Hearing Aids in Otology

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Hearing Aids in Otology

• Dr. Jerry Halik FRCSC
• Assistant Professor University of Toronto

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• Only 5 of patients seen for hearing loss may
  benefit from surgery
• John Shea MD

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Expectations of Ear Surgery

• Surgeon
• Safe
• Eradicate Disease
• Dry
• Function

• Patient
• Dry
• Function
• Safe
• Eradicate Disease

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Result of Hearing gain in Ear Surgery

• Tympanoplasty
• Long term result at 11 years
• - 81 closed Perforations
• - 9 Atelectatic pocket Formation
• 74 Normal Healed TM
• (Halik, Smyth 1988)

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Result of Hearing gain in Ear Surgery

• Mastoid Surgery
• - 25 Post op SRT lt30 dB

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Ossiculoplasty
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Ossiculoplasty Results

• TORP/ PORP- 25 SRT lt 31 dB
• 4/12 patients
• Assemblies 57 SRT lt31 Db
• 58/102 patients
• Follow up Up to 6 years (average 2 years)

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Stapes Surgery Goals

1. No Aid
2. No Aid Aid
3. Large Aid Small Aid

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Stapes Surgery
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Stapes Surgery Result

• N135Avg A-B gap closure (Post op air minus
  pre-op bone)

A-B gap 0.5,1,2 KHz 0.5,1,2,4 KHz
lt 10dB 118/135(87.4) 107/135(79.3)
lt20dB 13/135(9.6) 24/135(17.7)
gt20dB 4/135(3) 4/135(3)
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Stapes Surgery Result

• Post-op SRTlt 30dB111
• Pre-op possible SRTlt30db107
• Improvement111/107 (103)
• (Raut, Halik 2002)

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Post Stapes Chronic Progressive SNHL

• Large Fenestra 9.5 dB / 10 Years
• Small Fenestra- 3.2 dB / 10 Years
• (lt0.4 mm)
• (Smyth, Hassard 1986)

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Time to Hearing Aids Post Stapedectomy

• (Aided at 40 dB Level)
• Large Fenestra 13 Years
• Small Fenestra 21 Years
• (Smyth, Hassard 1986)

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Demographics of Hearing Loss Year 2000 in USA

• 29 Million Hearing Impaired(10)
• 5.6 Million Hearing Aid Users (1/5)
• Over 6 Million Age 45-54 with significant hearing
  loss

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Why Hearing Aids

• Critical for Communication
• Development speech Language
• Education
• Employment
• Quality of life

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Impact of Auditory Deprivation

• Problems fitting aids
• Sometimes permanent effects

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Hearing Aids

• Offering a Solution no One Wants
• Otologist- Role of Educator

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Conventional Hearing Aids

• Analogue Vs Digital
• Noise Management
• Clarity

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Implantable Hearing Aid

• Magnet (Implantable) Electromagnetic Driver
• Piezo-electrode

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BAHA
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Uses for BAHA

1. Unable to wear conventional Aid in suitable
   candidate
2. Unilateral complete SNHL (Vs transcranial fitting
   conventional aid)

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Cochlear Implants
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Summary

• Be realistic of surgical results especially long
  term
• Greater role for hearing aids on surgical
  patients over time
• Vast majority of patients not Surgical