Severity of Tinnitus Distress Negatively Impacts Quality of Life in Patients With Vestibular Schwannoma and Mimics Primary Tinnitus.

Takashi Kojima,Naoki Oishi,Kaoru Ogawa,Takanori Nishiyama

doi:10.3389/fneur.2019.00389

Abstract

Objective: Quality of life (QoL) and subjective symptoms are predominantly used to evaluate treatment outcome of patients with vestibular schwannoma (VS). However, for patients undergoing conservative treatment—the most frequently used intervention—the association between QoL and subjective symptoms is unclear. Moreover, it is unknown whether VS-related tinnitus could be associated with the audiological and psychological status of the patient. Our overall aim is to provide objective evidence of this association to better guide treatment of VS.Methods: In a prospective study, we analyzed factors that influence VS-related tinnitus and QoL in 72 patients receiving conservative management of unilateral sporadic VS. This was done through questionnaires that assessed QoL, anxiety, depression, and audiological examinations. We used the SF-36 Short Form to assess QoL; the Tinnitus Handicap Inventory, Dizziness Handicap Inventory, Facial Clinimetric Evaluation Scale, Visual Analog Scale for hearing impairment to assess symptoms subjectively; and pure tone audiometry, the speech discrimination for hearing measurements. For psychological status, we used the Hospital Anxiety and Depression Scale. For analyses, we used Pearson correlation analysis and multiple regression between variables and QoL.Results: Correlation and regression analyses revealed that the severity of tinnitus distress had the largest negative impact on QoL in all domains of SF-36. The severity of tinnitus was significantly associated with subjective hearing impairment and the degree of depression and anxiety. Hearing thresholds had no statistical association with severity of tinnitus.Conclusions: To our knowledge, this is the first study to investigate VS-related tinnitus with respect to both patients' hearing status and psychological condition. Our results suggest that tinnitus distress strongly affects VS patients' QoL and that its characteristics are similar to primary tinnitus. An intervention for VS-related tinnitus, therefore, should assess to what extent tinnitus bothers patients, and it should reduce any unpleasant emotions that may exacerbate symptoms. This approach should improve their QoL.

Highlights

Vestibular schwannoma (VS)—or acoustic neuroma—is a benign, slow-growing tumor of myelin-forming cells of the vestibulo-cochlear nerve
Multiple regression analysis revealed that Tinnitus Handicap Inventory (THI) was significantly related to all social functioning (SF)-36 domains, indicating that increasing severity of tinnitus significantly decreased the quality of life (QoL) of our participants (Table 3)
Our results show that tinnitus severity (THI) is the strongest predictor of whether QoL will be affected in conservatively managed VS patients

Summary

Introduction

Vestibular schwannoma (VS)—or acoustic neuroma—is a benign, slow-growing tumor of myelin-forming cells of the vestibulo-cochlear nerve. It usually causes progressive firstly unilateral hearing loss, tinnitus or/and vertigo appear and more progressive cases shows facial paresis. Conservative management using a wait-andscan protocol is adopted for more than half of VS patients [1]. The remaining patients receive active treatment, which includes radiotherapy (gamma knife or cyber knife) and microsurgery for tumor excision [1, 2]. Regardless of whether conservative management or active treatment is selected, quality of life (QoL) is decreased and anxiety is elevated [3, 4]

Methods

Results

Discussion

Conclusion