Download Hearing Aids in Otology

Hearing Aids in Otology
Dr. Jerry Halik FRCSC
Assistant Professor University of Toronto

“Only 5% of patients seen for hearing
loss may benefit from surgery”
John Shea MD
Expectations of Ear Surgery
Surgeon




Safe
Eradicate Disease
Dry
Function
Patient




Dry
Function
Safe
Eradicate Disease
Result of Hearing gain in Ear
Surgery

Tympanoplasty
Long term result at 11 years
- 81% closed Perforations
- 9% Atelectatic pocket Formation
74% Normal Healed TM
(Halik, Smyth; 1988)
Result of Hearing gain in Ear
Surgery

Mastoid Surgery
- 25% Post op SRT <30 dB
Ossiculoplasty
Ossiculoplasty Results

TORP/ PORP- 25% SRT < 31 dB
4/12 patients

Assemblies – 57% SRT <31 Db
58/102 patients
Follow up – Up to 6 years (average 2 years)
Stapes Surgery Goals
1.
2.
3.
No Aid
No Aid
Large Aid
Aid
Small Aid
Stapes Surgery
Stapes Surgery Result
N=135
Avg A-B gap closure (Post op air minus pre-op bone)
A-B gap
0.5,1,2 KHz
0.5,1,2,4 KHz
< 10dB
118/135(87.4
%)
107/135(79.3
%)
<20dB
13/135(9.6%) 24/135(17.7%
)
>20dB
4/135(3%)
4/135(3%)
Stapes Surgery Result

Post-op SRT< 30dB=111

Pre-op possible SRT<30db=107

%Improvement=111/107 (103%)
(Raut, Halik 2002)
Post Stapes Chronic
Progressive SNHL

Large Fenestra – 9.5 dB / 10 Years

Small Fenestra- 3.2 dB / 10 Years
(<0.4 mm)
(Smyth, Hassard; 1986)
Time to Hearing Aids Post
Stapedectomy

(Aided at 40 dB Level)
Large Fenestra – 13 Years

Small Fenestra – 21 Years
(Smyth, Hassard; 1986)
Demographics of Hearing Loss
Year 2000 in USA

29 Million Hearing Impaired(10%)

5.6 Million Hearing Aid Users (1/5)

Over 6 Million Age 45-54 with
significant hearing loss
Why Hearing Aids




Critical for Communication
Development speech & Language
Education
Employment
Quality of life
Impact of Auditory Deprivation

Problems fitting aids

Sometimes permanent effects
Hearing Aids

“ Offering a Solution no One Wants”

Otologist- Role of Educator
Conventional Hearing Aids

Analogue Vs Digital

“Noise Management”

Clarity
Implantable Hearing Aid


Magnet (Implantable)& Electromagnetic
Driver
Piezo-electrode
BAHA
Uses for BAHA
1.
2.
Unable to wear conventional Aid in
suitable candidate
Unilateral complete SNHL (Vs
transcranial fitting conventional aid)
Cochlear Implants
Summary …


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Be realistic of surgical results especially
long term
Greater role for hearing aids on surgical
patients over time
Vast majority of patients not Surgical