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Tinnitus Suppression After Auditory Brainstem Implantation in Patients With Neurofibromatosis Type-2
Daniel S Roberts1, Steve Otto, Brian Chen
1*Division of Otolaryngology-Head and Neck Surgery, University of Connecticut School of Medicine, Farmington, Connecticut †House Clinic and House Ear Institute, Los Angeles, California ‡Department of Otolaryngology-Head and Neck Surgery, William Beaumont Army Medical Center, El Paso, Texas §House Clinic, Neurosurgery, Los Angeles, California ||Huntington Medical Research Institutes, Pasadena, California.
Objective:
To evaluate whether an auditory brainstem implant (ABI) can impact levels of tinnitus in neurofibromatosis type-2 (NF2) patients who have undergone translabyrinthine craniotomy for vestibular schwannoma (VS) removal and to evaluate the burden of tinnitus in these patients.
Study Design:
A retrospective case series and patient survey.
Setting:
Tertiary neurotologic referral center.
Patients:
NF2 patients who underwent translabyrinthine removal of VS and ABI placement between 1994 and 2015.
Interventions:
A survey, retrospective review and two validated tinnitus handicap questionnaires (tinnitus handicap inventory [THI] and tinnitus visual analogue scale [VAS]) were used to characterize the degree of tinnitus in NF2 patients and whether an ABI can alter tinnitus levels.
Main Outcome Measures(S):
Survey results, THI and VAS scores.
Results:
One hundred twelve ABI users were contacted and 43 patients (38.3)% responded to our survey. Tinnitus was reported in 83.7% of patients. The THI score for responders was 17.8 ± 20.5 standard deviation (SD). For survey participants, the ABI reduced tinnitus levels (mean VAS: Off = 3.5; On 1-h = 2.1; p = 0.048). For patients who subjectively reported that the ABI reduced tinnitus loudness, tinnitus levels were immediately reduced on ABI activation and after 1 hour of use (mean VAS: Off = 4.8; On = 2.4; On 1-h = 1.8; p < 0.01). Suppression did not continue after the device was turned off. Audiological performance with the ABI did not correlate with tinnitus suppression.
Conclusion:
NF2 patients who have undergone removal of VS have a significant tinnitus handicap and benefit from tinnitus suppression through utilization of an ABI possibly through masking or electrical stimulation of the auditory brainstem.
