2017 Sec 1 Green Book

Reprinted by permission of Otol Neurotol. 2016; 37(2):e154-e160.

Otology & Neurotology 37 :e154–e160 2016, Otology & Neurotology, Inc.

Single-sided Deafness Cochlear Implantation: Candidacy, Evaluation, and Outcomes in Children and Adults

David R. Friedmann, Omar H. Ahmed, Sean O. McMenomey, William H. Shapiro, Susan B. Waltzman, and J. Thomas Roland Jr.

Department of Otolaryngology–Head and Neck Surgery, NYU School of Medicine, New York, NY, U.S.A.

Objectives: Although there are various available treatment options for unilateral severe-to-profound hearing loss, these options do not provide the benefits of binaural hearing since sound is directed from the poorer ear to the better ear. The purpose of this investigation was to review our center’s experience with cochlear implantation in such patients in providing improved auditory benefits and useful binaural hearing. Study Design: Retrospective chart review. Methods: Twelve adult patients and four pediatric patients with unilateral severe-to-profound hearing loss received an implant in the poorer ear. Outcome measures performed preoperatively on each ear and binaurally included conso- nant–nucleus–consonant (CNC) monosyllabic words and Single-sided deafness (SSD) refers to an asymmetric condition in which a patient has one ear with severe- profound sensorineural hearing loss with normal hearing in the contralateral ear. The impact of unilateral hearing loss may be variable and considerations in children are different from those in adults. Nevertheless, they experi- ence a substantial hearing deficit. In typical listening situations, sound reaching one ear differs from the sound that reaches the opposite ear in two ways: because of the head shadow effect, there is a difference in the intensity of the sound at each ear and there is a variance between the times when the sound reaches each ear. One of the most important uses of these differences is to allow the listener to know the direction from which a sound, including speech, originates. More- over, these abilities allow the listener to separate speech from background noise. Since the lack of ability to Address correspondence and reprint requests to David R. Friedmann, M.D., NYU Langone Medical Center, New York, NY 10016, U.S.A.; E-mail: drf249@nyumc.org Invited article presented at Proceedings of 14th Pediatric CI Sym- posium, Nashville, TN, U.S.A., December 2014. S.O.M., J.T.R., and W.H.S. are on the advisory boards for Cochlear Corp. J.T.R. is also on the advisory board for AB Corp. The remaining authors disclose no conflicts of interest.

sentences in noise. The mean pure-tune average in the better ear was within normal range. Results: Test scores revealed a significant improvement in CNC and sentence in noise test scores from the preoperative to most recent postoperative evaluation in the isolated implant ear. All adult subjects use the device full-time. Conclusions: The data reveal significant improvement in speech perception performance in quiet and in noise in patients with single-sided deafness after implantation. Per- formance might depend on factors including length of hearing loss, age at implantation, and device usage. Key Words: Pediatric and adult cochlear implantation — Single- sided deafness. Otol Neurotol 37: e154–e160, 2016. discriminate and understand speech in the presence of competing sounds reduces an individual’s competence and effectiveness in personal and professional inter- actions, the loss of binaural hearing can significantly affect socioeconomic and quality-of-life functions. Studies in children reveal that unilateral hearing impairment may negatively affect language develop- ment, social interactions, and academic performance (1,2). Some adults with postlingual SSD seem only minimally bothered by the loss and do not pursue further treatment, whereas others possibly related to occu- pational or social considerations seek assistive listening technologies. Still the benefits of binaural hearing, especially in aiding with difficult listening situations, are clear and have been well described elsewhere for both normal hearing listeners (3) and those with bilateral cochlear implants (4). These include improved speech understand- ing in quiet and in noise, better localization, and the ability to hear at greater distances. In addition to the objective benefits of binaural hearing there are numerous subjective advantages including a more ‘‘balanced’’ and less tiring listening experience. Most rehabilitative options for SSD route sound to the contralateral cochlea resulting in only unilateral auditory stimulation either with transmission via cross-routing of

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