1

Introduction

In the unfortunate event of profound unilateral sensorineural hearing loss, an ipsilateral osseo-integrated bone anchored hearing aid has proven value. The ability for sound waves from the patient’s deaf side to stimulate the contralateral cochlea and reduce the head shadow effect has been shown to provide a qualitative benefit . Studies have shown that the Bone Anchored Hearing Aid (BAHA®; Cochlear™) is superior to CROS (contralateral routing of offside signals) hearing aids in these cases . Although a cochlear implant is another option, the benefits for cochlear implantation in cases of unilateral deafness have not been clearly shown to outweigh the risks of surgery. However, there is ongoing research in this area and some studies have shown promising results with cochlear implantation in single sided deafness .

As a result of the original disease process, aging, or another unfortunate event, the contralateral ear may begin to deteriorate over time as well. When this occurs, the patient may transition into candidacy for cochlear implantation based on the degree of bilateral sensorineural hearing loss.

In such rare cases, the best ear to implant would obviously be BAHA ear with longstanding deafness. However surgery for cochlear implantation is complicated by the presence of an osteointegrated BAHA abutment in the surgical field ear. We present 3 cases which highlight this clinical scenario, and present our method for single stage removal of an osseo-integrated implant with placement of a cochlear implant on the ipsilateral side.

2

Cases

Patient 1 is a 65-year-old woman who developed sudden right sided sensorineural hearing loss that was refractory to standard medical treatment. Her word recognition score was 0% at 95 dB. She underwent surgery for placement of a BAHA a year later. However, this provided little benefit and her aided word recognition score with the BAHA remained poor. Throughout this experience, her left ear was stable with normal pure tone thresholds from 125 to 4000 Hz and downsloping mod–severe hearing loss at higher frequencies but she had a decline in speech discrimination. Further cochlea implant candidacy testing reveals her to be on the threshold for cochlear implant candidancy, and thus presented for subsequent cochlear implantation.

Patient 2 is a 37 year old man with history of bilateral Meniere’s disease treated with standard medical therapy. He had a complicated surgical history decades ago for closure of bilateral oval window fistulas with recovering of hearing. However, in 2006 he developed worsening right sided sensorineural hearing loss as a result of endolymphatic hydrops and received a BAHA. He did well until 2010, when his contralateral hearing deteriorated due to his active Meniere’s disease. His aided benefit decreased and met criteria for cochlear implantation. He was subsequently implanted in the ear with a BAHA.

Patient 3 is a 35 year old woman with rapid progressive left sided sensorineural hearing loss in 2013. This remained at profound levels despite optimal medical therapy and she underwent BAHA implantation shortly after. However, within 3 months of successful BAHA placement, she began to develop SSNHL in the contralateral ear. We suspected an autoimmune phenomenon and the patient was set up for cochlear implantation.

In all 3 cases, the patients had successful activation of their cochlear implants without delay. In subsequent follow up, all surgical sites healed well without any infectious complications. No additional antibiotics or revision procedures were required.

2

Cases

Patient 1 is a 65-year-old woman who developed sudden right sided sensorineural hearing loss that was refractory to standard medical treatment. Her word recognition score was 0% at 95 dB. She underwent surgery for placement of a BAHA a year later. However, this provided little benefit and her aided word recognition score with the BAHA remained poor. Throughout this experience, her left ear was stable with normal pure tone thresholds from 125 to 4000 Hz and downsloping mod–severe hearing loss at higher frequencies but she had a decline in speech discrimination. Further cochlea implant candidacy testing reveals her to be on the threshold for cochlear implant candidancy, and thus presented for subsequent cochlear implantation.

Patient 2 is a 37 year old man with history of bilateral Meniere’s disease treated with standard medical therapy. He had a complicated surgical history decades ago for closure of bilateral oval window fistulas with recovering of hearing. However, in 2006 he developed worsening right sided sensorineural hearing loss as a result of endolymphatic hydrops and received a BAHA. He did well until 2010, when his contralateral hearing deteriorated due to his active Meniere’s disease. His aided benefit decreased and met criteria for cochlear implantation. He was subsequently implanted in the ear with a BAHA.

Patient 3 is a 35 year old woman with rapid progressive left sided sensorineural hearing loss in 2013. This remained at profound levels despite optimal medical therapy and she underwent BAHA implantation shortly after. However, within 3 months of successful BAHA placement, she began to develop SSNHL in the contralateral ear. We suspected an autoimmune phenomenon and the patient was set up for cochlear implantation.

In all 3 cases, the patients had successful activation of their cochlear implants without delay. In subsequent follow up, all surgical sites healed well without any infectious complications. No additional antibiotics or revision procedures were required.