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Hearing loss is one of the most common disabilities worldwide. Implantable hearing devices offer exciting developments in treating hearing loss in patients who previously had poor treatment options, including those with anatomic abnormalities, chronic draining ears, or severe to profound sensorineural hearing loss. Examples of these new hearing technologies include bone-anchored hearing devices and implantable middle ear devices that offer hearing rehabilitation for conductive or mixed hearing loss and single-sided deafness. Cochlear implants also offer hearing options for patients with severe to profound sensorineural hearing loss. This chapter describes and highlights the interprofessional team’s role in evaluating and treating patients who undergo implantation of these new hearing devices. Objectives: Review the pathophysiology of hearing loss. Describe the treatment considerations for patients with hearing loss. Describe the common complications of implantable hearing devices. Summarize how interprofessional collaboration and communication can improve outcomes for patients who require implantable hearing devices. Access free multiple choice questions on this topic.

Many causes of hearing loss exist, but it is generally increasing with the aging population. As a result, it is important to help those with hearing loss function in their environments. Hearing rehabilitation is most commonly achieved with traditional hearing aid amplification, utilizing devices that sit within the ear canal and over the helix. However, under certain circumstances, treatment options for hearing loss include implantable hearing devices such as bone-conducting hearing prostheses, middle ear implantable hearing prostheses, cochlear implants, and auditory brainstem implants. This chapter provides an overview of these devices and an in-depth review of the background, indications, operative technique, complications, and outcomes of osseointegrated bone-conduction hearing prostheses and middle ear implantable hearing prostheses. For additional information regarding hearing aids, cochlear implants, and auditory brainstem implants, please reference the designated chapters for these topics.[1]

Complications of Transcutaneous and Percutaneous Implants Intraoperative complications of bone-anchored hearing device surgery are rare but include damage to nearby structures, including the dura and sigmoid sinus, with associated risk for CSF leak and bleeding, respectively. Complications in the postoperative period are most commonly associated with soft tissue-related issues. With technological improvements and innovations in operative technique, including smaller incisions and limited tissue dissection, the incidence of these complications has decreased. Soft tissue complications include infection, excess granulation tissue, and excess scar formation. These complications are more common in children, as well as adults with comorbidities, including smoking, diabetes mellitus, and obesity. Bone-related complications occur less frequently, and are the most common failure is lack of osseointegration. Technical fractures, as well as patient factors including trauma, chronic soft tissue infections, and inadequate bony recipient site, account for the majority of bone-related issues. Osteomyelitis is an exceedingly rare complication of bone-anchored hearing surgery. Complications of Middle Ear Implantable Hearing Prostheses Risks include those associated with traditional mastoid surgery and facial recess approach, including hearing impairment, changes in taste, facial nerve weakness, spinal fluid leak, and vertigo. Due to the exposure necessary through the facial recess, there is an increased risk to the chorda-tympani and tympanic annulus compared to cochlear implant approaches.

Enhancing healthcare outcomes for patients who receive implantable hearing devices is multifaceted and involves all healthcare team members. Physicians, audiologists, nurses, pharmacists, and other health professionals must consider implications on healthcare outcomes when treating patients with hearing loss since failure to adequately treat patients with hearing loss results in significant detriment to the patient and cost to society. Multidisciplinary care for patients receiving implantable hearing devices is critical in the pre-operative and post-operative settings. Pre-operatively establishing appropriate goals and expectations is of vital importance. Post-operatively, the ongoing role of the audiologist is crucial for device programming, troubleshooting, and training the patient and families.[14] [Level 5]