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When Hearing Aids are Not Enough

When Hearing Aids are Not Enough. James Tysome, ENT Consultant Frances Harris, Speech and Language Therapist Joanne Muff, Audiological Scientist. First single channel implant at Addenbrooke ’ s: 1985 First multichannel implant (Ineraid): 1989 First BAHA: 1991 First bilateral (adult): 1995

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When Hearing Aids are Not Enough

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  1. When Hearing Aids are Not Enough James Tysome, ENT Consultant Frances Harris, Speech and Language Therapist Joanne Muff, Audiological Scientist

  2. First single channel implant at Addenbrooke’s: 1985 First multichannel implant (Ineraid): 1989 First BAHA: 1991 First bilateral (adult): 1995 First ABI: 1999 Moved to The Emmeline Centre in 2000 First MEI: 2010 NICE approval for bilateral implants: 2007 Introduction to The Implant Service

  3. Offer a range of hearing implants One of two centres using ABI for condition NF2 4 surgeons, 14 clinical staff and 5 admin staff 1500 patients About 30 referrals per month (15-25 adults, 5-7 children) Implant approximately 100 adults and 40 children per year Accept referrals from audiologists, GPs, doctors, TODs, SLTs The Implant Service

  4. Indication for hearing implants • Patients likely to have better hearing rehabilitation with hearing implants than conventional hearing aids • Type of implant depends on residual hearing and cause of deafness

  5. Indications for BAHA / MEI • Specialised ear surgery commissioning • Bilateral conductive or mixed hearing loss • Unable to wear conventional hearing aids • Single-sided deafness (NEW April 2013)

  6. BAHA

  7. BAHA

  8. Middle ear implant

  9. Indications for cochlear implantation

  10. CI candidacy: NICE Criteria ADULTS <50% on BKB sentences @ 70 dB SPL CHILDREN Delayed speech, language and listening skills for age, developmental stage and cognitive ability

  11. Other Considerations • Borderline candidates e.g. PTA out of criteria but very poor discrimination • Patient very keen but long term deaf • Patient very reluctant / withdrawn from earlier referral • Include hearing history, PTAs and any information on hearing aids • Think of referral as information exercise, not a commitment to implantation – exploring: ‘what is the best device for your hearing loss?’

  12. Unmet need! • Children: • About 74% of suitable children aged 0-3 years receive CI, rising to 94% by age 17. • Adults: • About 5% of anticipated population receive CI. Raine 2013 Cochlear implants international vol 14: S32-37.

  13. Auditory brainstem implant

  14. Assessment for cochlear implants • Introduction and initial audiology • Listening skills assessment • Medical assessment • Objective testing • CT scan • Balance

  15. The Multi-disciplinary Team Meeting • Discussion of individual patients • Audiology and speech discrimination results (with respect to criteria) • Lifestyle • Medical concerns • Review CT scan • Balance

  16. Cochlear implantation - surgery • 1-2 hours • Day case / overnight stay • 2 weeks off work • Risks • facial nerve injury <1:1000 • dizziness or vertigo • tinnitus • taste disturbance • 1% device failure

  17. Hearing preservation surgery • Electrode • Technique • round window insertion • atraumatic insertion • steroids

  18. Programming & Rehabilitation: CI Initial programming at 4-6 weeks post surgery Ongoing care and support Variety of outcomes

  19. Rehabilitation: Structured l-i-s-t-e-n-i-n-g • Speech sound contrasts • Linking written text and sound • Use of context to derive meaning • Adding difficulty – • Faster rate of speech • More complex language • Background noise

  20. Telephone training

  21. Introduction to music

  22. Communication strategies • Positive communication tactics • Coping with changes in roles post implant

  23. Awareness of voice • Volume control • Breath support • Nasal resonance • Tension • Pitch control • Rhythm

  24. Expected Outcomes – CIAcquired Hearing Loss Speech Discrimination scores With lipreading Average = 94% (range 75 to 100; SD 40) (2010-2011 data; n=43) Without lipreading Average = 80% (range 0 to 100; SD 34) (2010-2011 data; n=48) MAY 2013 FOR CLINICIAN USE ONLY Function

  25. Expected Outcomes – CICongenital Hearing Loss Function Speech Discrimination scores** With lipreading Without lipreading MAY 2013 FOR CLINICIAN USE ONLY Phone use* (NB all progressive) Music appreciation* No phone use: 6 in 10 Simple conversation: 3/10 Wider phone use: 1/10 Yes: 85% No: 15% No interest: 0% *Phone and music data 2009-11 n=28 **Speech discrimination data 2010-11 n=19

  26. Seamless Services: pre-implant Information Sharing Balance Clinic The MDT Research & Audit SPClinic Referrals Joint Staff

  27. Seamless Services: post-implant Post CI Vestibular Rehab Balance Clinic Case Study Meetings Bimodal Users Tinnitus Research & Audit Joint Staff

  28. Benefits Continuity of care More appropriate referrals Increased Awareness Timely Referrals Expert Advice Technology Sharing Research

  29. Take Home Messages • Would a hearing implant help your patient? • What messages do you pass on to patients? • What could your service do to offer a more seamless approach to potential candidates?

  30. Need information? Please contact us: Emmeline Centre for hearing implants Addenbrookes Hospital, Box 163, Cambridge CB2 0QQ 01223 217589 emmelinecentrereception@addenbrookes.nhs.uk

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