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Cochlear implant - state of the art.

ABSTRACT: Cochlear implants are the treatment of choice for auditory rehabilitation of patients with sensory deafness. They restore the missing function of inner hair cells by transforming the acoustic signal into electrical stimuli for activation of auditory nerve fibers. Due to the very fast technology development, cochlear implants provide open-set speech understanding in the majority of patients including the use of the telephone. Children can achieve a near to normal speech and language development provided their deafness is detected early after onset and implantation is performed quickly thereafter. The diagnostic procedure as well as the surgical technique have been standardized and can be adapted to the individual anatomical and physiological needs both in children and adults. Special cases such as cochlear obliteration might require special measures and re-implantation, which can be done in most cases in a straight forward way. Technology upgrades count for better performance. Future developments will focus on better electrode-nerve interfaces by improving electrode technology. An increased number of electrical contacts as well as the biological treatment with regeneration of the dendrites growing onto the electrode will increase the number of electrical channels. This will give room for improved speech coding strategies in order to create the bionic ear, i.e. to restore the process of natural hearing by means of technology. The robot-assisted surgery will allow for high precision surgery and reliable hearing preservation. Biological therapies will support the bionic ear. Methods are bio-hybrid electrodes, which are coded by stem cells transplanted into the inner ear to enhance auto-production of neurotrophins. Local drug delivery will focus on suppression of trauma reaction and local regeneration. Gene therapy by nanoparticles will hopefully lead to the preservation of residual hearing in patients being affected by genetic hearing loss. Overall the cochlear implant is a very powerful tool to rehabilitate patients with sensory deafness. More than 1 million of candidates in Germany today could benefit from this high technology auditory implant. Only 50,000 are implanted so far. In the future, the procedure can be done under local anesthesia, will be minimally invasive and straight forward. Hearing preservation will be routine.

SUBMITTER: Lenarz T

PROVIDER: S-EPMC5818683 | biostudies-other | 2017

REPOSITORIES: biostudies-other

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Cochlear implant - state of the art.

Lenarz Thomas T

GMS current topics in otorhinolaryngology, head and neck surgery 20170101

Cochlear implants are the treatment of choice for auditory rehabilitation of patients with sensory deafness. They restore the missing function of inner hair cells by transforming the acoustic signal into electrical stimuli for activation of auditory nerve fibers. Due to the very fast technology development, cochlear implants provide open-set speech understanding in the majority of patients including the use of the telephone. Children can achieve a near to normal speech and language development p ...[more]

PMID: 29503669

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Project description:HYPOTHESIS:Clinical adult cochlear implant (CI) candidacy evaluations rely heavily on measures of sentence recognition under the best-aided listening conditions. The hypothesis tested in this study was that nonauditory measures of neurocognitive processes would contribute to scores on preoperative sentence recognition for CI candidates, above and beyond hearing ability as assessed using pure-tone average (PTA). Support for this hypothesis would suggest that best-aided sentence recognition is not simply a measure of hearing ability; rather, neurocognitive functions contribute to performance and should be considered while counseling patients during CI candidacy evaluation about postoperative rehabilitative and outcome expectations. BACKGROUND:Neurocognitive functions, such as working memory capacity, inhibition-concentration, information processing speed, and nonverbal reasoning contribute to aided speech recognition outcomes in adults with hearing loss. This study examined the roles of these neurocognitive factors on preoperative speech recognition performance in adults evaluated for CI candidacy. METHODS:Thirty-one postlingually deafened adult CI candidates were enrolled. Participants were assessed using nonauditory measures of working memory capacity, inhibition-concentration, information processing speed, and nonverbal reasoning. Measures of sentence recognition in quiet and in multitalker babble (AzBio sentences) as well as sentences from the City University of New York in quiet were collected under best-aided conditions. RESULTS:AzBio sentence recognition scores in babble were predicted significantly by scores of working memory capacity after accounting for PTA. Similarly, the City University of New York sentence recognition scores were predicted significantly by nonverbal reasoning after accounting for PTA. CONCLUSIONS:Findings support the idea that clinical measures of sentence recognition may be affected to varying degrees by neurocognitive functions, and these functions should be considered during evaluation for CI candidacy.

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Cochlear implant - state of the art.

Publications

Cochlear implant - state of the art.

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