MDNews - Cleveland-Akron-Canton

++++++++++++++++++++++++++ + +++ +CLINICAL SPOTLIGHT +++ ++++++++++++++++++++++++++ What's New with Cochlear Implants? An Update from Cleveland Clinic have a hearing loss, which is the third most common health problem in the United States. While hearing aids may be adequate for mild to moderate losses, cochlear implants are increasingly indicated for moderate to profound cases of hearing loss according to Erika Woodson, MD, and Sarah Sydlowski, AuD, PhD. Dr. Woodson is the Medical Director and Sydlowski is the Audiology Director of the Hearing Implant Program (HIP) at Cleveland Clinic's Head & Neck Institute, where nearly 100 patients per year receive cochlear implants. An otologist/neurotologist/skull-base surgeon, Dr. Woodson specializes in cochlear implantation and acoustic neuroma surgery. Sydlowski is an implant audiologist with clinical and research interests in electrophysiology and auditory/vestibular pathology. Expanded Candidate Criteria "A person doesn't have to be totally deaf to be a candidate for a cochlear implant, like they did a decade ago," says Dr. Woodson. "Even individuals with moderate hearing loss may be candidates if their speech understanding is less than approximately 50 percent with appropriate hearing aids." Sydlowski agrees. "Over the years, the criteria for cochlear implant candidacy have expanded to include individuals who still have significant residual hearing," she says. "While cochlear implant for single-sided deafness has not yet been FDA-approved, 24 | Cleveland/Akron/Canton MD NEWS an individual can have a hearing aid in one ear and a cochlear implant in the other. And, potentially, an individual could have a cochlear implant in one ear and a hearing aid in the same ear, with those devices stimulating different frequencies depending on the residual hearing that the individual had to begin with." Approximately 42,600 adults and 28,400 children in the U.S. have received cochlear implants, according to a report released in December 2010 by the National Institute on Deafness and Other Communication Disorders (NIDCD). Cochlear implantation was FDA-approved in 2000 for children as young as 12 months. Logically, the earlier a child is exposed to sound, the better his/ her speech and language skills. "There have been numerous advances in cochlear implant technology and surgery, and it has been shown to be safe in younger children," says Dr. Woodson. "Currently, we will implant children younger than a year old as long as they're medically appropriate and they and their families are ready." Early intervention is important — not only for children, but also for adults, according to Sydlowski. "The prior thought with older adults was to wait until there was no other option. However, we've realized that the earlier an appropriate candidate is identified, the more recently they have lost their hearing, and the more consistently they have been using hearing aids, the better their speech understanding outcomes will be. Additionally, the more residual hearing in the opposite ear, the better their ■ MDNEWS.COM ■ JANUARY/FEBRUARY 2014 overall potential for understanding will be in complex listening environments like background noise." Better Screening Methods The identification process may begin in the primary care physician's office with a few observations. Does the patient have difficulty hearing or understanding the physician when they are facing each other, even while wearing a hearing aid? When the physician is talking to other people in the exam room, or if the physician turns away while speaking, does the patient have trouble following the conversation? A "yes" answer to any of these questions may indicate the patient's hearing and/or hearing aid needs further evaluation. "Sometimes the signs are a little more subtle. I'll frequently ask patients and their families, 'are you [the patient] becoming more withdrawn and shying away from activities you used to enjoy, like going to church or going out with friends?' If so, that's a good sign that the patient is cut off communication-wise, and that can lead to depression or hasten the development of dementia," says Dr. Woodson. "The primary care physician should be in tune with these signals that a patient needs further help with his or her hearing." Cochlear implant candidates referred to Cleveland Clinic's Hearing Implant Program are assessed by a team of audiologists, neurotologists, otolaryngologists and speech language pathologists, all of whom subspecialize in this area. The evaluation PHOTOS © CLEVELAND CLINIC A LMOST 34.5 MILLION Americans

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