Cochlear implantation: indications, reviews. Cochlear implant
Statistics show that today more than 12 million Russians have hearing impairments. In order to compensate for the loss of this ability, in most cases there is a rather special apparatus. Unfortunately, their use is not always as effective as we would like. If the use of hearing aids is ineffective or ineffective at all for a person with hearing loss, hearing therapy is resorted to as a cochlear implant.
Cochlear implantation - what is it?
When most of the ear snail receptors are damaged, even the most advanced apparatus cannot provide high-quality hearing. Only sounds at low frequency with high and medium volume are accessible to a person, while quiet and high-frequency sounds remain inaccessible, the speech is heard indistinct.In such a situation, the child will not be able to learn to perceive speech at the ear and even more so to speak. In this case, cochlear implantation comes to the rescue - a system of measures with the use of high-tech means, which today is recognized as the most effective way to restore hearing.
Cochlear implantation is a standard treatment for severe bilateral hearing and deafness disorders. It shows high performance in case of severe and deep sensorineural hearing loss and deafness, in other words, in violation of the sound-perceiving system.
The principle of the implant
The cochlear implant system includes two main elements. An external (speech processor with microphones) is mounted on the ear and is removable. The internal - cochlear implant - is implanted under the skin and consists of a receiver and electrodes, through which a sound signal is transmitted to the auditory nerve.
The function of the cochlear implant is to receive the transmitted digital information from the head transmitter and convert it into an electrical signal that will be supplied through an electrode array embedded in the cochlea or the inner ear.The lattice electrodes stimulate the auditory nerve, due to which the impulses enter the brain, where they are recognized as sound.
Installing a cochlear implant allows you to act around the damaged ear region and send an electrical signal through the auditory nerve directly to the brain.
What is better for the deaf - surgery or hearing aid?
To determine which option is best suited for eliminating deafness, only a qualified specialist will help. The choice of one or another method depends on many factors. Among them are the type of hearing loss, the degree of hearing impairment in a patient, his intellectual abilities, motivation, age, duration of hearing loss, and others. Hearing aids are effective if the patient can hear sounds up to 80-90 dB, while cochlear implants save when the patient has pronounced hearing loss or does not hear at both ears, that is, the hearing threshold exceeds 90 dB.
Cochlear implantation: indications
Cochlear implantation involves surgery on the head, which can affect the work of the brain. Therefore, before you assign this operation,it is necessary to carefully study the patient’s medical history, consider the possibility of restoring hearing without resorting to the use of a cochlear implant, and also to predict the effectiveness of the operation in each particular case.
Cochlear implantation is performed in the case of:
• pronounced bilateral sensorineural deafness;
• the absence of a pronounced improvement in speech perception using an optimally selected hearing aid used for 3–6 months;
• absence of somatic diseases, cognitive and psychological problems.
A prerequisite for the operation is the motivation of the child, psychological support from the parents and their readiness for long-term rehabilitation.
It is worth noting that in children who do not hear from birth or have lost hearing in early childhood, cochlear implantation will give the best result if performed as early as possible.
Unfortunately, cochlear implantation is not an absolute solution to hearing problems.
The operation will not bring the desired result if the hearing loss is not due to damage or death of the cochlea's hair cells, but is associated with damage to the auditory nerve or those parts of the brainwhich are responsible for the auditory perception. So, if the hearing is lost due to neuritis (inflammation) of the auditory nerve or the cause was cerebral hemorrhage, which damaged the auditory cortex, the expediency of the operation is minimized.
In addition, cochlear implantation would be ineffective or completely useless if the cochlea of the inner ear underwent calcification or ossification, that is, it contained calcium salts or bone germination. All this prevents the implant from implanting into the cochlea and reduces the effectiveness of the operation.
Good results should not be expected if a patient with sensorineural hearing loss did not hear sounds for a long time, since this could lead to atrophy of the auditory nerve and the impossibility of its restoration. However, to say that cochlear implantation of hearing is not suitable for such patients is also impossible.
Stages of the procedure
As mentioned above, cochlear implantation in children is a whole range of activities aimed at restoring auditory perception. It consists of three stages:
• preoperative examination of the patient;
Preparation for surgery
Before immediate surgical intervention it is necessary to conduct an in-depth audiological examination. In addition, an otolaryngologist should give his opinion. To confirm the presence of sensorineural deafness, audiometry and other studies are carried out, indicating that the sound-perceiving device is really impressed. The pathology of the auditory nerve should also be excluded, since in this case the operation will not give the desired result. A prerequisite for cochlear implantation is the integrity of the tympanic septum. In addition, computed and magnetic resonance imaging, Doppler sonography and other methods of instrumental diagnostics can be prescribed.
Features of the operation
Surgical intervention is performed under general anesthesia and usually lasts two to five hours. During the operation, the surgeon places a cochlear implant under the skin on the temporal bone, and a hole is made in the mastoid process behind the ear. Through it to the cochlea is the electrode that transmits sound signals to the auditory nerve.The electrode joins the receiver, its work is checked, after which the incision is sutured.
Before the operation, the surgeon is obliged to notify the patient and his relatives about the possible risk of the operation. World practice shows that cochlear implantation is fairly safe. Only in rare cases can there be operative and postoperative complications, the cause of which can be general anesthesia, infection, inflammation and damage to the facial nerve, loss of sensation in the ear, vestibular disorder, noise in the head, temporary disturbance of taste and so on.
After surgery, the patient is in a medical facility for several days. The duration of wound healing in patients may vary. However, after 2-4 weeks, children can attend school. When swelling and redness at the operated site (on average after 4-6 weeks), the external part can be connected to the implant. In fact, it is from this moment that the rehabilitation period begins, during which the patient must learn to perceive and recognize sounds, as well as to switch on and adjust the sound processor, that is, the outer part of the cochlear system.
It should be understood that after the operation it is not possible to adequately perceive speech and sounds in the patient. For complete hearing, rehabilitation is necessary, which is the most difficult and lengthy stage of cochlear implantation.
If a child has lost his hearing at the time when he already had the formation of aural-speech image and speech, the duration of the recovery is significantly reduced. This mainly applies to hearing and late-bad children. This pattern is quite understandable, because in the memory of these children are preserved auditory images. The main task is to extract them and adapt them to the sound that the implant reproduces.
Another thing - deaf patients who have not developed speech and no auditory image. A person has to learn to isolate sounds, form speech and auditory images and learn to speak from scratch. Therefore, in this case, the rehabilitation process lasts much longer.
Components of rehabilitation
Is cochlear implantation always effective? Prospects for the effectiveness of the operation depend on many factors, in particular, such as the type and duration of deafness, the intellectual development of a person, the motivation of the child and parents, the duration of the postoperative period.Of particular importance is the quantity and quality of remedial exercises.
Classes with a child after cochlear implantation are a whole range of activities, which includes classes with a deaf-and-rehabilitation specialist, securing material passed at home with a specialist, practice with spontaneously arising situations.
An important part of the rehabilitation process is setting up the implant. Since the perception is constantly evolving and changing, the implant needs to be changed regularly, that is, it needs to be developed. The setting will eliminate discomfort and make the sound perception with the implant as comfortable as possible.
In addition, you should clearly form the motivation, so that a person can quickly learn to perceive sounds and speech.
What you need to use 2 devices
Bilateral implantation, or bilateral cochlear implantation, involves the installation of two cochlear implants. Clinical studies have proven the importance of using bilateral implants for many children with hearing loss.
The advantages of implanting two devices are that sounds differ much more easily, are perceived much more naturally, and the sound quality is much better and clearer than when using a single implant. Moreover, in this case, there is no need for constant adjustment of the sound. Bilateral implantation allows you to better determine the source of sound and perceive speech in a noisy environment. In addition, the wearing of two implants activates the work of both ears, thereby preventing the possibility of losing the ability to hear and distinguish sounds, as can happen when using a single device.
Is cochlear implantation so effective and safe? Reviews of patients with severe hearing impairments indicate that this operation allows you to restore and improve the perception of sounds and speaking, creates a sense of security and confidence, helps to improve communication with people and, as a result, improve the quality of life.
The effectiveness of cochlear implants, which are constantly being improved, has been repeatedly proven. According to experts, the best result can be obtained if the child or adult were able to talk before the operation.And the less time has passed after the loss of hearing, the more effective cochlear implantation will be. Children with a diagnosis of "hearing loss" with the help of an implant develop faster and live a brighter and more fulfilling life.
How much will cochlear implantation cost?
The cost of implantation includes preoperative diagnostic examination, surgery and postoperative correction. Usually the price starts from 1 200 000 rubles. Since cochlear implantation is an expensive medical aid, in Russia it can be carried out according to quota at the expense of funds allocated from the federal budget. In any case, it is better to consult with a specialist about where to do cochlear implantation - here or abroad.