- Published on 10 February 2014
Recent estimates suggest that between one and two newborn babies out of every thousand will suffer from deafness, while between three and four present other types of disabling auditory pathologies with serious repercussions in human, linguistic, educational, and social spheres.
This is one of the alarm bells sounding in today’s audiology field, and it emphasises the urgent need for work in audiology, otorhinolaryngology, and auditory-verbal therapy aimed at restoring hearing function. This was patent from the evidence at the V Iberoamerican Conference on Cochlear Implants and Related Sciences, held in Cancun, Mexico, from December 4 to 7, 2013. Former conferences were held between 2005 and 2012 in Mendoza, Argentina; Habana, Cuba; Cartagena de Indias, Colombia; and Buenos Aires, Argentina. In Mexico, the latest national census indicates that more than 285,000 people have hearing disabilities, and the World Health Organisation affirms that one in ten people (10% of the Mexican population) has some type or degree of hearing or linguistic difficulty. The medical profession and the field of scientific and technological development are racing to tackle the full epidemiological impact caused by hearing disability, and their methods mostly involve prosthetic restoration solutions for cases of profound or total hypoacusis. Here is how professors and experts at the conference see the problem, with all their knowledge and experience bringing the latest information to such key areas as cochlear implants.
A wonderful option
Cochlear implants are a wonderful alternative for patients with profound hearing loss. Technlological progress with these devices has put them among the most innovative and outstanding advances for rehabilitation of hearing disability. In the words of Pedro Berruecos, technical consultant at the Mexico General Hospital, Full Member of the National Academy of Medicine, and Conference Secretary, “cochlear implants (CI) are the only prosthetic possibility for restoration of one of our sense organs. Deaf patients are still deaf in respect of the injury or injuries they have, but their hearing function is restored almost totally.” Several factors combine in the case of CI options for children who are born deaf, and all of these factors are vital: “1) technological advances have led to devices being perfected, improvements in durability, better electroacoustic characteristics, more versatility in adapting to different problems, miniaturisation and improved sound processing systems, and far better language sound performance; 2) medical advancement has meant more reliable identification of the problems faced by the newborn, and practically before they are discharged from the hospitals where they are born, while surgical techniques have been perfected for more efficient, risk-free operations; and 3) advances in rehab methods and techniques, particularly through auditory-verbal therapy, have allowed for the integration of therapists and parents for short-term success in maturation of auditory perception skills using CI, as well as normal development of the child’s language, with language being the main functional product of hearing,” explained Berruecos.
Latin American vision
Latin America holds its ground when it comes to technological advances and cochlear implant operations, but there is still some way to go before all patients requiring CI solutions can be rehabilitated. According to this technical consultant from the Mexico General Hospital, “there has been exponential growth of CI programmes in Latin America. The countries with most implants achieved are Argentina, Brazil, Colombia, Mexico, and Venezuela, more or less in this order; it is important, however, to take into account that the 16 Latin American countries with well-established CI programmes, having a combined population of more than 500 million inhabitants, means there are around 120,000 candidates for the procedure. A calculation made in 2011 estimates that in these 16 countries around 16,000 people have been given implants, so we can work out that less than 15% of those requiring this technology have obtained it.” The first implant in Mexico was fitted in 1986. In 1988, there were 55 procedures recorded, and in 2011 some 2,000 implant operations had been carried out. The country has access to all advances in medical, audiological, otorhinolaryngological, therapeutic, and rehabilitation material. “In Mexico, you can obtain the most technologically advanced CI equipment, but there are serious problems when it comes to paying for it. Despite cost/benefit ratios being much better than other procedures in the health field, accessibility remains a big problem, so from this angle the advances don’t add up to much if you can’t get financing to make them work. Around 25,000 people, at the least, require CIs and yet just over 2,000 have obtained them, which is not even coverage of ten percent. In Colombia, Argentina, Brazil, and Cuba programmes are financed officially, while in Mexico, Peru, Venezuela, Chile, and Uruguay designated public funding is made up from important private financing. Awareness of this lack of funding should bring about greater support for cochlear implant programmes in Mexico,” stressed Pedro Berruecos.
Restoration of the auditory canal through CI allows for linguistic communication and opens the doors to cognitive development for those who benefit from it. The recent conference saw the presentation of the most important technological initiatives in CI, such as those by MED-EL. “MED-EL innovations in the cochlear implant field involve three components that come under our Triformance: Fine Hearing concept, which brings patients better tone perception and frequency handling for a more complete hearing experience. Fine Hearing is a unique strategy for codification of sounds in a cochlear implant which allows for up to 250 unique sound channels, thus obtaining more natural sound; it preserves the structures of the cochlea, uses soft and flexible electrodes, and it offers full cochlear cover, with a more natural auditory experience resulting from patients having a complete spectrum of sound,” says Marcos Atkinson, Area Manager of MED-EL LatinAmerica. MED-EL has also announced innovations in intact-skin hearing implants with products offering patients greater comfort and wellbeing. The most important of these is the Maestro™, which comprises two components: one external, the audio processor worn behind the ear, and an internal part, the implant itself with Opus 1, Opus 2 Opus 2XS and Rondo processors available, and Concerto, Sonata, and Pulsar implants. “Rondo, which was launched in 2013, is a first, unique audio processor in just one piece for the cochlear implant market, and it provides freedom for the ear thanks to a compact design which integrates the control unit, battery, and coil in one. The nucleus of the Maestro™ system is Concerto™, the smallest and lightest titanium cochlear implant on the market,” assures Franco Portillo, MED-EL Regional Manager. The most important intact-skin innovation from MED-EL is Bonebridge™, the world’s first transcutaneous active implant system using bone conduction. “This is indicated for people with conductive hearing loss, mixed hearing loss, or unilateral deafness. With Bonebridge™, intact-skin technology is offered for the first time (Intact Skin technology has been used before in other types of implants) and with all the advantages of an implant with stimulation through bone conduction,” explains José Luis Mancini, Regional Manager of MED-EL.
An overall outline
Besides the important business of the plenary sessions (selection of candidates, ethics in hearing implant programmes, and sociomedical aspects of cochlear implantation), the conference also held two round table discussions on much more controversial current subjects: implants in unilateral hearing problems, and auditory brainstem implants. “It is the first time the Iberoamerican Conference has been held in Mexico, and the programme was structured in such a way as to cover the three working groups directly involved in these programmes: audiologists, otorhinolaryngologists, and speechlanguage therapists. In the plenary sessions, specialists were either co-ordinators or participants, so there was a chance to reach conclusions and include comments in a multidisciplinary way,” points out conference Secretary, Pedro Berruecos. Participation in the conference was excellent, with more than 700 people in attendance including professors, speakers, and delegates - representing more than 25 countries - who were able to choose between more than 250 speeches of high academic level. During the pre-conference period, courses and workshops were held, supported by certain producers, and two of these were preconference courses for ENT and audiology specialists, sponsored by Cochlear. Also prior to the conference was a trans-conference event sponsored by Advanced Bionics and four satellite symposiums backed by Advanced Bionics, Cochlear, Med-El, and Oticon. The organising committee for this fifth version of conference comprised the following specialists: Antonio Soda Merhy, President; Pedro Berruecos V., Secretary; and a Scientific Committe featuring the participation of experts Gonzalo Corvera, Carlos de la Torre, Alfredo Luna, Marta Rosete and Felícitos Santos. The Conference Coordinators were Marcelino Covarrubias and Lisette Cristema Sánchez.