long-term evaluaon of cochlear implantaon in subjects with ... · mertens g, de bodt m, van de...
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Long-TermEvalua0onofCochlearImplanta0oninSubjectswithAcquiredUnilateralHearingLoss
andincapacita0ng0nnitusupto10YearsFocusonTinnitusOutcomes
PaulVandeHeyning,MD,PhDGrietMertens,PhD
Relevantfinancialrela0onshipswithcommercialinterests
thatpertaintothecontentofthispresenta0on:
Company:
GrantMED-EL(Innsbruck,Austria)andCOCHLEARpaidtotheins0tu0on
UZA.
TinnitusSubjects TAnnoyance Conclusion
Experimentalset-up• 30acquiredSSD/AHL&incapacita0ng0nnitus*;VAS>6/10
§ Dura0on>2yearand<10years§ IrresponsivetodrugsorTRT/CBT§ 19ptwithSSD§ 11ptwithAHL§ CIwithcompleteelectrodeinser0on(MED-EL)§ Regularficng4weeksaeerCI
• 7ptSSDwithprogressiveelectrodeac0va0onofCI• 3EAS• 1ABI• 2withmajordepression
TinnitusSubjects TAnnoyance Conclusion
TinnitusSubjects TAnnoyance Conclusion
Inclusioncriteria Exclusioncriteria
- SSD/AHLwithTinnitus- Severe0nnitus:0nnitusloudness6-10onVASfor>6months
- Majordepression- Notwillingtoahendrehabilita0onandfollow-up
- Subjec0ve0nnitusduetoipsilateralprofoundSNHLorpar0aldeafness
Othertypesof0nnitus- Standardtreatmentsof0nnitushavenoeffect Dura0onofdeafness>10years?
-Realis0cexpecta0ons
-Normalhearingtomoderatehearingloss
contralaterally(AHL)
-PatentScalatympani
Subjects Tinnitus TAnnoyance Conclusion
ControlCIoffCIon
-12-24mnths
Subjects Tinnitus TAnnoyance Conclusion
KleinePuntAetalCII2011;Suppl1:S26-9&HearRes2013;295:24-9.
Tinnituscharacteris0cs
• Nodifferencebetweenpuretonetype0nnitusnoisetype0nnituspolyphonicsensa0on
• NodifferencebetweenLowpitchMidpitchHighpitch
• Nodifferenceofdura0onofdeafness&0nnitus
Subjects Tinnitus TAnnoyance Conclusion!!
!!!!Figure 4. Scores of the Visual Analogue Scale (VAS) for assessing tinnitus loudness, pre-
operatively, 1, 3, 6, 12, 36 months post-operatively and at the Long-term test-interval. White bars
represent the CIOFF condition (�) and grey bars the CION condition (�).Significant differences (p<
0.01) are indicated with an asterisk (**).
0
1
2
3
4
5
6
7
8
9
10
pre-op 1M 3M 6M 1Y (3Y) LT LT_OFF
** ** **
VandeHeyningPetal.AnnOtolRhinolLaryngol2008;117:645-652MertensG,DeBodtM,VandeHeyningP.HearRes.2016Jan;331:1-6.
Subjects Tinnitus TAnnoyance Conclusion
012345678910VA
S6nn
itus_loud
ness
VandeHeyningPetal.AnnOtolRhinolLaryngol2008;117:645-652MertensG,DeBodtM,VandeHeyningP.HearRes.2016Jan;331:1-6.
Subjects Tinnitus TAnnoyance Conclusion
-10
-8
-6
-4
-2
0
2
SpeechRecep
0onThreshold(dB
SNR)
UnaidedAided0nnitustestcondi0oncontrolcondi0on
ThemeandifferenceinSRTinthenon-0nnitusearbetweenthetwocondi0ons(SRTCIoff-SRTCIon)=1,98dBSNR(SD3,01dBSNR)
MertensG.,KleinePunteA,VandeHeyningPOtolNeurotol2013;34(4):662-6
ContralateralSpe
echPe
rcep
6on
Subjects Tinnitus TAnnoyance Conclusion
-10
-8
-6
-4
-2
0
2
SpeechRecep
0onThreshold(dB
SNR)
UnaidedAided0nnitustestcondi0oncontrolcondi0on
ThemeandifferenceinSRTinthenon-0nnitusearbetweenthetwocondi0ons(SRTCIoff-SRTCIon)=1,98dBSNR(SD3,01dBSNR)
MertensG.,KleinePunteA,VandeHeyningPOtolNeurotol2013;34(4):662-6
ContralateralSpe
echPe
rcep
6on
Subjects Tinnitus TAnnoyance Conclusion
VandeHeyningPetal.AnnOtolRhinolLaryngol2008;117:645-652MertensG,DeBodtM,VandeHeyningP.HearRes.2016Jan;331:1-6.
TQTinnitusQues0onnaire
Lowerisbeher
Subjects Tinnitus TAnnoyance Conclusion!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Figure 6. Median Tinnitus Questionnaire scores for the A_SSD Group and for the B_AHL Group, including the individual
subscale scores; emotional distress, cognitive distress, auditory perceptual difficulties, intrusiveness, sleep disturbance,
and physical complaints. Dark bars (!) indicate pre-operative scores and light bars (!) indicate long-term scores.
Significant differences between both test moments are indicated with an asterisk (*).
TOTAL TQ SCORE Emo. Cogn. Aud. Intr. Sleep. Soma.
0
10
20
30
40
50
60
70
80
0%
20%
40%
60%
80%
100%
0%
20%
40%
60%
80%
100%
0
10
20
30
40
50
60
70
80
TQ s
core
TQ
sco
re
A_SSD
B_AHL
** ** * * * **
* * * *
TQTinnitusQues0onnaire
Lowerisbeher
VandeHeyningPetal.AnnOtolRhinolLaryngol2008;117:645-652MertensG,DeBodtM,VandeHeyningP.HearRes.2016Jan;331:1-6.
Subjects Tinnitus TAnnoyance Conclusion
MertensG,DeBodtM,VandeHeyningP.HearRes.2016Jan;331:1-6.
!
!!!!!Figure 7. Median scores of the Hyperacusis Questionnaire for the A_SSD Group and for the B_AHL Group. Total scores and
the three subscales: Attention, Social and Emotional are shown. Two conditions were surveyed; the CION condition (!) and the
CIOFF condition (!). Significant differences between the CION and the CIOFF condition are indicated with an asterisk (*).
0
10
20
30
40
50
0
10
20
30
40
50
Total Score Attention Social Emotional
A_SSD_Group
B_AHL_Group
Tot
al S
core
T
otal
Sco
re
* * *
HyperacusisQ(Khalfi)
Subjects Tinnitus SoundLocaliza0on Conclusion0 5 10 15 20
7 days a week
5h / day CI Switch-on = first act when rising; CI Switch-off last act before bedtime
Noise Polyphone Pure Tone
≤1 min. >1 - ≤10 min.
When start concentrating
≤1 min. >1 - ≤10 min.
When stop concentrating
Revealed from tinnitus
Tinnitus as primary advantage of CI Hearing as primary advantage of CI
Tinnitus as primary advantage of CI Hearing as primary advantage of CI
!
!
CI
Use
(n
=23)
!
Tin
nitu
s
(n=2
3)
Type of tinnitus
!
Tinnitus starts
decreasing
!
Tinnitus starts to
return!
!
!
AH
L
SSD
(n
= 11
) (
n= 1
2) !
MertensG,DeBodtM,VandeHeyningP.HearRes.2016Jan;331:1-6.
Subjects Tinnitus TAnnoyance Conclusion
Cochlearimplanta6oninUnilateralHearingLossSeeMertensS12at3.45PM
ü Improvedhearingcapabili0es-Speechpercep0oninnoise
-Soundlocaliza0on
ü Decreasingthe0nnitusloudnessanddistress
Unilateralhearinglossandincapacita6ng6nnitusisanewindica6onforCI.
ProgramdirectorsGrietMertensPhDAnoukHosensMaAudAnnickGillesPhDAnBoudewynsMDPhDOlivierVandervekenMDPhDConferenceOrganisa6onSemicoVenueIntFlandersConferenceCenterAntwerpDowntown
Prospects