Question for Auds/Dispensers

Question and Answer
#1

I was looking for a category that allowed pros to ask for opinions from other pros, but couldn’t find one. I hope I have posted this in the correct place. If not, please correct me.

OK here we go.

I have a patient who is an attorney. He has been diagnosed with Menier’s. His right ear shows a mild SNHL sloping to a moderate-to-severe SNHL. PTA is 35, MCL is 70dB with a WR at 88%.

Left ear shows a relatively flat mixed loss. PTA is 70, MCL is 95dB with a WR of 44%.

Both ears MCL was 60dB-R/85dB-L so, as is usual, binaural MCL dropped. At this level we got to 92% WR.

He states that hearing in his left ear, even at high volume, sounds like he’s hearing from under water.

He has a horrible time hearing in the courtroom, and one judge even mocks him for not being able to hear “His Honor”. (I hope no ADA case ever goes before that judge!) My patient was practically in tears saying that he’s thinking about hanging it all up and retiring. As an attorney who represents a lot of indigent clients, I would hate for this to happen.

The patient has worn hearing aids for a few years, but is struggling horribly.

Here’s my thought: I want to try a BiCROS on this patient. Since the left ear is so much worse than the right, and because amplification doesn’t seem to get past that “under water” feeling he has, my thinking is simply to bypass that ear entirely. My past experiences with BiCROS systems is that they “fool” the brain into thinking it’s getting binaural hearing. This leads me to think that the brain would still be getting the stimuli it craves to remain active. I also want to pair it with a lapel mic or something similar for the judge to wear during hearings and trials as an accommodation.

Have any of my fellow ear nerds ever had a similar situation? Have any of you used a CROS or BiCROS in that situation? If not, why not? What were your solutions?

Thank you so much. I’m really wanting to get this guy back to where he wants to be in life, and that includes being in the courtroom.

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#2

Sounds like there’s s couple of things happening.

Possibly some transcranial masking, possibly some over amplification. The problem with dropping sound into the worst ear at target is that it will be above the Threshold of the best one.

Have you attempted to alter the balance on the fitting to better reflect the speech scoring? You’d only need to drop the gain level to the worst ear by 10 to 15dB to eliminate the majority of transcranial effects. Doing this would retain the spatial and background noise functions of the ear. The better ear could still dominate in terms of speech.

What aids are fitted?

4 Likes
#3

Thank you for replying. I truly appreciate all input.

Transcranial masking was my first thought when the patient first came to me.

I have dropped the gain on the poor ear, and he hated the effect. Said it made him feel off balance, and the “under water” feeling was still there.

He’s currently wearing Lucid 96s (that’s the Sam’s Club brand.) Lucid aids do not use WDRC like other manufacturers, but instead use Adaptive Dynamic Range Optimization (ADRO). Not sure if this makes a difference with this level of hearing or not.

I think I’ve attached a copy of his audiogram (name removed, of course.)

audgm1
audgm11152×813 36.9 KB

#5

Thank you so much for the response! Every bit of information I can get is helpful.

The patient will be getting a Signia product due to pricing. Signia does not have a Roger or table mic from what I understand. They have a lapel mic which picks up a lot from what I understand.

I have tried going the other way by raising gain. I’ve tried raising and lowering the low freqs just to test different settings, because I’ve learned that 2 people with the same audiogram won’t hear the same due to the different ways in which their brains process sound. Also, I don’t always trust the computer.

I am accounting for the bone line.

What do you think of the idea of the BiCROS?

(I learned today about AmpCROS, a.k.a., TriCROS set-ups. Have you heard of that, and, if so, have you used it?)

Thanks again. I truly appreciate your input.

#7

I’m not a huge fan of the CROS/BiCROS, personally, but I’ve had patients who like it. Has the patient tried wearing hearing aid only on the right side? I find sometimes, like the user above alluded to, that when one ear is significantly worse in both threshold and WR, sometimes aiding that ear only serves to mask the other ear. You can do an SNR test with one and two aids in to see if there really is a difference.

I think if it were me, trying the BiCROS wouldn’t hurt, and if it doesn’t help, probably just go with the HA