Cochlear Implantation and Other Treatments in Single-Sided Deafness and Asymmetric Hearing Loss: Results of a National Multicenter Study Including a Randomized Controlled Trial

<b><i>Introduction:</i></b> Cochlear implantation is a recent approach proposed to treat single-sided deafness (SSD) and asymmetric hearing loss (AHL). Several cohort studies showed its effectiveness on tinnitus and variable results on binaural hearing. The main objective of this study is to assess the outcomes of cochlear implantation and other treatment options in SSD/AHL on quality of life. <b><i>Methods:</i></b> This prospective multicenter study was conducted in 7 tertiary university hospitals and included an observational cohort study of SSD/AHL adult patients treated using contralateral routing of the signal (CROS) hearing aids or bone-anchored hearing systems (BAHSs) or who declined all treatments, and a randomized controlled trial in subjects treated by cochlear implantation, after failure of CROS and BAHS trials. In total, 155 subjects with SSD or AHL, with or without associated tinnitus, were enrolled. After 2 consecutive trials with CROS hearing aids and BAHSs on headband, all subjects chose any of the 4 treatment options (abstention, CROS, BAHS, or cochlear implant [CI]). The subjects who opted for a CI were randomized between 2 arms (CI vs. initial observation). Six months after the treatment choice, quality of life was assessed using both generic (EuroQoL-5D, EQ-5D) and auditory-specific quality-of-life indices (Nijmegen Cochlear implant Questionnaire [NCIQ] and Visual Analogue Scale [VAS] for tinnitus severity). Performances for speech-in-noise recognition and localization were measured as secondary outcomes. <b><i>Results:</i></b> CROS was chosen by 75 subjects, while 51 opted for cochlear implantation, 18 for BAHSs, and 11 for abstention. Six months after treatment, both EQ-5D VAS and auditory-specific quality-of-life indices were significantly better in the “CI” arm versus “observation” arm. The mean effect of the CI was particularly significant in subjects with associated severe tinnitus (mean improvement of 20.7 points ± 19.7 on EQ-5D VAS, 20.4 ± 12.4 on NCIQ, and 51.4 ± 35.4 on tinnitus). No significant effect of the CI was found on binaural hearing results. Before/after comparisons showed that the CROS and BAHS also improved significantly NCIQ scores (for CROS: +7.7, 95% confidence interval [95% CI] = [4.5; 10.8]; for the BAHS: +14.3, 95% CI = [7.9; 20.7]). <b><i>Conclusion:</i></b> Cochlear implantation leads to significant improvements in quality of life in SSD and AHL patients, particularly in subjects with associated severe tinnitus, who are thereby the best candidates to an extension of CI indications.

Evaluation and Management of Severe Tinnitus: An Evidence-Based Case Report

Purpose Tinnitus is reported by millions of Americans and is significantly problematic for many people. Commonly, individuals suffering from tinnitus report disturbances in the areas of sleep, hearing, emotional well-being, and so forth. This case report presents the evaluation and treatment of an adult female with severe tinnitus and multiple relevant comorbidities. This case includes the onset, evaluation, and management of significantly bothersome tinnitus in a 60-year-old woman. Tinnitus was first reported after she was treated with an Epley maneuver intended to resolve benign paroxysmal positional vertigo. An evaluation of tinnitus (including a comprehensive audiometric evaluation, an assessment of the impact of tinnitus on her life, and psychoacoustic measures of tinnitus perception) was completed. The tinnitus was reported to have a severely negative impact on her overall health, mental state, and quality of life. Method This patient opted to manage her tinnitus with a combination of pharmaceuticals, sound therapy, and education (the latter two in the form of tinnitus retraining therapy). Results The course of her active treatment spanned approximately 18 months, and, at the completion of her treatment, she demonstrated significant improvements in all areas of her life that had been impacted by tinnitus. She has become an active advocate for tinnitus management and has made herself available as a resource for other individuals who are struggling to cope with intrusive tinnitus. Conclusion Tinnitus retraining therapy is a treatment option that may significantly improve the quality of life of individuals suffering from severely bothersome tinnitus.

The impact of occurrence of tinnitus in first degree relatives on the severity of disease among subjects

<p class="abstract"><strong>Background:</strong> The aetiology of tinnitus and the factors that contribute to the exacerbation from mild to severe tinnitus are poorly known. Particularly, a role of genetics has been proposed for tinnitus, although this has not been conclusive. In order to establish a possible role for heritability in our population, we explored the history of tinnitus among first degree family members of those suffering from tinnitus using cross-sectional community-based strategy.</p><p class="abstract"><strong>Methods:</strong> There were 300 subjects with idiopathic tinnitus with mean (±SD) age of 51.88 (±15.11, range=19-80 years) comprising 169 males and 131 females. </p><p class="abstract"><strong>Results:</strong> Tinnitus was severe in 37.9% and bilateral in 65.1% while 26.6% reported having family members with history of tinnitus. TInnitus was significantly more severe (p&lt;0.001) and more frequent (p&lt;0.001); and the psychological distress related to tinnitus (p&lt;0.001) measured by the mini-TQ was worse among those with family history compared to those without. Bivariate analysis reveals that the presence of tinnitus in other family members, occurrence of tinnitus for more than 3 months (p=0.003), increasing age (0.001) and higher mean mini-TQ scores (0.001) showed significant association with severity of tinnitus. Logistic regression reveals that presence of tinnitus in other family members increases the odds of frequency of tinnitus by 5.08 (95% CI=1.70-15.12), elevates the mean scores of the mini-TQ by 1.31 (95% CI=1.20-1.44) while increasing age greater than 50 years increases the odds of severity of disease by 2.81 (95%CI=1.59-4.94).</p><p class="abstract"><strong>Conclusions:</strong> We conclude that the findings of significant correlation between presence of tinnitus in first degree relatives and severity of tinnitus among the subjects provides an empirical evidence to explore a possible genetic aetiology for severe tinnitus in our population.</p>

Sex-Dependent Aggregation of Tinnitus in Swedish Families

Twin and adoption studies point towards a genetic contribution to tinnitus; however, how the genetic risk applies to different forms of tinnitus is poorly understood. Here, we perform a familial aggregation study and determine the relative recurrence risk for tinnitus in siblings (λs). Four different Swedish studies (N = 186,598) were used to estimate the prevalence of self-reported bilateral, unilateral, constant, and severe tinnitus in the general population and we defined whether these 4 different forms of tinnitus segregate in families from the Swedish Tinnitus Outreach Project (STOP, N = 2305). We implemented a percentile bootstrap approach to provide accurate estimates and confidence intervals for λs. We reveal a significant λs for all types of tinnitus, the highest found being 7.27 (95% CI (5.56–9.07)) for severe tinnitus, with a higher susceptibility in women (10.25; 95% CI (7.14–13.61)) than in men (5.03; 95% CI (3.22–7.01)), suggesting that severity may be the most genetically influenced trait in tinnitus in a sex-dependent manner. Our findings strongly support the notion that genetic factors impact on the development of tinnitus, more so for severe tinnitus. These findings highlight the importance of considering tinnitus severity and sex in the design of large genetic studies to optimize diagnostic approaches and ultimately improve therapeutic interventions.

Association between Hyperacusis and Tinnitus

Many individuals with tinnitus report experiencing hyperacusis (enhanced sensitivity to sounds). However, estimates of the association between hyperacusis and tinnitus is lacking. Here, we investigate this relationship in a Swedish study. A total of 3645 participants (1984 with tinnitus and 1661 without tinnitus) were enrolled via LifeGene, a study from the general Swedish population, aged 18–90 years, and provided information on socio-demographic characteristics, as well as presence of hyperacusis and its severity. Tinnitus presence and severity were self-reported or assessed using the Tinnitus Handicap Inventory (THI). Phenotypes of tinnitus with (n = 1388) or without (n = 1044) hyperacusis were also compared. Of 1661 participants without tinnitus, 1098 (66.1%) were women and 563 were men (33.9%), and the mean (SD) age was 45.1 (12.9). Of 1984 participants with tinnitus, 1034 (52.1%) were women and 950 (47.9%) were men, and the mean (SD) age was 47.7 (14.0) years. Hyperacusis was associated with any tinnitus [Odds ratio (OR) 3.51, 95% confidence interval (CI) 2.99–4.13], self-reported severe tinnitus (OR 7.43, 95% CI 5.06–10.9), and THI ≥ 58 (OR 12.1, 95% CI 7.06–20.6). The association with THI ≥ 58 was greater with increasing severity of hyperacusis, the ORs being 8.15 (95% CI 4.68–14.2) for moderate and 77.4 (95% CI 35.0–171.3) for severe hyperacusis. No difference between sexes was observed in the association between hyperacusis and tinnitus. The occurrence of hyperacusis in severe tinnitus is as high as 80%, showing a very tight relationship. Discriminating the pathophysiological mechanisms between the two conditions in cases of severe tinnitus will be challenging, and optimized study designs are necessary to better understand the mechanisms behind the strong relationship between hyperacusis and tinnitus.

Relationship between headaches and tinnitus in a Swedish study

The heterogeneity of tinnitus is likely accounting for the lack of effective treatment approaches. Headaches have been related to tinnitus, yet little is known on how headaches impact tinnitus. We use cross-sectional data from the Swedish Tinnitus Outreach Project to i) evaluate the association between headaches and tinnitus (n = 1,984 cases and 1,661 controls) and ii) investigate the phenotypic characteristics of tinnitus subjects with tinnitus (n = 660) or without (n = 1,879) headaches. In a multivariable logistic regression model, headache was significantly associated with any tinnitus (odds ratio, OR = 2.61) and more so with tinnitus as a big problem (as measured by the tinnitus functional index, TFI ≥ 48; OR = 5.63) or severe tinnitus (using the tinnitus handicap inventory, THI ≥ 58; OR = 4.99). When focusing on subjects with tinnitus, the prevalence of headaches was 26% and reached 40% in subjects with severe tinnitus. A large number of socioeconomic, phenotypic and psychological characteristics differed between headache and non-headache subjects with any tinnitus. With increasing tinnitus severity, fewer differences were found, the major ones being vertigo, neck pain and other pain syndromes, as well as stress and anxiety. Our study suggests that headaches could contribute to tinnitus distress and potentially its severity.