hearing aids in otology
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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 PresentationTRANSCRIPT
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Hearing Aids in Otology
Dr. Jerry Halik FRCSCAssistant Professor University of Toronto
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“Only 5% of patients seen for hearing loss may benefit from surgery”
John Shea MD
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Expectations of Ear Surgery
Surgeon Safe Eradicate Disease Dry Function
Patient Dry Function Safe Eradicate Disease
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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)
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Result of Hearing gain in Ear Surgery
Mastoid Surgery - 25% Post op SRT <30 dB
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Ossiculoplasty
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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)
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Stapes Surgery Goals
1. No Aid2. No Aid Aid3. Large Aid Small Aid
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Stapes Surgery
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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%)
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Stapes Surgery Result
Post-op SRT< 30dB=111
Pre-op possible SRT<30db=107
%Improvement=111/107 (103%)(Raut, Halik 2002)
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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)
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Time to Hearing Aids Post Stapedectomy
(Aided at 40 dB Level) Large Fenestra – 13 Years
Small Fenestra – 21 Years
(Smyth, Hassard; 1986)
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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
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Why Hearing Aids
Critical for Communication Development speech & Language Education Employment Quality of life
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Impact of Auditory Deprivation
Problems fitting aids
Sometimes permanent effects
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Hearing Aids
“ Offering a Solution no One Wants”
Otologist- Role of Educator
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Conventional Hearing Aids
Analogue Vs Digital
“Noise Management”
Clarity
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Implantable Hearing Aid
Magnet (Implantable)& Electromagnetic Driver
Piezo-electrode
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BAHA
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Uses for BAHA
1. Unable to wear conventional Aid in suitable candidate
2. Unilateral complete SNHL (Vs transcranial fitting conventional aid)
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Cochlear Implants
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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