Have you ever experienced a constant ringing or buzzing in your ears that just won't go away? If so, you're part of a significant group who experience tinnitus – one in seven have the condition, making it far from rare [1].

As more individuals turn to cochlear implants as a revolutionary solution for severe hearing loss, a question is capturing the attention of both medical experts and patients: can these advanced tools also cure tinnitus?

Consider the possibility of reducing the constant noise of tinnitus, where it no longer disrupts your focus, sleep, or social interactions. While we have a good understanding of what causes tinnitus, many potential therapies, including cochlear implants, are still in the exploratory phases.

Keep reading to find out what experts and studies say about using cochlear implants for tinnitus.

Hearing loss and tinnitus

It's a widely acknowledged fact that tinnitus and hearing loss often go hand in hand. Approximately 80% of individuals with hearing loss also experience tinnitus [2]. This high correlation suggests that by the time many people consider a cochlear implant, they are already dealing with the persistent noise of tinnitus.

Why are they linked?

The inner ear contains tiny hair cells that play a crucial role in translating sound waves into electrical signals for the brain. When these hair cells are damaged – often due to age, exposure to loud noises, or other factors – they can malfunction, leading to both hearing loss and tinnitus.

The emotional toll

Living with both conditions can be emotionally draining. The inability to hear clearly can lead to social isolation, while the constant noise from tinnitus can affect concentration, sleep quality, and overall mental well-being.

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What are cochlear implants?

A cochlear implant is an electronic device that is surgically implanted to allow some auditory perception in patients with significant hearing problems.

It can be thought of as having several parts, broadly divided into:

• Internal parts: Buried under the skin and/or in bone.
• External parts: Worn outside the skin and attached via magnets.

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How do cochlear implants work?

The transmission of sound impulses differs from the natural progression of sound through the hearing system. While the outcomes from direct electrical stimulation via a cochlear implant don't match the performance of a fully functional biological ear, it can markedly enhance an individual's hearing. This improvement might enable patients to answer a phone or detect their children's voices from another floor.

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The results of direct electrical stimulation from a cochlear implant are not as good as a well-functioning biological ear, but may improve people's hearing significantly, for example allowing patients to use a telephone, or to hear their children call from upstairs.

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Can a cochlear implant cure tinnitus?

While a cochlear implant is not a definitive 'cure' for tinnitus, research dating back to the 1970s suggests that it can significantly reduce tinnitus symptoms in some individuals with hearing loss. However, the effectiveness varies from person to person.

Quality of life improvements

It's important to note that while cochlear implants may improve hearing, their effectiveness in treating tinnitus is still under examination.

Recent studies have indicated that cochlear implants can improve the quality of life. For instance, one study found that the improvement was greater for patients with severe tinnitus compared to those without [3]. With that said, it's not entirely clear whether this observed change is due to the extra effort required by people with tinnitus to focus on conversations, a reduction in tinnitus severity post-implantation, or a combination of these factors.

Understanding the scales

The EuroQol 5D (EQ-5D) and the Nijmegen Cochlear Implant Questionnaire (NCIQ) are standardised instruments developed to measure health-related quality of life. They assess five dimensions: 

• Mobility: The ability to perform daily tasks without discomfort.
• Self-care: How independent a person is in managing their personal hygiene and daily routines.
• Usual activities: How well an individual can engage in their regular activities, such as work, study, housework, family, and leisure activities.
• Pain/discomfort: Ranging from mild discomfort to severe pain that may require medication or other forms of relief.
• Anxiety/depression: Gauges how the individual's emotional state impacts their overall quality of life.

Patients who report an improvement of around 20 points on the EuroQol 5D (EQ-5D) scale and 51.4 points on the Nijmegen Cochlear Implant Questionnaire (NCIQ) specifically for tinnitus are classed as significant. 

Other findings

A recent systematic review, which is a rigorous and replicable method for identifying scientific studies, screened over 4,000 research papers and identified seven that specifically focused on cochlear implantation for tinnitus. These studies collectively reported on more than 100 patients. Although they had some design limitations, they consistently showed statistically significant positive effects of cochlear implantation on tinnitus distress [4].

One particular study within this review focused on 53 adult cochlear implant recipients. The findings were promising: when the implant was activated, tinnitus was completely suppressed in 23 patients (43% of the total) and improved in 20 patients (38%). This suggests that more than 80% of the patients experienced some level of tinnitus relief or total suppression while using the device.

How cochlear implants may help with tinnitus

By understanding the following mechanisms, individuals can make more informed decisions about whether cochlear implants are a suitable treatment option for their tinnitus symptoms.

• Masking effect: The sound generated by the implant can mask the tinnitus noise, making it less noticeable.
• Auditory stimulation: The electrical stimulation may help to reorganise the neural pathways in the auditory system.
• Psychological benefits: Improved hearing can lead to better communication and social interaction, which may reduce stress.

But can cochlear implants help tinnitus?

‍A recent systematic review screened more than 4,000 research papers to find 7 studies describing cochlear implantation for tinnitus. A systematic review is a detailed and reproducible way to find scientific studies. These studies reported on more than 100 patients, and whilst the studies were not perfectly designed or carried out, the overall results suggest that cochlear implantation has a positive effect on tinnitus distress, with statistically significant differences shown in every study.

This study reported results of 53 adult cochlear implant recipients and showed that whilst the implant was on tinnitus was completely suppressed in 23 patients (43% of the total) and improved in 20 patients (38%), suggesting that in total more than 80% of patients with tinnitus reported some or total suppression of their tinnitus.

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‍Why aren't cochlear implants more widely used?

Cochlear implants have proven to be a transformative solution for many individuals suffering from severe hearing loss and associated conditions like tinnitus. However, despite their potential benefits, their adoption rate remains surprisingly low. 

Estimates suggest that only about one in 10 people who could benefit from a cochlear implant actually get referred for one. So, what are the barriers that prevent wider adoption? Let's explore some of the key factors.

• Lack of patient awareness: Many patients may not be aware that cochlear implants could offer them significant relief. This lack of awareness often leads them to think that their condition is untreatable, causing them not to seek further medical advice.

• Medical Oversight: On the other side of the equation, healthcare professionals like audiologists or ENT surgeons may not always recognise a patient's suitability for cochlear implantation, leading to missed opportunities for referral.

• Cost factor: The device can be expensive, and not all healthcare systems or insurance plans cover the cost. This financial barrier can deter potential candidates from considering this treatment option.

• Risk of hearing loss: Some individuals have residual hearing that they do not want to jeopardise. Cochlear implantation can, in some cases, result in the loss of any remaining natural hearing, making it a risky option for these people.

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Who is a good candidate for cochlear implants?

Cochlear implants have been a game-changer for many individuals grappling with severe hearing loss and tinnitus. However, it's crucial to understand that they are not a one-size-fits-all solution. Below, we break down the key criteria and steps involved in this important decision-making journey.

The evaluation process

The assessment is usually conducted by a specialised team of healthcare professionals. This team typically includes an audiologist, an otolaryngologist (ENT specialist), and a psychologist.

The evaluation process may encompass a variety of tests and assessments, including:

• Hearing tests to gauge the extent of hearing loss.

• Speech recognition tests to assess auditory comprehension.

• Medical examinations to evaluate overall health.

• Psychological assessments to understand the emotional impact of tinnitus and hearing loss.

Key considerations

• The severity of both hearing loss and tinnitus are critical factors in determining candidacy.

• General health conditions could influence the success of the implant and are therefore considered.

• A candidate's willingness to actively use and maintain the implant, as well as their expectations regarding its benefits, are also evaluated.

Realistic expectations

It's vital for potential candidates to understand that cochlear implants are not a guaranteed cure for tinnitus or hearing loss. They are an option for those who have exhausted other treatment avenues.

Being well-informed about the potential risks, such as loss of residual hearing, and the benefits, like improved auditory perception and tinnitus relief, is essential for making an informed decision.

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What to expect from cochlear implant surgery

If you're a suitable candidate for a cochlear implant, you'll undergo a surgical procedure that typically lasts two to three hours. Performed under general anaesthesia, the surgery involves making an incision behind the ear and drilling a small hole into the skull bone. The internal component of the implant is then inserted into the cochlea, and the surgical cut is sealed.

Recovery phase

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Expect a recovery period lasting between two to four weeks post-surgery. During this time, you may experience some swelling or discomfort around the incision area. Pain medication is often prescribed to manage these symptoms. Adhering to the post-operative guidelines from your surgical team is crucial for successful healing.

Post-operative care and rehabilitation

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Once you've recovered, the next phase is rehabilitation, which usually includes auditory training. This helps you learn to interpret the sounds captured by the implant and enhances your listening skills. You may work with professionals like speech-language pathologists or audiologists to practice recognising various sounds and speech patterns.

Device programming

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Another key aspect of rehabilitation is the programming of the cochlear implant. Specialised audiologists adjust the device's settings to optimise your hearing and potentially alleviate tinnitus symptoms. This involves a collaborative effort between you and the audiologist to fine-tune the settings based on your specific needs.

The journey ahead

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Rehabilitation can span several months or even longer, depending on your progress and objectives. Patience and commitment are essential, as adapting to the implant and achieving the best possible results is a gradual process.

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‍What does the future hold?

The scientific and clinical communities maintain a high interest in cochlear implants. Many otologists often express that cochlear implantation is among the most rewarding surgeries they conduct. However, there is a gap in the broader healthcare community's ability to identify appropriate candidates for the procedure, as also mentioned above. 

Addressing this discrepancy would likely involve enhanced training and education for healthcare professionals to improve patient identification and referral for cochlear implants, thereby ensuring that more individuals who could benefit from the procedure are given the opportunity to do so.

Moreover, while cochlear implants have already proven transformative for many with severe hearing loss, the frontier of research is being pushed even further. One of the most promising advancements involves the use of drug-eluting electrodes. These specialised electrodes slowly release medication directly into the cochlea. This innovative approach could potentially pave the way for new treatments currently in development to directly target the inner ear. 

However, as with all things tinnitus, the complex interrelationship between the ear and the brain means that we’ll just have to wait and see what the extent of the effect will be on tinnitus.

You can keep up to date with the latest tinnitus research in our articles section.

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Transform your tinnitus journey with Oto

While cochlear implants are a surgical solution primarily aimed at individuals with severe hearing loss, Oto provides a non-invasive, digital alternative accessible right from your mobile device.

What makes Oto unique?

Oto's digital program is a treasure trove of expertly curated content that focuses on sleep, concentration, and learning. The program is the brainchild of a team comprising doctors, ENT specialists, audiologists, and researchers, all of whom have a personal understanding of tinnitus.

Cognitive Behavioural Therapy (CBT) is the most effective proven treatment for tinnitus. Rather than relying on hardware or retraining therapies, Oto harnesses the unparalleled success of CBT to manage your symptoms. This evidence-based approach empowers you to take control of your life by tuning out tinnitus, a process known as habituation.

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Comprehensive features

• Guided audio programs: The app offers an experience akin to speaking directly with a therapist, guiding you through your journey of tackling tinnitus.

• Tailored tools: Whether you need help falling asleep or focusing during the day, Oto provides a range of tools, designed to address various aspects of life affected by tinnitus.

• Instant accessibility: Being a mobile platform, Oto ensures that help is always at your fingertips, wherever you are.

• Managing stress and anxiety: Through CBT techniques and mindfulness practices, Oto helps you manage the stress and anxiety that often accompany tinnitus.

• 1-1 program: For those seeking more personalised guidance, Oto offers a 1-1 program that combines expert video coaching sessions with the mobile app, providing a comprehensive solution for reducing tinnitus intrusion.

• Success stories and free consultations: Oto also features success stories from other tinnitus sufferers and offers free consultations with experts, adding value to your experience.

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Why choose Oto?

Oto's programs are not designed to mask or treat the sound associated with tinnitus. Instead, they aim to change your awareness of it, thereby minimising its impact on your life. Plus, recognising that many users may not be tech-savvy, it has been designed for simplicity and ease of use.

Don't let tinnitus dictate your life any longer. Download Oto from the App Store or Google Play today and embark on a personalised journey towards noticing your tinnitus less.

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Conclusion

Navigating the complexities of tinnitus relief presents a range of options, from surgical interventions like cochlear implants to innovative digital solutions. Oto distinguishes itself in this space by offering a mobile-based, non-invasive approach that leverages the proven efficacy of CBT. 

Ready to embark on a transformative journey to manage your tinnitus more effectively? Download Oto and leverage the most validated, non-invasive method for tinnitus management.

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References

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1. British Tinnitus Association. (n.d.). Tinnitus and stress. Retrieved 29th October, from https://tinnitus.org.uk/understanding-tinnitus/living-with-tinnitus/tinnitus-and-stress/

2. National Institute on Deafness and Other Communication Disorders. (n.d.). Quick statistics about hearing. Retrieved 29th October, from https://www.nidcd.nih.gov/health/statistics/quick-statistics-hearing

3. Francka J.J. Kloostra, Julia Verbist, Rutger Hofman, Rolien H. Free, Rosemarie Arnold, Pim van Dijk; A Prospective Study of the Effect of Cochlear Implantation on Tinnitus. Audiol Neurotol 15 March 2019; 23 (6): 356–363. https://doi.org/10.1159/000495132

4. Assouly, K. K. S., van Heteren, J. A. A., Stokroos, R. J., Stegeman, I., & Smit, A. L. (2021). Cochlear implantation for patients with tinnitus - A systematic review. Progress in brain research, 260, 27–50. https://doi.org/10.1016/bs.pbr.2020.06.013

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FAQs

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