Here's the other medical condition in dire need for intelligent solutions. See my other post for details. https://news.ycombinator.com/item?id=11002063

Acoustic Neuroma:

This is a benign tumor that grows around the auditory nerve between the brain and ear organs. It squeezes the nerve to the point where hearing on that side is eventually lost. This leads to SSD (single-side-deafness) which can be a debilitating condition.

One does not realize just how useful having two working ears happens to be. SSD causes two significant problems.

The first is the loss of the ability to locate the source of sounds. Your kid calls for help? You have no clue where they are. Someone calls you at the office? Same thing. You literally can't locate sounds.

The other problem is the inability of the brain to run its "noise reduction" routines on sounds coming in. I know people with SSD who, in a busy restaurant, literally can't hear the person sitting in front of them. The brain is able to process sound from both ears and allow the listener to cognitively focus on a desired source. It's a mini phased array with a powerful processor. Take away one of the two available microphones and the loss of capabilities is significant.

Another potential side effect of Acoustic Neuromas is that they can affect the facial nerve for one half of your face. If this happens, the muscles on half the face go limp and the entire half of your face droops.

Current "solutions" don't guarantee the preservation of hearing, hearing recovery or the preservation/protection of the facial nerve.

The first "solution" is to drill a ~ 1 inch hole on the skull right behind the ear and remove the tumor. Of course, the nerve is cut out with the tumor. So, SSD forever. The hole is filled with fat. A metal plate is used to cover the hole. A stud is screwed into your skull and a little box handed to you.

This box is a bone conduction transducer. It has a microphone and transducer that will vibrate your skull. The idea is that your skull will conduct this sound from one side to the other so you can hear sounds from both sides. Of course, you lost the phased array, so hearing this sound, while perhaps useful, might just add to the noise. And, of course, it probably won't be full fidelity. You get to walk around with a pager bolted to the back of your skull [1]. There are other, less invasive, solutions [2] but none that fix the underlying problems. The BAHA devices mean you have this stud --which looks like the end of a spark plug-- screwed into your skull. Skin infections and other problems are some of the issues patients have to deal with.

Believe it or not there's a whole building in Los Angeles dedicated to the above-described butchery. I believe it's run by a USC professor (or ex, don't remember). I believe the procedures start somewhere around $50K.

The next "solution" is endoscopic surgery. Not as brutal. They drill a 1 cm hole on your skull, go in and chip away at the tumor. Practitioners can be more careful and do their best to avoid damaging the acoustic and facial nerves. Yet, nobody will guarantee this. Complete loss of hearing is very likely and facial drooping could happen just as well. While less intrusive than a huge hole and a metal plate, this surgery does not seem to offer improvements in results. You are still likely to be offered a BAHA bone conduction device as an add-on. My guess is this procedure runs somewhere in the $80K+ range.

The third approach is to use Gamma Ray Surgery. This is commonly used for Cancer patients. The tumor is mapped via MRI. The patient's head is then bolted to a table under the Gamma Ray machine and the tumor's blood supply is zapped. The goal is to kill it and keep it from growing. Due to dose limits the treatment takes several weeks. I don't really know how much it costs.

This approach does not invade the cranial cavity, which is good --you can still go scuba diving. It can be precise enough that the nerves are not touched at all. In other words, some hearing could come back and facial feeling/control as well. Yet, nobody will guarantee any of it. Part of this is due to medical liability laws in the US, a whole other subject. BAHA devices might still be offered.

What is needed for people afflicted with this condition could take many forms:

- Early detection: This is a slow growing tumor. Can it be predicted through DNA or other testing? Is there an easy way to find markers and attack the tumor when it is at the 2 mm stage rather than waiting for the patient to notice hearing loss only to find a 3 cm tumor in their skull?

- Better treatment: Can Gamma Ray (or some other non-invasive approach) be improved/perfected in such a way that the tumor can be killed off more effectively while avoiding damage to the nerves and perhaps even restore natural hearing?

- Better devices: Surely there has to be a better and more intelligent approach to restoring some sound perception than bolting a stud into the patient's skull or shoving an uncomfortable lump of plastic into their ear.

[1] https://en.wikipedia.org/wiki/Bone-anchored_hearing_aid

[2] http://www.transear.com/