BAA MAGAZINE SUMMER 2017 DRAFT 4

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FEATURE Single Sided Deafness: CROS Aid or BAHA? KERRY DOWNES Advanced Audiologist, St George’s Hospital Single Sided Deafness (SSD) affects around 9,000 new people each year in the UK. For many individuals, the condition can have a profound and debilitating effect on their lives. Sufferers experience difficulty picking up sounds from their deaf side, struggle in crowds and background noise and are unable to localise sounds. Whilst some losses are congenital or acquired in early childhood, most occur in adulthood and are of sudden onset. Adjusting to SSD can cause stress and anxiety, and impact hugely on a person’s well-being. In particular, individuals report withdrawal from group activities and feelings of isolation (Wie et al, 2010). There is some evidence to support the use of intratympanic steroids for idiopathic sudden SSD (Ferri et al, 2012), but results have varied widely and research on success rates are limited. Consequently, SSD remains a predominantly permanent and untreatable condition. Rehabilitation options include support groups and counselling, and provision of either Contralateral Routing of Sound (CROS) or Bone-Anchored Hearing Aids (BAHA). CROS/ BiCROS aids and BAHA can help to alleviate the difficulties caused by the head-shadow effect and provide relief to some of the difficulties SSD sufferers face (Faber et al, 2013). Most of the available research comparing the two amplification options is in regard to older, more cumbersome and cosmetically unappealing CROS aids with a wire around the back of the neck, and percutaneous connected abutments for BAHAs which are also less cosmetically appealing and can be prone to infection. With the improved technology and cosmetics of CROS aids, and the release of subcutaneous Cochlear BAHA attracts, this study aimed to provide an up to date and relevant insight into patient choice between the two amplification options. The research also intended to challenge some common assumptions; such as congenital SSD sufferers not opting for amplification and elderly patients avoiding BAHA due to the surgery involved. Factors which may influence the choice were also investigated; age, cause of deafness, acoustic neuroma surgery and high frequency thresholds in the hearing ear. Methods: 30 individuals with SSD were referred to the BAHA service over the course of 16 months. All were offered back-to-back trials of wireless Phonak CROS/BiCROS aids (open-fit BTEs) and Cochlear BAHAs on soft-bands, for at least 2 weeks each. 27 completed trials with both devices, 3 declined trials with BAHAs as they had no interest in pursuing this option. Following the trials, the patients attended follow-up appointments to give their feedback on the devices. Based on their experiences, the patients then made the decision whether to: - Proceed with BAHA and be added to the surgery waiting list (Group A) - Continue with the CROS aids (discharged from BAHA Service) (Group B) - Decline both options and return to being unaided (Group C) Data was collected retrospectively from patient records and mean averages were calculated. With the “age of patient” being the age at the time of data collection rather than at the time of the trials. The 3 patients who refused BAHA trials were included in Group B. Findings: 90% of patients reported some level of benefit from either a CROS system or BAHA on soft-band, and only 3 people (10%) chose option C - to pursue neither device and return to being unaided. Of the 27 patients who reported benefit; 37% opted to be implanted with a BAHA (Group A), and 63% declined BAHA and chose to stick with their CROS aids (Group B). High frequency hearing in patients’ better ears were worse in Group B; with average thresholds at 4kHz and 8kHz: 14.4dB and 28.1dB compared with Group A; 12.5dB and 20.5dB. The age of patients varied in both groups. The mean average was lower in Group A: 45.5 years compared to 50.8 years in Group B. However the oldest patient assessed (81 years), chose to proceed with implantation – indicating that age is not an overriding factor in the decision-making process. 27% of patients involved had long-standing SSD – reporting that the hearing loss occurred either in childhood or >20 years ago, and the majority of these did report benefit from either BAHA or CROS aids; with only one person declining both options. The main cause of deafness in all groups was the removal of acoustic neuromas: 50% in Group A, 44% in Group B and 33% (one person) in Group C. Conclusions: Both BAHA and CROS aids were found to alleviate some of the difficulties associated with SSD for the majority of patients - with both long-standing and recently acquired hearing losses. Those with a high-frequency loss in their hearing ear may experience more benefit from a BiCROS system, due to the added amplification offered on this side. All individuals with SSD should be referred to Audiology and offered trials with both devices as part of their rehabilitation. Clinicians should be mindful not to influence patient choice based on out-dated assumptions of which device is more BAA MAGAZINE / SUMMER 2017 / 10
suitable, but instead, guide patients to make an informed decision themselves. Clinicians also noted that the outcome of the trials could not be predicted from the first appointment, as many who seemed wholly pessimistic about the devices returned triumphant, whilst others who seemed certain to benefit from one would report the opposite! The vast majority of patients included in this study lost their hearing suddenly; whether in childhood or as an adult. Suddenonset SSD clearly has huge psychological effects: many were suffering with anxiety and still carrying a sense of loss and grief about their hearing. A greater awareness of CROS aids and BAHAs is required in the medical community as many individuals are not referred for amplification until years after the onset of hearing loss. Research into the psychological aspects may present a case for an improved and well known pathway for these individuals; including counselling and support groups with other sufferers. With many people losing their hearing through planned acoustic neuroma surgery, there is the opportunity to provide support even before the surgery to help the patient prepare for what is to come and to know what services are available to them. References: Faber, H.T., de Wolf, M.J.F., Cremers, C.W.R.J. et al.. (2013). Benefit of Baha in the elderly with single-sided deafness. Eur Arch Otorhinolaryngol. 270, (4) 1285–1291 Ferri, E., Frisian, A., Fasson, A.C., Armato, E., Spinato, G., Amadori, M. (2012). Intratympanic steroid treatment for idiopathic sudden sensorineural hearing loss after failure of intravenous therapy. ISRN Otolaryngol. 2012: 647271. Wie, O. B., Pripp, A. H., Tvete, O. (2010). Unilateral Deafness in Adults: Effects on Communication and Social Interaction. Annals of Otology. 119(11):772-781. Feel the difference VIDEO OTOSCOPY OAE N O A H AUDIOMETRY IMC2 AND EMR READY C O U N S E L LI N G IMMITTANCE R E P O R T I N G H I T P M M Madsen ® Zodiac Control, confidence and efficiency in immittance testing The new MADSEN ® Zodiac from Otometrics is designed with focus on the probes and the way you work, making it reliable, responsive and easy to use. Contact us for a demo of Madsen Zodiac - or to hear more about our customized solutions with Otometrics ® Genie Sound Rooms, OTOsuite ® and our fully integrated hearing assessment and fitting equipment. Contact us today or read more at www.otometrics.co.uk/zodiac Sound Rooms Otometrics, UK. +44 (0) 870 9000 675. info-uk@otometrics.com Otometrics A/S, Denmark. +45 45 75 55 55. info-dk@otometrics.com www.otometrics.co.uk BAA MAGAZINE / SUMMER 2017 / 11
Page 1 and 2: This issue BAA Conference 2017 16 2
Page 3 and 4: Contents: General: 3 Editorial 4 Pr
Page 5 and 6: Power Your Senses Oticon NHS Study
Page 7 and 8: FEATURE To Assess the Effect of Che
Page 9: understanding conversation in a noi
Page 13 and 14: University using posters and email
Page 15 and 16: participants more likely to go ahea
Page 17 and 18: Programme: We felt that the slightl
Page 19 and 20: Thursday 16th November Solent Hall
Page 21 and 22: Friday 17th November 12:45 - 14:15
Page 23 and 24: FEATURE Development of the Spatial
Page 25 and 26: INFORMATION BAA Members - Education
Page 27 and 28: TRAINEES Deafness in Low and Middle
Page 29 and 30: INDUSTRY UPDATES The future is now:
Page 31 and 32: British Academy of Audiology 14th A

BAA MAGAZINE SUMMER 2017 DRAFT 4

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