9/13/2017. When to consider CI or BAHA evaluation? Krissa Downey, AuD, CCC A

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1 When to consider CI or BAHA evaluation? Krissa Downey, AuD, CCC A FDA Regulations Unilateral or bilateral cochlear implantation of an FDA approved cochlear implant device may be considered medically necessary in patients who meet these criteria: Age 12 months and older; and Bilateral severe to profound pre or post lingual (sensorineural) hearing loss, defined as a hearing threshold of pure tone average of 70dB (decibels) hearing loss or greater at 500 Hz (hertz), 1000 Hz and 2000 Hz Limited or no benefit from hearing aids. Cochlear implantation with a hybrid cochlear implant/hearing aid device that includes the hearing aid integrated into the external sound processor of the cochlear implant (e.g., the Nucleus Hybrid L24 Cochlear Implant System) may be considered medically necessary for patients ages 18 years and older who meet all of the following criteria: Bilateral severe to profound high frequency sensorineural hearing loss with residual low frequency hearing sensitivity; AND Receive limited benefit from appropriately fit bilateral hearing aids; AND Have the following hearing thresholds: º Low frequency hearing thresholds no poorer than 60 db hearing level up to and including 500 Hz (averaged over 125, 250, and 500 Hz) in the ear selected for implantation; AND Page 3 of 9 An Independent Licensee of the Blue Cross and Blue Shield Association Cochlear Implant º Severe to profound mid to high frequency hearing loss (threshold average of 2000, 3000, and 4000 Hz 75 db hearing level) in the ear to be implanted; AND º Moderately severe to profound mid to high frequency hearing loss (threshold average of 2000, 3000, and 4000 Hz 60 db hearing level) in the contralateral ear; AND Aided consonant nucleus consonant word recognition score from 10% to 60% in the ear to be implanted in the preoperative aided condition and in the contralateral ear will be equal to or better than that of the ear to be implanted but not more than 80% correct. Replacement of internal and/or external components is Off Label Anything that is a deviation from the above Insurance may deny coverage for implant services 1

2 Adults Individuals 18 years of age or older Moderate to profound sensorineural hearing loss in BOTH ears Limited benefit from amplification defined by preoperative test scores of 50% sentence recognition in the ear to be implanted and 60% in the opposite ear or binaurally 1 Children (2 17 Years) Severe to profound sensorineural hearing loss Limited benefit from binaural amplification Multisyllabic Lexical Neighborhood Test (MLNT) or Lexical Neighborhood Test (LNT) scores 30% Children (12 24 Months) Profound sensorineural hearing loss Limited benefit from binaural amplification Important Considerations: Remember that many individuals with residual low frequency hearing are CI candidates and can benefit from CI. When appropriate, discuss use of acoustic hearing: Does your patient have a passion for music? Work in noisy or reverberant environments? What are lifestyle demands? Determine motivation to experiment with hearing aids, in both the implanted and/or contralateral ears. Discuss the opportunity to use acoustic hearing to manage expectations and rehabilitation options, when appropriate. HINT or other test materials From 2

3 70 y/o Male Left discrim: 53% Right discrim: 40% Starkey Halo RITE with custom earmolds and REM obtained. Left: AZ Bio 28% CNC words 10% Right: AZ Bio 59% CNC words 32% He is a bilateral HYBRID candidate and opted for full electrode array on left ear. Struggling in everyday situations. Frustrated, depressed and missing out on life and interactions with loved ones. Audiogram 4 months after Left CI activation. AZ Bio 87% It was 28% with HA The POWER of Auditory Rehab and motivation. Conductive loss Mixed loss Single Sided Deafness Atresia & Microtia Acoustic neuroma Congenital deafness Chronic middle ear disease Cholesteatoma Otosclerosis Meniere s Disease Ototoxicity Sudden hearing loss 3

4 Unilateral or bilateral fully or partially implantable bone-conduction (bone-anchored) hearing aid(s) may be considered medically necessary as an alternative to an air-conduction hearing aid in patients 5 years of age and older with a conductive or mixed hearing loss who also meet at least one of the following medical criteria: Congenital or surgically induced malformations (e.g., atresia) of the external ear canal or middle ear; or Chronic external otitis or otitis media; or Tumors of the external canal and/or tympanic cavity; or Dermatitis of the external canal; and meet the following audiologic criteria: A pure tone average bone-conduction threshold measured at 0.5, 1, 2, and 3 khz of better than or equal to 45 db (OBC and BP100 devices), 55 db (Intenso device) or 65 db (Cordele II device). Page 4 of 8 An Independent Licensee of the Blue Cross and Blue Shield Association Implantable Bone Conduction Hearing Aids For bilateral implantation, patients must meet the above audiologic criteria, and have a SYMMETRICALLY conductive or mixed hearing loss as defined by a difference between left and right side bone conduction threshold of less than 10 db on average measured at 0.5, 1, 2 and 3 khz (4 khz for OBC and Ponto Pro), or less than 15 db at individual frequencies. An implantable bone-conduction (bone-anchored) hearing aid may be considered medically necessary as an alternative to an air-conduction CROS hearing aid in patients 5 years of age and older with single-sided sensorineural deafness and normal hearing in the other ear. The pure tone average air conduction threshold of the normal ear should be better than 20 db measured at 0.5, 1, 2, and 3 khz. Yes and No BAHA is only as good as your BC threshold rule BAHA 5 45dB loss or better BAHA 5P 55dB loss or better BAHA 5SP 65d loss or better When choosing a device, consider progression of BC thresholds over next 5 years. Perhaps CI would be a better choice? 36 y/o female Left BAHA evaluation Right discrim: 100% Left discrim : 100% at 100dB masked Could she wear a hearing aid? Would there be feedback problems? Any other concerns? Large mastoid cavity with EAC deformities from multiple ear surgeries. Current eardrum perf with chronic eardrum perf history. History of chronic drainage. No current drainage. 4

5 BAHA Activation 3 months after surgery. Left ear near normal sound field thresholds with right ear masked. AZ BIO: 100% at 65dB with right ear masked 36 y/o female Sound Field Audiogram Thank you Questions? KRISSA DOWNEY, AUD, CCC-A 5