[Observation of 5-year long-term efficacy of chronic tinnitus remaining after treatment for sudden deafness].

Objective

To further clarify the clinical characteristics and 5-year long-term efficacy observation of chronic tinnitus left over after treatment for sudden deafness. Method: A retrospective analysis was conducted on the clinical data of 210 patients with sudden deafness who received treatment from January 2017 to March 2020. The incidence, clinical characteristics, and treatment effects of tinnitus were explored. Patients after treatment were followed up for more than 5 years. Through investigation and regular follow-up, the situation before the start of treatment and 2 weeks, 6 months, 1 year, 2 years, and 5 years after treatment was recorded. Patients were required to fill out the survey information collection form, Tinnitus Evaluation Questionnaire (TEQ), and Tinnitus Disability Inventory (THI). Among the 210 patients, they were divided into low-frequency decline type, high-frequency decline type, flat decline type, and total deafness type according to different types of hearing loss. They were divided into four groups based on hearing efficacy: the cured, significantly effective, effective, and ineffective. According to the patient's sleep condition, they were divided into three groups based on the Insomnia Severity Index (ISI) score: non-insomnia group, mild insomnia group and moderate to severe insomnia group. According to age groups, they were divided into youth group (18-44 years old), middle-aged group (45-59 years old), and elderly group (over 60 years old). Descriptive analysis method was used, and Chi-square test was applied between groups. SPSS 22.0 software was used to analyze the data.

Results

Among the 210 patients, 199 had complete data, including 113 males and 86 females. The age range of the patients was between 25 and 90 years old, with an average age of 50.6 years. Among them, 94.0% (187/199) of patients had tinnitus symptoms at the time of onset. A 5-year follow-up showed that the overall improvement rate of tinnitus was 78.6% (147/187) after 5 years, with a significant improvement rate (including recovery) of 61.0% (114/187). Among the 114 patients who showed significant improvement, 38.6% (44/114) improved within 2 weeks, 47.4% (54/114) improved within 6 months, 12.3% (14/114) improved within 1 year, 0.9% (1/114) improved in the second year, 0.9% (1/114) improved in the fifth year, and the 5-year mild improvement rate was 17.7% (33/187). 21.4% of patients (40/187) had no significant improvement in tinnitus symptoms. Among different types of hearing loss, the significant improvement rates of tinnitus in the low-frequency decline type, high-frequency decline type, flat decline type, and total deafness type were 78.3% (36/46), 44.4% (8/18), 58.0% (40/69), and 55.6% (30/54), respectively, with statistically significant differences between groups (χ2=8.77, P=0.032). Among the groups with different hearing therapy effects, the significant improvement rates of tinnitus in the hearing recovery group [85.4% (41/48)], significant improvement group [60.9% (14/23)], effective group [63.5% (33/52)], and ineffective group [40.6% (26/64)] were statistically significant (χ2=27.13, P<0.001). Specifically, the difference between the hearing recovery group and the hearing significant improvement group was statistically significant (χ2=7.24, P=0.027); the difference between the hearing recovery group and the hearing effective group was statistically significant (χ2=9.34, P=0.009); and the difference between the hearing recovery group and the hearing ineffective group was statistically significant (χ2=25.96, P<0.001). Among different sleep quality groups, the significant improvement rates of tinnitus in the non-insomnia group [64.8% (79/122)], mild insomnia group [61.9% (26/42)], and moderate to severe insomnia group [39.1% (9/23)] were statistically significant (χ2=11.73, P=0.009). The difference between the moderate to severe insomnia group and the non-insomnia group was statistically significant (χ2=9.16, P=0.010); the difference between the moderate to severe insomnia group and the mild insomnia group was statistically significant (χ2=6.37, P=0.041); and the difference between the mild insomnia group and the non-insomnia group was not statistically significant (χ2=2.49, P=0.288); Among different age groups, there was a statistically significant difference in the significant improvement of tinnitus between the youth group [74.2% (66/89)], the middle-aged group [53.9% (21/39)], and the elderly group [45.8% (27/59)] (χ2=15.60, P=0.004). Specifically, the difference between the youth group and the elderly group was statistically significant (χ2=14.73, P=0.001); the difference between the middle-aged group and the elderly group was also statistically significant (χ2=6.68, P=0.035).

Conclusion

The incidence of residual tinnitus after sudden deafness treatment is high, and it eventually evolves into chronic tinnitus, which can last for more than 5 years. Most patients can experience varying degrees of relief and improvement. The improvement of tinnitus is most significant within 6 months after treatment, and it tends to flatten out after 6 months. The effect of hearing therapy can be used as a positive indicator to predict the prognosis of tinnitus. Multi frequency hearing loss involving middle and high frequencies, elderly people, and severe sleep disorders are unfavorable factors for the rehabilitation of tinnitus.