The diagnosis, treatment and outcomes of childhood hearing loss have changed dramatically in recent years. Today, many childen who are screened at birth and are diagnosed and treated appropriately, can develop speech and language at the same rate as their hearing peers.
Oral deaf education is a collaborative, family-centered educational approach that develops a child’s speech and listening abilities along with confidence and life skills to meet the challenges of the greater world. This means that parents and family play a key role right from the start. Oral deaf education integrates the earliest and most natural intervention, the most current and inclusive education along with today’s sophisticated hearing technologies, to enable children with a hearing loss to learn to listen and talk.
Ensuring the best outcomes for your child
The children in the videos you are viewing on this site were diagnosed with hearing losses ranging from severe to profound. Yet today they are all mainstreamed in neighborhood and/or private schools and universities and perform academically on level with their hearing peers. How is this possible? Oral deaf education offers a pathway – early identification and oral deaf education intervention, the family and appropriate technologies: each supports a child’s desire to know the joy of sound and to speak for himself or herself.
A cochlear implant is a device that works to restore hearing to those who cannot benefit from hearing aids. A candidate usually has profound to severe sensorineural deafness in both ears and should have enough intact aural nerve endings to benefit from the device. Cochlear implant surgery is a relatively safe procedure that can be performed on adults in good health and on children as young as 12 months old. Side effects are minimal, but as with any kind of surgery, there are risks to consider.
- A cochlear implant consists of an internal receiver that is surgically implanted behind the ear and an external earpiece that translates sound into electronic signals. A cochlear implant is not a hearing aid. It works by using electrodes to bypass the damaged part of the inner ear and send auditory cues to the brain. In contrast, a hearing aid only amplifies sound and is useless for those with nerve damage.
- Normal hearing is not fully restored with a cochlear implant. Speech and environmental noise do not sound the same, and the brain must relearn how to identify what it hears. Benefits vary greatly among candidates depending on how long they have lived with hearing loss, how well their brain can adapt to new stimulus, and their belief that the device will improve the quality of their lives. Hearing recognition improves greatly over time when combined with rehabilitation exercises, lip reading and speech therapy.
- Although a cochlear implant procedure is considered major surgery, there are relatively few side effects, and these usually abate after a few weeks. Minor side effects include nausea, disorientation, dizziness, pain and/or pressure around the ear and sore throat from the insertion of a breathing tube. Some people experience a metallic taste in the mouth or have other taste disturbances that may persist for a few months. Those who experienced tinnitus, or head noise, prior to surgery may find their symptoms have lessened, while for others tinnitus may increase.
- Serious side effects include a disturbance of facial nerves on the side where the device was implanted. The procedure requires close contact with facial nerves, and if they are damaged during surgery a temporary facial paralysis may result. This is a rare occurrence that can be treated with steroids or antiviral medications. Another side effect is the leakage of cerebrospinal fluid around the brain, which can cause inflammation and infection.
- Cochlear implant recipients may be at an increased risk for contacting bacterial meningitis. Those with congenital inner ear malformations, cerebrospinal fluid leaks, recurrent ear infections, a history of meningitis, a weakened immune system, or who are younger than 5 age are especially susceptible. Patients who receive a cochlear implant should be immunized against the disease as a precaution.
Minor Side Effects
Major Side Effects
sumber : ehow
A cochlear implant is a small electronic device that helps people hear. It can be used for people who are deaf or very hard of hearing. A cochlear implant is not the same thing as a hearing aid because it is surgically implanted and works in a different way.
There are many different types of cochlear implants. However, they are usually made up of several similar parts. One part of the device is surgically implanted into the bone surrounding the ear (temporal bone). It is made up of a receiver-stimulator, which accepts, decodes, and then sends an electrical signal to the brain.
The second part of the cochlear implant is an outside device. This is made up of a microphone/receiver, a speech processor, and an antenna. This part of the implant receives the sound, converts the sound into an electrical signal, and sends it to the inside part of the cochlear implant.
WHO USES A COCHLEAR IMPLANT?
Cochlear implants allow deaf people to receive and process sounds and speech. To a certain degree, they are devices that allow deaf people to “hear.” However, it is important to understand that these devices do not restore normal hearing. They are tools that allow sound and speech to be processed and sent to the brain.
The way candidates are selected for cochlear implants is changing over time as the technology changes, and our understanding of the brain’s hearing (auditory) pathways improves.
Both children and adults can be candidates for cochlear implants. They may have been born deaf or become deaf after learning to speak. Children as young as 1 year old are now candidates for this surgery. Although criteria are slightly different for adults and children, they are based on similar guidelines:
- The patient should be completely or almost completely deaf in both ears, and get almost no improvement with hearing aids. Anyone who can hear well enough with hearing aids is not a good candidate for cochlear implants.
- The patient needs to be highly motivated. After the cochlear implant is placed, they must learn how to properly use the device.
- The patient needs to have reasonable expectations for what will occur after surgery. The device does not restore or create “normal” hearing.
- Children need to be enrolled in programs that help them learn how to process sound.
- In order to determine if a patient is a candidate for a cochlear implant, the patient must have a medical evaluation by an ear, nose, and throat doctor (otolaryngologist). This evaluation may include a CT scan or MRI scan of the brain and the middle and inner ear.
- Patients (especially children) may need psychological evaluation to determine if they are good candidates.
HOW IT WORKS
In a normal ear, sounds are transmitted through the air, causing the eardrum and then the middle ear bones to vibrate. This sends a wave of vibrations into the inner ear (cochlea). These waves are then converted by the cochlea into electrical signals, which are sent along the auditory nerve to the brain.
A deaf person does not have a functioning inner ear. A cochlear implant attempts to replace the function of the inner ear by turning sound into electrical energy. This energy can then be used to stimulate the cochlear nerve (the nerve for hearing), sending “sound” signals to the brain.
Most cochlear implants operate using several similar parts. Sound is picked up by a microphone worn near the ear. This sound is sent to a speech processor worn on the body, usually on a belt. The sound is analyzed and converted into electrical signals, which are sent to a surgically implanted receiver behind the ear. This receiver sends the signal through a wire into the inner ear. From there the electrical impulses are sent to the brain.
HOW IT IS IMPLANTED
Surgery for inserting a cochlear implant is performed while you are fully asleep. A surgical cut is made behind the ear, sometimes after shaving part of the hair behind the ear. A microscope and bone drill are used to open the bone behind the ear (mastoid bone) to allow the inside part of the implant to be inserted.
The electrode array is passed into the inner ear (cochlea). The receiver is placed into a “well” created behind the ear. The “well” helps keep it in place, and makes sure it is close enough to the skin to allow electrical information to be sent from the device.
After surgery, there will be stitches behind the ear. You may be able to feel the receiver in its “well” behind the ear. Any shaved hair should grow back. The outside part of the device will be placed about 3 – 4 weeks after surgery to give the opening time to heal.
RISKS OF SURGERY
A cochlear implant is a relatively safe surgery. As with all surgeries, there are possible risks. One of the most common complications is wound-healing problems. This includes problems such as skin breakdown over the implanted device, infection where the surgical cut was made, and the device coming out.
Less common complications include:
- Damage to the nerve that moves the face on the side of the operation
- Leakage of the fluid around the brain (cerebrospinal fluid)
- Infection of the fluid around the brain (meningitis)
- Temporary dizziness (vertigo)
- Failure of the device to work
RECOVERY AFTER SURGERY
After surgery, you will probably be admitted to the hospital overnight for observation. Your health care provider will give you pain medicines and sometimes antibiotics to help with healing. Many surgeons place a large dressing over the operated ear. The dressing is changed the day after surgery.
Several weeks after surgery, the outside part of the cochlear implant is secured to the receiver-stimulator that was implanted behind the ear. It is only at this point that you will be able to use the device.
Once the surgery site is well healed, and the implant is attached to the outside processor and antenna, you will begin to work with specialists to learn to “hear” and process sound using the cochlear implant. These specialists may include:
- Speech therapists
- Ear, nose, and throat doctors (otolaryngologists)
This is a very important part of the process. To get the most benefit from the implant requires a coordinated effort between you and the team of specialists.
Results with cochlear implants vary widely. How well you do depends on:
- The condition of the hearing nerve before surgery
- Your mental abilities
- The device being used
- The length of time you were deaf
- The surgery
Some patients can learn to communicate on the telephone. Others can only recognize sound. Getting the maximum results can take several years, and you need to be motivated. Patients are often enrolled in hearing and speech rehabilitation programs.
LIVING WITH AN IMPLANT
Once you have achieved full hearing, there are few restrictions. Most activities are allowed. However, some health care providers recommend avoiding full-contact sports to lessen the chance of trauma to the implanted device.
Most patients with cochlear implants cannot get MRI scans, because the implant is made of metal.
Balkany TJ, Gantz BJ. Medical and surgical considerations in cochlear implantation. In: Cummings CW, Flint PW, Haughey BH, et al., eds. Otolaryngology: Head & Neck Surgery. 4th ed. Philadelphia, Pa; Mosby Elsevier; 2005:chap 159.
Brown KD, Balkany TJ. Benefits of bilateral cochlear implantation: a review. Curr Opin Otolaryngol Head Neck Surg. 2007;15:315-318.
Papsin BC, Gordon KA. Cochlear implants for children with severe-to-profound hearing loss. N Engl J Med. 2007;357:2380-2387.
A child who is born deaf or who has lost all of her hearing because of an illness or accident can regain the ability to hear with cochlear implants. Because she is still young, she can regain the ability to learn how to listen and speak through special speech therapy.
- When children receive cochlear implants, they will gain speech and language proficiency at a rate much different from other children. Depending on how old the child is, what his preferred communication style is, his hearing history, his learning style and the support he has, he might make faster progress in speech therapy than would another child. A child’s speech pathologist will work with the child to determine how much therapy is appropriate by considering the different stages of listening and speaking.
A speech pathologist will consider which therapy approach will work for the child and family because the family will be involved in the process. These speech therapy approaches include auditory/oral, auditory/verbal, cued speech and total communication. The goals established by the family and the speech pathologist will determine which therapy option will be used. One important consideration is that the therapeutic objectives and goals must be supported by the child’s school and home environments.
- Before children receives a cochlear implant, they undergo a trial period with hearing aids, which was supplemented with either speech or aural rehabilitation therapy. This time period should have lasted about three months before the implant surgery took place. This period before cochlear implant surgery is important because it helps to determine that the implants would be a benefit for the child as well as determining the child’s ability to gain speech using assistive technology. The information gathered by the child’s speech pathologist or therapist will be used to determine how much therapy will be necessary and when this therapy needs to begin.
- After a child’s implant surgery, a hearing specialist will work with the implant to fine-tune the sound levels for the sound and speech processor. The lowest and highest sounds necessary for a child will be determined. A child will not be using the implant at the highest power level at first. This process could potentially take several months, especially if the child was born deaf. The implant will work to stimulate new pathways within the child’s brain that are necessary for hearing.
While this fine-tuning and pathway-building process is going on, the child will be participating in speech and language therapy so he can learn to identify and interpret the sounds that are so new. Expect these sessions to last at least a year.
Speech Therapy Options
Prior Specch Therapy
Learning to Use the Implant
sumber : deafness.about.com
TERAPI gen berpotensial merestorasi alat pendengaran. Demikian penelitian atas tikus mencit yang dilakukan ilmuwan Amerika Serikat. Penelitian ini memberi harapan bagi mereka yang mengalami penurunan pendengaran.
Tim Oregon ini menemukan bahwa transfer gen menyebabkan diproduksinya sel-sel rambut yang merupakan bagian esensial dalam telinga bagian tengah untuk menginterpretasi suara. Pada mereka yang pendengarannnya normal, sel-sel rambut cochlear mengonversi suara menjadi signal listrik yang akhirnya akan ditransmisikan menuju otak.
Sekali sel-sel itu itu rusak atau hilang, mereka tak akan bisa diganti secara alami. MenurutRoyal National Institute for Deaf People (RNID) ada sekitar sembilan juta orang yang menderita tuli atau telinga berdenging di Inggris.
Kebanyakan dari mereka mengalami kehilangan pendengaran secara bertahap seiring bertambahnya usia yang disebabkan oleh menghilangkan sel-sel rambut pada bagian cochlear.
Paparan suara yang berlebihan dengan frekuensi tinggi juga menjadi salah satu sebab rusaknya sel-sel rambut ini. John Brigande dan timnya dari Oregon Health and Science Universitymenunjukkan, setidaknya pada tikus-tikus yang belum lahir, terapi gen dapat digunakan untuk memicu tumbuhnya sel-sel yang bakal menjadi sel-sel rambut.
Terapi gen menggunakan satu virus yang tidak berbahaya yang dimasukkan kopi-kopi gen kunci ke dalam sel-sel yang kemudian mereplikasinya. Gen kunci yang digunakan oleh tim Oregon adalah Atoh1 yang merupakan bagian terpenting bagi tumbuhnya sel-sel rambut.
Sel-sel Atoh1 ini fungsinya sangat mirip dengan sel-sel rambut. “Kemampuannya yang mirip dengan sel-sel rambut merupakan langkah awal yang penting, yang bisa digunakan untuk manusia mengatasi gangguan telinga,” ujar para peneliti.
Jadi terbuka kemungkinan bahwa sel-sel ini digunakan untuk manusia. Dan yang lebih penting, perbaikan cochlear ini tanpa menggunakan mesin atau alat listrik. Sekarang ini, sebenarnya sudah ada alat yang bisa ditanam (implan cochlear) dalam telinga dan berfungsi merangsang saraf pendengaran secara langsung.
Implan ini tidak merestorasi pendengaran menjadi normal tetapi memberi sensasi suara saja. Andy Forge, profesor biologi sel pendengaran dan penasihat Deafness Research UK mengatakan “Meski masih perlu diteliti, penelitian atas terapi gen memberi harapan bagi mereka yang tuli sejak lahir (congenital deafness) untuk bisa mendengar kembali.”
Sekitar 2000 anak tuli sejak lahir. Terapi ini menurut Andy sangat bermanfaat dan penting. Dr. Mark Downs dari RNID mengatakan “Perkembangan ini sangat luar biasa, membuat kita makin bersemangat dan kagum bahwa ternyata terapi gen bisa mengatasi gangguan pendengaran.”
Sumber : KOMPAS.com
Terompet telinga pertama dibuat 550 Sebelum Masehi oleh penulis dan ilmuwan Yunani Alcmaeon dari Croton. Alat ini tidak dirancang membantu pendengaran yang terg anggu. Alat bantu dengar itu justru dirancang untuk membantu mendengar suara dari jarak jauh terutama di lautan demi keperluan militer atau di lahan berburu.
Sekitar tahun 300 Sebelum Masehi, orang Yunani kuno mengimpor kulit kerang ke Phoenicia (wilayah Tunisia modern-red) sebagai terompet telinga. Kulit kerang dikeraskan kemudian dicat sehingga lebih menarik untuk dijual.
Terompet telinga modern dicatat dalam karya ilmuwan Belgia Jean Leurechon (1591-1670) dalam buku Recreations Mathematiques yang diterbitkan tahun 1624.
Perajin terompet telinga pertama di Inggris adalah Bevan di London tahun 1715.
Alat bantu dengar modern menggunakan mikropon karbon. Alat itu dibuat Perusahaan Diktograf Amerika Serikat tahun 1898.
Dalam perkembangan, tahun 1954, alat bantu dengar memiliki bentuk semakin kecil sehingga dapat dipasang di gagang kacamata. Selanjutnya alat bantu dengar digital yang dipasang di dalam telinga diperkenalkan tahun 1955.
Selanjutnya dilakukan implantasi alat bantu dengar (cochlear implant-red) yang dilakukan oleh Rod Saunders di Melbourne, Australia. Profesor Graeme Clark dari Melbourne memelopori teknik tersebut pada decade 1970-an.
Cochlear implant dikenal sebagai kuping bionik karena dapat menolong orang yang sama sekali tuli dan sulit mendengar dalam kondisi parah. Berbeda dengan alat bantu dengar biasa, cochlear implant tidak mengamplifikasi suara, tetapi merangsang saraf penerima dengan getaran listrik beberapa menit.
Cochlear implant pertama di Amerika Serikat dilakukan tahun 1984 setelah mendapat persetujuan US Federal Drug Adminisitration (Badan POM Amerika Serikat-red).
(Iwan Santosa disarikan dari The Book of Origins karya Trevor Homer, Penguin Books, London 2007).
sumber : KOMPAS.com