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Hearing Aids in Otology. Dr. Jerry Halik FRCSC Assistant Professor University of Toronto. “Only 5% of patients seen for hearing loss may benefit from surgery” John Shea MD. Surgeon Safe Eradicate Disease Dry Function. Patient Dry Function Safe

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Hearing aids in otology

Hearing Aids in Otology

Dr. Jerry Halik FRCSC

Assistant Professor University of Toronto



Expectations of ear surgery

Surgeon from surgery”

Safe

Eradicate Disease

Dry

Function

Patient

Dry

Function

Safe

Eradicate Disease

Expectations of Ear Surgery


Result of hearing gain in ear surgery
Result of Hearing gain in Ear Surgery from surgery”

  • Tympanoplasty

    Long term result at 11 years

    - 81% closed Perforations

    - 9% Atelectatic pocket Formation

    74% Normal Healed TM

    (Halik, Smyth; 1988)


Result of hearing gain in ear surgery1
Result of Hearing gain in Ear Surgery from surgery”

  • Mastoid Surgery

    - 25% Post op SRT <30 dB


Ossiculoplasty
Ossiculoplasty from surgery”


Ossiculoplasty results
Ossiculoplasty Results from surgery”

  • TORP/ PORP- 25% SRT < 31 dB

    4/12 patients

  • Assemblies – 57% SRT <31 Db

    58/102 patients

    Follow up – Up to 6 years (average 2 years)


Stapes surgery goals
Stapes Surgery Goals from surgery”

  • No Aid

  • No Aid Aid

  • Large Aid Small Aid


Stapes surgery
Stapes Surgery from surgery”


Stapes surgery result
Stapes Surgery Result from surgery”

N=135Avg A-B gap closure (Post op air minus pre-op bone)


Stapes surgery result1
Stapes Surgery Result from surgery”

  • Post-op SRT< 30dB=111

  • Pre-op possible SRT<30db=107

  • %Improvement=111/107 (103%)

    (Raut, Halik 2002)


Post stapes chronic progressive snhl
Post Stapes Chronic Progressive SNHL from surgery”

  • Large Fenestra – 9.5 dB / 10 Years

  • Small Fenestra- 3.2 dB / 10 Years

    (<0.4 mm)

    (Smyth, Hassard; 1986)


Time to hearing aids post stapedectomy
Time to Hearing Aids Post Stapedectomy from surgery”

(Aided at 40 dB Level)

  • Large Fenestra – 13 Years

  • Small Fenestra – 21 Years

    (Smyth, Hassard; 1986)


Demographics of hearing loss year 2000 in usa
Demographics of Hearing Loss Year 2000 in USA from surgery”

  • 29 Million Hearing Impaired(10%)

  • 5.6 Million Hearing Aid Users (1/5)

  • Over 6 Million Age 45-54 with significant hearing loss


Why hearing aids
Why Hearing Aids from surgery”

Critical for Communication

  • Development speech & Language

  • Education

  • Employment

  • Quality of life


Impact of auditory deprivation
Impact of Auditory Deprivation from surgery”

  • Problems fitting aids

  • Sometimes permanent effects


Hearing aids
Hearing Aids from surgery”

  • “ Offering a Solution no One Wants”

  • Otologist- Role of Educator


Conventional hearing aids
Conventional Hearing Aids from surgery”

  • Analogue Vs Digital

  • “Noise Management”

  • Clarity


Implantable hearing aid
Implantable Hearing Aid from surgery”

  • Magnet (Implantable)& Electromagnetic Driver

  • Piezo-electrode


BAHA from surgery”


Uses for baha
Uses for BAHA from surgery”

  • Unable to wear conventional Aid in suitable candidate

  • Unilateral complete SNHL (Vs transcranial fitting conventional aid)


Cochlear implants
Cochlear Implants from surgery”


Summary
Summary … from surgery”

  • Be realistic of surgical results especially long term

  • Greater role for hearing aids on surgical patients over time

  • Vast majority of patients not Surgical


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