Hearing from the Other Side: Understanding the Candidacy for SSD and Treatment Options

Patrick Hurley, PhD

December 15, 2017

This article is sponsored by Cochlear Americas.

Learning Outcomes

After this course, participants will be able to:

Identify single sided deafness and list challenges faced by patients with single-sided deafness (SSD).
Identify 3 advantages of a bone conduction system relative to other treatment options.
Describe the treatment pathway with Baha 5 technology for their SSD patients.

Introduction

Thank you for joining Cochlear to learn more about counseling and treating adults with single-sided deafness (SSD). Cochlear is a mission driven organization with a focus on transforming the treatment of hearing loss, with our ultimate focus being on improving the lives of individuals with hearing loss.

SSD Defined

Let's start by reviewing the definition of SSD. Single-sided deafness is a profound sensorineural hearing loss in the non-functioning ear on one side, with essentially normal hearing on the other side. Sounds from the deaf side are not heard, and speech understanding in noise is likely difficult in background noise. Those are important clinical side effects of having only one good ear.

The term SSD differentiates a unilateral sensorineural hearing loss from a unilateral conductive hearing loss, or an asymmetrical sensorineural hearing loss, in which the patient can use amplification in the poorer ear. For our purposes, in those with SSD, the "poor" ear can be described as having non-functional hearing (i.e., un-aidable, profound hearing loss). The key factor with SSD, is that the poor ear will not receive benefit when traditional acoustic amplification is applied, and other treatments must be considered. We will go into more detail about candidacy, fitting, and identifying criteria later in the presentation.

Common Causes of SSD

The possible etiologies of SSD are varied, and may be the result of congenital issues, diseases or trauma. It could also result from a previous medical intervention, such as acoustic neuroma or cholesteatoma. It may be determined that the cause of SSD is idiopathic. Regardless of the cause, individuals with SSD struggle with perception of speech and environmental sounds. Additionally, patients with SSD can struggle with social situations and often report retreating from small and large group conversations. This presentation is focused on single sided deafness in adults, but SSD can happen at any age. The first step is taking action and not letting the patient’s hearing loss go untreated.

Impact of SSD

Now that we have a common understanding of SSD, let’s discuss the impact of hearing with only one ear. As Audiologists, our common goal and the desired state for our patients is for them to hear bilaterally, with two ears. It’s important for us to not only talk about how unique the SSD patient may be, but also the impact of that type of hearing loss on the patient's daily life.

Binaural hearing functions may provide important listening features, such as sound localization, lateralization and the ability to separate and select verbal messages from the background signal and summation effects (redundancy of auditory input). Due to the profound sensorineural hearing loss in one ear, SSD patients experience monaural hearing, or only hearing with one ear. Listening with only one ear requires increased effort, which can be tiring and detrimental to learning.

Speech perception in noise challenges all individuals with hearing loss of any degree or type, but perhaps even more so for individuals with single-sided deafness. They often find it hard to understand speech and sounds, especially in noisy environments. Furthermore, they experience difficulty in determining the direction of a sound's location. Many SSD patients may also suffer from tinnitus, headaches and balance problems.

Hearing loss can have an impact on an individual's safety, as well as in social situations. According to McLeod, Upfold and Taylor (2008) patients who contracted single-sided deafness following vestibular schwannoma surgery reported that a limited ability to discern sounds led to social isolation. Furthermore, with regard to the safety aspect, in a survey of nearly one thousand SSD patients who were asked to report how their symptoms affected their lives, around half of those polled said that they experienced difficulties as a pedestrian due to SSD (Figure 1). Interestingly, they also reported that they could not interact as part of a group, and felt socially excluded. Another 41% reported severe difficulty using the phone, and 39% said that SSD had made work more difficult for them.

Safety and social impact of SSD

Figure 1. Safety and social impact of SSD. Data from survey contained in "Hear the other side: A report on single-sided deafness." Available from Cochlear, article E80414A.

Normal localization is based on interaural time differences and level differences. When input from one ear is missing, the brain has difficulty determining where the sound originated. In the normal hearing condition, when both cochleas are active, the time difference between when sound enters one cochlea and when it is centrally registered helps the person to understand the origin of that sound. With the single-sided deaf patient, because there is no input into the poor ear (as that cochlea is no longer working), they experience a Head Shadow Effect. This occurs when the head acts as an acoustic barrier for the better ear and attenuates signals (especially high frequency sounds) coming from the hearing field on the poor side.

Figure 2, illustrates SSD, in this case a damaged cochlea on the left and a normal cochlea on the right. This image illustrates the ways in which the high and low frequency signals are impacted when delivered on the individual’s left (or poorer) side. High frequency sounds are often lost in a person with SSD due to the head shadow effect.

Head shadow effect

Figure 2. Head shadow effect.

Treatment Options for SSD

The most common treatment options for SSD include the following:

Patient remains untreated
CROS hearing aids (contralateral routing of signal)
Steroids
Medical intervention (surgery, as in acoustic neuroma, or blockage of the ear)
Bone conduction devices - Baha System

I would like to emphasize that not any one treatment is absolutely the best way to go. We need to think about each individual patient, and where they are in their SSD journey at a given point in time. Except for remaining untreated, all of these have some degree of efficacy. It is important for both the patient and the physician to work through which method is appropriate.

How do you decide which treatment option is right? There are a few things to consider:

What are the patient's motivations and expectations?
What is the cost to the patient?
What are their cosmetic needs?
What level of power is needed?
Do they want a simple solution?

Comparing Treatment Options for SSD

For a person who has sudden idiopathic SSD, the first line of treatment is usually to try steroids. If that doesn't work, the next option is typically a CROS hearing aid. However, in some notable cases (as with acoustic neuroma, for example), a bone conduction device might be considered as another option.

In a recent survey of 29 hearing health professionals, they indicated that bone conduction was the most successful treatment. Clinicians indicated that in 90% of cases, when their patient received a Baha (or another kind of bone conduction solution), that served as the final line of treatment for patients with SSD, and continued treatment was no longer necessary. Of course, this should not imply that the patient is no longer going to see the clinician for routine care. They will still need rehab and need to be looked after from a treatment point of view. But in the patient's mind, they felt as if treatment had been successful.

Cochlear Baha System

How it Works

With the Baha system, implants can be used for either the Baha Attract (a magnet) or the Baha Connect (a typical abutment). The underlying process is the same in both types of implants: a sound processor detects sound and transforms it into vibrations (Figure 3). Next, a connecting abutment/internal magnet transfers sound into mechanical vibrations from the Baha device to the implant. In cases of SSD, the Baha implant then transfers sound vibrations received on the deaf side via the skull directly to the functioning cochlea.

Figure 3. How a Baha System works.

It is important to note that the Baha System also works for conductive and mixed hearing losses, because it bypasses any problems associated with the outer or middle ear. Causes of conductive HL may include Microtia/Atresia, aging, exposure to sounds, or ear blockages. With mixed hearing losses, it's can be a combination of factors, such as exposure to sound, head trauma, chronic draining or runny ears. Today, we're focusing on single-sided deafness, which has a sensorineural component (i.e., the cochlea is not functioning). As such, we need to figure out how to transmit sound received on the deaf side directly into the hearing ear.

When using the Baha System in SSD, the signal is routed to the normal ear via bone conduction across the skull; from the deaf side to the healthy cochlea side. Individuals with SSD have damage to that inner ear, such that traditional amplification does not provide any benefit. When we find candidates who are true SSD patients, they do benefit greatly from having a Baha device, because of that functioning cochlea on the good side.

Clinically Proven Patient Benefits

I would like to review some clinically proven patient benefits of the Baha System in patients with SSD. If you refer to the handout that accompanies this presentation, I have included a list of references to support these findings. Research has demonstrated that the Baha has benefited patients in the following ways:

Improved speech understanding in noisy environments. Studies have found that patients wearing Baha implants have experienced statistically significant improvements in audibility and speech understanding in noise and in quiet.
Helps to lift the head shadow effect.
Reduces the psychosocial consequences associated with hearing impairment.
Long-term patient satisfaction and hearing benefits.

Baha System vs. CROS Hearing Aids

The Baha System and CROS hearing aids are often thought of as potential treatments for SSD. Which one of these is a better way to go? As evidenced in many studies (see handout for references), the patient benefits of the Baha System versus CROS hearing aids are as follows:

There is no hardware in or occlusion of the hearing ear.
There is no need to wear hearing devices on both ears.
Patients can hear better in noise.
The Baha System offers improved sound quality due to direct bone conduction.
It is more useful in a variety of listening environments experienced in daily life.

Furthermore, in a market research poll of 29 clinicians that use the Baha System as a treatment option for hearing loss, clinicians reported that their patients did not prefer a CROS system, citing cosmetic reasons, sound quality or lack of benefit.

Other Important Patient Benefits

There are additional patient benefits when using the Baha System. It is the only surgical device that patients with hearing loss can "try before they buy." Patients appreciate the option to test it out before they commit to making a purchase and to implantation. They can trial the bone conduction devices using a Softband, a test rod or even a test band. The speech in noise measurements can be used as an accurate predictor of the overall benefits of a bone conduction system for patients with SSD, prior to implantation.

Another important factor is the potential for insurance reimbursement. As hearing loss treatments have evolved, reimbursement for auditory osseointegrated implant systems such as the Baha System have evolved as well, and are often covered by insurance. That does vary from state to state and provider to provider, and even within providers. There is a bit of leg work involved, but we have additional support here at Cochlear that can help you and your patients walk through the details of reimbursement.

Another patient benefit of the Baha System is our wearable technology. The Baha System can connect to a number of wireless devices in our portfolio. We offer the Made for iPhone capability (with the Baha 5 System, in particular). Not only does it have that functionality built into current iPhones, there is also the ability to do it with specific Android devices through some of our wireless technology. Patients can enjoy streaming music, talking on FaceTime or other types of video chat.

Baha System Evaluation for SSD

So far, the topics we have covered include a review of SSD, an overview of the impact it may have on an individual treatment options, and how our clinically-proven Baha System can be a great choice for patients with only one functioning cochlea. Let’s now discuss how you might identify patients in your clinic, as well as how your referring partners might help to find these patients and send them on to your clinic for comprehensive care.

The Baha System evaluation for SSD is a five-step process:

Step 1: Candidate Criteria
Step 2: Audiometric Testing
Step 3: Benefit Evaluation
- Hearing-in-noise testing
- Softband demonstration
- Subjective assessment
Step 4: Counsel the Candidate
- Fitting considerations
- Surgical consideration
- Select system and sound processor
Step 5: Refer to an ENT specialist for a consultation or proceed with fit non-surgically

Using this process should allow you to efficiently test these patients, counsel them, allow them to try the demo, and then have them understand the perceived benefit of the Baha System.

Step One: Candidate Criteria

The first step is to determine patients who can benefit from a bone conduction system, and which ones might be better off with a different solution. Before evaluating a candidate’s hearing, the candidate should feel the need for treatment. The patient may be of any age, although today’s focus is on the adult SSD candidate. These SSD patients may have specific expectations due to their type of hearing loss, and it is important to ensure their specific goals for hearing treatment can be met with a Baha System.

There are three areas to consider when determining candidate criteria: patient characteristics, patients with certain existing conditions, and patient attitude and history (Figure 4).

Determining candidate criteria

Figure 4. Determining candidate criteria.

Patient characteristics. The Baha Connect and Attract System (surgical implant) are contraindicated for anyone under five. However, we do have non-surgical options (softband) that are indicated for any age. Those connection points are the same, meaning you can use the Baha 5, the Power or the Superpower on any one of those connection points, whether it's Attract, Connect or Softband. Some of the common causes of SSD are sudden onset hearing loss, genetic factors, idiopathic causes and surgically related causes (such as removal of an acoustic neuroma).

Patients with certain existing conditions. I'd like to focus in particular on acoustic neuroma. In the past, there have been efforts to treat the acoustic neuroma, and install the implant at the same time. This is because once that acoustic neuroma is removed, hearing in that ear is no longer possible. Patients have that option to "kill two birds with one stone," so they can quickly get back into sound with the bone anchored implant.

Patient attitude and history. Is the patient willing and able to take care of the implant site? Care and maintenance is very important, particularly with the Connect or any sort of abutment style device implant. Are they comfortable with and open to a surgical option? Are they opposed to wearing a device in their good ear? Do they have realistic expectations of the benefits?

Step Two: Audiometric Testing

In addition to the audiological threshold criteria, protocol for speech testing is recommended to help objectively measure how clearly people can understand speech, with amplification and without (Figure 5). While pure tone thresholds are used to determine candidacy and gauge improvement in hearing levels, these measures have been demonstrated to be poor predictors of performance in background noise. The speech test material can be delivered through an audiometer via the bone conductor that is placed appropriately on the adult. To determine the presentation level, add 30 dB to the pure tone average, and increase by 15 dB until close to 100% is achieved on AB word test. Again, looking at the good ear is important in understanding an SSD patient.

Audiometric testing

Figure 5. Audiometric testing.

Step Three: Clinical Benefit Evaluation

Cochlear recommends the use of the following tests to help evaluate the benefit: QuickSin, HINT, or AZ Bio. Test two situations to help determine individual benefit: unaided condition and an aided condition (using a Softband). It's important to test speech perception ability with the Baha System, as compared to an unaided condition. The difference in the signal-to-noise ratio between these two situations is a good predictor of individual benefit: the bigger the difference between aided and unaided, the more benefit can be expected from a Baha. The demonstration can be done using the Softband to show what it is like to have a Baha bone conduction processor on your head, very similar to what you could expect from Attract. However, the patient should expect better sound transmission using a Baha Connect System due to the penetration, and the direct bone stimulation. With Attract or non-surgical options (like Softband), there is soft tissue and transcranial attenuation, which may result in a 10-15 dB attenuation. Further information about hearing in noise testing to evaluate clinical benefit can be found in the course handout.

Step Four: Counsel the Candidate

There are many factors to consider when counseling the patient, specifically fitting considerations, surgical considerations and deciding which system and sound processor is most appropriate.

Fitting Considerations. Practical points to consider include:

Hearing Expectations: Are they choosing the correct power level? For example, what if they want an Attract, but they need a Connect? It is important to manage their expectations.
Cosmetics: Are they okay with having something penetrating the skin (i.e., with Connect)?
Hygiene: Are they capable of cleaning their site thoroughly effectively?
Dexterity: Do they have dexterity issues? Will they be able to take the devices on and off? Will they be able to remove and replace the sound processor magnet, the software pads, and the processor itself?
Sporting Activities/Head Gear: In the case of younger individuals, what are their sporting activities? What's their lifestyle like? Will they require head gear?
Radiation/ MRIs

Surgical Considerations. Some typical surgical considerations to discuss include:

Routine outpatient procedure: Are they comfortable with an outpatient procedure? How are they in general with surgical needs and expectations?
General anesthesia: Are they okay being under general anesthesia? Are there any contraindications for them being under anesthesia?
Established treatment option +40 years

Cochlear has published a guidebook titled "What to Expect at Surgery/Activation." It's very thorough with regard to procedure details, and also comprehensive in terms of assuaging patient fears. It is useful to help counsel patients on what the surgery is like, the typical procedure duration, and how the device is activated, among other information.

System and Sound Processor Selection. The Baha System offers a wide range of power levels to treat various bone conduction threshold levels (Figure 6). The Baha 5 (far left), the Baha 5 Power (center) and the Super Power (far right), all have varying levels of decibel capabilities. This allows us to treat patients that we didn't have the capability of treating before. For patients with SSD, Power and Super Power might be good options, especially considering some individuals might want to go with an Attract as opposed to a typical abutment. It allows us flexibility, as a company and also as clinicians, to treat patients with different bone conduction thresholds and achieve the results that they want and need.

Figure 6. Baha System power levels.

In addition to selecting the power level and the processor, but we also need to think about what system is best for the patient: the Baha Connect System, the Baha Attract System, or the Baha Softband (Figure 7). The Baha Connect is the abutment style, and is the most direct into the bone; as such, it's going to provide the greatest amount of power. The Baha Attract is a magnet system, and has a little bit less power, even with a Power or Super Power device. However, we can achieve better results from a clinical aspect with a Power or Super Power on the magnet than was possible even a year-and-a-half ago, which is very encouraging. Then of course, Softband is an option for those who are considering non-surgical options, or for children under the age of five. Softband is going to provide results similar to Attract, but Softband doesn't perform as well as Attract.

Figure 7. Choosing the Baha system.

It is important to note that the two surgical options both use the same implant, which is compatible with either Connect or Attract Systems. This means that your patient could potentially transition as their hearing journey changes over time. In other words, if they start with an Attract, and their hearing deteriorates over time, they could move into a Connect, and vice versa.

Figure 8 shows the clinically proven hearing performance associated with both Softband and Attract, comparing unaided versus aided conditions. The aided conditions included on this graph are: Softband, Baha Attract at four weeks, Baha Attract at six weeks, and Baha Attract at nine months. You can see that the patient's speech to noise ratio is improved when there is an intervention, and as they progress in time, it gets even better. Improvement on the right shows that they're getting better and better with various treatment options, as compared to their unaided condition.

Figure 8. Clinically proven hearing performance.

Let's talk about the power associated with the three different devices (the Baha 5, the Baha 5 Power, and the Super Power). Figure 9 shows the force output level vs. frequency using the Attract System (as tested in a laboratory). The take away message is that Baha Attract with more power in the higher frequencies can also be augmented with the Baha 5 Power or the Super Power to achieve some of those force output readings that are going to be necessary for some of your patients.

Force output level versus frequency. Attract System

Figure 9. Force output level vs. frequency: Attract System.

Let's compare the Attract System to the Connect System (Figure 10). The force output is on the vertical axis, and frequency is on the horizontal axis. The gray line is Baha 5, the green line is Baha 5 Power, and the purple line is Super Power. The Super Power is the strongest and most complete direct system that we have in our repertoire.

Force output level versus frequency. Connect System

Figure 10. Force output level vs. frequency: Connect System.

SSD Fitting Scenarios. There is no particular SSD sound processor, especially now that people are fitting SSD in mild to moderate hearing loss on contralateral ears. However, if you are fitting an SSD patient on a Softband or a Baha Attract, you might need a power processor to overcome the transcranial attenuation and soft tissue attenuation (Figure 11). Pure SSD on a Connect System essentially means it could be managed with a Baha 5. Occasionally, you'll come across high transcranial attenuation and need more power, but often a Baha 5 is enough.

SSD fitting scenarios

Figure 11. SSD fitting scenarios.

Attenuation is measured by comparing BC Direct and BC Unmasked thresholds. You should be able to tell if someone has high transcranial attenuation pre-implant when you fit them on a Softband. That's why it's so important to conduct a Softband trial for these patients. It not only benefits the patient, but it also helps you so you can do some objective testing and understand what that device can and cannot do. In my opinion, I believe the Baha 5 is sufficient for SSD, because you're not trying to overcome a conductive component; it's a sensorineural component that's involved.

Overview of Suggested Evaluation Process. Figure 12 shows an overview and flow chart of the suggested evaluation process for candidates with SSD. First, you take BC thresholds within fitting range of that Baha sound processor, you perform the BC Direct measurement with the Baha sound processor on a Softband, and do the BC Direct thresholds. At that point, evaluate whether they are in fitting range of the Baha SP. If the answer is yes, you'll finalize that fitting, perform testing again, and ask if the patient is satisfied. If they are satisfied, it is appropriate to think about an Attract System. If the answer is no, you might need to switch to a more powerful processor. Again, go back to that fitting and testing, and if they're happy, they could consider doing an Attract. Let's assume that you start with a Baha 5 and move to a Baha 5 Power; you could still consider an Attract at that time. Then use the Softband as a nice proxy for the Baha 5. If not, then consider all of the important factors associated with the patient's lifestyle for a Connect System.

Overview of suggested evaluation process

Figure 12. Overview of suggested evaluation process.

Contraindications. There are five contraindications to consider, where the implantation of Baha would not be recommended:

Poor bone quality or thickness (e.g., osteoporosis): If the bone quality is not good, or it is not thick enough to hold the implant, you run the risk of having that implant not fit properly, as well as poor osseointegration. The surgeon will be able to assess whether or not they're a good candidate, based on a number of bone quality concerns.
Poor hygiene (if considering Connect): The Connect System requires more after care than the magnet, because it sticks through the skin. We recommend wipes and keeping those abutments nice and clean.
Unrealistic expectations (particularly with SSD): Is this going to restore my hearing in my dead ear? The answer is no: the cochlea is no longer functioning and there is sensorineural loss. Could it lift the Head Shadow Effect? Possibly. Could it help with lateralization? Sometimes. Is it going to restore full localization? Absolutely not. You want to make sure the patient has a clear understanding of what it can and cannot do.
Medical conditions affecting bone and skin growth: There are lot of those folks who have keloid scars, or other conditions that might affect how the skin overgrows a Connect, in particular.
Age (contraindicated in children below the age of 5): The age of the patient is a factor. Right now, the surgical options are contraindicated for children under the age of five.

Step Five: Refer to an ENT Specialist for a Consultation or Proceed with Non-Surgical Fitting

If your SSD patient meets candidate criteria outlined in Steps 1-4, your next step is to refer your patient to an ENT specialist for a consultation. You may work in offices where the implanting surgeon and others refer out. Either way, you can certainly allow your patients to take home a demonstration, if that's your office's preference. If your patient does not want to proceed with surgery, but does find value from the demonstration, consider fitting a Baha sound processor non-surgically and reevaluate over time.

SSD Case Studies

Now, I would like to go through a few case studies to talk about how these learnings can be applied in your practice.

Case Study: Steve

Steve is a 38-year-old man with sudden SSD of unknown etiology three years ago. He sings in a 1940's tribute band and wears suits and horn-rimmed glasses every day. He has been using a CROS aid, but he does not like wearing it with his glasses. With the CROS aid, he feels that his good ear is plugged, especially when he's trying to follow his bandmates and keep on time with his music.

According to Steve's left and right audiograms, this does appear to be a classic case of SSD (Figure 13).

Steve's audiogram thresholds

Figure 13. Steve's audiogram thresholds.

Following a successful trial in the clinic, Steve elected to move forward with a Baha Connect in the left ear. He successfully uses his Baha every day, and reports that it's so comfortable, he sometimes forgets he's wearing it. In Figure 14, you can see Steve's unaided condition, as compared to results from the Softband trial, and finally the abutment post-op.

Steve's outcome with Baha Connect in the left ear

Figure 14. Steve's outcome with Baha Connect in the left ear.

Steve commented, "I love using the Baha to talk on my iPhone. I didn't expect that it would be so clear to use on the phone." Patients love the Made for iPhone connectivity with any of the devices in our Baha 5 line.

Case Study: Lia

Lia is a 62-year-old woman with a congenital hearing loss in the right ear. Recently, she has noticed some loss of hearing in her good ear, and she is struggling to communicate at work. Lia is a florist who owns her own shop. She's very active and does not plan on retiring any time soon. Lia has not tried any previous treatment options for her hearing loss.

One thing that we didn't discuss is the difference between the prevalent and incident population. People in the incident population are those who experience sudden loss. People in the prevalent population are walking around unaided, having never received treatment for their hearing loss. They believe that one ear is good enough, or they never felt they had a deficit. I'd like to argue that at some point, those in the prevalent population are important to get in the door and have them at least test a device, so that they understand what they're missing.

Figure 15 shows Lia's left and right audiograms in the unaided condition.

Lia's audiogram thresholds

Figure 15. Lia's audiogram thresholds.

Lia's clinician discussed treatment options with her and she chose to try out the Baha first. She loved the sound of the Baha 5 Power on the Softband and elected to proceed with the Connect. Lia uses her Baha daily, and especially likes using the Mini Mic, another wireless device that does not need a dongle. It's just True Wireless between her sound processor and her device at work with her colleagues.

In Figure 16, you can see Lia's her unaided condition from a pre-op standpoint, her trial with the Softband and her improvement on the abutment. She commented, "I barely notice my Baha, but my employees at work definitely notice if I don't have it on!" This quote is a great commentary on how much Lia may have been missing in the unaided condition.

Lia's outcome

Figure 16. Lia's outcome.

Summary and Conclusion

In summary, some of the benefits of the Baha System that your patients with SSD may experience include:

Improved sound quality due to direct bone conduction
An enhanced sense of directionality due to increased sensation of sound on side with loss
Improved speech understanding in noisy environments
Long-term patient satisfaction and hearing benefits
Ability to try before they buy

Furthermore, additional benefits of Baha, as compared to two of the biggest complaints we hear related to CROS hearing aids, are:

No need to wear hearing devices on both ears
No occlusion of the hearing ear

I'd also like to add that there is always the possibility of insurance reimbursement. Devices are often reimbursed for patients, which is a very important consideration for their financial needs, as well as for their hearing health.

Thank you for joining us for today's presentation. For more information, please visit www.Cochlear.com/us

Questions and Answers

Is there a specific system (Attract or Connect) and processor that are recommended for SSD cases, or does it all come down to patient preference during the trial?

It is truly based on the patient's experience during the trial. Some patients want more power than you might expect, because they can hear the processor. Some opt for Baha 5 because it's small. We see a lot of SSD patients who select Baha 5 Power, because it's the most flexible of the three devices. It has a lot of power but can also be turned down. However, the Baha 5 Power isn't as small as the Baha 5, which is a drawback from a cosmetic point of view.

Can you explain the difference between MFI (Made for iPhone) and True Wireless?

Made for iPhone is an Apple device. It's made for specifically for current iPhones. A very old iPhone may not work. Nevertheless, it's directly connected; it's essentially an interface between your sound processor and your phone. That means you can stream music, you can stream videos, you can talk, use FaceTime, you can do any number of those things where the device transmits the sound directly into the processor and allows the person to hear.

With True Wireless, it's not an either/or situation. You can utilize the True Wireless system with a Baha 5 or a Baha 5 Power or a Baha 5 Super Power, and essentially that's three different devices. We have what we call a TV streamer, which hooks up to your television. It streams directly and connects directly via a 2.4 gigahertz signal into your sound processor, so there is no need for an intermediary device. There is a Mini Mic Two Plus, a very flexible device used a lot in pediatric cases. It's essentially a microphone that can be used in an omnidirectional manner, or in a unidirectional manner. It can be worn on a person, or it can be put on a table and used to pick up sounds in the room. It has the flexibility of a DAI, so it can be hooked up to an FM system. It is a tremendous device that has amazing flexibility for parents, teachers and students. The Phone Clip is also a True Wireless device. It can be used with both Android products as well as iPhones. It allows you to take calls and stream and do all those things that are nice for people who talk on the phone a lot.

Would you consider having a child wear the Softband until age five and then implant them? If so, are there things that prevent children from becoming candidates?

The short answer is yes. We would want to consider implantation at age five because there has been clear data to show the relationship between a permanent surgical solution and the development of the child. One way or the other, it's important for the child to be in sound, whether that's through a Softband or through surgery. It often has been seen to be a choice between the surgeon and the recipient, when they're ready. Implantation is something that is important to consider, for treating clinicians and for us as a company. What is our responsibility, and what is the most ideal way to transmit sound? The answer is through a surgical solution. It also allows the recipient to have that permanent reminder that they need to continue to wear their device. The non-compliance component of a non-surgical option can be difficult to overcome, which is why we think about the implant from a surgical point of view. Our products have a number of pediatric-friendly safety features (e.g., battery doors that lock, lights on the Baha 5 Power) that would make it easy for children meeting the age requirement to be implanted with a Baha device.

References

McLeod, B., Upfold, L., & Taylor, A. (2008). Self reported hearing difficulties following excision of vestibular schwannoma. International Journal of Audiology, 47(7), 420-30.

doi: 10.1080/14992020802033083.

Citation

Hurley, P. (2017, December). Hearing from the other side: Understanding the candidacy for SSD and treatment options. AudiologyOnline, Article 21327. Retrieved from www.audiologyonline.com

Hearing from the Other Side: Understanding the Candidacy for SSD and Treatment Options

Patrick Hurley, PhD

Learning Outcomes

Introduction

SSD Defined

Common Causes of SSD

Impact of SSD

Treatment Options for SSD

Comparing Treatment Options for SSD

Cochlear Baha System

How it Works

Clinically Proven Patient Benefits

Baha System vs. CROS Hearing Aids

Other Important Patient Benefits

Baha System Evaluation for SSD

Step One: Candidate Criteria

Step Two: Audiometric Testing

Step Three: Clinical Benefit Evaluation

Step Four: Counsel the Candidate

Step Five: Refer to an ENT Specialist for a Consultation or Proceed with Non-Surgical Fitting

SSD Case Studies

Case Study: Steve

Case Study: Lia

Summary and Conclusion

Questions and Answers

References

Citation

Patrick Hurley, PhD

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Course: #36657Level: Introductory0.5 Hours