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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: • • • • • • 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. • • 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