Workshop Patient Cases. Aurélie Dewael Education Manager Cochlear Academy - EMEA

Transcription

1 Workshop Patient Cases Aurélie Dewael Education Manager Cochlear Academy - EMEA

2 Please break in groups of 2 You will be assigned to a case You have 25 minutes preparation time, then each group will present and discuss their case for 10 to 15min. If no specific questions are asked in the case, think about all the aspects we have discussed during the Level 3: Candidcay Audiogram Counseling Listening Test System Choice: Attract - Connect Surgery Aftercare Soundprocessor choice Fitting consideration Magnet selection Accessories Follow-up sessions Possible Troubleshooting

3 Cases

4 CASE 1 Adrian Adrian It concerns a boy of almost 4 years old, with Down s syndrome. He has been investigated several times using free field audiometry during a period of 2 years. His thresholds vary from db (best result) to db. Recently, he received grommets due to a probable case of OME: however, on the left side it was impossible to place grommets due to a narrow ear canal. On the right side it was possible to place a grommet and glue has been sucked away. Whether the tube is functional is uncertain (only little volume with tympanometry). Free field audiometry now show 35 db in the right ear, the left ear is seriously weaker with thresholds on 50 db. By using a bone conductor in the free field test, thresholds improve to db. Should you place a Baha at this stage?

5 CASE 1 Adrian Audiogram

6 CASE 1 Adrian What can be recommended? Candidacy: good Baha candidate, conductive HL, period of 2 years of variable hearing treshold. Ear with grommet (ri ear is now better). Left side still quite bad. Audiogram: see previous slide Counseling: this child needs a solution cause this kind of hearing will have an influence on his language development. Counsel parents and child. Do we go for surgery now or softband? Down syndrome patients often keep issues with small earcanals and a conductive HL as a result. Listening Test: on the Baha softband should be at least as good as what you could get with the Bone conductor in FF. Bilateral or not? System Choice: Attract Connect: Depending on the result during the listening test we could advice for one or another system. Other considerations? Is retention an issue? Surgery: if Attract is the choosen system, keep in mind that we need 3mm skin thickness. Make sure to discuss the what if with the parents.. Would you go for a 3mm or 4mm implant? Aftercare: in case of Connect make sure parents but also the supervisors know how to take care of the abutment.

7 CASE 1 Adrian What can be recommended? Soundprocessor choice: Baha 5 Fitting consideration: make sure to start the fitting on the safe side, be aware that with small children you tend to have a reaction treshold in stead of a real hearing treshold. Make sure you can do a BC direct. Make sure you adapt your testing to the age of the child. Magnet selection: follow our guidelines, make sure you make the child at ease. It can be a great deal for him to be activated Accessories: discuss with the parents but also supervisors/ teachers if extra acessories are needed Follow-up sessions: monitor also the right side. Grommet is in place but in small ears they tend to fall out more easily. This could make the hearing worse on the right side... A bilateral Baha could then be a better solution. Possible Troubleshooting:?

8 CASE 2 Arlene Arlene It concerns a woman of 38 years old, mother of 3 teenagers. She has chronic ear problems since her youth. She has had several ear surgeries for cholesteatoma. The left ear is sensorineural deaf, on the right side she has a mixed hearing loss, with PTA bone conduction of 25dB, and PTA air conduction 70dB. The left ear is relatively dry since her last surgery 8 months ago. She wears an Power Hearing Aid in BICROS mode. Can you provide her with a better solution?

9 CASE 2 Arlene Audiogram

10 CASE 2 Arlene What can be recommended? Candidacy: good candidate she has a mixed hearing loss on the right side and an SSD on the left side. Multiple infections. She wears bilateral an earmould with her Bicros which could make the draining ears and infection worse. Also think about the amount of gain she needs on her right side with her hearing aid? How would that influence her soundquality? Audiogram: see previous slide Counseling: she needs information on difference between Baha and classic hearing aids. Also keep the earcanal open would make a big difference for her. Make sure she is also well counseled on expectations (she will not localize, cause she will still have only working Cochlea) Listening Test: on a softband bilateral! Be aware that on the right side you will probably need more gain (TA, skin attenuation and not a perfect hearing on the good side). Which soundprocessor would you choose? System Choice: Attract Connect: will depend on the listening test and its result. I could imagine her choosing for Connect (better performance/ more headroom for future). With connect system she would also probably be able to go for a Baha 5. Also think about other considerations like fe MRI (follow up on cholesteatoma?)

11 CASE 2 Arlene What can be recommended? Surgery: keep in mind she could have some scar tissue? Could be of any influence if she goes for an Attract Aftercare: what would you recommend in case of Connect Soundprocessor choice: Baha 5/ Baha 5 Power? Fitting consideration: she is already used to hearing aids but she will probably need to adapt to high frequencies (it is unlikely she will hear the high frequencies very well with her hearing aids. Magnet selection: what would you do if she for example has a lot o hair? Accessories: do you think she would benefit of some accessories? How would you make her choose an accessory? Follow-up sessions: once fitted and everything goes well, make sure patients come back at least once a year for a check up. Possible Troubleshooting:?

12 CASE 3 Sandra Sandra It concerns a child of 7 years old with congenital deafness on the right side. In the past the child has had several episodes of OME. Audiometry confirms deafness on the right side, on the left side thresholds are found between 5 and 20dB HL. Speech development is delayed. School development; class Despite normal cognitive capacity she is not doing well at school. The development is slow and the child does not have many friends, also She does not receive extra guidance in school as the request for this has been denied. Her hearing loss becomes clear when she has a cold. What to do?

13 CASE 3 Sandra Audiogram

14 CASE 3 Sandra What can be recommended? Candidacy: Do we think about other solutions? Do we know these have been tested. Be aware that her good ear often also suffer from an conductive hearing loss (due to OME). So there are periods she will have more difficulties then others? For a Cros solution you may be aware that if the good ear is worse then normal she would not benefit from it. Idem dito if you are using an FM Audiogram: see previous slide Counseling: Does the periods where there is OME make social interaction / lannguage development/ behaviour worse? Important to start guidance. Talk to teacher about hearing loss, have also a talk in the class to explain this to her peers; Listening Test: very important and should be extensive (use fe trial log), try to involve parents/ teachers in evaluating the test period. What do you expect from a congenital hearing loss e.g. compared to an acquired HL? System Choice: Attract Connect: probably a Baha Attract on the deaf side

15 CASE 3 Sandra What can be recommended? Surgery: in case of a Connect would you consider a two stage surgery/ a revised two stage or a one stage surgery? Aftercare: it is good to involve the child in this, give him some responsabilities, even at a young age Soundprocessor choice: for Attract depending on the level of TA, base upon the listening test. If TA is ok would you could go for Baha 4 or Baha 5? Fitting consideration: Anything? Magnet selection: Anything? Accessories: as she struggle in school we could work with the minimic especially in the more difficult class situations Follow-up sessions: make sure to follow closely on the left side especially when she has a cold Possible Troubleshooting

16 CASE 4 Alfred Alfred It concerns a man of 53, who works in the market. Since he was 32, he has conservative radical cavities, which have to be cleaned regularly. The mean hearing loss on the right side is 75dB with 20dB sensorineural, the left ear 75dB with 30dB sensorineural (measured with inserts). The patient has a Baha Divino for the past 8 years, which he is very happy with. However, in his work he experiences problems with understanding his clients, and in addition he is very tired after a day at work. What do you advise?

17 CASE 4 Alfred Audiogram

18 CASE 4 Alfred What can be recommended? Candidacy: patient has already one Baha (on the right side?) but he is probably a good bilateral candidate (bilateral cond/mixed HL) Audiogram: see previous slide Counseling: another Baha on the left side would help to restore binaural hearing. This will help him especially in noise and make it more easy to follow conversation. He will also have a sommation effect which will boost eventually loudness perception and comprehension Listening Test: pre-op testing with a headband and softband is still recommended System Choice: Attract Connect: probably as he has already one percutaneous solution you could go for another one on the left side.keep in mind he has a BC treshold already around 30dB. It is likely that the BC direct will be around 40 to 45dB which is on the limit for a Baha Attract. I would also keep in mind that the patient is already 53y old and his treshold will probably get worse due to presbyacousis... Surgery: Anything to consider? Aftercare: do we need to retrain him after surgery or does he exactly knows what to do (remember he will probably get a DermaLock)

19 CASE 4 Alfred What can be recommended? Soundprocessor choice: my preference would go to the Baha 5 Power bilateral because of the wireless possibility. Baha 5 could be also possible as we will have sommation effect so we will need less amplification (but keep in mind that for some patients a BC treshold around 30dB could be already difficult to match with a Baha 5). Fitting consideration: he is not used to digital soundprocessing so it could take some time for him to adjust to the new sound. If necessary work in steps.the digital soundprocessor are also better in letting the high frequencies goes through so maybe you will need to turn them down a little bit. Magnet selection:/ Accessories: he will benefit from a minimic and probably also a phoneclip as he is still working and have to deal with clients. Is the Smartapp something for him? Follow-up sessions: try to go from a linear more analogue fitting to a more digital one Possible Troubleshooting: what would you advice if he got skin infections around his first implant with skin overgrowth?

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