人工耳蜗植入对耳鸣的影响

目的观察人工耳蜗植入前、后耳鸣的变化情况,为耳鸣诊治寻找新的途径.方法对10例行人工耳蜗植入的语后聋患者进行问卷调查.结果人工耳蜗植入前9例患者有双侧耳鸣,1例患者无耳鸣.植入后4例患者双侧耳鸣均消失,2例患者植入后同侧耳鸣消失对侧耳鸣如植入前,1例患者植入后同侧耳鸣消失对侧耳鸣明显减弱,1例术后7天开始同侧耳鸣开机后耳鸣停止,2例双侧耳鸣仍如植入前.结论人工耳蜗植入可缓解、抑制大部分患者的耳鸣,亦有例外,提示耳鸣可能存在多种发生机制,单纯因耳鸣实施人工耳蜗植入仍缺乏充分依据.     

人工耳蜗植入对成人语后聋患者植入侧耳鸣的影响

目的 探究成人语后聋患者人工耳蜗植入术后植入侧耳鸣的变化,并分析其影响因素。方法 2017年1月～2021年12月于郑州大学第一附属医院耳科进行单侧人工耳蜗植入的47例成人语后聋伴耳鸣患者,分别于术前和术后开机6个月进行耳鸣问卷评估,评估材料为耳鸣障碍量表(tinnitus handicap inventory, THI)和视觉模拟量表(visual analogue scale, VAS),比较人工耳蜗植入术后患者耳鸣的变化,并分析其可能的影响因素。结果 47例患者人工耳蜗植入术前、术后开机6个月时THI评分别为36.94±13.337、14.48±12.726分,VAS评分分别为5.13±1.676、2.34±1.903分,术后评分均较术前降低,差异均有统计学意义(P<0.05);其中18例患者耳鸣完全消失,13例患者耳鸣减轻,14例患者耳鸣无变化,2例患者耳鸣加重,总体耳鸣有效率为66.0%(31/47);术前耳鸣病程与耳鸣严重程度对术后耳鸣预后有影响(P<0.05),术前耳鸣病程≤5年、中度及以上耳鸣组耳鸣有效率分别高于耳鸣病程>5年(P<0.05)、轻...     

人工耳蜗植入对成人语后聋患者耳鸣的影响

目的 探讨人工耳蜗植入（CI）对成人语后聋患者耳鸣的影响。方法 回顾性分析88例于我院行人工耳蜗植入的语后聋患者资料,筛选术前有耳鸣的患者分别于术前、术后0.5、1及6个月行耳鸣残疾量表（tinnitus handicap inventory,THI）和视觉模拟评分法（visval analogue scale,VAS）评价患者耳鸣及转归情况。结果 80.7%(71/88)的成人语后聋患者术前伴有耳鸣症状,不同性别患者耳鸣严重程度无差异;THI评分在术后6个月时降低最明显,耳鸣严重程度从术前的重度（38.48±23.95）降至中度（20.59±18.38）,响度也较术前明显减小。青年组患者术后耳鸣改善情况较中年组及老年组更好。使用声音处理器时耳鸣响度明显减小。结论 人工耳蜗植入术可有效改善语后聋成人患者的耳鸣症状,术后耳鸣症状可随时间推移逐渐缓解。青年患者耳鸣症状在术后得到改善的效果更好,所需时间更短。人工耳蜗开机后,声音处理器的使用对耳鸣的抑制有显著而长期的作用。     

人工耳蜗植入对老年性聋伴耳鸣患者的疗效研究

目的　探讨老年性聋伴耳鸣患者人工耳蜗植入术后的听觉和耳鸣康复效果。方法　分析42例老年性聋患者资料,耳鸣组23例,对照组19例。记录人工耳蜗植入前、后患者听觉行为分级、言语可懂度分级、言语识别率和耳鸣组患者耳鸣残疾量表和视觉模拟评分法得分,分析可能影响耳鸣预后的因素。结果　两组比较,患者听觉行为分级（t =16.47,P <0.01）、言语可懂度分级（t =11.93,P <0.01）和言语识别率WRS均较术前有显著提高（t =25.60,P <0.01）。在相同治疗阶段,两组间比较差异无统计学意义（P >0.05）;治疗前、后比较,耳鸣组患者耳鸣残疾量表（t =7.23,P <0.01）和视觉模拟评分法得分（t =5.53,P <0.01） 均较术前显著下降,耳鸣时间、重度耳聋时间及是否佩戴助听器对耳鸣预后无影响（P >0.05）。结论　人工耳蜗植入可有效提高老年性聋患者的听觉言语能力,改善老年性聋伴耳鸣患者的耳鸣症状。     

人工耳蜗植入巡礼

人工耳蜗植入是帮助极重度感音神经性听力损失患者恢复听力和言语交流能力的可靠手段，近十年来在我国取得了长足的进步。人工耳蜗涉及到医学、听力学、生物医学工程学、教育学、心理学和社会学等诸多领域，需要多学科人员的密切配合。本文从植人手术、听力学检查与调试、听觉言语康复等方面，围绕我国近十年来人工耳蜗技术的发展做了回顾和展望，指出目前亟待解决的问题，对人工耳蜗国产化寄予期望。     

人工耳蜗植入与耳鸣

目前,学者们对于耳鸣的研究是建立在公认的Jastreboff[1]耳鸣神经心理模型的基础上,同时也采用了诸如耳鸣残疾量表(tinnitus handicap inventory,THI)[2]或耳鸣问卷[3]等有效问卷     

多导人工耳蜗植入后电极阻抗的初步研究

目的研究多导人工耳蜗植入后电极阻抗变化的特点,对比直电极和弯电极的阻抗差异,为人工耳蜗植入术后的调试提供参考。方法在Nucleus多导人工耳蜗编程调试界面上,应用R126V1.3和NRTV3.0软件,测试11例语前聋儿童在不同时期的阻抗值,并进行分析比较。结果CI24M和CI24Rcontour两种植入体阻抗随时间变化的基本规律是:术中较低,开机时最高,以后随时间推移逐渐降低。CI24Rcontour阻抗高于CI24M。结论人工耳蜗植入体阻抗开机后随时间推移而逐渐降低,新型CI24Rcontour植入体与CI24M相比,其阻抗值在术中至开机后3周内明显要高。     

人工耳蜗植入及其电刺激对不同频率残余听力的影响

目的 从听力学的角度评价人工耳蜗植入的安全性，并进一步探讨人工耳蜗植入及其电刺激对患者不同频率残余听力的影响。方法 筛选出手术前后能够良好配合纯音听力检查、中耳内耳无明显异常、测听条件基本相同的单侧Nucleus人工耳蜗植入者31例，了解并分析其耳蜗植入前后不同频率残余听力的变化情况。结果 经人工耳蜗植入手术及一段时间的耳蜗电刺激后，部分患者植入耳的残余听力会有所保留（66.67%）；植入侧1kHz以下频率段的残余听力较手术前有显著差别，损失最重的是500Hz或1kHz，其次是250Hz；植入侧2、4kHz较手术前无显著差别；非植入侧听力较手术前无显著差别。结论 人工耳蜗植入及耳蜗电刺激对植入耳的残余听力并非完全破坏，对不同的频率会造成不同程度的损害，且1kHz以下频率受损较重。     

语速和耳语对人工耳蜗植入者言语识别效果的影响

目的研究不同语速和耳语式的言语是否会影响人工耳蜗植入者的言语识别效果。方法在本研究中,分别对一组人工耳蜗植入者和一组听力正常者进行以下4种不同说话方式的言语识别率测试：慢速言语、常速言语、快速言语和耳语。测试时,人工耳蜗植入者聆听由扬声器播放的未经处理的言语声,正常受试者聆听经4通道人工耳蜗处理的言语声,二者使用相同的原始测试材料。结果人工耳蜗植入组与正常对照组对4种不同说话方式的言语识别结果相似,当说话语速增加时言语识别率逐渐下降,耳语的识别率最差,对于人工耳蜗植入者来说快速言语的识别率显著低于慢速言语识别率。结论人工耳蜗植入者言语识别效果会随着所聆听言语的语速增加而降低,并且聆听耳语式的言语对人工耳蜗植入者来说是非常困难的。     

多导人工耳蜗植入病人的心理护理

目的分析总结人工耳蜗植入病人的心理特点,探索相应的心理护理方法以促进术后听力言语康复。方法对37例多导人工耳蜗植入病人在手术前、后进行有计划的、系统的心理护理,并总结护理体会。结果37例病人均积极配合手术和术后听力言语康复训练,所有病人恢复至应用听力。结论恰当的心理护理促进了人工耳蜗植入病人术后的听力言语康复。     

Interaction of tinnitus suppression and hearing ability after cochlear implantation

Objectives: To study the postoperative impact of cochlear implants (CIs) on tinnitus, as well as the impact of tinnitus on speech recognition with CI switched on.

Methods: Fifty-two postlingual deafened CI recipients (21 males and 31 females) were assessed using an established Tinnitus Characteristics Questionnaire and Tinnitus Handicap Inventory (THI) before and after cochlear implantation. The tinnitus loudness was investigated when CI was switched on and off in CI recipients with persistent tinnitus. The relation between tinnitus loudness and recipients’ satisfaction of cochlear implantation was analyzed by the visual analogue scale (VAS) score.

Results: With CI ‘OFF’, 42?CI recipients experienced tinnitus postimplant ipsilaterally and 44 contralaterally. Tinnitus was totally suppressed ipsilateral to the CI with CI ‘ON’ in 42.9%, partially suppressed in 42.9%, unchanged in 11.9% and aggravated in 2.4%. Tinnitus was totally suppressed contralaterally with CI ‘ON’ in 31.8% of CI recipients, partially suppressed in 47.7%, unchanged in 20.5%. Pearson correlation analysis showed that tinnitus loudness and the results of cochlear implant patients satisfaction was negatively correlated (r?=?.674, p?Conclusion: The study suggests six-month CI activation can be effective for suppressing tinnitus. The tinnitus loudness may affect patients’ satisfaction with the use of CI.     

Tinnitus after cochlear implantation

Objective

The purpose of this study was to investigate properties of tinnitus which starts after cochlear implantation. Of the 17 adult patients in our cochlear implant group, four (23.5%) who had no pre-implantation tinnitus were eligible for the study.

Methods

Each patient was requested to complete a short questionnaire regarding his or her experience with tinnitus. Tinnitus match test was performed for each patient by using an Interacoustic Clinical Audiometer (model AC40; Assens, Denmark).

Results

Tinnitus match test revealed a tinnitus frequency of a 4 KHz for three and of a 6 KHz for one patient. Mean value of the loudness score was calculated as 17.5 dB SL.

Conclusions

The results of this study emphasize the importance of counseling patients regarding risks of tinnitus after cochlear implantation.     

Tinnitus modifications after cochlear implantation

Tinnitus can be defined as a phantom sensation in the absence of an external sound. In our study, we evaluated the effect of cochlear implant on tinnitus evolution. Among adult, postlingually deaf patients who underwent cochlear implantation at our clinic, we selected 20 subjects with pre-implantation tinnitus (group A) and 10 subjects without pre-implantation tinnitus (group B). Pre- and post-surgery tinnitus was assessed through two questionnaires: the first one dealing with tinnitus characteristics and psychosocial impact, and the second one represented by THI, an internationally validated score of evaluation of the effects of tinnitus on patient’s emotions and activities of daily living. None of the patients belonging to group B developed tinnitus after surgery. As for group A, 40% of patients declared suppression of tinnitus, 30% attenuation of tinnitus after surgery, 25% reported tinnitus was unchanged and 5% reported worsening of tinnitus. In the nine patients with bilateral tinnitus (45%), after implantation tinnitus disappeared from both sides in four patients and attenuated bilaterally in four patients. A comparison between pre- and post-implantation THI scores showed decreased score in 65% of cases, unchanged score in 30% and increased score in 5%. The beneficial effect of cochlear implant on tinnitus, reported by a majority of patients, could be due to acoustic masking, to direct electrical stimulation of the acoustic nerve, and above all to a possible cochlear implantation dependent reorganization of the central auditory pathways and associative cerebral areas. In the light of these results, the authors propose (1) to include tinnitus in the selection criteria of which ear to implant; (2) to consider implantation eligibility for patients with bilateral severe hearing loss associated with severe tinnitus; and (3) to inform patients about the small risk of post-operative tinnitus worsening.     

Investigation of the effect of cochlear implantation on tinnitus,and its associated factors

Abstract

Background: Many studies have focused on the suppressive effects of cochlear implants (CIs) on loudness of tinnitus.

Aims/objective: This study aimed to examine the effects of CIs and their activation on changes in loudness and tinnitus and explore other factors associated with this effect.

Material and methods: We recruited 26?CI recipients according to specific criteria. Participants asked to complete tinnitus questionnaires, while the CI was kept on and at 30?min after the CI was turned off. Tinnitus improvement after CI was tested using Wilcoxon signed rank tests, and correlation was tested using Spearman’s rank correlation coefficients and multiple linear regression.

Results: After CI, tinnitus reduced from 62% to 46%. Total and partial reduction in tinnitus was seen in 76% subjects with pre-CI tinnitus. However, 6% of the subjects had tinnitus since birth, and none showed worsening tinnitus. The average THI score while the CI on was significantly lower than that CI off.

Conclusions: Post-CI tinnitus improvement was seen in 76% of those with pre-CI tinnitus; however, the low risk of new or aggravating tinnitus should be considered, and reasonable expectations for tinnitus reduction should be built into the pre-CI assessment.     

Tinnitus and cochlear implantation

Tinnitus is a common experience, but there is very marked heterogeneity of aetiology, perception and the extent of distress among individuals who experience tinnitus. In view of this, a modern approach to tinnitus should consider homogeneous groups of individuals. This review considers tinnitus experiences in patients undergoing cochlear implantation, this being of interest because the prevalence of tinnitus in this patient group prior to surgery may shed some light on the link between cochlear dysfunction and tinnitus. Second, any change in tinnitus experience as a result of electrode placement surgery or cochlear implant activation has relevance for patient counselling and informed consent. Finally, in recent tinnitus retraining therapy literature there has been the suggestion that unilateral sound therapy for tinnitus patients may set up an unhelpful asymmetry of input to the auditory system, with possible exacerbation of contralateral tinnitus. Unilateral cochlear implant use represents the most dramatic asymmetry possible and hence is a test of that hypothesis. Relevant papers (n = 32) were identified from literature databases. The standard of reporting tinnitus results was inconsistent. Tinnitus is experienced by up to 86% of adult cochlear implant candidates, but is not universal and is only troublesome in a small proportion (reported as 27% in one study). Electrode insertion may induce tinnitus in a small (up to 4%) number of patients, but this is rare. Cochlear implant device use is associated with reduction of tinnitus intensity and awareness in up to 86% of patients, and rarely with exacerbation (up to 9%). There are some indications in the literature that the more complex the simulation strategy, the larger that effect. Specifically, unilateral cochlear implant use was generally associated with reduction of contralateral tinnitus (in up to 67% of individuals) rather than exacerbation, and so the assertion that unilateral sound therapy for tinnitus is contraindicated is not proven.     

Cochlear-motor,transduction and signal-transfer tinnitus: models for three types of cochlear tinnitus

Summary The present paper reviews possible molecular and cellular mechanisms in the cochlea that might contribute to tinnitus. They constitute a part of a highly integrated network in cochlear sound processing and are divided for easier understanding into three different models, i.e. active motor tinnitus, transduction tinnitus and signal-transfer tinnitus. Some of the steps of the pathophysiological models can even be pharmacologically influenced (as exemplified by experimental applications of lidocaine, calcium channel blocker, benzodiazepane, glutamate and atropine). This provides a rationale for the efficient suppression of tinnitus in some patients by these drugs. The most evident problem of all models in tinnitus, including the ones proposed in this paper, is the lack of objective verification by measurement. Thus, the well-defined clinical situation of each patient is hardly attributable to one of the models suggested. In addition, adequate therapy — perhaps one of the drugs considered — still cannot be based upon a reliable clinical finding.Correspondence to: H. P. Zenner     

Cochlear implantation for single-sided deafness and tinnitus suppression

Objective

To quantify the potential effectiveness of cochlear implantation for tinnitus suppression in patients with single-sided deafness using the Tinnitus Handicap Inventory.