Avtor/Urednik		Lehnhardt, Ernst; Lehnhardt, Monika
Naslov		Cochlear implant - quo vadis
Prevedeni naslov		Polžkov vsadek - quo vadis
Tip		članek
Vir		Med Razgl
Vol. in št.		Letnik 39, št. Suppl 3
Leto izdaje		2000
Obseg		str. 173-7
Jezik		eng
Abstrakt		Technological progress is advancing faster and faster. Two decades ago physiologists stated that C.I. would never compensate for the deficiency in the inner ear and provide access to hearing for deaf people. Clinical results have proven their theories wrong and benefits outweigh the risks by far. Indications have broadened significantly: we recommend providing children with a C.I. as early as possible and we consider severely hearing impaired as very suitable candidates. What has raised our level of confidence? Smaller and very flexible implant designs, a variety of speech coding strategies that suit the individual's needs, telemetry that confirms proper functioning of the device, Neural Response Telemetry that indicates what gets processed through the auditory pathway. Most convincing for me are the results I have seen when children are implanted under the age of 5, preferably even under 2. They acquire open set speech understanding and speech production that is comparable to normal hearing children. They can be mainstreamed and later become fully integrated members of the hearing society. The Cochlear Implant technology is currently exploited in other areas of sensory nerve deficiency, like pain relief, urinary incontinence, bowel control, functional electrical stimulation, sleep apnea, epilepsy, Parkinson's disease. These are amazing and highly promising perspectives that will have a major positive impact on patients with serious problems. What will be the future of cochlear implants then? Anatomical considerations - especially in view of the lowering age at implantation - will become even more important. In depth histological studies will be needed before we will accept new electrode designs, getting very close to the modiolus. Smaller, thinner and very flexible implants are desirable. Cosmetic considerations seem to lead to the totally implantable C.I. (Abstract truncated at 2000 characters).
Izvleček		Tehnološki napredek je vse hitrejši in hitrejši. Pred dvema desetletjema so fiziologi trdili, da pložkov vsadek (CI) ne bo nikoli nadomestil nedelujočega notranjega ušesa in tako zagotovil sluha gluhim osebam. Klinični rezultati so zavrgli te njihove teorije in zaenkrat prednosti CI odtehtajo njihove nevarnosti. lndikacije za uporabo Cl so se močno razširile in taku sedaj svetujemu vsaditev CI otrokom kakor hitro je mogoče, prav tako pa so sedaj kandidati tudi težko naglušni bolniki. Kaj je povečalo naše zaupanje? Vedno manjši in bolj mehanično prilagodljivi - upogljivi CI, raznolikost govornega kodiranja, ki sledi potrebam posameznika, telemetrija, ki potrdi dobro delovanje naprave, in telemetrija živčnega odgovora, ki nam pokaže dogajanje v slušni poti. Za mene so bili najbolj preprečljivi rezultati otrok, ki so prejeli CI do starosti pet let, še bolj do starosti dveh let. Sposobni so pridobiti razumevanje govora pri testih "odprtih serij" (angl. open set) in razviti govor, ki je primerljiv z normalno slišečimi otroci. Kasneje se lahko ti otroci popolnoma vključijo v normalno slišeče okolje. Tehnologija CI je nedavno prodrla tudi na druga področja medicine, kjer je prav tako prišlo do izgube delovanja zaznavnih živcev, kot lajšanje bolečine, nezadrževanje seča, nadzor nad črevesjem, funkcionalna električna stimulacija, prenehanje dihanja med spanjem, epilepsija, Parkinsonova bolezen. Vsi ti vidiki so osupljivi in hkrati zelo obetavni za bolnike z resnimi težavami. Kakšna pa bo prihodnost CI? Zaradi nižanja starosti pri vsajanju CI bo vse bolj postajalo pomembno upoštevanje anatomskih razmer. Potrebne bodo poglobljene histološke raziskave, preden bo sprejeta nova oblika elektrod, ki bo ležala zelo blizu modiolusu. Zaželeni so manjši, tanjši in upogljivi - prilagodljivi CI. Z upoštevanjem lepotnih smernic se razvijajo popolnoma vsadljivi CI. Hitrost njihovega razvoja je odvisna od sočasnega razvoja tehnologije baterij. (Izvleček skrajšan na 2000 znakov).
Deskriptorji		COCHLEAR IMPLANT HEARING LOSS, SENSORINEURAL TREATMENT OUTCOME HEARING AIDS