Miller School Faculty Among International Authors of First Bimodal Hearing Guidelines

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An international group of audiology experts including University of Miami Miller School of Medicine faculty has authored first-of-their-kind guidelines of best practices for managing hearing loss in adults with bimodal hearing configurations. The guidelines are published in Otology and Neurotology Open.

“Whenever you see a group of authors on a key publication like this, it’s really important to have representation from the Miller School Ear Institute, which is an internationally recognized program for treating patients with hearing loss,” said guidelines author Meredith A. Holcomb, Au.D., CCC-A, director of the Hearing Implant Program and associate professor of otolaryngology at the 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 caring for patients with hearing loss.”

Approximately 80% of patients with a cochlear implant in one ear have residual hearing in the other ear, which means they would likely benefit from a bimodal hearing system.

Prior to this publication, there were no recommendations on standard of care practices for fitting adult patients with bimodal hearing technology for the treatment of bilateral hearing loss. It is a common problem that often goes untreated, according to Dr. Holcomb.

Costs 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, employment, communication, mental health, and cognition,” said Dr. Holcomb, who also is the immediate past-chair of the American Cochlear Implant Alliance.

More than 1.5 billion people globally live with hearing loss, and more than 430 million people have hearing loss disabling enough to warrant treatment — a number that could rise to over 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 global standard of care treatment for adults with bilateral severe to profound hearing loss, but utilization is low. In the U.S., 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 in which acoustic input from a hearing aid in one ear is combined with electrical stimulation from a cochlear implant in the other ear, according to the guidelines paper.

Prior to this publication, there were no recommendations on standard of care practices for fitting adult patients with bimodal hearing technology for the treatment of bilateral hearing loss.
Best Practices for Better Outcomes

“We found an enormous gap in the literature about how to best manage bimodal patients. As a result, we developed these best practices to educate anyone who works with patients with hearing loss, including primary care physicians, hearing instrument specialists, and audiologists. The guidelines should assist hearing health care providers in achieving best outcomes for their adult patients, with the most appropriate available hearing technology,” Dr. Holcomb said.

The new guidelines include the benefits of bimodal hearing; preoperative cochlear implant evaluation and surgery; postoperative cochlear implant fitting and assessment; bimodal hearing aid fitting; evidence for selecting a contralateral routing of signal device; evidence to support cochlear implant and hearing aid treatment for tinnitus relief; and when to consider aural 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 gleaned from her world-renowned research on decrements in patients who only have hearing in one ear, according to Dr. Holcomb.

“Dr. Snapp added a tremendous amount to these guidelines with the work she has done throughout her career in the area of single-sided deafness,” Dr. Holcomb said. “My contributions were primarily from the clinical viewpoint of managing cochlear implant recipients over the last 15 years.”

Dr. Snapp said that she and Dr. Holcomb are “incredibly proud to join our colleagues at leading institutions, including Vanderbilt University Medical Center, the University of Iowa, and Erasmus Medical Center in the Netherlands, in important initiatives such as this.

“These guidelines address several important aspects of care for the management of patients with hearing implant technology,” she said. “Such contributions are important in closing gaps to treatment, increasing access to care, and improving the quality of patient care and patient outcomes.”

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