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When Hearing Aids are Not Enough

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When Hearing Aids are Not Enough. James Tysome, ENT Consultant Frances Harris, Speech and Language Therapist Joanne Muff, Audiological Scientist. First single channel implant at Addenbrooke ’ s: 1985 First multichannel implant (Ineraid): 1989 First BAHA: 1991 First bilateral (adult): 1995

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When Hearing Aids are Not Enough

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  1. When Hearing Aids are Not Enough James Tysome, ENT Consultant Frances Harris, Speech and Language Therapist Joanne Muff, Audiological Scientist

  2. First single channel implant at Addenbrooke’s: 1985 First multichannel implant (Ineraid): 1989 First BAHA: 1991 First bilateral (adult): 1995 First ABI: 1999 Moved to The Emmeline Centre in 2000 First MEI: 2010 NICE approval for bilateral implants: 2007 Introduction to The Implant Service

  3. Offer a range of hearing implants One of two centres using ABI for condition NF2 4 surgeons, 14 clinical staff and 5 admin staff 1500 patients About 30 referrals per month (15-25 adults, 5-7 children) Implant approximately 100 adults and 40 children per year Accept referrals from audiologists, GPs, doctors, TODs, SLTs The Implant Service

  4. Indication for hearing implants • Patients likely to have better hearing rehabilitation with hearing implants than conventional hearing aids • Type of implant depends on residual hearing and cause of deafness

  5. Indications for BAHA / MEI • Specialised ear surgery commissioning • Bilateral conductive or mixed hearing loss • Unable to wear conventional hearing aids • Single-sided deafness (NEW April 2013)

  6. BAHA

  7. BAHA

  8. Middle ear implant

  9. Indications for cochlear implantation

  10. CI candidacy: NICE Criteria ADULTS <50% on BKB sentences @ 70 dB SPL CHILDREN Delayed speech, language and listening skills for age, developmental stage and cognitive ability

  11. Other Considerations • Borderline candidates e.g. PTA out of criteria but very poor discrimination • Patient very keen but long term deaf • Patient very reluctant / withdrawn from earlier referral • Include hearing history, PTAs and any information on hearing aids • Think of referral as information exercise, not a commitment to implantation – exploring: ‘what is the best device for your hearing loss?’

  12. Unmet need! • Children: • About 74% of suitable children aged 0-3 years receive CI, rising to 94% by age 17. • Adults: • About 5% of anticipated population receive CI. Raine 2013 Cochlear implants international vol 14: S32-37.

  13. Auditory brainstem implant

  14. Assessment for cochlear implants • Introduction and initial audiology • Listening skills assessment • Medical assessment • Objective testing • CT scan • Balance

  15. The Multi-disciplinary Team Meeting • Discussion of individual patients • Audiology and speech discrimination results (with respect to criteria) • Lifestyle • Medical concerns • Review CT scan • Balance

  16. Cochlear implantation - surgery • 1-2 hours • Day case / overnight stay • 2 weeks off work • Risks • facial nerve injury <1:1000 • dizziness or vertigo • tinnitus • taste disturbance • 1% device failure

  17. Hearing preservation surgery • Electrode • Technique • round window insertion • atraumatic insertion • steroids

  18. Programming & Rehabilitation: CI Initial programming at 4-6 weeks post surgery Ongoing care and support Variety of outcomes

  19. Rehabilitation: Structured l-i-s-t-e-n-i-n-g • Speech sound contrasts • Linking written text and sound • Use of context to derive meaning • Adding difficulty – • Faster rate of speech • More complex language • Background noise

  20. Telephone training

  21. Introduction to music

  22. Communication strategies • Positive communication tactics • Coping with changes in roles post implant

  23. Awareness of voice • Volume control • Breath support • Nasal resonance • Tension • Pitch control • Rhythm

  24. Expected Outcomes – CIAcquired Hearing Loss Speech Discrimination scores With lipreading Average = 94% (range 75 to 100; SD 40) (2010-2011 data; n=43) Without lipreading Average = 80% (range 0 to 100; SD 34) (2010-2011 data; n=48) MAY 2013 FOR CLINICIAN USE ONLY Function

  25. Expected Outcomes – CICongenital Hearing Loss Function Speech Discrimination scores** With lipreading Without lipreading MAY 2013 FOR CLINICIAN USE ONLY Phone use* (NB all progressive) Music appreciation* No phone use: 6 in 10 Simple conversation: 3/10 Wider phone use: 1/10 Yes: 85% No: 15% No interest: 0% *Phone and music data 2009-11 n=28 **Speech discrimination data 2010-11 n=19

  26. Seamless Services: pre-implant Information Sharing Balance Clinic The MDT Research & Audit SPClinic Referrals Joint Staff

  27. Seamless Services: post-implant Post CI Vestibular Rehab Balance Clinic Case Study Meetings Bimodal Users Tinnitus Research & Audit Joint Staff

  28. Benefits Continuity of care More appropriate referrals Increased Awareness Timely Referrals Expert Advice Technology Sharing Research

  29. Take Home Messages • Would a hearing implant help your patient? • What messages do you pass on to patients? • What could your service do to offer a more seamless approach to potential candidates?

  30. Need information? Please contact us: Emmeline Centre for hearing implants Addenbrookes Hospital, Box 163, Cambridge CB2 0QQ 01223 217589 emmelinecentrereception@addenbrookes.nhs.uk

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