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AUSTRALIAN MEDICAL ASSOCIATION (WA)
The ways in which we can care for patients with hearing loss have developed and improved significantly over the years, allowing us to provide increasingly individualised solutions for different hearing needs.
In cases where patients are unable to benefit from, or are not suitable for hearing aids, implantable options can be considered. There are a number of different solutions available depending on the patient’s hearing loss.
A cochlear implant is a sophisticated electronic medical device that goes beyond the function of a hearing aid by bypassing damaged sensory hair cells within the cochlea to directly stimulate the auditory nerves.
A cochlear implant consists of two parts – an external sound processor and an internal implant. As technology has improved, the speech perception outcomes for cochlear implant recipients have increased. Research has shown that between 3-12 months after implantation, 82 per cent of the recipients score above 90 per cent on tests of sentence understanding.
Cochlear implants have been recommended for people with bilateral severe-profound hearing loss for over 30 years. However, recent changes in cochlear implant candidacy criteria mean that many more people are eligible for cochlear implants, including those with very poor hearing in one ear and normal hearing in the better ear (single-sided deafness) or those who can hear deep sounds well but not sharp sounds, such as alarms, even when wearing a hearing aid.
Bone conduction implants
Bone conduction implants can be used for the treatment of conductive and mixed hearing losses, or single sided deafness. They consist of an external processor and an implant which may be placed either percutaneously or subcutaneously, and sound is presented to the cochlea via mechanical vibration of the skull.
Provided sufficient gain is achievable, research has shown that the outcomes achieved with a bone conduction implant are similar to those achieved with conventional hearing aids, or bone conduction hearing aids without the need to use an ear mould or the discomfort of wearing a bone conduction device on a headband. This is of great benefit to those with atresia or chronically discharging ears.
Middle ear implants
A middle ear implant consists of an external processor and an internal implant and transducer that is coupled to one of various structures within the middle ear, including the ossicles or the round window membrane. Outcomes achieved with a middle ear implant are similar to those achieved with conventional hearing aids and they are particularly effective for individuals who cannot tolerate hearing aids, with research indicating significantly improved patient comfort and satisfaction.4,5 They can be used to treat conductive, mixed and sensorineural hearing losses, provided there is no active middle ear disease and sufficient gain is achievable.
Where required, a good audiologist will always involve the patient’s GP and/ or an ear, nose and throat specialist to ensure all medical avenues are considered before proceeding with amplification or implantation.
The audiologist and ENT specialists work closely together to evaluate each patient to determine the implantable solution that will be most suitable and perform extensive post-operative rehabilitation with the patient to facilitate a good outcome. It is important to choose a fellowship trained ENT specialist that works with university-qualified implant audiologists when making a referral for an implantable hearing solution.
The author wishes to acknowledge the help of audiologist Lize Coetzee.