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Health and Quality of Life Outcomes
Published in: Health and Quality of Life Outcomes 1/2018

Open Access 01-12-2018 | Research

Clinically important change in tinnitus sensation after stapedotomy

Authors: Henryk Skarżyński, Elżbieta Gos, Beata Dziendziel, Danuta Raj-Koziak, Elżbieta A. Włodarczyk, Piotr H. Skarżyński

Published in: Health and Quality of Life Outcomes | Issue 1/2018

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Abstract

Background

When measuring the treatment effect in tinnitus with multi-item outcome instruments, it is crucial for both clinical and research purposes to take into consideration clinical importance of the outcome scores. The aim of the present study is to determine minimal important change (MIC) in tinnitus which is clinically meaningful to patients with otosclerosis.

Methods

The study population was 95 patients with otosclerosis, suffering from tinnitus. They completed the Tinnitus Functional Index before stapedotomy and 3 months after the surgery. The minimal important change was estimated with the Clinical Global Impression Scale as the external criterion (anchor). The mean change method and the receiver operating characteristic (ROC) method were used to determine minimal important change in tinnitus sensation.

Results

The improvement in tinnitus after stapedotomy was reported by 69.4% of the patients with otosclerosis. Minimal important change in tinnitus was estimated as reduction of 8.8 points in the Tinnitus Functional Index.

Conclusions

The anchor-based approach using an external criterion (anchor) allows to determine change in tinnitus sensation which is meaningful to patients after stapedotomy. The value of 8.8 points in Tinnitus Functional Index could be used as benchmark of stapedotomy effectiveness in otosclerosis patients suffering from tinnitus. Hearing difficulties comorbid with tinnitus could affect the perception of tinnitus change.
Footnotes
1
Justification for the lack of subjectively perceived improvement of hearing after stapedotomy:
For one patient who reported no change in hearing, mean air conduction (AC) threshold for frequencies: 0.5, 1, 2, 4 kHz was 80.0 dB HL before the surgery (pre-op) and it improved to 51.2 dB HL after the surgery (post-op). Simultaneously, the air-bone gap (ABG) reduced from 34.6 dB to 18.2 dB, which could be assumed to be a good result (< 20).
Another patient who reported no change in hearing had mean AC threshold 63.8 dB HL before stapedotomy and 47.5 dB HL after stapedotomy. Mean BC threshold was better after stapedotomy (22.5 dB HL) than before stapedotomy (30.8 dB HL). Comparing the improvement of AC thresholds post-op with BC thresholds pre-op the air-bone gap (ABG) reduction to 9.8 dB HL was obtained which means that the result of the surgery was very good (< 10 dB). Post-op BC thresholds improved by 8.3 dB so the effect of the surgery was good (ABG = 18.1 dB).
The mean AC threshold for the next patient was 62.5 dB HL pre-op and improved to 41.3 dB HL post-op. The ABG reduced from 33.6 dB to 10.25 dB, which means nearly very good result.
According to PTA results, considerable improvement of hearing was achieved due to stapedotomy, but in the patients’ opinion it was not sufficient. The reduction of ABG after surgery or even closure of ABG within 10 dB in patients with mixed hearing loss could yield sensorineural hearing loss, which in some cases could result in not full speech comprehension. For such patients air conduction hearing aids are recommended. The other possible cause of no change in hearing reported by patients could be persistent tinnitus, which disturbed full speech understanding.
The pre-op AC thresholds for the next patient were 80–100 dB HL for the frequencies 500–8000 Hz. The mean AC threshold was 93.8 dB HL pre-op and 76.2 db HL post-op. The patients with profound hearing loss and far-advanced otosclerosis present a special challenge. It is important to find individual needs and expectations of the patients and inform them about possible benefits, i.e. reducing severity of tinnitus, providing better and more effective prosthetic correction of hearing impairment by means of hearing aids.
 
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Metadata
Title
Clinically important change in tinnitus sensation after stapedotomy
Authors
Henryk Skarżyński
Elżbieta Gos
Beata Dziendziel
Danuta Raj-Koziak
Elżbieta A. Włodarczyk
Piotr H. Skarżyński
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Health and Quality of Life Outcomes / Issue 1/2018
Electronic ISSN: 1477-7525
DOI
https://doi.org/10.1186/s12955-018-1037-1

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