The impact of cochlear implantation on tinnitus, stress and quality of life in postlingually deafened patients.

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.

Elderly patients benefit from cochlear implantation regarding auditory rehabilitation, quality of life, tinnitus, and stress.

OBJECTIVES/HYPOTHESIS: To determine the effect of cochlear implantation on quality of life, speech performance, tinnitus, perceived stress, and coping strategy in patients aged≥70 years in comparison with younger patients. STUDY DESIGN: Retrospective study. METHODS: A total of 55 postlingually deafened adults who were unilaterally implanted with a multichannel cochlear implant for at least 6 months were included in the study. Twenty patients were aged≥70 years (70-84 years), and 35 patients were <70 years (19-67 years). Speech perception was measured using the Freiburg monosyllable test in quiet and the Hochmair-Schulz-Moser sentence test. In addition, the patients filled in six validated questionnaires. RESULTS: Speech perception and subjectively assessed auditory ability were similar in the two age groups after implantation. Disease-specific quality of life was improved in patients aged≥70 years and even to a higher extent as compared to younger patients. Tinnitus annoyance and perceived stress were reduced in elderly patients to the same extent as in younger patients in the case of high initial severity level. The scores for the coping subdomain "seeking support" were reduced in elderly patients. CONCLUSIONS: The present study provides evidence that cochlear implantation constitutes a very successful procedure of auditory rehabilitation, even for patients aged ≥70 years. In addition, elderly patients benefit from implantation, with increased quality of life and reduced tinnitus and stress.

Cochlear implantation has a positive influence on quality of life, tinnitus, and psychological comorbidity.

OBJECTIVES: To determine the effect of cochlear implantation (CI) on health-related quality of life (HRQoL), tinnitus, and psychological comorbidity in patients with severe to profound postlingual hearing loss and to analyze the relationship between these parameters. STUDY DESIGN: Prospective study. METHODS: Using six validated questionnaires, we evaluated the pre-CI and post-CI scores of HRQoL, tinnitus, perceived stress, symptoms of depression and anxiety, and coping strategies in 43 patients implanted unilaterally with a multichannel implant for at least 6 months. RESULTS: In addition to improvements in hearing, speech understanding, and disease-specific HRQoL, psychological comorbidity was reduced and coping strategies were improved following CI. In the 39 tinnitus patients, their tinnitus was reduced. We found negative correlations between HRQoL and stress, depression, and anxiety. Pre-CI, tinnitus severity did not correlate with HRQoL and psychological comorbidity. However, patients with a high-level tinnitus had lower HRQoL as well as a higher level of perceived stress and anxiety symptoms than patients with a low-level tinnitus and no/incidental tinnitus before CI. Moreover, patients with severe hearing loss had a higher level of perceived symptoms of stress and depression than patients with profound hearing loss before CI. CONCLUSIONS: The present study provides evidence that tinnitus and psychological comorbidity may play an important role in the rehabilitation of CI patients, and that there is a correlation between HRQoL and these parameters. In addition to hearing tests, tinnitus, stress, and psychological comorbidity should be assessed using validated questionnaires before and after CI. This will help to improve the rehabilitation process.

Antonovsky's Sense of Coherence in psychosomatic patients - a contribution to construct validation.

OBJECTIVE: The objective of the present study is to contribute towards the validation of the SOC (Sense of Coherence) construct on the basis of data from psychosomatic patients. METHOD: The study included a total of 1403 patients treated as out-patients or in consultations in the Clinic for Psychosomatic Medicine at the Charité University of Medicine, Berlin, between July 2002 and October 2005. Correlations were tested between the sense of coherence (SOC-L9), sociodemographic variables and the following psychometric instruments: Patient Health Questionnaire (PHQ), Brief COPE, Questionnaire on Self-Efficacy, Optimism and Pessimism (SWOP-K9) and Perceived Stress Questionnaire (PSQ-20). RESULTS: Associations were found between sense of coherence and age, but not with gender. In addition, high sense of coherence was correlated with high self-efficacy, optimism, subjective physical well-being and favourable coping strategies as well as with low perceived stress. CONCLUSION: The results contribute to the validation of the SOC construct. Future investigations should include longitudinal studies of the precise association between sense of coherence and other psychological variables.