Cochlear Implantation in Adults With Single-sided Deafness: Outcomes and Device Use

Abstract

Objective: To describe our experience with adults undergoing cochlear implantation (CI) for treatment of single-sided deafness (SSD). Study Design: Retrospective case review. Setting: Tertiary referral center. Patients: Fifty-three adults with SSD. Intervention(s): Unilateral CI. Main Outcome Measure(s): Speech perception testing in quiet and noise, tinnitus suppression, and device usage from datalogs. Results: The mean age at CI was 53.2 years (SD 11.9). The mean duration of deafness was 4.0 years (SD 7.8). The most common etiology was idiopathic sudden SNHL (50%). Word recognition improved from 8.7% (SD 15) preoperatively to 61.8% (SD 20) at a mean follow-up of 3.3 years (SD 1.8) (p < 0.0001). Adaptive speech recognition testing in the “binaural with CI” condition (speech directed toward the front and noise toward the normal hearing ear) revealed a significant improvement by 2.6-dB SNR compared to the preoperative unaided condition (p = 0.0002) and by 3.6-dB SNR compared to when a device to route sound to the contralateral side was used (p < 0.0001). Tinnitus suppression was reported to be complete in 23 patients (43%) and improved in 20 patients (38%) while the device was on. The addition of the CI did not lead to a decrement in hearing performance in any spatial configuration. Device usage averaged 8.7 (SD 3.7) hours/day. Conclusions: Cochlear implantation in adult SSD patients can suppress tinnitus and achieve speech perception outcomes comparable with CI in conventional candidates. Modest improvements in spatial hearing were also observed and primarily attributable to the head shadow effect. Careful patient selection and counseling regarding potential benefits are important to optimize outcomes.

Impact of Duration of Deafness on Speech Perception in Single-Sided Deafness Cochlear Implantation in Adults

“…Prolonged duration of deafness is often considered a strong negative prognostic factor in speech perception outcomes for traditional bilateral hearing loss CI recipients (20); however, the association of this feature in SSD CI recipients is not yet well-characterized. Previous studies evaluating speech perception outcomes in the SSD CI population have alluded to absent or negative associations with prolonged duration of deafness, although most reports lack rigorous support for clinical implications (1)(2)(3)21,22). The present study evaluates the impact of prolonged auditory deprivation in SSD CI recipient speech perception outcomes through a direct comparison between SSD patients with and without prolonged duration of deafness.…”

Electrical stimulation of the cochlea for treatment of chronic disabling tinnitus: an open-label trial towards the development of an implantable device

“…The clinical significance of the treatment response observed in the present work is also strengthened by a United States survey of 439 civilians and 269 military service members where nearly 75% of respondents reported being willing to receive an implantable device if it reduced tinnitus by even 50% [ 20 ]. Of note, the rate of complete or near-complete suppression of subjects’ tinnitus following trans-tympanic promontory stimulation (approximately 40%) is comparable to prior rates observed in the setting of cochlear implantation [ 7 ]. Notwithstanding the improvement in tinnitus severity among all study subjects, the duration of tinnitus suppression observed following trans-tympanic cochlear promontory stimulation was limited and returned close to baseline by 3 months following the last stimulation session for most subjects.…”

“…Cochlear implantation has emerged as an effective treatment for bothersome chronic tinnitus in adults with concomitant moderate to profound sensorineural hearing loss [ 5 , 7 ]. The therapeutic effect appears independent of the improved access to sound and has been shown to be durable in long-term follow-up [ 8 , 9 ].…”

“…It is estimated that 2 million residents of the United States are severely impacted by chronic tinnitus, and tinnitus constitutes the most commonly compensated service-connected disability among veterans nationally [ 1 – 3 ]. Although the etiology of tinnitus is complex and multifactorial, [ 3 ] growing evidence surrounding tinnitus outcomes among patients undergoing cochlear implantation for moderate to profound sensorineural hearing loss has demonstrated that almost 90% of patients with preoperative tinnitus experience notable improvement and up to 45% experience complete suppression of their tinnitus during device use [ 4 – 7 ].…”

Traitement de la surdité unilatérale par l’implant cochléaire

“…11,14 Tous ces gains, mesurés et objectivables, se reflètent dans une amélioration substantielle de la qualité de la vie globale 13. Il est important de savoir que la performance auditive avec un implant cochléaire pour surdité unilatérale reste inférieure par rapport à celle d'un patient avec une audition normale.…”