Who will benefit from bone conduction implants (BCI)?
Patients with conductive hearing loss or severe loss in one ear (i.e. single-sided deafness) might benefit from a BCI.
How does it work?
A BCI uses the bone of the skull as a conductor and transmits sound to the inner ear directly, bypassing the outer and middle ear, which are the sites of pathology in conductive hearing loss. In single-sided deafness, the BCI is implanted on the deaf side and transmits sound to the other ear. Thus, sounds coming in from the deaf side are not missed.
What is the implantation process like?
Before surgery, you will undergo a CT scan for surgical planning and an anaesthetist will determine fitness for general anaesthesia. Implantation of the BCI involves a short surgery under general anaesthesia and a one night stay. After activation of the BCI, a few visits to the Audiologist will be required for fine tuning of the implant.
Who will benefit from cochlear implants (CI)?
Patients with severe hearing loss that will not benefit from hearing aids might benefit from a CI (refer to Hearing Tests).
A CI stimulates the hearing nerve directly and bypasses the hair cells of the cochlea, which are frequently dysfunctional in sensorineural hearing loss.
Before surgery, you will undergo radiological imaging (e.g. CT or MRI scan) for surgical planning and an anaesthetist will determine fitness for general anaesthesia. Implantation of the CI involves a short surgery under general anaesthesia and a one night stay. After activation of the CI, a period of rehabilitation (approximately one year) with an audiologist and speech therapist is required for to derive benefit from the implant.
Our service routinely undertakes surgeries such as canalplasty, myringoplasty, ossiculoplasty, stapedotomy and mastoidectomy. More complex lateral skull base procedures such as temporal bone resections, vestibular schwannma resections, and resections of jugular foramen pathologies are undertaken in collaboration with a Head and Neck Surgeon and a Neurosurgeon.
Hearing aids offer a simple and non-invasive way to rehabilitate various degrees and types of hearing loss. They come in various styles and differ in features such as speech processing strategies, wireless connectivity and recharge-ability. We will help you decide on the type of hearing aid after a thorough evaluation of your hearing loss and needs. Singaporeans aged 60 years and above may be eligible for government subsidies when purchasing hearing aids.
Hearing implants may be necessary if you have severe sensorineural hearing loss, or are unable to tolerate hearing aids for reasons such as the occlusion effect (i.e. sensation of blockage in your ear), recurrent ear infections or altered ear anatomy from a previous surgery. We take a multi-disciplinary approach to hearing implants. The pre-implantation evaluation, surgery and post-implantation rehabilitation involve otologists, audiologists and speech therapists while a medical social worker is called on when facilitating subsidies.
Hearing Tests
We offer the following hearing tests:
Pure tone audiometry (PTA)
This is the most basic hearing test where sounds of various frequencies and loudness are presented in a soundproof room using calibrated equipment. This will allow us to determine your type (conductive vs sensorineural) and degree of hearing loss. Further testing and hearing rehabilitation options depends on the outcome of this test.
Tympanometry
This is performed with a PTA and measures your middle ear pressure. The test is useful to detect eustachian tube dysfunction or conductive hearing loss.
Speech audiometry
This test complements a PTA and is usually performed for those who have a greater degree of hearing loss. It is performed in a similar manner to the PTA, but words and sentences are presented instead of sound. This ability to pick up material will guide us in the rehabilitation of hearing. Poor speech discrimination ability suggests that patients will not derive meaningful benefit from conventional hearing aids and may need a cochlear implant.
Other more specialised tests that we provide include acoustic reflexes, oto-acoustic emission (OAE), auditory steady state response (ASSR) and auditory brainstem response (ABR).
Who will benefit from middle ear implants (MEI)?
Patients with mixed or sensorineural hearing loss who cannot tolerate conventional hearing aids might benefit from a MEI.
The MEI stimulates the ossicles (i.e. bones) of the middle ear directly. Besides leaving the outer ear patent (i.e. no occlusion effect), the sound quality achieved is better than that of conventional hearing aids.
Before surgery, you will undergo a CT scan for surgical planning and an anaesthetist will determine fitness for general anaesthesia. Implantation of the MEI involves a short surgery under general anaesthesia and a one night stay. After activation of the MEI, a few visits to the audiologist will be required for fine tuning of the implant.
Cochlear implants (CI) restore hearing in individuals who are severely to profoundly deaf and/or are unable to derive benefit from conventional hearing aids. After implantation, perceived sounds initially appear unnatural. Therefore, rehabilitation is necessary for CI recipients to "decode" the electrical signals from the implant and perceive them as sounds.
Our program is dedicated to and tailored for adult CI recipients. An audiologist and speech therapist will take you through this process and provide constant technical and psychological support.
Assessment by your speech therapist includes understanding your functional listening skills, communication needs and expectations, as well as preoperative counselling. Subsequently, post-implantation intervention involves auditory training, telephone training and teaching of communication repair strategies.
The ENT Surgeon may refer you for tinnitus counselling after evaluation. The intent of tinnitus counselling is to minimise the impact of tinnitus on a patient's life.
Our approach to counselling uses educational material which is easily understood to educate patients on the auditory pathways and pathophysiology of tinnitus.
Psychological support is offered as a component of counselling and self-help strategies are discussed. In combination with the other strategies, we hope to give our patients a greater sense of control and be self-reliant in the management of their tinnitus.
We take a multi-disciplinary approach to dizziness. Audiologists and physiotherapists with additional training and interest in the management of dizziness perform tests to determine the cause of dizziness.
A customised exercise and education program will be designed to manage symptoms of dizziness. If a patient is assessed to be at risk of falls, we will determine which factors place them at most risk and make appropriate recommendations to reduce such risks. This can include advice on fall prevention, recovery strategies, use of assistive walking devices as well as strengthening and conditioning.
Therapy can help compensate for imbalance and maintain physical activity, keeping patients independent in their daily activities while granting them a better quality-of-life.
This test, which is more commonly known as balance testing, is used to obtain information about the balance function of the inner ear and the central nervous system connections associated with it. It helps with diagnosis and planning of rehabilitation strategies.
We offer the following balance tests:
Videonystagmography (VNG)
In this test, eye movement will be monitored when the patient is asked to perform various tasks in different positions while cold and warm air / water is instilled into their ears.
Vestibular Evoked Myogenic Potentials (VEMP)
For this test, muscular activity of the neck or eye muscles is measured while a sound is presented to the patient’s ear.
Video Head Impulse Testing (vHIT)
The vHIT measures reflexic eye movements in response to brisk jerks of the patient’s head.
Risk of Falls Evaluation
This is a multidimensional assessment of factors which are known to be predictive of falls in the future.
Computerised Dynamic Visual Acuity (CDVA)
This is a test of visual acuity while the head is moving.
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