Deaf in one ear: Communication and social challenges of patients with single-sided deafness post-diagnosis

A Randomized Crossover Study in Single-Sided Deafness Comparing a Cartilage Conduction CROS System and an Air-Conduction CROS System

OBJECTIVE

To investigate if cartilage conduction (CC) rerouting devices are noninferior to air-conduction (AC) rerouting devices for single-sided deafness (SSD) patients by measuring objective and subjective performance using speech-in-noise tests that resemble a realistic hearing environment, sound localization tests, and standardized questionnaires.

STUDY DESIGN

Prospective, single-subject randomized, crossover study.

SETTING

Anechoic room inside a university.

PATIENTS

Nine adults between 21 and 58 years of age with severe or profound unilateral sensorineural hearing loss.

INTERVENTIONS

Patients' baseline hearing was assessed; they then used both the cartilage conduction contralateral routing of signals device (CC-CROS) and an air-conduction CROS hearing aid (AC-CROS). Patients wore each device for 2 weeks in a randomly assigned order.

MAIN OUTCOME MEASURES

Three main outcome measures were 1) speech-in-noise tests, measuring speech reception thresholds; 2) proportion of correct sound localization responses; and 3) scores on the questionnaires, "Abbreviated Profile of Hearing Aid Benefit" (APHAB) and "Speech, Spatial, and Qualities of Hearing Scale" with 12 questions (SSQ-12).

RESULTS

Speech reception threshold improved significantly when noise was ambient, and speech was presented from the front or the poor-ear side with both CC-CROS and AC-CROS. When speech was delivered from the better-ear side, AC-CROS significantly improved performance, whereas CC-CROS had no significant effect. Both devices mainly worsened sound localization, whereas the APHAB and SSQ-12 scores showed benefits.

CONCLUSION

CC-CROS has noninferior hearing-in-noise performance except when the speech was presented to the better ear under ambient noise. Subjective measures showed that the patients realized the effectiveness of both devices.

Skin Deep Disclosures: Motivations Driving Visible Forms of Disclosure among People Living with a Concealable Stigmatized Identity

Individuals with invisible disabilities continually undergo decision-making processes regarding whether or not, and if so, how to disclose their disability to others. While a great deal of theorization exists regarding disclosure processes, less work has considered how and why individuals with invisible disabilities forgo the disclosure process by making the invisible visible. This study examines motivations for using tattoos as a mechanism for invisible disability disclosure among the single-sided deaf (SSD) community. Interviews with 41 individuals with SSD across the U.S. reveal a complex set of motivations for permanently and visibly disclosing invisible disability through the use of tattoos. Motivations ranged from being (1) functionally driven, such as normalizing and naturalizing disability disclosures in mixed interactions (2) identity driven, such as showing pride in their condition with the goal of de-stigmatizing SSD (3) community driven, such as educating others about SSD and increasing camaraderie within the hard-of-hearing community to (4) personally driven, such as memorializing a loss, marking the legitimacy of deafness to the self and to others, and increasing disability identification. This study contributes to existing disclosure models by considering how this emerging form of disclosure bypasses and complicates some of the foundational assumptions of disclosure decision-making processes regarding whether, to whom, and how individuals with disabilities disclose. This provides important insights regarding how disclosure decisions can be predetermined and made independent of context, situation, and relationship(s), which has several theoretical and practical implications.

Ear-Specific Hemispheric Asymmetry in Unilateral Deafness Revealed by Auditory Cortical Activity

Profound unilateral deafness reduces the ability to localize sounds achieved via binaural hearing. Furthermore, unilateral deafness promotes a substantial change in cortical processing to binaural stimulation, thereby leading to reorganization over the whole brain. Although distinct patterns in the hemispheric laterality depending on the side and duration of deafness have been suggested, the neurological mechanisms underlying the difference in relation to behavioral performance when detecting spatially varied cues remain unknown. To elucidate the mechanism, we compared N1/P2 auditory cortical activities and the pattern of hemispheric asymmetry of normal hearing, unilaterally deaf (UD), and simulated acute unilateral hearing loss groups while passively listening to speech sounds delivered from different locations under open free field condition. The behavioral performances of the participants concerning sound localization were measured by detecting sound sources in the azimuth plane. The results reveal a delayed reaction time in the right-sided UD (RUD) group for the sound localization task and prolonged P2 latency compared to the left-sided UD (LUD) group. Moreover, the RUD group showed adaptive cortical reorganization evidenced by increased responses in the hemisphere ipsilateral to the intact ear for individuals with better sound localization whereas left-sided unilateral deafness caused contralateral dominance in activity from the hearing ear. The brain dynamics of right-sided unilateral deafness indicate greater capability of adaptive change to compensate for impairment in spatial hearing. In addition, cortical N1 responses to spatially varied speech sounds in unilateral deaf people were inversely related to the duration of deafness in the area encompassing the right auditory cortex, indicating that early intervention would be needed to protect from maladaptation of the central auditory system following unilateral deafness.