An international group of audiology experts, including the University of Miami Miller School of Medicine, has developed the first-of-its-kind best practice guidelines for managing hearing loss in adults with bimodal hearing configurations. The guidelines are published in Otology and neurotology open.
“When you see a group of authors on a major publication like this, it’s very important to have representation from the Miller School Ear Institute, an internationally recognized program for the treatment of patients with hearing loss,” said Meredith A. Holcomb, author of the guidelines, Au.D., CCC-A, director of the Hearing Implant Program and associate professor of otolaryngology at Miller School. “It speaks volumes that we have not one, but two authors on this publication. It highlights not only our ability to contribute to the literature, but also our long-standing commitment to the care of patients with hearing loss.”
Prior to this publication, there were no recommendations on standard care practices for fitting adult patients with bimodal hearing technology for the treatment of bilateral hearing loss. It’s a common problem that Dr. Holcomb often goes untreated.
Cost of unaddressed hearing loss
“Effective management of these patients is important because untreated hearing loss is a huge burden on patients, family members, quality of life, work, communication, mental health and cognition,” said Dr. Holcomb, who is also the immediate past president of the American Cochlear Implant Alliance.
Worldwide, more than 1.5 billion people live with hearing loss, and more than 430 million have hearing loss that is sufficiently disabling to warrant treatment – a number that could rise to more than 700 million by 2050. Unaddressed hearing loss costs the global economy $980 billion due to loss of productivity, societal costs and more, according to the World Health Organization.
Cochlear implants are the worldwide standard of treatment for adults with bilateral severe to profound hearing loss, but use is low. In the US, for example, only about 10% of adult patients who need cochlear implants have them, according to Dr. Holcomb.
Studies suggest that approximately 80% of patients with a cochlear implant in one ear have residual hearing in the other ear. This means they would likely benefit from a bimodal hearing system that combines acoustic input from a hearing aid in one ear with electrical stimulation from a cochlear implant in the other ear, according to the guidelines.
Best practices for better results
“We found a huge gap in the literature on how best to manage bimodal patients. As a result, we have developed these best practices to educate everyone who works with patients with hearing loss, including primary care physicians, hearing aid specialists and audiologists. helping hearing care providers achieve the best outcomes for their adult patients, with the most appropriate hearing technology available,” said Dr. Holcomb.
The new guidelines include the benefits of bimodal hearing; preoperative evaluation and surgery of cochlear implants; postoperative placement and assessment of cochlear implants; bimodal fitting of hearing aids; evidence for selecting a contralateral routing of signal device; evidence to support treatment of cochlear implants and hearing aids for tinnitus relief; and when to consider auditory rehabilitation.
Hillary Snapp, Au.D., Ph.D., chief of audiology and associate professor of otolaryngology at the Miller School, an author of the guidelines, contributed expertise gained from her world-renowned research on decline in hearing-only patients in one ear, according to Dr. Holcomb.
“Dr. Snapp has added tremendously to these guidelines with the work she has done on unilateral deafness throughout her career,” said Dr. Holcomb. “My contributions have been mainly from the clinical point of view of the treatment of cochlear implant recipients over the past 15 years.”
dr. Snapp said she and Dr. Holcomb “be incredibly proud to join our colleagues from leading institutions, including Vanderbilt University Medical Center, the University of Iowa and the Erasmus Medical Center in the Netherlands, in important initiatives such as this one.
“These guidelines address several important aspects of patient care management with hearing implant technology,” she said. “Such contributions are important in closing treatment gaps, increasing access to care and improving the quality of patient care and patient outcomes.”