Download Auditory Implants - Kansas Speech-Language

Auditory Implants: Improving Patient Satisfaction
with Cutting-Edge Technology
Robert Cullen, M.D.
Kristen Lewis, Au.D, CCC-A, F-AAA
Midwest Ear Institute
4200 Pennsylvania Ave, Ste. 100
Kansas City, MO 64111
[email protected]
816-932-1660
Patients no longer have to be profoundly deaf before they can benefit from an
auditory implant!
Cochlear Implants
Currently Approved Devices:
Advanced Bionics HiRes 90K
Cochlear Americas Nucleus 5
Med-El Sonata
Candidacy Criteria:
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Bilateral moderate to profound sensorineural hearing loss
Minimal benefit from traditional amplification (i.e. less than 50% open set speech
discrimination in the ear to be implanted and less than 60% in the opposite ear)
Ages 12 months and older (less than 30% open set speech discrimination required for
children under 18)
CT-scan or MRI showing no contraindications to electrode placement in the cochlea
Medical exam showing no contraindications to surgery
Appropriate expectations and high motivation
Clinical Trials at MEI:
1. Nucleus Hybrid
• Expansion of ongoing study beginning in 2003.
• Designed for ski-slope hearing losses, where traditional hearing aids provide no benefit to speech
understanding.
• Electrode only partially inserted for high frequencies, patient hears lower pitches acoustically.
• First Hybrid devices were 10 mm, 6 electrodes, now 15 mm, 22 electrodes.
Candidacy Criteria:
• 18 years of age or older
• Severe to profound SNHL >1500 Hz (PTA 2k, 3k, 4k >= 75 dB HL).
• LF thresholds up to and including 500 Hz no poorer than 60 dB HL.
• CNC word score between 10% and 60% in the ear to be implanted.
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CNC word score in the contralateral ear better than or equal to ear to be implanted, but not
more than 80%.
Appropriate expectations and high motivation
2. Cochlear Implants in Adults with Asymmetrical Hearing Loss
• Designed for patients with asymmetrical hearing loss, they are effectively functioning with one
ear, but may be missing benefits of binaural hearing (localization, hearing in noise, quality)
• Traditionally candidates with a “poorer” ear perform worse with the implant when done in the
poorer ear
• Does crossover from the “good” ear help keep the poorer ear functioning for an implant?
• Subjects are a traditional implant candidate in one ear, but not in the “good” ear (i.e. speech
recognition better than 60%)
Candidacy Criteria:
• 18 years of age or older
• Poorer ear (implant ear): severe to profound sensorineural hearing loss, meets current CI
candidacy criteria
• Better ear: sensorineural hearing loss with 4-frequency PTA >= 40 dB HL, but not reaching
severe to profound range
– Does not meet current CI candidacy criteria
– Documented stable hearing thresholds for at least one year
– Uses appropriately fit hearing aid
• Appropriate expectations and high motivation
Middle Ear Implants
Currently Approved Devices:
Med-El Vibrant Soundbridge
Candidacy Criteria:
 Mild to severe sensorineural hearing loss
 Discrimination score better than 50% under headphones in ear to be implanted
 Recommended for individuals who cannot use or are dissatisfied with conventional hearing
aids for medical reasons
 18 years of age or older
 Appropriate expectations and high motivation
Clinical Trials at MEI:
DACS
Candidacy Criteria:
Bone Conduction Implants
Currently Approved Devices:
Cochlear Americas Baha
Oticon Medical Ponto
Candidacy Criteria:
 Ages 5 years and older
 Appropriate expectations and high motivation
 Conductive or mixed hearing loss
 Bone conduction PTA (.5, 1, 2 and 3K) better than 45 dB HL
 Discrimination score better than 60% on phonetically balanced words
(recommended)
 Inability to use air conduction hearing aids due to middle ear disease (e.g.
drainage)
or
 Single-sided deafness
 Profound loss in one ear, normal hearing in contralateral ear
 Air conduction PTA (.5, 1, 2 and 3K) better than 20 dB HL in normal ear