Download Hearing aids and cochlear implants: Indications/directions

Stimmheilzentrum
Bad Rappenau
Hörgeräte und Cochlea Implantate:
Indikationen/Entwicklungen
Annerose Keilmann
Stimmheilzentrum Bad Rappenau
5th Phonak European Pediatric Conference Berlin
Current Developments and New Directions in Pediatric Audiology
Berlin, June 16th - 18th 2016
1962
• Beckmann wrote in his teaching
book that children with inborn
deafness should be supplied
with hearing aids at age 2
• for that time age 2 was extremly early
– no regular health check for children (in Germany
using the yellow booklet)
– no newborn hearing screening
– no ABR
– no otacoustic emissions
3. Mai 1995
Indications to CI
1984
1990
1998
today
age
adults
From age 2 on
From 18 months
on
<12M
onset
Postlingual
Degree of hearing
loss
Complete
deafness
Resudual
hearing
Severe HL
(adults)
Residual hearing
(children)
Severe hearing loss
(adults/children)
bilateral
bilateral
bilateral
uni- or bilateral
0%
0%
<40%
Speech audiometry
4
Postlingual
Postlingual adults
adults
&
&
Pre/Postlingual
Pre/Postlingual
children
children
Postlingual adults
&
Pre/Postlingual
children
Indication to CI
• There is a deficit looking at hearing
and/or understanding
• Fitting with hearing aids is not
sufficient or is presumably not
sufficient
• but: hearing aids can be tried without
risk, cochlea implant surgery is risky
I there a hearing loss (HL)?
The child does not
want to hear (at least
The child cannot hear:
in the moment),
• playing with high
concentration
• testing the limit
• difficult behaviour
• conductive HL
• sensorineural HL
• central auditory
processing disorder
• functional = psychogenic
HL
Possible mistakes and differential
diagnosis:
•
•
•
•
•9
insuffcient instruction
missing comprehension of the task
missing cooperation
cognitive problems
autism, other psychic disease
I there a hearing loss (HL)?
The child does not
want to hear (at least
The child cannot hear:
in the moment),
• playing with high
concentration
• testing the limit
• difficult behaviour
• conductive HL
• sensorineural HL
• central auditory
processing disorder
• functional = psychogenic
HL
We must take care about the
development
• newborns are unable to do speech
audiometry….
• adults with hearing loss (with insuffcient
supply) loose nonverbal intelligence
Different reasons for impaired
hearing and understanding
• wrong hearing aid or right hearing aid with bad
programming
• changing middle ear leads to inconstant hearing
• circumstances for hearing are bad, in rooms with
reverberation, without wireless transmission
systems
• early loss of concentration, it is too hard to listen
• insufficient learning conditions in the past
• central auditory processing disorder
The guidelines aren't an algorithm
that gives a clear simple solution
for every case.
Instead:
work with an interdisciplinary
team work step for step –
without loosing too much time
Fitting of hearing aids
• modern technology
• reasonable preselection on the basis of
expert knowledge for comparing fitting
• sufficient learning conditions
• training of hearing
• additional technology
Hearing in different conditions
• acoustically favourable and less
favourable rooms
• with and without Hearing Assistive
Devices/Hearing Assistive Techniques
• concentration loss during the day?
• social withdrawal?
Hearing anamnesis
• fitting too late
• deficit recuperable?
• receptive and productive speech and
language development
• articulation deficit?
• nonverbal intelligence
• development of identity as deaf or hearing
person?
• coping
Expectations of the parents/
the patient
• Can a regular wearing be expected?
• Will the patient be able and willing to train
the hearing?
• Will the costs be covered?
• Will the patient attend the control
appointments?
Cochlear implant
• is time consuming
• medical risks
– vertigo, balance disorders
– facial paresis /dyseugesia
– problems with wound healing
• problems with imaging
What would happen without
cochlear implant?
• progressive hearing loss
• insufficient training with the hearing aids
(financial reasons?)
• development of identity
Delayed maturation of the
auditory pathways
• Could it be that the hearing loss will
disappear?
• Immature auditory pathway, serous otitis
media with effusion
• Relevant conductive component?
• In children with a severe hearing loss a
delayed maturation is not probable.
Auditory neuropathy or
functional hearing loss
• contradicting results in subjective
audiometry
• changing hearing levels
• otoacoustic emissions present do not
exclude that an cochlear implant is
indicated
What is my summary?
Work with an interdisciplinary
team work step for step –
without loosing too much time
Thank you for your kind
attention!