Devices to help you hear

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Thanks for logging in to this Powerpoint. This is a grand rounds presentation I delivered at Swedish Hospital in Seattle in January, 2011. Enjoy!

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  • A sound processor picks up sound vibrations. An abutment transfers sound from the Baha device to the implant. A small titanium implant transfers the sound vibrations via the skull bone to the functioning cochlea.
  • Typical audiogram ranges
  • Sudden, progressive, etc. How long without sound? (hearing aids) Spoken vs. sign
  • HINT sentence scores in quiet (Q): N=53. HINT sentence scores in noise preoperative (N)=19 and postoperative (N)=53 The reason for the different Ns in quiet and noise is that only patients who performed >20% in quiet were tested in noise. Only 19 subjects scored over 20% in noise preoperatively . Therefore, those 19 subjects were tested preoperatively in noise and all 53 were tested postoperatively in noise.
  • Patients currently being helped: < 10% cochlear implant < 1% Baha implant
  • Important to have a highly motivated patient. Counseling is imperative. It is important that the patient and family understand what benefits the device will provide- improve lip-reading and detect environmental sounds. It takes time to learn to use the information provided by the device.
  • PET mesh added to help stabilize device and minimize movement.
  • Translab approach typically used this surgical photo demonstrates the appropriate location for the array, near the point where the eighth nerve enters the brainstem
  • READ SLIDE
  • The ABI can help patients communicate by improving lipreading and hearing environmental sounds. A small number of patients experience open set understanding. True benefit often underestimated Helps recipient cope with their illness ABI can reduce isolation and improve their quality of life
  • Devices to help you hear

    1. 1. Opportunities with Implantable Hearing Technologies Douglas D. Backous, MD, FACS Medical Director, Swedish Center for Hearing and Skull Base Surgery Seattle, Washington USA SNI Grand Rounds January 6, 2011
    2. 2. Plan of Attack <ul><li>Discuss the options for hearing restoration for differing levels of hearing loss </li></ul><ul><ul><li>Introductory talk </li></ul></ul><ul><li>Outline the indications for Baha </li></ul><ul><li>Introduce cochlear implants and auditory brainstem implants </li></ul><ul><ul><li>Indications and outcomes for each </li></ul></ul>
    3. 3. Disclosures <ul><li>Cochlear Corporation: Surgical Advisory Board </li></ul><ul><li>Medtronics Neurotechnologies: Consultant </li></ul>
    4. 5. Left bone Right air Left air 100% 100% Right bone Understanding the Audiogram Normal Mild Hearing Loss Moderate Hearing Loss Severe Hearing Loss Profound Hearing Loss
    5. 6. Left bone Right air Left air 82% 100% Right bone Case 1
    6. 7. Hearing Aids
    7. 8. Osseointegrated Implants
    8. 9. Baha System <ul><li>Detachable Sound Processor </li></ul><ul><li>External Abutment </li></ul><ul><li>Titanium implan t </li></ul>
    9. 10. Identifying Baha Patients <ul><li>Conductive hearing loss </li></ul><ul><ul><li>Anatomical abnormalities (e.g. atresia) </li></ul></ul><ul><ul><li>Large Conductive Hearing Loss (CHL) </li></ul></ul><ul><li>Mixed hearing loss </li></ul><ul><ul><li>CHL > 30dBHL </li></ul></ul><ul><ul><li>Up to 65 dBHL sensory loss </li></ul></ul><ul><li>Single Sided Deafness </li></ul><ul><ul><li>Normal or Minimal hearing loss on ‘good ear’ </li></ul></ul>
    10. 11. Right bone Left air 52% 100% Right air Case 2 43 year old female with chronically draining right radical mastoid cavity
    11. 12. Baha
    12. 13. Left bone Left air CNE 100% Right bone Single-sided Deafness 61 year old white male with Sudden hearing loss 2 years ago
    13. 14. SSD Solution with Baha
    14. 17. Cochlear Implants Cochlear Corporation, Ltd. (Lane Cove, Australia) MED-EL (Innsbruck, Austria) Advanced Bonics (Sylmar, California)
    15. 18. Left bone CNE CNE Right bone Severe to Profound Hearing Loss 49 year old white male with progressive hearing loss
    16. 19. Cochlear Implant System An internal implant placed just under the skin, behind the ear 1 And an external sound processor 2
    17. 20. Tonotopic Organization
    18. 21. Candidacy Criteria Adults Adults/children 2+ Adults/children 1+ Speech recognition criteria Adults : < 50% sentences in ear to be implanted < 60% bilaterally (best aided condition) Children: <30% MLNT or LNT best aided Frequency (Hz)
    19. 22. Predicting success <ul><li>Adult considerations: </li></ul><ul><ul><li>Onset of deafness </li></ul></ul><ul><ul><li>Duration of deafness </li></ul></ul><ul><ul><li>Mode of communication </li></ul></ul><ul><ul><li>Commitment/motivation to getting a cochlear implant </li></ul></ul><ul><li>Pediatric considerations: </li></ul><ul><ul><li>Age of the child at implantation </li></ul></ul><ul><ul><li>Aural (re)habilitation </li></ul></ul><ul><ul><li>Family commitment </li></ul></ul>
    20. 23. Cochleostomy Positioning ← incudo- stapedial joint ↑ ↑ Scala tympani cochleostomy site Prior cochleostomy site (Risk to basilar membrane)
    21. 24. Proper electrode placement
    22. 25. Outcomes
    23. 26. Contraindications <ul><li>Hearing loss of central origin </li></ul><ul><li>Absence of cochlear or VIIIth nerve development </li></ul><ul><li>Medical contraindications to surgery </li></ul><ul><li>Unrealistic expectations </li></ul><ul><li>Disabilities that limit participation in (re)habilitation </li></ul>
    24. 27. Hearing loss in the U.S. 1.Kochkin, S. The Hearing Review,(2005); July. 2.Blanchfield, B.B.. JAAA. (2001);12: 183-189. 3.Available Mkt- National Institute on Deafness & Communication Disorders (NIDCD) 2004 4. Recipients– Internal Cochlear data Total hearing loss 1 1.6% annual growth rate 32m Potential device candidates 2,3 1 - 1.2 million severe-profound and profound 1 million SSD, mixed and conductive ~2m Total implanted population 4 10% Cochlear Implant /1% Baha <100k
    25. 28. Auditory Brainstem Implant
    26. 29. Auditory Pathway
    27. 30. Indications <ul><li>Neurofibromatosis Type 2 </li></ul><ul><li>Twelve years of age or older </li></ul><ul><li>Implantation may occur during first or second side tumor removal </li></ul><ul><li>Medically and psychologically suitable </li></ul><ul><li>No audiological criteria are indicated </li></ul>
    28. 31. Nucleus 24 ABI Receiver-stimulator Monopolar reference electrodes Micro-coiled electrode wires Electrode array (21 platinum disks 0.7mm diameter) T-shaped PET mesh Removable magnet Stabilisation PET mesh
    29. 32. Position of the ABI in the Brainstem
    30. 33. Main differences: ABI vs. CI <ul><li>Patient has a debilitating disease that is life-threatening </li></ul><ul><li>Precise placement of the array more difficult </li></ul><ul><li>Side effects during activation to be expected </li></ul><ul><li>Surface tonotopicity of CN is not predictable </li></ul><ul><li>Outcomes generally poorer </li></ul>
    31. 34. Outcomes <ul><li>ABI recipients should experience: </li></ul><ul><li>Detection of medium to loud environmental sounds at comfortable listening levels </li></ul><ul><li>Detection of conversational speech at comfortable listening levels </li></ul>
    32. 35. Outcomes <ul><li>Over 80% of ABI recipients were able to perceive sound and use the device postoperatively. </li></ul><ul><li>Over 80% of the recipients demonstrated statistically significant improvements in open-set sentence understanding, when using their Nucleus ABI in conjunction with lip-reading </li></ul>
    33. 36. Conclusions <ul><li>Technological interventions are now available for defects at each level of the auditory pathway </li></ul><ul><li>Indications for Baha continue to increase </li></ul><ul><li>Cochlear implants continue to deliver higher levels of auditory function in people of all ages </li></ul><ul><li>ABI remains the best intervention for NF-2 patients </li></ul>
    34. 37. Thank you

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