Struggling with Your Current Hearing Devices?

Dr. Ullauri answers some common questions about hearing aids and cochlear implants.

Patients who are current hearing aid users who are experiencing problems, or patients who want cochlear implant assessments, must navigate a changing technological landscape. Below, Dr. Ullauri tackles 4 common questions that address these issues:

I was told many years ago I wasn’t a cochlear implant candidate. Is there anything new?

YES! Cochlear implant candidacy standards are changing constantly as more research becomes available. There are many patients who are cochlear implant candidates today who may not have been candidates 5-10 years ago. For example, patients with a unilateral hearing loss (normal hearing in one ear and a profound hearing loss in the other ear) may be cochlear implant candidates today (Rahne & Plontke, 2016), and that was not always the case. Also, the degree of hearing loss required for a cochlear implant is different. Today, current Medicare guidelines for cochlear implants in adult’s state that a candidate must have a moderate to profound sensorineural hearing loss (CMS, 2015). However, as recently as 2004, the Medicare guidelines for adult cochlear implants required a profound hearing loss. Further, the age for implanting children has lowered significantly since the 1990’s. Back in 1995, The Journal of American Medical Association published the then current consensus for pediatric and adult cochlear implantation. For children, it was at least 2 years of age, and for adults it was bilateral profound deafness (JAMA, 1995). Today, implanting children who were born with hearing loss at age 2 is considered late implantation. Many centers around the world are advocating for implantation as early as 6 months of age. You may be an implant candidate despite what you previously heard. Keeping in touch with your Audiologist and ENT is crucial so that you can find out about new technologies and protocols in the diagnosis and treatment of hearing loss.

I have bilateral hearing loss, and despite my new powerful hearing aids, I struggle with my hearing. Do I need another brand? Are there better hearing solutions?

If you are an experienced hearing aid user and, despite having hearing aids, you continue to make trips to your audiologist on regular basis for communication problems, you do not need to keep buying different hearing aids. Instead, take a step back and follow these suggestions:  see an audiologist to ensure that your hearing aids are powerful enough for your loss, were programmed properly, and that your hearing aid program was verified by taking some measurements with a probe inside your ear. Most importantly, make sure your audiologist conducted Speech Perception testing.

Speech perception testing will yield crucial information about what you do with what you hear. Hearing is not enough if you don’t understand what you hear. Hearing in quiet environments only is not enough if you live in a noisy world (we all do). Speech Perception testing is conducted while you wear your hearing devices. You are asked to repeat words and sentences presented in quiet first, and then in noise. This information is key to finding out if hearing aids are what you need, or if other technologies like cochlear implants are needed. We find that patients stay a little too long in the hearing aid trial cycle without knowing of other and better alternatives.

I have a cochlear implant in one ear, do I need a hearing aid in the other ear? Or is my cochlear implant enough?

If you have residual hearing (some hearing) in your non-implanted ear, talk to your Audiologist. You might benefit from a contralateral hearing aid. You could become a BIMODAL user: Cochlear Implant in one ear, hearing aid in the other.

A few things to know about BIMODAL hearing:

• Hearing from both ears is ALWAYS be better than hearing from only one ear.
• The better your residual hearing and the better your speech discrimination scores, the more benefit you will get from BIMODAL amplification. Studies have shown improvement in sound perception and quality of social activities when using BIMODAL hearing (Devocht, George, Janssen, Stokroos, 2015)
• Today, some cochlear implant companies offer a contralateral hearing aid that is compatible and can connect to your cochlear implant (Advanced Bionics, 2016).

I received my cochlear implant many years ago; however, I still struggle with hearing in that ear. Sometimes I hear better through my hearing aid in the other ear, but this aid is not improving my hearing like it used to. I think I may need a second implant, but I’m afraid to move forward because my first implant is not working like I want it to.

First, let’s start with the fact that BILATERAL cochlear implants in adults are common. In many countries, implanting both ears is becoming the standard practice for adults with bilateral hearing loss (Kraaijenga et al., 2016). Studies have shown that patients with bilateral cochlear implants hear better in noise, improve localization skills, and have greater ease of listening. Many centers around the world are starting to offer adult patients bilateral cochlear implants simultaneously (Kraaijenga et al., 2016; De Seta et al., 2016). If your hearing was symmetrical (similar in both ears), and you already received a cochlear implant, becoming a bilateral CI user might be the way to go.

Outcomes after cochlear implantation in adults vary, and there are many reasons why (Moberly, Bates, Harris, & Pisoni., 2016).  If you received your CI many years ago and receive a second implant now, the procedure will be markedly different. Surgical techniques have improved and cause less trauma to the inner ear (cochlea) (Holden et al., 2013). The electrodes have also improved, and are thinner and more flexible (Holden, et al., 2013).  Studies have shown that the design of the electrodes in the new implants have improved speech understanding (Holden, et al., 2013). Also, insertion of the electrode is better now, resulting in a better placement of the electrode in relation to the modiolus (De Seta et al., 2016). This also results in better speech understanding.

My advice is: explore a second side cochlear implant with your cochlear implant team. Technology and surgical techniques have improved significantly, and these improvements have shown to have a positive impact in speech understanding.  Plus, hearing from both sides will always be better than hearing only from one side. If you are wearing BIMODAL hearing devices (Cochlear Implant + Hearing Aid), discuss your current speech perception scores with your Audiologist. How is your performance in quiet and in noise? Is your hearing aid helping or does it provide limited amplification? Have you completed an aural rehabilitation program? Training your brain to hear is key to the process of acquiring better hearing. Once you have all these information, your cochlear implant team will be able to advice you better on how to improve your hearing. If you have been struggling for a while, but have not paid a visit to your team, make an appointment to see them today.

SUMMARY:

Don’t give up in your search for better hearing and easier communication.

• Stay in touch with your team about new treatment options, new technologies, and new upgrades that allow better mapping/programming.
• Remember that hearing from both ears is key to understanding speech in noise and is always better than hearing only from one ear.
• If you have residual hearing that can benefit from conventional amplification, you should try BIMODAL hearing. It works. It’s not invasive. It offers you more auditory information that will help your brain understand more of what it hears.
• Bilateral implants are also becoming the norm in adult cases. Remember that if you received a cochlear implant many years ago, things have changed significantly for the better. This might be the best time to become a Bilateral Cochlear Implant user.

If you have any questions, please do not hesitate to contact me at alejandra@35.232.203.107

Alejandra Ullauri, Certified Cochlear Implant Audiologist.

References:

Advanced Bionics (2016). Made for each other the naiad link hearing solution. Retrieved from http://www.advancedbionics.com/com/en/products/bimodal.html.

CMS, (2005, April 4). Cochlear Implantation. Retrieved from https://www.cms.gov/Medicare/Coverage/Coverage-with-Evidence-Development/Cochlear-Implantation-.html , Accessed on September 23, 2016.

De Seta D., Nguyen Y., Bonnard D., Ferrary E., Godey B., Bakhos D., Mondain M., Deguine O., Sterkers O., Bernardeschi D., Mosnier I., (2016). The role of electrode placement in bilateral simultaneously cochlear-implanted adult patients. Otolaryngology Head Neck Surg Sep;155(3):485-93.

Devocht E.M., George E.L., Janssen A.M., Stokroos R.J. (2015). Bimodal Hearing Aid Retention after Unilateral Cochlear Implantation. Audiol Neurootol. 2015;20(6):383-93.

JAMA. (1995). NIH Consensus conference. Cochlear implants in adults and children. JAMA Dec 27,274(24):1955-61.

Kraaijenga V.J., van Zon A., Smulders Y.E., Ramakers G.G., Van Zanten G.A., Stokroos R.J., Huinck W.J., Frijns J.H., Free R.H., Grolman W. (2016). Development of a squelch effect in adult patients after simultaneous bilateral cochlear implantation. Otol Neurotol Oct 37(9):1300-6.

Holden L.K., Finley C.C., Firszt J.B., Holden T.A., Brenner C., Potts L.G., Gotter B.D., Vanderhoof S.S., Mispagel K., Heydebrand G., Skinner M.W. (2013). Factors affecting open-set word recognition in adults with cochlear implants. Ear Hear. 2013 May-Jun;34(3):342-60.

Moberly .C., Bates C., Harris M.S., Pisoni D.B. (2016). The enigma of poor performance by adults with cochlear implants. Otol Neurotol. Sep 14, 2016.

Rahne T., & Plontke S.K. (2016). Functional result after cochlear implantation in children and adults with single sided deafness. Otol Neurotol. Oct;37(9):332-40.