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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 the auditory nerves with resultant speech perception is not feasible M. Lawrence, 1964
  3. 3. “It is a crime to provide deaf children 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 Presbyacusis physiological, 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 of Opportunity
  11. 11. Sharma et al, 2002 Ear and Hearing, December 2002
  12. 12. Sharma et al, 2004 450 400 350 13 month old recipient P1 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 250 200 14 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 Performance ref: 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 Denmark N=168. 91 girls. 77 boys. Age 1-18yrs. Mean age if CI = 4 years 50 spoken language 85 support sign 30 sign
  18. 18. Lone Percy-Smith continued Summary – Speech and Language Data tests 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 implantation Waltzman S & Roland T. 2005 Pediatrics ‘Cochlear Implantation in Children Younger than 12 Months’ James A. & Papsin J. 2004 The Laryngoscope ‘Cochlear Implant Surgery at 12 Months of 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 will be 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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