Issues in pre- and postopera/ve counselling and clinical management for children with Single Sided Deafness/ Asymmetric Hearing Loss

Transcription

1 Issues in pre- and postopera/ve counselling and clinical management for children with Single Sided Deafness/ Asymmetric Hearing Loss Rebecca Farrell 1,, Karyn Galvin 2, Jaime Leigh 1,2,3, Arielle Kaicer 1,Richard Dowell 1,2,3 Markus Dahm 1 and Robert Briggs 1,2 1. Cochlear Implant Clinic, Royal Victorian Eye and Ear Hospital Melbourne, Australia 2. University of Melbourne, Department of Otolaryngology 3. CooperaNve Research Centre for Cochlear Implant and Hearing Aid InnovaNon

2 What are the benefits in bilateral hearing? Ability to localise sounds Timing and intensity cues Ease of listening in complex listening environments e.g. noisy classroom

3 Management Op/ons Nothing No benefit (possible to monitor language over Nme) CROS Reduce head-shadow effect Discomfort i.e. blocking natural hearing of good ear Bone ConducNon hearing aid/baha Reduce head-shadow effect Discomfort i.e. pressure on head Surgery? Clinically panents are encouraged to explore these non invasive opnons before considering a CI

4 Will Cochlear implanta/on help children with SSD/AHL? A cochlear implant (CI) is the only opnon which has the potennal to improve hearing in the deaf ear and as a result have the potennal to gain binaural benefits What are the issues to consider? Acknowledging the limited research and experience available Outcomes for adults with SSD not necessarily applicable to congenital paediatric populanon

5 Issues when considering CI for children with SSD/AHL Presence of an acousnc nerve early MRI recommended prior to discussing opnons Counseling expectanons Difficult to predict outcomes (limited research available) RelaNvely subtle benefits compared to tradinonal bilaterally profound CI candidates Longer adaptanon Nme required to adjust to the electrical sound Risk of device rejecnon Older children may have significant input to the decision esp. in regards to monvanon

6 Issues specific to the child Perceived need (monvanon) Child unaware of deficit. Use of goals/quality of life quesnonnaires can highlight needs Familiarity with hearing devices Likely to be unaided and not using ALDs Peer Pressure Not wannng to be/look different from peers

7 Tes/ng and Programming Pre-op/Post -op assessments Standard pre/post op tesnng not sensinve enough to measure deficit Extra tesnng should involve spanally separated inputs and quesnonnaires Post-op may need direct audio input to measure CI alone outcome (age dependent) Programming the implant Difficulty hearing/recognising T & C during psychophysics Balancing loudness Establishing an opnmal map may be slower

8 Post Opera/ve Management/Rehab AdjusNng and integranng the sound of the implant with normal hearing Provide support - Good to establish a posinve a`tude and good paaern of use early Set achievable goals - Use data logging Praise and encourage small achievements HabilitaNon aimed at the implanted ear specifically Direct audio input/wireless streaming/fm input Audio books and computer based programs (familiar and easy) - Challenging situanons may need to be avoided ininally

9 Finance and Support Funding for the implant SSD categorised as low priority panent Early intervennon and support are not funded in Victoria, Australia Each country and state may differ

10 Conclusion Children with SSD/ASL are presennng for candidacy for cochlear implantanon. As implant clinicians, we need to be aware of the unique issues that may arise for their pre and post management to help increase the likelihood of success.