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    SSD | Cochlear implant

    Audiological aspectAudiological aspect   Medical aspect  Medical aspect     User's report User's report




    Audiological aspect Restoring hearing in deaf ear

    "The CI improved localization accuracy and reduced side bias. [...]. The CI improved masked sentence recognition when the masker was presented from the front or from the side of normal or near-normal hearing. [...] CI benefits were consistently observed across individual subjects." (Buss et al. 2018)

    "A CI is the only device that can restore auditory input in the deafened ear and provide the user with access to the binaural hearing system." (Kurz et al. 2020)

    "The post-CI developmental trajectory provided clear evidence of age-appropriate development of auditory cortical responses, and decreased cross-modal reorganization, consistent with improved speech perception and sound localization. Post-CI, the child [with SSD] demonstrated age-appropriate auditory cortical development and improved speech perception and sound localization suggestive of significant benefits from cochlear implantation."
    (Sharma et al. 2016)

    More: Tavora-Vieira et al. 2013, Lorens et al. 2019, Polonenko et al. 2017, Finke et al. 2017, Peters et al. 2018, Arndt et al. 2011, 2017, Firszt et al. 2012, Blasco et al. 2014

    Audiological aspect Binaural hearing

    "Patients with a postlingual onset of a profound hearing loss in one ear and normal hearing or only a moderate loss in the other ear are able to make the effective use of a CI in the profound-loss ear in conjunction with acoustic stimulation of the other ear." (Lorens et al. 2019)

    "Cortical auditory evoked response latencies recorded from the CI and NHe showed no significant difference, indicating that the detection of sound in the auditory cortex occurred simultaneously, providing the cortex with auditory information for binaural hearing." (Wedekind et al. 2020)

    More: Mertens et al. 2016, Buss et al. 2018, Tavora-Vieira et al. 2019, 2015, Erbele et al. 2015, Arndt et al. 2017

    Audiological aspect Decreased head shadow / improved SNR / improvement in summation & squelch

    "CIs provide listeners with unilateral deafness important benefits for speech perception in complex spatial environments, including a larger head-shadow benefit when speech and noise originate on opposite sides of the head." (Bernstein et al. 2017)

    Tavora-Vieira et al. (2013) observed significant improvement in speech in noise scores for 3 challenging spatial configurations (conclusion / Tavora-Vieira et al. 2013)

    "For adults with SSD or AHL [...] who had postlingual onsets of the profound loss in the non-hearing ear, [...] the addition of the CI enables binaural hearing with positive and highly significant effects of binaural summation, head shadow, and binaural squelch." (Lorens et al. 2019)

    More: Vlastarakos et al. 2014, Kitoh et al. 2016, Kurz et al. 2020, Buss et al. 2018, Mertens et al. 2016, Arndt et al. 2017, Rahne et al. 2016, Hansen et al. 2013, Mlynski et al. 2012, Tavora-Vieira et al. 2019

    Audiological aspect Better localization and directionality

    Literature shows a statistically significant improvement of localisation abilities after CI implantation, but the duration of deafness influences the results (HEARRING consensus)

    Tavora-Viera et al showed that "adults with >25 years of unilateral deafness obtained speech perception scores and subjective outcomes that are similar to those attained by individuals with normal hearing and/or those with bilateral CI". (conclusion / Tavora-Vieira et al. 2013)

    More: Buss et al. 2018, Mertens et al. 2016, Tavora-Vieira et al. 2016, Arndt et al. 2017, Lorens et al. 2019, Großmann et al. 2016, Blasco et al. 2014, Erbele et al. 2015, Kurz et al. 2020, Ehrmann-Müller et al. 2020

    Medical aspect MRI conditionality

    "Patients undergoing 1.5 T MRIs with devices including a diametrically bipolar magnet or a rigid implant screw fixation, experienced no pain, even without headbands." (Todt et al. 2018)

    Intraindividual artifact size differences between the three magnets and are smaller than interindividual maximum artifact size differences. 3 T MRI scans, in comparison to 1.5 T MRI scans, show a difference between soft artifact areas. Conclusion: We observed no major difference between maximum implant magnet artifact sizes of the three implant magnet types." (Todt et al. 2020)

    More: Wimmer et al. 2019, Bawazeer et al. 2019, Azardamaki et al. 2014

    User's report Increased confidence in social situations

    "[In the structured interviews of SSD CI participants,] increased engagement in social activities since implantation was mentioned as well as social withdrawal preimplantation (e.g. return to an active social life after CI switch-on, higher self-confidence)." (Finke et al. 2017)

    More: Vermeire et al. 2009, Arndt et al. 2011, Kleine Punte et al. 2011

    User's report Decreased fatique

    Bess et al. (2014) showed how exhausting listening with SSD can be and the beneftit a CI can bring. (conclusion / Bess et al. 2014)

    User's report Increased listening and language acquistion

    McKay (2010) states, that getting access to the advantages of binaural hearing, leads to increased listening and language acquistion. (conclusion / McKay 2010)

    More: Buss et al. 2018, Dirks et al. 2019, Tavora-Vieira et al. 2015

    User's report Increased scholastic performance

    During the period of development, binaural hearing is even more important in young children than it is in adulthood. As shown in longitudinal studies, pediatric [unilateral hearing loss] can lead to significant psychosocial difficulties and school problems (…) (conclusion / Lieu et al. 2012)

    More: Bess et al. 2014, Spencer et al. 2004

    User's report Increased quality of life and opportunities for individual recipients (also elderlys QoL)

    "Furthermore, cochlear implantation in patients with SSD and additional tinnitus was successful for tinnitus reduction and able to improve quality of life." (Prejban et al. 2018)

    "Responses from 14 (SSD) participants accounted for a substantial change in their quality of life after CI activation. (...) With respect to working life,  (SSD) CI users state that prior to implantation they had the feeling to be no more capable of pursuing their job in the same way as before their [hearing loss] (...) The return to an active social life, privately and professionally, increased the perceived self-value of all participants." (Finke et al. 2017)

    "In this study, older adults with more than 25 years of unilateral deafness obtained scores in speech perception testing and in subjective evaluation that are similar to those attained by individuals with normal hearing and/or those with bilateral cochlear implants." (Tavora-Vieira et al. 2013)

    Cloutier et al. (2014) showed great quality of live benefits and significant improvement in audiologic performance as seen in speech recognition scores (conclusion Cloutier et al. 2014)

    More: Vermeire et al. 2009, Arndt et al. 2011, Kleine Punte et al. 2011, Pok et al. 2011, Dillon et al. 2017, Mertens et al. 2016, Tavora-Vieira et al. 2019, Finke et al. 2017, Carlsson et al. 2011

    User's report Increased music appreciation

    "Music enjoyment from electric stimulation is extremely poor relative to a readily interpretable [normal hearing] baseline for CI-SSD listeners. However, the combination of this unenjoyable signal presented through a CI and an unmodified acoustic signal presented to a [normal hearing] (or near-[normal hearing]) contralateral ear results in enhanced music enjoyment with respect to the acoustic signal alone." (Landsberger et al. 2019)

    Brockmeier (2011) found that SSD CI users listen to music with their implants, that music has a greater role in their lives following implantation, and that overall, music activities are enhanced after implantation. (HEARRING consensus)

    "For all objective tests of music discrimination and speech perception in noise, there were no statistically significant differences between MED-EL and Cochlear CI systems. Subjectively, four subjects thought their MED-EL device was better than their Cochlear device for music appreciation. Four thought that music sounded more natural, less tinny and more reverberant with their MED-EL CI than with their Cochlear CI." (Harris et al. 2011)

    More: Todd et al. 2017

    User's report Tinnitus reduction

    Stimulation via a CI resulted in a significant reduction in
    tinnitus loudness (…)." (Van de Heyning et al. 2008)

    More: Häußler et al. 2019, Liu et al. 2018, Dillon et al. 2017,
    Tavora-Vieira 2015, Mertens et al. 2015, 2016, Peter et al. 2019




    Audiological aspect Intensive counselling needed to raise realistic expectations

    “Elective non-use among adult CI recipients with single-sided deafness was very rare and could be further prevented by comprehensive counselling to ensure that candidates have realistic expectations about the rehabilitation requirements and the outcomes with the CI” (Tavora-Vieira et al. 2020)

    "Several factors such as deafness duration, age of deafness onset, the presence of residual hearing, patient motivation, and the rehabilitation intensity need to be further investigated in order to understand their impact on performance after implantation." (Tavora-Vieira et al. 2013)
    "However, CI surgery is expensive and duration of SSD affects the outcome." (Cho et al. 2020)

    More: Kurz et al. 2019, Vlastarakos et al. 2014, Bosco et al. 2012, Thomas et al. 2017

    Medical aspect CI requires life long aftercare

    "After implantation, the surgeon is responsible to organize and perform a life-long follow-up. It refers to the technical check-up as well as the settings of the implants. Furthermore, regular updates of the software and hardware are necessary since they make progress of the implant technology useable for the patients." (Lenarz 2018)

    Medical aspect Not applicable in cases with congenital cochlear nerve deficiency (e.g. congenital SSD)

    "Congenital deafness (n= 24). More than 50% (n=14) of the congenitally deaf children showed aplasia / hypoplasia of the cochlear nerve in MRI; therefore they did not qualify for CI surgery" (Arndt et al. 2015)

    Medical aspect MRI artifacts

    "Metallic implants are a significant concern because of their interaction with the complex MR environment, which can introduce significant force, voltage, heat, image artifact, demagnetization, and potential device malfunction." (Shew et al. 2019)

    User's report Need for rehab

    "Nevertheless, several studies have defended the importance of intensive auditory training in order for all CI users with SSD, regardless of age, to achieve optimal outcomes." (Tavora-Vieira et al. 2019)

    More: Tavora-Vieira et al. 2015, Van de Heyning et al. 2016

    User's report Acceptance of CI hearing

    "The rapid increase of hearing-related QoL after 3-6 months ... indicates that our patients had little problems with adapting to the new hearing sensation provided by the CI." (Muigg et al. 2019)

    "An interesting finding is that in our case series even patients with long-standing deafness (...) were able to rapidly integrate the electric stimulation into their acoustic normal hearing, and to improve their speech perception scores in complex listening conditions as early as at 3 months postimplantation." (Tavora-Vieira et al. 2013)

    "Another factor that may contribute to the early and consistent benefit observed for CI recipients in the present study is the relatively deep insertion of the (...) standard electrode array. Monaural speech perception and binaural processing can be degraded by a shift in the mapping of place to frequency." (Buss et al. 2018)

    "Relatively accurate and asymptotic pitch perception was observed at the 1-month interval, indicating either very rapid acclimatization or the provision of familiar place and rate cues. Early availability of appropriate pitch cues could have played a role in the early improvements in localization and masked speech recognition previously observed in this cohort." (Dillon et al. 2019)

    More: Ehrmann-Müller et al. 2020, Thomas et al. 2017, Dorman et al. 2019

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