Updated Optimal Management of Single-Sided Deafness

TRIO Best Practice articles are brief, structured reviews designed to provide the busy clinician with a handy outline and reference for day-to-day clinical decision making. The ENTtoday summaries below include the Background and Best Practice sections of the original article. To view the complete Laryngoscope articles free of charge, visit Laryngoscope.com.

Acknowledgment: The article is an update of “Optimal Management of Single-Sided Deafness,” which was originally published in The Laryngoscope on January 11, 2013.

Background

Current trends in auditory rehabilitation for single-sided deafness (SSD) reflect a renewed interest in the functional impact of unilateral hearing loss and also in advances in technologies for SSD that make interventions more effective and more appealing to patients. Clinicians are now equipped with an array of therapeutic options ranging from Bluetooth contralateral routing of signal (CROS) devices to in-the-ear bone conduction hearing aids (TransEar, Ear Technology Corp., Johnson City, Tenn.), as well as bone-anchored technologies (BAHA) (Ponto, Oticon Medical AB, Askim, Sweden; Sophono, Medtronic, Dublin 2, Ireland; and BoneBridge, Med-El, South Yorkshire, UK). Even unilateral cochlear implantation represents an emerging (and as of yet, investigational) intervention that may offer yet another option to patients in the future. A persistent deficiency in this field is the absence of concise and evidence-based guidelines for patient and intervention selection. Factors to consider when recommending the best treatment include functional handicapping due to SSD, speech understanding in noise, sound localization, ease of use, the need for surgery, and cost. Imaging compatibility of implantable devices has also posed a potential problem in considering management options. However, the increasing compatibility of current devices with magnetic resonance imaging (MRI) has mitigated this concern. This article seeks to review the pertinent literature on this topic and offer a best-practice framework.

Best Practice

As a best practice, it is reasonable to consider a sequential interventional approach for SSD patients that takes into consideration the degree of invasiveness or risk associated with each intervention. For example, an initial trial of a CROS or TransEar (Ear Technology Corp.)-type hearing aid can be recommended as a nominal risk, noninvasive option for patients with SSD. If those trials prove unsatisfactory, the patient might then be considered an appropriate candidate for an implantable bone conduction device (e.g., BAHA; Ponto, Oticon Medical AB; or Sophono, Medtronic). Cochlear implantation remains an investigational intervention for patients with handicapping single-sided deafness (Laryngoscope. Published March 17, 2017 online ahead of print. doi: 10.1002/lary.26553)