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Objectives/hypothesis: The objective of this study was to evaluate the outcome of cochlear implantation in elderly patients (80 or older) with progressive bilateral deafening. The measured outcomes included the quality of life, speech understanding, tinnitus distress, stress level, anxiety, and depressiveness., Study Design: Prospective cohort study., Methods: Seventeen 80+ years (mean 82.9 ± 2.7 years) patients with progressive, postlingual, bilateral deafness were unilaterally implanted with multichannel cochlear implants. Data about their health-related quality of life (Nijmegen Cochlear Implantation Questionnaire) and their comorbidities were collected using specific validated questionnaires (tinnitus questionnaire, General Anxiety Disorder-7, Depression Scale, Perceived Stress Questionnaire). The speech understanding was assessed with the Freiburg Monosyllabic Test, whereas the subjective hearing was evaluated with the Oldenburg Inventory., Results: After the surgery, not only the subjective hearing but also health-related quality of life, speech understanding, and tinnitus distress of the implanted patients improved significantly. The perceived stress, general anxiety, and depressiveness were low or normal prior and after surgery., Conclusion: This study demonstrates a significant improvement in the quality of life and speech understanding in a group of elderly patients who underwent cochlear implantation. An additional positive indicator of a promising hearing rehabilitation was a significant improvement of the tinnitus distress. Perceived stress level, general anxiety, and the depressiveness of implanted patients were low and remained unaffected., Level of Evidence: 4. Laryngoscope, 126:2811-2816, 2016., (© 2016 The American Laryngological, Rhinological and Otological Society, Inc.)

Emotional stress is a constant companion of tinnitus patients, since this phantom sound can unfortunately be a very effective stressor. However, the mechanism of stress contribution to the onset or progression of tinnitus remains unknown. Here, we review the pathways induced by emotional stress and the outcome of their induction: corticosteroid-dependent changes in gene expression, epigenetic modulations, and impact of stress on neuronal plasticity and neurotransmission. Using clinical examples, we demonstrate the presence of emotional stress among tinnitus patients and we present methods to measure the degree of stress. The evidence causally linking emotional stress with tinnitus is still indirect-the main difficulty lies in the inaccessibility of human auditory tissues and the inability to directly measure tinnitus-induced psychological distress in animal models. However, we believe that translational research is the future way of filling this gap, finding the answers, and thereby improving both the diagnosis and treatment of tinnitus patients.

Successful management of patients with chronic tinnitus is an important health issue. One of the tinnitus management strategies used at our Tinnitus Center is a combination of tinnitus retraining therapy (TRT) with physiotherapy and psychological management [called modified TRT (MTRT)]. We have used this type of management for over a decade and have described the protocol in detail elsewhere. In the present study, we wanted to determine the effect of MTRT on the well-being of tinnitus patients 3 years after treatment onset. One hundred and thirty patients with chronic tinnitus were assessed using psychometric instruments immediately before 7-day MTRT, immediately after the therapy and 3 years later. Patients with very severe tinnitus-related distress associated with major depression and a risk of suicide were excluded from this study. MTRT resulted in a sustained reduction of tinnitus-related distress. Moreover, the quality of life of patients had increased, as assessed by a separate questionnaire. The effect of MTRT was influenced by the degree of tinnitus-related distress and by the patients' age, the latter being gender dependent. Hearing loss and tinnitus duration had only a minor influence on the therapeutic effect. Taken together, we report a positive change in the state of well-being of patients with chronic tinnitus measurable with various psychometric instruments 3 years after the onset of MTRT., (© 2014 S. Karger AG, Basel.)

Recently, we have demonstrated that the exposure of Wistar rats to psycho-social stress results in a transient auditory hypersensitivity. Here, to learn more about modifications occurring in auditory brainstem, we have analyzed gene expression pattern in inferior colliculus using quantitative RT-PCR. As targets, we have chosen genes associated with: neural activity (FBJ osteosarcoma viral oncogene, cFos), hypoxia (nitric oxide synthase inducible, iNos; superoxide dismutase 2, Sod2), neuroprotection (nerve growth factor beta, Ngfb; heat shock factor 1, Hsf1; heat shock protein 70, Hsp70) and inflammation (tumor necrosis factor alpha, Tnfa; tumor necrosis factor alpha receptor, Tnfar; substance P, Sp; cyclooxygenase 2, Cox2). We found that the expression of all genes was modified following stress, as compared to the controls. Immediately after stress, the number of transcripts encoding iNos, Sod2, Hsf1, Ngfb, Tnfa, Tnfar and Sp was significantly increased, suggesting possible modulation during exposure to stressor. Interestingly, we found that expression of Hsf1 and Ngfb at this particular time was left-right asymmetrical: there were more transcripts of both genes found in the left colliculi, as compared to the right colliculi. Three hours post-stress, iNos, Hsf1, Tnfa and Tnfar were still upregulated, Sod2, Ngfb and Sp went back to baseline and Cox2 was upregulated. Six hours post-stress, cFos mRNA became downregulated. The number of Hsp70 mRNA increased 24h post-stress. Except for the reduced number of cFos transcripts, expression of all other genes tested reached the baseline seven days post-stress. Presented results corroborate the concept of auditory system responding to the psycho-social stress. Post-stress changes in the IC gene expression could likely indicate shift from allostasis to homeostasis in the auditory brainstem., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Tinnitus is a common complaint in the candidates for cochlear implantation (CI). Tinnitus-related distress has often been measured in these patients using categorical ratings, which lack information about tinnitus severity, stress and health-related quality of life or their correlation. Here, using 4 validated questionnaires, we evaluated psychometric parameters and the quality of life of 32 postlingually deafened patients before and after CI. The data regarding pre-CI were collected retrospectively. Of all patients included in this study, 28 (87.5%) suffered from tinnitus before implantation. Following a mean of 24 months after surgery, these patients reported a significant decrease (39.2%) of tinnitus impairment, as measured by the Tinnitus Questionnaire. In none of the 28 patients has tinnitus worsened. Moreover, the 4 tinnitus-free patients remained so after the CI surgery. In addition, the implant supply resulted in 36.7% reduction in perceived stress and in 15.4% reduction in evasive coping. In addition, the focus on positive coping has improved by 12.3%, whereas the health-related quality of life improved by 53.4% in all patients. Tinnitus impairment and stress were reduced more strongly in patients who had initially higher scores. Interestingly, a significant correlation between the psychometric scores was found mainly after CI. Our results indicate that patients with higher tinnitus-related distress have a lower quality of life, lesser coping abilities and perceive more stress, but before implantation it is masked by deafness. We conclude that tinnitus-related screening of patients before and after CI is an important step in the identification of individuals who would benefit from specific fitting and/or tinnitus therapy after implantation., (Copyright © 2011 S. Karger AG, Basel.)

Emotional stress is often associated with auditory phenomena such as hyperacusis, tinnitus, Ménière's disease and vertigo. Stress develops as a result of a person's attempts to come to terms with the increased or unexpected demands of his or her environment. Stress serves to protect one from physical danger and to temporarily increase one's performance in order to increase the probability of survival. Sleep and appetite are particularly reduced, while anxiety increases. The mental changes induced by stress may contribute to the onset or exacerbation of tinnitus. The following links exist between the auditory and stress systems: the limbic system, which regulates instinctive behavior and emotions, is linked to the auditory system via the medial geniculate body (amygdala). The hypothalamus, which is the integrative center of the endocrine and autonomic systems, is linked to the auditory system via the inferior colliculus. The reticular system, which is focused on the behavior pattern of attention and excitement, projects serotonergic fibers to all pathways of the auditory system, ranging from the cochlea to the auditory cortex.