Article contributed by Roulla Katiri, audiologist at The Mater Misericordiae University Hospital, Dublin.
If your hearing does not recover, following sudden sensorineural hearing loss (SSNHL), there are things you can do to help.
For people with mild to moderate hearing loss, a standard hearing aid in the affected ear may be used to amplify the sounds you are not hearing. An audiologist can perform a hearing test to help determine the best device for your needs.
If the hearing loss is severe or profound, a conventional hearing aid may not help.
Impact of Unilateral Hearing Loss
Unilateral hearing loss (UHL) refers to hearing loss in one ear. When this loss is severe or profound, it is often called single-sided deafness (SSD).
Single-sided deafness can lead to a range of hearing difficulties. These include:
- Impaired spatial awareness i.e. telling where sounds are coming from
- Difficulties understanding speech accurately in demanding listening environments, like in a busy restaurant
These difficulties can affect the individual’s emotional well-being, causing effects such as anxiety or worry. For example, people might withdraw from social activities that are too demanding.
Depending on the cause of your SSD, you may also experience tinnitus and imbalance.
What Can You Do About It?
The most commonly available treatments for SSD help to restore two-sided (bilateral) access to sounds by re-routing sounds from the impaired ear to the better-hearing ear.
The Contralateral Routing of Signals (CROS) Hearing System
The Contralateral Routing of Signals (CROS) hearing system by Phonak, Oticon or Signia, is made up of two parts: a wireless microphone which is mounted onto the impaired ear and is wirelessly paired to a hearing aid that is worn on the better-hearing ear. If you happen to have a degree of hearing loss on the other side, a Bilateral CROS (BiCROS) aid can be fitted.
Both the BiCROS and CROS systems provide hearing benefits to users with SSD by diverting sounds to the better-hearing ear. They can be fitted and programmed by an audiologist who can also give you advice on how best to use the aid.
Its performance can be compromised in the presence of background noise, therefore you need to pay attention to your positioning with regards to any source of noise in your listening environment and adopt communication strategies accordingly.
The Bone Anchored Hearing Aid (BAHA)
An alternative solution is the Bone Anchored Hearing Aid (BAHA) device, which transmits signals from the impaired ear to the better-hearing ear via bone vibration. Unlike hearing aids, BAHAs are surgically implanted devices.
There are different types of BAHA devices:
- A device by Oticon MedicalTM or CochlearTM Baha® where a titanium abutment is placed on the skull bone behind the impaired ear. A removable sound processor gets attached onto the abutment. The benefit of this device is that, unlike the CROS, the better-hearing ear does not have a hearing aid in it.
- The Baha® Attract where a magnet is placed under the skin, instead of using an abutment. The processor gets attached onto an external magnet when in use. The benefit of this system is that the implant is hidden under the skin and so cannot be seen when the processor is not attached.
- The Osia System, which also works through bone conduction. The vibrating part (transducer) sits within the internal implant, rather than the external sound processor. This helps the signal travel more directly through the bone. The system works using technologies that are optimised to deliver more power, especially in the high frequencies, the area of sound most important for speech understanding.
An audiologist can carry out an assessment to determine whether you are a good candidate for this treatment. You will also have the opportunity to trial the device on a BAHA Softband (headband) for at least 2-4 weeks. If it is found to be beneficial, the BAHA can be implanted by an Ear Nose and Throat (ENT) surgeon.
The ADHEAR by MedEl is an adhesive bone conduction device that requires no surgery. It has been reported to be a possible option for SSD. One study compared the ADHEAR with the CROS device and reported that the users’ satisfaction was comparable.
Similarly, to the CROS hearing system, it is important to consider your positioning in the listening environment, and communication strategies should be used for optimum benefits.
Less commonly available treatments for SSD restore the hearing in the poor-hearing ear by surgically inserting an auditory prosthesis, such as a middle ear implant or a cochlear implant. These treatments are currently available in some European countries like Belgium, Germany, the Netherlands and France, as well as the United States and Australia.
The cochlear implant helps by providing direct electrical stimulation to the impaired ear via an electrode placed in the impaired cochlea of the inner ear. Several studies have reported improved spatial awareness and hearing in noise when a user with SSD is wearing a cochlear implant compared to no treatment.
What is the Best Treatment for SSNHL?
There is still uncertainty with regards to how helpful the available SSD treatment options are. This is due to the different ways the pros and cons are captured and reported by clinicians and scientists. Scientists are working hard to harmonise the way treatment effects are captured and documented, so it is easier for us to compare and combine the evidence to make an informed decision.
You won’t know if a device proves beneficial for you unless you trial it. So, speak to your audiologist or ENT consultant at the first opportunity.
Thank you to the following people:
- Many thanks to Roulla Katiri, audiologist at The Mater Misericordiae University Hospital, Dublin, for writing this article and for support with editing.
- Liam Dalrymple, Marketing Executive at Oticon Medical, for sharing and allowing the use of images.
- Natalie Gibson, Marketing Executive at Phonak UK, for sharing and allowing the use of images.