Eine Cochlea-Implantat-Versorgung reduziert langfristig die Tinnitusbelastung bei älteren Patienten

Zusammenfassung

Hintergrund Tinnitus gehört bei hochgradig schwerhörigen bzw. ertaubten Patienten zu den häufigsten otologischen Komorbiditäten. Das Cochlea-Implantat (CI) kommt vermehrt auch bei älteren Patienten zur Hörrehabilitation erfolgreich zum Einsatz. Ziel dieser Nachuntersuchung war die Beurteilung der Tinnitusbelastung im Langzeitverlauf bei älteren Patienten nach Hörrehabilitation mittels CI.

Material und Methode In diese prospektive longitudinale Untersuchung konnten 15 Patienten zwischen dem 72. und 92. Lebensjahr mit einem präoperativen unstillbaren Tinnitus eingeschlossen werden, die vor etwa 6 Jahren erstmalig unilateral mit einem CI versorgt wurden. Es erfolgte die Erhebung des Einsilbersprachverstehens sowie der Tinnitusbelastung mithilfe des Mini-Tinnitus-Fragebogens. Die Ergebnisse wurden mit unserer vorangegangenen Untersuchung [24], in der wir die ersten 6 Monate nach CI-Versorgung betrachteten, verglichen.

Ergebnisse Sechs Jahre postoperativ kam es zu einer nicht signifikanten Zunahme des Einsilbersprachverstehens auf 61,7±26,3%, verglichen mit den Ergebnissen 6 Monate postoperativ (p=0,069). Die Belastung durch den Tinnitus zeigte sich 6 Jahre postoperativ mit 3,9±3,6 Punkten im Mittel, verglichen mit der 6-Monats-Kontrolle, stabil niedrig (p=0,689) und deutlich reduziert zum präoperativen Status mit 6,9±6,5 Punkten (p=0,016).

Schlussfolgerung Die Hörrehabilitation mit CI führt bei älteren Menschen zu einer anhaltenden Verbesserung der Einsilberdiskrimination und zu einer langfristigen Reduktion der Tinnitusbelastung.

Abstract

Background Tinnitus is one of the most common otologic comorbidities, particularly in older patients with severe hearing loss or deafness. Cochlear implants (CI) have been used for hearing rehabilitation more and more successfully in elderly patients and CI treatment is performed in Germany without an age limit. The aim of this follow-up study was to assess the tinnitus burden in the long-term follow-up of elderly patients with hearing rehabilitation using CI.

Material and Methods This prospective longitudinal study included 15 patients between 72 and 92 years of age with preoperative tinnitus who had been treated unilaterally with a CI for the first time about six years ago. Monosyllabic speech understanding and tinnitus burden were assessed using the Mini-Tinnitus Questionnaire. The results were compared with our previous study [24], focusing on the first six months.

Results Six years postoperatively, there was a nonsignificant increase in monosyllabic understanding to 61.7 ± 26.3%, compared with the results six months postoperatively (p = 0.069). The burden of tinnitus showed a stable low mean of 3.9 ± 3.6 points six years postoperatively, compared with the six-month control (p = 0.689) and significantly reduced compared to the preoperative status with 6.9 ± 6.5 points (p = 0.016).

Conclusion Hearing rehabilitation by using CI leads to a stable improvement of monosyllabic discrimination in elderly people as well as to a stable reduction of tinnitus burden over years.

Schlüsselwörter

Tinnitus - Cochlea-Implantat - Langzeitverlauf - Alter - Hörrehabilitation

Keywords

tinnitus - cochlea implant - long term - elderly - hearing rehabilitation

Publication History

Received: 23 January 2024

Accepted after revision: 30 April 2024

Article published online:
06 June 2024

• Literatur

• 1 Stattrop U, Goebel G. Tinnitus – durchaus ein Fall für Psychiater und Neurologen. DNP 2019; 20: 21-28
• 2 Jarach CM, Lugo A, Scala M. et al. Global prevalence and incidence of tinnitus: A systematic review and meta-analysis. JAMA Neurology 2022; 79: 888-900
• 3 Tziridis K, Friedrich J, Brüeggemann P. et al. Estimation of tinnitus-related socioeconomic costs in Germany. IJERPH 2022; 19: 10455
• 4 Han KM, Ko YH, Shin C. et al. Tinnitus, depression, and suicidal ideation in adults: A nationally representative general population sample. J Psychiatr Res 2018; 98: 124-132
• 5 Hildebrandt J, Koehler U, Conradt R. et al. Schlafstörungen bei Patienten mit chronischem Tinnitus. LRO 2024; 103 (01) 47-52
• 6 Oosterloo BC, Croll PH, Baatenburg de Jong RJ. et al. Prevalence of Tinnitus in an aging population and its relation to age and hearing loss. Otolaryngol Head and Neck Surg 2021; 164: 859-868
• 7 Hackenberg B, Döge J, Lackner KJ. et al. Hearing loss and its burden of disease in a large German cohort-hearing loss in Germany. The Laryngoscope 2022; 132: 1843-1849
• 8 Hackenberg B, O’Brien K, Döge J. et al. Tinnitus prevalence in the adult population – results from the Gutenberg Health Study. Medicina 2023; 59: 620
• 9 Bourn SS, Goldstein MR, Morris SA. et al. Cochlear implant outcomes in the very elderly. Am J Otolaryngol 2022; 43: 103200
• 10 Aimoni C, Ciorba A, Hatzopoulos S. et al. Cochlear implants in subjects over age 65: Quality of life and audiological outcomes. Med Sci Monit 2016; 22: 3035-3042
• 11 Chatelin V, Kim EJ, Driscoll C. et al. Cochlear implant outcomes in the elderly. Otol Neurotol 2004; 25: 298-301
• 12 Wong DJ, Moran M, O’Leary SJ. Outcomes after cochlear implantation in the very elderly. Otol Neurotol 2016; 37: 46-51
• 13 Buchman CA, Fucci MJ, Luxford WM. Cochlear implants in the geriatric population: benefits outweigh risks. Ear Nose Throat J 1999; 78: 489-494
• 14 Dillon MT, Buss E, Adunka MC. et al. Long-term speech perception in elderly cochlear implant users. JAMA Otolaryngol Head Neck Surg 2013; 139: 279-283
• 15 Andries E, Bosmans J, Engelborghs S. et al. Evaluation of cognitive functioning before and after cochlear implantation in adults aged 55 years and older at risk for mild cognitive impairment. JAMA Otolaryngol Head Neck Surg 2023; 149: 310-316
• 16 Völter C, Götze L, Kamin ST. et al. Can cochlear implantation prevent cognitive decline in the long-term follow-up?. Front Neurol 2022; 13: 1009087
• 17 Issing C, Baumann U, Pantel J. et al. Impact of hearing rehabilitation using cochlear implants on cognitive function in older patients. Otol Neurotol 2021; 42 (08) 1136-1141
• 18 Issing C, Baumann U, Pantel J. et al. Cochlear implant therapy improves the quality of life in older patients – A prospective evaluation study. Otol Neurotol 2020; 41 (09) 1214-1221
• 19 Issing C, Holtz S, Loth AG. et al. Long-term effects on the quality of life following cochlear implant treatment in older patients. Eur Arch Otorhinolaryngol 2022; 279 (11) 5135-5144
• 20 Walia A, Bao J, Dwyer N. et al. Predictors of short-term changes in quality of life after cochlear implantation. Otol Neurotol 2023; 44: e146-e154
• 21 Jayakody DMP, Friedland PL, Nel E. et al. Impact of cochlear implantation on cognitive functions of older adults: Pilot Test Results. Otol Neurotol 2017; 38: e289-e295
• 22 Weichbold V, Zelger P, Galvan O. et al. 5-year observation period of quality of life after cochlear implantation. Otol Neurotol 2023; 44: e155-e159
• 23 Baguley DM, Atlas MD. Cochlear implants and tinnitus. Prog Brain Res 2007; 166: 347-355
• 24 Issing C, Baumann U, Pantel J. et al. Die Hörrehabilitation mittels Cochlea-Implantat – Eine Möglichkeit der Tinnitus-Reduktion im Alter. LRO 2021; 100: 285-290
• 25 Holder JT, O’Connell B, Hedley-Williams A. et al. Cochlear implantation for single-sided deafness and tinnitus suppression. Am J Otolaryngol 2017; 38: 226-269
• 26 Olze H, Szczepek AJ, Haupt H. et al. The impact of cochlear implantation on tinnitus, stress and quality of life in postlingually deafened patients. Audiol Neurootol 2012; 17: 2-11
• 27 Goebel G, Hiller W. Tinnitus-Fragebogen (TF). Göttingen: Hogrefe Verlag; 1998
• 28 Nondahl DM, Cruickshanks KJ, Dalton DS. et al. The impact of tinnitus on quality of life in older adults. J Am Acad Audiol 2007; 18: 257-266
• 29 Hilly O, Hwang E, Smith L. et al. Cochlear implantation in elderly patients: stability of outcome over time. J Lar Otol 2016; 130: 706-711
• 30 Wilkerson BJ, Porps SF, Babu SC. The impact of comorbidities in the aging population on cochlear implant outcomes. Otol Neurotol 2017; 38: e285-e288
• 31 Yang Z, Cosetti M. Safety and outcomes of cochlear implantation in the elderly: A review of recent literature. J Otol 2016; 11: 1-6
• 32 Olze H, Gräbel S, Förster U. et al. Elderly patients benefit from cochlear implantation regarding auditory rehabilitation, quality of life, tinnitus, and stress. The Laryngoscope 2012; 122: 196-203
• 33 Kloostra FJ, Arnold R, Hofman R. et al. Changes in tinnitus after cochlear implantation and its relation with psychological functioning. Audiol Neurotol 2015; 20: 81-89
• 34 Knopke S, Grabel S, Forster-Ruhrmann U. et al. Impact of cochlear implantation on quality of life and mental comorbidity in patients aged 80 years. The Laryngoscope 2016; 126: 2811-2816
• 35 Quaranta N, Wagstaff S, Baguley D. Tinnitus and cochlear implantation. Int J Audiol 2004; 43: 245-251
• 36 Mikkelsen KS, Ovesen T, Swan CZ. Pre- and post-operative dizziness, tinnitus, and taste disturbances among cochlear implant recipients. J Lar Otol 2017; 131: 309-315
• 37 Stöver T, Plontke SK, Guntinas-Lichius O. et al. Struktur und Einrichtung des Deutschen Cochlea-Implantat-Registers (DCIR). HNO 2023; 71: 767-778
• 38 Stöver T, Plontke SK, Guntinas-Lichius O. et al. Konzeption und Implementierung eines Zertifizierungssystems zur Qualitätssicherung der Cochlea-Implantat-Versorgung in Deutschland. HNO 2023; 71: 396-407