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Question - Answer

  • How does a person hear?

    The human ear has three main parts:

    Outer ear

    The auricle that helps us determine where the sound comes from.
    The auditory meatus serves as an audio channel. It can accumulate earwax.

    Middle ear

    The tympanic membrane, which is tightly stretched, like the skin of a real drum, and turns sound vibrations into vibrations.
    A chain of three small bones, called a hammer, an anvil and a staple, and carry out vibrations into the inner ear.

    The inner ear


    A snail that is coiled like a real snail and filled with liquid. It contains very sensitive cells called hair cells, because at the end of each cell there is a tiny formation, similar to a hair. Hair cells, hesitating, produce electrical impulses which, through the auditory nerve, enter the brain, which recognizes them as sounds.

    A person hears with the brain, not with the ear!

  • In what cases is it recommended that a child should have a cochlear implantation?
    Cochlear implantation is done for children with bilateral deafness or 4 degree of hearing loss. In recent years, the indications for cochlear implantation have been expanding, and it can be recommended to a child with residual hearing.

    At the same time, modern correctly selected and tuned hearing aids do not help the child, because most of the hair cells in the cochlea are damaged. The decision on expediency of carrying out of operation to the child is accepted by the special commission in the center of cochlear implantation according to complex survey.
  • Rehabilitation program after cochlear implantation "I hear the world!"


    Postoperative auditory rehabilitation is the most important part of all measures for cochlear implantation, without it it is impossible to achieve the optimal result after cochlear implantation in the development of natural auditory behavior.

    The purpose of rehabilitation is to learn to perceive (acoustic) sound signals (non-verbal and speech), to understand them and to use new auditory sensations for the development of oral speech.

    The program of auditory rehabilitation "I hear the world!" Is an innovative method developed by the staff of the St. Petersburg Research Institute of the ENT, combining the efforts of doctors, faculty, children and their parents and ensuring the creation of a single developmental listening environment for the child, as well as its integration into society hearing people.

    In the process of postoperative rehabilitation, a whole team of specialists participates: otorhinolaryngologist, speech therapist, faculty, psychologist, psychiatrist, engineer, etc. Leading specialists of the institute are the head of the rehabilitation team: V. Pudov, I. Koroleva, O. Zontova. Only thanks to the well-coordinated efforts of a large team of the institute, which has more than 15 years of experience, we achieve good results after cochlear implantation in practically all patients. Even among those who were denied in other centers. The fact that all the specialists of the Institute work remarkably and with full dedication, say the numerous gratitude of patients, who were returned to the ability to study and work on an equal basis with hearing people.
  • Why are hearing impaired?


    Hearing loss occurs either as a result of damage to parts of the outer and middle ear, or if the parts of the inner ear are damaged, therefore distinguish:

         1. Conductive hearing loss
         2. Sensorineural hearing loss
         3. Auditory Neuropathy
         4. Centralized hearing disorder

    In pediatric surdology, the most common is conductive and sensorineural hearing loss.


    Conductive Hearing Loss

    With conductive hearing loss, changes do not affect the structure of the inner ear and the auditory nerve, but affect the region of the tympanic membrane and middle ear. For example, impairment of mobility in the system of auditory ossicles or extensive trauma of the tympanic membrane. Such hearing impairment in children occurs due to: atresia (complete or partial underdevelopment) of the external auditory canal, sulfur plugs, developmental anomaly and damage to the eardrum and otitis media, otitis etc. Conductive deafness leads to hearing loss of 1-2 degrees.

    The hearing aid will help to overcome the damaged area - increasing the pressure of sound. It happens when the damage is so severe that it completely prevents the oscillations, and even the most powerful hearing aid can not help - in this case the doctor chooses between the operation to restore the middle ear or the operation to implant the vibrating implant.

    Sensorineural hearing loss

    With sensorineural hearing loss, hair cells in the cochlea or auditory nerve are damaged, which is less common. With this kind of hearing impairment in young children, sound vibrations can not be converted into electrical signals, which leads to the impossibility of recognizing sounds by the brain. With a small, moderate or even moderately severe hearing loss, sound will be perceived by the surviving hair cells.

    The most common causes of sensorineural hearing loss in children are hereditary hearing impairment, hypoxia, high bilirubin level, viral infections of the mother during pregnancy, meningoencephalitis, ototoxic drugs, etc. Hearing loss - from 1 degree to deafness.

    In this case, the hearing aid will significantly improve the partially left auditory function - due to more intense stimulation of the hair cells.

    When a significant part, or all hair cells, died - hearing aids are often ineffective. Then a cochlear implant is used which, taking sounds, converts them into an electrical signal, and transfers them directly to the nerve, bypassing the structures of the affected cochlea.

    Auditory Neuropathy

    This violation is highlighted in recent years due to the emergence of objective methods of hearing research. In contrast to sensorineural hearing loss, it is characterized by the preservation of external hair cells. The main cause is a violation of synchronization of excitation in the fibers of the auditory nerve. Internal hair cells can also be damaged. These patients are characterized by difficulties in speech perception, although hearing loss is usually insignificant.

    Conductive and sensoneural hearing loss, auditory neuropathy refer to peripheral hearing impairments.


    Central hearing impairment

    These disorders are caused by damage to the subcortical, beginning with the cochlear nuclei, and cortical centers of the auditory system. At the same time, the processes of analyzing acoustic, including speech, signals are detected - detection, discrimination, recognition, recognition, and memorization of sound signals.

    Children with central hearing disorders behave as hearing impaired, although they have normal or slightly elevated hearing thresholds. These disorders are especially characteristic for children with pathology of the nervous system caused by hypoxia and hyperbilirubinemia.

    Hearing disorders can be one-sided (one ear is damaged - left or right) and bilateral (both ears are damaged).

    Violations can be hereditary (including those caused by genetic mutations), congenital, acquired. In 50% of newborns, deafness is of hereditary origin. In a third of these children, hearing disorders are combined with other disorders, that is, they are part of the syndrome. Hearing disorders can be combined with diseases of the eyes, bone-muscular, integumentary, nervous, endocrine systems, kidney diseases. Hereditary hearing loss is more often caused by irreversible changes in the structure of the cochlea, but there are disorders associated with anomalies of the external and middle ear. Hereditary hearing impairments can occur immediately after the birth of a child or develop gradually.

    Currently, more than 50 genes have been identified, mutations in which cause various hearing disorders. Most of these disorders are congenital or develop in a child at an early age before mastering speech.


    Auditory perception with varying degrees of hearing loss

    Depending on the degree of hearing loss, I, II, III, IV degree and deafness are distinguished.

    Degree of hearing loss

    Mean thresholds of hearing

    Perception of spoken and loud speech

    Perception of Whisper Speech

    I

    26–40 dB

    6–3 m

    2 m– at ear

    II

    41–55 dB

    3 m – at ear

    at ear – no

    III

    56–70 dB

    loud speech at the ear

    no

    IV

    71–90 dB

    cry at the ear

    no

    Deafness

    >91 dB

    no

    no


    Deafness

    Depending on when a person has lost his hearing, they sing out:

         1. Dealingual deafness is a deep hearing loss since birth or in the first year of life. Children with such hearing impairment can learn speech only with great difficulty and more often use sign language for communication;
         2. Perieningual deafness - it includes hearing loss in the period of mastering speech until it is fully mastered (from 1 year to 5 years);
         3. Post-lingual deafness - it includes hearing loss that occurs after speech acquisition (late-patient patients).

  • What is the difference between a cochlear implant and a hearing aid?

    The hearing aid simply amplifies the sounds and transfers them to the eardrum. The cochlear implant converts sounds into a sequence of electrical impulses that stimulate the auditory nerve with the help of electrodes in the cochlea.