Baha-Mediated Rehabilitation of Patients with Unilateral Deafness: Selection Criteria

Abstract

The aim of our study was to identify clinical criteria for optimizing rehabilitation of patients with unilateral deafness using the Baha device. We made a retrospective study of 102 patients with unilateral deafness requesting auditory rehabilitation over a period of 5 years. All subjects underwent a series of stereo audiometric tests, with and without Baha worn on a headband, and were then referred to a hearing care specialist for a real life trial of 15 days. The Glasgow Health Status Inventory (GHSI) questionnaire was administered. Patients refusing the implantation were retrospectively submitted to a questionnaire specifically designed to ask the reasons for refusal. We measured stereo audiometric test results, age, aetiology of deafness, duration of auditory deprivation on the rehabilitated ear, and GHSI score. At the conclusion of testing, the implantation rate was 29%. During preoperative testing, the improvement in understanding of speech-in-noise was 22 ± 11% for patients agreeing to the implantation versus 13 ± 11% for patients refusing the implantation. Age, aetiology of deafness and duration of auditory deprivation had no influence on the implantation decision. Speech-in-noise testing and aided stereo audiometric gain were the only two measures showing statistically significant differences between the groups agreeing to and refusing the implantation. There were multiple reasons for refusal of the implantation. Among these, the four principal reasons were: absence of perceived benefit during stereo audiometric testing (59%), requirement for surgery (35%), cost of the solution (44%), and aesthetics (41%). Hence, no other criteria except the preoperative improvement in understanding of speech-in-noise and the aided gain from Baha worn on a headband were found to be predictive of the patient's acceptance of surgical implantation of a bone-anchored implant/abutment for Baha. Speech-in-noise testing with and without Baha worn on a headband has a role to play in deciding on the implantation of a bone-anchored hearing solution.

How do patients decide on interventions for single sided deafness? A qualitative investigation of patient views

“…Participants considered potential and actual benefit from their options of hearing technology in an ongoing process, as described in the theme "Iterative Judgements". This supports findings that benefit was the most frequently reported reason for proceeding with implantation of a BAHA TM and, equally, limited benefit was the main reason for rejection of a BAHA TM (Pennings, Gulliver, and Morris 2011;Saroul et al 2014;Siau et al 2015Siau et al , 2016Ng, et al 2017;Wendrich et al, 2017). Supporting the importance of subjective benefit is that the benefit from use of a conventional hearing aid in older adults with acquired hearing loss was key to their continued use of the hearing aid (Meyer, Hickson, and Fletcher 2014;Korkmaz et al 2016).…”

Sound-localization performance of patients with single-sided deafness is not improved when listening with a bone-conduction device

“…Whether or not SSD listeners opt for a CROS intervention might depend on several factors. Perceived limited benefits after a soft-band trial is one of the common reasons to decline implantation (Saroul et al, 2014; Siau et al, 2015). Alternatively, it might be that (congenital) SSD patients are not aware of the disadvantages of unilateral hearing (Lieu, 2004, 2013; Vila and Lieu, 2015), and therefore do not ask for clinical help.…”

Treatment choice in single‐sided deafness and asymmetric hearing loss. A prospective, multicentre cohort study on 155 patients

“…Among them, Pennings et al 8 stated that only 50% of SSD subjects interested in bone conduction device (BCD) treatment after a first short trial within the clinic eventually proceeded to surgery. This rate approximated 30% according to Saroul et al 9 and mostly involved SSD subjects where hearing benefits can be demonstrated during spatialised assessments of speech recognition in noise. The high rate of device rejection implies that a significant proportion of SSD subjects remain untreated and that abstention is de facto an option in the follow‐up of these patients.…”