Hearing Loss, Cancer Treatments and Ototoxicity

Hearing Loss and Cancer Treatments and Ototoxicity

Certain medications can cause damage to the ear which could result in hearing loss, balance disorders or ringing in the ear. These medications are considered ototoxic (Cone, Dorn, Konrad-Martin, Lister, Ortiz and Schairer, 2016). There are now more than 200 known ototoxic drugs. These medicines are used to treat heart disease, serious infections and cancer. Ototoxic drugs can include NSAIDS, certain aminoglycoside antibiotics such as Gentamycin, Erythromycin, Tobramycin, Streptomycin, as well as diuretics such as furosemide, and cancer chemotherapy drugs including cisplatin and carboplatin (American Tinnitus Association, 2012).

The platinum based compounds cisplatin and carboplatin have been known to cause hearing loss, especially in high doses. Chemotherapy from the platinum group is used to treat head and neck cancers, brain cancer and lung, bladder and ovarian cancers. They are also used to treat brain, bone and liver cancers in children (Cone et al., 2016). Hearing loss from the platinum group is typically bilateral, symmetrical and sensory neural in nature (Bass, White and Jones, 2013). Hearing loss usually occurs shortly following treatment; however, a late onset hearing loss has also been documented in patients treated with cisplatin. Bass et al. report the number of cancer-surviving children with hearing loss as the result of ototoxicity is significant. While carboplatin is far less ototoxic than cisplatin, the risk for developing hearing loss should not be discounted.

It is still important to remember that treatment with a particular medication, even an ototoxic one, may actually be the best hope for curing a life-threatening disease or infection. Therefore, anyone who has undergone cancer treatment with cisplatin or high doses of carboplatin or radiation to the head or neck, or treatment for serious infections with certain aminoglycoside antibiotics, should have their hearing tested at least once following completion of the treatment (Vanderbilt Cancer Center, 2016).

References
American Tinnitus Association. (2012). Ototoxic brochure by League for Hard of Hearing.
Bass, J., White, S., Jones, S. (2013). Monitoring ototoxicity in the pediatric oncology population. American Speech-Language-Hearing Association. http://www.asha.org/Articles/ Monitoring-Ototoxicity-in-the-Pediatric-Oncology-Population/
Cone, B., Dorn, P., Konrad-Martin, D., Lister, J., Ortiz, C., & Schairer, K. (2016). Ototoxic medications (medication effects). American Speech-Language-Hearing Association. http://www.asha.org/public/hearing/Ototoxic-Medications/
Vanderbilt Cancer Center. (2016). Hearing loss. http://www.mc.vanderbilt. edu/documents/cancersurvivor/files/Hearing.pdf

Bone-Anchored Devices for Conductive and Mixed Losses

Bone-Anchored Devices for Conductive and Mixed Losses

A bone anchored implant combines the concepts of osseointegration and bone conduction hearing. Osseointegration is a structural and functional connection between living bone and the surface of an implant. This involves the anchoring of a surgical implant (as in a bone-anchored implant) by the growth of bone around it. A bone-anchored device is a surgically implantable system for the treatment of hearing loss through direct bone conduction (Cass and Tringali, 2016).

Bone-anchored devices have been used since 1977 and were FDA approved for treatment of conductive and mixed hearing loss in the U.S. in 1996. In 2002, the FDA approved its use for single-sided deafness as well (Cass and Tringali, 2016)(this was discussed in the SSD blog on our website).

The bone-anchored system consists of three parts:
• A small titanium implant that sits in the bone behind the implanted ear
• An abutment or magnet
• A sound processor that sits behind the ear

How does it work?
The sound processor either clicks on the abutment or a magnet is implanted under the skin and the processor is attached to a second external magnet which attracts to the internal magnet. Once the processor is attached, the processor picks up sound waves and transforms them into sound vibrations through the skull.

Who is a candidate?
Those with conductive or mixed hearing loss could be considered a candidate. Ear problems which could cause conductive or mixed losses include recurrent ear infections, congenital aural atresia or ear malformation or stenosis of the ear canal.

At SENT Hearing Aid Center, we program two transcutaneous devices: one by Oticon Medical and another by Cochlear Corporation. We also program the two magnet-based systems: one made by Cochlear Corporation and the other by Sophono.

For more information, contact our office.

References
Cass, S., & Tringali, S. (2016). Surgical placement of bone-anchored hearing systems. Medscape, http://emedicine.medscape.com/article/1604065-overview

MEDIA RELEASE: SENT Hearing Aid Center Donates Hearing Aids and Services to Long-Time Patient

LOCAL AUDIOLOGY PRACTICE DONATES HEARING AIDS TO LONG-TIME PATIENT

Sacramento, Calif. (August 23, 2016)—S.E.N.T. Hearing Aid Center, a division of Sacramento Ear, Nose & Throat Surgical and Medical Group (SacENT), is fitting Gabby Eyman, a 24-year-old Sacramento native, with a pair of hearing aids as a part of their community giving program on August 31.

Eyman, a long-time patient of SacENT and S.E.N.T. Hearing Aid Center, was born with Turner Syndrome, a chromosomal disorder. Signs of Turner Syndrome include hearing problems, as well as short stature, delayed puberty, infertility, heart defects and learning disabilities. Eyman has worn hearing aids her entire life; her current pair of hearing aids are outdated and do not fit well.

The hearing aids, donated by Siemens/Signia, will make Eyman’s job as a full-time nanny much easier. S.E.N.T. Hearing Aid Center is donating all hearing aid services regarding fitting this instrument, and follow-up thereafter to this patient. “I’m super excited to get these new aids,” said Eyman. “It is very hard to understand what I hear sometimes and these aids will help me so much.”

Hearing aids bring sound into the ear and amplify it to a level that compensates for the level of hearing loss. If not covered by any insurance, hearing aids can cost up to $5,000 for a pair. People with hearing loss typically benefit most from hearing aids that have been individually fitted and programed for their specific hearing needs by an audiologist.

Single-Sided Deafness

Single-sided deafness (SSD) is defined as a condition when one has non-functional hearing in one ear that does not receive benefit from traditional amplification and normal or near normal hearing in the other ear. While the precise incidence of SSD is unknown, the prevalence is estimated at 3-6% of the population (Baguley et al., 2006). Those with SSD experience problems hearing in background noise, difficulties with localization and spatial hearing and difficulties hearing those who are near their non-functional side (Cire, 2012).

Causes of SSD
• Presence or removal of an acoustic neuroma (a benign, slow-growing tumor in the cerebellopontine angle).
• Sudden idiopathic loss due to an unexplained viral infection often causing permanent damage to the hair cells and fine structures of the cochlea.
• Vascular issues that damage the auditory pathway.
• Blunt trauma to the head which results in a transverse fracture of the temporal bone.
• Meniere’s disease whereupon excess fluid pressure in the inner ear causes long-term damage to the cochlea.
• Congenital or genetic issues.
• Autoimmune ear disease.
(Cire, 2012)

Solutions
• Do nothing.
• CROS/BICROS hearing aid: CROS is an acronym for contralateral routing of signals. It consists of two parts, a microphone (transmitter) worn at the bad ear and a hearing aid (receiver) worn at the good or better ear. The microphone at the dead ear picks up sounds and routes the sound from the dead ear to the better ear. While previous wireless devices had issues with excessive battery drain, the new Siemens/Signia CROS device provides clear transmission of sound without excessive battery drain. We have had great success with this instrument. For more information on Signia and Siemens hearing instruments visit: https://www.signiausa.com/
• Bone conduction solutions: Originally referred to as BAHA (bone anchored hearing aid), this solution consists of osseointegrated devices which include an implant, an external abutment or a magnet and a sound processor. The sound processor sends vibrations via the abutment or magnet to the implant through the skull through bone conduction to the better hearing ear. Surgical implantation is required and can be completed through Sacramento ENT: www.sacent.com
Following a specified healing period, the sound processor is fit to the patient. At SENT Hearing Aid Center, we offer bone-conduction devices from these manufacturers:
 Oticon Medical: http://www.oticonmedical.com/
 Cochlear Corporation: http://www.cochlear.com/
 Sophono: http://sophono.com/

What a CROS Aid or Bone Conduction Device Does:
• Helps you hear when someone is speaking at the “bad ear” by sending the sound to the “good ear.”
What a CROS Aid or Bone Conduction Device Does Not Do:
• It does not improve sound localization. Two ears provide cues that allow us to localize sounds. When one ear is taken out of the equation, confusion occurs, and we have difficulty identifying near and distant sounds. Since all the sounds are going to one ear, localization may still be difficult.
• This device may not help with understanding speech in noise.
Which Device is Right for You?
I have found that those who have lived with congenital, unilateral hearing loss may be better off doing nothing. They have learned how to live with the issue. If the loss was recently acquired, the CROS or BAHA may be a good option. It is always easier to start with the “non-surgical” CROS option, and at SENT Hearing Aid Center, we offer a 60 day trial on hearing aids, including the CROS.

References
Baguley, D., Bird, J., Humphriss, R. & Prevost, A. (2006). The evidence base for the application of contralateral bone anchored hearing aids in acquired unilateral sensorineural hearing loss in adults. Clinical Otolaryngology, 31, 6-14
Cire, G. (2012). Understanding single sided deafness: Evaluation and treatment for professionals. Audiology Online

COCHLEAR IMPLANTS

This next blog was written by our Cochlear Implant audiologist, James Griffitts, Au.D. and 4th Year Doctoral student, Meghan Williams.

COCHLEAR IMPLANTS

Have you ever been in a situation where it is quiet, you are wearing your hearing aids, and you just cannot understand what your wife, child, or significant other is saying? Has your audiologist told you that your hearing aids are turned up all the way, and just cannot be turned up anymore? Do you find yourself withdrawing from social situations because even with hearing aids you might not understand someone, and don’t want to embarrass yourself? While these situations can be frustrating for individuals with hearing loss, they may be a sign you are a cochlear (koe-klee-er) implant candidate.

What is a cochlear implant?
A cochlear implant, a small electronic device, is the alternative that can be used when one no longer receives benefit from hearing aids. There are two parts to a cochlear implant: the external component that sits behind the ear, like a hearing aid, and the internal component that is surgically implanted. (National Institute on Deafness and Other Communication Disorders, 2014)

Step-by-step how the cochlear implant works:
In order for an individual with a cochlear implant to “hear,” sound must travel from the external component to the internal component of the device. The external component includes the microphone, speech processor, and transmitter. The microphone gathers sound from the environment and sends it to the speech processor. The information received by the speech processor is then changed into a digital signal and sent to the transmitter and to the internal components of the device. The internal component includes the receiver/stimulator and the electrode array. The receiver/stimulator receives the signal from the transmitter and changes it into electrical impulses that travel along the electrode array. The electrode array activates the auditory nerve and sends the signal to the brain, where it is interpreted as sound. (U.S. Food and Drug Administration, 2014)

Who is a candidate?
Not everyone with hearing loss is a candidate for a cochlear implant. The hearing loss must be due to damage to the hearing nerve, also known as sensorineural hearing loss. For individuals who are 18 years or older, the hearing loss must be in both ears, moderate to profound in severity, and the individual must have limited or no benefit from hearing aids. For children 2-17 years of age, they must have severe to profound sensorineural hearing loss in both ears and receive little or no benefit from hearing aids. Children 12-24 months must have profound hearing loss in both ears and receive little or no benefit from hearing aids. The benefit from hearing aids is evaluated by an audiologist when determining candidacy. (Cochlear Ltd., 2016)

Manufacturers:
There are currently three cochlear implant manufacturers that are FDA approved in the United States, and several other smaller manufactures throughout the world (U.S Food and Drug Administration, 2015). The companies approved in the U.S. are Cochlear Corporation, Advanced Bionics and Med-El. At Sacramento ENT, we currently offer cochlear implants from Cochlear Corporation and Advanced Bionics.

Services provided by Sacramento ENT:
Receiving a cochlear implant begins with a thorough evaluative process. One must undergo a number of tests in order to establish candidacy. These tests include hearing tests, imaging studies including a CT scan and/or MRI scan, and a test of inner ear balance function called a VNG. Other medical tests may be necessary depending on age or health. Once the decision has been met to proceed with the cochlear implant, one of our audiologists will sit down and help reach decisions regarding the colors, sizes, and accessory devices that are included with the implant. Four to six weeks after the device is surgically implanted by our otologist, the patient will be seen by one of our audiologists to provide the external processor and “turn on” the device; this is also known as the initial activation. This appointment is primarily used to begin to re-introduce sound to the patient as well as provide enough knowledge to be able to manage batteries, remote controls and other accessories. It is important to remember that this is the first of multiple appointments with the audiologist. Several follow up appointments will take place within the first few months, at which times the processor settings will be adjusted and fine-tuned. Reaching maximum performance with the cochlear implant can take up to a year or more. These appointments are also used to review and demonstrate accessories such as wireless devices to be used with the phone or television. The audiologist will also monitor your progress with additional auditory tests as well as ensure the device is being used as much as possible as this facilitates faster progress.

Our audiologists are always happy to answer any questions and help with any concerns throughout this process. If you would like more information on candidacy, please contact one of our Cochlear Implant audiologists through the website: www.sacent.com.

References
Cochlear Ltd. (2016). Candidacy. Retrieved from http://www.cochlear. com/wps/wcm/connect/us/for-professionals/products/cochlear-implants /candidacy
National Institute on Deafness and Other Communication Disorders (NIDCD). (2014). Cochlear Implants. Retrieved from https://www.nidcd.nih.gov/health/cochlear-implants#c
U.S. Food and Drug Administration. (2014, June 6). What is a Cochlear Implant? Retrieved from http://www.fda.gov/MedicalDevices/ ProductsandMedicalProcedures/ImplantsandProsthetics/CochlearImplants/ucm062823.htm
U.S. Food and Drug Administration. (2015, October 28). Cochlear Implants. Retrieved from http://www.fda.gov/MedicalDevices/Productsand MedicalProcedures/ImplantsandProsthetics/CochlearImplants/