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. 2023 Apr 20;18(4):e0284719.
doi: 10.1371/journal.pone.0284719. eCollection 2023.

The impact of tinnitus on adult cochlear implant recipients: A mixed-method approach

Kelly K S Assouly  1   2   3 , Maryam Shabbir  4 , Bas van Dijk  3 , Derek J Hoare  4   5 , Michael A Akeroyd  4   5 , Robert J Stokroos  1   2 , Inge Stegeman  1   2 , Adriana L Smit  1   2
Affiliations

The impact of tinnitus on adult cochlear implant recipients: A mixed-method approach

Kelly K S Assouly et al. PLoS One. .

Abstract

Background: Tinnitus is a common problem in patients with a cochlear implant (CI). Between 4% and 25% of CI recipients experience a moderate to severe tinnitus handicap. However, apart from handicap scores, little is known about the real-life impact tinnitus has on those with CIs. We aimed to explore the impact of tinnitus on adult CI recipients, situations impacting tinnitus, tinnitus-related difficulties and their management strategies, using an exploratory sequential mixed-method approach.

Methods: A 2-week web-based forum was conducted using Cochlear Ltd.'s online platform, Cochlear Conversation. A thematic analysis was conducted on the data from the forum discussion to develop key themes and sub-themes. To quantify themes and sub-themes identified, a survey was developed in English with face validity using cognitive interviews, then translated into French, German and Dutch and disseminated on the Cochlear Conversation platform, in six countries (Australia, France, Germany, New Zealand, the Netherlands and United Kingdom). Participants were adult CI recipients experiencing tinnitus who received a Cochlear Ltd. CI after 18 years of age.

Results: Four key themes were identified using thematic analysis of the discussion forum: tinnitus experience, situations impacting tinnitus, difficulties associated with tinnitus and tinnitus management. Among the 414 participants of the survey, tinnitus burden on average was a moderate problem without their sound processor and not a problem with the sound processor on. Fatigue, stress, concentration, group conversation and hearing difficulties were the most frequently reported difficulties and was reported to intensify when not wearing the sound processor. For most CI recipients, tinnitus seemed to increase when performing a hearing test, during a CI programming session, or when tired, stressed, or sick. To manage their tinnitus, participants reported turning on their sound processor and avoiding noisy environments.

Conclusion: The qualitative analysis showed that tinnitus can affect everyday life of CI recipients in various ways and highlighted the heterogeneity in their tinnitus experiences. The survey findings extended this to show that tinnitus impact, related difficulties, and management strategies often depend on sound processor use. This exploratory sequential mixed-method study provided a better understanding of the potential benefits of sound processor use, and thus of intracochlear electrical stimulation, on the impact of tinnitus.

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Conflict of interest statement

KKSA and MS received funding from the European Union’s Horizon 2020 research and innovation program under the Marie Sklodowska-Curie grant (agreement number 764604). KSSA and BvD are employed at Cochlear Technology Centre, Mechelen, Belgium. The content of the study belongs to the authors alone and do not reflect Cochlear Technology Centre policy. No further conflict of interest is reported by the authors. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Design of the web-based discussion forum.
The forum opened the discussion on a new topic every two days. Each topic was open for discussion until the forum closed, six days after it opened.
Fig 2
Fig 2. Themes, sub-themes, and codes from the thematic analysis.
See this image and copyright information in PMC

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