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How to cite this article Yonehara E, Mezzalira R, Porto PR, Bianchini WA, Calonga L, Curi SB, Stoler G, et al. Suppression of tinnitus by electrical stimulation via a cochlear implant has been studied in recent years. Tinnitus may be defined as a conscious perception of a buzzing, hissing, or ringing sound in the absence of environmental noise.
Recent studies have demonstrated the occurrence of neuronal plasticity and cortical reorganization related to perception of sound after cochlear damage. Many patients with sensorineural hearing loss present with tinnitus, especially those with an indication for cochlear implantation. Just one study in the Brazilian national literature reported tinnitus improvement in four of five patients who underwent monochannel cochlear implant surgery [11]. We conducted a retrospective study involving 29 adults who had postlingual sensorineural hearing impairment and underwent surgery for Nucleus 24K multichannel (Cochlear Ltd.) cochlear implant at the cochlear implant sector of the Otorhinolaryngology, Head and Neck Surgery Department, University of Campinas (UNICAMP), Sao Paulo, Brazil, from May 2003 to June 2005. Before surgery, 21 individuals (72%) presented with tinnitus, which was bilateral in 14 patients (67%). Twelve (86%) of the 14 individuals who presented with bilateral tinnitus reported either complete disappearance or decrease in both ears and, in 2 patients (14%), the tinnitus worsened, even in the contralateral ear (Fig. In our study, the incidence of tinnitus in individuals with profound bilateral sensorineural hearing loss was 72%, compatible with the data in the literature [10,12]. The literature contains no consensus regarding the cochlear implant mechanism of tinnitus suppression. The literature demonstrates that multichannel devices have proven to be more effective than the monochannel implants in reducing tinnitus. Reports have cited the possibility of tinnitus worsening or being exacerbated after cochlear implant surgery [10] but, according to Ruckenstein et al.
Our results in relation to tinnitus suppression and partial suppression were similar to those found in the literature [9,13-18].
Postsurgical onset of tinnitus occurred in one of our patients when the implant was activated. The postsurgical cochlear implant benefits obtained by patients with tinnitus raise the following question: Is cochlear implant surgery justifiable for the treatment of tinnitus?
The results of this study demonstrated that cochlear implants had a positive effect on tinnitus and could also induce its partial or total suppression in the contralateral ear. This research was presented at the Fourth Brazilian Triological Meeting, Sao Paulo, Brazil, November 10-14, 2005. Some individuals who undergo cochlear implant surgery report total or partial relief of the symptoms even in the contralateral ear.

It is a common symptom, with heterogeneic etiologies, perception, and discomfort, that affects 15% of Americans [1]. The disproportional increase in the number of neurons sensitive to the remaining frequencies of hearing or greater spontaneous activity in reorganized areas may explain the buzzing sensation. Although several therapies have been recommended for the treatment of tinnitus, none of them has been totally effective. The purpose of our research was to study tinnitus before surgery and after activation of the cochlear implant, to observe the suppression of tinnitus perception and to correlate these results with data in the literature.
After the cochlear implant was activated, tinnitus completely disappeared in seven patients (33%) and partially decreased in eight (39%). Evolution of tinnitus after cochlear implant activation in patients with bilateral complaints.
Tinnitus decrease or suppression after cochlear implantation in 71% of cases was also compatible with the results obtained by similar studies [10,12,13], regardless of the type of internal component.
The masking effect most probably works like environmental noise that induces vibration of the basilar membrane at the damaged site, suppresses abnormal activity of the cilia cells in the internal ear, and produces a buzzing noise. It is suggested that the greater the external sound received by the cochlear implant, the smaller the tinnitus perception [10].
Electrical stimulation of the implant is transmitted to the cochlear and superior olivary nuclei, causing direct inhibition of the inner-ear cilia cells through the efferent pathways.
However, asymmetrical stimulation produced by the cochlear implant has proved to be beneficial even in the contralateral ear [9,12,16- 18].
A probable explanation is that program adjustment had not occurred owing to the short period of activation.
Similarly, the influence of tinnitus in relation to choice of ear for cochlear implantation is also a complex subject.
Several studies suggest that electrical promontory stimulation is effective in suppressing tinnitus [3-6]. A similar effect could be produced by a hearing prosthesis that would improve hearing and suppress tinnitus [9]. Activation of the efferent system would explain the suppressive effect of the cochlear implant on tinnitus [9].
Some indications suggest that cochlear implantation in the ear in which tinnitus is more severe has a chance of greater suppression [15]. Tinnitus suppression by electrical stimulation of the cochlear wall and by cochlear implantation.
The results obtained in our study demonstrated an improvement of 71% in 29 implant cases, confirming data found in the literature.

Jastreboff's 1990 neurophysiological model [2] emphasized the importance of the interaction of the central auditory system, the limbic system, and the sympathetic autonomic system. Reduced tinnitus has been reported after cochlear implant surgery [7,8], including in the contralateral ear [9].
In two of the three cases, tinnitus was slightly worsened, and in only one case the patient referred to an annoying effect.
Our aim was to study tinnitus in individuals before surgery and after cochlear implant activation and to observe improvement in the perception of tinnitus, comparing these results with data in the literature. According to this model, peripheral lesions produce an electrical signal that, added to an inefficient control of the encephalic stem system and to emotional and behavioral reactions, leads to an unpleasant buzzing sensation. We conducted a retrospective study of 29 postlingual adults who had profound sensorineural hearing loss and underwent cochlear implant surgery at the cochlear implant sector of the Otorhinolaryngology, Head and Neck Surgery Department, University of Campinas, Sao Paulo, Brazil, between May 2003 and June 2005.
Reorganization of these areas, which occurs after cochlear implant, may reduce this activity and, as a result, diminish tinnitus. The device employed in this procedure was the Nucleus 24K multichannel device (Cochlear Ltd, Lane Cove, Australia). After the implant, approximately 86% presented with partial or total improvement, with exacerbation seen in only 9%. Owing to decussation in the central hearing system, decrease of tinnitus is also expected in the contralateral ear after cochlear implantation [10]. In our study, 12 patients also presented with tinnitus improvement in the contralateral ear. Before surgery, 21 of the 29 patients (72%) who later underwent cochlear implant surgery presented with tinnitus, which was bilateral in 14 cases (67%).
However, two patients reported that tinnitus had worsened in the contralateral ear after surgery. After the cochlear implant was activated, seven patients (33%) presented with total suppression, and eight patients (39%) reported partial relief.
In the 14 cases with bilateral symptoms, tinnitus was totally suppressed or decreased in both ears in 12 cases (86%). Individuals who underwent multichannel cochlear implant surgery presented with reduced tinnitus even in the contralateral ear.

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