HomeNewsThe law of physics, anatomy and labor
12 февраля 2018

The law of physics, anatomy and labor

Director of the St. Petersburg Research Institute of Ear, Nose, Throat and Speech (SRI ENT), academician of the Russian Academy of Sciences, Yuri Yanov, talks about cochlear implantation.
According to statistics of the Ministry of Health of Russia, there are more than 1 million deaf and hard of hearing people in the country. For partial hearing loss, the main technical remedy is the hearing aid. In the case of total deafness, only the cochlear implant system can help. These operations in Russia are free of charge and require serious rehabilitation, for which constant and competent work is needed together.

Every year more than a thousand deaf children are born in the country. Another one or two children lose their hearing in the first two years of life. In addition, adult citizens who have lost hearing in the postlingual period due to trauma or illnesses become deaf.

Academician Yuri Yanov , the director of the St. Petersburg Institute of Ear, Throat, Nose and Speech (SRIENT), cites world statistics: one deaf child per 1,000 births.

Yuri Yanov, Academician of the Russian Academy of Sciences, Director of the Research Institute, MUDr.
In 60% of cases, the fetus results in an infectious disease transferred by the mother during pregnancy, in 35% - the ototoxic effect of antibiotics, and only 2-3% of cases of deafness result fr om the genetic pathology of the fetus.

In order to determine the ability of the newborn to hear, we are audited for the second-third day of the child's life by audiological screening (otoacoustic emission check), which gives approximate information about the presence of the problem. If the result is positive, the baby is sent to the nondestructive center of the subject of the federation for in-depth study by SAEP method (short-latent auditory evoked potentials).

The diagnosis of "deafness of the fourth degree" in the Russian Federation is an absolute indication for cochlear implantation (CI), provided to citizens of the country by quota of high-technology medical care (VMP) free of charge.

The cost of one CI system is fr om 1.1 to 1.4 million rubles and self-pay units are ready to be paid. However, doctors believe, the Ministry of Health successfully solves this problem. "The state task for the year is distributed by the Ministry of Health on the basis of the requests of the subjects of the federation, drawn up taking into account the statistics for the region." The screening error is minimal, but due to inadequate evaluation, bureaucratic delays, and sometimes because of inconsistent actions of parents, applications are not submitted to all those who need For example, in the country, more than 1.7 million children were born in 2016. According to the applications of the subjects, about 1.2 thousand patients are obtained.Saving that the task is being adjusted and adjustments can take place several times a year, "- says Yuri Yanov.

ENT Research Institute conducted the most cochlear implant among medical institutions in the world In 2009, the Institute joined the association <- noindex -!> Hearring , which includes 25 leading world clinics to help deaf and hard of hearing people.

As the head physician of the Clinical Hospital N 122 named after them said. Sokolov "FMBA professor Yakov Nakatis , in St. Petersburg in 2017 quotas for CI divided among themselves three federal institutions: the Research Institute of ENT - 402 operations, N122 - 151, and another ten - the Military Medical Academy. In the institution under the control of Mr. Nakatis, about 90% of the operated children are children under 16 years old. And this situation is typical for the whole country: according to Mr. Yanov, the ratio of pre-implanted children and adults is 80 to 20 (for comparison, in European countries and the US it is 30 to 70). "The cochlear implant also helps in deafness of the third degree, when hearing aids fail, with hearing loss in people in old age, as well as noise in the ears," the academician explains. "But the health systems we have and abroad differ: in Russia prefer to solve more global problems ". In Russia, only eight clinics conduct cochlear implantation mainly in Moscow and St. Petersburg.

The process is nothing but a jeweler: the doctor's task is to make a small hole in the round window of the cochlea and ins ert an electrode that spirally fills the cochlea completely, touching the auditory cells. The path length is 32 mm. The inner ear (where the electrode is inserted) practically does not grow, so operations can be done at a very early age, leaving a little person more time for complex and multi-stage rehabilitation. Associative connections between auditory and speech systems can develop only in childhood, so the rule is simple: the sooner you take the child for surgery, the better the speech will develop . The youngest patient at the Research Institute of ENT at the time of the operation was only a few months.

"Our task is for the child to hear and speak normally by the time of admission to the first grade. Recovery is complete, but it depends not only on the patient and technology, but also on the motivation of the parents, "Yuri Yanov shared." In general, rehabilitation lasts five to seven years. If the implantation is done in seven or eight years, the speech will develop, but worse, and the lost time will not catch up, it will not be usual to go to school, the rehabilitation will be prolonged for a long time, there will be no perfect results. "
What is cochlear implantation?
After installing the implant part, it is the turn of the external component of the system - the speech processor (SP) to be connected to the ear with a magnet. It catches the sound signals and converts it into electrical energy transferred to the implant, and through it through the electrode - into the auditory nerve. Processors of different firms have design features and are not interchangeable. But they, unlike the implant, which is not installed for life, should be changed every five years, which is also paid by the state from the compulsory medical insurance funds.

However, the operation can be complicated by developmental anomalies, for example, overgrowth of a cochlea due to a meningococcal infection, a neurofibromatosis transferred by a mother or a child, or simply a complete absence of a cochlea.

"Then we make a stem implant, implanting the active electrode directly in to the medulla oblongata, wh ere the auditory nuclei are located on the bottom of the fourth ventricle.In addition, there are cardiovascular and respiratory centers, stimulation of which can receive an undesirable reaction, so a team of super specialists with rich experience.In 2014 in Russia, for the first time, stem implantations were carried out - for a child and two adults.Over two years we were able to evaluate the results: adults say the child is rehabilitated simply superbly. D 2016 we made four operations now Petersburg covers the entire spectrum of pathologies, wh ere it is possible to provide medical care ", -. emphasizes the director of the Institute of ENT.

In the case of cochlear implantation, further audio processor settings are required, conducted by an audiologist at least once every three months, then every six months, then once a year. A lengthy auditory rehabilitation of the patient is needed in specialized institutions.

"Petersburg Institute of Ear, Throat, Nose and Speech is a pioneer in the field of remote adjustment of speech processors and can do this for a patient in In 2012, a group of electrophysiologists together with IT specialists from Krasnoyarsk created a methodology and software that based on neural networks and expert systems allows you to model the patient's auditory system and adjust the implant with an efficiency of 99.2%, while even for the most skilful live tuner this indicator 75% ", - proudly says Yuri Yanov.

The importance of postoperative actions can not be underestimated. Lack of desire for long-term work with the faculty after the implantation (in adults) or support of family members and their readiness for long-term work (in children) may be a contraindication to implantation along with medical factors. Also, surgery is useless for children with serious mental disorders.

"With constant and competent work with children, rehabilitation is good, effective and predictable. For this, we conduct summer training camps for children and parents, issue methodological instructions. Moreover, the magazine "I hear the world!" is published, 4,000 copies of which are distriuted for free due to the the help of a powerful parent community, " says Mr. Yanov.

For a clear functioning of the system at the state level, a close interdisciplinary work of the ministries of health, education and labor is necessary, he ensures.

Source:  newspaper KOMMERSANT