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Central Neural Auditory Prosthesis PowerPoint Presentation

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Description : Check out this medical presentation on Brain Stem Glioma (Childhood), which is titled "Central Neural Auditory Prosthesis", to know about the auditory prostheses, both at the level of the sensory nerve and at the brainstem.

Tags : Brain Stem Glioma, Childhood, Central Neural Auditory Prosthesis, auditory prostheses, sensory nerve, brainstem

Published on : May 10, 2021 | Views : 2037 | Downloads : 1

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Slide 1-

Central Neural Auditory Prosthesis Chp. 161 Irene Kim
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Auditory Brainstem Implant (ABI) Effective partial hearing restoration in patients with NF2 Most common indication for ABI is NF2 In US, criteria is for postlingual NF2 patients 12 yrs or older First or second side vestibular schwannoma removal
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ABI in Non-NF2 Patients Patients who have failed CI Loss of 8th CN integrity 2/2 skull base fx, traumatic avulsion Severe post-meningitic cochlear ossification Possible in cochlear dysplasia or cochlear nerve aplasia Hearing outcomes SIGNIFICANTLY BETTER than in NF2 patients
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http://www.youtube.com/watch?v=kcCRmFNpoxI
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ABI Benefits Limited to environmental sound perception and aid to lip reading Rarely, open set speech understanding Definitely POORER hearing than with cochlear implant
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Current ABI 21-electrode array Stimulated similar to a cochlear implant Transcutaneous radiofrequency transmitter and receiver
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Timing of ABI Placement Usually placed at time of 2nd vestibular schwannoma removal Can place at time of first side tumor removal (“sleeper”) Second stage procedure after previous vestibular schwannoma surgery Advantages/Disadvantages
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Surgical Approach Translabyrinthine Favored by most surgeons for ABI placement in NF2 patients More lateral view of brainstem Cerebellar retraction reduced or avoided Retrosigmoid
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Surgical Approach
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Auditory Performance Useful auditory perception Hearing level much less compared to CI Loss of peripheral tonotopic stimulation Improvement in auditory sensation Rare significant open set speech understanding (telephone use)
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Penetrating Auditory Brainstem Implant Two generations (combo of penetrating and surface arrays) Electode inserted into cochlear nucleus Outcomes are not better than surface electrode ABI
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Penetrating Auditory Midbrain Implant Stimulate auditory midbrain proximal to damaged cochlear nucleus Dorsal surface of inferior colliculus Penetrating electrode array Access tonotopic orientation of inferior colliculus
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Complications Cerebrospinal fluid fistula through the wound and risk of infx in presence of ABI Possible hydrocephalus Displacement of electrode array Nonauditory/somatic sensations Ipsilateral facial tingling/throat discomfort
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TAKE HOME POINTS 1. Effective method of partial hearing restoration in patients with NF2 2. Provides environmental sound awareness 3. Open set speech perception achieved only rarely. 4. Trials of penetrating ABI and AMI have not shown improved hearing 5. Better speech perception in patients w/o NF2
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Hearing Aids: Strategies of Amplification Chp. 162 Irene Kim
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General HA predominantly for: SNHL with flat or sloping hearing loss Patient is candidate for HA depending on: 1. Degree of hearing loss 2. Extent of communication disorder resulting from loss 3. Motivation of patient/attitude towards hearing aid use
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Hearing Aid Technology Component miniaturization Programmability Wireless connectivity Permits communication from one hearing aid to another From hearing aids to other electronic devices and signal sources FM radio, phones, computers
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Hearing Aid Microphone, amplifier, receiver Microphone: converts acoustic energy into electric energy Amplifier: adds gain to level of electric signal Receiver: receives amplified electric signal and converts it back to acoustic energy Telecoil or t-coil Allows HA to receive electromagnetic signals directly, bypassing microphone Classroom setting
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Electroacoustic Characteristics Frequency gain Input-output Linear Non-linear Output limiting
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Nonlinear Amplification Designed to address major problem with SNHL Reduced dynamic range Normal hearing: Range is 0 to 100 dB Patient w/ SNHL: Range is reduced Compression circuitry Peak clipping
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Hearing Aid Features Directionality Directional microphone Noise reduction Feedback reduction Program management Automatic adaptivity Data logging
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Hearing Aid Styles Behind-the-ear (BTE) Microphone and amplifier behind the ear Receiver may be in the canal or behind ear Potential for feedback lowest In-the-ear (ITE) In-the-canal (ITC) Completely-in-canal (CIC) Reduction of wind nose, ease of phone/stethoscope use
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Hearing Assistive Technology Assistive listening devices (ALDs) Personal amplifiers, FM systems Enhances acoustic signal over background noise Uses remote microphone Closed captioning of TV shows
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HA Fitting Fitting Verification (objective measurements) Real-ear unaided response or gain (REUR/G) Real aided response or gain (REAR/G) REAG-REUG = real insertion gain (REIG)
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Outcome Measurement Self-assessment scales Assessment by spouses Hearing Handicap Inventory for Elderly (HHIE) Other Quality of Life measures
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Hearing Aids in Children Always fitted w/ binaural hearing aids Children grow quickly; hearing aids often adjusted Usually BTE Maximize audibility Can remake ear mold of BTE as ear canal grows