HEARING REPORT

Deafness - A public health issue that has always a solution

The vocation of the institute of the Ear is to be able to take care in a complete way and on the same geographical place any patient presenting with hearing loss, from the slight deficit to the patient requiring the installation of a cochlear implant.

Deafness is a frequent pathology, the incidence of which increases with the aging of the population. It is estimated that 65% of people aged 65 and over present with hearing loss, but the young population may also be affected.

The presenting symptom is often an auditory discomfort noticed by the patient himself or one of his relatives in noisy atmospheres (family or professional meetings, outings with friends). It induces social isolation with repercussions on the quality of life. The other causes for consultation are: professional noise exposure, associated symptoms (dizziness, tinnitus ...), family deafness.

The assessment will be organised urgently in the event of barotrauma, sudden deafness, acoustic shock, etc.

The hearing loss assessment is guided by the ORL of the Ear Institute based on the initial interview (history of hearing loss, professional / family / social situation, sound environment, need to listen, discomfort in daily life, personal history, associated deficits ...) and otoscopic examination. It will be adapted according to each patient.

The technical platform of the Ear Institute allows to carry out a comprehensive assessment, done by an exploration technician or by the ENT specialist, depending on the complexity of the case, in a soundproof cabin.

The Ear Institute performs 2 types of hearing tests:

• Subjective hearing tests, requiring active patient' participation. They are performed to assess the degree and type of deafness, speech intelligibility (tonal and vocal audiometry with headphones) as well as the compliance of the tympano-ossicular system and recruitment (impedancemetry). Noise audiometric tests are only performed by 50% of hearing professionals in current practice. However, this is one of the main expectations of hearing-impaired patients: "improving intelligibility in noise". Speech audiometry in noise (VRB) is essential to quantify the degree of real handicap in terms of communication in noisy environments, which can be underestimated if we limit ourselves to conventional audiometric tests, carried out only in silence.

Similarly, it is essential to carry out spatial sound localisation tests, stereo-audiometry available at our center.

The Ear Institute will be responsible for monitoring its fitted or implanted patients (evaluation of prosthetic gain during an audiometry in free field).

• Objective hearing tests, without active patient participation. These objective hearing tests (hearing evoked potentials, ASSR, OAS, headland tests, etc.) are necessary in the context of severe to profound deafness, retrocochlear pathologies (vestibular schwannoma, cochlear, etc.), tinnitus assessment or when the audiometric thresholds are difficult to specify.

At the end of the ENT assessment, additional investigations (imaging, internal medicine and autoimmune assessment, etc.) will complete the hearing loss assessment in collaboration with our fellow radiologists and internists.

Different therapeutic strategies can then be proposed:

• medical treatment (SOM, sudden deafness)

• hyperbaric room (barotrauma, sudden deafness)

• audioprosthetic rehabilitation (conventional equipment / CROS / bone conduction equipment)

• surgical management (repair surgery of the tympano-ossicular chain, otosclerosis, cholesteatoma, otitis sequelae, middle ear implant, bone anchored implant, cochlear implant)

• an assessment and a speech therapy rehabilitation with learning lip reading and mental support ...

In particular, a patient with deafness is at high risk for cognitive impairment. A psychological and cognitive assessment is essential in the context of a moderate to severe hearing loss and in particular when an implant indication is discussed. This assessment may be carried out by the psychologist, the speech pathologist and the gerontologist.