Abstract: In 2019, the FDA approved CI children with SSD age 5 years and older. Researchers have shown significant benefits in children with SSD who wear CI. Children/families with SSD face barriers that may detract from pursuing a CI. This preliminary study explores potential barriers to CI in children with SSD.
Description: Introduction. Limited data exist on outcomes for children with single-sided deafness (SSD) with cochlear implants (CI). Previous research shows children with SSD are 10 times more likely to repeat a grade in school and have trouble with speech recognition in noise and sound localization. Historically, audiologic management for children with SSD involved assistive technology such as contralateral-routing-of-signal hearing aids or bone conduction devices. While these provide some benefit for children with SSD, they do not mediate permanent changes in the auditory cortex caused by auditory deprivation. In contrast, a CI can provide auditory stimulation to avoid negative effects of auditory deprivation. In 2019, the FDA approved CI for those with SSD age 5 years and older. Researchers have shown significant benefits (e.g., improved speech recognition in quiet and noise, better sound localization, increased quality of life) in children with SSD who wear CI versus other (or no) auditory technologies. However, children with SSD and their families face barriers that may detract from pursuing a CI. This preliminary study explores potential barriers to CI in children with SSD based on clinical data. Methods. This study involves a clinical case review of 20 children with SSD (i.e., profound hearing loss in one ear with limited benefit from hearing aids and typical hearing/mild sensorineural hearing loss in the contralateral ear), approximately half of whom received a CI. Most (75%) participants had congenital hearing loss with pre-implant speech recognition < 30% correct. One-half have atypical anatomy (e.g., ossification, nerve hypoplasia) confirmed via imaging. One-half of participants used public health insurance. Variables of interest related to the decision to implant a child with SSD included demographic characteristics (e.g., age, hearing loss, etiology), insurance type (private vs. public), communication skills (e.g., speech recognition pre- and post-CI), and datalogging (i.e., daily device use in hours/day). Results. Families of children with SSD had higher rates of pursuing CI for children with younger chronologic age (i.e., 75% vs. 20% for < 6 years vs. >6 years, respectively) and private vs. public insurance (56% vs. 33%). Post-implantation, datalogging revealed the child implanted at the oldest age wore the device the least (1.6 hours per day) and the child with the highest speech recognition scores post-CI wore the device the most (9.2 hours per day) compared to the overall mean daily device use of 5 hours per day. All children implanted in preschool/early elementary school (4-5 years of age) showed better attention and more vocalizations post-CI compared post- vs. pre-CI. Conclusion. Beyond meeting audiometric criteria, age at implantation and patient insurance are associated with whether children with SSD get implanted. Professionals working with this population should understand not only when to refer, but also how to counsel families with potential barriers to pursuing CI for children with SSD.
Presentation Format & Methods: PowerPoint
Supporting Research: Reference 1: Park, L. R., Griffin, A. M., Sladen, D. P., Neumann, S., & Young, N. M. (2022). American Cochlear Implant Alliance Task Force Guidelines for Clinical Assessment and Management of Cochlear Implantation in Children With Single-Sided Deafness. Ear and hearing, 43(2), 255–267.
Supporting Research: Reference 2: Sangen, A., Royackers, L., Desloovere, C., Wouters, J., & van Wieringen, A. (2017). Single‐sided deafness affects language and auditory development–a case–control study. Clinical Otolaryngology, 42(5), 979-987.
Supporting Research: Reference 3: Arndt, S., Prosse, S., Laszig, R., Wesarg, T., Aschendorff, A., & Hassepass, F. (2015). Cochlear implantation in children with single-sided deafness: does aetiology and duration of deafness matter?. Audiology and Neurotology, 20(Suppl. 1), 21-30.
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Learning Objectives:
As a result of this presentation, the participant will be able to define Single Sided Deafness (SSD).
As a result of this presentation, the participant will be to describe cochlear implant candidacy for single-side deafness.
As a result of this presentation, the participant will be able to discuss two barriers to implantation in children with single-sided deafness.