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Cochlear implant: a chance for a normal life

Simona Serban
University of Medicine and Pharmacy “Carol Davila”, Bucharest, ROMANIA
Institute of Phonoaudiology and ENT Functional Surgery, Bucharest, ROMANIA



simona serbanCochlear implantation is the acknowledged best treatment for severe to profound hearing loss. In 1990, the FDA has approved cochlear implants for children with severe-to-profound bilateral sensorineural hearing loss who are at least 1 year of age and who have not benefited from an adequate trial (4 to 6 months) of hearing-aid amplification. A similar  position was taken in 2000 by the Joint Committee on Infant Hearing. Early identification of infant hearing loss represents a major change from the situation that existed years ago when most children with hearing loss were not identified until they were 2 and 1/2 years of age. 
An implant does not restore normal hearing but it can give to a deaf person a useful representation of sounds in the environment and help the deaf person to understand speech. A cochlear implant is an electronic device which is very different from a hearing aid. Hearing aids amplify sounds which are processed by damaged ears. Instead, cochlear implants bypass damaged portions of the ear and directly stimulate the auditory nerve.
Signals generated by the implant are sent by way of the auditory nerve to the brain, which interprets the signals as sound. Each implant system consists of two parts: an internal component and an external component. The internal part consists of a decoder and magnet housed in protective casting. The electrode array emerges from this casing. The external components consists of a microphone, cords, a transmitting coil and a speech processor. The speech processor contains a program individual to each listener establishing the minimum amount of current needed for a hearing sensation and the maximum amount of current tolerable. 
This program extracts the most important aspects of the incoming speech signal and transmits this information back up the long cord across the transmitting coil. The signal is transmitted across the skin via radio frequencies to the internal component. The decoder of the internal component takes this information and establishes which electrodes will be activated and what amount of current will be delivered.
Standard criteria for candidacy continue to change as technology and surgical procedures advance. New minimally invasive cochlear implantation procedure reduces risks of complications compared with the traditional technique. Instead of cutting a large scalp ear flap, surgeons create a small pocket for the cochlear implant device. The advantages of avoiding a scalp flap include reduced risk of infection, tissue death and flap failure.
Factors which may affect outcomes in cochlear implantation include: duration of hearing loss, amount of residual  hearing, age of identification and intervention, age at implantation, status of the cochlea and cochlear nerve as well as other medical conditions. About 130,000 people oll over the world use cochlear implants. Performance with the latest cochlear implant systems includes good speech understanding, the ability to use the telephone and to enjoy music.
The cost savings of educating a child receiving an implant at age 3 are about $30,000-$100,000 over the course of primary and secondary school education. At present, the cochlear implant remains the only solution to reconnect deaf and hearing impaired people to the hearing world.