Page 32 - Waterfall_Issue 4_2022

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indications in patients with hearing standards of care and ethics in the
loss. In patients with a dominant process of cochlear implantation.
conductive hearing loss, a bone
conduction hearing aid provides A cochlear implant is an electronic
a very effective way of delivering device that is surgically embedded
sound to the cochlear nerve, using into a patient’s temporal bone.
the bone of the skull as a conducting The procedure involves the
medium. This involves the placement placement of an electrode directly
of a titanium implant into the bone into the patient’s cochlea. This
of the skull. This then connects to connects transcutaneously to an
an external sound processor. The external sound processor, which
processor converts sound energy converts sound energy to electrical
to a vibro-tactile response that is impulses that are directly delivered
transmitted directly to the cochlear to the cochlea hair cells.
nerve. Speech reception in a noisy
environment has shown to be quite Cochlear implants are recommended
good with bone conduction implants. for patients with severe sensory
hearing loss, where they gain no Auditory brainstem implant
In patients with sensory hearing loss benefit from conventional hearing
or mixed (both nerve/sensory and aids. These implants have received from as young as six months, with
conductive) hearing loss which is not the CE mark in Europe for Single- no upper age limit – but medical risk
severe enough to qualify for a cochlear sided Deafness. In South Africa, these factors for the surgical procedure
implant, it is possible to surgically cases are dealt with on an individual have to be taken into consideration.
implant a device that couples to the basis as per an established protocol.
second bone of hearing (the incus) AUDITORY BRAINSTEM
to directly drive the ossicular chain, Cochlear implant teams are established IMPLANTS (ABI)
thus amplifying acoustic hearing. in all the major cities in South Africa In certain conditions resulting in
and comprise ENT surgeons trained in severe to profound sensory hearing
COCHLEAR IMPLANTS cochlear implant surgery; audiologists loss, cochlear implantation may
South Africa can proudly boast of trained in mapping cochlear devices; not be possible. These conditions
having one of the most established and speech therapists trained in auditory- include Neurofibromatosis Type 2,
oldest cochlear implant programmes verbal therapy; along with consulting where tumours called vestibular
in the world, with the first cochlear input from psychologists and neuro- schwannomas arise from the hearing
implant being done in 1986. The South developmental paediatricians. and balance nerve (8th nerve).
African Cochlear Implant Group is the Resection of these tumours results in
custodian of maintaining the highest Cochlear implants may be inserted the loss of function of the 8th nerve.
Other indications would include
How the cochlear implant works congenital malformations of the
cochlea where cochlear implantation
is not possible, and meningitis, which
causes calcification of the cochlea.

In these cases, it is possible to place
an electrode paddle directly onto
the auditory centre of the brainstem.
This surgery is usually performed
simultaneously by a neurosurgeon
and an ENT trained in ABI surgery.

CONCLUSION
Hearing loss can have devastating
effects on a person’s social, family
and workplace functioning.
Fortunately, there are numerous
modalities available in South Africa
to rehabilitate hearing loss and
Cochlear implant produce a functional outcome.

30 Waterfall Issue 4 2022