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Bilaterale Cochleaimplantatversorgung

Bilateral cochlear implants

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Zusammenfassung

Die Cochleaimplantat(CI)-Versorgung gilt als Standard bei der Hörrehabilitation einer hochgradigen Schwerhörigkeit oder Taubheit. Bei beidseitiger Indikation wird heute i. d. R. (leitliniengemäß) eine beidseitige Versorgung empfohlen. Die bilaterale CI-Versorgung ermöglicht besseres Sprachverstehen in Ruhe und im Störlärm sowie Richtungshören und räumliches Hören. Kindern wird mit der bilateralen CI-Versorgung eine auf Hören gestützte Hör-Sprach-Entwicklung ermöglicht. Bilateral versorgte Kinder entwickeln sich schneller im Rahmen ihrer individuellen Möglichkeiten als unilateral versorgte und erreichen z. B. einen größeren Wortschatz. Erst die bilaterale CI-Versorgung ermöglicht „binaurales Hören“ mit allen Vorteilen, von denen auch Normalhörende profitieren, nämlich: besseres Sprachverstehen in Ruhe und im Rauschen sowie Richtungs- und räumliches Hören. Naturgemäß benötigt die Entwicklung Zeit. Binaural versorgte CI-Träger profitieren von den gleichen Effekten wie Normalhörende: Kopfschatteneffekt, Squelch-Effekt sowie von Summations- und Redundanzeffekten. Eine sequenzielle Implantation ist nicht zwingend nachteilig; sowohl simultan als auch sequenziell versorgte Patienten profitieren gleichermaßen. Für Kinder scheinen eine möglichst frühe Implantation und ein möglichst kurzes Intervall zwischen beiden Operationen bei beidseits gegebener Indikation vorteilhaft zu sein.

Abstract

Cochlear implants (CI) are standard for the hearing rehabilitation of severe to profound deafness. Nowadays, if bilaterally indicated, bilateral implantation is usually recommended (in accordance with German guidelines). Bilateral implantation enables better speech discrimination in quiet and in noise, and restores directional and spatial hearing. Children with bilateral CI are able to undergo hearing-based hearing and speech development. Within the scope of their individual possibilities, bilaterally implanted children develop faster than children with unilateral CI and attain, e.g., a larger vocabulary within a certain time interval. Only bilateral implantation allows “binaural hearing,” with all the benefits that people with normal hearing profit from, namely: better speech discrimination in quiet and in noise, as well as directional and spatial hearing. Naturally, the developments take time. Binaural CI users benefit from the same effects as normal hearing persons: head shadow effect, squelch effect, and summation and redundancy effects. Sequential CI fitting is not necessarily disadvantageous—both simultaneously and sequentially fitted patients benefit in a similar way. For children, earliest possible fitting and shortest possible interval between the two surgeries seems to positively influence the outcome if bilateral CI are indicated.

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Notes

  1. Wilson BS, pers. Mitteilung, Wullstein Symposium 2001, Würzburg

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Danksagung

Dieser Beitrag ist meinen Lehrern Herrn Prof. Dr. med. Dr. med. h.c. Jan Helms zum 80. Geburtstag und Herrn Dr. rer. nat. Franz Schön in Dankbarkeit gewidmet.

Unser Dank gilt auch den CI-Trägern und den Eltern der versorgten Kindern für das entgegengebrachte Vertrauen und ihr Engagement.

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  1. Funktionsbereich Otologie und Cochlea Implantate, CI- und Ohrzentrum, Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Campus Großhadern und Campus Innenstadt, Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland

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J. Müller gibt Folgendes an: Reisekostenerstattung, finanzielle Unterstützung für Forschung, Member Medical Advisory Board (Fa. ARRI Medical, Fa. ATMOS, Fa. Heinz Kurz GmbH Medizintechnik, Fa. Med-El).

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Müller, J. Bilaterale Cochleaimplantatversorgung. HNO 65, 561–570 (2017). https://doi.org/10.1007/s00106-017-0370-8

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