pre-operative evaluation and post-operative rehabilitation for paediatric cochlear implantation han...
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Pre-operative evaluation and post-operative rehabilitation for paediatric cochlear implantation
Han Demin, M.D., Ph.D.Beijing Institute of OtolaryngologyBeijing TongRen Hospital Capital University of Medical Sciences
Advances in
Deafness Management2005-10-8-9 Hong Kong
Instruction
The census of China (local) in 2000
– More than 20 million hearing impaired people,
the largest handicapped persons of all the categories.
– Universal Newborn Hearing Screening an incidence of 1 to 3 per thousand live births
800,000 children with hearing impairment
30,000 children per year born with hearing loss
One of the important factors to impact on the quality of life.
Effective early intervention is essential.
Cochlear Implants in mainland of China
There are totally around 2500 cochlear implant recipients since 1996 in mainland of China.
The age of CI recipients has lowered More clinics are conducting surgery and
rehabilitation.
Manufacturers of CI in china
According to the CI Recipients in mainland of China (about 2500 cases)NUCLEUS from AustraliaCLARION from America MED-EL from Austria
995
68 116241
2 21103
22290
0
200
400
600
800
1000
1200M
SP
SPE
CT
RA
SPR
INT
ESP
RIT 3G
TE
MP
O+
CIS
Pro
S-SE
RIE
S
PL
AT
INU
M
BT
E
Distribution of the external
CⅡHifocusSpiral
CI24M
CI22M
CI24R
CI24K
COMBI40+
Distribution of the internal
290
522
443
250
155
0
100
200
300
400
500
600
0-2. 99 3-5. 99 6-11. 99 12-17. 99 18-
Distribution of the age
Essential elements of the process
Surgical technique
Rehabilitation and training
Hearin
g th
e w
orld
Key
Necessity
Periodic mapping
Bridge
Accurate evaluation
Basis
Audiometric assessment system
Psychological and pediatric assessment
Auditory and facial nerve monitoring
Mapping, rehabilitation
Evaluation of hearing aid fitting
Speech audiometry
study for adults and children
Subjective and objective assessment
Researches on Cochlear Implantation
Audiological and Radiological researches
1. Investigation of tone vocalization in Mandarin with CI Recipients
2. Available speech materials and to be standardizing in mandarin and rehabilitation procedures for adults
3. Development of the Lexical Neighborhood Test in Mandarin as a speech test for children
4. Radiological study on the abnormal modality of the cochlea in order to improve surgical skills of cochlear implantation
Researches on Cochlear Implantation
Clinical applications
1. Investigation of audiometric assessment strategies for patients pre- and post- cochlear implantation
2. Setting up the standard of classification for cochlear malformation
3. Establishing indications for selecting teen-age patients who can benefit from cochlear implantation
4. Cochlear Implantation in abnormal cochlea (Mondini, Large vestibular aqueduct syndrome, etc.)
Pre-operative evaluation
• Comprehensive audiological evaluation
• Other tests :
• language, psychological, mental tests
• radiological tests (CT & MRI)
• learning ability tests
Comprehensive audiological evaluation
Subjective hearing test ( behavioral test ) Impedance test ABR Auditory steady-state response (ASSR) OAEs Speech audiometry Hearing aid fitting
Behavioral test
Behavioral observation audiometry (BOA): under 6 month
Visual reinforcement audiometry (VRA): 6 to 24 months
Play audiometry (PA) : 2 to 6 years old
Also be used to get the threshold for speech reception
Not widely used in China and this limits the appropriate
candidate selection for cochlear implants
Impedance test
Testing the status of the middle ear Rule out conductive hearing losses.
ABR
• ABR (click induced) can only give thresholds at
middle to high frequencies (2000 ~ 4000 Hz)
without an accurate estimation of low frequency
hearing threshold
• Tone-burst stimulation can be used to obtain
thresholds for each frequency, but takes a long time
Auditory steady-state response (ASSR)
Used for children at different ages Main advantage: frequency specificity Each clinic should establish its own
normalization data before interpreting the results
OAEs
OAE is used to evaluate the function of the cochlea, especially the outer hair cells
OAE is not ease to define the degree of the hearing loss
Speech audiometry
Available speech materials in mandarin– for adults: the minimal auditory capabilities
(MAC)– for children: pediatric speech perception test
We are going to standardizing the mandarin materials
Hearing aid fitting
Pre-operation Binaurally hearing aid fitting 3-6 months auditory training Aided audiogram, and speech perception testing
at the start and end of the trial Compare the results with current average CI res
ults
Current situation of post-operative rehabilitation
Rehabilitation Service Rehabilitation and training model Rehabilitation and training approach Factors affecting outcome Psychological education for cochlear implant recipients and
parents
Government organizations Private organizations Home based Special schools Hospitals or welfare organizations
Rehabilitation Service
Rehabilitation and training model
Class model Class plus parents Individual rehabilitation Individual plus parents Individual combing with integrated class mode Intensive training combing with integrated class
Rehabilitation and training approach
Auditory verbal training Real scenario verbal training
Factors affecting outcome (1)
Auditory detection frequency range Normal delivery at birth is better than at risk factors Infants with normal motor skills are better Onset of hearing loss, late onset is better than
congenital Duration of hearing loss, shorter is better More residual hearing is better
Factors affecting outcome (2)
Intervention pre-operatively: Early binaural intervention with full frequency range is better
Rehabilitation and education history: intensive Age Degree of speech disorder Family and language environment Expectation of parents and recipients
Psychological education for CI recipients and parents
Communication between the rehabilitation organizations and the parents
Improve teachers’ ability to provide counseling Make friends with the recipients Create an environment for emotional rehabilitation Back to mainstream