Question
Please discuss possible audiologic management of bilateral atresia.
Answer
Providing audiologic management for bilateral atresia is a challenge requiring thoughtful analysis and patience on the part of the clinician as well as the patient.
Once the extent of the atresia is determined and surgical intervention provided, if appropriate, the patient needs to be evaluated for the most useful, practical and comfortable amplification system. If surgery is not an option, then a power behind-the-ear, with a bone conduction receiver mounted onto a headband can be used effectively.
In my experience, given the delicacy of such an instrument and the normal wear and tear associated with it, I believe it is worthwhile for the patient to have a matching spare system to eliminate down time, if and when the primary system is being repaired.
If reconstructive surgery is done to rebuild the canal and pinna, it MAY be possible to try a canal hearing instrument, if the new canal will cradle the instrument properly. If that does not work, an air conduction behind-the-ear hearing aid may be used, assuming there is enough give in the pinna for it to rest behind the ear.
In my experience, neither of these options worked, despite many creative attempts and modifications.
My patient continues to use an Oticon E38 BTE with a bone conduction receiver mounted onto a headband. Her functional receptive and expressive communication ability is very good.
BIO:
Donna S. Wayner, Ph.D. is the former Director of the Diagnostic and Rehabilitative Audiology Department and Clinical Associate Professor of Surgery in the Department of Otolaryngology at the Albany Medical Center in Albany, New York . She is presently Co-president of Hear Again, Inc. in Austin, Texas (www.hearagainpublishing.com).