Hearing loss is a major issue in America, with an aging population prone to the issue and other environmental factors steadily deteriorating the hearing of other, younger patients. Then there are those that are born deaf and must deal with their inability to hear from a young age, either due to genetic issues or damage to the ear at birth.
All those that deal with hearing loss as adults, and all those born deaf as children, deserve the very best in hearing tests and aid to help them through the problem. This is especially true in young children that need the best start in life possible. Here a tailor-made, effective screening process and the very best in cochlear implants are essential. The good news for all patients and their parents is that improvements and development occur consistently.
Newborn Screening And The Preferred Screening Tests For Children
It is important that we identify hearing loss in children as soon as possible to minimize the impact on their development. Those with undetected hearing loss can struggle to understand the world around them and delay speech development. The sooner they receive help to hear, the better the outcome. This is why many hospitals now screen for hearing issues soon after birth.
A series of hearing tests can catch issues more easily, as a failure on the first test may not indicate a permanent issue. The average age of detection is approximately 14 months.
Adults are pretty familiar with the pure tone method of hearing test in America. This is the simple process of raising a hand or pressing a button when a tone is detectable. This is easy enough for us to understand, and still works well as a means or determining the details of hearing loss through pitch and frequency. The problem is that this doesn’t work so well with very young children that don’t understand the process.
Specialists now prefer to use visual reinforcement audiometry for those aged six months to 2 years, and conditioned play audiometry for those aged 2-5. They now feel that the visual model is best for babies as it encourages them to look towards the source of the sound. It is reactive and instinctive and doesn’t require much training.
Kids also get the pleasure of watching the toy that is making the noise. Older children respond well with the physical act of the play, performing an activity when they hear a sound. This time the test becomes a game, minimizing the stress and producing great results.
Profound hearing loss and the need for devices other than hearing aids.
Some children receive hearing aids after their hearing screening to help them tune into the noises around them and keep up with other children. However, traditional hearing aids don’t work for everyone. It all depends on the intensity of hearing loss and the damage that has occurred. Those with sensorineural hearing loss will often need an implant.
What Is A Cochlear Implant And How Does It Work?
This type of hearing loss is Sensorineural hearing loss occurs when there is damage to the tiny hair cells of the cochlear, or inner ear. Sound cannot then stimulate auditory nerve in the same way as those with healthy hearing. The only solution here is to bypass this hair with an implant that will pick up the sounds and transmit directly to the nerve.
Surgeons implant a receiver and electrodes just under the skin behind the ear. Then there are the external parts, such as the microphone, speech processor, and transmitter, that pick up the sounds around the patient and process them. This is the part that is visible on the surface of the head and around the ear. The microphone sits behind the ear like a hearing aid, the transmitter is a disc on the head, and the processors are within a box worn in a pocket. It is all complex and cumbersome but can help deaf patients to hear again.
The need for regular research and development into the best possible approaches to these devices
A Major study was recently carried out on the benefits and performance of cochlear implants that highlight key areas for improvement. Researchers from Vanderbilt University looked at the implants and hearing of 230 patients with varying forms of the implant and noted that the “no wire” approach was preferable. These lateral wall electrodes offered the best residual hearing in the inner ear. It was also noted that the surgical procedure for these non-wire electrodes was less traumatic, with a reduced width of injury or fractures inside the inner ear.
Patients that experience the “round window” approach with this non-wire system, which means no drilling through the bone, increased the chance of keeping their residual hearing, while the other often caused fibrosis and scarring.
This reserved is welcome for all those looking for the most non-invasive, convenient methods of cochlear implant surgery.
The easier it is to fit the implant and begin the process of aiding hearing loss, the easier it is for the patient. All advancements are welcome at a time when cochlear surgery becomes more common in younger patients.
There are some concerns over age limits for candidates for cochlear implant surgery. On the one hand, surgeons want to help children with the profound hearing problem as much as possible. On the other, this is a drastic process that many may not fully understand.
ASHA view the best child candidates as those with a profound hearing loss that occurs in both ears, where they would experience little to no benefit from hearing aids. There should also be no medical conditions that would make the surgery risky, and the patient should have some understanding of the procedure and their role in achieving the best results. This is easier said than done with cases of children born deaf.
Here parents and doctors want to act quickly to give children a chance to learn to hear and speak and not suffer the consequences of their deafness for long. These new advancements in surgery will help to achieve this. There are cases of children under 2 receiving these implants successfully and enjoying the benefits. They are unlikely to understand what is going on, and rehabilitation can be difficult.
This is a three step process for all children and adults: testing, surgery, and rehabilitation. The first two are improving rapidly, but the latter still offer concerns.
After the testing and the fitting of the implants, it is all about the therapy and support. This is where some families struggle the most. There is that wondrous moment where the child can play and begin to hear the voices of loved ones, the sounds of toys or other noises we take for granted. Then the reality of the situation sinks in. This is a foreign experience and children have to learn to listen, learn what they are hearing and begin to develop their speech. They need access to follow-up services, speech therapists, and other auditory help.
There is a long process from this initial internal implantation to the final, working system. This can be hard for parents and young children that simply want the process to be over and hate the regular trips to the clinics. Also, there are sure to be issued over the accessibility of services in some areas.
Around 4–6 weeks after surgery, the patient will revisit the auditory center to attach the microphone and speech processor to the implant. It is only then when the implants are turned on, that hearing therapy can begin. Over the next months, the patient learns to use the implants and hear again, while specialists fine tune the hardware and processors for the best experience.
There is a constant need to update cochlear implants to provide both children and adults with the best technology and designs.
It is easy to focus on the inner workings and receivers for the sound, and the way they interact with the hearing process within the ear and brain. However, this could mean that we overlook the need to improve the external element. This is important for two reasons.
First of all, these receivers on the outside of the ear, and the aids in the ear need the best software and electronics to pick up and transmit sound in the most efficient manner. An old cochlear device could mean that many deaf adults still miss out on sound and the best possible aural experience, even though they should be on the same level as those with perfect hearing.
The other reason is the look of the device. There is no getting away from the fact that these implants are noticeable on the side of the head and hard to disguise. There are many stories of family members, often older brothers, tattooing images of the receivers into their heads so that younger children do not feel they are alone. Where possible, a more discrete, or personalized system can help. Children can either hide the issue or own it as their superpower, depending on how they feel about the situation.
In Australia, patients received upgrades with improved Bluetooth and wireless connections to the devices that improved the signal and translation of sounds. This has helped those that struggle with television or when making calls. Other say there are better able to isolate different noises and concentrate on the ones they need to hear, such as tuning out background noise like traffic to focus in on speech. Wireless models also help to streamline the processes and designs so that there isn’t quite so much external hardware.
The ideal solution for many is a more discrete device that is more sophisticated and beneficial to the wearer.
The main aim here is to create a cochlear implant with no external hardware. Ideally, this will eliminate the need for this large microphone and other hardware on the side of the head. This would then improve the look of the system and potentially hide it all together.
Deaf citizens that want others to treat them as though they do not hear impaired may finally get that chance. The microphone and processors would fit in the middle ear, out of sight, with the same capabilities as the hardware used today.
Developers at MIT have high hopes for the system. They insist that it has potential because the inner microphone area of the ear is often still functional in cochlear implant candidates.
The plans for the device stretch beyond this implant, with ideas about wireless charging via a phone or smart charging pillows to top up the battery night. There are some problems here. The first is cost and availability. This is unlikely to roll out on a national level anytime soon. The second is that the new implant and receivers would require an entirely different type of surgery.
At the moment, the above advancements in wire-free, non-invasive approaches allow surgeons to complete the process in just an hour. This process, with the internal receiver, could take up to 4 hours. Therefore, this is only suitable for the adults that are willing to go through the process. Children are better off with the model above until researchers can reduce this time frame.
Advancements in cochlear implants and hearing evaluation are substantial, and there is still much more to achieve.
Hearing loss specialists, surgeons, and researchers in auditory aids have all come a long way in recent years with the development of treatment options and devices for the deaf. This is particularly true when dealing with the needs of the young, as children now have access to improved cochlear implants and screening measure at an early age.
These new findings on the surgical procedures and wire-free devices can only improve the situation for those younger patients in need of a non-invasive approach. The same is true for all those adults in need of an upgrade to their out-dated systems.
These tests, new wireless devices in Australia and MIT’s bring hopes for an internal device and show that we still have a long way to go. With time, hearing tests can become more effective and cochlear implants may become practically invisible, highly sophisticated and easy to install.