Effects of auditory rehabilitation with cochlear implant on tinnitus prevalence and distress, health-related quality of life, subjective hearing and psychological comorbidities: Comparative analysis of patients with asymmetric hearing loss (AHL), double-sided (bilateral) deafness (DSD), and single-sided (unilateral) deafness (SSD)

Abstract

Introduction: Auditory rehabilitation with a cochlear implant (CI), in many cases, positively impacts tinnitus. However, it is unclear if the tinnitus-related benefit of CI is equal for patients with various indications for CI. Therefore, this study aimed to determine differences in tinnitus prevalence and distress, health-related quality of life, subjective hearing, perceived stress, and psychological comorbidities between patients diagnosed with asymmetric hearing loss (AHL), single-sided (unilateral) deafness (SSD), and double-sided (bilateral) deafness (DSD) before and six months after cochlear implantation.

Methods: One hundred-one CI candidates were included in this prospective study (39 AHL patients, 23 DSD patients, and 39 SSD patients). The patients completed questionnaires measuring tinnitus distress, health-related quality of life, subjective hearing, perceived stress, and psychological comorbidities before and 6 months after CI.

Results: The prevalence of tinnitus in the entire cohort (80.2% before CI) decreased 6 months after CI to 71.3%. The DSD group had the lowest tinnitus prevalence at both time points. The degree of tinnitus-induced distress decreased significantly in all three groups after CI. Differences in quality of life, subjective hearing, and psychological comorbidities between the groups at the study onset disappeared after CI. Significant correlations existed between anxiety, depression, and tinnitus distress in AHL and SSD but not in DSD patients before and after CI.

Discussion: Our results demonstrate significant differences between the three groups of CI candidates, which might affect the implantation outcome. These differences suggest a need for personalized psychological counseling during the auditory rehabilitation process, focusing on anxiety and depressive symptoms for SSD and AHL patients.

Keywords: asymmetric hearing loss; auditory rehabilitation; cochlear implant; double-sided deafness; single-sided deafness; tinnitus.

Figure 1

The data was collected from all patients at the study baseline (T1). Only the patients with tinnitus were included in further analysis. T2 indicates the time at which the patients in all groups had their CI activated. The second data set was collected at T3 (six months after activation of the cochlear implant). Created with BioRender.com.

Figure 2

Between-group differences regarding the TQ subscale “emotional impact of tinnitus”. Kruskal-Wallis with Bonferroni correction (^*p < 0.05) demonstrated that six months after cochlear implantation, the DSD group patients reported significantly less tinnitus-induced emotional distress than the SSD group. ns, not significant.

Figure 3

Between-group differences in the health-related quality of life (NCIQ) before and after CI. The Kruskal-Wallis test with Bonferroni- correction indicated significant differences. ^*p < 0.05. ^**p < 0.01. ^***p < 0.001. ^****p = 0.0. ns, not significant.

Figure 4

Between-group differences in the self-reported quality of hearing before and after CI. The sound perception in quiet and noise, as well as the total score of the Oldenburg Inventory, differed between AHL and DSD and SSD and DSD but not AHL and SSD before implantation. The DSD group scored poorer than the other two. Six months after the activation of CI, there were no longer differences between the groups. ^***p < 0.001. ^****p = 0.0. ns, not significant.

Figure 5

Between-groups differences in the perceived stress (PSQ). At the study onset, the DSD group reported significantly less tension than the AHL and SSD patients. Six months after implantation, there were no longer differences detected with the Kruskal-Wallis test. ^*p < 0.05. ^**p < 0.01 after Bonferroni correction. ns, not significant.

Figure 6

Between-group differences in the anxiety symptoms (GAD-7). Kruskal-Wallis test indicated a significant difference between the DSD and SSD groups at the study onset. After implantation, there were no longer differences between the groups. ^*p < 0.05; ns, not significant.