Long-Term Cochlear Implant Sound Processor Usage in Children with Single-Sided Deafness.

OBJECTIVE: To assess cochlear implant (CI) sound processor usage over time in children with single-sided deafness (SSD) and identify factors influencing device use. STUDY DESIGN: Retrospective, chart review study. SETTING: Pediatric tertiary referral center. PATIENTS: Children with SSD who received CI between 2014 and 2020. OUTCOME MEASURE: Primary outcome was average daily CI sound processor usage over follow-up. RESULTS: Fifteen children with SSD who underwent CI surgery were categorized based on age of diagnosis and surgery timing. Over an average of 4.3-year follow-up, patients averaged 4.6 hours/day of CI usage. Declining usage trends were noted over time, with the first 2 years postactivation showing higher rates. No significant usage differences emerged based on age, surgery timing, or hearing loss etiology. CONCLUSIONS: Long-term usage decline necessitates further research into barriers and enablers for continued CI use in pediatric SSD cases.

Early cochlear implantation for children with single sided deafness.

OBJECTIVES: Single-sided deafness (SSD) can have consequences for a child's language, educational, and social development. A cochlear implant (CI) is the only device which can restore true binaural hearing, yet they are only approved for children with (SSD) over the age of five in the United States. Reports on speech perception outcomes for children implanted at a younger age are limited. The present study aims to examine the effects of age at implantation, duration of deafness, hearing loss etiology, and presence of additional disabilities on device usage and speech perception outcomes. METHODS: A retrospective chart review was used to examine demographics and speech perception outcomes for 18 children implanted at age five or younger. RESULTS: Speech perception results were highly variable, with some children deriving significant benefit and others demonstrating no sound awareness through the implant alone. Age at implantation and duration of deafness did not have a clear impact on outcomes. Device usage was low in many children, often those with anatomical abnormalities such as a hypoplastic cochlear nerve. There are challenges to assessing speech perception in young children with SSD, leading to a lack of standardized outcome measures. CONCLUSIONS: Early CI for children with SSD may improve speech perception, but benefit is not guaranteed. Candidacy evaluation should consider both medical and audiological factors, in addition to the degree of family support and realistic expectations. Caution is especially warranted in children with significant anatomical anomalies.

Long-Term Outcome of Cochlear Implantation in Children With Congenital, Perilingual, and Postlingual Single-Sided Deafness.

OBJECTIVES: We investigated the long-term outcomes of children with single-sided deafness (SSD) after cochlear implant (CI) surgery, during and after rehabilitation, and compared the results of children with congenital, perilingual, and postlingual SSD. We evaluated the impact of SSD at age at onset and duration of deafness on their performance. DESIGN: Thirty-six children with SSD treated with CI participated in the study: 20 had congenital, seven perilingual (defined: >0 to 4 years), and nine had postlingual deafness (defined as >4 years of age). Their outcome with CI were measured on both subjective and objective scales: duration of device use, speech intelligibility in noise and in quiet, bilateral hearing and localization ability, quality of life and hearing, presence and loudness of tinnitus, and hearing ability of the better hearing ear. RESULTS: After a mean follow-up time of 4.75 years, 32 of the 36 children used their CI on a regular basis. The remaining four children were nonusers. These children had congenital SSD and were older than three years at the time of CI surgery. Overall, for congenital/perilingual and postlingual SSD, speech intelligibility in noise and the Speech, Spatial and Qualities of Hearing Scale (SSQ) speech subscore were significantly improved, as were their subjective and objective localization ability and hearing-related quality of life. Children with postlingual SSD benefited from the CI with regard to speech intelligibility, SSQ speech/spatial/total score, and localization error, and children with congenital SSD showed better results with a short duration of deafness of less than 3 years compared with those with a longer deafness period. CONCLUSIONS: Cochlear implantation is a successful treatment for children with congenital/perilingual or postlingual SSD. Results largely differed with respect to the onset and duration of deafness, and better outcomes were achieved by children with postlingual SSD and with a short duration of deafness. Our data also confirmed that children with congenital SSD should be implanted with a CI within three years of age.

Use of Socioeconomic Demographic Data in Studies on Pediatric Unilateral Hearing Loss: A Scoping Review.

OBJECTIVES: Social determinants of health (SDOH) (healthcare access and quality, education access and quality, socioeconomic status, social and cultural context, neighborhood and built environment) ( Healthy People 2030 ) have been shown to impact a wide range of health-related outcomes and access to care. Given the medical and nonmedical costs associated with children with unilateral hearing loss (UHL), the varied insurance coverage for hearing healthcare services, and the differences in hearing aid utilization rates between children of different sociodemographic classes, the sociodemographic information of children with UHL enrolled in research studies should be collected to ensure the generalizability of hearing healthcare interventions. Therefore, the objective of this scoping review is to assess the reporting of SDOH data for participants in studies of pediatric UHL and its comparison to population trends. DESIGN: Two searches of published literature were conducted by a qualified medical librarian. Two reviewers then evaluated all candidate articles. Study inclusion parameters were from 2010 to present, peer-reviewed studies with prospective study design, and participant population including children (age 0 to 18 years old) with UHL. RESULTS: Two literature searches using PubMed Medline and Embase found 442 and 3058 studies each for review. After abstract and paper review, 87 studies were included in final qualitative review, with 22 of these studies reporting race distribution of participants, 15 reporting insurance status or family income, and 12 reporting the maternal education level. CONCLUSIONS: Sociodemographic data are not commonly reported in research studies of children with UHL. In reported samples, research participants are more likely to have private insurance and higher family income compared with overall population distribution. These demographic biases may affect the generalizability of study results to all children with UHL. Further evaluation is warranted to evaluate whether participant recruitment affects outcomes that reflect the overall population.

Long-Term Perceived Benefit of Pediatric Cochlear Implant Users with Unilateral Hearing Loss.

OBJECTIVE: To assess the perceived benefit of cochlear implant (CI) use for children with unilateral hearing loss (UHL) and evaluate whether perceived abilities are associated with performance on measures of speech recognition and spatial hearing. METHOD: Nineteen children with moderate-to-profound UHL underwent cochlear implantation. The Speech Spatial and Qualities of Hearing Questionnaire modified for children (SSQ-C) were completed by parental proxy pre-operatively and at 3, 6, 9, 12, 18, and 24 months post-activation. Linear mixed models evaluated perceived benefits over the study period. Pearson correlations assessed the association between subjective report and performance on measures of word recognition with the CI alone and spatial hearing (speech recognition in spatially-separated noise and sound source localization) in the combined condition (CI plus contralateral ear). RESULTS: For the SSQ-C, parents reported significant improvements with CI use as compared to pre-operative perceptions (p < 0.001); improved perceptions were either maintained or continued to improve over the 2-year post-activation period. Perceived benefit did not significantly correlate with word recognition with the CI alone or spatial hearing outcomes in the combined condition. CONCLUSION: Families of children with UHL observed benefits of CI use early after cochlear implantation that was maintained with long-term device use. Responses to subjective measures may broaden our understanding of the experiences of pediatric CI users with UHL in addition to outcomes on typical measures of CI performance. LEVEL OF EVIDENCE: 3 Laryngoscope, 134:919-925, 2024.

Benefits of unilateral cochlear implantation in adults with asymmetric hearing loss: Audiologic and patient-related outcome measures.

PURPOSE: To investigate the benefits of cochlear implantation in adults with single-sided deafness (SSD) and asymmetric hearing loss (AHL). STUDY DESIGN: Prospective within-subjects repeated-measures. SETTING: Two tertiary cochlear implant centers. PATIENTS: Fourteen adults with severe-to-profound sensorineural hearing loss in the worse hearing ear and up to moderate SNHL in the better hearing ear. INTERVENTION: Cochlear implantation in the worse hearing ear. MAIN OUTCOME MEASURES: Consonant-nucleus-consonant (CNC) test, AzBio sentence test in noise, and lateralization testing were conducted preoperatively and at 3-, 6-, and 12-months post-activation. Patient-related outcomes were measured using the Speech, Spatial, and Qualities of Hearing Scale and Glasgow Benefit Inventory. Tinnitus Handicap Inventory was administered to subjects with tinnitus. RESULTS: Mean length of hearing loss in the worse hearing ear was 3.5 years. The mean CNC change scores from baseline were 54.8, 55.9, and 58.9 percentage points at 3-, 6-, and 12-months (p < 0.001). AzBio sentence test in noise demonstrated improved scores in all spatial configurations, although statistically significant in S0N0 (speech front, noise front) only. Lateralization testing showed significant improvement of 22.9, 24.5, and 24.0 percentage points at 3-, 6-, and 12 months post-activation (p = 0.002). All patient-related outcome measures revealed significant improvement. CONCLUSION: This study demonstrates improved speech perception in noise, sound lateralization, quality of life, and reduction in tinnitus perception in adults with SSD/AHL who undergo cochlear implantation. Our results add to the growing body of evidence that cochlear implant should be offered to this population.

The Relationship Between Auditory Performances and Satisfaction of Unilateral Bone-Anchored Hearing in Conductive and Mixed Hearing Loss.

BACKGROUND: The aim of this study is to investigate the deviced and non-deviced auditory performance results of patients with unilateral bone-anchored hearing aid. METHODS: Deviced and non-deviced free field hearing thresholds, speech discrimination, and sentence discrimination scores were evaluated. Shortened profile of the benefit from the hearing instrument (Abbreviated Profile of Hearing Aid Benefit) was used. RESULTS: A total of 17 patients participated in the study. The mean age was 37.9 ± 17.1 years. There was a statistically significant difference between the Abbreviated Profile of Hearing Aid Benefit satisfaction questionnaire and total scores, Background Noise (BN), Reverberation (RV) subscales according to device status (P -lt; .05). No significant difference was found between the Abbreviated Profile of Hearing Aid Benefit total score result of the group divided by the hearing aid threshold (P -gt; .05). No significant difference was found between the Abbreviated Profile of Hearing Aid Benefit total score result of the group divided by the threshold without a hearing aid (P -gt; .05). CONCLUSION: Bone-implanted hearing aids are effective and reliable amplification methods in patients with conductive and mixed hearing loss. Positive results of patient satisfaction and evaluation inventories were obtained from this study.

[Cochlear implant and tinnitus]. / Cochleaimplantat und Tinnitus.

Cochlear implant (CI) treatment is now established as a successful standard of care for auditory rehabilitation of profoundly deaf or severe hearing loss patients. CI candidates with tinnitus also benefit from improved health-related quality of life (HRQoL) and tinnitus burden. Current CI indications include bilateral (double-sided) profound hearing loss and deafness (DSD), unilateral (single-sided) deafness (SSD), and asymmetric hearing loss (AHL). The new and expanded indications for cochlear implants result in different healthcare situations, which may also be associated with differences in tinnitus burden before and after CI treatment. In this article, we discuss the prevalence of tinnitus in different patient groups and the influence of CI on tinnitus prevalence and severity in these groups. In addition, further therapeutic options for tinnitus suppression based on the CI principle are presented, including the development of an anti-tinnitus implant (proof of concept).

[Prospective comparative analysis of cochlear implant patients with single-sided deafness and asymmetric hearing loss with regard to health-related quality of life, tinnitus distress and psychological comorbidities]. / Prospektive Vergleichsanalyse von CI-Patienten mit einseitiger Taubheit und asymmetrischem Hörverlust hinsichtlich der gesundheitsbezogenen Lebensqualität, Tinnitusbelastung und psychischen Komorbiditäten.

BACKGROUND: Patients with single-sided deafness (SSD) and asymmetric hearing loss (AHL) are increasingly being treated with cochlear implants (CI) due to the demonstrated improvements in auditory abilities and quality of life. To date, there are few published studies in which these two groups are comparatively studied. The aim of the current study was to examine which factors differ between those two patient groups, especially preoperatively. METHODS: A secondary analysis of the previously published raw data of 66 prospectively recruited CI patients (21 SSD/45 AHL) was performed. In addition to the hearing outcome, tinnitus distress (tinnitus questionnaire), health-related quality of life (Nijmegen Cochlear Implant Questionnaire, NCIQ), stress (Perceived Stress Questionnaire, PSQ), and psychological comorbidities (General Depression Scale, ADS­L and Generalized Anxiety Disorder scale, GAD-7) were assessed in SSD and AHL patients pre- and postoperatively. RESULTS: Preoperatively, SSD patients showed significantly higher scores in the NCIQ subdomains "elementary" and "advanced sound perception" than the AHL group. Stress (PSQ) and anxiety symptoms (GAD-7) were significantly higher preoperatively in SSD patients than in AHL patients. After CI, these differences were strongly reduced, with minimal differences being detectable between the groups in the investigated domains postoperatively. CONCLUSION: SSD and AHL patients differ significantly preoperatively in terms of their subjective hearing assessment and psychosocial parameters. In SSD patients, psychological stress factors may have a stronger impact on the quality of life than in AHL patients. These aspects should be taken into account in the preoperative counseling and postoperative rehabilitation.

Postoperative optimization of cochlear implantation for single sided deafness and asymmetric hearing loss: a systematic review.

OBJECTIVE: Identify and evaluate the effectiveness of methods for improving postoperative cochlear implant (CI) hearing performance in subjects with single-sided deafness (SSD) and asymmetric hearing loss (AHL). DATA SOURCES: Embase, PubMed, Scopus. REVIEW METHODS: Systematic review and narrative synthesis. English language studies of adult CI recipients with SSD and AHL reporting a postoperative intervention and comparative audiometric data pertaining to speech in noise, speech in quiet and sound localization were included. RESULTS: 32 studies met criteria for full text review and 6 (n = 81) met final inclusion criteria. Interventions were categorized as: formal auditory training, programming techniques, or hardware optimization. Formal auditory training (n = 10) found no objective improvement in hearing outcomes. Experimental CI maps did not improve audiologic outcomes (n = 9). Programed CI signal delays to improve synchronization demonstrated improved sound localization (n = 12). Hardware optimization, including multidirectional (n = 29) and remote (n = 11) microphones, improved sound localization and speech in noise, respectively. CONCLUSION: Few studies meeting inclusion criteria and small sample sizes highlight the need for further study. Formal auditory training did not appear to improve hearing outcomes. Programming techniques, such as CI signal delay, and hardware optimization, such as multidirectional and remote microphones, show promise to improve outcomes for SSD and AHL CI users.

Hearing outcomes in children with single sided deafness: Our experience at a tertiary paediatric otorhinolaryngology unit.

INTRODUCTION: Hearing rehabilitation options for single sided deafness (SSD) include contralateral routing of sound (CROS) aids and bone conduction devices (BCDs). This study aimed to review the management of children with SSD at our tertiary paediatric otolaryngology unit over the last 15 years. MATERIAL AND METHODS: A retrospective cohort study was performed. Primary hearing outcomes were measured using the Children's Home Inventory for Listening Difficulties (CHILD) questionnaire score and secondary hearing outcomes were measured using hearing thresholds for speech in noise. Outcomes were measured pre and post bone conduction device (BCD) trial. RESULTS: 49 patients with SSD were identified. 20 children had trial of a BCD. 16 patients had pre- and post- BCD trial CHILD scores available for analysis. There was a statistically significant improvement in CHILD scores and speech in noise testing at +5 dB and +0 dB following amplification with a BCD. The mean use of BCD was 1.3 h per day. DISCUSSION: We have described the management of children with SSD in our unit. This study demonstrated a statistically significant benefit of BCD use on hearing outcomes. However, device compliance is low suggesting hearing advice choice in the population is complex and further research is warranted.

Two-Year Outcomes of Cochlear Implant Use for Children With Unilateral Hearing Loss: Benefits and Comparison to Children With Normal Hearing.

OBJECTIVES: Children with severe-to-profound unilateral hearing loss, including cases of single-sided deafness (SSD), lack access to binaural cues that support spatial hearing, such as recognizing speech in complex multisource environments and sound source localization. Listening in a monaural condition negatively impacts communication, learning, and quality of life for children with SSD. Cochlear implant (CI) use may restore binaural hearing abilities and improve outcomes as compared to alternative treatments or no treatment. This study investigated performance over 24 months of CI use in young children with SSD as compared to the better hearing ear alone and to children with bilateral normal hearing (NH). DESIGN: Eighteen children with SSD who received a CI between the ages of 3.5 and 6.5 years as part of a prospective clinical trial completed assessments of word recognition in quiet, masked sentence recognition, and sound source localization at regular intervals out to 24-month postactivation. Eighteen peers with bilateral NH, matched by age at the group level, completed the same test battery. Performance at 24-month postactivation for the SSD group was compared to the performance of the NH group. RESULTS: Children with SSD have significantly poorer speech recognition in quiet, masked sentence recognition, and localization both with and without the use of the CI than their peers with NH. The SSD group experienced significant benefits with the CI+NH versus the NH ear alone on measures of isolated word recognition, masked sentence recognition, and localization. These benefits were realized within the first 3 months of use and were maintained through the 24-month postactivation interval. CONCLUSIONS: Young children with SSD who use a CI experience significant isolated word recognition and bilateral spatial hearing benefits, although their performance remains poorer than their peers with NH.

Cochlear Implantation for Unilateral and Asymmetric Hearing Loss: Long-Term Subjective Benefit.

OBJECTIVES: Assess the long-term patterns of perceived tinnitus severity and subjective benefit for adult cochlear implant (CI) users with asymmetric or unilateral hearing loss (AHL or UHL). METHODS: Forty adults underwent cochlear implantation as part of a prospective clinical trial assessing the outcomes of CI use in cases of AHL (n = 20) and UHL (n = 20). Subjective measures included the Tinnitus Handicap Inventory (THI), the Speech, Spatial, & Qualities of Hearing Scale (SSQ), and the Abbreviated Profile of Hearing Aid Benefit (APHAB). Responses were obtained preoperatively and at routine intervals out to 5 years post-activation. RESULTS: For subjective benefit, participants with AHL and UHL reported a significant improvement as compared to preoperative abilities, which was maintained with long-term CI use. For perceived tinnitus severity, participants with AHL and UHL reported a significant reduction with CI use as compared to preoperative perceptions. The perceived tinnitus severity significantly differed for the AHL and UHL cohorts over time. This pattern of results is likely influenced by the worse perceived severity levels for the UHL cohort preoperatively and the fluctuating perceived severity levels for some participants in the AHL cohort post-activation. CONCLUSION: Adults with AHL and UHL report an early, significant reduction in perceived tinnitus severity and improvement in quality of life with CI use that is generally maintained with long-term device use. Questionnaires such as the THI, SSQ, and APHAB may contribute to a more holistic assessment of the benefits of cochlear implantation in this population. LEVEL OF EVIDENCE: 2 Laryngoscope, 133:2792-2797, 2023.

Influence of listening environment on usage patterns in cochlear implant patients with single-sided deafness.

OBJECTIVE: To compare cochlear implant (CI) data logging of patients with single-sided deafness (SSD) and bilateral sensorineural hearing loss (biSNHL) in various acoustic environments and study the implications of data logging on auditory performance. STUDY DESIGN: Retrospective case control study. METHODS: Adult CI patients with SSD or biSNHL from 2010 to 2021 with usage data collected at 3-, 6-, and 12-months following device activation were identified. The CI listening environment was defined as speech in noise, speech in quiet, quiet, music or noise. Auditory performance was measured using the CNC word, AzBio sentence tests and the Tinnitus Handicap Index (THI). RESULTS: 60 adults with SSD or biSNHL were included. CI patients with biSNHL wore their devices more than those with SSD at 3-months post-activation (11.18 versus 8.97 hours/day, p = 0.04), though there were no significant differences at 6-12 months. Device usage was highest in the speech in quiet environment. In SSD CI users, there was a positive correlation (p = 0.03) between device use and CNC scores at 12-months and an improvement in THI scores at 12-months (p = 0.0004). CONCLUSIONS: CI users with SSD and biSNHL have comparable duration of device usage at longer follow-up periods with greatest device usage recorded in speech in quiet environments.

Long-Term Binaural Hearing Improvements for Cochlear Implant Users with Asymmetric Hearing Loss.

OBJECTIVE: To assess long-term binaural hearing abilities for cochlear implant (CI) users with unilateral hearing loss (UHL) or asymmetric hearing loss (AHL). METHODS: A prospective, longitudinal, repeated measures study was completed at a tertiary referral center evaluating adults with UHL or AHL undergoing cochlear implantation. Binaural hearing abilities were assessed with masked speech recognition tasks using AzBio sentences in a 10-talker masker. Performance was evaluated as the ability to benefit from spatial release from masking (SRM). SRM was calculated as the difference in scores when the masker was presented toward the CI-ear (SRMci ) or the contralateral ear (SRMcontra ) relative to the co-located condition (0°). Assessments were completed pre-operatively and at annual intervals out to 5 years post-activation. RESULTS: Twenty UHL and 19 AHL participants were included in the study. Linear Mixed Models showed significant main effects of interval and group for SRMcontra . There was a significant interaction between interval and group, with UHL participants reaching asymptotic performance early and AHL participants demonstrating continued growth in binaural abilities to 5 years post-activation. The improvement in SRM showed a significant positive correlation with contralateral unaided hearing thresholds (p = 0.050) as well as age at implantation (p = 0.031). CONCLUSIONS: CI recipients with UHL and AHL showed improved SRM with long-term device use. The time course of improvement varied by cohort, with the UHL cohort reaching asymptotic performance early and the AHL cohort continuing to improve beyond 1 year. Differences between cohorts could be driven by differences in age at implantation as well as contralateral unaided hearing thresholds. LEVEL OF EVIDENCE: 3 Laryngoscope, 133:1480-1485, 2023.

Improving Auditory Perception in Pediatric Single-Sided Deafness: Use of Cochlear Implants' Direct Connection for Remote Speech Perception Rehabilitation.

PURPOSE: Unilateral cochlear implants (CIs) can restore binaural hearing in single-sided deafness (SSD). Direct stimulation of the CI can be obtained via the Bluetooth connection of a device to the CI, thus excluding the typical-hearing ear. This study aims to investigate the use of CI connectivity features as a rehabilitative strategy in a small cohort of children affected by SSD. METHOD: A newly developed training protocol was presented to children with SSD who have less than 2 years of experience with CI. We developed a user-friendly and short-term (six sessions within 20 days) training protocol for speech perception that patients themselves can manage independently at home using CI connectivity systems. Children were telematically tested before and after the training by trained speech and language therapists. RESULTS: Four patients met the inclusion criteria. They all showed better results in the final online assessment, when compared with the initial one. CONCLUSIONS: To our knowledge, this is the first clinical focus article presenting an auditory training protocol for SSD patients with CI using the Bluetooth connectivity systems for teletherapy. The results, although preliminary, support the efficacy of this rehabilitative strategy. Further research is needed to support our findings.

American Cochlear Implant Alliance Task Force Guidelines for Clinical Assessment and Management of Adult Cochlear Implantation for Single-Sided Deafness.

The indications for cochlear implantation have expanded to include individuals with profound sensorineural hearing loss in the impaired ear and normal hearing (NH) in the contralateral ear, known as single-sided deafness (SSD). There are additional considerations for the clinical assessment and management of adult cochlear implant candidates and recipients with SSD as compared to conventional cochlear implant candidates with bilateral moderate to profound sensorineural hearing loss. The present report reviews the current evidence relevant to the assessment and management of adults with SSD. A systematic review was also conducted on published studies that investigated outcomes of cochlear implant use on measures of speech recognition in quiet and noise, sound source localization, tinnitus perception, and quality of life for this patient population. Expert consensus and systematic review of the current literature were combined to provide guidance for the clinical assessment and management of adults with SSD.

Children With Unilateral Hearing Loss After Newborn Hearing Screening in Taiwan.

PURPOSE: We explored the intervention characteristics and language outcomes of children with unilateral hearing loss (UHL) in Taiwan after the implementation of universal newborn hearing screening (UNHS) to highlight changes in attitudes and actions toward hearing-related treatments. METHOD: Data of 132 children with UHL in birth cohorts from 2012 to 2019 were included. This retrospective study examined differences in age at identification, hearing aid (HA) fitting, and seeking supportive services. Commonly requested attributes of services, reasons for HA rejection, and children's language performance were investigated. RESULTS: The age at identification decreased from 50.3 months in 2012 to 2.6 months in 2019. Similar trends of declining age were obtained for the age at HA fitting and age at first service contact. In addition, 40% of the parents did not seek support until the child became older (M = 30.5 months) and showed more noticeable behaviors related to hearing loss, and only 64% of the children were consistent HA users. Children with UHL enrolled in the intervention programs approximated the average language performance of the assessment norm; however, they showed depressed language levels when compared to the norm group at the 75th percentile. CONCLUSIONS: UNHS had a positive impact on early identification and intervention in children with UHL. Compared to parents of children with all types of hearing loss, parents of children with UHL seemed to be more uncertain about aural habilitation at the early stage.

Aplicabilidade e considerações clínicas do Sistema Contralateral Routing of Signal (CROS): revisão sistemática / Applicability and clinical considerations of the Contralateral Routing of Signal System (CROS): systematic review / Aplicabilidad y consideraciones clínicas del sistema de enrutamiento de señal contralateral (CROS): revisión sistemática

Introdução: O Sistema Contralateral Routing of Signal (CROS) é uma opção de intervenção auditiva com propósito de melhorar a percepção monoaural e minimizar as dificuldades da perda auditiva unilateral. Objetivo: analisar e descrever o público-alvo, o tempo de adaptação, o controle de uso do Sistema CROS, as avaliações utilizadas para medir os seus benefícios, sua efetividade e limitações. Método: Este estudo foi conduzido de acordo com as diretrizes PRISMA. A pesquisa bibliográfica foi realizada através dos bancos de dados científicos online na área da saúde, PubMed e Scopus, foram utilizadas as palavras-chave "Unilateral hearing loss", "Hearing aid", "CROS" e "Contralateral Routing of Signal". Os resultados da pesquisa limitaram-se a artigos científicos experimentais, que abordavam diretamente o sistema CROS, publicados em inglês, português ou espanhol. Resultados: Onze artigos foram selecionados para a revisão do texto completo. Quanto aos usuários do CROS, a faixa etária variou entre nove a 84 anos; prevalência do sexo masculino. Observou-se grande diversidade nas avaliações, sendo realizadas com tempo de uso inferior a 30 dias e superior a seis meses, após adaptação do CROS. Tal avaliação era realizada por meio de questionários não padronizados e avaliações objetivas com estímulos controlados. O uso do CROS proporcionou benefícios na localização sonora, efeito sombra da cabeça e inteligibilidade de fala, porém não mostrou eficácia em situações ruidosas. Conclusão: Por ser um dispositivo, não invasivo, de fácil adaptação e manuseio que traz benefícios imediatos, o CROS deve ser a primeira opção na reabilitação da perda auditiva unilateral.

Introducción: El Sistema Contralateral Routing of Signal (CROS) es una opción de intervención auditiva con el propósito de mejorar la percepción monoaural y minimizar las dificultades de la pérdida auditiva unilateral. Objetivo: analizar y describir el público objetivo, el tiempo de adaptación, el control del uso del Sistema CROS, las evaluaciones utilizadas para medir sus beneficios, su efectividad y limitaciones. Metodo: Este estudio se realizó de acuerdo con las pautas PRISMA. La búsqueda bibliográfica se realizó a través de bases de datos científicas online del área de salud, PubMed y Scopus, utilizando las palabras clave "Unilateral hearing loss", "Hearing aid", "CROS" y "Contralateral Routing of Signal". Los resultados de la investigación se limitaron a artículos científicos experimentales, que abordaron directamente el sistema CROS, publicados en inglés, portugués o español. Resultados: Se seleccionaron once artículos para revisión de texto completo. En cuanto a los usuarios de CROS, la edad osciló entre los nueve y los 84 años; prevalencia masculina. Hub gran diversidad en las evaluaciones, realizadas con tiempos de uso de menos de 30 días y más de seis meses tras la adaptación del CROS. Dicha evaluación se realizó mediante cuestionarios no estandarizados y evaluaciones objetivas con estímulos controlados. El uso de CROS proporcionó beneficios en la localización del sonido, el efecto de sombra de la cabeza y la inteligibilidad del habla, pero no fue efectivo en situaciones ruidosas. Conclusión: Al tratarse de un dispositivo no invasivo, de fácil adaptación y manejo que aporta beneficios inmediatos, CROS debería ser la primera opción en la rehabilitación de la hipoacusia unilateral.

Introduction: The system Contralateral Routing of Signal (CROS) is an option of auditory intervention in order to improve the monaural perception and minimize the difficulties of unilateral hearing loss. Objective: to analyze and describe the target users, the adaptation time and the control use of CROS system, the evaluations utilized to measure its benefits, as well as its effectiveness and limitations. Method: This study was conducted according to the PRISMA guidelines. The bibliographic research was through the scientific data online banks in the health area, PubMed and Scopus, using the keywords "Unilateral hearing loss", "Hearing aid", "CROS" and "Contralateral Routing of Signal". The results of the research were limited to experimental scientific articles, which address directly the CROS system, published in English, Portuguese or Spanish. Results: Eleven studies were selected to review. The age of CROS users ranged from nine to 84 years and male sex prevalence. There was great diversity in the evaluations being carried out. The performance's evaluation date varied between less than 30 days and more than six months after the adaptation. Such assessments were performed using non-standardized questionnaires and objective evaluations with controlled stimuli. The use of CROS provides benefits in sound localization, head shadow effect and speech intelligibility, but it is not effective in noisy situations. Conclusion: CROS should be the first option in unilateral hearing loss rehabilitation for being a non-invasive, easy adaption, handling dispositive and with good benefits to the client.