Audiological decision-making in a complex bimodal case of adult congenital atresia
Reviewed by Nathan Barlow

The authors describe a clinical case of a 65-year-old man with left congenital atresia who, as an adult, developed hearing loss in his right (better) ear and subsequently began seeking audiological intervention for hearing difficulties. Their client’s unique case history is further discussed in August’s The Hearing Journal. Results in this September follow-up article present this particular individual’s unaided AZBio (a US speech-in-noise test) score, his subsequent speech-in-noise ability with his BAHA only; his speech-in-noise ability using his right (RIC) hearing aid only, and, most interestingly in this particular case study, his speech-in-noise performance in binaural aided conditions (BAHA plus hearing aid). These speech-in-noise metrics are paired with traditional sound field audiometry, the results of which are summarised. Mast et al’s case study is of particular value, given that the personal and clinical decision-making rationales are explained and the audiological benefits are shown extremely clearly. The authors conclude that, while all combinations were better than the client’s remaining natural hearing ability (bilaterally unaided), the uniqueness of this particular case study illustrates that at 4000 Hz (considered to correlate with audibility-in-noise) the BAHA-alone delivered half the gain (10 dB) when compared to the hearing aid alone (20 dB gain). However, when using binaural (bimodal) amplification, gain at 4000 Hz increased by 15 dB (to 35 dB) and additionally improved 2000 Hz by 10 dB. Additionally, the authors describe self-assessment (IOI-HA) methods, which helped clinicians identify and troubleshoot perceived loudness issues within CROS vs. BiCROS settings on the BAHA. Overall, this is a strong two-part case study article, which helps educate clinicians about decision-making in complex cases involving bimodal hearing devices and clearly illustrates the benefits of various choices available to the client.

Audiological Intervention for an Adult with Congenital Aural Atresia.
Mast DD, Joseph AR, Whitcomb MC.
HEAR J
2024;77(9):3–5.