1. Introduction disruption in unilateral deafness is underestimated (Laryngoscope. 2012 Sep;122(9):2088-95) educational 12-41% additional needs (Bess 1988) 22-35% grade failures (Cho Lieg 2004) social isolation vocational quality of life tinnitus perception in noise

2. CI for Single Sided Deafness “absurd concept historically” long period of deprivation limited benefit for hearing possible uses for tinnitus short period of deprivation? X X X X X

3. Effect of Unilateral Stimulation

5. Adult Data unilateral tinnitus (n=26) (Punte AK, et. al. Cochlear Implants Int. 2011 May;12 Suppl 1:S26-9) unilateral SNHL all post-lingually deaf better with short periods of deprivation

6. Pediatric (and Adult) Data CI for SSD (n=40) vs. CROS aid BAHA untreated patients decreased hearing handicap improved localization improved speech in noise (Arndt S, Laszig R, Aschendorff A, et. al., HNO. 2011 May;59(5):437-46).

7. CI for SSD – Speech perception performance duration of deprivation 100 0 01234567>7 From Arndt, Laszig, Aschendorff

8. CI for SSD – Speech perception performance duration of deprivation 100 0 01234567>7 From Arndt, Laszig, Aschendorff

9. Patient Recruitment inclusion strict minimal deprivation normal anatomy exclusion anomalous cochlea (narrow nerve!) developmental delay

10. Unaided Aided Bimodal users in the CI program at SickKids

11. Binaural Fusion Cochlear Implant (CI) Electric Cochlear Implant (CI) Hearing Aid (HA) Acoustic Electric

12. GroupNAge at Test (years) Hearing/Bimodal Age (years) Normal Hearing 148.6 ± 1.6 Bimodal Hearing 412.0 ± 1.85.0 ± 1.8 (M. Deighton) CI HA L R

13. Current Opinion not expanded criteria experimental protocols short deprivation careful assessment of bilateral function vigilant reporting