introduction disruption in unilateral deafness is underestimated (laryngoscope. 2012...
TRANSCRIPT
AAO Instruction Course, Vancouver BC – Sept. 2013
Introduction
disruption in unilateral deafness is underestimated (Laryngoscope. 2012 Sep;122(9):2088-95) educational
12-41% additional needs (Bess 1988)
22-35% grade failures (Cho Lieg 2004)
social isolation vocational quality of life
tinnitus perception in noise
AAO Instruction Course, Vancouver BC – Sept. 2013
CI for Single Sided Deafness
“absurd concept historically”
long period of deprivation limited benefit for hearing possible uses for tinnitus
short period of deprivation?
X X X X X
AAO Instruction Course, Vancouver BC – Sept. 2013
Effect of Unilateral Stimulation
AAO Instruction Course, Vancouver BC – Sept. 2013
Effect of Unilateral Stimulation
AAO Instruction Course, Vancouver BC – Sept. 2013
Adult Data
unilateral tinnitus (n=26) (Punte AK, et. al. Cochlear Implants Int. 2011 May;12 Suppl 1:S26-9)
unilateral SNHL all post-lingually deaf better with short periods of deprivation
AAO Instruction Course, Vancouver BC – Sept. 2013
Pediatric (and Adult) Data
CI for SSD (n=40) vs. CROS aid BAHA untreated patients
decreased hearing handicap improved localization improved speech in noise (Arndt S, Laszig R, Aschendorff A, et. al., HNO. 2011 May;59(5):437-46)
.
AAO Instruction Course, Vancouver BC – Sept. 2013
CI for SSD – Speech perceptionpe
rfor
man
ce
duration of deprivation
100
00 1 2 3 4 5 6 7 >7
From Arndt, Laszig, Aschendorff
AAO Instruction Course, Vancouver BC – Sept. 2013
CI for SSD – Speech perceptionpe
rfor
man
ce
duration of deprivation
100
00 1 2 3 4 5 6 7 >7
From Arndt, Laszig, Aschendorff
AAO Instruction Course, Vancouver BC – Sept. 2013
Patient Recruitment
inclusion strict minimal deprivation normal anatomy
exclusion anomalous cochlea (narrow nerve!) developmental delay
Unaided
Aided
Bimodal users in the CI program at SickKids
Binaural Fusion
Cochlear Implant (CI)
Cochlear Implant (CI)
Electric Electric
Cochlear Implant (CI)
Hearing Aid (HA)
AcousticElectric
+1000 +400 0 -400 -10000.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
Left
Right
Interaural Timing Difference (µs)
Resp
onse
Rat
e
CI +2000 +1000 +400 0 -400 -1000 -2000 -3000 HA0.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
CI
HA
Interaural Timing Difference (µs)
Resp
onse
Rat
e
Group N Age at Test
(years)
Hearing/Bimodal Age (years)
Normal Hearing
14 8.6 ± 1.6 8.6 ± 1.6
Bimodal Hearing
4 12.0 ± 1.8 5.0 ± 1.8
(M. Deighton)
CI HA
L R
AAO Instruction Course, Vancouver BC – Sept. 2013
Current Opinion
not expanded criteria
experimental protocols short deprivation careful assessment of bilateral function
vigilant reporting