Fluctuating Hearing Loss in the Only Hearing Ear: Cochlear Implantation in the Contralateral Deaf Side

Didier Bouccara ¹ Francesca Yoshie Russo ¹ Daniele De Seta ¹ Ghizlene Lahlou ^1,2 Stéphanie Borel ¹ Yann Nguyen ^1,2 Olivier Sterkers ^1,2 Daniele Bernardeschi ^1,2 Isabelle Mosnier ^1,2

¹ENT, AP-HP, GHU Pitié-Salpêtrière, Service ORL, Otologie, Implants Auditifs et Chirurgie de la Base du Crâne
²INSERM, Sorbonne Universités, Université Pierre et Marie Curie Paris 6, Inserm, Unité Réhabilitation Chirurgicale Mini-invasive et Robotisée de L’audition

Objective: To investigate the hearing performance of adult patients presenting unilateral deafness with contralateral fluctuating hearing loss who received a cochlear implant on the deaf side.

Study Design: Retrospective case review.

Setting: University tertiary referral center.

Subjects and Methods: Preoperatively, and at 6 and 12 months postoperatively, all patients underwent pure tone audiometry, and speech audiometry with disyllabic and monosyllabic words in a quiet environment, and sentences in quiet and noisy (SNR +10 dB SPL) environments, under best-aided conditions. The Abbreviated Profile of Hearing Aid Benefit (APHAB) inventory was evaluated preoperatively, at 6 and 12 months.

Results: Twenty-three patients were included. No difference was found between preoperative and postoperative tests for disyllabic and monosyllabic words. For sentences in quiet and noisy environments, a difference between preoperative and postoperative performance was present at 1 year (p=0.002 and p=0.02, respectively). In a noisy environment, a difference was present at both 6 and 12 months postoperatively compared to the preoperative value (6 months: 42±7.1% vs 61±6.5%, p=0.016. A significant improvement in the APHAB score was found at 6 and 12 months postimplantation (Friedman’s two-way ANOVA by ranks p < 0.001). The number of years of hearing deprivation of the deaf ear was not correlated with performance.

Conclusion: When an invalidating fluctuating hearing loss occurs in patients presenting a contralateral deaf ear, a cochlear implant is indicated in the latter ear, allowing the difficulty in conventional hearing aid fitting to be overcome, significantly improving performance in noisy conditions, and achieving a better quality of communication.