Objective: Tinnitus Handicap Inventory (THI) is one of the world’s most commonly used tools to assess tinnitus severity. The aim of the current study was to establish a revised THI grading system using standard Z-scores and percentiles. Design: Cross-sectional observational study. Study sample: Adult patients (1042 participants – 518 (49.7%) female and 524 (50.3%) male) reporting tinnitus duration of a minimum of 6 months with complete documentation on patient’s clinical status (age, gender, tinnitus duration and laterality, tinnitus handicap based on THI and hearing status based on pure-tone audiometry) were included in the study. Results: Multivariate analysis of variance was used to analyse the effects of gender and hearing loss on THI scores and revealed there was a significant effect of both. Consequently, separate grading systems for women and men, as well as for subjects with normal hearing and hearing loss, is proposed. Conclusions: Our findings are generally consistent with existing grading. Normative values proposed for THI scores, based on a large group of tinnitus patients, could be useful to guide decisions about appropriate intervention options or to evaluate treatment outcomes.

OBJECTIVES: In addition to progressive hearing loss, subjective tinnitus is one of the primary symptoms of the otosclerosis development. The aim of this study was to evaluate the prevalence and severity of preoperative tinnitus among a group of consecutive adult patients with otosclerosis, using standardized research tools. MATERIALS and METHODS: The study included 157 cases of clinical otosclerosis (106 women, 51 men). All patients were tested using pure-tone audiometry. The preoperative prevalence and severity of tinnitus were tested using three validated questionnaires: The Tinnitus and Hearing Survey (THS-POL), Tinnitus Handicap Inventory (THI-POL), and Tinnitus Functional Index (TFI-Pl). RESULTS: Preliminary results showed that 107 of 157 patients with otosclerosis (68.2%) had preoperative tinnitus. Of them, 51 (47.7%) had unilateral tinnitus (in the ear that qualified for stapes surgery), and 56 (52.3%) had bilateral tinnitus. The THS results showed that for 23.4% patients, tinnitus was a problem equal to or greater than hearing loss. The average result of the TFI-Pl questionnaire was 31.6 points, and for THI-POL, it was 38.6 points, indicating that preoperative tinnitus was moderately severe. The statistical analysis did not reveal a correlation between the tinnitus severity and audiometric results (p>0.05). The severity of tinnitus did not differ significantly between men and women (p>0.05), although the TFI-Pl and THI-POL questionnaires indicated that the tinnitus severity generally increased with age in women, while it decreased in men. CONCLUSION: This is a scientific study conducted to evaluate the prevalence and severity of preoperative tinnitus in Polish patients with otosclerosis, using three validated questionnaires. Cite this article as: Skarżyński PH, Dziendziel B, Gos E, Włodarczyk E, Maiśkiewicz B, Rajchel JJ, Skarżyński H. Prevalence and Severity of Tinnitus in Otosclerosis: Preliminary Findings from Validated Questionnaires. J Int Adv Otol 2019; 15(2): 277-82.

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. 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. 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. 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.

Objective: To report the improvement in hearing preservation and speech understanding of five pediatric patients who received cochlear implantation via Electro-natural Stimulation Partial Deafness Treatment, the largest group so far treated. Study Design: Retrospective case review. Setting: Tertiary referral center. Patients: A series of five children aged 9 to 16 years old with bilateral normal hearing at 125 to 1500 Hz and severe-to-profound hearing loss above 1500 Hz, who were subjected to unilateral cochlear implantation. Intervention: All the patients underwent unilateral cochlear implantation by the same senior otosurgeon. Surgery involved six principal steps using an approach to scala tympani through the round window and use of an extremely delicate electrode with active length of up to 21 mm. Main Outcome Measures: Pre- and postoperative hearing for air- and bone-conduction was assessed using pure-tone audiometry. Speech understanding was evaluated with the Pruszewicz monosyllabic word test in free field. Hearing preservation was assessed using the Hearing Preservation Calculator developed by the HEARRING group. Results: Over the 3-year observation period, preoperative hearing thresholds were completely preserved in three children (60%) and partially in the remaining two (40%). A useful improvement in speech understanding of about 30% (compared with the best fitted hearing aids in the preoperative period) was observed in both quiet and noise. Conclusions: Cochlear implantation seems to be a successful way of restoring hearing ability in ENS-Partial Deafness Treatment patients who are beyond the scope of effective rehabilitation with hearing aids. Excellent results of hearing preservation in ENS patients encourage discussion on extending the inclusion criteria for cochlear implantation.

Objective: To evaluate the impact of electrode length on hearing preservation (HP) in Partial Deafness Treatment–Electrical Complement (PDT-EC) subjects. Study Design: Retrospective case review. Setting: Tertiary referral center. Patients: Twenty-three PDT-EC patients (with preoperative air-conduction thresholds ≤30 dB up to 500 Hz) were divided into two groups: Flex20 electrode (Med-EL GmbH, Innsbruck, Austria) (12 patients) and Flex24 electrode (Med-EL GmbH, Innsbruck, Austria) (11 patients). Interventions: All participants were subjected to minimally invasive cochlear implantation using the round window approach. Main Outcome Measure(s): Pure tone audiometry (125–8000 Hz) was performed preoperatively and at 1, 6, 12, and 24 months postoperatively. HP was established using the HEARRING group formula. Speech understanding was assessed preoperatively and at 12 and 24 months postoperatively. Results: Analysis of HP for every individual indicates that more than half the patients with Flex20 and Flex24 had complete HP at 6 months follow-up. None of the patients from either group had complete loss of hearing. At activation, average air-conduction thresholds for low frequencies (125–500 Hz) were slightly better for the short electrode (M = 29.03) than for the long (M = 39.10) but the difference was not statistically significant (p = 0.067). The effect of electrode (Flex20 versus Flex24) was not significant in terms of pure tone audiometry and speech recognition at long-term follow-up. Conclusions: In the early postoperative period, complete HP was possible in a majority of patients from both groups, but slightly better HP outcomes were achieved by Flex20. In the long term, the length of the electrodes does not affect the degree of HP or speech understanding.