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Contralateral Routing of Signal (CROS)

Contralateral Routing of Signal (CROS)

Audiology Today Mar/Apr 2019…What’s Inside This Issue?

The editorial team and I are so happy to announce the content for this latest issue of Audiology Today. We are featuring a number of comprehensive, relevant, and interesting articles, as well as some short reads on public relations, coding and reimbursement, and audiology advocacy.

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Coding and Reimbursement Image

CODING AND REIMBURSEMENT | Coding Update: Contralateral Routing Device

The American Academy of Audiology (the Academy) and others recently requested revisions for codes and code descriptors in the CROS/BiCROS family and Centers for Medicare and Medicaid Services approved many of the proposed changes. The groups requested the changes to reflect changes in CROS/BiCROS technology. 

Topic(s): Audiologist, Binaural, Behind The Ear (BTE), Bilateral microphones with contralateral routing of signal (BiCROS), Contralateral Routing of Signal (CROS), In The Ear (ITE), Hearing Aids, Coding, Reimbursement, Practice Management, Medicaid, Medicare, Fitting, Sensorineural Hearing Loss

Author(s): 

Publication Issue: Audiology Today March/April 2019

A Proposed Protocol: Assessment for Patients with Single-Sided Deafness or Asymmetric Hearing Loss

Do you fit bone-conduction hearing aids, contralateral routing of signals (CROS) hearing aids, and/or cochlear implants to your adult patients with single-sided deafness or asymmetric hearing loss (with the four-frequency pure-tone average in the poorer ear being greater than or equal to 70 dB HL)? Curious which one is the best treatment? If so, you may be interested in a consensus paper by Van de Heyning et al (2016). 

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Unilateral Hearing Loss: What to Do?

Patients with unilateral hearing loss can present with variable issues. Much is dependent on the severity of the hearing loss (threshold and speech understanding), age of onset, hearing status of contralateral ear, and presence of comorbidities (e.g., vertigo, cognitive status, central auditory processing, hyperacusis, tinnitus, disease/pathology/disorder, etc.). Adult-onset severe-to-profound unilateral sensorineural hearing loss with normal hearing sensitivity in the contralateral ear presents a unique dilemma.

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Single-Sided Deafness, Cochlear Implants, and Speech Understanding

Zeitler et al (2015) reported on nine people (ages 12 to 63 years) with single-sided deafness (SSD) and normal hearing in the other ear, all of whom underwent cochlear implantation in the SSD ear. With regard to post-op speech understanding in noise, the authors report “one of our aims was to assess the value of a CI for SSD patients when the listening environment simulated a ‘real world’ situation, that is, listening in a restaurant where the talker was on the side of the CI.

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Cochlear Implants, Normal Hearing, and Single-Sided Deafness

Many reports in the literature have demonstrated that cochlear implants are a reasonable, successful, and viable option for people with severe-to-profound unilateral hearing loss (Arndt et al 2011; Baguley, 2010; Buechner et al 2010; Popelka et al 2010; Van Zon et al 2015; Van De Heyning et al 2008).

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CROS and BiCROS Hearing Aids

Contralateral routing of signal (CROS) amplification systems are intended to be used when (essentially) one ear is normal or has a mild/moderate hearing loss (i.e., is generally a candidate for amplification) and the other ear is (more-or-less) not “aidable.” CROS hearing aids might be recommended for single-sided deafness (SSD) or for people with very poor unilateral word recognition scores.

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Comparing CROS Hearing Aids and Bone-Anchored Hearing Devices

Finbow et al (2015) evaluated 8 adults with single-sided deafness (SSD) with regard to contralateral routing of signal (CROS) and bone-anchored hearing devices (BHADs). The authors report CROS and BAHDs are the two main interventions used to treat SSD, although they also report cochlear implants (CIs) have also been used to treat SSD.

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