Ce diaporama a bien été signalé.
Nous utilisons votre profil LinkedIn et vos données d’activité pour vous proposer des publicités personnalisées et pertinentes. Vous pouvez changer vos préférences de publicités à tout moment.

Cochlear Implant

  • Soyez le premier à commenter

Cochlear Implant

  1. 1. Cochlear Implants - An introduction R.Ranjith Audiologist Madras ENT Research Foundation Chennai
  2. 2. What is a cochlear implant ? <ul><li>A cochlear implant is a hearing prosthesis designed to restore or provide a level of auditory sensation to adults and children who have a severe to profound bilateral sensori-neural hearing impairment and who get limited benefit from hearing aids </li></ul>
  3. 3. Parts of CI <ul><li>External </li></ul><ul><li>Microphone </li></ul><ul><li>Speech Procressor </li></ul><ul><li>Transmitting coil </li></ul><ul><li>Internal </li></ul><ul><li>Receiver /Stimulator </li></ul><ul><li>Electrode array </li></ul>
  4. 4. The Cochlear Implant in situ
  5. 5. Electrode Array in the Cochlea
  6. 7. Sound is received by the microphone Microphone
  7. 8. Sound is sent from microphone to speech processor cable Speech processor
  8. 9. Speech processor analyzes and digitizes the sound into coded signals Speech Processor
  9. 10. Coded signals are sent to the transmitting coil Transmitting coil Cables
  10. 11. Transmitting coil sends the code across the skin to the receiver/ stimulator of internal implant Transmitting coil Receiver/ stimulator
  11. 12. Signals are sent to the electrodes to stimulate the remaining nerve fibres electrode
  12. 13. Signals are recognized as sounds by the brain producing a hearing sensation
  13. 16. <ul><li>1985: </li></ul><ul><li>First children implanted </li></ul><ul><li>with Nucleus multichannel </li></ul><ul><li>cochlear implant in </li></ul><ul><li>Melbourne. </li></ul><ul><li>Over 50,000 children have been implanted and the age of implantation has dropped significantly. </li></ul>
  14. 17. Selection criteria - Children <ul><li>Twelve months of age or older </li></ul><ul><li>Bilateral severe to profound sensori- neural hearing loss - congenital or acquired </li></ul><ul><li>No or less benefit with the most optimised hearing aid </li></ul><ul><li>Aided audiometric thresholds that fall outside speech range at 2kHz </li></ul><ul><li>No medical or radiological contraindications </li></ul><ul><li>Motivation and good family support. </li></ul>
  15. 18. Candidacy Guideline Audiograms
  16. 19. Selection Criteria - Adults <ul><li>18 years of age or older </li></ul><ul><li>Profound, severe-profound, bilateral sensorineural hearing loss </li></ul><ul><li>Post lingual onset of profound deafness </li></ul><ul><li>Little or no benefit from hearing aids </li></ul><ul><li>No medical or radiological contraindications for surgery </li></ul>
  17. 20. Factors that may exclude candidacy <ul><li>Absence of auditory nerve or l ack of auditory nerve integrity bilaterally </li></ul><ul><li>Neurological damage impeding auditory processing </li></ul><ul><li>Medical risks of surgery that exceed the expected benefits of the cochlear implant </li></ul>
  18. 21. Factors that may influence outcomes with an implant <ul><li>Length of profound deafness </li></ul><ul><li>Age at implant </li></ul><ul><li>- 0 to 5yrs optimal </li></ul><ul><li>- 5 to 7 yrs Results will vary </li></ul><ul><li>-7yrs and above provided good HA use and </li></ul><ul><li>re/habilitation </li></ul><ul><li>Aetiology </li></ul><ul><li>Use of hearing aids prior to implantation </li></ul><ul><li>Amount and quality of re/habilitation before and after implant </li></ul><ul><li>Family support and commitment </li></ul><ul><li>Educational methods and communication mode </li></ul>
  19. 22. The process of getting an implant <ul><li>Pre surgery : </li></ul><ul><li>Initial Referral </li></ul><ul><li>Full medical evaluation </li></ul><ul><li>Full audiological evaluation to assess level and type of hearing loss (PTA.Impedance,ABR,ASSR,OAE and Prom-Stim) </li></ul><ul><li>Optimal hearing aid fitting and evaluation </li></ul><ul><li>Hearing aid trial and auditory training </li></ul><ul><li>Post training evaluation </li></ul><ul><li>Counseling of parents and family members </li></ul><ul><li>Acceptance for implant and final counseling </li></ul>
  20. 23. The process of getting an implant The process of getting an implant <ul><li>Surgery: </li></ul><ul><li>3 to 5 hours </li></ul><ul><li>1 to 2 day hospital stay </li></ul><ul><li>3 to 4 weeks later – switch on </li></ul>
  21. 24. X-Ray of Cochlear Implant in Situ
  22. 25. Next Details Menu Back
  23. 26. Neural Response Telemetry System Next Details Menu Back Transmitter Receiver Decoder Current Source Transmitter Encoder Amplifier Receiver PCI IF5 Card
  24. 27. Stimulation and Recording Modes Details Next Menu Back Stimulation Recording
  25. 28. Post Surgery: Fitting the externals <ul><li>Switch on </li></ul><ul><li>About three weeks following surgery the implantee will return to the clinic to have the external parts of the device fitted </li></ul><ul><li>This first fitting is called the ‘switch on’ or ‘tune up’ of the device </li></ul>
  26. 29. Clinical Programming System CPS
  27. 30. What is involved in activating the system? <ul><li>the term referred to as MAPping/programming </li></ul><ul><li>the procedure required for fine tuning the device to suit each individual’s hearing needs </li></ul><ul><li>requires specialised software and programming interface systems to program the speech processor. </li></ul><ul><li>Is the process of measuring and controlling the amount of electrical current delivered to the cochlea. To provide the patient with comfortable and useful hearing sensations. </li></ul>
  28. 31. <ul><li>Listening training </li></ul><ul><ul><li>An individual program is worked out for each recipient </li></ul></ul><ul><ul><li>Focus is on listening </li></ul></ul><ul><ul><li>For children: Listening training follows normal child speech and language developmental milestones – hearing age vs chronological age </li></ul></ul><ul><ul><li>Family must be involved </li></ul></ul><ul><ul><li>With children the parent is trained to carry over listening to home – in a natural environment </li></ul></ul>Listening training pre and post implant (AVT)
  29. 32. The Cochlear Implant Team: Core members <ul><li>The Parents </li></ul><ul><ul><li>Need to be involved in all evaluation processes and decisions. Must have realistic expectations and fully understand all aspects of process. </li></ul></ul><ul><li>The Surgeon </li></ul><ul><ul><li>Full medical and surgical evaluation, counseling, surgery and post surgical care </li></ul></ul><ul><li>The Audiologist </li></ul><ul><ul><li>Full audiological evaluation, hearing aid fitting, counseling, mapping, adult rehabilitation and ongoing follow up </li></ul></ul><ul><li>The Teacher of the Deaf/ Habilitationist </li></ul><ul><ul><li>Pre and post surgery listening training, full habilitation program planning for individual and full home training program for parents </li></ul></ul>
  30. 33.  Audallion beam former  Brain Stem Implants  Espirit 3 G speech processor  Neural response telemetry - NRT Newer developments
  31. 34. <ul><li>Completely implantable Implants </li></ul><ul><li>Neuronal regeneration factors </li></ul><ul><li>Improved speech coding strategies </li></ul><ul><li>Automated Mapping based on NRT </li></ul>Future
  32. 37. Thank You

    Soyez le premier à commenter

    Identifiez-vous pour voir les commentaires

  • Vickyramswamy28

    May. 25, 2019
  • JoginderSingh138

    Jul. 18, 2019
  • saikyiwin

    Sep. 14, 2019
  • JijomohanSachu

    Oct. 7, 2019
  • SenthilKumar2498

    Nov. 2, 2019
  • karthikeshwarantm

    Dec. 3, 2019
  • LavanyaViswanadham

    Dec. 25, 2019
  • DPokiya

    Apr. 20, 2020
  • RaziaRazia2

    Apr. 24, 2020
  • RaanR1

    Jun. 5, 2020
  • RAKHIM5

    Jun. 17, 2020
  • ShreyaBisht10

    Aug. 26, 2020
  • madalamnischal

    Sep. 21, 2020
  • rishabhshiwan

    Oct. 27, 2020
  • SusiPriya1

    Jan. 4, 2021
  • snarmadhasivakumar

    Feb. 17, 2021
  • KetanMohapatra

    Mar. 10, 2021
  • MahiParmar6

    Mar. 25, 2021
  • KrishnaPatel495

    Apr. 4, 2021
  • InduRajkumar1

    Apr. 27, 2021

Vues

Nombre de vues

23 958

Sur Slideshare

0

À partir des intégrations

0

Nombre d'intégrations

178

Actions

Téléchargements

2 275

Partages

0

Commentaires

0

Mentions J'aime

93

×