OUTCOMES OF TINNITUS POST-COCHLEAR IMPLANTATION IN ADULT POPULATIONS: A SYSTEMATIC REVIEW by EVANGELINE WONG
ABSTRACT
Advisor: Donald A. Vogel, Au.D., CCC-A
Purpose: The purpose of this investigation is to conduct a systematic review on the outcomes of tinnitus, in both its characteristics and psychosocial impact, post-cochlear implantation in profound bilateral and single-sided deafness (SSD) adult populations. A longitudinal case study will also be presented to show long-term effects of tinnitus outcomes in a cochlear implant recipient in a clinical setting.
Objective: The investigation may, in turn, provide information regarding tinnitus in the selection criteria of which ear to implant, considerations in implantation eligibility for patients with bilateral and unilateral severe hearing loss associated with severe tinnitus, and to inform patients about the possible risk of postoperative tinnitus worsening. The collective data may also encourage further assessment of tinnitus in cochlear implant (CI) patients during audiological testing.
Methods: A comprehensive search utilizing various peer-reviewed databases accessible through the City University of New York (CUNY) Graduate Center's Mina Rees Library was conducted to identify relevant studies evaluating quantitative and qualitative outcome measures of tinnitus post-cochlear implantation. Inclusion criteria were studies with tinnitus and bilateral and unilateral cochlear implant users, bilateral hearing loss subjects, and SSD patients.
Results: A total of 13 articles were selected for review based on the inclusion criteria, research design, and publication date. 10 of the 13 studies focused on tinnitus outcomes in subjects with bilateral profound hearing loss, while the remaining three studies investigated tinnitus outcomes v in cochlear implant subjects with SSD. Evaluation of standardized questionnaires (THI, TQ), non-standardized questionnaires reporting on perceptual characteristics of tinnitus, speech perception scores, and psychosocial outcomes were included in the analysis. Various conditions of tinnitus outcomes (i.e., processor on versus off, hearing aid versus CI, one versus two cochlear implants) were additionally evaluated.
Discussion: All studies, both in individuals with bilateral profound hearing loss and SSD cases, noted an improvement in tinnitus outcomes both in standardized and non-standardized questionnaires. However, some of the included literature did report participants with either no change or worsening of their tinnitus. Despite the strong correlation between tinnitus outcomes and the included psychosocial measures, the following research did not indicate a relationship between speech perception and tinnitus outcomes. Assessment of the case study displays both an improvement and deterioration of THI scores as indicated by the literature. The case emphasizes the lack of follow-up regarding tinnitus measures in the current research and the demand for a more comprehensive examination of tinnitus in clinical settings.
Conclusion: Results from the current review broadly indicate improved tinnitus outcomes on standardized and non-standardized measures post-cochlear implantation in bilateral profound and SSD hearing. Expansion in the clinical report and management of tinnitus as well as standardization of tinnitus measures will be crucial to make more definitive statements regarding these outcomes as the indications for CI implantation in post lingually-deafened individuals continue to expand.