单侧耳聋患者人工耳蜗植入后的耳鸣结局：一项探索性前瞻性多中心研究。

文献信息

中文摘要

背景： 耳鸣被认为可通过人工耳蜗植入（CI）部分逆转听觉传入剥夺而被抑制。通过刺激传入剥夺的听觉通路，多项研究显示，在接受CI的患者中，66%-92%的患者耳鸣得到显著抑制。本研究旨在评估CI作为耳鸣治疗手段的疗效，并探讨单侧耳聋（SSD）患者CI后的听力学结局。方法：2018年11月至2020年7月，在三家三级转诊医院前瞻性招募了10例诊断为SSD并伴有耳鸣的患者。本研究参与者同意接受CI作为耳鸣治疗。测量术后助听听纯音测听（PTA）和言语识别率（WRS）。 administered与耳鸣相关的问卷，如耳鸣残疾量表（THI）和视觉模拟量表（VAS）评分，包括响度、痛苦和感知。此外，获取耳鸣图以进行响度和音调匹配。将CI的听力学结局与耳鸣图音调匹配结果结合分析。结果：所有10例患者完成了设备开启评估，9例患者完成了设备关闭评估。THI评分在CI后3个月在设备开启和设备关闭条件下均显示统计学显著改善（术前：78；设备开启：38，p = 0.027；设备关闭：50，p = 0.049）。VAS评分在CI后也显示显著改善（术前：8.2；设备开启：3.3，p = 0.011；设备关闭：6.5，p = 0.012）。4例患者在CI后表现出心理声学耳鸣特征的变化：2例变为更低频率，1例变为更高频率，1例患者的耳鸣从白噪声变为特定可识别的频率。在音调匹配频率的阈值（T级和C级）变化方面没有显著趋势。结论：与既往文献一致，这项探索性多中心研究表明，在单侧耳聋伴耳鸣患者中，CI后耳鸣响度和痛苦得到改善，并且在设备激活时观察到耳鸣强度有更大降低的趋势。此外，约一半患者在CI后表现出耳鸣心理声学特征的变化。鉴于样本量小且缺乏非植入对照组，这些发现应被视为探索性和产生假设性的，并需要在足够把握度的对照试验中加以证实。

英文摘要

Tinnitus is thought to be suppressed through partial reversal of auditory deafferentation via cochlear implantation (CI). By stimulating the deafferented auditory pathway, multiple studies have revealed that tinnitus is significantly suppressed in 66-92% of patients undergoing CI. This study aimed to evaluate the efficacy of CI as a treatment for tinnitus and to investigate post-CI audiologic outcomes in patients with single-sided deafness (SSD). From November 2018 to July 2020, 10 patients who were diagnosed with SSD and suffering from tinnitus were prospectively recruited at three tertiary referral hospitals. Participants in this study agreed to undergo CI as a treatment for tinnitus. Postoperative aided pure tone audiometry (PTA) and word recognition score (WRS) were measured. Questionnaires related to tinnitus, such as the tinnitus handicap inventory (THI) and visual analogue scale (VAS) scores including loudness, distress, and perception, were administered. Additionally, a tinnitogram was obtained for loudness and pitch matching. Audiological outcomes of CI were analyzed in conjunction with the results of pitch-matching from the tinnitogram. All 10 patients completed device-on evaluations, and 9 patients completed device-off evaluations. THI scores showed statistically significant improvement 3 months after CI in both the device-on and device-off conditions (preoperative: 78; device on: 38, p = 0.027; device off: 50, p = 0.049). VAS scores also demonstrated significant improvement after CI (preoperative: 8.2; device on: 3.3, p = 0.011; device off: 6.5, p = 0.012). Four patients demonstrated changes in psychoacoustic tinnitus features after CI: 2 changed to lower frequency, 1 changed to higher frequency, and 1 patient's tinnitus changed from white noise to a specific identifiable frequency. There was no significant tendency for threshold (T-level and C-level) changes in pitch-matching frequency. In line with previous literature, this exploratory multicenter study demonstrated improvement in tinnitus loudness and distress after CI in patients with single-sided deafness and tinnitus, with a tendency for greater reduction in tinnitus intensity observed when the device was activated. Additionally, approximately half of the patients showed changes in the psychoacoustic characteristics of tinnitus after CI. Given the small sample size and the absence of a non-implanted control group, these findings should be regarded as exploratory and hypothesis-generating, and warrant confirmation in adequately powered controlled trials.