Everyone knows a lot about hearing aids, but for the cochlear implant, many people know very little about it. They only know that when the hearing aid of the hearing aid is not up, you can choose a cochlear implant. Today, Xiaobian takes everyone to know about cochlear implants and their indications.~
A cochlear implant is an electronic device consisting of two parts, in vitro and in vivo. The external part includes: a microphone, a speech processor, a connecting wire, and a transmitting coil; and the internal part includes: a receiving processor and an electrode sequence. The working principle is that the microphone collects the signal and converts the acoustic signal into an electrical signal for transmission to the speech processor. The speech processor analyzes the acoustic signal to stimulate the electrodes implanted in the cochlea, then transmits the instructions to the receiving processor in the body, and then stimulates the acoustic fibers in the cochlea through the electrode sequence in the body, and the auditory nerve receives the electrical signal, and Send them to the auditory center of the brain and finally hear the sound. Cochlear implant is a biomedical engineering device that can help people with hearing impairment to restore their hearing and speech communication skills. It is a new technology in the field of medicine and rehabilitation and is constantly updated with the development of science and technology. Therefore, in the choice of indications, preoperative evaluation Guidance for surgery, postoperative adjustment, and auditory speech rehabilitation is needed.
First, the patient’s selection criteria
Cochlear implants are mainly used to treat severe or very severe sensorineural hearing loss.
1. Selection criteria for pre-linguistic patients:
1 implantation age is usually 12 Month -6 year old. The smaller the implantation age, the better the effect, but special prevention of complications such as anesthesia accident, excessive blood loss, and internal and external nerve injury of the tibia. Currently not recommended as 6 Children under the age of 2 implanted cochlear implants, but meningitis caused by deafness due to the risk of coronal ossification, it is recommended to operate as soon as possible with complete surgical conditions.6Children or adolescents over the age of a child need to have a certain level of listening and speaking. From childhood, they have a history of hearing aids and a history of auditory speech rehabilitation training;
2 binaural or very severe sensorineural hearing loss. Comprehensive hearing assessment, hearing aids for children with severe hearing 3-6 If the month is invalid or the effect is not satisfactory, cochlear implant should be performed; children with extremely severe sputum may consider direct cochlear implant;
3 no surgical contraindications;
4 Guardians and / or implanters have a correct understanding of the cochlear implant and appropriate expectations;
5 have the conditions for auditory speech rehabilitation education.
2. Selection criteria for patients with post-linguistic deafness:
1 post-linguistic patients of all ages;
2 binaural severe or very severe sensorineural hearing loss, relying on hearing aids can not perform normal auditory speech communication;
3 no surgical contraindications;
4 The implanter and/or guardian has a correct understanding of the cochlear implant and appropriate expectations.
Second, surgical contraindications
1. Absolute contraindications: severe deformities of the inner ear, such as Michel Malformation; lack of auditory nerves or interruption; acute suppurative inflammation of the middle ear mastoid.
2. Relative contraindications: Frequent seizures cannot be controlled; severe mental, intellectual, behavioral, and psychological disorders cannot be combined with auditory speech training.
Third, special circumstances of the clinical practice of cochlear implant clinical guiding recommendations
1. White matter lesions: also known as white matter malnutrition, is a group of lesions mainly involving the white matter of the central nervous system, characterized by abnormal or diffuse damage of the central white matter.
如果 MRI Found that there are white matter lesions, intelligence and nervous system signs are required. MRI Review. If there is no retrogression in intelligence and motor development, other system functions be normal except for hearing and speech. There is no positive pyramidal sign or no change in signs in the nervous system examination.MRI There is no high signal in the white matter lesion area (DWI Like); dynamic observation (interval is greater than 6 Months) There is no enlargement of the lesion, and cochlear implants may be considered.
2. Auditory neuropathy (audiopathic spectrum disorder): A special type of neurological deafness that is a hearing disorder caused by dysfunction of inner hair cells, auditory synapses, and/or the auditory nerve itself. The auditory mechanics test has its typical characteristics, which are expressed as otoacoustic emissions. (OAE) And/or cochlear microphonic potential (CM) Normal auditory brainstem response (ABR) Missing or severely abnormal.
At present, cochlear implants are effective in improving hearing in most patients with auditory neuropathy, but some patients may be ineffective or ineffective, so patients and/or guardians must be informed about the risks before surgery.
3. Bilateral Cochlear Implantation: Bilateral implantation can improve the sound source localization function, speech and background speech noise, help to obtain a more natural sound experience, and promote the development of auditory speech and music appreciation. Simultaneous implantation or sequential implantation on both sides can be chosen. The shorter the interval between the two surgical procedures, the better the postoperative speech rehabilitation.
4. Cochlear implants with residual hearing: those with residual hearing, especially those with high frequency and steep drop hearing loss, are suitable for electrode implantation with residual hearing. After surgery, the combined sound and electricity stimulation mode can be selected. Inform patients and/or guardians of the risk of residual hearing loss or loss after surgery.
5. Cochlear implants in patients with abnormal inner ear structure: The structural abnormalities of the inner ear associated with cochlear implant include common cavity malformation, cochlear dysplasia, cochlear ossification, internal auditory canal stenosis, etc. Most patients can perform cochlear implants, but Case discussions should be organized before, and careful treatment should be performed during surgery. Face nerve monitoring is recommended. The postoperative effects vary widely among individuals.
6. Cochlear implants in patients with chronic otitis media with tympanic membrane perforation: Chronic otitis media with tympanic membrane perforation If the inflammatory response is controlled, one-stage or staged surgery can be selected. The first-stage operation refers to the cochlear implant at the same time as the middle ear mastoid lesion, the tympanic membrane repair (or the papillary cavity autologous tissue packing and the external auditory canal closure); the staging operation refers to the first lesion removal, repairing the tympanic membrane perforation or closing the external auditory canal.3-6 Cochlear implants were performed months later.