Successful outcomes of cochlear implantation in long-term unilateral deafness

Purpose of review Recently, more patients with single-sided deafness (SSD) have been undergoing cochlear implantation. We review recent studies and case reports to provide an overview of the efficacy of cochlear implants (CIs) to rehabilitate patients with SSD with regards to sound localization, speech discrimination, and tinnitus suppression. Recent findings There are a growing number of studies evaluating the effect of cochlear implantation for rehabilitation of the deficits associated with SSD over the past several years as more centers offer this treatment modality to patients with SSD. While individual studies have few subjects and are underpowered, the vast majority report improvement in sound localization, speech understanding in quiet and noise, and tinnitus. In some cases the outcomes with CI appear superior to those achieved with other devices including contralateral routing of sound (CROS) devices and osseointegrated implants (OIs). Summary Although CI is not an FDA-approved treatment for SSD, several recent studies show improvements in speech understanding, sound localization, and tinnitus. Due to the low number of cases, it is difficult to conclusively compare outcomes achieved with CIs and those provided by other devices. However, based on encouraging early results and the unique ability to restore binaural sound processing, a growing number of centers offer CIs as treatment for SSD. Forthcoming studies will help define outcome expectations in different populations.

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“…All nine subjects also exhibited objective and subjective improvement in speech discrimination (p = 0.008) 29 .…”

Section: Effectiveness Of Cis To Improve Sound Localization and Speecmentioning

confidence: 81%

Cochlear implantation and single-sided deafness

Tokita¹,

Dunn²,

Hansen

2014

Current Opinion in Otolaryngology & Head and Neck Surgery

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“…assessed by the promontory stimulation test or magnetic resonance imaging • Be willing and able to undertake all assessments required in the study and to go through rehabilitation training Concerning postlingual hearing loss, most studies on SSD or AHL to date have presented evidence from cohorts with a duration of unilateral deafness of less than 10 years. However, a study in a group of CI users with long-term unilateral deafness who underwent extensive rehabilitation concludes that patients with postlingual unilateral deafness should not be excluded as CI candidates on the basis of a long duration of deafness [Távora-Vieira et al, 2013b]. In all subjects of this group, the duration of unilateral deafness was even greater than 15 years, which raises some doubts that there is a hard cutoff in the duration of deafness.…”

Section: Populationmentioning

confidence: 97%

Towards a Unified Testing Framework for Single-Sided Deafness Studies: A Consensus Paper

et al. 2016

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Background: While hearing aids for a contralateral routing of signals (CROS-HA) and bone conduction devices have been the traditional treatment for single-sided deafness (SSD) and asymmetric hearing loss (AHL), in recent years, cochlear implants (CIs) have increasingly become a viable treatment choice, particularly in countries where regulatory approval and reimbursement schemes are in place. Part of the reason for this shift is that the CI is the only device capable of restoring bilateral input to the auditory system and hence of possibly reinstating binaural hearing. Although several studies have independently shown that the CI is a safe and effective treatment for SSD and AHL, clinical outcome measures in those studies and across CI centers vary greatly. Only with a consistent use of defined and agreed-upon outcome measures across centers can high-level evidence be generated to assess the safety and efficacy of CIs and alternative treatments in recipients with SSD and AHL. Methods: This paper presents a comparative study design and minimum outcome measures for the assessment of current treatment options in patients with SSD/AHL. The protocol was developed, discussed, and eventually agreed upon by expert panels that convened at the 2015 APSCI conference in Beijing, China, and at the CI 2016 conference in Toronto, Canada. Results: A longitudinal study design comparing CROS-HA, BCD, and CI treatments is proposed. The recommended outcome measures include (1) speech in noise testing, using the same set of 3 spatial configurations to compare binaural benefits such as summation, squelch, and head shadow across devices; (2) localization testing, using stimuli that rove in both level and spectral content; (3) questionnaires to collect quality of life measures and the frequency of device use; and (4) questionnaires for assessing the impact of tinnitus before and after treatment, if applicable. Conclusion: A protocol for the assessment of treatment options and outcomes in recipients with SSD and AHL is presented. The proposed set of minimum outcome measures aims at harmonizing assessment methods across centers and thus at generating a growing body of high-level evidence for those treatment options.

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“…We have previously looked at a small cohort of five patients with more than 25 years of deafness duration and did not find that deafness duration was a determinant factor in the CI outcomes in postlingual unilateral deafness (Távora-Vieira et al 2013b). There is some evidence that if unilateral deafness occurs after maturation e94 TÁVORA-VIEIRA ET AL.…”

Section: Introductionmentioning

confidence: 99%