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The impact of tinnitus on adult cochlear implant recipients: A mixed-method approach

Assouly, Kelly K.S.; Shabbir, Maryam; van Dijk, Bas; Hoare, Derek J.; Akeroyd, Michael A.; Stokroos, Robert J.; Stegeman, Inge; Smit, Adriana L.

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Kelly K.S. Assouly

Maryam Shabbir

Bas van Dijk

Associate Professor in Hearing Sciences

Robert J. Stokroos

Inge Stegeman

Adriana L. Smit


Prashanth Prabhu


Tinnitus is a common problem in patients with a cochlear implant (CI). Between 4% and 25% of CI recipients experience a moderate to severe tinnitus handicap. However, apart from handicap scores, little is known about the real-life impact tinnitus has on those with CIs. We aimed to explore the impact of tinnitus on adult CI recipients, situations impacting tinnitus, tinnitus-related difficulties and their management strategies, using an exploratory sequential mixed-method approach.

A 2-week web-based forum was conducted using Cochlear Ltd.’s online platform, Cochlear Conversation. A thematic analysis was conducted on the data from the forum discussion to develop key themes and sub-themes. To quantify themes and sub-themes identified, a survey was developed in English with face validity using cognitive interviews, then translated into French, German and Dutch and disseminated on the Cochlear Conversation platform, in six countries (Australia, France, Germany, New Zealand, the Netherlands and United Kingdom). Participants were adult CI recipients experiencing tinnitus who received a Cochlear Ltd. CI after 18 years of age.

Four key themes were identified using thematic analysis of the discussion forum: tinnitus experience, situations impacting tinnitus, difficulties associated with tinnitus and tinnitus management. Among the 414 participants of the survey, tinnitus burden on average was a moderate problem without their sound processor and not a problem with the sound processor on. Fatigue, stress, concentration, group conversation and hearing difficulties were the most frequently reported difficulties and was reported to intensify when not wearing the sound processor. For most CI recipients, tinnitus seemed to increase when performing a hearing test, during a CI programming session, or when tired, stressed, or sick. To manage their tinnitus, participants reported turning on their sound processor and avoiding noisy environments.

The qualitative analysis showed that tinnitus can affect everyday life of CI recipients in various ways and highlighted the heterogeneity in their tinnitus experiences. The survey findings extended this to show that tinnitus impact, related difficulties, and management strategies often depend on sound processor use. This exploratory sequential mixed-method study provided a better understanding of the potential benefits of sound processor use, and thus of intracochlear electrical stimulation, on the impact of tinnitus.

Journal Article Type Article
Acceptance Date Apr 6, 2023
Online Publication Date Apr 20, 2023
Publication Date Apr 20, 2023
Deposit Date Apr 21, 2023
Publicly Available Date Apr 26, 2023
Journal PloS one
Electronic ISSN 1932-6203
Publisher Public Library of Science (PLoS)
Peer Reviewed Peer Reviewed
Volume 18
Issue 4
Article Number e0284719
Keywords Tinnitus; ears; hearing; exercise therapy; mental health therapies; deafness; drug therapy; surveys
Public URL
Publisher URL


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