Tinnitus after cochlear implantation.

Abstract

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.
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).
Tinnitus match test revealed a tinnitus frequency of a 4KHz for three and of a 6KHz for one patient. Mean value of the loudness score was calculated as 17.5dB SL.
The results of this study emphasize the importance of counseling patients regarding risks of tinnitus after cochlear implantation.

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ANL-1125; No of Pages 3
Please cite this article in press as: Akdogan O, et al., Tinnitus after cochlear implantation, Auris Nasus Larynx (2008),
doi:10.1016/j.anl.2008.04.005
Tinnitus after cochlear implantation
Ozgur Akdogana,*, Ibrahim Ozcana, Cem Ozbekb, Huseyin Derec
aAnkara Numune Education and Research Hospital, 4th ENT Clinic, Attending Otolaryngolog Ankara, Turkey
bAnkara Numune Education and Research Hospital, 2th ENT Clinic, Attending Otolaryngolog Ankara, Turkey
cAnkara Numune Educational and Research Hospital, 4th ENT Clinic, Chief Otolaryngolog Ankara, Turkey
Received 25 November 2007; accepted 16 April 2008
Abstract
Objective: The purpose of this study was toinvestigate 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 experiencewith 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: Theresultsofthisstudyemphasizetheimportanceofcounselingpatientsregardingrisksoftinnitusaftercochlearimplantation.
# 2008 Elsevier Ireland Ltd. All rights reserved.
Keywords: Tinnitus; Cochlear implantation; Tinnitus match test
1. Introduction
Tinnitus is defined as a phantom sensation in the absence
of an external sound. Population estimates of adults with
chronic tinnitus range between 6% and 20%, with 1–3%
experiencing severe and disabling tinnitus that interferes
with daily life [1,2].
Theword tinnitus is derived from the Latin word ‘tinnire’
which means ringing. It is distinguished clinically into
subjective and objective types: subjective being when noise
is perceived by patient alone, whilst objective may be heard
by others [3,4].
It is also a frequent symptom in patients with cochlear
implant. There were several reports claming that tinnitus
was suppressed by cochlear implantation [5,6]. The purpose
of this study was to better define characteristics of tinnitus
appearing after cochlear implantation.
2. Materials and methods
Retrospective data collection was performed on post-
lingually implanted patients in our center. Four patients who
had no pre-implantation tinnitus were requested to complete
a short questionnaire regarding his or her experience with
tinnitus. Tinnitus characteristics such as duration and
loudness and causes and duration of deafness were also
evaluated. Tinnitus match test was performed by using an
Interacoustic Clinical Audiometer (model AC40; Assens,
Denmark) for each patient who reported tinnitus.
3. Results
There were 17 adult patients in our cochlear implant
group.Theprevalenceoftinnitusaftercochlear implantation
was found to be 23.5% for this particular cohort. Male/
female ratio was 1/3. Median age of patients was 37 years
(range 23–55). All of the patients complained of tinnitus in
their implanted ears. Two patients had tinnitus all the time
and other two had most of the time.
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* Corresponding author at: Boncuk street 14/8 Kurtulus ¸ Ankara, Turkey.
Tel.: +90 312 4354785; fax: +90 312 3126876.
E-mail address: drozgurakdogan@gmail.com (O. Akdogan).
0385-8146/$ – see front matter # 2008 Elsevier Ireland Ltd. All rights reserved.
doi:10.1016/j.anl.2008.04.005

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Tinnitus was bothersome for all patients and was
interfered with their sleep and concentrating ability.
Exacerbating symptoms included noise in one patient.
The descriptions defined by the patients as ‘‘ring’’ 3
respondents as ‘‘buzz’’1 respondent. Patients were asked
whether they experienced headache or dizziness at the
time of tinnitus. Only one patient had a history of
dizziness and one other reported positive family history
about tinnitus.
Tinnitus match test were performed and 3 of the patients
reported their tinnitus frequency as a 4 KHz, one patient as
6 KHz. Mean value of the loudness score was found as
17.5 dB SL.
4. Discussion
Tinnitus is a common experience for patients with
cochlear implants. Previous studies reported that tinnitus
was suppressed with implants and electrical stimulation was
effective in 77% of the patients [7,8]. In another study, they
claimed that cochlear implantation provides effective
tinnitus suppression but its mechanism was not clearly
defined.Tinnituscharacteristicsinpreandpost-implantation
period were compared in an additional study. Decrease or
increase in tinnitus handicap inventory scores was reported
in 65% and only 5% of the patients, respectively [9]. In
another study, most of the patients (74%) reported that their
cochlear implant was helpful in tinnitus particularly for
implant bearing ear. Contralateral residual inhibition and
tinnitus suppression suggest a central mechanism contribut-
ing to this phenomenon [10]. The relationship between
tinnitus and cochlear implantation is important because it
may affect the implant use. Demajumdar et al. showed in his
study with 99 patients that, there was a marked suppression
of tinnitus after implantation and presence of tinnitus before
and after implantation had no detrimental effects on
performance. Implanting ear with the worst tinnitus was
also recommended [11].
Tinnitus status can change during time after the surgery.
Forinstance,loudnessoftinnitususuallyreportedtoreduce
with time. Duration of tinnitus also reduces but not as
obviously as loudness [12]. In our study tinnitus had started
after implantation and complaint of all patients increased
with time. They all reported that with time both loudness
and pitch of their tinnitus amplified after surgery. Half of
them had continuous tinnitus an others had intermittent
type. All of them reported that frequency of tinnitus
increased by the time and relief in their symptoms after
medical treatment.
Basically, the relationship of cochlear implantation and
pre-implantation tinnitus was discussed in the literature.
However only two studies reported appearance of tinnitus
when cochlear implant activated [13,14]. In another study
included 253 patients with cochlear implant reported
persistent increase in tinnitus after cochlear implant
activated [15]. Although the patients were tinnitus-free
before implantation four had tinnitus following implantation
in our study. In one study, cochlear implant device use was
found to be associated with reduction of tinnitus intensity
and awareness in up to 86% of the patients and rarely with
exacerbation (up to 9%) [13]. In another study only two
patients with tinnitus who had not experienced tinnitus
before was reported [14]. We reported tinnitus in 23.5% of
our patients’ started after cochlear implantation.
Effect of cochlear implantation on vestibular system was
reported several times in literature. Some of patients with
cochlear implant experienced improvement in vestibular
responsiveness [16]. However dizziness after cochlear
implantation was a frequently reported complication
[17,18]. Delayed dizziness can be related to chronic changes
in the inner ear because of the surgery [19]. Same theory
may be true for tinnitus perception after implant surgery.
Tinnitus had started in early post-implantation period and
evolved with time in our study. Tinnitus in our group had a
high pitch and loudness. This characteristic of tinnitus may
be caused by the insertion trauma of the electrode in basal
part of the cochlea.
The results of this study emphasize the importance of
adequately informing the patient of possible tinnitus after
cochlear implantation.
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