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Single-Sided Deafness – What Are Your Options?

Online Health Chat with ­Erika Woodson, MD and Sarah Sydlowski, AuD, PhD

October 3, 2013

Description

Do you experience difficulty hearing in one ear? Do you have to sit next to your friend with your ‘good ear’ in order to participate in a conversation? Are you unaware of sounds arising on your deaf side? Do you find it challenging to converse in groups or in background noise? If so, your physician may diagnose single-sided deafness (SSD)? While there is no cure for SSD, there are treatment options available that can restore the sensation of hearing sound on the deaf side.

The loss of hearing in one ear—SSD—is more common and more troublesome than most people realize. About 60,000 people in the U.S. acquire single-sided deafness (SSD) every year and many try to manage without the benefit of available devices. Many patients who use these devices report listening is easier and more comfortable with a device than without one. Some current hearing device options include bone-anchored implants, CROS (contralateral routing of signal) and BiCROS (bilateral contralateral routing of signal) hearing aids, TransEar® and SoundBite®. There is also potential for cochlear implants in the future.

Many management options are available that can restore your ability to hear and understand speech in your deaf ear.


About the Speaker

­Erika Woodson, MD, is the Medical Director of Cleveland Clinic’s Hearing Implant Program and otologist/neurotologist/skull-base surgeon. She is an associate staff member in Cleveland Clinic’s Department of Otolaryngology and the Gamma Knife Center in the Head & Neck Institute. Dr. Woodson is board certified in orolaryngology and otology/neurotology. Her research interests include hybrid cochlear implantation and acoustic neuroma surgery. Her specialties include acoustic neuroma, Bell’s palsy, benign paroxysmal positional vertigo, carotid body tumor, cerebrospinal fluid leak repairs, cholesteatoma and chronic ear disease.

Dr. Woodson completed her fellowship in neurotology and skull base surgery after her residency in otolaryngology at University of Iowa Hospitals and Clinics, in Iowa City, Ia. She graduated from medical school from Virginia Commonwealth University Medical College, in Richmond, Va. Dr. Woodson sees treats children, adolescents and adults at Cleveland Clinic main campus and Beachwood Family Health & Surgery Center.

Sarah Sydlowski, AuD, PhD is the Audiology Director of the Hearing Implant Program and a clinical audiologist in the Head & Neck Institute at Cleveland Clinic. Dr. Sydlowski specializes in cochlear implants, bone-anchored implants, evoked potentials, hearing aids, and diagnostics. She is a fellow of the American Academy of Audiology and a certified member of the American Speech-Language-Hearing Association.

Dr. Sydlowski earned her doctorate in audiology at Gallaudet University in Washington, DC, and continued further training in audiology at Mayo Clinic Arizona, in Scottsdale, Az. She also earned a second doctorate from University of Louisville, in Louisville, Ky.

Dr. Sydlowski treats children, adolescents and adults in the Department of Otolaryngology at Cleveland Clinic main campus.


Let’s Chat About Single-Sided Deafness—What Are Your Options?


Single-Sided Deafness

dollars n cents: What is single-sided deafness?

Erika_Woodson,_MD: Single-sided deafness (SSD) is the condition of having nonserviceable hearing in one ear. Nonserviceable is defined as having no hearing, or having hearing loss at a level at which a hearing aid is no longer helpful because word understanding is so poor even with amplification from a hearing aid. The exact percentage for word understanding varies, but most SSD options are investigated after all hearing options have been investigated.

hunter: How exactly can one have single-sided deafness (SSD), with no apparent cause? I don't quite understand this.

Erika_Woodson,_MD: No apparent cause actually means 'we don't know'. The inner ear is a small organ with a microscopic blood supply in an area that is not amenable to biopsy. Imaging can confirm that the SSD is not due to a tumor, but rarely confirms a cause due to the limits of the MRI technology today.

jeffery: With hearing loss due to the immune system, what exactly is the cause of the hearing loss?

Erika_Woodson,_MD: Much is theoretic, but some knowledge is based on studies where scientists have examined the inner ears of subjects after death. What we typically see is destruction of the hearing cells of the inner ear (hair cells). We may also see destruction of the supporting cells that surround the hair cells. Another common feature is degradation of the stria vascularis, which are the vessels of the inner ear that filter blood going into the cochlea.

callien: What causes a person to lose their hearing over night versus over a period of time? With hearing loss in both ears with no apparent physical cause, I was told that my hearing loss was probably immunological and I lost it over time. I have spoken to others who seemed to have lost their hearing overnight. Is one type worse than the other?

Erika_Woodson,_MD: Immune-mediated hearing loss (autoimmune inner ear disease, or AIED) affects both ears and is defined by having fluctuating or stepwise loss of hearing that is steroid responsive. It is far less common than sudden hearing loss, and its prognosis overall is worse. Since it does impact both ears, AIED is much more problematic for the patient. In contrast, sudden hearing loss is defined as hearing loss that happens over three days or less. It can have a spontaneous recovery rate of up to 60 percent. Sudden hearing loss does not recur, and does not impact the other ear.

ShelbyTP: While I was free diving last summer, I tried too hard to equalize my ear and damaged my right ear. The doctor wasn't entirely sure what was wrong, so he did surgery to patch my round and oval windows because he thought they could have ruptured. However, if I remember correctly, he didn't actually see a tear when he was doing the surgery, but patched them just in case. The surgery was over a year ago and some of my hearing has come back. Can I dive again? I tried to discuss this with my doctor, but he just had his secretary call me to say ‘no’ without any explanation or willingness to talk to me personally. I am hoping to get an idea of any new risks involved now that I have had this surgery, or if I will even be able to equalize my ear efficiently. I have gone into a pool up to eight feet deep this summer and was able to slowly equalize without any problems, but I am nervous about diving to a deeper depth without information from a doctor.

Erika_Woodson,_MD: After significant barotrauma (damage due to pressure changes in the ear) to the ear, I recommend against further participation in diving and/or Scuba. Certainly the inner ear is at greater risk of further damage due to its previous injury. I could not guarantee that your surgery did anything to reduce your further risk of injury.

man: If you have single-sided hearing loss, how do you determine if you are likely to lose hearing in the good ear? Does it depend on the reason for the hearing loss?

Erika_Woodson,_MD: Much depends on the reason. It is an obvious and legitimate concern for anyone who has lost hearing in one ear. I recommend a consultation with an otolaryngologist or otologist, so they can advise you as to your individual risk.

Sarah_Sydlowski,_AuD,_PhD: We also advise everyone, but especially patients with known hearing loss, to be very vigilant about using hearing protection in noise to try to prevent noise-induced hearing loss. There are disposable earplugs and earmuffs readily available online or in pharmacies. Custom hearing protection is available from your audiologist, and there are even special options for musicians and hunters.

yme973: My child is deaf in the left ear. What are her options?

Erika_Woodson,_MD: Like everyone, your child will need a medical clearance to pursue any option. For a child born with deafness, an investigation into why the ear has hearing loss should be performed, as some children will have a risk of hearing loss in the other ear. This may change how we would counsel you. For children, the current FDA-approved options would include a bone-anchored auditory implant (BAAI), i.e., BAHA® or Ponto, CROS (contralateral routing of signal) system, or FM use in school. Families interested in BAAI should be aware that this intervention is safest when the skull has developed enough thickness, and the child is mature enough to understand the process. We recommend considering this option starting at around the age of six years old. SoundBite® and TransEar® are not FDA-approved for use in children.

jackson4: Does it matter how long I've been deaf in my bad ear?

Erika_Woodson,_MD: For cochlear implants, the duration of deafness is an important factor in how well you may perform. For patients who are candidates for one of the traditional rerouting methods of rehabilitating single-sided deafness (Ponto and BAHA®, SoundBite®, TransEar®, CROS [contralateral rerouting of signal] or BiCROS [bilateral contralateral rerouting of signal), the duration of deafness does not matter. An adult who was born deaf in one ear is still likely to benefit from the options they have.

clippy: Why would someone choose surgery over a hearing aid? Is the outcome better?

Erika_Woodson,_MD: Some patients objectively perform better with a bone-conductive option (like the Ponto or the SoundBite®) than they do with a CROS (contralateral rerouting of signal) hearing aid. That is why we do testing in the single-sided deafness evaluation—to demonstrate to us and you what your best option is. Despite the objective data, many patients do not want surgery and that is fine. For some people, it also boils down to out-of-pocket costs.

Sarah_Sydlowski,_AuD,_PhD: Additionally, some people prefer not to wear any device on their ear and a bone-anchored implant offers that opportunity.


Single-Sided Deafness (SSD) Auditory Device Options

helena: I have gotten along for many years with only one hearing ear. Why should I consider investigating a device now?

Sarah_Sydlowski,_AuD,_PhD: Most people who decide to pursue a device for single- sided deafness report that they cannot believe how much sound they were missing and how much easier it is to hear and listen. When relying on only one ear, the ‘listening effort’ you expend is much greater than when you have two ears working together. Focusing and concentrating in order to stay connected in a conversation can cause unnecessary strain and fatigue. Plus, patients report that it is wonderful not to have to think about choosing the ideal seat at a party or positioning themselves on the ‘right’ side of their conversation partner.

jj345: How do single-sided deafness (SSD) devices work?

Sarah_Sydlowski,_AuD,_PhD: In SSD, the head essentially acts as a shield, blocking sounds from the poorer hearing ear from reaching the better hearing ear effectively. There are a variety of available management options for SSD designed to address the resulting hearing challenges. All available systems consist of a microphone that is worn on the poorer hearing ear. Using a variety of configurations, SSD management options re-route the signal from the poorer hearing ear to the better hearing ear. By directing important environmental and speech sounds to the better hearing ear, these devices eliminate the ‘head shadow effect’ resulting in noticeable improvement in sound awareness, speech understanding, and necessary listening effort.

stillwater: How well will I hear on my deaf side, or know that I am hearing from my deaf side?

Erika_Woodson,_MD: It is important to realize that the current FDA-approved options for single-sided deafness do not 'restore' hearing to the deaf ear. They re-route sound to the good ear. Due to this strategy, all sound is going into the good ear. Therefore, you will not hear in stereo. The benefits of these hearing strategies are to improve awareness of sound from 360 degrees, but you will not be able to localize sound (i.e., know accurately which ear it is meant to be coming from).

jj345: What devices are available for single-sided deafness and how do they work?

Sarah_Sydlowski,_AuD,_PhD: There are a couple of different devices:

  • SoundBite® wirelessly transmits sound to a retainer-like device worn on the upper molars. This device converts the input into vibrations that are transmitted through teeth and bone to the better hearing ear.
  • The CROS (contralateral routing of signal) system wirelessly transmits speech from a microphone worn on the poorer hearing ear to a receiver worn on the better hearing ear. It also has the flexibility to be reprogrammed should a hearing loss develop in the better ear.
  • The TransEar® system resembles a traditional hearing aid and is worn in the poorer hearing ear. Instead of amplifying sound, it sends the signal through bone conduction to the better hearing ear.
  • Bone-anchored implant (BAI) is a surgically implanted titanium abutment with a removable sound processor. This system does not require any devices to worn in the ear and routes sound to the better ear through bone conduction.

dello: What do I need to do to be a good SoundBite® candidate?

Erika_Woodson,_MD: SoundBite® technology requires normal hearing in the good ear, an ear canal in the deaf ear that would accommodate the microphone, and molars in good condition on the top row (maxillary) on the side of good hearing. Having had previous dental work does not exclude a candidate, but a dentist would need to do a thorough assessment of the tooth to make sure it was in good repair.

punkin spice: How does TransEar® compare to CROS (contralateral routing of signal) hearing aids?

Sarah_Sydlowski,_AuD,_PhD: While CROS, BiCROS (bilateral contralateral routing of signal) and TransEar® are designed to pick up sound on the poorer hearing side and route sound to the better hearing ear, they do so in different ways. CROS hearing aids require the user to wear two devices (one on each ear). Sound is sent wirelessly (through air conduction) from the poorer hearing side to the device in the better hearing ear. The TransEar® consists of a single device that is worn on the poorer hearing ear. It consists of a deep, tight-fitting ear mold that vibrates in response to sound and sends the sound vibrations through the bone of the ear canal and skull to the better hearing ear. These devices are both designed to keep the good ear very open, so you can still hear sounds naturally on that side.

jakal: When using CROS (contralateral routing of signal) hearing aids, how do they work with the phone? Do you have to take it off when you put the phone to your ear?

Sarah_Sydlowski,_AuD,_PhD: With CROS (contralateral routing of signal) hearing aids, most individuals prefer to continue the phone on their better hearing ear. The advantage with the CROS system, however, is that you do not have to take the system out to listen on the phone. The piece that fits in the better hearing ear is designed to leave the ear very open, so you can still hear through that ear naturally. Additionally, if you wear the CROS microphone on the poorer hearing ear, you will still have awareness of sound in the room while blocking the good ear with the phone. If you are interested in ‘hands-free’ options, there are also wireless accessories available that would allow you connect to your cell phone through Bluetooth® and wirelessly stream your phone conversations through your CROS system.

jardin3: I wear an open-canal hearing aid on my ‘good’ ear because of my high-frequency hearing loss. Does this mean I am not a candidate for TransEar® on the deaf side?

Sarah_Sydlowski,_AuD,_PhD: Most single-sided deafness device options (CROS [contralateral routing of signal], bone-anchored implant, TransEar® and SoundBite®) are designed for individuals with normal hearing in their better hearing ear. For individuals with one nonserviceable ear and hearing loss in the better ear as well, a great option is a BiCROS (bilateral contralateral routing signal) system. Similar to the CROS system, the BiCROS consists of a device worn on both ears. Sound is picked up by a microphone on the poorer hearing ear and wirelessly sent to the better hearing ear, but the device worn on the better hearing ear also acts as a hearing aid to provide appropriate amplification for sounds coming from all sides.

Ceaper: The cause of my hearing impairment is not known, but I have a hearing aid to cover the side that is at only 40 percent level of hearing. I am wondering what type and brand is the best hearing aid available. The one I have does not seem to work very well especially in bars and restaurants.

Sarah_Sydlowski,_AuD,_PhD: This is a common question and I can understand your frustration! Unfortunately, there is not necessarily a ‘best’ brand of hearing aid, but there are certainly features of various devices that may be better suited to assisting you in more challenging listening environments. For example, some devices can be more aggressive with noise reduction and also very automatic, so that you don't have to manually make changes depending on the environment that you're in. For certain hearing aids, there are also wireless accessories that are designed to give you an improved signal in background noise, which may be beneficial for you. Your audiologist can best work with you to determine what options would be most beneficial for your type and degree of hearing loss.

grand illusion: Does the brand of hearing aid make a difference?

Sarah_Sydlowski,_AuD,_PhD: The brand of hearing aid is less important than processing features, and most importantly, working with a qualified professional who can guide you in selecting the appropriate device and them programming it optimally for your hearing abilities and challenges. There are hundreds of hearing aid companies and many have similar capabilities, but selecting appropriate features and then utilizing them appropriately will ultimately impact outcomes more than the manufacturer.

johnson3k4: Can I try each of the devices before I make my decision?

Sarah_Sydlowski,_AuD,_PhD: The ability to try different devices may vary depending on where you have your evaluation. At Cleveland Clinic, a sensory device evaluation includes objective testing using speech in noise measures. We measure how challenging understanding speech in noise is for you without a device, as well as how much improvement you experience with each of three demonstration devices, which include CROS (contralateral routing of signal), SoundBite® and bone-anchored implant. This information can be very valuable when determining which device is most appropriate for you. Because TransEar® and CROS are classified as hearing aids, under state law you have a 30-day right to return period. Because the SoundBite® is a custom device and because the bone-anchored implant requires surgery, there is not a return period.

done deal: Are these single-sided deafness (SDD) device options covered by insurance?

Erika_Woodson,_MD: Insurance coverage is variable. Bone-anchored auditory implants are typically covered by insurance, but plans vary for coverage for SSD. SoundBite® is new; therefore, coverage has been variable. It is currently not covered by Medicare or Medicaid. There is likely to be partial coverage for the device if you have commercial insurance. After assessment to determine your candidacy, the company could perform a benefits investigation so you could anticipate your out-of-pocket expenses. TransEar®, CROS (contralateral routing of signal) and BiCROS (bilateral contralateral routing of signal) devices are considered hearing aids. Most insurance plans—including Medicare—do not cover hearing aids.


SSD Auditory Device Accessories

howdy do: Are there accessories or other tools to help me on the phone or when listening to music?

Sarah_Sydlowski,_AuD,_PhD: Yes! Depending on the device you choose, there may be accessories available that will use Bluetooth® technology to stream phone calls, TV and music to your device.

man: As an accessory to the CROS (contralateral rerouting of signal) system, do you have to order the Bluetooth® for phone use at the same time, or can you order it at a later time? Does insurance cover the accessories?

Sarah_Sydlowski,_AuD,_PhD: Accessories can easily be ordered and paired to the device at any time. Most centers will offer a right-to-return period for accessories, so you have the opportunity to try them at home before committing to purchase them. Insurance does not cover accessories and they would be an out-of-pocket expense.


Hearing Loss and Tinnitus

sthomas: Do any of these devices eliminate the constant ringing in the poorer hearing ear?

Sarah_Sydlowski,_AuD,_PhD: Unfortunately, most single-sided deafness (SSD) devices are not able to help tinnitus. There is no cure for tinnitus although some patients do benefit from using hearing aids or maskers in the ear that has ringing. In SSD, the hearing loss is usually so severe that these devices are not strong enough to stimulate the ear. Similarly, SSD devices are not designed to actually stimulate the affected ear and would not be strong enough to impact the tinnitus. Currently, the only option for very severe tinnitus and single-sided deafness is cochlear implantation. This is only in the clinical trial stage at select clinics. Early research suggests that this technology may hold promise for individuals with severe-to-profound hearing loss and severe tinnitus because the cochlear implant provides stimulation directly to the hearing nerve.

mn890: I had a hearing aid years ago when I still had some hearing. When I took it out, I had terrible tinnitus. Will these new devices cause the same problem?

Erika_Woodson,_MD: Tinnitus is the brain's reaction to the information it's not getting from the ear (in the setting of hearing loss). Most individuals find a hearing aid to be beneficial in reducing tinnitus because it is providing some 'good sound' to the ear (and, therefore, the brain). What is likely occurring is that the brain benefited from the hearing aid, and the tinnitus was more noticeable with the aid out. The devices available for single-sided deafness should not influence tinnitus one way or the other, as they're not stimulating the ear directly.


Bone-Anchored Implant: Ponto and BAHA®

cranwood: In which cases do you recommend a surgical option for a hearing aid? In what type of patients does this work better?

Sarah_Sydlowski,_AuD,_PhD: For single-sided deafness, i.e. when hearing is normal in one ear and understanding is extremely poor in the other ear, there are several non-surgical options, including the CROS (contralateral routing of signal) system, TransEar® and SoundBite®. A bone-anchored implant is a surgical choice. Part of the audiologic evaluation to determine your candidacy for various devices includes evaluating your ability to understand speech in a noisy room with each of these devices. If you demonstrate equal benefit among the devices and you are medically and surgically cleared, the choice may be yours. Various factors may contribute including preference for using devices on one or both ears, interest in wireless accessibility, and, of course, insurance benefits.

ljkmer: I will be having bone-anchored implant hearing device surgery in November. We sometimes travel by plane. Will I set off the alarms with this device? Also, will background noise be less than it was with the Wi-Fi® system I had previously? Should I investigate an FM system?

Erika_Woodson,_MD: Depending on manufacturer, your implant will either be solid titanium or a combination of titanium and gold. It is very unlikely to set off a metal detector, but would be noticeable on the whole-body scanners. You should carry documentation of your medical device with you when you travel, in case the TSA (Transportation Security Administration) agent is unfamiliar with the device.

Sarah_Sydlowski,_AuD,_PhD: I'm not sure what you are referring to as a Wi-Fi system®, but I can tell you that technology for background noise reduction is quite good with bone-anchored implant systems today. No system will completely remove background noise, but many patients do very well in noisier environments—especially if they can position themselves such that noise is behind them. Some systems have more automatic capabilities while others allow for manual control depending on the environment you are in. An FM system may be a good option as well, but I usually recommend waiting until you have had a chance to experience the benefit you are able to achieve with any device before determining if additional components are necessary.

MPP3: What is the difference between BAHA® and Ponto?

Erika_Woodson,_MD: BAHA® and Ponto are made by different manufacturers. These are both osseointegrated (bone attached) implants that are FDA-approved for single-sided deafness. They both use an implant into the skull, with an abutment (a connection) which protrudes though the skin and allows for the external wearing of a bone conduction hearing processor. The surgery is the same. The implants look and function similarly, and the hearing processors have some cross compatibility. The hearing processors look different, and have some differing features. Both manufacturers update their technology every few years, allowing patients to take full advantage of the latest technology for their loss without additional surgery (the implant abutment would not need to be changed or replaced).

lovinghearts: What does Ponto surgery involve?

Erika_Woodson,_MD: The surgery for bone-anchored auditory implants (BAAI), either for Ponto or BAHA®, is the same. Different surgeons may use slightly different techniques, but some elements are the same. The surgery takes about an hour or less. There is usually little pain, and numbness to the area and scalp is common for several weeks after the procedure. Patients frequently return to work the next day. The implant will not be ready to use for three months while it heals to bone. However, the scalp is typically healed within a couple of weeks.

hard sell: Can you swim with a Ponto?

Erika_Woodson,_MD: The implant and abutment is safe for water. The processor needs the same care as a hearing aid. They are not waterproof and would need to be taken off before swimming. We also recommend protecting it from exposure to rain.

copperm: Can you get an MRI after an implant?

Erika_Woodson,_MD: The BAHA® and Ponto implants are MRI safe. The hearing processor needs to be taken off. A cochlear implant is MRI compatible only in certain situations. Some cochlear implants are MRI compatible, but the majority of them require minor surgery to make them safe for MRI.


Cochlear Implant

jacknjill: What makes for a good candidate for cochlear implants?

Erika_Woodson,_MD: Cochlear implants (CIs) are indicated for bilateral (both ears) sensorineural hearing loss (hearing loss due to inner ear or inner ear nerve damage). However, there is now a recognized role for CI in patients who have nonserviceable hearing loss in the candidate ear and advanced—but still ‘aidable’—hearing loss in the good ear. If the deaf ear has been without hearing for more than 20 years, it is likely that the implant will not restore levels of understandable speech that could be achieved in patients with a shorter term of deafness. Insurance does cover these devices, but different insurance providers may have their own criteria for approval that may differ from our medical determination of your candidacy.

mn890: Do you place cochlear implants for single-sided deafness?

Erika_Woodson,_MD: Cochlear implants (CIs) in the setting of SSD with fairly normal hearing on the other side would be considered 'off label', meaning that it is not an indication that the FDA has approved. As a center, we do recommend a CI evaluation if there is significant hearing loss in the better ear, as those individuals may benefit greatly from implantation. There are some U.S. centers doing experimental trials for CIs in the setting of SSD.

jpp: If you have single-sided deafness (SSD) and are considered a candidate for cochlear implants, do you get an implant in both ears or only in the deaf ear?

Sarah_Sydlowski,_AuD,_PhD: As we mentioned earlier, cochlear implants are not currently being offered for SSD. Cochlear implants are for individuals who have some less severe hearing loss in the better ear and determined to be a candidate for a cochlear implant, which is typically placed in the poorer hearing ear.

sthomas: So cochlear implants are not recommended for people with a good ear that functions normally?

Sarah_Sydlowski,_AuD,_PhD: Currently cochlear implants are only FDA approved for use in bilateral sensorineural (hearing loss due to inner ear or inner ear nerve damage) hearing loss. Use of cochlear implants for individuals with a normal hearing ear is still at the clinical trial stage.

Erika_Woodson,_MD: Obviously, the 'experimental' or 'off-label' use of the device impacts insurance coverage as well. Most of us cannot afford to pay for cochlear implants out-of-pocket!

chelinda: I lost most all of the hearing in the right ear about 12 years ago with an initial diagnosis of possible autoimmune disease of the inner ear and a final diagnosis of inner ear virus. I was told the hair cells—the nerve receptors—were mostly destroyed. I have a hearing aid in the left ear to help me, since I have moderate loss there. I was told that a hearing aid in the right ear would not help, but Avada Audiology convinced me to buy an expensive pair that cost $8000. However, I usually don't wear the aid in my right ear due to ineffectiveness and feedback. Would I be a good candidate for a cochlear implant in the right ear only, and are they more effective and safer than they were 12 years ago?

Sarah_Sydlowski,_AuD,_PhD: Determining whether you may be a good cochlear implant candidate would involve completing a thorough evaluation. That evaluation would include a medical/surgical assessment and two audiologic appointments, including a standard hearing test and also an appointment to assess how well you are able to hear with hearing aids. This appointment would help us understand whether you can benefit from hearing aids or whether a cochlear implant would be your best option. While hearing aids make sounds louder, if you're hearing loss has progressed to a certain point, cochlear implants may be better able to make sound clearer and more understandable. Given the description that you provided, we feel that it would be very appropriate for you to complete a cochlear implant evaluation. Technology has certainly improved over the years and many patients are very successful bimodal recipients (with a hearing aid in the better ear and a cochlear implant in the poorer hearing ear).


Meniere Disease Hearing Loss Treatment

RMB118720: Which of the sound re-routing options are appropriate for someone with Meniere disease? Only one ear of mine is affected.

Erika_Woodson,_MD: Patients with Meniere disease (MD) have successfully made use of all of the options available. Again, much depends on the status of the better ear. If a patient has had surgical intervention for MD treatment, then sometimes that may alter placement of the bone-anchored implant (BAHA® or Ponto). However, that option could still be pursued.

robbockscc: My girlfriend has single-sided deafness (SSD) due to Meniere disease. When we go to concerts, I promote hearing protection even for the deaf ear, in hopes there may someday the hearing loss may be reversed. Are there any restorative treatments today or on the horizon for SSD due to Meniere disease?

Erika_Woodson,_MD: Once an ear has lost all hearing, especially in the setting of Meniere disease, then there is very little to 'restore' hearing. What we're discussing today are the rehabilitation options for living with SSD. For patients who have SSD in one ear and significant hearing loss in the better hearing ear, then a cochlear implant may be an option.


Implant with FM System

snow bunny: Is it true that the combination of one implant with an FM system provides better speech recognition in noise than two implants alone?

Sarah_Sydlowski,_AuD,_PhD: An FM system is possibly some of the best technology available to combat background noise, reverberation (echo) and distance of the speaker. An FM system consists of a microphone that the speaker wears called a transmitter and a receiver that the person with hearing loss wears. The speaker’s voice is picked up by the transmitter and is wirelessly sent to the receiver. This device may be used independently, but is most commonly used in combination with various devices. It can be used with a cochlear implant, a CROS (contralateral routing of signal) system or a bone-anchored implant. For certain individuals, it can be a very helpful supplement in noisy environments.


Audiology Consultation and Follow Up

say what: I am interested in being evaluated for single-sided deafness (SSD) management. What should I do?

Erika_Woodson,_MD: Contact the Cleveland Clinic Hearing Implant Program to schedule an SSD evaluation to determine your eligibility. The assessment consists of an audiologic evaluation (unless you have had a hearing test within six months), a medical evaluation with an otologist, and an SSD evaluation with an audiologist. The appointment includes an opportunity to try several of the devices in a background of noise and experience the potential benefit offered by a specific SSD management option! To schedule an appointment, call 216.444.0354 or email hipteam@ccf.org.

better times: How often do I need to see my audiologist once I have been fitted with a hearing device?

Sarah_Sydlowski,_AuD,_PhD: During your device fitting, your audiologist will program the device specifically for your hearing and will teach you how to use and care for your device. There may be different recommendations for follow up depending on your audiologist, but I typically recommend at least one follow-up visit during the first month of use and annually thereafter.


Future Technological Advances in Hearing Aids and Implants

ljkmer: Is Bluetooth® technology available when I have my bone-anchored hearing device surgery in November?

Sarah_Sydlowski,_AuD,_PhD: Bone-anchored auditory (BAAI) implant technology is rapidly improving and wireless capability is on the very near horizon! Some devices are already able to offer wireless accessories—while we anticipate others will soon. With both cochlear implants and BAAI, most technology upgrades are made to external equipment. This means that as new features become available, recipients will have access to them without another surgery.

Gray_matter: Are there any new options being worked on that would restore hearing in a deaf ear? Or is that still a long way off?

Erika_Woodson,_MD: That is still a long way off. In the laboratory, scientists have been able to re-grow the auditory hair cells of a chicken. Work in mammals has been met with much frustration, and has not been duplicated. Atrophy (or withering) of the cochlear nerve will start to happen after a period of non-stimulation (i.e., deafness). It is, therefore, exceedingly unlikely that anything will be developed soon enough to restore hearing cells in the inner ear of a human.


Closing

Moderator: The hour has gone fast. I am sorry to say that we are at the end of our chat. Thank you, Dr. Woodson and Dr. Sydlowski, for taking the time to discuss single-sided hearing loss with us. The questions were excellent and your responses were detailed and personal.

Sarah_Sydlowski,_AuD,_PhD: Thank you for attending the chat today. It was a pleasure to discuss this important topic with you all.

Erika_Woodson,_MD: Agreed! These were great questions today.


For Appointments

To schedule an appointment with Dr. Woodson or Dr. Sydlowski, or any of the other specialists in the Head & Neck Institute at Cleveland Clinic, please call 216.445.8500 or 800.223.2273 ext 48500. You can also visit us online at clevelandclinic.org/audiology.


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On Cleveland Clinic

Cleveland Clinic's Hearing Implant Program in the Head & Neck Institute is committed to providing high quality, team-centered, patient-focused hearing care for adults and children with hearing loss. The Hearing Implant Program Team consists of specialists from a variety of disciplines, including audiology, neurotology, otolaryngology, and speech language pathology, who specialize in the assessment, treatment, and (re)habilitation of cochlear implant and bone-anchored hearing implant recipients. The HIP team is dedicated to the long-term support of our implant recipients: from candidacy evaluation through surgery, initial device fitting and programming, (re)habilitation, and long-term management. Cleveland Clinic HIP team members offer comprehensive clinical services and are also involved in various areas of implant research.

The HIP team works closely with patients and their families to guide them toward the best course of treatment based on their personal and family goals. We look forward to answering your questions to determine if you or your family member is a candidate for a hearing implant(s).

On Your Health

MyChart®: Your Personal Health Connection, is a secure, online health management tool that connects Cleveland Clinic patients with their personalized health information. All you need is access to a computer. For more information about MyChart®, call toll-free at 866.915.3383 or send an email to: mychartsupport@ccf.org.

A remote second opinion may also be requested from Cleveland Clinic through the secure Cleveland Clinic MyConsult® website. To request a remote second opinion, visit eclevelandclinic.org/myConsult.


Contact Information

If you need more information, click here to contact us, chat online or call the Center for Consumer Health Information at 216.444.3771 or toll-free at 800.223.2272 ext. 43771 to speak with a Health Educator. We would be happy to help you. Let us know if you want us to let you know about future web chat events!

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Reviewed: 10/13

This information is provided by Cleveland Clinic as a convenience service only and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. Please remember that this information, in the absence of a visit with a health care professional, must be considered as an educational service only and is not designed to replace a physician's independent judgment about the appropriateness or risks of a procedure for a given patient. The views and opinions expressed by an individual in this forum are not necessarily the views of the Cleveland Clinic institution or other Cleveland Clinic physicians. ©Copyright 1995-2013. The Cleveland Clinic Foundation. All rights reserved.

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