Implants HEARING AIDS (Implantable HEARING DEVICES)

Implants HEARING AIDS
(Implantable HEARING DEVICES)

By:
Tutut SRIWILUDJENG T.
Dr. Wahidin Sudiro Husodo Mojokerto

INTRODUCTIONMore than 10% of Americans a loss of hearing, this is because the more menigkatnya deisebabkan age of life, especially over 65 years. The amount is only 20% are willing to use conventional hearing aids, 16.2% of them then do not use it again. The main reason karean aesthetic factor causing embarrassment in the association, limited hearing, voice distortion, an inconvenience for the use (appliance plugged into ears, causing irritation, infections and ear feeling clogged due to dirt that has accumulated), maintenance of complex equipment (cleaning equipment requires replacement battery on a regular basis), and so forth. For more than 2 decades, research directed towards the development of a conventional hearing aid, so find a hearing aid, known as implantable hearing aid / Implantable Hearing Devices (IHD). In this refarat will discuss the type, indication, the workings of IHD.Hearing aid implant (Implantable Hearing Devices)Implantable hearing aids / Implantable Hearing Devices (IHD) is a hearing aid that panguat system sound and sound waves Conductor system implanted in the ear. Can be used for patients who experience mild to severe hearing loss. Gain use of IHD compared with conventional hearing aids, the sound is more natural, more clearly (without going through the barrier), the use of longer battery life (can be replaced within a period of 5 years or so), volume settings can be adjusted by using the remote control.Some types of IHD:1. Cochlear Implant (Cochlea Implant)Cochlear implant is a small electronic device implanted in place of the cochlea and serves to provide a voice for people who experience hearing loss. This tool is one part in place behind the ear, while the rest are planted under the skin, teridir from:a. Microphone that serves to accommodate the sound from outside.b. Speech Processor function to sort the sound that fit to the microphone.c. Transmitter and receiver / stimulator function receives the sound from the speech processor and convert them into electrical waves.d. Electrode array (coil electrode) that serves to collect sound waves from the stimulator and sends them to other parts of the auditory nerve.Cochlear implants can not restore normal hearing, but can represent the voice - a voice from the outside so that patients can understand pervcakapan voice.





Figure 1: The cochlea consists of a microphone, speech processor, transmitter and receiver / stimulator and electrode array.IndicationNot all patients with hearing loss might be the installation of a cochlear implant. Audiology experts will give them some criteria, patients who suffered severe hearing loss on both ears. Severe hearing loss is characterized by the inability to hear sounds 90 dB or more at a frequency of 500, 1000 and 2000 Hz. Secondly, patients are expected to improve keomunikasi at least 30% after the installation of a cochlear implant. The third patient at least 1 year of age or older with sensorineural hearing loss in the two ears.How it worksHow cochlear implants work differently with other hearing aid. Cochlear implants bypass function in the ear is damaged and send the entire signal to the brain through the nerves - nerves pendengaan. Implus sound received through a microphone, be forwarded to the speech processor that selects an appropriate voice information into a voice code. Sound code delivered to the transmitter. Voice code transmitted via cable and through the skin into the receiver or stimulator. The code changes sound into electrical signals and transmitted to the electrodes - electrodes that fit within the cochlea that stimulate the fibers - the nerve fibers. Continue the hearing nerve to the brain and translate this information as sound. The sound produced by normal hearing is different from that produced by a cochlear implant, but the patient was asked to be able to learn and adapt to achieve better kemunikasi.2. Auditory brainstem implantsAuditory brainsten implants (Abis) is designed for patients where the tumor pressing neurofibromatis nerve VII and VIII, so people lose their hearing. Tools Abis planted after tunor appointed kenudian dati planted in the lateral ventricle adjacent to the nucleus cochlear four without going through the cochlea and cochlear N.koklearis replace function and nerve - the nerve of hearing.IndicationAbis initially performed on patients aged over 12 years, having neurofibromatosis type 2, there are schawannoma bilateral vestibular tumors. Installation operation is done after removal of the tumor, patients on medical and psychological condition stable (because after surgery selessi usually followed by giving radiotherapy). End - the end is also done on the Abis pendertia with N koklearis bilateral trauma and children with N koklearis malfunctions due melformasi akustikus meatus internus (atresia) which causes apliasi of N koklearis shohet reported by 16 patients who showed improvement mainly done Abis Lip skills - reading and only a few can reach the open word diskrimainasi test - set after the patient received votes Abis premises will assist communication and quality of life.






Figure 2: Abis planted after the tumor is removed, then implanted in the lateral of the fourth ventricle adjacent to the nucleus through the cochlea and cochlear tanpan N koklearis.How it worksAbis tool consists of 3 parts of the receiver / stimulator, speech processor and microphone or headset. The receiver / stimulator is placed behind the ear. Cable from the receiver / stimulator is connected directly to the electrode implanted in the brainstem. Speech processor and microphone will accommodate implus sound and convert it into electricity and sending it via cable to the electrode implanted in the brainstem.3. Middle ear hearing aids / Impalntable Middle Ear DevicesMiddle ear hearing aid / Implantable Middle Ear Deveices grown attached to the bone - bone loss, and serves to vibrate the bone - bone pemdengaran.IndicationThis hearing aid can be used in patients with hearing loss deaf premises sensoneural moderate to severe.How it worksThe working principle of the middle ear implants / implantable middle ear devices, this work stimulates the bone - bone loss directly by using the wave gataran elektromahnetik to improve on the third hearing bone is the malleus, incus, stapes. Several types of middle ear implants that are common among them:a. Vibrant sounbrige devicesThis device consists of processors, amplifiers and a vibrating ossicular prosthesis (the coil that produces a wave megnetik). Sound entering the microphone towards justice lies at the back of the ear (postauricular) will be forwarded to the vibrating ossicular prosthesis to the bone mengetrkan hearing.





Figure 5: Tranducer placed osikularb. Middle Ear TransducerThis tool is put together with the incus body, where the function of this tranducer menterjamahkan electrical waves into mechanical motion by stimulating osikel.




Figure 6: Tranducer fused incus denanc. Sooundtec direct systemThis tool is placed encircling the neck of the stapes as far as ± 2 mm from the location of the tympanic membrane. Functioning as a thrilling mahnet osikel. Elektromahnetik waves generated outside the ear canal, the quality of the resulting wave is much more than the wave aik dihasilakan on konensional hearing aid.







Figure 7: Soundtec direct system, mahnet placed encircling stape4. Bone anchored Hearing AidBone anchored Hearing Aid (Baha) is a hearing aid that percutaneous planted in the area behind the ear.IndicationBaha is pengenbangan bone conductor hearing aid (Bone conduction Hearing Aid konensional), Bone conduction Hearing Aid is often used in a few years ago when middle ear infections are still common and difficult to perform medical therapy or surgery, as well as in patients with external ear canal atresia / axternus acusticus meatus. Baha used for patients with conduction deafness (hearing aid where others are not appropriate to use because of chronic infection, atresis mae, congenital abnormalities of the external ear). End - the end of this Baha is also used in patients with total unilateral sensorineural deafness premises (single sided Deafness) where the results indicate more effective than the contralateral Routing Of Signal Hearing Aid / CROs. A bad appearance and aesthetic factor is also the consideration of using CROs Baha than HA. Baha planted on the side of the deaf will continue the delivery of sound waves through the bone to the contralateral cochlea.Advantages patients with conduction deafness who use Baha can hear without occlusion effect or irritation mae, whereas patients with total sensorineural deafness to hear on the deaf side and can determine the location of the sound.






Figure 3: Components of bone conducting hearing aid / Bone conduction Hearing AidHow it worksBaha consists of 2 parts, parts of titanium implanted in the head behind the auricle is a microphone placed on the outside with a fixed position attached to the titanium. The sound is captured through the microphone signal will be transmitted as waves through the ear, these vibrations will proceed directly to the inner ear without passing through the outer ear or middle ear. Conductor skull is an ideal sound vibrations directly to the cochlea on both sides.










Figure 4 A-B: Baha. Microphone meleakt in titanium, bone conductor used to deliver the sound directly into the cochlea.SummaryImplantable hearing aid / Implantable Hearing Devices is a hearing aid that when compared with conventional tool produces a more natural sound, leibh clear, use the battery more durable and use more sophisticated technology.Cochlear implant is a small electronic device implanted cochlear debagai replacement and serves to provide a voice for people who experience hearing kehinlangan.Auditory brainstem implants (Abis) a hearing aid designed for patients with neurofibromatosis type 2, N koklearis trauma and children with malformations akustikus meatus internus (atresia) which causes aplasis N koklearis.Middle ear implants / implantable devices, middle-era work stimulates the bone - bone loss directly by using the wave elektromahnetik. Several types of middle ear implants including: Vibrant sounbrige devices, Middle Ear Tranducer, Soundtec direct system.Bone anchored Hearing Aid (Baha) is a hearing aid that is planted in the area of ​​post-auricular percutaneous functioning deliver bone malalui wave, then proceed directly to the ears in without going through the outer ear or middle ear.
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