cochlear implantation for pediatric patients with single-sided deafness · 2018. 4. 3. · results...
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Cochlear Implantation for Pediatric Patients with Single-Sided Deafness Janet Green, AuD, Kaitlyn Coscione Tona, AuD, William Shapiro, AuD, Susan Waltzman, PhD, J. Thomas Roland Jr., MD
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Children with Single-Sided Deafness Ø May present with difficulties including
Ø Decreased hearing in background noise
Ø Poor localization ability
Ø Speech and language deficits
Ø Decreased educational performance
Ø Increased incidence of behavioral issues in the classroom
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Current Treatment Options
Ø Traditional amplification
Ø CROS (Contralateral Routing of Signal) systems
Ø Osseo integrated bone anchored devices Ø FM systems in the classroom
Ø No treatment
Ø These options can not provide hearing to the affected ear or binaural hearing
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Results for SSD Adults with Cochlear Implants
Ø Improved speech perception in background noise
Ø Improved localization ability
Ø Reduced tinnitus
Ø All 12 patients are full-time users of their cochlear implants
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Objective
Ø To determine the effects of cochlear implantation in pediatric patients presenting with single-sided deafness
Ø To identify factors which may affect performance
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Subjects S1 S2 S3 Etiology EVA, progressive,
Pendred syndrome Congenital hereditary Congenital unknown
Length of Deafness Unknown; Dx at age 7 6yr, 2mo 2yr
Hearing Device pre-‐CI HA; BAHA HA; BAHA HA; CROS
PTA (Better/normal hearing ear) 12dBHL 13dBHL 13dBHL
PTA (Ear to be implanted) 110dBHL 96dBHL 115dBHL
Age at Implant 9yr, 6mo 6yr, 2mo 2yr
Device Nucleus CI512 Advanced Bionics HiRes 90K Advantage
Nucleus Freedom CA
Length of CI use 3yr, 2mo 2yr 3mo
Educational Setting Mainstream Mainstream Early IntervenSon; Daycare
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Methods
Ø Standard, age-appropriate audiometric procedures for air/bone conduction thresholds using insert phones
Ø Speech perception measures performed in sound field at 60dBSPL using plug and muff
Ø Monosyllabic words – LNT, PB-K, CNC
Ø Sentences in noise – Common Phrases, HINT-C, BKB-SIN
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Results
Ø All subjects have fully inserted electrode arrays
Ø S1 and S3: consistent use of their speech processor
Ø S2 wears the speech processor only in school
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S1 Results CNC Words
0
20
40
60
80
100
Pre-Op 1-yr 3-yrs
CI Ear BH Ear Bilateral
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S1 Results BKB-SIN (CI Ear)
0
5
10
15
20
25
Pre-op 1-yr
SF/NF SF/NL (towards CI) SF/NR (towards NH ear) BE)
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S1 Results BKB-SIN (Bilateral)
-5
0
5
10
15
20
25
Pre-op 1-yr 3-yr
SF/NF SF/NL (towards CI) SF/NR (towards NH ear) BE)
Due to onset of HL in better ear, BKB-SIN scores declined
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S1 Audiogram
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S2 Results: 3-Month Data Monosyllabic Words and Sentences
0
20
40
60
80
100
PB-K Words HINT-C (Q) HINT-C (N)
Pre-op CI Ear NH Ear Bilateral
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S3 Results: 3-Month Data Monosyllabic Words and Sentences
0
20
40
60
80
100
PB-K CP NF CP N-CI CP N-NH
Pre-op CI Ear NH Ear Bilateral
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Summary & Conclusions Ø Overall, subjects demonstrated
Ø Open-set speech perception in the implanted ear Ø Bilateral improvement in background noise
Ø Subjectively, parents and schools report Ø Increased attention Ø Improvement in grades Ø No longer asking “what” repeatedly Ø No longer fearful of social situations (e.g., school cafeteria, outings with friends)
Ø Cochlear Implants: Viable treatment option for children with SSD
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Issues
Ø Counseling Ø Benefits of binaural hearing for home, school and social settings Ø Compliance with device usage
Ø When to implant
Ø Difficult parental decision
Ø Cost
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NYU Cochlear Implant Center
• Co-Directors of the Cochlear Implant Center • J. Thomas Roland Jr., M.D. • Susan Waltzman, Ph.D.
• Surgeons • J. Thomas Roland Jr., M.D. • Sean McMenomey, M.D. • Daniel Jethanamest, M.D. • David Friedmann, M.D. – Fellow
• Cochlear Implant Audiologists • William Shapiro, Au.D. –Supervisor • Betsy Bromberg, M.A. • Janet Green, Au.D. • Laurel Mahoney, Au.D. • Carie Page, Au.D. • Alison Singleton, Au.D. • Kaitlyn Coscione Tona, Au.D. • Jennifer Rhodes, B.S. – Au.D. Fellow
• Educational Coordinator • Rose Drous, M.Ed., Cert AVT
• Speech Language Pathologist • Nancy Geller, M.A.
• Research • Mario Svirsky, Ph.D. • Susan Waltzman, Ph.D. • Arlene Neuman, Ph.D. • David Landsberger, Ph.D. • Matthew Fitzgerald, Ph.D. • Chin-Tuan Tan, Ph.D. • Elad Sagi, Ph.D. • Mahan Avadpour, Ph.D. • Monica Padilla-Velez, Ph.D. • Annette Zeman, Au.D. • Maggie Miller, Au.D. • Natalia Stupak, Au.D.