Cochlear implant surgery began to be performed in 1985 in Japan. Since then, more than 7000 highly hearing-impaired patients have received cochlear implant surgery. Cochlear implant surgery is the only means to restore hearing ability in these patients. In spite of the good results from the point of view of hearing ability, several problems related to social factors have been reported. This year, Oto-Rhino-Laryngological Society of Japan has revised the criteria and indications for cochlear implant surgery in children. In this paper, we discuss the new criteria together with the social problems associated with cochlear implant surgery.
Previously, health care providers at our department selected hearing aids taking into account factors such as the social background and hearing ability of the patients. However, in some cases, patients have expressed dissatisfaction with the mechanism of adjustment of the hearing aid and the model of the hearing aid, and requested change of the hearing aid to a different model. Therefore, we decided to implement a comparative hearing aids hearing aid comparison system as a new method for selecting hearing aids. In this system, the patient selects the hearing aid by testing several hearing aids from different manufacturers and comparing the hearing effectiveness. We found that by using this system, the number of patients desiring replacement of hearing aids reduced to 20 of 544 patients (3.7%). Furthermore, none of the 11 patients who purchased hearing aids expressed dissatisfaction with the selected hearing aid model. We believe that allowing patients to freely choose a hearing aid after testing and comparing several brands led to a high degree of satisfaction and acceptance for the hearing aid model that the patients selected.
While fitting hearing aids, we not only try to obtain a good hearing aid outcome, but also ensure that the patient is satisfied with the use of the hearing aid during daily life activities. If patients are not satisfied, we should try to ascertain the reason (s) for the dissatisfaction and the factors affecting patient satisfaction. Therefore, we used a patient satisfaction questionnaire that included questions on the distress and handicap that the patients experience in their daily lives because of their hearing loss and the reason behind the dissatisfaction. In this study, 394 patients wearing hearing aids for more than 6 months were requested to respond to the questionnaire. The speech recognition scores and insertion gain outcomes were favorable in all the patients. The average satisfaction score was 73 (on a scale of 0-100); only 37 (9%) patients received a score of 100. Their distress and handicap in daily life due to hearing loss was associated more with the satisfaction level with the hearing aid than with their hearing ability. The most important reason for patient dissatisfaction was that they hoped to have better hearing ability with the hearing aid?. There was no discussion on the benefits of wearing the hearing aid. The present study showed that it is important to evaluate patient satisfaction and assess why patients may not be completely satisfied.
To determine the features of hearing impairment in the oldest-olds seeking hearing help, we analyzed the data from outpatients in a hearing-aid clinic of the National Center for Geriatrics and Gerontology. Statistical analysis was carried out to determine the association between age and pure-tone averages, and the age and speech intelligibility, with the patients classified as 80 years old or over or under 80 years old. The percentage of individuals whose maximum intelligibility score for the better ear was below 70% was 25.0% in males under the age of 80 years, and 67.7% in males aged 80 years or over. The rate was significantly higher in those aged 80 years or over (p<0.001). Similar results were obtained for females. A statistically significant negative correlation between age and maximum intelligibility score for the better ear was observed in both genders. Since individuals with poor speech intelligibility are likely to receive less than the desired benefit from hearing aids, the disappointments may lead to non-compliance with hearing aids . The hearing help-seeking behavior and rehabilitation in the oldest-olds were discussed based on previous reports from different countries. The negative attitude of others to hearing aids has previously been noted to impact the hearing-impaired elderly, therefore, provision of counseling to the individuals and their families is predicted to be effective.
We compared the trends in the results of tests in patients with bilateral hearing aids and unilateral hearing aids according to the tests for adaptability to hearing aids recommended in the guideline (2010). A total of 37 sensorineural hearing loss patients at our hospital, 21 of whom wore with bilateral hearing aids and 16 of whom wore unilateral hearing aids, were evaluated by 5 tests recommended in the guideline, including the speech discrimination tests in quiet and noisy environments, subjective test for environmental noise, threshold test for wearing hearing aids, and a questionnaire survey to determine hearing ability. The adaptation rate of patients with bilateral hearing aids was higher than that of patients with unilateral hearing aids according to the results of the speech discrimination tests in a quiet environment, subjective test under environmental noise, threshold test for wearing hearing-aids and the response to the questionnaire to determine hearing ability, but not according to the results of the speech discrimination tests in noisy environments. Also the adaptation rate to bilateral hearing aids was significantly higher according to the result of the subjective test under environmental noise in patients under the age of 60 and under the sound of dishwashing, and the threshold test for wearing hearing-aids in patients under the age of 60. Use of bilateral hearing aids was effective to improve speech discrimination in quiet environments. However, the results of subjective assessment may not be consistent with those of objective assessment of speech discrimination in noisy environments. Therefore, we propose that an evaluation method needs to be devised for bilateral and unilateral hearing aids.
In this study, we investigated the current status of hearing aid functions, wearing conditions, and the selection of hearing aids by surveying facilities for the fitting of infants and toddlers with hearing aids in Japan. Our results revealed that the behind-the-ear type of hearing aid was confirmed to be the most popular type of hearing aid. The desirable functions of hearing aids for infants and toddlers were considered to be, in order, the tamper-resistant volume, acoustic feedback cancellation, noise reduction, a wireless hearing aid system, and directivity. The causes of disruptions in common use and wearing were acoustic feedback, refusal to wear hearing aids, and the hearing aid falling off the ear easily. A common cause of malfunction was sweat. In the selection of hearing aids for infants and young children, concerns such as a reduction of the economic burden, a shape that fits the auricle, and waterproofing performance were emphasized. The need to replace new hearing aids because of a child's growth can create an economic burden for young parents of hearing-impaired infants. Hearing-aid fitting programs for hearing-impaired infants and their parents are needed and should be held in close cooperation with specialists involved in rehabilitation.