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Cochlear Implant

Cochlear Implant. The Fundamental Concept of Cochlear Implant. To bypass the damaged hair cells. History:. Old generation: Sound awareness only New generation: Improved communication abilities (auditory cues with lip reading, open set speech)

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Cochlear Implant

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  1. Cochlear Implant

  2. The Fundamental Concept of Cochlear Implant To bypass the damaged hair cells.

  3. History: • Old generation: Sound awareness only • New generation: Improved communication abilities (auditory cues with lip reading, open set speech) • Since 1972 more than 16 different cochlear implants • 1984 FDA approval for adults • 1990 children approval

  4. Anatomy Anatomy

  5. Anatomy Scala tympani Scala vestibuli Cochlear duct Basilar membrane Vestibular membrane Tectoral membrane Hair cells (outer/inner) Cochlear nerve fibers

  6. Anatomy-micro

  7. Physiology of Hearing

  8. Anatomy

  9. Pathologic Anatomy

  10. Structure of Cochlear Implant • External components • Internal components

  11. Components of Cochlear Implant

  12. Anatomy of a Cochlear Implant

  13. How does it work?

  14. Indication for Cochlear Implant • Adults • 18 years old and older (no limitation by age) • Bilateral severe-to-profound sensorineural hearing loss (70 dB hearing loss or greater with little or no benefit from hearing aids for 6 months) • Psychologically suitable • No anatomic contraindications • Medically not contraindicated

  15. Indications for Cochlear Implantation -- Children • 12 months or older • Bilateral severe-to-profound sensorineural hearing loss with PTA of 90 dB or greater in better ear • No appreciable benefit with hearing aids (parent survey when <5 yo or 30% or less on sentence recognition when >5 yo) • Must be able to tolerate wearing hearing aids and show some aided ability • Enrolled in aural/oral education program • No medical or anatomic contraindications • Motivated parents

  16. Factors Affecting Patient Selection • Onset of deafness (congenital or adventitious) • Year of deafness • Length of sensory deprivation (i.e. no hearing aids) • Socioeconomic factors • Educational level • Individual ability to use minimal cues • General health

  17. Factors Affecting Pt. (cont.) • Personality • Willingness to participate in rehabilitation program • Language skills • Appropriate expectations • Desire to communicate in a hearing society • Psychological stability • Cochlear patency

  18. Audiologic Evaluation • Pure tone audiometry under headphones • Warble tone audiometry with a hearing aid in a monitored free field • Immittance testing • Speech recognition testing • Speech awareness testing

  19. Audiologic Evaluation (cont.) • Environmental sounds (closed and open set) • Speech reading (lip reading) ability • Electrical response audiometry • Auditory discrimination • Transtympanic electrical stimulation (promontory or round window test)

  20. Medical Evaluation • Clinical history and initial interview • Preliminary examination • Complete medical and neurologic examination • Cochelar imaging using computed tomography (CT or magnetic resonance imaging (MRI) • Vestibular examination (electronystagmography) • Pathology tests • Psychologic or psychiatric assessment or both • Vision testing • Assessment for anesthetic procedures

  21. CT Findings

  22. 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 ossificans—follow scans • Advanced otosclerosis

  23. Surgical Procedure All electrode insertions are carried out through the facial recess approach. Various incision designs are used to allow wide exposure of the mastoid and squamous portions of the temporal bone. The temporalis muscle and periosteum are widely stripped to accommodate a “table” for the pedestal of the Ineraid device or the receiver-stimulator of the other devices. The mastoidectomy is not widely saucerized, but instead overhanging ledges are purposefully maintained. Care must be exercised so as not to damage the fibrous annulus during the facial recess approach..

  24. Surgical Technique

  25. Complications: A. Intraoperative 1. Intraoperative cannot be placed appropriately. 2. Insertion trauma 3. Gusher

  26. Complications (cont.): B. Postoperative 1. Postauricular flap edema, necrosis or separation 2. Facial paralysis 3. Transient vertigo is more likely to occur on a totally nonfunctioning vestibular system. 4. Pain is usually associated with stimulation of Jacobson’s nerve, the tympanic branch of the glossopharyngeal nerve. 5. Facial nerve stimulation 6. Meningitis 7. Device extrusion

  27. Rehabilitation Tuning or mapping of the external processor to meet individual auditory requirements after 3 - 4 weeks postop. 1. Multisensory approach 2. Bimodal stimulation 3. Suprasegmental discrimination training 4. Segmental discrimination and recognition training 5. Speech tracking 6. Counseling

  28. Rehabilitation

  29. Rehabilitation

  30. Rehabilitation

  31. Rehabilitation

  32. Rehabilitation

  33. Rehabilitation

  34. Rehabilitation

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