Cochlea Implant and Hearing Aid

Transcription

1 Cochlea Implant and Hearing Aid Optimizing the fitting of the bimodal situation - A Case Study - Andrea Bohnert K. L. Lippert A. Limberger A. Keilmann Department for ENT, University Hospital Mainz Director: Univ.-Prof. Dr. Dr. h.c. mult. W. Mann Division for Communication Disorders Head of Department: Prof. Dr. A. Keilmann Clinic for Communication Disorders, University Mainz 1

2 Studies Morera et al., Acta Oto-Laryng.:2005 Tyler et al., Ear and Hearing: 2002 Ching et al., Ear and Hearing: 2001 Armstrong et al., Am J Otol: 1997 Blamey et al., Cochlear Implants: 1997 Chmiel et al., Ann Oto Rhin Laryng suppl Dooley et al., Arch Otolaryngol HNS: 1993 Shallop et al., J Sp Lang Path Aud: 1992 Clinic for Communication Disorders, University Mainz 2

3 Protocol CI optimization HA optimization Speech tests in quiet and in noise Loudness-scaling tests Questionnaires for the child, parents and teacher Clinic for Communication Disorders, University Mainz 3

4 The Method Hearing Aid RECD-Measurement / In-situ-Measurement DSL[i/o]-Method / SPL-O-Gram Loudness-scaling (WHF-System) CI-System Loudness-scaling (WHF-System) Loudness-scaling (WHF-Scale) Clinic for Communication Disorders, University Mainz 4

5 The Method Touchscreen Presentation of Results Clinic for Communication Disorders, University Mainz 5

6 The Method Procedure for CI: WHF with CI only CI-optimization WHF with optimized CI only AIM: WHF-profile with optimized HA only should be similar to profile with optimized CI Clinic for Communication Disorders, University Mainz 6

7 The Method Procedure for HA: Fitting on the basis of DSL[i/o] Verification with SPL-O-gram WHF with HA only Localising deviations in the WHF Checking SPL-O-gram for possibilities of fitting correction due to the WHF results Clinic for Communication Disorders, University Mainz 7

8 The Method Procedure for HA Changing HA parameters in area of deviations Verifying the finetuning with WHF / SPL- O-gram Clinic for Communication Disorders, University Mainz 8

9 A Case Study 12 - year old male Hearing impairment since birth Cause may be hereditary Hearing loss L > R First presentation in clinic at 9 months First HA-fitting (both ears) at 11 months First CI-fitting (left ear) at 7 years HA Phonak Supero 412 CI MED-EL Combi 40+ / Tempo+ Clinic for Communication Disorders, University Mainz 9

10 Audiogram Clinic for Communication Disorders, University Mainz 10

11 WHF only CI (L) - after optimization Clinic for Communication Disorders, University Mainz 11

12 Speechaudiogram CI only after optimization / HA + CI before optimization only CI before % 80% 70% 70% 70% 60% 55dB 65dB 80dB Speech audiogram Göttinger II Clinic for Communication Disorders, University Mainz 12

13 WHF only HA (R) - before optimization Clinic for Communication Disorders, University Mainz 13

14 SPL-O-Gram HA (R) - before / after optimization Clinic for Communication Disorders, University Mainz 14

15 Changes of Hearing Aid Parameters db Frequency (Hz) before optimizing after optimizing difference Clinic for Communication Disorders, University Mainz 15

16 WHF only HA (R) - after optimization Clinic for Communication Disorders, University Mainz 16

17 WHF HA + CI - after optimization Clinic for Communication Disorders, University Mainz 17

18 Speech audiogram CI only - after optimization / HA + CI - before optimization HA + CI after optimizaton only CI before after % 70% 100% 70% 70% 100% 80% 90% 100% dB 65dB 80dB Speech audiogram Göttinger II Clinic for Communication Disorders, University Mainz 18

19 Speech audiogram CI only after optimization / HA + CI before optimization HA + CI after optimization only CI before after % 60% % 0 65 db Speech audiogram Göttinger II with competing noise Clinic for Communication Disorders, University Mainz 19

20 Validation assessment of real word outcomes use of questionnaires for the child, parents and teachers Clinic for Communication Disorders, University Mainz 20

21 Validation When using both devices, parents comment he asks for repetition less often he is not so tired after school his concentration is better he picks up the conversation of others his speech is clearer Clinic for Communication Disorders, University Mainz 21

22 Summary Careful optimization of the bimodal situation can improve the outcome of - speech perception in quiet and in noise - functional performance in school - functional performance in everyday life Clinic for Communication Disorders, University Mainz 22

23 Thank You for Your Attention! Clinic for Communication Disorders, University Mainz 23