Postoperative Tinnitus Handicap Inventory Research Articles

Treatment of venous pulsatile tinnitus by compression reconstruction of sigmoid sinus

Background Surgical intervention can effectively treat venous pulsatile tinnitus. Aim/objectives To assess the effectiveness of treating of venous pulsatile tinnitus (VPT) by compression reconstruction of sigmoid sinus (SSCR) under local anesthesia. Material and methods This study retrospectively reviewed 41 patients with VPT in our otolaryngology department between September 2009 and February 2019. Under local anesthesia, all patients were received SSCR. Pre- and postoperative Tinnitus Handicap Inventory (THI) degree and scores were used to evaluate the efficacy of SSCR for VPT. Results Of the 41 patients, 36 patients were followed up from 9 months to 8 years and 5 patients were lost to follow-up and were excluded from the data analysis. SSCR was clinically effective in 86% of patients with complete disappearance in 18 patients (50%), partial remission in 10 patients (28%), slight alleviation in 3 patients (8%), and no change in 5 patients (14%). The pre- and postoperative THI degree and scores were significantly different (p < .001 and p = .002, respectively). Conclusions and significance SSCR under local anesthesia is effective for treating patients with VPT. It is critical to perform a rigorous pre-operative clinical and radiological evaluation to reduce intra- and postoperative complications.

Management of tinnitus in patients with vestibular schwannoma who underwent surgical resection.

To evaluate tinnitus and its management in patients with vestibular schwannoma (VS) who underwent surgery, we investigate the effect of surgical approach or residual hearing on tinnitus severity and the effects of intervention for tinnitus including educational counseling, sound therapy using hearing aids (HAs), and medication (selective serotonin reuptake inhibitors, and SSRIs). Seventy-one subjects of VS patients who underwent surgery were included. Their tinnitus severity was evaluated using the Japanese version of the Tinnitus Handicap Inventory (THI). The relationships between postoperative THI scores and surgery types or residual hearing levels were examined. We also examined longitudinal changes in THI scores and the efficacy of the intervention. Surgery approach, hearing preservation or hearing loss surgery, and residual hearing levels were not significantly related to the postoperative tinnitus severity. In 71 cases, 45 cases did not require any management for tinnitus. On the contrary, 26 patients had at least one episode of tinnitus distress (THI score was greater than or equal to 18). Educational counseling alone was found to be effective in 17 cases out of the 26 cases, and the remaining 9 cases required more intervention than educational counseling alone. We selected sound therapy with HA for 7 cases and administration of SSRI for 2 cases, which was found to be highly effective in 8 cases. Based on the present study, we consider that appropriate management may be possible for tinnitus in the majority of VS patients who underwent surgery.

Postoperative Tinnitus after Vestibular Schwannoma Surgery: A Neglected Entity.

This prospective study analyzes the factors responsible for pre and postoperative persistent tinnitus following vestibular schwannoma (VS) surgery and discusses the possible etiopathogenetic mechanisms. Sixty-seven consecutive patients with unilateral VS operated via the retrosigmoid-suboccipital approach were included in the study. The Cochlear nerve, often unidentifiable from the tumor capsule, was resected during the surgery. Tinnitus Handicap Inventory (THI) score assessed the severity of pre and postoperative tinnitus. Twenty-eight (41%) patients had preoperative tinnitus. Out of those 28 patients, 24(85%) had significantly improvement in postoperative THI score. In 15 of the 24 patients, tinnitus subsided completely. In 3 of the 28 (10%) patients, THI scores were unaltered, and in 1 of the 28 (3.5%) patients, THI scores worsened. In 39 (58.2%) patients without preoperative tinnitus, 4 (10%) developed a new-onset postoperative tinnitus. Patients with severe sensory neural hearing loss (SNHL) had significantly higher incidence of postoperative persistent tinnitus (PPT) (P = 0.00) compared to those with mild-to-moderate SNHL. Patients with profound SNHL, however, had a much lower incidence of PPT (P = 0.007; odds ratio = 0. 0.077; 95% CI: 0.009-0.637). Large (P = 0.07) and giant schwannomas (P = 0.03) VS had an increased risk of PPT. Patients with PPT further analyzed with brain stem auditory evoked response (BAER) showed normal contralateral waveform. Assessment of tinnitus is mandatory during the management of VS as there are high chances (nearly 46%) of PPT. Preoperative tinnitus, linked to the degree of SNHL (higher incidence in severe SNHL compared to mild-to-moderate/profound SNHL), is dependent on an intact cochlear nerve functioning. However, PPT is dependent on other mechanisms (brain stem/ipsilateral cochlear nuclei compression, and cortical reorganization) as it persists despite cochlear nerve resection.

Tinnitus suppression after cochlear implantation in patients with single-sided deafness

BackgroundTinnitus associated with single-sided deafness (SSD) is frequent and often incapacitating, and is difficult to treat. Numerous studies have reported the suppression of tinnitus by electrical stimulation of the acoustic pathway through a cochlear implant (CI), with a low risk of worsening of tinnitus after implantation.ObjectiveThe main aim of this study was to demonstrate the effectiveness of CI as a treatment option in patients with SSD and incapacitating tinnitus.Patients and methodsWe studied the tinnitus-suppression effect of CI in a series of 13 patients with unilateral profound sensorineural hearing loss (SSD), associated with incapacitating tinnitus with normal hearing in the contralateral ear. Tinnitus impact was measured with the Tinnitus Handicap Inventory (THI), and tinnitus severity was measured with the Tinnitus Rating Scale (TRS) before and after CI.ResultsThirteen patients were enrolled in this study, eight men and five women, ranging in age from 24 to 60 years with a mean±SD of 40±10 years. Mean scores for THI and TRS were obtained preoperatively and at 1 and 3 months postoperatively after activation of the CI. Mean scores for the THI total scores ranged from 79.6±7 preoperatively to 12±13.5 at 3 months postoperatively. Mean scores for the TRS ranged from 4.53±0.5 preoperatively to 1.46±0.5 at 3 months postoperatively. The postoperative THI and TRS improved significantly as compared with the baseline preoperative scores (P<0.005).ConclusionThe outcome of the current study supports the belief that CI is not only a treatment option for hearing loss in SSD but also a treatment option to suppress tinnitus.

Change in Tinnitus After Acoustic Neuroma Removal Using a Translabyrinthine Approach. A Prospective Study

IntroductionTinnitus is one of the primary symptoms of vestibular schwannoma (VS) and the effect of surgery is unpredictable. Materials and methodsWe conducted a prospective study of the patients who underwent a translabyrinthine approach for the treatment of their VS (2009–2013) at our Hospital. Patients answered the Tinnitus Handicap Inventory (THI) questionnaire pre- and postoperatively. The clinical charts provided data such as age, gender, tumour size, preoperative audiometry and postoperative facial function. ResultsThe study included 39 patients. Of these, 71.8% suffered from tinnitus: 50% grade I, 17.9% grade II, 10.7% grade III, 21.4% grade IV and 0% grade V. We found no statistical association between tinnitus and the different variables measured preoperatively. Postoperatively, 48.7% of the patients suffered from tinnitus: 31.6% grade I, 36.8% grade II, 10.5% grade III, 15.8% grade IV and 5.3% grade V. The difference between mean pre- and postoperative THI was statistically significant (P=.011); this difference was greater in younger patients. We have found a significant negative correlation (r=−0.335; P=.037) between preoperative audiometry and postoperative THI. ConclusionsWe did not find any significant association between tinnitus and age, gender, tumour size and postoperative facial function. Translabyrinthine surgical removal of VS in these patients led to better THI results, with the younger patients having better outcomes. The patients with poorest preoperative audition were the ones that had the best results in the postoperative THI questionnaire.

Sigmoid Sinus Wall Reconstruction for Pulsatile Tinnitus Caused by Sigmoid Sinus Wall Dehiscence: A Single-Center Experience.

ObjectiveTo evaluate clinical characteristics and present surgical outcomes of PT caused by sigmoid sinus wall dehiscence (SSWD)MethodsThis study retrospectively reviewed 34 patients with PT who were diagnosed with SSWD in our institution between December 2008 and July 2013. Among them, 27 patients underwent sigmoid sinus wall reconstruction (surgery group) and 7 patients refused surgery (non-surgery group). Preoperative data were obtained from the patients’ medical records. All patients were followed up regularly for at least 25 months. Preoperative and postoperative computed tomography angiography (CTA) images were compared. Student’s t-tests were used to compare age, body mass index (BMI) and preoperative Tinnitus Handicap Inventory (THI) scores between the surgery and the non-surgery groups and to compare pre- and follow-up THI scores.ResultsThere was no significant difference in age, body mass index, or preoperative THI scores between groups. Following surgery, 14 patients had complete resolution, 5 had partial resolution, 7 experienced no change and PT was aggravated in 1 patient. The difference between preoperative and postoperative THI scores was significant. No severe complications were found postoperatively. Comparison of the preoperative and postoperative CTA images revealed that remnant unrepaired dehiscences were the cause of unsatisfactory outcomes following surgery. In the non-surgery group, PT remained largely unchanged.ConclusionsSigmoid sinus wall reconstruction is an effective and safe treatment for PT caused by SSWD. It is imperative that all regions of the dehiscence are sufficiently exposed and resurfaced during surgery.

Estudio prospectivo de la evolución del acúfeno tras exéresis por vía translaberíntica del neurinoma del acústico

IntroductionTinnitus is one of the primary symptoms of vestibular schwannoma (VS) and the effect of surgery is unpredictable. Materials and methodsWe conducted a prospective study of the patients who underwent a translabyrinthine approach for the treatment of their VS (2009-2013) at our Hospital. Patients answered the Tinnitus Handicap Inventory (THI) questionnaire pre- and postoperatively. The clinical charts provided data such as age, gender, tumour size, preoperative audiometry and postoperative facial function. ResultsThe study included 39 patients. Of these, 71.8% suffered from tinnitus: 50% grade I, 17.9% grade II, 10.7% grade III, 21.4% grade IV and 0% grade V. We found no statistical association between tinnitus and the different variables measured preoperatively. Postoperatively, 48.7% of the patients suffered from tinnitus: 31.6% grade I, 36.8% grade II, 10.5% grade III, 15.8% grade IV and 5.3% grade V. The difference between mean pre- and postoperative THI was statistically significant (P=.011); this difference was greater in younger patients. We have found a significant negative correlation (r=–0.335; P=.037) between preoperative audiometry and postoperative THI. ConclusionsWe did not find any significant association between tinnitus and age, gender, tumour size and postoperative facial function. Translabyrinthine surgical removal of VS in these patients led to better THI results, with the younger patients having better outcomes. The patients with poorest preoperative audition were the ones that had the best results in the postoperative THI questionnaire.

Clinical evaluation of inner ear changes as result of chronic otitis media and its surgery.

This study aims to evaluate whether chronic otitis media (COM) may cause inner ear damages or middle ear surgery may improve this damage with regard to sensorineural hearing loss (SNHL) and tinnitus and dizziness-related disability. An observational prospective study was performed on a series of 65 patients (41 males, 24 females; mean age 26.4±12.6; range 11 to 62 years) who were diagnosed with COM and were scheduled for surgical intervention at the Department of Otorhinolaryngology of the Haydarpasa Numune Education and Research Hospital. Patients were divided into two subgroups as tympanoplasty and mastoidectomy group according to the surgical procedure. Standard patient work-up included otomicroscopy, pure tone audiometry and completion of the Turkish translation of Dizziness Handicap Inventory (DHI) and Tinnitus Handicap Inventory (THI) before surgery and eight weeks after surgery. We found higher bone conduction thresholds in the group of patients with mastoidectomy preoperatively. There was a statistically significant difference in the mean preoperative and postoperative THI and DHI scores between the groups (p<0.05). Our study results suggest that a successful surgery results in improved tinnitus and vertigo symptoms in patients with COM.