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HESP 701- Hearing Aids II > Lecture 3- Alternatives to Traditional Hearing aids > Flashcards

Lecture 3- Alternatives to Traditional Hearing aids Flashcards

1
Q

Why doesn’t a traditional hearing aid work for everyone?

A

Some patients reject hearing aids due to their limitations:
- acoustic feedback, occlusion effect, frequent battery changes/maintenance, discomfort, infection, irritation, lifestyle restrictions, repair, loss, and damage

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2
Q

What is the CROS and BiCROS?

A
  • Microphone on bad ear and receiver on better ear
  • Solves the head shadow effect problem
  • Doesn’t improve localization; some patients report that they can lateralize better
  • Can improve spatial awareness
  • Do not occlude the good ear
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3
Q

What are the advantages and disadvantages of the Cros/BiCros system?

A

Advantages: might be covered by insurance, non-invasive, reversible

Disadvantages: might not be covered by insurance, requires 2 devices

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4
Q

What are the candidacy factors for Cochlear Baha?

A

3 candidate groups: single-sided deafness, mixed hearing loss, conductive hearing loss

3 models: standard, power, and super power

Recommended BC PTA for each model: 45, 55, 65

3 considerations for selection: no pinna or ear canal, lifestyle, gain requirements

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5
Q

What is osseointegration?

A

Direct connection between bone and implant

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6
Q

What are factors affecting osseointegration?

A

Material used: implant is made of titanium (99.75%)

Bone condition factors

Surgical considerations:

  • bone cannot get too hot
  • risk of fibrous tissue growth around the implant
  • if the implant is not perpendicular to the skull, it is possible for the implant to make contact with soft tissue
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7
Q

What is the Oticon Ponto?

A
  • Another bone-anchored hearing aid

- Use Oticon’s signal processing

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8
Q

What is the TransEar?

A
  • A single unit
  • Behind-the-ear processor has a microphone and an amplifier
  • Not very comfortable (transfer unit has to be tight to have bone conduction stimulation)
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9
Q

How does the TransEar work?

A
  • Picks up the acoustic signal and converts to digital
  • Digital signal is converted to mechanical energy
  • Good ear processes vibrations
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10
Q

What is the Sound Bite?

A
  • Retainer unit that is fit onto the back-teeth of the good-ear side
  • Piece behind the ear transfers the acoustic signal to the ITM (in the mouth piece)
  • Battery only lasts for 9 hours
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11
Q

How would you counsel your patient with SSD?

A
  1. Discuss non-surgical vs. surgical options
  2. Counsel on the trial period for the CROS system
  3. Discuss what options are covered by insurance
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12
Q

What is the Lyric?

A
  • Analog hearing aid
  • Good for natural sound quality
  • Lyric is so deep in the ear; don’t need directional microphone
  • Trial period
  • Battery lasts up to 120 days (4 months)
  • FDA has cleared for 120 days of continuous use
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13
Q

What are the disadvantages of the Lyric system?

A
  • Doesn’t fit every ear
  • Can’t fit people who are prone to bleeding, radiation to the head or neck, auto-immune compromised patient
  • Price: $2000 per ear per year
  • Can’t swim or dive with lyrics; can’t wear during MRI
  • Not much published research about Lyric
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14
Q

Who is a candidate for Middle Ear Implants?

A
  • People who do not benefit from or are unable to use traditional hearing aids
  • Obstruction of the outer or middle ear
  • People who cannot wear hearing aids or ear molds
  • People who are unable to benefit from sound amplification

Ex. Physicians who wear stethoscopes, lifeguards, musicians

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15
Q

How might IMEDHDs be better than traditional hearing aids?

A
  1. Direct vibrational drive
    - 1 less step in transducing sound (reduction in distortion)
  2. Minimal distortion
    - Small speaker element
  3. No feedback
    - No need for an ear mold; depends on the type of middle ear implant
  4. Special fitting
    - Problematic anatomies, conductive hearing loss
  5. Increased long-term wear and comfort
  6. Improvement in signal processing & noise management (theoretically)
  7. Good alternative for some patients
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16
Q

What do proponents of Middle Ear implants claim?

A
  1. Devices address feedback, occlusion, distortion
  2. Preserve residual hearing
  3. Present minimal risk
  4. Cost-effective over the life of the device
  5. Permit patients a full range of normal activities (swimming & showering)
  6. Improve patient quality of life
17
Q

What is the piezoelectric transducer?

A
  • Based on a ceramic material that will change shape (deform) when a voltage is applied to it
  • Wide frequency response
18
Q

What are the 2 configurations of the piezoelectric transducer?

A
  1. Monomorph
    - Uses expansion and contraction to directly provide displacement to the middle and inner ear
  2. Bimorph
    - Uses 2 pieces of piezoelectric materials bonded together with opposite polarities causing bending of the structures
19
Q

What are the limitations o the piezoelectric transducer?

A
  • Gain is lower than other devices
  • Adequacy of high frequency response is questionable
  • Necessity to disarticulate the ossicles is controversial
20
Q

What is the electromagnetic transducer?

A

Consist of a magnet (usually made of rare earth, like Samarian cobalt or neudymium iron boron) and an energizing coil

  • Becoming a Floating Mass Transducer (FMT) along with a vibrating ossicular prosthesis
  • Magnet can be attached to an assicle, the TM, or the oval window
  • A fluctuating magnetic field is generated when the coil is energized by a signal corresponding to an acoustic input
  • Magnetic field causes the ossicles or the cochlear fluids directly

All components must be in close and stable proximity in order to achieve an efficient system

21
Q

What are the limitations of the electromagnetic transducer?

A
  1. Magnet and the coil must be close together to maximize efficiency
  2. Magnet weight has to be kept low to avoid mass effect
  3. Different patients get different results depending on their anatomy
22
Q

What is the electromechanical transducer?

A
  1. Developed in response to limitations of other devices
  2. Variation of electromagnetic transducer
  3. Energizing coil and magnet are housed within a single assembly with an optimized spatial and geometric relationship
    - Mechanical energy produced is transmitted by a direct connection of the transducer to the ossicular chain
  4. Microphones
    - Can be externally worn (like traditional hearing aids), partially implanted
    - Could be subcutaneous in the scalp or in the ear canal
23
Q

What devices are commercially available?

A
  1. Vibrant Soundbridget
  2. Maxum (Ototronix, LLC)
  3. Carina (Cochlear Americas)
  4. Esteem (Envoy Medical)
24
Q

What is the Vibrant Soundbridge?

A
  • One of the first to be FDA approved
  • Partially implantable
  • Electromagnetic transducer
  • Originally developed by Symphonix and then acquired by Med El

Internal part: includes internal receiver coil & magnet

  • Wire attached to the long arm of the incus
  • Transducer is a magnet surrounded by an electromagnetic coil (FMT) which drives the ossicular chain

External device

  • Microphone, signal processor, and magnet
  • Amplified sound is transmitted to internal receiver and delivered via the wire to a transducer delivering amplified vibration to the ossicular chain
  • Surgery is similar to CI surgery
  • Battery changes are about once a week
25
Q

What is the candidacy criteria for the Vibrant Soundbridge?

A

> 18 years old

  • Moderate-to-severe SNHL, ChLm or MHL (stable for 2 years
  • Unsuccessful with, or medically unable to wear, conventional hearing aids
  • > 50% WRS in implant ear
  • Hearing thresholds within limits shown at right
26
Q

What is the Maxum implant?

A

Partially implanted device

  • Implanted device: magnet surrounded in titanium & implanted between in the incudostapedial joint
  • Behind the ear device
  • Magnet is stimulated by an electromagnetic coil that is placed near the TM
  • Sound processor is delivered to the coil
  • Minimally invasive; done under local anesthesia
  • Uses trans-canal approach; the TM is retracted and transducer is attached to the ossicles
27
Q

What are the candidacy considerations for the Maxum implant?

A

> 18 years old
Moderate-to-severe SNHL
- Desiring an alternative to HAs, after a trial with suitable conventional amplification

28
Q

What are the contraindications for the Maxum implant?

A
  1. Conductive HL
  2. Retrocochlear or central auditory disorder
  3. Active middle ear infections
  4. TM perforation with recurrent ME infections
  5. Disabling tinnitus
29
Q

What is the Carina implant?

A
  • Fully implantable
  • Evolved from a partially implantable device

Driver: small electromagnetic transducer
- tip is usually attached to a small hole that is drilled in the incus

  • Implant consists of digital signal processor, rechargeable battery, microphone, radio frequency coil (used for programming), and connector for wire that connects to the transducer
  • Implanted behind the ear in a similar manner to a CI
  • Sound is detected by the subcutaneous microphone, behind the ear, is amplified by the sound processor and delivered to the transducer which drives the ossicular chain
  • Surgery is similar to a CI; surgical approach to its placement varies
30
Q

What is the candidacy for the Carina implant?

A
  • Minimum age 14 y/o
  • Postlingual hearing loss
  • Moderate to severe SNHL
  • Air/bone gaps less than or equal to 10 dB
  • WRS greater than or equal to 40% in implant ear
  • Stable hearing
  • Realistic expectations
31
Q

What are the contraindications for the Carina?

A
  1. Vestibular changes
  2. Degenerative bone disorders
  3. Middle ear disease
  4. Retrocochlear or central nervous system disorders
  5. Prelingual hearing loss
32
Q

What is the Esteem implant?

A
  • Founded in 1995
  • A fully implantable piezoelectric device to sense movement of the TM and to drive the stapes
  • Costs approximately $30,000
  • When voltage is applied to the transducer, the transducer is forced into movement
  • Device turned on ~8 weeks after implantation
  • Battery life: 4.5 to 9 years
  • Surgery for battery placement is similar to CI surgery
33
Q

What are the candidacy factors for the Esteem?

A
  1. Stable HL caused by defective hair cells in the IE (SNHL) in both ears
  2. Moderate-to-severe SNHL as defined by PTA (500, 1000, 2000)
  3. WRS less than or equal to 40%
  4. Normal Eustachian tube function
  5. Normal ME anatomy
  6. Normal TM
  7. Adequate space for implant
  8. Minimum of 30 days experience with appropriately fitted HAs
  9. Patients must be less than 18 years of age
34
Q

What are the contraindications for the Esteem?

A
  1. Post-adolescent chronic ME infections
  2. Inner ear disorders or recurring vertigo requiring Tx
  3. Disorders such as infection of mastoid bone
  4. Swelling in IE
  5. Meniere’s disease
  6. Disabling tinnitus which requires Tx
  7. Fluctuating AC and/or BC HL over the past 1 year of +/- 15 dB at less than or equal to 2 or more frequencies between 500-4000 Hz
  8. Swimmer’s ear (OE) or ecaema of the OE canal
  9. Destructive ME disease (cholesteatoma)
  10. Central auditory disorders (retrocochlear)
  11. Thick scar tissue that continues to grow (keloid formation)
  12. Excessive sensitivity to silicone rubber, polyurethane, stainless steel, titanium, and/or gold
35
Q

Why would you consider an implantable device to replace a standard hearing aid?

A
  1. Appearance
  2. Convenience: some can be worn in water or 24/7
  3. Sound quality: more gain without feedback and no occlusion
36
Q

What are the disadvantages of IMEHDs?

A
  1. Surgery is required
  2. MRI compatibility
  3. Further surgeries
  4. Expensive
  5. Some still have an external component
  6. Limited insurance reimbursement
37
Q

How do we verify/validate IMEHDs?

A
  1. Have to return to functional gain and speech recognition measures
  2. Subjective validation is informative with this population

HESP 701- Hearing Aids II (9 decks)

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