. The area under the receiver operating characteristics curve (AUC) of the initial model was 0.722 (IQR: 0.703–0.729). After internal validation of this prediction model, the AUC decreased to 0.696 (IQR: 0.667–0.700).

Conclusion and relevance Lower preoperative CVC score, unilateral localisation of tinnitus and larger deterioration of residual hearing at 250 Hz were significant predictors for tinnitus recovery following unilateral cochlear implantation. The performance of the model developed in this retrospective study is promising. However, before clinical use of the model, the conduction of a larger prospective study is recommended.

Source: http://bmjopen.bmj.com/content/8/6/e021068

 

A friend from an old forum I was on has just had a cochlear implant put in last week as she is profoundly deaf in both ears and has tinnitus.

She gets it turned on in 3 weeks and so happy for her and can't wait to hear from her... we met on Asthma UK many years ago.

love glynis

 

interesting find.

 

A Prospective Study of the Effect of Cochlear Implantation on Tinnitus
https://doi.org/10.1159/000495132

Abstract
Previous studies have shown diverse and sometimes even contrary results concerning the effect of cochlear implantation on tinnitus and the factors that can influence this effect. The aim of this prospective questionnaire study was to determine the effects of cochlear implantation on tinnitus and explore which factors can influence the effect of cochlear implantation on tinnitus. Forty-four of the patients implanted in our hospital returned 2 questionnaire packages, i.e., one before the cochlear implantation and one 6 months after implantation. Before implantation, 66% of the patients experienced tinnitus. This study shows that cochlear implantation could help to reduce tinnitus and the tinnitus handicap in at least 28% of the patients with preoperative tinnitus. In 72% of the patients the tinnitus remained after implantation. None of the patients developed tinnitus after implantation. A shorter duration of tinnitus prior to implantation, a more fluctuating type of tinnitus, a higher tinnitus handicap prior to implantation, and a round-window surgical approach might have a positive influence on the effect of cochlear implantation on tinnitus, but further research is necessary to confirm these findings.

 

I firmly believe that implants will be the ultimate cure. Once we've developed an implant to perfectly mimic the human inner ear that is. Just imagine being able to have perfect hearing your whole life without ever having to fear tinnitus or hearing loss ever again.

 

Out of curiosity @glynis, have you been able to touch base with her? I would be curious to hear how she's doing

 

We are nowhere near that, in fact CIs are designed to cut off at 8 kHz. Such an insult.

 

She is doing really well.

love glynis

 

Why haven't there been ones made past that point, or even hearing aids with higher frequencies? Is it because a sudden sound of these can cause even more damage, or? Now I'm really interested to know why this isn't a thing if the sounds can be produced and why 8 kHz is the guideline/baseline for auditory functioning. Is it because finding unmasked sounds, vibrations the bodies produce and such. Our voices.

 

Because they are morons that don't care about how the ear works, even if CIs do get above 8 kHz they won't have the ability to understand music and speech in noise.

 

Okay, that makes sense sound isn't ever just a pure tone. Sucks though. You would think they would look further into that since the computer/electrical side of technology are improving quicker than medical.

I mean, we have holograms. We have robots and phones that obey voice and voice commands. Work on stuff that actually makes life easier for a human being than making humans more lazy... sob.. Moneygrabbers.

 

Focus on hearing loss regeneration, it's a much more promising field than CI advancements.

 

I really like to be positive, really but the medical field is so lacking compared to other areas that I doubt this will happen any time soon. I mean, look how the industry has tried to help hearing. They stick an electrical probe using technology developed in the 80s with a few stimuli through a destructive procedure into your cochlea and call it a miracle. I'm sorry, I'm a software developer who writes hundreds of thousands of line of code a year using complex abstract data structures and complex algorithms to achieve a pretty sophisticated outcome to interface with the end user sometimes taking months or years to write a develop a single system. All a doctor does is drill your skull and stick a probe in it in a hurry because he has another patient to attend to so he/she can make more money and here I'm supposed to be impressed?

A cochlear implant is not a miracle. In fact, it's a very basic device and one that is very easily understood and developed. It has very basic circuity going back 50+ years that basically sample the incoming signal and chop up the frequency into a handful of stimuli. The ear has what, about 15,000 hair cells combined (inner and outer) and all the medical field could do is very roughly stimulate very large areas of the cochlea to mimic a few sounds?

Technology in computing has far outpaced the medical industry. I don't know if it's due to regulation, control from large pharma, government or what but until this changes, we are going nowhere fast. It's just so depressing. We still work at the macro level when it comes medicine. Throw medicine after medicine at them and move on to the next patient.

Again, I really hate to be negative about all this but if we just keep closing our eyes and hoping things change, nothing will happen. Nothing.

 

Maybe it has to do with medicine at large being a kind of monopoly. There are a bunch of large pharma companies and that's it. If they are happy selling cochlear implants for huge amounts of money and people buy them, why should companies do some research to obtain a better outcome and produce implants that are cheaper and more effective?

Also, the parts and pieces of those implants are really expensive to replace, and it is also a kind of monopoly.

We dont need to go as far as cochlear implants. Take the standard pair of hearing aids. Some of them go for 5.000 or more a pair, and these are devices that maybe cost like 100 bucks to produce, let alone they are pretty much useless for many people with hearing problems (this is something they discover after spending the money).

Actually, after developing hyperacusis I have come to think that 99% of ENTs are just useless. These are people who write prescriptions for a little inflammation or who empty a nose with big turbinates, but not much more.. that's what it is. They can fix like 3 simple things, and prescribe 3 different families of medication, and that's all folks.

 

The Influence of Cochlear Implantation on Tinnitus in Patients with Single-Sided Deafness: A Systematic Review.

DOI: 10.1177/0194599819846084
Abstract
OBJECTIVES: This systematic review provides an overview of the available studies (published by January 29, 2018) with descriptive data analysis about the influence of cochlear implantation on tinnitus in patients with single-sided deafness (SSD). DATA SOURCES: PubMed, EMBASE, Web of Science, Cochrane Library, and Google Scholar. REVIEW METHODS: Original studies about the influence of cochlear implantation on tinnitus, measured with different tinnitus questionnaires or visual analog scale, in patients with SSD were included. The pre- and postimplantation tinnitus scores of the included studies were extracted for the further systematic review. RESULTS: The systematic search yielded 1028 studies. After evaluating titles, abstracts, and full texts, 1011 of these were dismissed. From the remaining 17 studies, 4 showed a low directness of evidence or high risk of bias and were therefore excluded. Due to the nature of cochlear implantation in SSD, only cohort studies and no randomized trials exist, which limits the evaluation in a systematic review. Generally, the mean tinnitus questionnaire scores decreased after cochlear implantation in these 13 studies with a total of 153 patients. The most widely used tinnitus questionnaire was the Tinnitus Handicap Inventory. In these studies, 34.2% of patients demonstrated complete suppression, 53.7% an improvement, 7.3% a stable value, and 4.9% an increase of tinnitus, and none of the patients reported an induction of tinnitus. CONCLUSION: This review shows a clear improvement of tinnitus complaints after cochlear implantation in patients with SSD. Therefore, tinnitus might be considered as an additional indication for cochlear implantation in SSD.

 

Comparative analysis with regard to tinnitus distress, quality of life and hearing improvement between CI patients with single-sided deafness, asymmetric hearing loss and bilateral deafness
https://www.thieme-connect.com/products/ejournals/html/10.1055/s-0039-1686390

Introduction:

Tinnitus is a common symptom in CI candidates, who can be divided into three groups: patients with single sided deafness (SSD), asymmetric hearing loss (AHL) and bilateral deafness (DSD). The aim of this study is the comparison of these groups with regard to tinnitus distress, health related quality of life (QOL) and hearing improvement without and with CI and therefore with binaural hearing.

Methods:

94 postlingually deafened patients (SSD, AHL, DSD), who did not significantly differ with regard to age, duration of deafness, speech perception and tinnitus distress, were included in this prospective analysis between 11/2009 and 04/2016. The impact of CI on tinnitus distress (Tinnitus Questionnaire, TQ), QOL (Nijmegen Cochlear Implant Questionnaire, NCIQ) and speech perception (Freiburg Monosyllable Test, Oldenburg Sentence Test) was evaluated pre- and 6 months postoperatively for SSD, AHL and DSD patients.

Results:

Tinnitus prevalence varied between 72.7% (DSD, TQ Total Score 24.0 ± 19.40), 84.8% (SSD, TQ Total Score 32.6 ± 22.5) and 87.2% (AHL, TQ Total Score 28.7 ± 17.9). Before CI QOL (NCIQ Total) was significantly better in the groups SSD and AHL compared to the DSD group (p < 0.001).

Postoperatively there was a significant improvement of tinnitus distress (TQ Total) and speech perception (ES, OLSA) in all groups. Additionally the NCIQ scores of the DSD group adjusted the SSD and AHL scores, postoperatively the NCIQ Total score did not any more differ significantly between the three groups (p = 0.200).

Conclusion:

The possibility of binaural hearing with CI is a great advantage for all groups (SSD, AHL, DSD) with regard to improvement of tinnitus distress, QOL and speech perception.

Dr. med. Sophia Marie Häußler
Klinik für Hals-Nasen-Ohrenheilkunde, Charité Berlin,
Kuglerstr.7, 10439
Berlin
sophia-marie.haeussler@charite.de

 

A good hint that restoring "sound signals", however imperfect they may be, seem to help alleviate the "phantom sounds". It helps fuel optimism about other types of hearing restoration techniques, when it comes to impact on T.

 

*SPOILER* The drugs still aren't there. *SPOILER*

 

Some tinnitus frequencies can't be masked by such devices, good luck masking tinnitus at 14 kHz (that's what I have, nothing covers it short of the shower, and no, artificially producing the sound of an actual shower or rain does NOT cover it.)

 

Hearing rehabilitation using a cochlear implant - a way of reducing tinnitus in the elderly

Background: Tinnitus is a common symptom of severe hearing loss or deafness especially in older people. Hearing rehabilitation for these patients is usually only possible with a cochlear implant (CI). In recent years, an increasing number of old and very old patients have been treated with a CI. The aim of this study was to examine the influence of hearing rehabilitation with a CI on the tinnitus of older people.

Materials and methods: In this prospective study 34 patients between the age of 65 and 86 were included, who were unilaterally treated with a CI for the first time. 16 patients (47.1 %) had tinnitus preoperatively. At three time points (preoperative, on initial fitting and six months postoperatively), tinnitus severity was assessed in addition to speech discrimination in patients with tinnitus using the mini-tinnitus questionnaire (Mini-TF12).

Results: Six month postoperatively we found a highly significant improvement of speech discrimination (preoperatively 11.5 ± 17.4, six-month visit 54.4 ± 28.1 %, p = 0.001) that was accompanied by a highly significant reduction in tinnitus severity according to Mini-TF12 scores (preoperatively 6.9 ± 6.5, six-month visit 4.3 ± 3.3, p = 0.001).

Conclusions: Hearing rehabilitation by means of CI leads to a highly significant reduction of tinnitus severity of pre-operatively existing tinnitus in the elderly.

Source: https://pubmed.ncbi.nlm.nih.gov/32575139/

 

I think that this bodes well when we consider the fact that the treatments which provide additional auditory stimulation in theory (like OTO-6XX and FX-322) will work most likely to reduce tinnitus.

 

Another thing that makes me optimistic about these treatments is how effective benzos are at the beginning for tinnitus and hyperacusis. They slow down brain hyperactivity and regenerating the cochlea would likely have the same effect but naturally. At this point it's not a matter of "if," but a matter of when these treatments will hit the market.

 

This is weird, I was watching a YouTube video on this yesterday. Is a cochlear implant an approved treatment for tinnitus. Is the procedure reversible?

 

Only if you're deaf enough for a cochlear implant to make sense and you've tried every avenue to live with the tinnitus. It would be very difficult to get one if you had better than severe or profound hearing loss. The risk is whatever hearing you may have might be lost in the procedure.

 

Old post...

But did the CI implant help your friend?

 

I don't think a cochlear implant is a treatment for tinnitus. It is mainly used to treat severe cases of sensorineural hearing loss.

 

This is accurate, although at present we know that a cochlear implant can reduce an individual’s tinnitus. Therefore it is an additional benefit in some cases with the treatment should you need it.

 

Single-centre experience and practical considerations of the benefit of a second cochlear implant in bilaterally deaf adults

Purpose
Bilateral cochlear implant (CI) implantation is increasingly used in the auditory rehabilitation of bilaterally deafened adults. However, after successful unilateral implantation, objective patient counselling is essential.

Methods
We investigated the extra benefit of a second CI in adults in terms of health-related quality of life, tinnitus, stress, anxiety, depression, quality of hearing, and speech recognition. Hearing ability was assessed by using the Freiburg monosyllable speech discrimination test (FB MS) and the Oldenburg sentence test with azimuth variations. In a prospective patient cohort, we administered validated questionnaires before a CI, after a first CI and after a second CI implantation.

Results
The study included 29 patients, made up of nine women and 20 men. The median time between the first and the second implantation was 23 months. The mean total NCIQ score and TQ before a CI improved significantly after both implantations. Stress, anxiety, and depression were stable over time and were not significantly affected by CI implantations. Speech recognition with noise significantly improved after the first and again after the second CI. Correlation analysis showed a strong connection between auditory performance and HRQoL.

Conclusion
We demonstrated that a unilateral CI benefitted many fields and that the second sequential CI leads again to additional improvement. Bilateral CI implantation should, therefore, be the standard form of auditory rehabilitation in deafened adults.

Tinnitus is well studied in the full article:
https://link.springer.com/article/10.1007/s00405-020-06315-x

 

Indeed, with an advanced CI, you could combine an infinity of stimulations trough the electrodes (independantly to the input of the external sounds) to find if you can achieve a decrease of your tinnitus.

Changes in Tinnitus by Cochlear Implantation: A Parametric Study of the Effect of Single-Electrode Stimulation

Introduction: While cochlear implantation may have a positive effect on tinnitus, it is not effective in reducing tinnitus in all patients. This may be due to different patients requiring different strategies of electrical stimulation in order to obtain a positive effect on tinnitus. It is, therefore, important to identify the most effective stimulation strategies to reduce tinnitus. The simplest possible strategy is stimulation by only one electrode. In this study, we investigated tinnitus suppression by electrical stimulation via a single electrode of the cochlear implant.

Methods: We performed a listening experiment in 19 adult participants, who had received a unilateral cochlear implant (CI) because of severe bilateral hearing loss. All of these patients had indicated that they suffered from tinnitus. During a 300-s interval, patients listened to blocks of single-electrode stimulation and rated the loudness of the stimulus and any effects on their tinnitus. The 300-s interval included a block of single-electrode stimulation (duration 120 s). In consecutive intervals, the stimulus differed in its cochlear location (basal or apical), its pulse rate (720 or 725 Hz, 1,200 Hz, and 2,400 or 2,320 Hz), and amplitude (just above threshold or equivalent to moderate loudness). Thus, 2 × 3 × 2 = 12 stimulus conditions were tested in each participant, and each condition was presented only once. During the experiment, the participants promptly rated the loudness of the stimuli and the loudness of their tinnitus on a Visual Analogue Scale (10-point VAS).

Results: Significantly more tinnitus reduction was observed with stimuli at a moderate intensity level (30%) compared to stimuli at near-threshold level (18%) (χ2 [1, N = 222] = 14.115, p < 0.01). No significant differences in tinnitus levels resulted from the different pulse rates and stimulation sites. Eight participants reported an increase of tinnitus loudness under at least one stimulus condition. Changes in tinnitus loudness were generally minor, and never exceeded 3 points on the VAS. The overall effect of cochlear implantation on tinnitus, that is, the effect with full-array stimulation, was not correlated with the effectiveness of the single-electrode stimulation on tinnitus.

Conclusion: In conclusion, the effect of single-electrode stimulation on tinnitus is relatively insignificant in comparison to the effect of full-array stimulation. However, in some individual cases, sustained single-electrode stimulation may be beneficial for tinnitus management.

Full article: https://www.karger.com/Article/FullText/509202

 

Effect of cochlear implantation on tinnitus and the prognosis mode analysis

Objective:
To describe the effects of the possible related factors in unilateral cochlear implantation（CI） on tinnitus，and analysis the hearing and speech ability in different tinnitus prognosis mode.

Method:
The 70 post-lingual deafness CI patients（27.73±14.032 years old） in the clinical trial for LCI-20PI cochlear implant and LSP-20A sound processor project by a fast questionnaire about the tinnitus positive or negative respectively before the CI, 3rd, 6th, 9th and 12th months after the first mapping. 6 modes about tinnitus development were record: Type A（-to-）, no tinnitus before the CI and continued negative until the last follow-up; Type B（+ to-）, have tinnitus before CI and disappeared after the mapping; Type C（-to +）, no tinnitus before but appeared after the surgery; Type D（+ to-to +）, have tinnitus before the CI and disappeared during the continue follow-up, but finally the tinnitus show up again at last; Type E（-to + to-）, no tinnitus before and suffered from tinnitus after the CI surgery, but the noise disappeared at last; Type F（+ to +）, have the tinnitus in all the duration. Then we briefly analyzed the factors like age, gender, the duration of hearing loss, and the duration of hearing aids usage. Compare the characteristics in all the modes of tinnitus prognosis.

Result:
In this research CI treatment effect rate on tinnitus is 80%. The mean age of Type A （tinnitus from -to- ） group is （20.79 ±11.364） years old; Type B （tinnitus from + to-） group is （32.69±10.606） years old; Type C（tinnitus from-to +） group is （40.25±2.217） years old; Type D（tinnitus from + to-to +） group is （28.00±0） years old; Type E （tinnitus from-to + to-） group is （52.50±6.364） years old; Type F （tinnitus from + to +） group is （30.33±11.015） years old. And P<0.05 between the groups, while the severe-deaf-duration intergroup differences （P>0.05）. The mean speech discrimination rates are all elevate after 12 months and no statistical significance between the groups. But the E group has a lowst elevation in mean pure tone threshold （22.50±3.535 ） dB HL, when the F group has the best promotion （56.04±10.649 ） dB HL, and the difference between the groups is statistically significant.

Conclusion:
The cochlear implantation could eliminate tinnitus in 80% patients in this research. The better elevation of hearing and speech ability in the patients with persist tinnitus pre-and post-CI usage may related to amount and functions of the residual auditory nerves. Age may be an important factor in tinnitus generation, which may need more explanation and attention during the rehabilitation period.

Source:
https://pubmed.ncbi.nlm.nih.gov/33254311/