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BACKGROUND: Tinnitus is a common symptom among individuals with a vestibular schwannoma. In recent years, cochlear implantation, often combined with tumor resection, is an increasingly used option in the management of these patients. The existing literature does not account well for the effect of treatment on tinnitus burden. Thus, this paper reports the effect of cochlear implantation on tinnitus in a cohort of vestibular schwannoma patients. METHODS: Individuals with vestibular schwannoma undergoing cochlear implantation were retrospectively reviewed for tinnitus burden, as evaluated by the Tinnitus Handicap Inventory, administered before and after implantation. The outcome measures were total Tinnitus Handicap Inventory score and scores from each of the Tinnitus Handicap Inventory subdomains (functional, emotional, and catastrophic). In addition, the existing literature on tinnitus in cochlear implanted vestibular schwannoma patients was reviewed. RESULTS: Tumor management consisted of simultaneous resection (77%), previous resection (9%), observation (9%) and radiation (5%). Complete Tinnitus Handicap Inventory evaluation was available for 17 patients. After implantation, the median THItotal changed from 18 to 10 (P = .0006), the subdomain THIfunctional from 10 to 3 (P = .006), the THIemotional from 3 to 0 (P = .023) and the THIcatastrophic from 6 to 1 (P = .004). In the scarcely reported tinnitus outcomes in the literature, most but not all cases experienced a decrease in tinnitus. CONCLUSIONS: The tinnitus burden is significantly reduced by cochlear implantation in individuals with a vestibular schwannoma. This agrees with findings for other etiologies indicating cochlear implantation and supports the eligibility for hearing rehabilitation with a cochlear implant for this specific group of patients.

Conclusion: Hearing restoration using an active middle ear implant (AMEI) is a highly cost-effective treatment for a selected group of patients with no other possibilities for auditory rehabilitation. Objectives: To evaluate the cost-utility of using an AMEI for hearing rehabilitation. Methods: This was a prospective, multicenter, single-subject repeated study in six tertiary referral centers. Twenty-four patients with sensorineural (SNHL), conductive (CHL), and mixed hearing loss (MHL) were implanted with the AMEI Vibrant Soundbridge (R) (VSB) for medical reasons. All patients were previously rehabilitated with conventional hearing aids. Multiple validated quality of life patient questionnaires, Health Utilities Index (HUI 2 and 3), and Glasgow Hearing Aid Benefit Profile (GHABP) were used to determine the utility gain and quality adjusted life years (QALY). Directly related treatment costs for the implantation were calculated and related to utility gain and QALY. Results: The cost/QALY for patients with SNHL was estimated at (sic)7260/QALY, and for patients with C/MHL at (sic)12 503/QALY.

Objective: To explore the short-term and long-term variability of tubal opening and closing in ears with advanced retractions and in healthy ears. Study Design/Methods: Twenty ears with retraction type middle ear disease (R-MED) and 20 normal ears underwent direct recording of the middle ear pressure during repeated forced openings, equalization of +100 daPa and -100 daPa by swallowing, Valsalva inflation, and forceful sniffing. Tests were performed twice (separated by 30 min) on each of 2 days separated by 3 to 4 months. Results: There was considerable intraindividual variability of the forced opening pressure and the closing pressure in both groups, within as well as between sessions and test days. Although the variability was 1.5 to 2 times higher in ears with retraction than in the normal group, mean Po and Pc did not differ between the groups. Compared with normal ears, ears with retraction changed more frequently from a positive to negative test response, or vice versa, when re-tested after 30 minutes. Rates of positive response in the equalization and Valsalva tests were significantly lower in diseased ears compared with normal ears. Conclusions: Eustachian tube opening and closing functions vary more in ears with retraction disease than in normal ears, which is consistent with the variable clinical course of R-MED and implies that single tubal function tests have little prognostic value on the individual level.