Evaluating Hearing Loss for Individuals with Cochlear Implants (2021) / Chapter Skim
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5 Evaluating Hearing Ability in Persons with Cochlear Implants with Single-Sided Deafness or Asymmetric Hearing Loss
5 Evaluating Hearing Ability in Persons with Cochlear Implants with Single-Sided Deafness or Asymmetric Hearing Loss
Pages 85-98
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From page 85... ...
Whether there is a correlation between the presence and degree of hearing loss in the less-affected ear and the recovery time or treatment for individuals with single-sided deafness or asymmetric hearing loss receiving a cochlear implant in their more-affected ear; c. Whether there is a level of hearing ability in the less-affected ear which would render cochlear implantation in the more-affected ear immaterial with respect to meeting the severity of hearing loss in the Listings (i.e., would not prevent an adult from engaging in any gainful activity nor a child from having "marked" limitations in two domains of functioning or an "extreme" limitation in one domain1)
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From page 86... ...
in individuals with cochlear implants. The chapter also provides an overview of special considerations inherent in evaluating hearing ability in patients with SSD or AHL who receive a cochlear implant.
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From page 87... ...
First, current indications for disability due to hearing loss not treated with cochlear implantation (SSA Listing 2.10) base eligibility on the hearing in the better hearing ear; individuals will qualify for disability if they have an average air conduction hearing threshold of 90 dB or greater in the better ear and an average bone conduction hearing threshold of 60 dB or greater in the better ear (2.00B2c)
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From page 88... ...
It needs to be determined whether patients with SSD and AHL who receive a cochlear implant and possess normal or near-normal hearing in one ear should automatically be covered under disability for a period of 1 year after they receive the cochlear implant. SPECIAL CONSIDERATION IN THE TESTING AND TREATMENT OF PERSONS WITH BILATERAL BUT UNEQUAL HEARING LOSS Hearing Testing Hearing can be measured unilaterally (one ear at a time)
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From page 89... ...
Unaided Testing During unaided testing, masking noise is typically delivered to the non-test ear via insert earphones, and the level of masking is determined by several factors, including the air and bone conduction thresholds of the non-test ear, the air conduction threshold of the test ear, and the level of presentation of the signal in the test ear. The masking level is also influenced by such factors as interaural attenuation (IA)
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From page 90... ...
, surgical treatment in the case of conductive or mixed losses, or the surgical insertion of a cochlear implant. Because of the significant nature of the hearing loss in the affected ear, patients with SSD or AHL pose special treatment challenges because the affected ear typically cannot receive benefit from traditional technologies, such as an air conduction hearing aid.
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From page 91... ...
The only treatment option that provides truly binaural hearing for SSD patients or patients with an AHL with an ear that has profound hearing loss is a cochlear implant. As has been explained previously, cochlear implants include surgical placement of an electrode array into the cochlea of the affected ear, with the patient using an externally worn sound processor that picks up sound from the environment and sends the signal to the implanted electrode array, which stimulates the inner ear and provides sound information to the brain.
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From page 92... ...
The presence of reduced speech recognition in the implanted ear soon after receiving a cochlear implant is somewhat common. However, reduced speech recognition with the cochlear implant is not as detrimental or as difficult for adult or pediatric patients with SSD or AHL as they are able to rely on the hearing ability of their normal hearing or near-normal hearing ear to communicate.
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From page 93... ...
Currently, patients without a cochlear implant qualify for Listings-level disability if they demonstrate an average air conduction hearing threshold of 90 dB or greater in the better ear and an average bone conduction hearing threshold of 60 dB or greater in the better ear (2.10A) or if they demonstrate a word recognition score of 40 percent correct or less in the better ear determined using a standardized list of phonetically balanced monosyllabic words (2.10B)
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From page 94... ...
, it is reasonable to consider the hearing in the better ear when determining whether a patient with a cochlear implant qualifies for disability due to hearing loss after they receive a cochlear implant. TESTING HEARING ABILITY IN PERSONS WITH SINGLE-SIDED DEAFNESS OR ASYMMETRIC HEARING LOSS RECEIVING A COCHLEAR IMPLANT SSA asked the committee whether the tests identified in task 3 of the Statement of Task remain appropriate for testing hearing ability in persons with SSD or AHL receiving a cochlear implant and why and also if there are any differences in how the tests should be administered or interpreted.
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From page 95... ...
. PROXIES FOR THE HEARING IN NOISE TEST FOR INDIVIDUALS WITH SINGLE-SIDED DEAFNESS OR ASYMMETRIC HEARING LOSS The committee was asked to determine whether the equivalent scores identified in task 3 remain accurate proxies for the HINT word recognition scores when assessing persons with SSD or AHL receiving a cochlear implant.
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From page 96... ...
2014. Cochlear implants in single-sided deafness.
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From page 97... ...
2017. Unilateral cochlear implantation reduces tinnitus loudness in bimodal hearing: A prospective study.
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