Tinnitus: surgical treatment

Abstract

Surgical treatment of tinnitus includes destructive procedures, neurectomies, stapedectomies and tympanosympathectomies. Translabyrinthine procedures for the removal of acoustic neuromas and sectioning of the eighth nerve to eliminate vertigo are analogous to cutting the eighth nerve as a surgical intervention for tinnitus. After surgical removal of acoustic tumours with excision of the auditory nerve in 414 patients, only 40% reported improvement in their tinnitus. Of 68 patients undergoing translabyrinthine eighth nerve section, 60 (80%) had tinnitus preoperatively. Improvement occurred in 45%, while 55% reported the condition to be the same or worse. In patients undergoing middle cranial fossa section of the vestibular nerve for vertigo or dizziness, most reported the tinnitus to be the same but a significant number felt that it was worse. Stapedectomy improves hearing in most patients but improves the symptom of tinnitus in only about half of the patients. Cochlear implant patients report an improvement in their tinnitus with use of the stimulator and implant. Implant procedures might therefore be used in patients who suffer from severe tinnitus. Surgical management of tinnitus, although successful in some cases, does not provide a valid and reliable mode of treatment for subjective tinnitus.