cochlear implant ok print
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LITERATURE READING
Oke Kadarullah
Department of Otorhinolaryngology-Head and Neck SurgeryHasan Sadikin Hospital
Medical Faculty Padjadjaran University2012
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INTRODUCTION
Hearing loss poses a monumental obstacle ofeffective communication skills.
The perception and the production of speech arehighly dependent on the ability to processauditory information.
Early identification
An appropriate sensory aid recommended.
Conventional amplification is initial choice.cochlear implants or other implantable hearingaids.
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Anatomy & Physology of Hearing
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Component CI system
Microphone.
Speech processor.
Electrode array.
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Role of The Cochlea
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The Cochlea (Spiral Ganglion)
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Otte et al : We Need
10.000 ganglion
cells with 3.000
apically to have agood speech
discrimination
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How CI Works
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Implant Selection
Nucleus
Clarion/Bionic
MedEl
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Selection & Evaluation of Patients
Children
12 months or older
Bilateral severe-to-profound sensorineural hearingloss with PTA of 90 dB or greater in better ear
No appreciable benefit with hearing aids (parentsurvey when 5 yo)
Must be able to tolerate wearing hearing aids andshow some aided ability
Enrolled in aural/oral education program
No medical or anatomic contraindications
Motivated parents
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Contraindications
Incomplete hearing loss
Neurofibromatosis II, mental retardation, psychosis,organic brain dysfunction, unrealistic expectations
Active middle ear disease CT findings of cochlear agenesis (Michel deformity) or
small IAC (CN8 atresia)
Dysplasia not necessarily a contraindication, but
informed consent is a must H/O CWD mastoidectomy
Labyrinthitis ossificansfollow scans
Advanced otosclerosis
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Classification of Cochlear Implant Recipients
1. Postlingually deafened adults and children:
deaf at or after age 5 years
High level of success
2. Congenitally or early deafened children:
most frequently encountered type of profound SNHL
variable results
3. Congenitally or early deafened adolescents and adults:patient who has had little or no experience with sound
low level of success
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General Workup
Audiologic exam with binaural amplification
CT scan/MRI of temporal bones
Trial of high-powered hearing aids
Psychological evaluation
Medical evaluation
Any necessary tests to discover etiology of hearing
loss
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Surgical Anatomy
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Mastoidectomy
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Posterior Tympanotomy
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Cochleostomy
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SURGICAL IMPLANTATION
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SURGICAL IMPLANTATION
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SURGICAL IMPLANTATION
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SURGICAL IMPLANTATION
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SURGICAL IMPLANTATION
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Step by step surgery
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Preview film
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Special Circumstances
Cochlear Ossification
Cochlear Malformation
Bilateral Implantation
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Postoperative Management
Initial Stimulation & Device Programming
Post operative Rehabilitation
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Complication
Infrequent Wound infection
Facial nerve injury
Tinnitus Infected foreign body
Electronic malfuction
Delayed mastoiditispostauricular abscess.
Meningitis Further degeneration of the central auditory
system
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Result
Wide range of outcomes
(subjective & objective measurements)
Adult outcome
Pediatric outcome
Spoken word recognition
Speech production and language outcomes
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Other Implantable Hearing Devices
Implantable Hearing Devices (IHDs) that couple with theossicular chain in the middle ear
Advantages of IHDs :
(1)elimination of acoustic feedback
(2)a wider frequency response
(3)elimination of a tight-fitting external ear canal mold
(4)improved perception of the auditory signal.
Devices : Vibrant Soundbridge
Direct System
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Vibrant Soundbridge
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Components:
(1)A surgically implanted internal receiver that
includes the floating mass transducer, which is
crimped onto the long process of the incus(2)External processor, which picks up sound from
the environment and transmits the signal to
the implanted receiver. The implant is
positioned through a mastoid-facial recess
approach
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Vibrant Soundbridge
Appropriate for moderate sensorineural hearing loss
Not appropriate for conductive hearing loss or
retrocochlear hearing loss
Speech discrimination must be at least 50%. A stable middle ear should be present and the tympanic
membrane must be intact.
Average functional gain of 10 to 15 dB across thefrequency spectrum
Aided speech recognition scores comparable with
conventional hearing aids31
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Direct System
consists of : a neodymium-iron-boron (Nd-Fe-Bo) magnet
implanted at the incudostapedial joint via a transcanal
procedure
An external processor produces an electromagnetic fieldthat sets the implanted magnet into motion.
Average functional gain of 10 to 15 dB for all tested
frequencies lower than 6 Hz.
There was no significant change in average residual hearing
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HIGHLIGHTS
Cochlear implants (multichannel design)sound information : intensity, timing, andfrequency.
Postlinguistically deafened adultsthemost predictable beneficiaries of cochlearimplants.
Ossified or congenitally deformed cochleas(i.e., Mondini deformity) do notcontraindicate cochlear implantation.
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HIGHLIGHTS
A detailed hearing-aid trial with training isrequired to compare hearing-aid performance
with that expected with a cochlear implant.
The standard surgical approach is through the
mastoid and facial recess, providing access to
the round window.
Detailed longitudinal studies are now clearly
demonstrating improvements in speech
perception and speech production.34
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Cumming otolaryngology HNS 4thed Elsevier 2007
Bailey BJ, Head & Neck Surgery - Otolaryngology, 4th Edition
Lippincott Williams & Wilkins 2006
Snow, JB., Ballenger JJ, Otorhinolaryngology Head and Neck
Surgery, sixteenth Edition, BC Decker 2003
Dhingra PL, Diseases of Ear, Nose and Throat, 4thedition,
Elsevier, 2005
Moller, A.R, Cochlear and Brainstem Implants, Karger, 2006
Ulug T., Atlas of Temporal Bone Surgery, 1stedition,Thieme, 2010
Niparko J.K, CochlearImplants: Principles and Practice, 2nd,
Lippincott, 2009
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