Hearing impairment surgery: Difference between revisions

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'''Editor-In-Chief:''' [[C. Michael Gibson, M.S., M.D.]] <nowiki>[[Mailto:charlesmichaelgibson@gmail.com|[1]]]</nowiki>; '''Associate Editor(s)-in-Chief:'''{{Hearing impairment}}
{{Hearing impairment}}


==Surgery and Device Based Therapies==
==Overview==
* [[Myringotomy]] and tube placement (middle ear effusions)
A surgical candidate is the patients with conductive hearing loss due to mechanical problems, such as perforation of the [[eardrum]], [[ossicular disease]], or a [[cholesteatoma]] in the [[Middle ear|middle ear.]] [[Hearing Aid|Hearing Aids]] and [[Cochlear implant|cochlear implantation]] technology and surgical techniques have advanced significantly.
* [[Hearing aid]]s
 
* Middle ear implantable devices
==Indications==
*[[ Cochlear implants]]
Surgery is not the first-line treatment option for patients with [[hearing loss]]. Surgery is usually reserved for patients with either [[Perforated eardrum|perforation of eardrum]], [[ossicular]] disease, or a [[cholesteatoma]] in the [[middle ear]].
* Reconstructive middle ear surgery (including stapedectomy and tympanoplasty)
 
==Surgery and Device Based Therapies<ref name="pmid33253610">{{cite journal| author=Nieman CL, Oh ES| title=Hearing Loss. | journal=Ann Intern Med | year= 2020 | volume= 173 | issue= 11 | pages= ITC81-ITC96 | pmid=33253610 | doi=10.7326/AITC202012010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=33253610  }}</ref>==
A surgical candidate is the patients with [[conductive hearing loss]] due to mechanical problems, such as [[Perforated eardrum|perforation of the eardrum]], ossicular disease, or a [[cholesteatoma]] in the [[middle ear]].
 
*[[Myringotomy]] and tube placement (middle ear effusions)
*[[Hearing aid]]s ( There are different styles of hearing aid depending upon their location behind the ear, in the ear, in the canal, completely in the canal. Devices worn in the canal are difficult to use.)
*[[Middle ear]] implantable devices
 
*[[ Cochlear implants]] (Patients with a range of hearing who no longer benefit from hearing aids may benefit from cochlear implantation)
 
*[[Reconstructive]] [[middle ear]] [[surgery]] (including [[stapedectomy]] and [[tympanoplasty]])
 
===[[Hearing aids]]===
 
 
Hearing devices are either implantable or [[non-implantable]]. These devices include:
 
*[[Conventional medicine|Conventional]] air-conduction [[hearing aids]]: The traditional air-conduction hearing aids are used with a [[microphone]] that converts sound wave into electrical signals, returned to the ear as amplified sound. They're are useful for patients with mild-to-severe [[deafness]].
*[[Hearing aids|Bone-anchored hearing aids]] (BAHAs): BAHA devices incorporate a titanium plate that is surgically anchored to the skull on the hearing-impaired side, to directly stimulate the inner ear by [[Conducting zone|conducting]] sound vibrations through the bone. Some of the indications for BAHA include severe conductive hearing loss, [[Ear canal atresia|congenital ear canal atresia]], [[SNHL]], and difficulty wearing a conventional air-conduction aid with an ear [[Fungus|fungal]] infection, due to recurrent ear infections.
 
*They are the foremost recommended devices for persons with [[deafness]]. They vary in features, cost, efficacy, simple use, and style.
*They can be programmed for various [[frequencies]] and [[loudness]]. This adjustment can optimize listening comfort for patients.
*It contains [[Bluetooth]] capabilities, which permit to regulate through a smartphone and may enhance telephone use
*It is rechargeable. This feature requires limited [[dexterity]], [[vision impairment]], or limited [[Financial market|financial]] resources because it is straightforward to use and saves money from buying expensive batteries again and again.
*It can adjust volume and listening settings through buttons on the device and/or a mobile app on a smartphone.
*One hearing aid provides a gain in decibels perceived; the second helps with [[speech discrimination]] and localizing the source of the sound. So bilateral [[Hearing aids|hearing aid]] is best if there are no financial constraints for patients.
 
{| class="wikitable"
|+''<u>Location and form factor</u>''
!
!Behind the ear
!In the ear
!In the canal
!Completely within the canal
|-
|''Indication''
|All ranges
|All ranges
|Moderate
|Moderate
|-
|''Ease of Use''
|Easy
|Easy
|Difficult
|Difficult
|-
|''Description''
|Receiver worn behind the ear
|Earpiece sits inside pinna
|Most of the device in external canal
|Entire device within the [[external canal]]
|-
|Adverse effects
|
|
|Difficult to adjust
|Will not fit ear canals;
High dexterity required.
|}
 
===[[ Cochlear implants]]===
Patients who no longer benefit from hearing aids may benefit from [[Cochlear implant|cochlear implantation]]. Cochlear implantation technology and surgical techniques have advanced significantly since its approval for commercial use in 1985. <ref name="pmid32294347">{{cite journal| author=Carlson ML| title=Cochlear Implantation in Adults. | journal=N Engl J Med | year= 2020 | volume= 382 | issue= 16 | pages= 1531-1542 | pmid=32294347 | doi=10.1056/NEJMra1904407 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32294347  }}</ref>
 
====Mechanism of Action====
 
*Cochlear implants: The cochlear implant is a biomedical device that's surgically placed into the cochlea of the inner ear. It converts sound energy into an electrical signal, which is then conducted to t<nowiki/>he [[ganglion cell]]<nowiki/>s within the [[cochlea]] via electrodes. This conduction ultimately produces an [[auditory]] sensation in the form of sound to the person who allows the detection of sensation, especially speech sounds.
 
*Cochlear implants send sound signals directly to the [[auditory nerve]], bypassing [[Cochlear nerve|cochlear hair cells]]. A receiver unit and an intracochlear electrode that is surgically implanted, typically under [[anesthesia]]. Once the device is activated, a speech processor is worn behind the ear.<br />
 
====Risks associated with surgery: <ref name="pmid332536102">{{cite journal| author=Nieman CL, Oh ES| title=Hearing Loss. | journal=Ann Intern Med | year= 2020 | volume= 173 | issue= 11 | pages= ITC81-ITC96 | pmid=33253610 | doi=10.7326/AITC202012010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=33253610  }}</ref>====
 
*[[Facial nerve paralysis|Facial nerve injury]]
*[[Dizziness]]
*[[Cerebrospinal fluid|Cerebrospinal fluid leak]]
*[[Infection]]
*[[Chorda tympani]] lesion causing loss of taste
 
==Contraindications==
High risk patients with multiple co-morbidities, whose life span is < 6 months and is on the end of life care is excluded from surgical intervention.


==References==
==References==

Latest revision as of 09:14, 10 May 2021


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [[Mailto:charlesmichaelgibson@gmail.com|[1]]]; Associate Editor(s)-in-Chief:

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Overview

A surgical candidate is the patients with conductive hearing loss due to mechanical problems, such as perforation of the eardrum, ossicular disease, or a cholesteatoma in the middle ear. Hearing Aids and cochlear implantation technology and surgical techniques have advanced significantly.

Indications

Surgery is not the first-line treatment option for patients with hearing loss. Surgery is usually reserved for patients with either perforation of eardrum, ossicular disease, or a cholesteatoma in the middle ear.

Surgery and Device Based Therapies[1]

A surgical candidate is the patients with conductive hearing loss due to mechanical problems, such as perforation of the eardrum, ossicular disease, or a cholesteatoma in the middle ear.

  • Myringotomy and tube placement (middle ear effusions)
  • Hearing aids ( There are different styles of hearing aid depending upon their location behind the ear, in the ear, in the canal, completely in the canal. Devices worn in the canal are difficult to use.)
  • Middle ear implantable devices
  • Cochlear implants (Patients with a range of hearing who no longer benefit from hearing aids may benefit from cochlear implantation)

Hearing aids

Hearing devices are either implantable or non-implantable. These devices include:

  • Conventional air-conduction hearing aids: The traditional air-conduction hearing aids are used with a microphone that converts sound wave into electrical signals, returned to the ear as amplified sound. They're are useful for patients with mild-to-severe deafness.
  • Bone-anchored hearing aids (BAHAs): BAHA devices incorporate a titanium plate that is surgically anchored to the skull on the hearing-impaired side, to directly stimulate the inner ear by conducting sound vibrations through the bone. Some of the indications for BAHA include severe conductive hearing loss, congenital ear canal atresia, SNHL, and difficulty wearing a conventional air-conduction aid with an ear fungal infection, due to recurrent ear infections.
  • They are the foremost recommended devices for persons with deafness. They vary in features, cost, efficacy, simple use, and style.
  • They can be programmed for various frequencies and loudness. This adjustment can optimize listening comfort for patients.
  • It contains Bluetooth capabilities, which permit to regulate through a smartphone and may enhance telephone use
  • It is rechargeable. This feature requires limited dexterity, vision impairment, or limited financial resources because it is straightforward to use and saves money from buying expensive batteries again and again.
  • It can adjust volume and listening settings through buttons on the device and/or a mobile app on a smartphone.
  • One hearing aid provides a gain in decibels perceived; the second helps with speech discrimination and localizing the source of the sound. So bilateral hearing aid is best if there are no financial constraints for patients.
Location and form factor
Behind the ear In the ear In the canal Completely within the canal
Indication All ranges All ranges Moderate Moderate
Ease of Use Easy Easy Difficult Difficult
Description Receiver worn behind the ear Earpiece sits inside pinna Most of the device in external canal Entire device within the external canal
Adverse effects Difficult to adjust Will not fit ear canals;

High dexterity required.

Cochlear implants

Patients who no longer benefit from hearing aids may benefit from cochlear implantation. Cochlear implantation technology and surgical techniques have advanced significantly since its approval for commercial use in 1985. [2]

Mechanism of Action

  • Cochlear implants: The cochlear implant is a biomedical device that's surgically placed into the cochlea of the inner ear. It converts sound energy into an electrical signal, which is then conducted to the ganglion cells within the cochlea via electrodes. This conduction ultimately produces an auditory sensation in the form of sound to the person who allows the detection of sensation, especially speech sounds.
  • Cochlear implants send sound signals directly to the auditory nerve, bypassing cochlear hair cells. A receiver unit and an intracochlear electrode that is surgically implanted, typically under anesthesia. Once the device is activated, a speech processor is worn behind the ear.

Risks associated with surgery: [3]

Contraindications

High risk patients with multiple co-morbidities, whose life span is < 6 months and is on the end of life care is excluded from surgical intervention.

References

  1. ↑ Nieman CL, Oh ES (2020). "Hearing Loss". Ann Intern Med. 173 (11): ITC81–ITC96. doi:10.7326/AITC202012010. PMID 33253610 Check |pmid= value (help).
  2. ↑ Carlson ML (2020). "Cochlear Implantation in Adults". N Engl J Med. 382 (16): 1531–1542. doi:10.1056/NEJMra1904407. PMID 32294347 Check |pmid= value (help).
  3. ↑ Nieman CL, Oh ES (2020). "Hearing Loss". Ann Intern Med. 173 (11): ITC81–ITC96. doi:10.7326/AITC202012010. PMID 33253610 Check |pmid= value (help).

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