cochlear implant protocol

1
???????? ????? ??????? cochlear implant protocol

• ?????
• ??????? ??? ?????? ?????
• ??????? ???? ?????

2
?????Introduction

• ?? ????? ??????? Cochlear implant(CI) ?? ???????
  ?????? ????? ??????? ???????????? ??? ???? ???
  ????? ?????? ???? ????????? ?? ????? ???????
  ????????? ?????? ?? ??????.
• ??? ????? ????? ?????? ???????Food and drug
  Administration (FDA) ??? ??? ???? ????? ???
  ???????? ??? 1985????? 1990 ??? ???????.
• ??? ??? 2006? ???? 120000 ??? ?????? ????? ?????
  ??? ??????.
• ?? ????? ?????? ???? ???? ?????? ??????? ??????
  ???????
• Advanced Bionics(US)
• Cochlear(Australia)
• Med-el(Austria)
• Neurelec(France)
• ???? All Hear ????? ???? ???? ?????? ??????? ????
  ???? ?????? ?? ???? ??? ?????? FDA ?????.

3
???? ????? Implant Team

• ???? ???? ??? ??????? ?? ??????? ??? ????? ????
  CI ??? ???? ????? ??? ???????.
• ????? ?????? ???? ????? ????? ?????? ?????
  Candidacy ?????? ????? ????? ????? ????? ?????
  ?????? ????? ?????? ????? ??????.
• ??????? ????? ??? ?? ??????? ???? ?????
• ?????? ???????? Audiologest ?????? ????? ?
  ?????? ??????? processor fitting????????
  ?????????.
• ???? ????? ?????? ???????? ??????? ????? ? ?????
  ??????? ???????? ?? ??? ????? ???????.
• ?????? ?????? ?????? Speach- language pathologist
  ?????? ?????? ?????? ?????? ????? ?????? ? ????.
• ???????? ???????? ( ??????) Educational
  specialists ?????? ?????? ????????? ? ??? ???????
  ? ?????? ????? ??????? .
• ?????? ??? ????? Psychologist ??????? ??????
  ??????? ??????? ????? ????? .
• ?????? ?????????Social Worker ?????? ??????
  ???????? ?????? ????????.
• ???? ???? ????? Implant team coordintor ???????
  ??? ????? ????? ??????? ?????????? ?????? ????
  ???? ??? ?????? ???? ???? ?????? ???????? ??
  ?????? ?????? ?????? ?? ??? ??????? ??????.

4
????? ??? ?????Definition of hearing loss
5
??????? ???????? Assessment and evaluation
6
??????? ????? ENT

• ?????? ???? ??? ???? ????? ??????? ???????
  ??????? ?????? ??????? ?????? ????? CI????????
  ????????? ???????? ???? ???? ??????? ????????
  ???????????? ??????? ??????? ?????? ??? ?????
  ?????? ?????? ?????? ??????.
• ????? ???????????? ???? ?? ?????? ??????? ????
  ???????.
• ??????? ?????? ??????? ?MRI ?????? ???? ??
  ?????? ?? ????? ??????? ?????? ????? ?? ?? ??????
  ????? ?? ???????.
• ??????? ?????? ???? ?? ??? ????????????? ??????
  ?????? ??????.

7

• ?????? ?????? ?????? Speech-languge
  pathologist?????? ??????? ?????? ?????? ???????
  ???????? ???????? ????????? ????????? ?????? ????
  ?????? ?????? ?????? ????? ???? ????? ?????????
  ???????? ??? ?????.
• ?????? ??? ????? Psychologist?????? ??????
  ??????? ?????? ???? ???????? ???? ????? ????????
  ????? ????????? stability ???? ?????? ??????
  ????? CI ????? ??????? ?? ??????? ???????? ?????
  ????? ??????? ?????????.
• ?????? ?????????????? ??? ??????? ????????
  ???????????????? ?????? ????? ????? ?????????
  ????? ?????.
• ???? ??????????? ????? ????????? ???????? ?????
  ????? ???? ????? ??? ?? ?????? ?????? ??????? ??
  ??? ??????? ???????? ?????CI ????? ????? ??????
  ?????? ?? ????? ????? ??????? ???? ?? ??????? ???
  ????? ???????.

8
??????? Candidacy

• ???????????? ???????? ???????? ??????
• ???????? ??????? ??????? ?? ?????? ??FDA???????
  ????????? ?????? ???????? ??????
• ??? ?? ???? ???? 16 ??? ?? ????.
• ???? ???? ??? ??? ???? ??? ???? (70 Db hl )??
  ????.
• ????? ?????????? ???????? Open set sentence 50
  ????? ?? ???? ???????.
• ?????? ??????.
• ?????? ?????? ?????? ?????? ????? ????? ??????
  ??????.
• ????? ??????? ???? ???????? ?? ???? ??? ???.
• ??? ???? ?????? ??????? ???? ?????? ???????.
• ??????? ?? ????? ??????? ????????? ?????? ??
  ??????.

9

• ?????? ?????? ????? ???????? ??????
• ??? ??? ??? ???? ???? (lt 12 ??? ?? ?????).
• ??? ??? ??? ???? ???? ??? ???? (lt 24 ??? ??
  ?????).
• ???? ????? ??????? ??????? ?? ??????? ?????
  ??????? ???????? (????? ??? 3 ??? 6 ????).
• ??? ???? ???? ??????? ??? ?????? ???????.
• ???? ???? ??? ??????? ?????? ??? ????? ????????.
• ????? ??????? ???? ???????? ?? ???? ??? ???.
• ???? ??? ?????? ???? ?? ?????? ??? ??????? ??????
  ??????? .

10

• ????? ???????? ??? ???? ??? ??????? Prioritizing
  of CI patient
• ???? ??? ?????? ????? ?? ????? ????????(????????)
  ??? ????? CI ??? ???????(??? ?????? ???
  ????????)
• ??????? ????? ???????? ??????????? ??? ?????
  ????? ???? ???? ??????? ???? ????? ?????? ???????
  ????????? ??????? ??????????? ??????? ??????
  ????? ?? 12 ??? ?? ????? ?? ??? (???? ??????
  ??????? ???????? ???????? .
• ??????? ??????? ????? ????? Post-lingual ????????
  ???? ???? ?? ??????? ????? ?????Pre- lingual.
• ??????? ??? ???????? ?????? ????? ?????? ?? CI
  ???? ?? ??????? ????? ?????? ????? ????? ??????
  ?????? ???????.
• ???????? ????? ?????? ?? ??? ??? ????? ????? ????
  ????? ?????? ?????? ???? ????? ???????? ??????
  ????? ????? ???????.
• ?? ?????? ?????? ??? ????? ???? ??? ??????? ?????
  ????? ?????? ?????? ?????? ??????? ??? ??? ????
  ???????? ????????.
• ???? ???????? ?? ???????? ??????? Auditory
  plasticity ???? ??? ??? ???? ????? ???????? ????
  ????? ????? ?????? ???? ?? ??? ????? ?????? ???
  ????? ????? ????? ???????? ?????? ????? ???? 6
  ????? ?? ????? ??? ????? ???? ???? ?? ???? CI
  ?????? ????? ?? ???????? ??????? ??? ??? ?????
• ?? ????? ??? ??? ??? ?????? ??? ?????? ?????
  ?????? ?? ???????? ??? ?????? ?????? ?????? ???
  ??CI .

11
Ear Selection for CI

• .

Imaging

• Aplasia cochlea,coclear nerve.
• Dysplasia.
• Ossification of scala.
• Facial nerve,vascular anomaly.
• Poor pneumtization,OM

Abnormal
Normal
Medical Evaluation
IMPLANT BETTER EAR
Abnormal

• Chronic OM
• Trauma
• Prior Surgery.
• Tumor.
• Gamma knife.

Normal
Audiology

• Anacusis
• gt10years disuse

IMPLANT WORSE EAR
Bilateral Residual hearing
12

• ?????? ?????????
• Contraindications
• ?????? ?????? ??????II ??????? ?????????????
  Psychsis ???? ?????? ?????? Organic brain
  dysfunction ??????? ??? ??????.
• ??? ???? ?? ????? ??????.
• ?????? ???? ????? .
• ??????? ??????? ??????? ???? ???? ????? ???????
  Cochlear agenisis (???? ?????) ?? ??? ???? ?????
  ??????( ??? ????? ?????? ?????? CN8 atresia).
• ??? ?????? ???? ???????? ?? ???? ???? ????????
  ??? ??? ?????? ??? ?????? ??????.
• ?? ?????? ?????? ???? ?????? CWD mastoidectomy.
• ???? ??????? Cochlear ossification.
• ??????? ???????? ?? ??? ?????? ?????? Advanced
  otoseclerosis.

13

• ????? ????? CI
• Risks of CI surgery
• (ASHA technical reports 2004)
• ??? ????? ?????? ??????? ??? ????? ??????? ?????
  ?????
• ???? ????? ??????.
• ?????? ??? ????? ???????.
• ?????? ??????? .
• ???? ?????? ??????? ??????.
• ??? ?????? ???????Delayed device failure(??? ??
  2).
• ???? ?????? ?? ???????.

14
?????????? ???????

• ??? ???? ???? ??? ????? ??????? ??? ??????? ?????
  ???
• Flap break down.
• Cholesteatoma.
• Ear drum perforation
• Facial nerve damage
• Persistent infection.
• Meningitis.
• Extrusion of the array.
• Device falure.
• ??????? ?? ???? ??? ??? ????? ??????? ???????
  ?????? ??????? ???? ??? ????? ?? ???.

15
?????????? ???????

• ??? ?????????? ???? ???? ??????? ???????
• ????? ?????.
• ???? ?? ???????.
• ????????.
• ????? ????? ???????.
• ????.
• ???? ????.

16
??????? ????

• ????? ???? ????? ??? ?????? ??? ??????? ??? ??
  ????? ???? ???????? ????? ??? ????? ????? ?????
  ????? ??? ?? ???????? ???? ?? ????????? ?????
  ?????? ?????? ? ???? ?? ????? ????? ??? ??? ????
  ?????.
• ??? ????? ???? ???????? ???? ????? ??? ?????
  ?????? Bimodal listineng ???? ???? ????? ?????
  ????? ???? ??? ????? ??????(Litovsky et al,ching
  etal 2006) .
• ????? ???????? (3-6) ???? ???? ?? ????? ??? ??
  ????? ??? ????? ?? ??????? ??????? ??????? ???
  ??????? ??? ?????? ???????? ???? ?? ???? ????? ??
  ??? ?????.
• ??? ?????? ?? ??? ????? ???? ?????? ??????? ????
  ?????? ??? ???? ??? ????? ?? ?????? ???? ??
  ???????? ??? ????? ??????.

17
???? ?????????

• ?? ?????? ?????? ??????? ???? ???? ??????
  ???????? ??????? ??? ??? ???? ??????? ???? ?????
  ??? ?????? ?? ???? ??????? ????? ?????? ?? ???
  ????????? ?? ??????? ????????.
• ?????? ??????? ?????? ???? ?? ????? ??? ???????
  ???? ?????? ??? ??? ?? ????? ???? ?????? ??????.

18
??????? Documentaion

• ????? ???????.
• ????????.
• ?????? ?????? ?????? .
• ?????? ?????? ??????? ??? ??????? ??? ??????? ???
  ???????.
• ???? ?????? ?? ????? ????????? ????????? ???
  ????? ??????? ???? ?????.
• ????? ????? ???????.
• ????? ?????? ????? ?????? ??????? ???????.

• ????? ???????.
• ????????.
• ?????? ?????? ?????? .
• ?????? ?????? ??????? ??? ??????? ??? ??????? ???
  ???????.
• ???? ?????? ?? ????? ????????? ????????? ???
  ????? ??????? ???? ?????.
• ????? ????? ???????.
• ????? ?????? ????? ?????? ??????? ???????.

19

• References
• ASHA www.asha.org/puplic/hearing/treatment/cochle
  ar_implant.htm
• Waltzman,s.and shapiro,w.(2007 Cochlear implants
  in adults.in Valente,Hosford-Dunn and
  Roesser(eds) Audiologytreatment.New YorkThieme
  medical puplisher,Inc.
• ASHA Technicol Reports 2004.
• Sharma et al.
• Intj Pediatric otorhinolaryngology, PubMed
  ID10577804.
• Acta otolaryngology PubMed ID12701751.
• Adapted from American Speech-Language-Hearing
  association,1997.