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Introduction

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.

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Introduction

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  1. 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

  2. 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

  3. Effect of Unilateral Stimulation

  4. Effect of Unilateral Stimulation

  5. Adult Data • unilateral tinnitus (n=26) (PunteAK, et. al. Cochlear Implants Int. 2011 May;12 Suppl1:S26-9) • unilateral SNHL • all post-lingually deaf • better with short periods of deprivation

  6. 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) .

  7. CI for SSD – Speech perception 100 From Arndt, Laszig, Aschendorff performance 0 0 1 2 3 4 5 6 7 >7 duration of deprivation

  8. CI for SSD – Speech perception 100 From Arndt, Laszig, Aschendorff performance 0 0 1 2 3 4 5 6 7 >7 duration of deprivation

  9. Patient Recruitment • inclusion strict • minimal deprivation • normal anatomy • exclusion • anomalous cochlea (narrow nerve!) • developmental delay

  10. Bimodal users in the CI program at SickKids Unaided Aided

  11. Binaural Fusion Electric Electric Cochlear Implant (CI) Cochlear Implant (CI) Acoustic Electric Cochlear Implant (CI) Hearing Aid (HA)

  12. (M. Deighton) R L HA CI

  13. Current Opinion • not expanded criteria • experimental protocols • short deprivation • careful assessment of bilateral function • vigilant reporting

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