hearing aids in otology

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Hearing Aids in Otology Dr. Jerry Halik FRCSC Assistant Professor University of Toronto

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Hearing Aids in Otology. Dr. Jerry Halik FRCSC Assistant Professor University of Toronto. “Only 5% of patients seen for hearing loss may benefit from surgery” John Shea MD. Surgeon Safe Eradicate Disease Dry Function. Patient Dry Function Safe - PowerPoint PPT Presentation

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Page 1: Hearing Aids in Otology

Hearing Aids in Otology

Dr. Jerry Halik FRCSCAssistant Professor University of Toronto

Page 2: Hearing Aids in Otology

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

John Shea MD

Page 3: Hearing Aids in Otology

Expectations of Ear Surgery

Surgeon Safe Eradicate Disease Dry Function

Patient Dry Function Safe Eradicate Disease

Page 4: Hearing Aids in Otology

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)

Page 5: Hearing Aids in Otology

Result of Hearing gain in Ear Surgery

Mastoid Surgery - 25% Post op SRT <30 dB

Page 6: Hearing Aids in Otology

Ossiculoplasty

Page 7: Hearing Aids in Otology

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)

Page 8: Hearing Aids in Otology

Stapes Surgery Goals

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

Page 9: Hearing Aids in Otology

Stapes Surgery

Page 10: Hearing Aids in Otology

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%)

Page 11: Hearing Aids in Otology

Stapes Surgery Result

Post-op SRT< 30dB=111

Pre-op possible SRT<30db=107

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

Page 12: Hearing Aids in Otology

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)

Page 13: Hearing Aids in Otology

Time to Hearing Aids Post Stapedectomy

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

Small Fenestra – 21 Years

(Smyth, Hassard; 1986)

Page 14: Hearing Aids in Otology

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

Page 15: Hearing Aids in Otology

Why Hearing Aids

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

Page 16: Hearing Aids in Otology

Impact of Auditory Deprivation

Problems fitting aids

Sometimes permanent effects

Page 17: Hearing Aids in Otology

Hearing Aids

“ Offering a Solution no One Wants”

Otologist- Role of Educator

Page 18: Hearing Aids in Otology

Conventional Hearing Aids

Analogue Vs Digital

“Noise Management”

Clarity

Page 19: Hearing Aids in Otology

Implantable Hearing Aid

Magnet (Implantable)& Electromagnetic Driver

Piezo-electrode

Page 20: Hearing Aids in Otology

BAHA

Page 21: Hearing Aids in Otology

Uses for BAHA

1. Unable to wear conventional Aid in suitable candidate

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

Page 22: Hearing Aids in Otology

Cochlear Implants

Page 23: Hearing Aids in Otology

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