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Long-term evaluation of treatment of chronic, therapeutically refractory tinnitus by neurostimulation.
Stereotact Funct Neurosurg. 2007; 85(4):150-7.SF

Abstract

OBJECTIVE

Long-term evaluation of treatment of chronic, therapeutically refractory tinnitus by means of chronic electrical stimulation of the vestibulocochlear nerve.

PATIENTS

Inclusion criteria were severe, chronic, therapeutically refractory, unilateral tinnitus and severe hearing loss at the ipsilateral site. Out of 6 patients, 4 patients were selected for long-term evaluation. Two patients were not evaluated because of premature dropout.

MATERIAL AND METHODS

A stimulation electrode was placed around the vestibulocochlear nerve through a retrosigmoid approach and connected to a subcutaneously positioned pulse generator via an extension cable. Follow-up was performed 3 months and 42.5 months after implantation. Three measures for treatment outcome were used. First, effect sizes were determined by means of the total Tinnitus Handicap Inventory (THI) score using Cohen's formula. Second, general and tinnitus-specific audiometric tests were performed in on and off conditions of the neurostimulation system. Third, recordings were noted for tinnitus severity and treatment success on a visual analogue scale.

RESULTS

All 4 patients reported successful treatment with neurostimulation. The effect size after 3 months was 0.7, indicating an average effect, while the effect size measured during long-term follow-up was 1.75, indicating a substantial effect with major clinical implications. No changes in hearing level for both ears were measured. The neurostimulation system did not change the tinnitus pitch in any of the patients, and resulted in a minimal reduction of tinnitus loudness in only 2 patients. In all 4 patients the original tinnitus sound was replaced by another, pleasantly perceived sound. The average VAS score of perceived tinnitus severity was reduced from 8 to 3.25. The average VAS score for treatment success was 7.25.

CONCLUSIONS

The long-term follow-up of neurostimulation treatment for chronic tinnitus shows promising results. Long-term results were better than those determined after a 3-month follow-up. In all patients the tinnitus was replaced by another sound, which was perceived as pleasant. Further studies are needed before accepting neurostimulation as a treatment modality for chronic, therapeutically refractory tinnitus.

Authors+Show Affiliations

Department of Otorhinolaryngology, University Medical Center Groningen, Groningen, The Netherlands. h.bartels@kno.umcg.nlNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

17259751

Citation

Bartels, H, et al. "Long-term Evaluation of Treatment of Chronic, Therapeutically Refractory Tinnitus By Neurostimulation." Stereotactic and Functional Neurosurgery, vol. 85, no. 4, 2007, pp. 150-7.
Bartels H, Staal MJ, Holm AF, et al. Long-term evaluation of treatment of chronic, therapeutically refractory tinnitus by neurostimulation. Stereotact Funct Neurosurg. 2007;85(4):150-7.
Bartels, H., Staal, M. J., Holm, A. F., Mooij, J. J., & Albers, F. W. (2007). Long-term evaluation of treatment of chronic, therapeutically refractory tinnitus by neurostimulation. Stereotactic and Functional Neurosurgery, 85(4), 150-7.
Bartels H, et al. Long-term Evaluation of Treatment of Chronic, Therapeutically Refractory Tinnitus By Neurostimulation. Stereotact Funct Neurosurg. 2007;85(4):150-7. PubMed PMID: 17259751.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-term evaluation of treatment of chronic, therapeutically refractory tinnitus by neurostimulation. AU - Bartels,H, AU - Staal,M J, AU - Holm,A F, AU - Mooij,J J A, AU - Albers,F W J, Y1 - 2007/01/26/ PY - 2007/1/30/pubmed PY - 2007/7/26/medline PY - 2007/1/30/entrez SP - 150 EP - 7 JF - Stereotactic and functional neurosurgery JO - Stereotact Funct Neurosurg VL - 85 IS - 4 N2 - OBJECTIVE: Long-term evaluation of treatment of chronic, therapeutically refractory tinnitus by means of chronic electrical stimulation of the vestibulocochlear nerve. PATIENTS: Inclusion criteria were severe, chronic, therapeutically refractory, unilateral tinnitus and severe hearing loss at the ipsilateral site. Out of 6 patients, 4 patients were selected for long-term evaluation. Two patients were not evaluated because of premature dropout. MATERIAL AND METHODS: A stimulation electrode was placed around the vestibulocochlear nerve through a retrosigmoid approach and connected to a subcutaneously positioned pulse generator via an extension cable. Follow-up was performed 3 months and 42.5 months after implantation. Three measures for treatment outcome were used. First, effect sizes were determined by means of the total Tinnitus Handicap Inventory (THI) score using Cohen's formula. Second, general and tinnitus-specific audiometric tests were performed in on and off conditions of the neurostimulation system. Third, recordings were noted for tinnitus severity and treatment success on a visual analogue scale. RESULTS: All 4 patients reported successful treatment with neurostimulation. The effect size after 3 months was 0.7, indicating an average effect, while the effect size measured during long-term follow-up was 1.75, indicating a substantial effect with major clinical implications. No changes in hearing level for both ears were measured. The neurostimulation system did not change the tinnitus pitch in any of the patients, and resulted in a minimal reduction of tinnitus loudness in only 2 patients. In all 4 patients the original tinnitus sound was replaced by another, pleasantly perceived sound. The average VAS score of perceived tinnitus severity was reduced from 8 to 3.25. The average VAS score for treatment success was 7.25. CONCLUSIONS: The long-term follow-up of neurostimulation treatment for chronic tinnitus shows promising results. Long-term results were better than those determined after a 3-month follow-up. In all patients the tinnitus was replaced by another sound, which was perceived as pleasant. Further studies are needed before accepting neurostimulation as a treatment modality for chronic, therapeutically refractory tinnitus. SN - 1011-6125 UR - https://www.unboundmedicine.com/medline/citation/17259751/Long_term_evaluation_of_treatment_of_chronic_therapeutically_refractory_tinnitus_by_neurostimulation_ L2 - https://www.karger.com?DOI=10.1159/000099073 DB - PRIME DP - Unbound Medicine ER -