Models to predict positive and negative effects of cochlear implantation on tinnitus

Objectives: The effect of cochlear implantation on tinnitus is heterogeneous: implantation does not always reduce tinnitus and may even worsen tinnitus. Therefore, it is important to know which factors influence the consequences of cochlear implantation for tinnitus. To date, no consensus has been reached regarding the factors that influence tinnitus. This study aimed to create prognostic models, using binary logistic regression analyses to predict positive or negative changes in tinnitus after cochlear implantation. Methods: For this study we retrospectively sent two questionnaire packages to 117 cochlear implant patients. Results: In the binary logistic regression analyses of the responses to the questionnaires, it was not possible to create a significant model to predict a positive effect of cochlear implantation on tinnitus. However, a negative effect of cochlear implantation on tinnitus was predictable, using a backward stepwise selection method in a model including the Abbreviated Profile of Hearing Aid Benefit (APHAB) and Tinnitus Handicap Questionnaire (THQ) (P < .001, Nagelkerke R2 = 0.529). Conclusions: Our results suggest that the lower the preoperative tinnitus handicap and the preoperative hearing handicap, the higher the chance that cochlear implantation will worsen tinnitus. More research needs to be done, preferable in a big prospective study, to make this model instrumental for clinical decision making and preoperative patient counselling. However, our results might suggest that preoperative THQ and APHAB screening could be meaningful. Especially in patients who are afraid to develop tinnitus or tinnitus worsening as complication of cochlear implantation. Level of Evidence: 4

Validation of a Dutch version of the Tinnitus Functional Index in a tertiary referral tinnitus clinic

Introduction: Tinnitus is a condition with a subjective nature that requires self-report questionnaires for its assessment. Aspects such as quality of life, sleep or intrusiveness have been addressed by multiple tinnitus questionnaires, but the high responsiveness to treatment effects of the Tinnitus Functional Index (TFI) makes this questionnaire part of the standard practice in tinnitus screening. To date, the TFI has been translated to more than 20 languages and used in more than 22 countries. In this study, the TFI was translated to Dutch and validated through a clinical population in the Netherlands. Methods: After a back-translation procedure, the Dutch TFI was filled-out by 377 patients in the tinnitus outpatient clinic at the Ear, Nose and Throat (ENT) department of the University Medical Center Groningen, in the Netherlands. Reliability and construct validity of the questionnaire were assessed by correlations with one other tinnitus questionnaire (Tinnitus Handicap Inventory, THI) and with three psychological functioning questionnaires (Rand-36, Cantril's ladder and the Hospital Anxiety and Depression Scale (HADS)). The eight-factor structure of the Dutch TFI was tested by means of exploratory factor analysis using three different models (ICM-CFA, ESEM and ESEM-CFA). Results: The Dutch TFI showed a high internal consistency (α = 0.95), and construct validity was proven by moderate-to high-convergent correlations with the THI (r = 0.47–0.79) and by moderate convergent (r = 0.55–0.67) and good-to moderate-divergent (r = 0.12–0.47) correlations with the psychological functioning questionnaires. The eight-factor structure of the TFI was confirmed for the Dutch version by the three models. Conclusion: The Dutch version of the TFI is a reliable instrument for screening tinnitus impact in a clinical population, and its psychometric properties are comparable to the original TFI and other validated tinnitus questionnaires

A Prospective Study of the Effect of Cochlear Implantation on Tinnitus

Previous studies have shown diverse and sometimes even contrary results concerning the effect of cochlear implantation on tinnitus and the factors that can influence this effect. The aim of this prospective questionnaire study was to determine the effects of cochlear implantation on tinnitus and explore which factors can influence the effect of cochlear implantation on tinnitus. Forty-four of the patients implanted in our hospital returned 2 questionnaire packages, i.e., one before the cochlear implantation and one 6 months after implantation. Before implantation, 66% of the patients experienced tinnitus. This study shows that cochlear implantation could help to reduce tinnitus and the tinnitus handicap in at least 28% of the patients with preoperative tinnitus. In 72% of the patients the tinnitus remained after implantation. None of the patients developed tinnitus after implantation. A shorter duration of tinnitus prior to implantation, a more fluctuating type of tinnitus, a higher tinnitus handicap prior to implantation, and a round-window surgical approach might have a positive influence on the effect of cochlear implantation on tinnitus, but further research is necessary to confirm these findings. (C) 2019 The Author(s) Published by S. Karger AG, Basel</p

Außergewöhnliche Manifestation eines Magenkarzinoms mit Meningeosis carcinomatosa und spinaler Metastase

Zusammenfassung: Hintergrund:: Eine Meningeosis carcinomatosa ist eine seltene Komplikation solider Tumoren, wie Mamma-, Bronchial- oder gastrointestinale Karzinome. Klinisch manifestiert sie sich mit einer äußerst variablen Symptomatik wie z. B. radikulären Schmerzen mit oder ohne neurologische Ausfälle sowie Kopfschmerzen bis hin zu halluzinatorischen Reizsymptomen. Fallbeschreibung:: Berichtet wird über den seltenen Fall eines 57-jährigen Patienten mit neurologischen Reiz- und Ausfallsymptomen, hervorgerufen durch eine Meningeosis carcinomatosa und eine spinale Metastase bei einem asymptomatischen Siegelringzellkarzinom des Magens. Trotz kombinierter Radiochemotherapie verstarb der Patient bereits 4 Wochen nach Entlassung aus dem Spital an einer Hirnblutung. Schlussfolgerung:: Die Prognose der Meningeosis carcinomatosa ist bis heute unabhängig vom Primärtumor mit einer mittleren Überlebenszeit von 3-4 Monaten sehr schlech