Adult Patients With Severe-to-Profound Unilateral Sensorineural Hearing Loss
American Academy of Audiology. (2015).
Reston (VA): American Academy of Audiology, 1-49.
This guideline provides comprehensive recommendations and strategies for the assessment and management of adults with severe-to-profound unilateral sensorineural hearing loss (USNHL). The target audience includes audiologists, physicians, dentists, and other healthcare providers who support the treatment plans of adults with severe-to-profound USNHL. Recommendations for assessment, device selection, device fitting, device verification, device validation, and counseling are presented.
American Academy of Audiology
Device orientation for adults with unilateral sensorineural hearing loss should include information about device features, insertion and removal of device, battery use, care and cleaning of ear mold and device, feedback, device warranty, moisture control, user manual, wearing schedule, phone use with the device, troubleshooting, return policy, and post-fitting follow-up. (Levels 1, 2, 3, 4, and 6 Evidence, Grades A, B, C, and D Recommendation; pp. 42-46).
Audiologists should assess the non-auditory needs of adults with unilateral sensorineural hearing loss (USNHL) to establish which factors may impact the patient’s treatment plan, to screen additional areas such as cognition or depression as appropriate, to determine whether referrals to other specialists are required, and to identify any other unique needs of a patient with USNHL (Levels 4 and 6 Evidence, Grades B, C, and D Recommendation; pp. 14-15).
Validated questionnaires should be used to select the appropriate hearing device for adults with sensorineural hearing loss and should specifically evaluate the patient’s baseline communication needs, performance, and goals (Level 4 Evidence, Grades B, C, and D Recommendation; p. 12).
Education and counseling for adults with severe-to-profound unilateral, sensorineural hearing loss should include the patient’s primary communication partner(s)/caregiver(s), can be provided in a group or individual setting, and may require follow-up (Levels 2 and 4 Evidence, Grades A and B Recommendation; pp. 44-46).
For adults with severe-to-profound unilateral sensorineural hearing loss considering a bone conduction (BC) device,
<ul>
<li>transcranial attenuation (TA) of BC thresholds on the better hearing side should be measured and compared to the BC thresholds on the side with hearing loss;</li>
<li>a power device should provide additional output to overcome TA during candidacy assessment;</li>
<li>speech-in-noise should be assessed using a 45- or 90-degree azimuth on each side to determine whether head shadow effect has been eliminated;</li>
<li>counseling regarding hearing performance in noise should be provided; and</li>
<li>at-home, programmed testband trials should be provided to those patients who have a TA of less than 10dB and improved aided speech-in-noise performance (Levels 2, 3, and 4 Evidence, Grades A, B, and C Recommendation; pp. 20-21).</li>
</ul>
Clinicians should evaluate device and hearing outcomes of adults with severe-to-profound unilateral sensorineural hearing loss (USNHL). For the USNHL population, the following questionnaire tools are useful:
<ul>
<li>The Speech, Spatial, and Qualities of Hearing Scale (SSQ),</li>
<li>The Bern Benefit in Single Sided Deafness Questionnaire (BBSS),</li>
<li>The Glasgow Hearing Aid Benefit Profile (GPHAB), or</li>
<li>The Hearing Handicap Inventory for Adults (HHIA) (Ungraded; p. 48).</li>
</ul>
For adults with severe-to-profound unilateral, sensorineural hearing loss (USNHL), “determining candidacy for rehabilitative treatment should incorporate deficit-specific measures to quantify the degree [of hearing loss] ... and provide a benchmark for future outcomes” (p. 18). USNHL should be identified by an air conduction (AC) pure-tone average (PTA) of greater than or equal to 70 dB in one ear at 500, 1000, 2000, and 3000 Hz and normal hearing (AC PTA that is less than or equal to 20 dB at 500, 1000, 2000, and 3000 Hz) in the other ear (Ungraded; p. 18).
Hearing Assistive Technology (HAT) should be considered as a supplement to other devices for adults with unilateral sensorineural hearing loss. Implementation of HAT should include counseling, instruction, coaching, and establishing goals to optimize HAT use. HAT devices should be personalized and adjusted to achieve optimal gains (Levels 4, 5, and 6 Evidence, Grade, B, C, and D Recommendation; pp. 39-40).
When selecting a device for an adult with severe-to-profound unilateral sensorineural hearing loss,
<ul>
<li>anatomical exclusion criteria should be considered,</li>
<li>demographic characteristics should not be a factor in device recommendations,</li>
<li>audiometric thresholds alone are not adequate for device selection,</li>
<li>transcranial attenuation should be assessed and factored into possible outcomes,</li>
<li>device trials should be provided as possible,</li>
<li>aided and unaided speech-in-noise measurements for device options should be assessed to determine which device provides the greatest benefit,</li>
<li>patients should complete questionnaires to assess their perceived benefit,</li>
<li>assessment and consideration should be given to: “cosmetics, opposition to surgery, comfort and ease of use, opposition to occlusion of better hearing ear, battery life and manipulation, perceived benefit, ability to maintain site and device, cost and insurance coverage, as well as the benefits and limitations associated with the various device-fitting configurations and technical characteristics” (p. 26),</li>
<li>the presence and severity of tinnitus should be measured and considered,</li>
<li>the presence or potential progression of a hearing loss in the better ear should be considered, and</li>
<li>all appropriate fitting options and their advantages and disadvantages should be presented to the patient (Level 2, 3, 4, and 6 Evidence, Grades A, B, C, and D Recommendation; pp. 26-29).</li>
</ul>
During the device fitting and verification process for adults with severe-to-profound unilateral sensorineural hearing loss,
<ul>
<li>a validated, prescriptive method of fitting should be used whenever possible;</li>
<li>the fit of the device and manageability should be assessed to ensure physical fit and comfort, ease of insertion/removal, and ability to manipulate device features;</li>
<li>air conduction device verification should use real ear probe microphone measures;</li>
<li>bone conduction device verification should be electromechanically verified;</li>
<li>sound field measures should not be the primary verification measure;</li>
<li>speech-in-noise, with the speech signal forwarded to the aided ear, should be used as the behavioral method of verification;</li>
<li>word recognition in noise and loudness comfort should be used in the absence of electroacoustic verification; and </li>
<li>subjective assessment tools should augment objective validation measures (Levels 1, 2, 3, 4, and 6 Evidence, Grades A, B, and C Recommendation; pp. 34-36).</li>
</ul>
Education and counseling for adults with unilateral sensorineural hearing loss should include information about the anatomy of the auditory system, audiogram results, goals and expectations, supplemental HAT options, environmental listening challenges, adapting to different settings, communication strategies, speech reading, participation in rehabilitation classes, wearing hearing protection, and realistic understanding of outcomes. (Levels 1, 2, 3, 4, and 6 Evidence, Grades A, B, C, and D Recommendation; pp. 42-46).
Prior to fitting hearing devices for adults with severe-to-profound unilateral sensorineural hearing loss, all hearing devices should undergo electroacoustic verification. Device features (e.g., directional microphone, noise reduction, feedback management) and physical parameters (e.g., earmold/shell style, vent size, color) should also be verified. In instances when features cannot be verified by standard electroacoustic or physical examination, devices should be verified through a listening check (Levels 4 and 6 Evidence, Grades B and D Recommendation; pp. 30-31).
Assessment and diagnosis of adults with severe-to-profound unilateral sensorineural hearing loss should “identify the type, degree, and configuration of the hearing loss for each ear” (p. 9). Additional audiological monitoring should occur annually. The process should include:
<ul>
<li>“case history, otoscopic examination, comprehensive audiometric examination that includes air conduction thresholds, bone conduction thresholds, speech recognition threshold (SRT) and word recognition score (WRS), otoacoustic emissions, tympanometry, and acoustic reflex thresholds and reflex decay” (p. 9), </li>
<li>additional evaluation and/or medical referral as needed,</li>
<li>assessment of candidacy for amplification and/or hearing assistive technology (HAT),</li>
<li>determination for any required medical clearances,</li>
<li>characterization of the impact of USNHL on daily life, and </li>
<li>counseling the patient and caregivers about assessment results and recommendations (Ungraded; p. 9).</li>
</ul>
Audiologists should “be knowledgeable about current fitting and device options and the procedures for verifying, validating, and counseling patients with severe-to-profound [unilateral sensorineural hearing loss] USNHL” (Ungraded; p. 5).
Comprehensive management plans for adults with severe-to-profound unilateral sensorineural hearing loss should include the following components:
<ul>
<li>service provision by a licensed audiologist, </li>
<li>multi-disciplinary care including the audiologist, patient, otologist, family/caregivers, or other health-care professionals as appropriate, </li>
<li>assessment of quality of life and community participation, </li>
<li>functional and realistic treatment goals, </li>
<li>appropriate device selection, quality control, fitting, and verification, </li>
<li>use of hearing assistive technology as appropriate, </li>
<li>instruction, orientation, and counseling of device use, and </li>
<li>outcome assessment (Ungraded; p. 8).</li>
</ul>
