Tinnitus is a common complaint in the candidates for cochlear implantation (CI). Tinnitus-related distress has often been measured in these patients using categorical ratings, which lack information about tinnitus severity, stress and health-related quality of life or their correlation. Here, using 4 validated questionnaires, we evaluated psychometric parameters and the quality of life of 32 postlingually deafened patients before and after CI. The data regarding pre-CI were collected retrospectively. Of all patients included in this study, 28 (87.5%) suffered from tinnitus before implantation. Following a mean of 24 months after surgery, these patients reported a significant decrease (39.2%) of tinnitus impairment, as measured by the Tinnitus Questionnaire. In none of the 28 patients has tinnitus worsened. Moreover, the 4 tinnitus-free patients remained so after the CI surgery. In addition, the implant supply resulted in 36.7% reduction in perceived stress and in 15.4% reduction in evasive coping. In addition, the focus on positive coping has improved by 12.3%, whereas the health-related quality of life improved by 53.4% in all patients. Tinnitus impairment and stress were reduced more strongly in patients who had initially higher scores. Interestingly, a significant correlation between the psychometric scores was found mainly after CI. Our results indicate that patients with higher tinnitus-related distress have a lower quality of life, lesser coping abilities and perceive more stress, but before implantation it is masked by deafness. We conclude that tinnitus-related screening of patients before and after CI is an important step in the identification of individuals who would benefit from specific fitting and/or tinnitus therapy after implantation.

Keywords:
Cochlear implant, Tinnitus, Quality of life, Stress, Coping
1.
Adoga AA, Adoga AS, Obindo JT: Tinnitus and the prevalence of co-morbid psychological stress. Niger J Med 2008;17:95–97.
2.
Adunka O, Kiefer J: Impact of electrode insertion depth on intracochlear trauma. Otolaryngol Head Neck Surg 2006;135:374–382.
3.
Akdogan O, Ozcan I, Ozbek C, Dere H: Tinnitus after cochlear implantation. Auris Nasus Larynx 2009;36:210–212.
4.
Andersson G: Psychological aspects of tinnitus and the application of cognitive-behavioral therapy. Clin Psychol Rev 2002;22:977–990.
5.
Andersson G, Freijd A, Baguley DM, Idrizbegovic E: Tinnitus distress, anxiety, depression, and hearing problems among cochlear implant patients with tinnitus. J Am Acad Audiol 2009;20:315–319.
6.
Baguley DM, Atlas MD: Cochlear implants and tinnitus. Prog Brain Res 2007;166:347–355.
7.
Baumgartner WD, Jappel A, Morera C, Gstottner W, Muller J, Kiefer J, Van De HP, Anderson I, Nielsen SB: Outcomes in adults implanted with the FLEXsoft electrode. Acta Otolaryngol 2007;127:579–586.
8.
Budd RJ, Pugh R: Tinnitus coping style and its relationship to tinnitus severity and emotional distress. J Psychosom Res 1996;41:327–335.
9.
Carver CS: You want to measure coping but your protocol’s too long: consider the brief COPE. Int J Behav Med 1997;4:92–100.
10.
Carver CS, Scheier MF, Weintraub JK: Assessing coping strategies: a theoretically based approach. J Pers Soc Psychol 1989;56:267–283.
11.
Cohen J: A power primer. Psychol Bull 1992;112:155–159.
12.
Cohen SM, Labadie RF, Dietrich MS, Haynes DS: Quality of life in hearing-impaired adults: the role of cochlear implants and hearing aids. Otolaryngol Head Neck Surg 2004;131:413–422.
13.
D’Amelio R, Archonti C, Scholz S, Falkai P, Plinkert PK, Delb W: Psychological distress associated with acute tinnitus. HNO 2004;52:599–603.
14.
Damen GW, Beynon AJ, Krabbe PF, Mulder JJ, Mylanus EA: Cochlear implantation and quality of life in postlingually deaf adults: long-term follow-up. Otolaryngol Head Neck Surg 2007;136:597–604.
15.
de Wolf MJ, Shival ML, Hol MK, Mylanus EA, Cremers CW, Snik AF: Benefit and quality of life in older bone-anchored hearing aid users. Otol Neurotol 2010;31:766–772.
16.
Demajumdar R, Stoddart R, Donaldson I, Proops DW: Tinnitus, cochlear implants and how they affect patients. J Laryngol Otol Suppl 1999;24:24–26.
17.
Eshraghi AA, Van De Water TR: Cochlear implantation trauma and noise-induced hearing loss: apoptosis and therapeutic strategies. Anat Rec A Discov Mol Cell Evol Biol 2006;288:473–481.
18.
Fliege H, Rose M, Arck P, Walter OB, Kocalevent RD, Weber C, Klapp BF: The Perceived Stress Questionnaire (PSQ) reconsidered: validation and reference values from different clinical and healthy adult samples. Psychosom Med 2005;67:78–88.
19.
Gibson WPR: The effect of electrical stimulation and cochlear implantation on tinnitus; in Aran JM, Dauman R (eds): Proceedings of the Fourth International Seminar, Bordeaux, 1991. Amsterdam, Kugler, 1992, pp 403–408.
20.
Goebel G, Hiller W: Tinnitus-Fragebogen (TF) – Ein Instrument zur Erfassung von Belastung und Schweregrad bei Tinnitus, Handanweisung. Göttingen, Hogrefe, 1998.
21.
Greimel KV, Meco C, Mair A, Kohlbock G, Albegger K: How is tinnitus influenced by cochlear implantation? HNO 2003;51:226–231.
22.
Harris JP, Anderson JP, Novak R: An outcomes study of cochlear implants in deaf patients: audiologic, economic, and quality-of-life changes. Arch Otolaryngol Head Neck Surg 1995;121:398–404.
23.
Harter M, Maurischat C, Weske G, Laszig R, Berger M: Psychological stress and impaired quality of life in patients with tinnitus. HNO 2004;52:125–131.
24.
Hazell JW, McKinney CJ, Aleksy W: Mechanisms of tinnitus in profound deafness. Ann Otol Rhinol Laryngol Suppl 1995;166:418–420.
25.
Hebert S, Lupien SJ: The sound of stress: blunted cortisol reactivity to psychosocial stress in tinnitus sufferers. Neurosci Lett 2007;411:138–142.
26.
Heinecke K, Weise C, Schwarz K, Rief W: Physiological and psychological stress reactivity in chronic tinnitus. J Behav Med 2008;31:179–188.
27.
Henry JA, Dennis KC, Schechter MA: General review of tinnitus: prevalence, mechanisms, effects, and management. J Speech Lang Hear Res 2005;48:1204–1235.
28.
Hinderink JB, Krabbe PF, Van Den BP: Development and application of a health-related quality-of-life instrument for adults with cochlear implants: the Nijmegen cochlear implant questionnaire. Otolaryngol Head Neck Surg 2000;123:756–765.
29.
Hirschfelder A, Grabel S, Olze H: The impact of cochlear implantation on quality of life: the role of audiologic performance and variables. Otolaryngol Head Neck Surg 2008;138:357–362.
30.
Hol MK, Snik AF, Mylanus EA, Cremers CW: Long-term results of bone-anchored hearing aid recipients who had previously used air-conduction hearing aids. Arch Otolaryngol Head Neck Surg 2005;131:321–325.
31.
House WF: Cochlear implants. Ann Otol Rhinol Laryngol 1976;85(suppl 27):1–93.
32.
Kim HN, Shim YJ, Kim YM, Kim ES: Effect of electrical stimulation on tinnitus in the profoundly deaf; in Reich GE, Vernon J (eds): Proceedings of the Fifth International Tinnitus Seminar. Portland, American Tinnitus Association, 1995.
33.
Klop WM, Boermans PP, Ferrier MB, van den Hout WB, Stiggelbout AM, Frijns JH: Clinical relevance of quality of life outcome in cochlear implantation in postlingually deafened adults. Otol Neurotol 2008;29:615–621.
34.
Knoll N: Coping as a personality process: how elderly patients deal with cataract surgery. http://www.diss.fu-berlin.de/2002/108/.
35.
Kocalevent RD, Levenstein S, Fliege H, Schmid G, Hinz A, Brahler E, Klapp BF: Contribution to the construct validity of the Perceived Stress Questionnaire from a population-based survey. J Psychosom Res 2007;63:71–81.
36.
McKerrow WS, Schreiner CE, Snyder RL, Merzenich MM, Toner JG: Tinnitus suppression by cochlear implants. Ann Otol Rhinol Laryngol 1991;100:552–558.
37.
McKinney CJ, Nunn TB, Archer KAM, Fitzgerald-O’Connor A: Factors influencing tinnitus severity in cochlear implant patients; in Patuzzi R (ed): Proceedings of the Seventh International Tinnitus Seminar. Perth, University of Western Australia, 2002, pp 176–181.
38.
Mirz F, Mortensen MV, Gjedde A, Pederson CD: Positron emission tomography of tinnitus suppression by cochlear implantation; in Patuzzi R (ed): Proceedings of the Seventh International Tinnitus Seminar. Perth, University of Western Australia, 2002, pp 136–140.
39.
Miyamoto RT, Bichey BG: Cochlear implantation for tinnitus suppression. Otolaryngol Clin North Am 2003;36:345–352.
40.
Miyamoto RT, Wynne MK, McKnight C, Bichey B: Electrical suppression of tinnitus via cochlear implants. Int Tinnitus J 1997;3:35–38.
41.
Mo B, Harris S, Lindbaek M: Tinnitus in cochlear implant patients – a comparison with other hearing-impaired patients. Int J Audiol 2002;41:527–534.
42.
Olderog M, Langenbach M, Michel O, Brusis T, Kohle K: Predictors and mechanisms of tinnitus distress – a longitudinal analysis. Laryngorhinootologie 2004;83:5–13.
43.
Osaki Y, Nishimura H, Takasawa M, Imaizumi M, Kawashima T, Iwaki T, Oku N, Hashikawa K, Doi K, Nishimura T, Hatazawa J, Kubo T: Neural mechanism of residual inhibition of tinnitus in cochlear implant users. Neuroreport 2005;16:1625–1628.
44.
Pan T, Tyler RS, Ji H, Coelho C, Gehringer AK, Gogel SA: Changes in the tinnitus handicap questionnaire after cochlear implantation. Am J Audiol 2009;18:144–151.
45.
Quaranta N, Fernandez-Vega S, D’elia C, Filipo R, Quaranta A: The effect of unilateral multichannel cochlear implant on bilaterally perceived tinnitus. Acta Otolaryngol 2008;128:159–163.
46.
Quaranta N, Wagstaff S, Baguley DM: Tinnitus and cochlear implantation. Int J Audiol 2004;43:245–251.
47.
Seydel C, Haupt H, Szczepek AJ, Klapp BF, Mazurek B: Long-term improvement in tinnitus after modified tinnitus retraining therapy enhanced by a variety of psychological approaches. Audiol Neurootol 2010;15:69–80.
48.
Souliere CR, Jr., Kileny PR, Zwolan TA, Kemink JL: Tinnitus suppression following cochlear implantation: a multifactorial investigation. Arch Otolaryngol Head Neck Surg 1992;118:1291–1297.
49.
Stobik C, Weber RK, Munte TF, Frommer J: Psychosomatic stress factors in compensated and decompensated tinnitus. Psychother Psychosom Med Psychol 2003;53:344–352.
50.
Stobik C, Weber RK, Munte TF, Walter M, Frommer J: Evidence of psychosomatic influences in compensated and decompensated tinnitus. Int J Audiol 2005;44:370–378.
51.
Summerfield AQ, Barton GR, Toner J, McAnallen C, Proops D, Harries C, Cooper H, Court I, Gray R, Osborne J, Doran M, Ramsden R, Mawman D, O’Driscoll M, Graham J, Aleksy W, Meerton L, Verschure C, Ashcroft P, Pringle M: Self-reported benefits from successive bilateral cochlear implantation in post-lingually deafened adults: randomised controlled trial. Int J Audiol 2006;45:S99–S107.
52.
Tyler RS: Advantages and disadvantages expected and reported by cochlear implant patients. Am J Otol 1994;15:523–531.
53.
Tyler RS, Kelsay D: Advantages and disadvantages reported by some of the better cochlear-implant patients. Am J Otol 1990;11:282–289.
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