Cochlear implantation (CI) has been conducted in Russia since 1991. The largest number of surgeries are performed by the doctors of the St. Petersburg Institute of Ear, Nose, and Throat (St. Petersburg Research Institute of ENT): 2,923 of almost 5,000 implants made in Russia at the beginning of 2014. We asked the institute specialists to tell more about the domestic experience of CI, as well as to give an expert assessment of this method of hearing restoration. The questions are answered by Vladislav Evgenievich Kuzovkov - doctor of medical sciences, otosurgeon of SPb Research Institute of ENT, expert of the International Association of Leading Medical Centers of Auditory Implantation (HEARRING).
- Vladislav Evgenievich, tell us, please, what is CI?
- CI is a surgical method of hearing rehabilitation and the only method in medicine that can completely replace the function of the sense organ. It is indicated for patients with bilateral sensorineural hearing loss of high degree and deafness in the absence of serious cognitive and psychological problems.
- How common is this operation in the world?
In most developed countries, CI is a routine operation. To date, the number of implanted patients in the world is hundreds of thousands, about 50-60 thousand operations per year.
- How do you assess the effectiveness of this operation?
- The effectiveness of CI depends on the patient's age, timing and etiology (cause) of deafness. The most encouraging results are observed in postlingual or late-onset patients: in adults who have mastered speech but who for some reason have lost hearing (trauma, meningitis, etc.). It is important to emphasize that patients who ceased to hear due to meningitis, it is necessary to conduct CI as early as possible.
With congenital deafness, the primary is the surgical intervention of the child at the prelingual stage, that is, before the speech is mastered. In this case, the chances of full integration of an implanted child into society increase.
- Starting at what age, is it possible to implant a child?
- With congenital sensorineural deafness, surgical intervention can be performed from four months - so do in Germany. We, on our part, consider it optimal to do cochlear implantation at the age of 9-15 months. In general, the best results of rehabilitation are observed in children implanted up to three years.
- Can you tell us more about the rehabilitation of patients?
- It is believed that the contribution of the surgical stage to the success of CI is only 10%, the remaining 90% is almost entirely dependent on rehabilitation. Therefore, when deciding on implantation, it is necessary to make sure that there is strong support from the parents and relatives of the patient: their readiness for a long postoperative rehabilitation period, sessions with audiologists, surdopedagogists, speech therapists and psychologists.
- What time is required for rehabilitation so that the patient can speak?
- Again, everything depends on the age of the patient and the availability of speech skills. Often post-linguistic patients begin to disassemble speech after the first connection of the speech processor and the first settings. Whereas the prelingual child who, when connected, hears the sound for the first time in his life, can syllables about a month later. The further development of such a baby will directly depend on the degree of interest of parents and teachers. With attentive and correct attitude, such a child will be able to attend an ordinary kindergarten and school.
- What contraindications exist for the CI?
- The main contraindication is the lack of speech in adults. Unfortunately, a deaf-mute adult can not learn not only to speak, but also to hear (in case he did not use hearing aids). In addition, ki will be ineffective in patients with retrochlear pathology (damage to the auditory nerve, neurinoma of the auditory nerve), complete obliteration of the cochlea, and intellectual insufficiency.
- Are CI technologies improving?
- Yes, technologies are developing every year. And during the work on the program of cochlear implantation in St. Petersburg Research Institute of ENT, we can clearly observe how new coding strategies appear, the implant models are being improved, and surgical approaches are becoming easier. Separately, I want to note the active development of telemedicine technologies, applicable both at the pre-operational stage and during the rehabilitation period. This is especially true for patients from distant regions who can not come to specialists for the next setting: now the audiologists of our clinic can help these patients remotely.
- What are the prospects for this type of operation?
- In my opinion, until the technology of stem cell transplantation into the inner ear is developed, CI will remain the only method of rehabilitation of patients with bilateral high-degree sensorineural hearing loss and deafness. The main thing to remember is that the most important role in the overall effectiveness of the operation belongs to regular and regular auditory rehabilitation of the patient in the postoperative period. So, the patient should be ready for constant work on himself, only then the joint efforts of the doctor and the patient will be rewarded.