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
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. 1995 Dooley et al., Arch Otolaryngol HNS: 1993 Shallop et al., J Sp Lang Path Aud: 1992 Clinic for Communication Disorders, University Mainz 2
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
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
The Method Touchscreen Presentation of Results Clinic for Communication Disorders, University Mainz 5
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
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
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
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
Audiogram 10002 Clinic for Communication Disorders, University Mainz 10
WHF only CI (L) - after optimization 10013 Clinic for Communication Disorders, University Mainz 11
Speechaudiogram CI only after optimization / HA + CI before optimization only CI before 100 90 80 70 60 50 40 30 20 10 0 90% 80% 70% 70% 70% 60% 55dB 65dB 80dB Speech audiogram Göttinger II Clinic for Communication Disorders, University Mainz 12
WHF only HA (R) - before optimization 10012 Clinic for Communication Disorders, University Mainz 13
SPL-O-Gram HA (R) - before / after optimization Clinic for Communication Disorders, University Mainz 14
Changes of Hearing Aid Parameters db 70 60 50 40 30 42 47 51 53 60 61 39 53 20 14 10 0 5 2 1 200 600 2300 4400 Frequency (Hz) before optimizing after optimizing difference Clinic for Communication Disorders, University Mainz 15
WHF only HA (R) - after optimization 10014 Clinic for Communication Disorders, University Mainz 16
WHF HA + CI - after optimization Clinic for Communication Disorders, University Mainz 17
Speech audiogram CI only - after optimization / HA + CI - before optimization HA + CI after optimizaton only CI before after 120 100 80 60 60% 70% 100% 70% 70% 100% 80% 90% 100% 40 20 0 55dB 65dB 80dB Speech audiogram Göttinger II Clinic for Communication Disorders, University Mainz 18
Speech audiogram CI only after optimization / HA + CI before optimization HA + CI after optimization only CI before after 70 60 50 40 50% 60% 30 20 10 20% 0 65 db Speech audiogram Göttinger II with competing noise Clinic for Communication Disorders, University Mainz 19
Validation assessment of real word outcomes use of questionnaires for the child, parents and teachers Clinic for Communication Disorders, University Mainz 20
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
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
Thank You for Your Attention! Clinic for Communication Disorders, University Mainz 23