MM106 - Interdisciplinary Assessment and Management of Acquired Central Hearing Loss: A Case Study

Abstract:
Acquired central deafness or central hearing loss can present similarly to other retrocochlear hearing losses. Given the infrequency audiologists encounter central hearing loss and lack of treatment options widely available, these patients can be challenging to manage. In this presentation, we review a case study of a 43-year-old female patient with acquired central deafness following multiple cerebrovascular incidents. This case study will review the audiologic diagnostic tools and interdisciplinary management options utilized to guide clinical decision-making in the patient’s functional outcomes.

Summary:
This presentation examines a unique case of acquired central deafness in a 43-year-old female patient with a medical history of three cerebral infarcts affecting both anterior and middle cerebral artery territories. Although her peripheral auditory function remained intact, the patient faced substantial challenges in speech comprehension, consistent with a retrocochlear hearing loss. Due to her medical history, she was diagnosed with a cortical hearing loss.

Initial evaluations indicated preserved her ability to comprehend speech monaurally, prompting the fitting of a BiCROS and Roger Select device. However after her final infarct, her speech understanding declined to 0% bilaterally and binaurally, despite audiometric assessments revealing borderline normal to mild thresholds.

In collaboration with a multidisciplinary team of audiologists and neurotologists, various rehabilitation strategies were explored, including auditory verbal therapy (AVT), speech-to-text applications, learning sign language, lip-reading courses and the potential for cochlear implantation. Given the consideration for cochlear implantation, it was determined that confirmation of site of lesion of her hearing loss would be necessary. Comprehensive assessments, including auditory brainstem and cortical auditory evoked potential tests, confirmed her diagnosis of cortical hearing loss, eliminating the possibility for implantable devices. The patient chose to pursue AVT, with an emphasis on enhancing her spoken communication abilities. Despite facing challenges such as hyperacusis that hindered her ability to utilize hearing aids, the patient has made notable progress through AVT, demonstrating improved auditory skills and active participation in therapy.

This case highlights the necessity of an interdisciplinary approach in addressing central hearing loss, particularly given the limited treatment options and the profound impact on functional communication in central hearing loss. The role of audiology was crucial in determining the site of lesion in this retrocochlear hearing loss, given that treatment options vary based on the site of lesion. This presentation will also address future implications for therapeutic interventions and diagnostic methodologies, emphasizing the importance of comprehensive assessment in developing effective treatment plans.

Brief Summary of Clinical Takeaways:
Central deafness can be challenging for audiologists to manage; however, with an interdisciplinary approach and utilization of less frequently used audiometric measures, audiologists can be pivotal in contributing to functional outcomes.