Outcomes and Tinnitus Treatment with Cochlear Implants in Single

OutcomesandTinnitusTreatmentwithCochlear
ImplantsinSingle-SidedDeafnessPa<ents
Preliminaryresults
Chris&nePoncet-Wallet,ChristopheVincent,OlivierSterkers,IsabelleMosnier,
BenoitGodey,EmmanuelLescanne,EricTruy,NicolasGuevara,BrunoFrachet
Conflictofinterests
O&conMedicalissponsoringthestudyandmypar&cipa&ontotheconference.
Nootherconflictofinterestexists,noneoftheexperimenterscollabora&ngtotheproject
werepaidfortheirpar&cipa&on.
Objec<ves Methods Results
Conclusions
Promoter:O&conMedical(Vallauris,France)
• 
27par<cipantswithSSD(singlesideddeafness)associatedwithdisabling<nnitus.
Contralateralhearingnormalorclosetonormal.
• 
7centers(ParisRothschild,Lille,ParisPi&é,Rennes,Tours,Lyon,Nice)
•  Objec<ves
Evaluatetheeffectofelectricals&mula&onon&nnitus
•  Secondaryobjec<ves
EvaluatethebenefitinspeechintelligibilityprovidedbytheCI(cochlearimplant)for
pa&entswithSSD
Objec<ves Methods Results
Conclusions
Inclusioncriteria
- 18+yearsold
- Unilateralseveretoprofoundperceptualdeafnessassociatedwithdisabling<nnitus.
- Normalornearnormalhearingontheotherear
- Disabling<nnitus:THI(<nnitushandicapinventory)>58andVAS(visualanologscale)≥8for
<nnitusnuisance
-Par&cipantsunresponsivetousual&nnitustreatments
-Tinnitusdura&onbetween1and15years
Exclusioncriteria
-Deafnessrelatedtoatumoroftheauditorynerve
-Tinnitusrelatedtoextra-cochlearpathology
-Cochlearossifica&on
-Centralneurologicalpathology
-Pulsingorfluctua&ng&nnitus
-Middleearinfec&onortympanicperfora&on
-DepressionwithBDI(BeckDepressionInventory)>16ornega&verecommenda&onfromthe
psychologist/psychiatrist.
Objec<ves • 
Methods Results
Conclusions
V1–V2:inclusion
•  V3:implanta&on
•  V5:whitenoiseac&va&on:whitenoises&mula&ononly(noenvironmentalsounds)
•  V6:(1monthpostac&va&on)standards&mula&on:s&mula&onbyenvironmentalsounds,likea
standardIC
•  V7:(M1:1monthpoststandardac&va&on)fi]ngandcontrols
•  V8:fi]ngandcontrols
•  V9:fi]ng+intelligibilitytests
•  V10:fi]ng+intelligibilitytests
Cochlear
Implanta<on
V1-2
3
Onemonth
White
noise
5
6
Standards<mula<on
7
M1
8
9
M3
M6
10
M12
Objec<ves Methods Results
Conclusions
27par&cipantshavebeenincludedinthestudy
Tothisday,15pa<entscompletedthestudy:resultsforthese15cases
• 
• 
Cochlear
Implanta<on
V1-2
3
Onemonth
27pa&ents
White
noise
5
6
Standards<mula<on
7
M1
25pa&ents
8
9
M3
M6
17pa&ents
10
M12
15pa&ents
Objec<ves Methods Results
Conclusions
1.Tinnitusevalua<on
Twovisualanalogscale(VAS):loudnessanddistress
Threeques8onnaires:
•  TinnitusHandicapInventory(THI)self-report&nnitushandicapmeasure.Evaluatethe
difficul&esexperiencedineverydaylifeac&vi&esandemo<onaldifficul&es.
• 
Tinnitus Reac<on Ques<onnaire (TRQ) evaluate the general psychological distress
associatedwith&nnitus
• 
Subjec<ve<nnitusSeverityScale(STSS)evaluate&nnitusseverity
Objec<ves Methods Results
Conclusions
1.Tinnitusevalua<on
SignificanteffectsofCIon<nnitusreduc<onforallmeasures(THI,TRQ,STSSandVAS).
However,2par<cipantswithdrewfromthestudyatV8(3monthspost-standard
ac&va&on)becauseofalackofbenefitorincreaseof&nnitus.
Objec<ves Methods Results
Conclusions
*p<0.05(Bonferronicorrected)
THI:
TinnitusHandicapInventory
emo&onalandeveryday
lifeaspects
implanta<on
Maineffect
p<0.0001
Pre-CI Whitenoise Standards<mula<on
*p=0.009(Bonferronicorrected)
implanta<on
VAS:
VisualAnalogScale
Catastrophic
Severe
Moderate
Mild
Slight
Maineffect
p<0.0001
Methods TRQ:
TinnitusReac<onQues<onnaire
Psychological
distress
Maineffect
p<0.0001
Conclusions
Significantpsychologicaldistress
STSS:
Pre-CI Whitenoise
Subjec<ve<nnitusSeverityScale(STSS)
Severity
Significantdistress
Nodistress
Standards<mula<on
*p=0.03(Bonferronicorrected)
Severe
implanta<on
Maineffect
p<0.0001
Results
*p=0.03(Bonferronicorrected)
implanta<on
Objec<ves Moderate
Mild
Objec<ves Methods Results
Conclusions
2.Speechintelligibilitymeasures
Speechinnoise
Singleword(Fourniermonosyllabic)intelligibilityinfreefield,normalhearingearunplugged.
Percentofwordscorrectlyiden&fiedmeasured:
•  Withandwithoutthespeechprocessor
•  2SNR:-3dBand+5dB
•  In3differentspa&alconfigura&ons
Speechinquiet:resultscollectedduringspeechtherapyrou9nevisit
Singlewordandsentenceintelligibility,withmaskingofcontrolateralear
Objec<ves Methods Results
Conclusions
2.Speechintelligibilitymeasures
BenefitofCIonspeechintelligibilityinallcondi&ons.
IntelligibilitywithCIonlydevelopsover&me.
Objec<ves N=15pa<ents
Methods Results
Conclusions
Visit10,12monthspost-ac8va8on
EffectofCIOFF/ON
p=0.02
BeherglobalperformancewithCIONthanOFF.
Nosignificantinterac<onwiththeotherfactors(condi&onandSNR).
Objec<ves N=15pa<ents
Methods Results
Conclusions
Visit10,12monthspost-ac8va8on
Nbofsubjects
BeeerwithCI
Same
Worse
%correctresponses
WithoutCI
WithCI
Par<cipants
Largevariability,butmostpar&cipantsperformbeeerwiththeCIinallcondi&ons
Objec<ves N=10pa<ents
Methods Results
Visit10,12monthspost-ac8va8on
Resultscollectedduringspeechtherapyrou<nevisit
ICalone,otherearmasked
Conclusions
Speechinquiet:
Singlewordandsentence
intelligibility,
withmaskingofcontralateral
ear
IntelligibilitywithCIonlydevelopsover&me.
Objec<ves Methods Results
Conclusions
Resultscollectedduringspeechtherapyrou<nevisit
3.Localiza<on
-Whitenoise
-5loudspeakers
-1loudspeakershif:45°degreeoferror
3differentscores:
-  Score/15(numberofgoodresponses)
-  Difficulty(1pointper45°oferror)
-  Meanerrordegree
CI
Objec<ves Methods Results
Resultscollectedinequippedcenters
3.Localiza<on
BenefitofCIonlocaliza<onabili<es.
Conclusions
Objec<ves N=5pa<ents
Methods Results
Conclusions
Localiza8on
Resultscollectedin
equippedcenters
WithoutCI
WithCI
Beherlocaliza<onwithCI:higherscore,lessdifficulty,smallerdegreeoferror
Objec<ves Methods Results
Conclusions
4.Rela<onshipbetween<nnitusandspeechintelligibilty
Correla<onanalyses.Predic<onofoverallimprovementon<nnitusrelatedscoreswith
•  Numberofhoursofeverydayuse
•  Scoresatspeechinnoisetests
•  DifferencebetweenCIONandCIOFFinnoisetests
•  PTA(puretoneaveragethresholds)
àNosignificantcorrela&onwithPTAornumberofhours,ofdailyuse
àSignificantcorrela<onwithspeechinnoisescores(R2=0.73p=0.04)
Highestcorrela&onswithbenefitofCIinS0N0(R=0.63,p=0.05)andS0NICcondi<ons
(R=0.70,p=0.02)
Objec<ves • 
• 
• 
• 
• 
• 
Methods Results
Conclusions
Preliminaryresults
Posi<veeffectofelectricals&mula&onon<nnitusformostpa&ents:
–  Inaverage,betweenpre-implantand12monthspost-ac&va&on:
•  Emo&onalandeverydayeffectsof&nnitusdropfrom«Catastrophic»to«Mild»
•  Tinnitusseveritydropsfrom«Severe»to«Mild»
•  Psychologicaldistressdecreasefrom56à22(20:nodistress)
•  VASdropsfrom8à5-4
However,2par<cipantswithdrewfromthestudybecauseofalackofbenefitorincreaseof&nnitus.
Aeen&onshifsfrom&nnitustothedesiretohearbeeer.
BenefitofCIonspeechintelligibility.
BenefitofCIonlocaliza<onabili<es.
Correla<onbetweengaininspeechintelligibilityand<nnitusreduc<on
Thanks
Chris&nePoncet-Wallet,ChristopheVincent,OlivierSterkers,
IsabelleMosnier,BenoitGodey,EmmanuelLescanne,EricTruy,
NicolasGuevara,BrunoFrachet
Objec<ves Methods Results
Conclusions
4.Rela<onshipbetween<nnitusandspeechintelligibilty
R2=0.73
p=0.04
R=0.63,p=0.05
R=0.70,p=0.02
àSignificantcorrela&onwithspeechinnoisescores.Highestcorrela&onswithbenefitofCIinS0B0
andS0BICcondi<ons
Authors
N
Stats
Follow
up
(months)
Localisa<on
Speech
Tinnitus
Comments
Punte1
26
VASSp<0.001
TQp<0.001
1to24
NA
NA
VAS
Tinnitusabolished(withCIon)in3pa&ents,2
pa&entswithCIoff
Ramosetal.2012
10
NA
≥3
NA
NA
THI,VASdistress
Noimprovementfor1pa&ent.Suppressionin
2cases,decreasein7.
Arndtetal.2011
10
ComparisonCI/unaided
S0N0NS;SCINHES;
SoundLocalisa&onS;TinnitusS
6
7loudspeakers
HSM,OISa
VAS-distress
Firsztetal.2012
10
Localiza&onp<0.05;speechpercep&onTIMIT
p<0.05forpa&entswithHA
6and12
15loudspeakers,10°
apart
CNC,HINT,
TIMIT
N/A
Stelzigetal.2011
4
N/A
6
N/A
HSM,OISa
N/A
TavoiraVieiraet
al.2015
28
S0N0,S0NHE,SCINHE(p<0.005),Tinnitus
(p=0.011)
12and24
N/A
BKB-SIN
TRQ
Vermeireetal.
2008
20
S0N0NS,S0NCIforHAgrouponlyp=0.03,
SCIN0(p<0.04)
12
N/A
LIST
N/A
2subjectssmallornega&veeffectson&nnitus
Punteetal.2013
7
VASandTQp=0.04
1,3and6
N/A
N/A
VASloudness;TQ
Tinnitusreduc&onminimalfor2subjects,
howevers&llusingCI
Mertensetal.
2013
15
VAS(CION/OFF)p<0.01
12
N/A
N/A
VASloudness;TQ
Buechneretal.
2010
5
12
N/A
OISa
VASloudnessand
distress
VandeHeyning
etal.2008
22
VASp<0.01;TQp<0.01
24
Cardieuxetal.
2013
5
Speechandlocaliza&onimprovementfor3
subjectswithHAoutof5subjects
6
15loudspeakers,10°
apart
CNC,HINT,
BKN-SIN
Us
15
SpeechS0N0,SCIN0,S0NCI:global
improvementwithCIp=0.02;THI,TRQ,STSS,
VASloudnessanddistress(p<0.05);
localiza&on
1,2,3,6
and12
5loudspeakers45°
apart
Fournier
monosyllabic
Benefiton&nnitusvarieswithcondi&onsand
pa&ents
VASloudness;TQ
THI,TRQ,STSS,
VASloudnessand
distress
2pa&entslefthestudyat3monthsbecause
oflackofimprovmentorworseningofthe
&nnitus