Cochlear Implants as a Treatment of Tinnitus

[Frédéric]

Cochlear implant and tinnitus–a meta-analysis

Abstract
Introduction
Tinnitus is a frequent symptom in cochlear implant patients, often reported as persistent and disabling in implant candidates. Tinnitus is rarely considered in the preoperative evaluation of patients who are eligible for cochlear implantation. Many studies have shown that a cochlear implant leads to a significant change in the perception of tinnitus.

Objective
To identify evidence in the scientific literature indicating that cochlear implant in eligible patients with tinnitus can improve tinnitus perception.

Methods
One hundred forty articles were found from nine databases, and 20 articles from the gray literature mentioned the relationship between cochlear implant and tinnitus perception in patients eligible for cochlear implant. The PICOS (population, intervention, comparison, and outcome) strategy, was used to define the eligibility criteria. The studies that met the inclusion criteria for this second step were included in a qualitative synthesis, and each type of study was analyzed using the Joanna Briggs Institute critical appraisal checklist for quasi-experimental studies and the Joanna Briggs Institute critical appraisal checklist for randomized clinical trials.

Results
The full texts of 11 articles were read, and 6 studies were selected for the meta-analysis. The total sample size in the evaluated articles was 136 patients with tinnitus who were eligible for cochlear implantation.

Conclusions
Taken together, these findings support the feasibility of cochlear implantation to reduce the perception of tinnitus, thus providing a new perspective in the treatment of tinnitus in patients with hearing loss who are candidates for cochlear implantation.

 

[Gb3]

Are there any studies that include hybrid high frequency cochlear implants?

 

[David S]

Has anyone heard of a patient being offered a cochlear implant as a treatment for severe tinnitus and sound sensitivity without profound hearing loss? Might sound like a strange question for most of you but I think some of you will understand.

 

[Stacken77]

Has anyone heard of a patient being offered a cochlear implant as a treatment for severe tinnitus and sound sensitivity without profound hearing loss? Might sound like a strange question for most of you but I think some of you will understand.

When I asked my ENT if there was a "last resort" treatment, no matter how extreme it was, she brought up Cochlear Implants but in the same moment pointed out that it would likely yield worse hearing, and worse tinnitus, in cases like ours who doesn't have profound hearing loss. I know it isn't the answer you sought, just my 2 cents.

 

[David S]

When I asked my ENT if there was a "last resort" treatment, no matter how extreme it was, she brought up Cochlear Implants but in the same moment pointed out that it would likely yield worse hearing, and worse tinnitus, in cases like ours who doesn't have profound hearing loss. I know it isn't the answer you sought, just my 2 cents.

Yes, you are probably right. For sure worse hearing and a small possibility of less tinnitus.

 

[Piney]

Yes, you are probably right. For sure worse hearing and a small possibility of less tinnitus.

Other doctors say tinnitus will be reduced by 75% due to a cochlear implant, and yes the hearing may be different or may become close to normal like before after a year. It's all up in the air.

@Gb3, you can get a cochlear implant with single-sided deafness with moderate to severe hearing loss with tinnitus.

 

[AfroSnowman]

Other doctors say tinnitus will be reduced by 75% due to a cochlear implant, and yes the hearing may be different or may become close to normal like before after a year. It's all up in the air.

@Gb3, you can get a cochlear implant with single-sided deafness with moderate to severe hearing loss with tinnitus.

I thought a cochlear implant destroys what is left in the cochlea and makes everything into a flat robot voice.

The new Tinnitus Talk Podcast discusses this. The researcher talked about playing with the impulse of someone's cochlear implant until they could make the tinnitus go away. Like entirely away. I think they said it came back when it was turned off after a couple hours.

 

[DimLeb]

If you think about it, a cochlear implant, at a fully advanced, perfected version, could be the solution to all hearing disorders as it could completely overwrite the cochlea. But currently, it's a very destructive, barbaric option for anyone who has better than profound hearing loss.

I wonder if technology can advance and somehow cochlear implants may not destroy what is left in the cochlea and kind of work synergistically with it.

 

[Piney]

A cochlear implant is considered for the patient when a hearing aid is no longer of value. If a hearing aid is useless and word recognition is very poor, you either stay deaf or choose to get a cochlear implant. Without restorative advances in medicine, there just aren't many choices.

 

[tommyd87]

If you think about it, a cochlear implant, at a fully advanced, perfected version, could be the solution to all hearing disorders as it could completely overwrite the cochlea. But currently, it's a very destructive, barbaric option for anyone who has better than profound hearing loss.

I wonder if technology can advance and somehow cochlear implants may not destroy what is left in the cochlea and kind of work synergistically with it.

This is already occurring at present.

Pretty much there are two main aspects being assessed right now to improve this.

The first is that there's tonnes of effort/research/work being done to preserve hearing in cochlear implant candidates. Currently there has been some major improvement in this and people are not losing residual hearing as regularly as happened previously.

Secondly there is currently research into methods to improve the outcomes with a cochlear implant including looking at new designs etc to improve their benefits.

Other doctors say tinnitus will be reduced by 75% due to a cochlear implant, and yes the hearing may be different or may become close to normal like before after a year. It's all up in the air.

@Gb3, you can get a cochlear implant with single-sided deafness with moderate to severe hearing loss with tinnitus.

It does all come down to your benefit from hearing aids as to whether you would be able to obtain a cochlear implant. Currently there have been many candidates who have either obtained significant reductions or eliminated tinnitus through the receipt of the cochlear implant.

 

[DimLeb]

The first is that there's tonnes of effort/research/work being done to preserve hearing in cochlear implant candidates. Currently there has been some major improvement in this and people are not losing residual hearing as regularly as happened previously.

To be honest, I haven't followed cochlear implant research closely (or at least not as close as the tinnitus research), but I don't think there is a cochlear implant yet, that doesn't destroy the cochlea in some way. For people with no hearing loss at all, it's absolutely insane to go for a cochlear implant in hopes of diminishing tinnitus and given what cochlear implants currently offer.

I may be wrong though, but a cochlear implant is an option when the ear is pretty much deaf.

 

[Gb3]

To be honest, I haven't followed cochlear implant research closely (or at least not as close as the tinnitus research), but I don't think there is a cochlear implant yet, that doesn't destroy the cochlea in some way. For people with no hearing loss at all, it's absolutely insane to go for a cochlear implant in hopes of diminishing tinnitus and given what cochlear implants currently offer.

I may be wrong though, but a cochlear implant is an option when the ear is pretty much deaf.

They have hybrid high frequency ones.

 

[Nick47]

Secondly there is currently research into methods to improve the outcomes with a CI including looking at new designs etc to improve their benefits.

Now then, are these the hybrid cochlear implants? I was in a Twitter conversation with a doctor who said these are aimed at those with severe to profound hearing loss at high frequencies and do not interfere with the lower frequencies. Basically they do not trash the parts of the cochlear that still work well.

 

[Nick47]

The first is that there's tonnes of effort/research/work being done to preserve hearing in cochlear implant candidates. Currently there has been some major improvement in this and people are not losing residual hearing as regularly as happened previously.

Is this in relation to SENS-401, currently in Phase 2?

 

[Nick47]

Large review and right up to date!

In conclusion, this review included a large number of studies reporting the effectiveness of CI in suppressing disabling tinnitus in SSD patients when conventional treatment is insufficient. Tinnitus improvement is maintained in the long-term (>12 months). Considering the positive effect observed in all the studies, CI indication deserves to be more widely considered in such patients.

Cochlear implants also reduce hyperacusis as mentioned in the review paper.

Short- and Long-Term Effect of Cochlear Implantation on Disabling Tinnitus in Single-Sided Deafness Patients: A Systematic Review

 

[Nick47]

Sad state of affairs in the UK.

 

[Fightthearmy]

I was wondering, why are doctors allowed to tell patients there are no treatments, given cochlear implants?

A small preamble; although it should be said that nothing is guaranteed, and there's a small number of patients (10% if I'm correct) who have experienced an increase in tinnitus, it's become quite obvious that cochlear implants improve or eliminate tinnitus in most cases (80-90%). From where I'm coming from, those are pretty good chances for someone suffering from severe tinnitus, and skepticism about Susan Shore's device, its efficacy, and its timeline, is where I'm coming from, despite what anyone says.

To say that there is no effective treatment for tinnitus is simply false, and to mislead patients in this way should entitle them their money back. My doctors have stood by that mantra as recently as October. When the ENT I visited eight years ago told me that there is not much that can be done about it, their lack of knowledge might have been forgivable. But today that's just insincere, or unprofessional. I don't know exactly how invasive cochlear implants are, or if they're worth it for patients with mild tinnitus, but if doctors can legally get away with saying there is no effective treatment for tinnitus, then in my opinion they should be exposed. Disagree?

 

[Aussie Lea]

I don't know exactly how invasive cochlear implants are

Yeah, maybe you should research first... Cochlear implants destroy any residual hearing, so obviously no doctor in this world is going to do the surgery on you just because of tinnitus if you don't have mega severe hearing loss to go with it that can't be fixed with hearing aids. And this is why cochlear implant is not a treatment option. It doesn't matter if you're OK with your residual hearing being gone and relying solely on the cochlear implant, it's how the world works, natural hearing isn't destroyed for this reason. You can't blame doctors for not telling about something that no doctor anywhere will perform unless you meet the strict criteria for the cochlear implant.

 

[Fightthearmy]

Yeah, maybe you should research first... Cochlear implants destroy any residual hearing, so obviously no doctor in this world is going to do the surgery on you just because of tinnitus if you don't have mega severe hearing loss to go with it that can't be fixed with hearing aids. And this is why cochlear implant is not a treatment option. It doesn't matter if you're OK with your residual hearing being gone and relying solely on the cochlear implant, it's how the world works, natural hearing isn't destroyed for this reason. You can't blame doctors for not telling about something that no doctor anywhere will perform unless you meet the strict criteria for the cochlear implant.

So it's better to suffer indefinitely until Dr. xxxxx comes and saves us rather than asking people to talk a bit louder to you and actually being able to work and pursue a career normally? (Who knows if Dr. Shore might not still have a long way to go, IF it even works well.) Excuse me, I don't believe 'how the world works' should be used for an argument for cruelty.

 

[Nick47]

I was wondering, why are doctors allowed to tell patients there are no treatments, given cochlear implants?

A small preamble; although it should be said that nothing is guaranteed, and there's a small number of patients (10% if I'm correct) who have experienced an increase in tinnitus, it's become quite obvious that cochlear implants improve or eliminate tinnitus in most cases (80-90%). From where I'm coming from, those are pretty good chances for someone suffering from severe tinnitus, and skepticism about Susan Shore's device, its efficacy, and its timeline, is where I'm coming from, despite what anyone says.

To say that there is no effective treatment for tinnitus is simply false, and to mislead patients in this way should entitle them their money back. My doctors have stood by that mantra as recently as October. When the ENT I visited eight years ago told me that there is not much that can be done about it, their lack of knowledge might have been forgivable. But today that's just insincere, or unprofessional. I don't know exactly how invasive cochlear implants are, or if they're worth it for patients with mild tinnitus, but if doctors can legally get away with saying there is no effective treatment for tinnitus, then in my opinion they should be exposed. Disagree?

The issue here is they are only likely to improve tinnitus if you have severe-profound hearing loss. Is this what you have @Fightthearmy?

 

[Stacken77]

So it's better to suffer indefinitely until Dr. xxxxx comes and saves us rather than asking people to talk a bit louder to you and actually being able to work and pursue a career normally?

If you are profoundly deaf, a Cochlear Implant may give you better hearing, hence improving tinnitus. If you already have okay hearing and are given a Cochlear Implant, which destroys that natural hearing, chances are you will be off with worse hearing than when you started, hence you'll likely get worse tinnitus. That's the reason why it's not considered a treatment, because most people are not profoundly deaf.

 

[DimLeb]

So it's better to suffer indefinitely until Dr. xxxxx comes and saves us rather than asking people to talk a bit louder to you and actually being able to work and pursue a career normally? (Who knows if Dr. Shore might not still have a long way to go, IF it even works well.) Excuse me, I don't believe 'how the world works' should be used for an argument for cruelty.

You are just ignoring the obvious here. Apart from the fact that no doctor will do the operation if you don't have profound hearing loss, it would be stupid to go destroy your hearing with a cochlear implant because you may end up with worse tinnitus. The way it's done is almost like having a controlled traumatic cochlea injury and that rapid loss of hearing is exactly what can cause bigger tinnitus.

Now, if you already have no hearing in that ear and you have tinnitus, then you've got nothing to lose getting a cochlear implant. Also, cochlear implants only give you a limited band of frequencies of hearing, so I imagine if they don't resolve the tinnitus via their electrical signal going off or something, it would be a lot harder (or impossible) to use masking if the tinnitus is out of that band of frequencies.

 

[Juan]

I do not see how a cochlear implant is going to fix tinnitus... makes no sense at all.

 

[Gb3]

You don't need profound hearing loss for a cochlear implant. They changed the parameters.

 

[Nick47]

You don't need profound hearing loss for a cochlear implant. They changed the parameters.

I've looked into hybrids and reviews are not great. Basically even though the array is shorter, many still lose low frequency hearing. Then the electrode array is too short to amplify the low frequencies.

My unilateral severe profound hearing loss starts somewhere between 3000 - 4000 Hz and continues through to 8000 Hz.

 

[Gb3]

I've looked into hybrids and reviews are not great. Basically even though the array is shorter, many still lose low frequency hearing. Then the electrode array is too short to amplify the low frequencies.

My unilateral severe profound hearing loss starts somewhere between 3000 - 4000 Hz and continues through to 8000 Hz.

They're not meant to amplify the low frequencies. They are for high frequency hearing loss. They are actually doing a lot of studies right now on how to implant them without damaging the cochlea by means of a robot assisted surgery.

The standard has been changed for regular cochlear implants too.

 

[AfroSnowman]

Are there any studies showing the efficacy of hybrid cochlear implant on tinnitus? I might be willing to give up some of my high range hearing in one ear if it could quiet down the tinnitus.

 

[Nick47]

They're not meant to amplify the low frequencies. They are for high frequency hearing loss. They are actually doing a lot of studies right now on how to implant them without damaging the cochlea by means of a robot assisted surgery.

The standard has been changed for regular cochlear implants too.

I take your point. Problem is you ask an ENT and they only know what's available now. Hybrids are not used here in the UK because once you lose low frequency hearing, there are no electrodes deep enough to work.

 

[Fightthearmy]

The issue here is they are only likely to improve tinnitus if you have severe-profound hearing loss. Is this what you have @Fightthearmy?

No, I don't have significant hearing loss. Look, I get it, I should read up on the subject, but am currently very busy.

You are just ignoring the obvious here. Apart from the fact that no doctor will do the operation if you don't have profound hearing loss, it would be stupid to go destroy your hearing with a cochlear implant because you may end up with worse tinnitus. The way it's done is almost like having a controlled traumatic cochlea injury and that rapid loss of hearing is exactly what can cause bigger tinnitus.

Now, if you already have no hearing in that ear and you have tinnitus, then you've got nothing to lose getting a cochlear implant. Also, cochlear implants only give you a limited band of frequencies of hearing, so I imagine if they don't resolve the tinnitus via their electrical signal going off or something, it would be a lot harder (or impossible) to use masking if the tinnitus is out of that band of frequencies.

I don't know about you guys, but masking makes my tinnitus more acute once it's been switched off. Some hyperacusis, maybe.

 

[antonio77]

A small preamble; although it should be said that nothing is guaranteed, and there's a small number of patients (10% if I'm correct) who have experienced an increase in tinnitus, it's become quite obvious that cochlear implants improve or eliminate tinnitus in most cases (80-90%).

If that were true, years ago all tinnitus sufferers would have had a cochlear implant.

No, what you say is not true at all, but if you believe it, it's not that difficult to convince an otolaryngologist to operate on you. Get a cochlear implant and tell us. When you have hearing loss and tinnitus, the mere fact of recovering your hearing makes the tinnitus less noticeable, it is a form of camouflage, not a cure. Listen to music and you will have the same result.