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

Abstract

Objectives To describe the treatment choice in a cohort of subjects with single‐sided deafness (SSD) and asymmetric hearing loss (AHL). To assess the reliability of the treatment trials. Design In this national, multicentre, prospective study, the choice of subjects was made after two consecutive trials of Contralateral Routing Of the Signal (CROS) hearing aids and a Bone Conduction Device (BCD) on a headband. Subjects could proceed with one of these two options, opt for cochlear implantation or decline all treatments. Setting Seven tertiary university hospitals. Participants One hundred fifty‐five subjects with SSD or AHL fulfilling the candidacy criteria for cochlear implantation, with or without associated tinnitus. Main outcome measures After the two trials, the number of subjects choosing each option was described. Repeated assessments of both generic and auditory‐specific quality of life were conducted, as well as hearing assessments (speech recognition in noise and horizontal localization). Results CROS was chosen by 75 subjects, followed by cochlear implantation (n = 51), BCD (n = 18) and abstention (n = 11). Patients who opted for cochlear implantation had a poorer quality of life (P = .03). The improvement of quality of life indices after each trial was significantly associated with the final treatment choice (P = .008 for generic indices, P = .002 for auditory‐specific indices). The follow‐up showed that this improvement had been overestimated in the CROS group, with a long‐term retention rate of 52.5%. Conclusions More than one third of SSD/AHL subjects are unsatisfied after CROS and BCD trials. Repeated quality of life assessments help counselling the patient for his/her treatment choice.

Middle-term cochlear implant use in case of asymmetric hearing loss and single-sided deafness: A retrospective single-centre cohort study

“…Demographic data and audiometric evaluation of 72 patients (66 AHL, 6 SSD) are reported in Table 1. The mean follow up was 3 +-1.8 years [1][2][3][4][5][6][7]. Only three AHL candidates did not use a hearing aid on the acoustic-hearing ear: two cases with mild hearing loss (PTA: 33 and 35 dB, respectively) and one vestibular schwannoma.…”

“…Among the 40 AHL patients with a 5-years follow-up, only one patient became non-user (2.5 %). In the literature, after the first year post-implantation, the percentage of non-users varies among studies: 10% at 2-years post-implantation among 20 SSD patients (3), 4.4% among 114 SSD patients with a follow-up of 1.5 to 60 months (2), 9.8 % among 41 SSD and 0% among 37 AHL patients with a follow-up of 6 to 11 years (1), 19% among 28 SSD and AHL patients with a follow-up of 45 to 67 months (6). The reported main reasons of non-use were lack of perceived benefit, as in our study, and unrealistic expectations.…”

Brain plasticity and hearing disorders

“…Different binaural hearing rehabilitation techniques exist in both children and adults and depend on the degree of UHL. In the most severe cases of single-sided deafness (SSD), a cochlear implant provides the highest quality of life and higher behavioral performances, such as localization and speech recognition in noise [64,83]. Cortical activity recovery after SSD rehabilitation was shown for the moment only with EEG within a pediatric SSD population [62,84].…”

Choice of treatment evaluated after trial periods with bone conduction devices and contralateral routing of sound systems in patients with single‐sided deafness

“…However, the methodological heterogeneity of these studies hinders the direct comparison of the BCD and CROS trial period outcomes. For instance, the patients' experience can be influenced by a fixed order of the trial periods used in these studies, 20,21 the different duration of trial periods 21 and whether other treatment options are offered (CI, remote microphone or in the ear hearing aid) 22–25 …”

“… 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 Less is known about the experience or preference of SSD patients with a CROS trial period or when both devices are sequentially trialed. The few studies 20 , 21 , 22 , 23 , 24 , 25 directly comparing the CROS and BCD trial periods highlight the high variability of the choice of treatment after the trial periods. However, the methodological heterogeneity of these studies hinders the direct comparison of the BCD and CROS trial period outcomes.…”