Cochlear implantation journey candidacy to communication (1)


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Cochlear implantation journey candidacy to communication (1)

  1. 1. Cochlear Implantation Journey- candidacy to communication DR SHEELU SRINIVAS CONSULTANT ENT SURGEON
  2. 2. Cochlear Implant• Bionic ear• Hearing is the only special sense which is conquered• Electronic device when implanted provides sense of sound• The cochlear implant is the most significant technical advance in the treatment of hearing impairment since the development of the hearing aid around the turn of the century.
  3. 3. :
  4. 4. Normal EarDeafness: Normallyfunctioning hair cellsnot present; someatrophy of 8th N fibers.
  5. 5. What is the difference between CI & Hearing Aid?• HA simply amplify sounds.CI on the other hand transforms speech sounds into electrical energy used to stimulate the surviving auditory nerve fibers in the inner ear.• CI have internal & external parts & a surgical process is needed to place internal processor components
  6. 6. Candidacy• Age: most important criteria• Maximum Benefit in speech & language: in children born with bilateral sensorineural hearing loss is to be carried out before age of 3 years.• Up to the age of 6 years good benefit• Above 6 years limited benefit
  7. 7. 2 groupsPre lingual Post lingual• Lost hearing before • Lost hearing after acquisition of speech acquisition of speech• Implant before 3 years • Implant as soon as• CEREBRAL PLASTICITY possible • Any age 6 months to 100 yrs
  8. 8. Newborn hearing screening• Two to four new-borns, out of every 1,000, have hearing deficiency• among the high-risk babies, the number of hearing-impaired is 5 to 14 per cent.• High-riskers include those birth weight was less than 1.5 kg; jaundice, meningitis or birth asphyxia; ventilation after birth; family history of hearing loss
  9. 9. Do we need a test?• Initially, babies who are born with hearing loss do not look or behave any differently from babies who are hearing.• However, undetected and untreated hearing loss has serious consequences on the acquisition of language skills as well as cognition and emotional and social development.• The first 6 months of a baby’s life are very crucial for the development of speech and language.
  10. 10. Results• Given immediately• Either Pass/Refer• Even though child passes if he is a high risker further assessment done• Up to 3 years ,every 6 months
  11. 11. Audiological assessment• OAE-oto acoustic emission• ABR/BERA• Play Audiometry• Impedance audiometry
  12. 12. Audiological
  13. 13. Radiology absolute requirements• Presence of cochlea(either normal or malformed)• Presence of auditory nerve• Combination of CT/MRI is performed
  14. 14. Cochlear aplasia.
  15. 15. Absence of the cochlear nerve.
  16. 16. Speech & Language assessments
  17. 17. Psychological & IQ
  18. 18. Medical work up• Pediatric• Syndromes-Usher’s• Ophthalmology• Neurology• Psychology• Immunization: Prevenar(pneumococcal),Hib
  19. 19. Counseling/Expectations• Factors affecting the performance of cochlear implantee• Duration of deafness• Age of onset of deafness• Age at implantation• Duration of hearing aid use• Others: no. of surviving spiral ganglion cells, electrode placemt,signal processing strategy
  20. 20. What is a cochlear implant system?• Microphone• Sound processor: is a tiny computer that takes the sound captured by the microphone and converts it into detailed digital information. This digital information is sent to the magnetic headpiece, transmitted to the implant, and then sent to the hearing nerve, which in turn sends electrical impulses to the brain, where they’re interpreted as sound.
  21. 21. Surgery
  22. 22. Risks & complications of surgery• Injury to facial nerve• Meningitis• CSF leak• Skin infection• Flap hematoma• Extrusion of device• Tinnitus• Dizziness
  23. 23. Duration of AVT therapy & benefit in speech• Compulsory therapy for 1 year• However speech benefits go on for 4 years post implant• Involvement of family-most crucial
  24. 24. Why are we not implanting all eligible candidates?• COST FACTOR• LATE PRESENTATION• COMMITMENT FOR AVT