Differences in the sensitive phase    of the maturation of the auditory and visual pathways     Dr. Dr. hc. Monika Lehnhar...
„Direct stimulation of theauditory nerves with resultantspeech perception is not feasibleM. Lawrence, 1964
“It is a crime to provide deafchildren with a cochlear implant”German physiologist R. Klinke, 1988
From: “Strabismus und Motilität” Zur Entstehung der Amblyopie. Experimentelle Untersuchungen, G.K. v.Noorden Ber. Dtsch. O...
Presbyopie      Presbyacusisphysiological,   pathological, mechanical      sensorineural
Charles Eyries,        André Djurno,Otologist in Paris   Engineer co-working                         with Eyries
Fritz Zöllner          Wolf Dieter Keidel,Otologist in Freiburg   Physiologist in Erlangen
History of the Cochlear Implant Vision for a technology that  would enable the deaf to hear Research supported by public...
Prof. Dr. Dr. med. dent. hc. Ernst Lehnhardt
The Window    ofOpportunity
Sharma et al, 2002Ear and Hearing, December 2002
Sharma et al, 2004                 450                 400                 350                                            ...
Categories of Auditory Performanceref: P Govaerts, C De Beukelaer et al., Neurotology and Audiology 2002 (Antwerp)        ...
Govaerts, et al. 2002                                       Age at Mainstream Integration                          100 Per...
Manuel Manrique,                                                                                 et al (2004)             ...
Svirsky, et al (2004)                                         Average Language Development                           84 Ex...
Lone Percy-Smith   E. Danish CI centre, Gentofte Hospital University of              Copenhagen. October 2007   Factors as...
Lone Percy-Smith continuedSummary – Speech and Language Datatests scored for HA, not CA.• Strong statistical effect of com...
Lone Percy-Smith conclusions• 64% of CI children had high level of social wellbeing• 36% of CI children with low level   -...
Early implantationWaltzman S & Roland T. 2005 Pediatrics‘Cochlear Implantation in Children Youngerthan 12 Months’James A. ...
Vision In 20 years, an implant willbe the treatment of choice for   anyone with a hearing loss       greater than 50 dB   ...
Thank you for your attention!
Differences in the sensitive phase of the maturation of the auditory and visual pathways - Dr. Dr. h. c. Monika Lehnhardt
Differences in the sensitive phase of the maturation of the auditory and visual pathways - Dr. Dr. h. c. Monika Lehnhardt
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Differences in the sensitive phase of the maturation of the auditory and visual pathways - Dr. Dr. h. c. Monika Lehnhardt

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Differences in the sensitive phase of the maturation of the auditory and visual pathways - Dr. Dr. h. c. Monika Lehnhardt

  1. 1. Differences in the sensitive phase of the maturation of the auditory and visual pathways Dr. Dr. hc. Monika Lehnhardt Cernobbio, June 2008
  2. 2. „Direct stimulation of theauditory nerves with resultantspeech perception is not feasibleM. Lawrence, 1964
  3. 3. “It is a crime to provide deafchildren with a cochlear implant”German physiologist R. Klinke, 1988
  4. 4. From: “Strabismus und Motilität” Zur Entstehung der Amblyopie. Experimentelle Untersuchungen, G.K. v.Noorden Ber. Dtsch. Ophthalmol. Ges. 77, 815 – 828 (1980), P. 821, Abb. 4a
  5. 5. Presbyopie Presbyacusisphysiological, pathological, mechanical sensorineural
  6. 6. Charles Eyries, André Djurno,Otologist in Paris Engineer co-working with Eyries
  7. 7. Fritz Zöllner Wolf Dieter Keidel,Otologist in Freiburg Physiologist in Erlangen
  8. 8. History of the Cochlear Implant Vision for a technology that would enable the deaf to hear Research supported by public donation, commenced 1967 First cochlear implant, 1978, Melbourne Hospital “In spite of the problems and criticisms, I just had to go on. A cochlear implant was their only hope of ever hearing.” Professor Graeme Clark
  9. 9. Prof. Dr. Dr. med. dent. hc. Ernst Lehnhardt
  10. 10. The Window ofOpportunity
  11. 11. Sharma et al, 2002Ear and Hearing, December 2002
  12. 12. Sharma et al, 2004 450 400 350 13 month old recipientP1 latency, ms 300 250 200  At CI activation 150 100 1 week post CI 50 Normal limits 1 month post CI 0 0 5 10 15 20 25 30  3 months post CI Age  12 months post CI 350 300 P1 latency, ms 250 20014 month old recipient 150 100 50 Normal limits 0 0 12 24 36 Age Archives of Otolaryngology – Head & Neck Surgery, May 2004
  13. 13. Categories of Auditory Performanceref: P Govaerts, C De Beukelaer et al., Neurotology and Audiology 2002 (Antwerp) Children with normal hearing use of telephone discrimination of speech sounds response to speech sounds
  14. 14. Govaerts, et al. 2002 Age at Mainstream Integration 100 Percentage of children 80 Age at implantation 60 Under 2 yrs 40 2 to 4 yrs 20 0 0 3 5 7 Age (in years)Otology & Neurology, vol 23; 2002
  15. 15. Manuel Manrique, et al (2004) Reynell 7 "Reynell" age (years) 6 < 2 yrs 5 4 3 2 to 6 yrs 2 1 0 0 1 2 3 4 5 6 7 Chronological age (years)Laryngoscope, August 2004
  16. 16. Svirsky, et al (2004) Average Language Development 84 Expressive Language Age 72 60 (months) 12-24 months 48 25-36 months 36 37-48 months 24 12 0 0 12 24 36 48 60 70 84 AGE (months)Audiology and Neuro-Otology, vol. 9, 2004
  17. 17. Lone Percy-Smith E. Danish CI centre, Gentofte Hospital University of Copenhagen. October 2007 Factors associated with Speech/Language Outcomes and Social Well-being for Children with Cochlear Implant in DenmarkN=168. 91 girls. 77 boys.Age 1-18yrs. Mean age if CI = 4 years50 spoken language 85 support sign 30 sign
  18. 18. Lone Percy-Smith continuedSummary – Speech and Language Datatests scored for HA, not CA.• Strong statistical effect of communication mode at home• Clear improvement of sp./lang. dev. for children exposed to spoken Danish only• Parent assessments and test responses are highly positively associated. (auditory capacity and speech intelligibility)
  19. 19. Lone Percy-Smith conclusions• 64% of CI children had high level of social wellbeing• 36% of CI children with low level - 57% operation age >36 mon - 68% in schools or kindergarten for deaf - 85% use sign support or sign language Level of social well being significantly associated with communication mode.
  20. 20. Early implantationWaltzman S & Roland T. 2005 Pediatrics‘Cochlear Implantation in Children Youngerthan 12 Months’James A. & Papsin J. 2004 The Laryngoscope‘Cochlear Implant Surgery at 12 Monthsof Age or Younger’.Colletti V. et al. 2005 The Laryngoscope‘Cochlear Implantation at under 12 Months: Report on 10 Patients.’
  21. 21. Vision In 20 years, an implant willbe the treatment of choice for anyone with a hearing loss greater than 50 dB Dr Jay Rubenstein , March 2004
  22. 22. Thank you for your attention!

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