hearing aids in otology

Hearing Aids in Otology

Dr. Jerry Halik FRCSCAssistant Professor University of Toronto

“Only 5% of patients seen for hearing loss may benefit from surgery”

John Shea MD

Expectations of Ear Surgery

Surgeon Safe Eradicate Disease Dry Function

Patient Dry Function Safe Eradicate Disease

Result of Hearing gain in Ear Surgery

Tympanoplasty Long term result at 11 years

- 81% closed Perforations - 9% Atelectatic pocket Formation 74% Normal Healed TM (Halik, Smyth; 1988)

Result of Hearing gain in Ear Surgery

Mastoid Surgery - 25% Post op SRT <30 dB

Ossiculoplasty

Ossiculoplasty Results

TORP/ PORP- 25% SRT < 31 dB 4/12 patients

Assemblies – 57% SRT <31 Db 58/102 patients

Follow up – Up to 6 years (average 2 years)

Stapes Surgery Goals

1. No Aid2. No Aid Aid3. Large Aid Small Aid

Stapes Surgery

Stapes Surgery ResultN=135

Avg A-B gap closure (Post op air minus pre-op bone)

A-B gap 0.5,1,2 KHz 0.5,1,2,4 KHz

< 10dB 118/135(87.4%)

107/135(79.3%)

<20dB 13/135(9.6%)

24/135(17.7%)

>20dB 4/135(3%) 4/135(3%)

Stapes Surgery Result

Post-op SRT< 30dB=111

Pre-op possible SRT<30db=107

%Improvement=111/107 (103%)(Raut, Halik 2002)

Post Stapes Chronic Progressive SNHL

Large Fenestra – 9.5 dB / 10 Years

Small Fenestra- 3.2 dB / 10 Years (<0.4 mm)

(Smyth, Hassard; 1986)

Time to Hearing Aids Post Stapedectomy

(Aided at 40 dB Level) Large Fenestra – 13 Years

Small Fenestra – 21 Years

(Smyth, Hassard; 1986)

Demographics of Hearing Loss Year 2000 in USA

29 Million Hearing Impaired(10%)

5.6 Million Hearing Aid Users (1/5)

Over 6 Million Age 45-54 with significant hearing loss

Why Hearing Aids

Critical for Communication Development speech & Language Education Employment Quality of life

Impact of Auditory Deprivation

Problems fitting aids

Sometimes permanent effects

Hearing Aids

“ Offering a Solution no One Wants”

Otologist- Role of Educator

Conventional Hearing Aids

Analogue Vs Digital

“Noise Management”

Clarity

Implantable Hearing Aid

Magnet (Implantable)& Electromagnetic Driver

Piezo-electrode

BAHA

Uses for BAHA

1. Unable to wear conventional Aid in suitable candidate

2. Unilateral complete SNHL (Vs transcranial fitting conventional aid)

Cochlear Implants

Summary …

Be realistic of surgical results especially long term

Greater role for hearing aids on surgical patients over time

Vast majority of patients not Surgical