- Published on 16 January 2015
The speech thus outlined the future direction of cochlear implant medicine, at least from the perspective of specialists from across the Atlantic. A fundamental concept is the fact that functional acoustic hearing can be maintained in most subjects with electrodes to preserve hearing in the initial activation phase, up to 93%. A percentage between 16% and 51% of patients lose functional hearing over time, most after activation. Therefore, we should remember that shorter electrodes involve higher rates of preservation over time and that as a result it is particularly important to evaluate the benefit/risk ratio and the choice of the custom-made implant. In addition, it should be emphasized that functional acoustic hearing and high perception points in speech can be maintained for more than a decade using electric acoustic stimulation. Also, it is important to note that selecting the length of the electrode must depend on the duration of deafness at high frequencies, on thresholds at middle frequencies and the benefit/risk of functional hearing. If in the future, it is possible to preserve functional hearing equal to 95%, Gantz concluded, electric acoustic stimulation could be extended to patients with presbycusis.
Innovations at EAONO 2014
The EAONO 2014 event will be remembered as an edition with major technical and scientific innovations. Here’s a short review of some of them.
The most significant and remarkable innovation that is likely to change the lives of cochlear implant wearers is a hearing device enabling the user to undergo magnetic resonance imaging, a diagnostic technique that is more and more widely used to detect a growing number of disorder and that was until now contraindicated in patients with implants, unless the aid was removed. A cochlear implant is indicated for severe to profound cochlear deafness. New much smaller devices compared to a few years ago and that have an external part that is now a small disk of two centimeters in diameter applied to the skin, provide stimulation that is increasingly close to normal levels. And the surgery required has become less and less invasive over the years, now requiring hospitalization of just one day.
One of the topics that most interested otology and neuro-otology specialists was brain plasticity, i.e. the ability of the brain to change its own structure, to adapt to stimuli from the environment or to compensate for damage to certain areas. According to the Franco Trabalzini, “thanks to this, it is possible to recover the sense of hearing with application of a device or cochlear implant. When sensory input is restored early through an artificial organ of sense, central sensory pathways are once again stimulated and trained, and both connections within the sensory area and connections with other associated areas are newly reactivated. For people with profound hearing loss that occurred congenitally, this could mean rehabilitation to a life of nearly normal communication”.
In school without a special teacher: a dream or a possible reality? This is the aim that otology science has given itself to improve the lives of children with hearing loss. In pediatric patients in particular, auditory defects that are not diagnosed and treated early irreversibly alter processes of language acquisition and development, significantly hindering verbal communication with serious consequences on cognitive, mental, motor and social development. If hypoacusis is persistent, even when it is mild to moderate or unilateral, can result in difficulty hearing in noise, for instance in a classroom setting, and in localizing the source of sounds. Just think about how important this ability is simply to cross the street safely. Often, diagnosis of this less obvious form of hearing loss is delayed and a sign may be reduced performance at school. “Thanks to rehabilitation based on hearing aids and cochlear implants,” says Trabalzini “our current objective is to enable development of hearing and language abilities in order to allow entry of children with hearing impairment into primary education along with normal-hearing children, and without support.”
During the 7th Instructional Workshop of EAONO, the experts also looked into the latest research that has not yet been applied clinically regarding use of stem cells for neurosensory disturbances and possible use in receptors that stimulate nerve cells.
Lastly, intratympanic drugs that are always administered by physicians are the new frontier to treat some types of cochlear hypoacusis and also certain vertigo syndromes. They are administered directly into the middle ear to reduce systemic adverse effects and to increase local therapeutic efficacy.
Claudia Patrone, editor in chief of Audiology Infos Italy
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