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American Journal of Audiology Vol.5 23-32 March 1996.
© American Speech-Language-Hearing Association
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A Family With Autosomal-Dominant Progressive Sensorineural Hearing Loss

Rehabilitation and Counseling

Chris Halpin 1, Barbara Herrmann 1, and Margaret Whearty 1

1 Massachusetts Eye and Ear Infirmary, Boston

The family described in this article provides an unusual opportunity to relate findings from genetic, histological, electrophysiological, psychophysical, and rehabilitative investigation. Although the total number evaluated is large (49), the known, living affected population is smaller (14), and these are spread from age 20 to age 59. As a result, the findings described above are those of a large-scale case study. Clearly, more data will be available through longitudinal study of the individuals documented in the course of this investigation but, given the slow nature of the progression in this disease, such studies will be undertaken after an interval of several years.

The general picture presented to the audiologist who must rehabilitate these cases is that of a progressive cochlear degeneration that affects only thresholds at first, and then rapidly diminishes speech intelligibility. The expected result is that, after normal language development, the patient may accept hearing aids well, encouraged by the support of the family. Performance and satisfaction with the hearing aids is good, until the onset of the speech intelligibility loss, at which time the patient will encounter serious difficulties and may reject hearing aids as unhelpful. As the histological and electrophysiological results indicate, however, the eighth nerve remains viable, especially in the younger affected members, and success with cochlear implantation may be expected. Audiologic counseling efforts are aided by the presence of role models and support from the other affected members of the family. Speech-language pathology services were not considered important by the members of this family since their speech production developed normally and has remained very good. Self-correction of speech was supported by hearing aids and cochlear implants (Case 5's speech production was documented in Perkell, Lane, Svirsky, & Webster, 1992). These patients received genetic counseling and, due to the high penetrance of the disease, exhibited serious concerns regarding future generations and the hope of a cure.

Note:

This article is one of three related articles in this issue. The Short Course, "New Methods in the Molecular Genetic Study and Treatment of Hearing Loss," gives the reader a foundation in the genetic methods used in the series; the Article, "Autosomal-Dominant Progressive Sensorineural Hearing Loss in a Large North American Family," provides the data and methods; and, finally, this Grand Rounds explores the clinical implications.

Key Words: hearing loss, genetic, rehabilitation, hearing aids, cochlear implants

Submitted on August 11, 1994
Accepted on March 17, 1995






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