Bartels H, Staal M J, Holm A F, Mooij J J A, Albers F W J
Department of Otorhinolaryngology, University Medical Center Groningen, Groningen, The Netherlands.
Stereotact Funct Neurosurg. 2007;85(4):150-7. doi: 10.1159/000099073. Epub 2007 Jan 26.
Long-term evaluation of treatment of chronic, therapeutically refractory tinnitus by means of chronic electrical stimulation of the vestibulocochlear nerve.
Inclusion criteria were severe, chronic, therapeutically refractory, unilateral tinnitus and severe hearing loss at the ipsilateral site. Out of 6 patients, 4 patients were selected for long-term evaluation. Two patients were not evaluated because of premature dropout.
A stimulation electrode was placed around the vestibulocochlear nerve through a retrosigmoid approach and connected to a subcutaneously positioned pulse generator via an extension cable. Follow-up was performed 3 months and 42.5 months after implantation. Three measures for treatment outcome were used. First, effect sizes were determined by means of the total Tinnitus Handicap Inventory (THI) score using Cohen's formula. Second, general and tinnitus-specific audiometric tests were performed in on and off conditions of the neurostimulation system. Third, recordings were noted for tinnitus severity and treatment success on a visual analogue scale.
All 4 patients reported successful treatment with neurostimulation. The effect size after 3 months was 0.7, indicating an average effect, while the effect size measured during long-term follow-up was 1.75, indicating a substantial effect with major clinical implications. No changes in hearing level for both ears were measured. The neurostimulation system did not change the tinnitus pitch in any of the patients, and resulted in a minimal reduction of tinnitus loudness in only 2 patients. In all 4 patients the original tinnitus sound was replaced by another, pleasantly perceived sound. The average VAS score of perceived tinnitus severity was reduced from 8 to 3.25. The average VAS score for treatment success was 7.25.
The long-term follow-up of neurostimulation treatment for chronic tinnitus shows promising results. Long-term results were better than those determined after a 3-month follow-up. In all patients the tinnitus was replaced by another sound, which was perceived as pleasant. Further studies are needed before accepting neurostimulation as a treatment modality for chronic, therapeutically refractory tinnitus.
通过对前庭蜗神经进行慢性电刺激，对慢性、治疗难治性耳鸣的治疗效果进行长期评估。
纳入标准为严重、慢性、治疗难治性单侧耳鸣以及同侧严重听力损失。6名患者中，4名患者被选入进行长期评估。2名患者因过早退出研究而未被评估。
通过乙状窦后入路将刺激电极置于前庭蜗神经周围，并通过延长电缆连接至皮下植入的脉冲发生器。分别在植入后3个月和42.5个月进行随访。采用了三种治疗效果评估方法。第一，使用科恩公式，通过耳鸣残障量表（THI）总分确定效应量。第二，在神经刺激系统开启和关闭状态下进行常规和耳鸣特异性听力测试。第三，在视觉模拟量表上记录耳鸣严重程度和治疗成功率。
所有4名患者均报告神经刺激治疗成功。3个月后的效应量为0.7，表明为中等效果，而长期随访期间测得的效应量为1.75，表明为显著效果，具有重要临床意义。双耳听力水平均未出现变化。神经刺激系统未改变任何患者的耳鸣音调，仅2名患者的耳鸣响度略有降低。所有4名患者的原始耳鸣声均被另一种令人愉悦的声音所取代。耳鸣严重程度的平均视觉模拟量表（VAS）评分从8降至3.25。治疗成功率的平均VAS评分为7.25。
慢性耳鸣神经刺激治疗的长期随访显示出有前景的结果。长期结果优于3个月随访时确定的结果。所有患者的耳鸣均被另一种令人愉悦的声音所取代。在将神经刺激接受为慢性、治疗难治性耳鸣的一种治疗方式之前，还需要进一步研究。
