Question
Are there any long-term indications for the temporal bone for bone anchored hearing systems in children?
Answer
Ravi Sockalingam: No. There are no long-term negative effects on the temporal bone. This surgery is actually reversible. You could take the implant out if the patient does not want to use the device after a while. Sometimes during the drilling in surgery, the surgeon can go into the dura, and in some cases there are cerebrospinal fluid (CSF) leaks. This is usually not a huge problem to resolve, even on its own. Doctors are well-trained to deal with that, and if it happens, it is not life threatening. It also does not affect the temporal bone.
Are there differences in gain that we should look for when fitting a child who has SSD?
SSD assumes one normal ear, so what we are doing when we fit someone with single-sided deafness is routing sound to the good ear. The gain you are going to prescribe is to compensate for the transmission loss as sound crosses to the other side. There is usually a loss of energy, especially in the high frequencies; although it is very small, it happens. We tend to provide some gain to overcome that in the high frequencies. That is why we also tend to increase the gain in the high frequencies for that.
Are indicator lights a possibility with future devices? This is on many parents’ wish lists.
Yes. That is also on our wish list and something that we are definitely considering. It is a very useful feature to have, but one thing that we need to be aware of is the battery consumption. That is probably the stumbling block to implementation.
Is it still recommended to wait until after 12 months of age to fit a softband due to the skull differences?
No. This is based on my conversation with many practicing pediatric audiologists. They feel that the child is ready to get a softband as young as five or six months. Most of this has to do with head control. When the child exhibits a bit of head control and when the softband with the device in place will stay on the head, it is often an indication that the child should be able to benefit from wearing it.
At what age would children with SSD be recommended for implantation?
There are two schools of thought on this issue. One group would say that we do not see any problems and the parents do not report any problems with children with SSD, so we do not usually intervene. On the other hand, we have literature that shows that these children are at a greater risk of having problems in school. The second group says we should intervene as early as possible with these children. Even if you intervene, how do you measure the outcomes and know that these children are benefitting from the device before they go to school? This is something that we need to investigate. It is a good question, and one of the many that are unanswered today.
This Ask the Expert is an excerpt from the Oticon Medical webinar, Surgical and Audiological Considerations in Pediatric Bone Anchored Solutions. For more information about Oticon Medical and the Ponto system, please visit www.oticonmedical.com or the Oticon Medical Expo Page on AudiologyOnline.
