Outcomes of Paediatric Cochlear implantation in Single-Sided Deafness or very Asymmetrical Hearing Loss (SSD/AHL)

Transcription

1 Outcomes of Paediatric Cochlear implantation in Single-Sided Deafness or very Asymmetrical Hearing Loss (SSD/AHL) Karyn Galvin 1, Michelle Todorov 1, Rebecca Farrell 2, Robert Briggs 1,2,3,4, Markus Dahm 2, Jaime Leigh 2 1 Dept Audiology & Speech Pathology, The University of Melbourne, Australia 2 Cochlear Implant Clinic, Royal Victorian Eye and Ear Hospital, Melbourne, Australia 3 HEARing CRC, Melbourne, Australia 4 Dept Surgery, The University of Melbourne, Australia

2 Off-label declaration the work reported here involves off-label use of the Nucleus CI

3 Disclosures Karyn Galvin: University of Melbourne Department of Audiology & Speech Pathology received project-based funding from Cochlear Ltd. Michelle Todorov: University of Melbourne Department of Audiology & Speech Pathology received project-based funding from Cochlear Ltd. Rebecca Farrell: none Robert Briggs: University of Melbourne Department of Audiology & Speech Pathology received project-based funding from Cochlear Ltd.; A/Prof Briggs acts as a consultant to Cochlear Ltd. Markus Dahm: none Jaime Leigh: none

4 Project aims document families preoperative expectations & postoperative experiences conduct a broad assessment of CI benefit consider impact of child demographics

5 Selection criteria profound hearing loss in one ear (onset <12y age) contralateral ear does not fulfil current CI criteria

6 LVAS (progressive) HL Detected 2y9m Left HA worn full time P1: Preoperative Audiogram Hearing Level (db HL) AGE AT CI: 10y4m Frequency (Hz)

7 P1 Results: Functional outcomes Time point Parent report From switch-on adapted easily to CI usage full-time At 6m At 12m At 21m significantly reduced reliance on lipreading, FM system, and positioning speaker on good side improved ability to follow group conversation & locate speaker within the home very reliant on CI (preferred over HA)

8 Speech perception test setup noise centre Co-incident speech & noise: CI speech noise Better ear noise contra Speech at 0 0 & noise 90 0 contralateral to CI: CI speech noise Better ear

9 P1 Results: Speech perception (4AFC spondees)

10 Spatial hearing test setup: Localisation loudspeaker array

11 P1 Results: 8-loudspeaker localisation HA 24m Postop HA+ CI 24m Postop Response Loudspeaker Identified by Child Response Loudspeaker Identified by Child Presenting Loudspeaker Presenting Loudspeaker 8

12 Speech, Spatial & Qualities of Hearing Scale parent rates child s performance in everyday listening situations three separate areas of assessment speech spatial hearing qualities of hearing

13 P1 Results: SSQ-Parent Similar pattern of results with child selfreport version * p<0.05

14 Summary of Results Participant & Postoperative time point Usage Functional reports Speech perception in noise testing Spatial hearing testing Everyday listening (SSQ) Quality of life Classroom engagement Classroom participation P1 24m X X

15 CMV; premature HL Detected 2y9m Right HA worn full time P2: Preoperative Audiogram Hearing Level (db HL) AGE AT CI: 6y11m Frequency (Hz) V V V V 8000

16 P2 Results: Functional outcomes Time point By 3m usage 70% Parent report At 12m child generally wearing CI without prompting Clinician report no evident CI benefit Early months data logging 1.5hr/day increase in usage over time; may be due to better tolerance of lower level maps trialed to promote usage

17 P1 & P2: Summary of Results Participant & Postoperative time point P1 24m P2 12m Usage?? Functional reports X Speech perception in noise testing X X Spatial hearing testing X Everyday listening (SSQ) X Quality of life - Classroom engagement X - Classroom participation -

18 Meningitis at 6wks P3: Preoperative Audiogram Hearing Level (db HL) AGE AT CI: 3m (ossification evident) Frequency (Hz) X 8000

19 P3 Results: Functional outcomes Time point From switch-on Parent report adapted easily to CI use At 6m usage 6hr/day WITH CI ON: more content & engaged increased frequency & variety of babbling better able to identify sound direction By 12m full-time use of HA+CI (HA fitted 7m) speech & language progressing well

20 P1 to P3: Results Summary Participant & Postoperative time point P1 24m P2 12m Usage?? Functional reports X Speech in noise testing X X - P3 12m Spatial hearing testing X (LvsR) Everyday listening (SSQ) X - Quality of life - - Classroom engagement X - - Classroom participation - -

21 Family Hx HL Detected 3y6m P4: Preoperative Audiogram Hearing Level (db HL) AGE AT CI: 10y4m Frequency (Hz)

22 P4: Functional outcomes Time point Parent report From switch-on usage 8.5hr/day happy to wear CI but hides it with hoodie By 6m usage full-time takes responsibility for CI no evident CI benefit

23 P4 Results: 8-loudspeaker localisation N H 6 months post op. N H + CI 6 months post op. 8 8 Loudspeaker Response Loudspeaker Response Presenting Loudspeaker Presenting Loudspeaker 8

24 P1 to P4: Results Summary Participant & Postoperative time point P1 24m P2 12m P3 12m Usage?? Functional reports X X Speech in noise testing X X - X Spatial hearing testing X X Everyday listening (SSQ) X - X Quality of life Classroom engagement X Classroom participation P4 6m

25 Participant & Postop time point P1 24m P2 12m P3 12m P4 12m Usage? Functional reports X X Speech in noise testing X X - X Spatial hearing testing X X Everyday listening (SSQ) X - X Quality of life Classroom engagement X Classroom participation P5 5m P1 to P7: Results Summary P6 6m P7 7m Etiology Family Hx Meningitis LVA Onset Assumed cong (diag 7y) 2y10m 6y Age at CI 11y10m 6y0m 15y5m Usage X

26 In conclusion CI for SSD/AHL presents challenges and opportunities careful research is required to: evaluate benefit (administer broad assessment protocol) track progress longer term (usage) determine influential factors end result of research must be evidence-based pre and postoperative counselling and clinical management practices

27 Acknowledgements contribution of: participating children and their families Staff of the Royal Victorian Eye & Ear Hospital Cochlear Implant Clinic, Melbourne financial supporters of the work reported: University of Melbourne Department of Audiology & Speech Pathology Royal Victorian Eye and Ear Hospital William Angliss Charitable Fund Collier Charitable Fund THANK YOU!