Patient Benefit Following Bimodal CI-provision: Self-reported Abilities vs. Hearing Status

Objectives: Patient-reported outcomes gain importance for the assessment of auditory abilities in cochlear implant users and for the evaluation of auditory rehabilitation. Aims of the study were to explore the interrelation of self-reported improvements in auditory ability with improvements in speech comprehension and to identify factors other than audiological improvement that affect self-reported auditory ability.Study Design: Explorative prospective analysis using a within-subjects repeated measures design.Setting: Academic tertiary care center.Participants: Twenty-seven adult participants with bilateral sensorineural hearing loss who received a HiRes 90K CI and continued use of a HA at the non-implanted ear (bimodal hearing).Intervention: Cochlear implantation.Main Outcome Measures: Self-reported auditory ability/disability assessed by the comparative version of the Speech, Spatial and Qualities of Hearing Scale (SSQ-B), and monosyllable as well as sentence comprehension in quiet and within speech modulated noise from different directions assessed pre- as well as 3 and 6 months post-implantation.Results: Data of 17 individuals were analyzed. At the endpoint of the study, improvement of self-reported auditory ability was significant. Regarding audiometric measures, significant improvement was seen for CI-aided pure tone thresholds, for monaural CI-assisted and bimodal sentence comprehension in quiet and in speech-modulated noise that was presented from the same source or at the side of the HA-ear. Correlations between self-reported and audiometric improvements remained weak, with the exception of the improvement seen for monaural CI-aided sentence comprehension in quiet and self-perceived improvement of sound quality. Considerable correlations existed between self-reported improvements and current level of depression and anxiety, and with general self-efficaciousness. Regression analyses substantiated a positive influence of self-efficaciousness on self-reported improvement in speech comprehension and between the improvement of monaural CI-aided sentence comprehension in quiet and perceived sound quality as well as a negative influence of anxiety on self-reported improvement in spatial hearing. Self-reported improvements were significantly better in the subgroup with intensive as compared to regular rehabilitation.Conclusions: Self-reported auditory ability/disability represents an important measure for the success of bimodal CI-provision. It is influenced by personal and mental health factors that may improve CI-rehabilitation results if addressed during rehabilitation

Tinnitus: Distinguishing between Subjectively Perceived Loudness and Tinnitus-Related Distress

OBJECTIVES: Overall success of current tinnitus therapies is low, which may be due to the heterogeneity of tinnitus patients. Therefore, subclassification of tinnitus patients is expected to improve therapeutic allocation, which, in turn, is hoped to improve therapeutic success for the individual patient. The present study aims to define factors that differentially influence subjectively perceived tinnitus loudness and tinnitus-related distress. METHODS: In a questionnaire-based cross-sectional survey, the data of 4705 individuals with tinnitus were analyzed. The self-report questionnaire contained items about subjective tinnitus loudness, type of onset, awareness and localization of the tinnitus, hearing impairment, chronic comorbidities, sleep quality, and psychometrically validated questionnaires addressing tinnitus-related distress, depressivity, anxiety, and somatic symptom severity. In a binary step-wise logistic regression model, we tested the predictive power of these variables on subjective tinnitus loudness and tinnitus-related distress. RESULTS: The present data contribute to the distinction between subjective tinnitus loudness and tinnitus-related distress. Whereas subjective loudness was associated with permanent awareness and binaural localization of the tinnitus, tinnitus-related distress was associated with depressivity, anxiety, and somatic symptom severity. CONCLUSIONS: Subjective tinnitus loudness and the potential presence of severe depressivity, anxiety, and somatic symptom severity should be assessed separately from tinnitus-related distress. If loud tinnitus is the major complaint together with mild or moderate tinnitus-related distress, therapies should focus on auditory perception. If levels of depressivity, anxiety or somatic symptom severity are severe, therapies and further diagnosis should focus on these symptoms at first

Psychoacoustic tinnitus loudness and tinnitus-related distress show different associations with oscillatory brain activity.

BACKGROUND: The phantom auditory perception of subjective tinnitus is associated with aberrant brain activity as evidenced by magneto- and electroencephalographic studies. We tested the hypotheses (1) that psychoacoustically measured tinnitus loudness is related to gamma oscillatory band power, and (2) that tinnitus loudness and tinnitus-related distress are related to distinct brain activity patterns as suggested by the distinction between loudness and distress experienced by tinnitus patients. Furthermore, we explored (3) how hearing impairment, minimum masking level, and (4) psychological comorbidities are related to spontaneous oscillatory brain activity in tinnitus patients. METHODS AND FINDINGS: Resting state oscillatory brain activity recorded electroencephalographically from 46 male tinnitus patients showed a positive correlation between gamma band oscillations and psychoacoustic tinnitus loudness determined with the reconstructed tinnitus sound, but not with the other psychoacoustic loudness measures that were used. Tinnitus-related distress did also correlate with delta band activity, but at electrode positions different from those associated with tinnitus loudness. Furthermore, highly distressed tinnitus patients exhibited a higher level of theta band activity. Moreover, mean hearing loss between 0.125 kHz and 16 kHz was associated with a decrease in gamma activity, whereas minimum masking levels correlated positively with delta band power. In contrast, psychological comorbidities did not express significant correlations with oscillatory brain activity. CONCLUSION: Different clinically relevant tinnitus characteristics show distinctive associations with spontaneous brain oscillatory power. Results support hypothesis (1), but exclusively for the tinnitus loudness derived from matching to the reconstructed tinnitus sound. This suggests to preferably use the reconstructed tinnitus spectrum to determine psychoacoustic tinnitus loudness. Results also support hypothesis (2). Moreover, hearing loss and minimum masking level correlate with oscillatory power in distinctive frequency bands. The lack of an association between psychological comorbidities and oscillatory power may be attributed to the overall low level of mental health problems in the present sample

Tinnitus-Related Distress and the Personality Characteristic Resilience

It has been suggested that personality traits may be prognostic for the severity of suffering from tinnitus. Resilience as measured with the Wagnild and Young resilience scale represents a positive personality characteristic that promotes adaptation to adverse life conditions including chronic health conditions. Aim of the study was to explore the relation between resilience and tinnitus severity. In a cross-sectional study with a self-report questionnaire, information on tinnitus-related distress and subjective tinnitus loudness was recorded together with the personality characteristic resilience and emotional health, a measure generated from depression, anxiety, and somatic symptom severity scales. Data from 4705 individuals with tinnitus indicate that tinnitus-related distress and to a lesser extent the experienced loudness of the tinnitus show an inverse correlation with resilience. A mediation analysis revealed that the relationship between resilience and tinnitus-related distress is mediated by emotional health. This indirect effect indicates that high resilience is associated with better emotional health or less depression, anxiety, and somatic symptom severity, which in turn is associated with a less distressing tinnitus. Validity of resilience as a predictor for tinnitus-related distress is supported but needs to be explored further in longitudinal studies including acute tinnitus patients

Partial correlation of band power averaged over all electrodes with audiological parameters for the subgroup with pure tone tinnitus.

<p>Correlation coefficients (Spearman's ) and corresponding significance levels () for tinnitus loudness (TL), minimum masking level (MML), mean hearing loss (MHL) with oscillatory band power in the delta to gamma range are reported. MHL: mean hearing loss averaged for left and right ears and for the frequencies between 0.125 kHz and 16 kHz; TL: tinnitus loudness measures (see section “Psychoacoustic measurements” and <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0053180#pone-0053180-t002" target="_blank">Table 2</a>); MML: minimum masking level with white noise; : minimum masking level with white noise above mean hearing threshold. Significant correlations () are indicated by bold letters. Correlations which remained significant after FDR correction (FDR 0.05) are denoted by at the corresponding -value.</p

Participant characteristics.

<p>Group means and standard deviations are reported. Auditory measures: mean hearing loss (MHL, left and right ear averaged for the frequency range 0.125 kHz to 16 kHz); mean threshold of uncomfortable loudness (UCL, left and right ear averaged for the frequency range 0.125 kHz to 10 kHz). Psychological measures derived from the SCL-90-R: global severity index (GSI), positive symptom total (PST), positive symptom distress index (PSDI), depressiveness subscale (DEP), somatization subscale (SOM), anxiety subscale (ANX). Tinnitus characteristics: tinnitus duration (TinDur), tinnitus-related distress (TinDis) derived from the Tinnitus Questionnaire (scores : low tinnitus-related distress, scores : high tinnitus-related distress). Tinnitus loudness measures (TL, see section “Psychoacoustic measurements” and <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0053180#pone-0053180-t002" target="_blank">Table 2</a>); frequency of the major peak in tinnitus spectrum (); minimum masking level when masking with white noise (MML) as well as minimum masking level above mean hearing threshold (); rating of similarity of reconstructed tinnitus sound to own tinnitus (RTS, 0: no match, 10: perfect match).</p

Correlation strength between MML and oscillatory band power.

<p>Group average for all tinnitus patients is shown. Power spectra were interpolated with a resolution of 40 points per 1 Hz. Correlations were controlled for age, global psychological distress (GPD) and mean hearing loss (MHL) between 0.125 kHz and 16 kHz. (A) Correlation strength (Spearman's ) at each electrode and frequency point is shown. Plot (B) shows the correlation map with averaged correlation strength () topographies between MML and delta oscillatory power. After FDR correction, correlations at the F8 and T8 electrode position remained significant (FDR 0.05: ).</p

Correlations of tinnitus loudness and distress with auditory parameters.

<p>For the patient group, correlation coefficients (Spearman's ) and corresponding significance levels () for each of the five different measures for tinnitus loudness (TL, see section “Psychoacoustic measurements” and <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0053180#pone-0053180-t002" target="_blank">Table 2</a>) with tinnitus-related distress (TinDis), mean hearing loss (MHL), minimum masking level (MML), as well as minimum masking level above mean hearing threshold (). Mean hearing loss (MHL) was averaged for left and right ears and for the frequency range between 0.125 kHz and 16 kHz. Minimum masking level (MML) was measured with white noise. Significant correlations () are indicated by bold letters. Correlations did not remain significant after FDR correction (FDR 0.05).</p

Spatio-spectral distribution of correlation strength between tinnitus loudness and oscillatory band power for the subgroup with pure tone tinnitus.

<p>Group averages are shown. Power spectra were interpolated with a resolution of 40 points per 1 Hz. Tinnitus loudness was determined by adjusting the contribution of each frequency component and the loudness of such a reconstructed tinnitus spectrum to the perceived tinnitus. Correlations were controlled for age, global psychological distress (GPD), and mean hearing loss (MHL) between 0.125 kHz and 16 kHz. (A) Correlation strength (Spearman's ) at each electrode and frequency point is shown. Plots (B) and (C) show correlation maps corresponding to (A) with averaged correlation strength () topographies for the tinnitus loudness and delta (B) or gamma (C) oscillatory power. Correlation strength for delta band power and tinnitus loudness was highest in the frontal half of the brain and lowest at posterior locations. For the correlation between gamma band power and tinnitus loudness the distribution of correlation strength across electrode positions was more uniform. Highest correlation strength was reached at the left temporal and right occipital electrode positions. After FDR correction (FDR 0.05: ) correlations remained significant at all electrode positions except for T8 and P8 locations for the gamma band, whereas significant correlations in the delta band were attained at the fronto-central locations Fp2, F1, Fz, F2, F4, F8, C3, Cz, and at P7.</p

Correlation strength between tinnitus loudness and oscillatory band power for the subgroup with unilateral pure tone tinnitus.

<p>Group averages are shown. Electrode positions of left and right hemisphere were interchanged for right-sided tinnitus. Left ear in the plots is the tinnitus ear. Power spectra were interpolated with a resolution of 40 points per 1 Hz. Tinnitus loudness was determined by matching the contribution of each frequency component and the loudness of such a reconstructed tinnitus spectrum to the perceived tinnitus. Correlations with oscillatory band power were controlled for age, global psychological distress (GPD), and mean hearing loss (MHL) between 0.125 kHz and 16 kHz. Note that correlation strength for tinnitus loudness and delta band power is highest at the fronto-central electrodes contralateral to the tinnitus ear (A), whereas it is highest at the contralateral fronto-temporal electrodes for tinnitus loudness and gamma band power (B). Correlation strengths did not remain significant after FDR correction (FDR 0.05).</p