人工耳蜗植入工作指南（Guidelines for cochlear implant work）The cochlear implant is a biomedical engineering device that helps deaf people recover their hearing and speech communication skills. The cochlear implant is a new technology in the field of medicine and rehabilitation, so in the selection of indications and perioperative evaluation, surgery, postoperative machine and hearing and speech rehabilitation are a reference standard. This guide is intended to provide guidance for clinicians, engaged in the work of hearing and speech rehabilitation workers, the cochlear implant in our country to achieve standardization and standardization, so as to improve the therapeutic effect, to avoid unnecessary risks.Cochlear implantation involves medical, audiology, biomedical engineering, pedagogy, psychology and sociology and other fields, to aurist and listening teachers, speech therapists, training teachers, engineers and parents together constitute the cochlear implant group, collaborative work.Selection of indicationsFirst, the patient selection criteriaFor severe or very severe deafness in both ears, the cochlear implant can be used for localizing the lesion to the cochlea.Selection criteria for deaf patients before speech:1. bilateral severe or profound sensorineural hearing loss; the best age should be 12 months to 5 years; the right of hearing aids, hearing rehabilitation training after 3 ~ 6 months afterhearing language ability has no obvious improvement; and there is no contraindication; the family and (or) implanted himself the correct understanding and appropriate expectations for cochlear hearing; the language rehabilitation education conditions.The smaller the age at which the preoperative deaf patients operate, the better the effect of hearing deprivation and expanding the potential of speech and language skills before the critical period of brain plasticity. More than 6 year old children or adolescents need to have some hearing language foundation, was a hearing aid with history and listening or language training history. The hearing aid is invalid or poor results, is an open hearing in the best listening environment phrase recognition rate is less than 30% or two word recognition rate is less than 70%.Selection criteria for deafness 2. language: deaf patients of all ages after the language; the bilateral severe or profound sensorineural hearing loss; the hearing aid is invalid or poor results, opening phrase recognition rate is less than 30%; and there is no contraindication; the good psychological quality and subjective initiative. Have a correct understanding and appropriate expectations for the cochlear implant; family support.The age of onset and the duration of deafness in post deaf patients are closely related to the outcome after surgery. Generally speaking, the age of onset is earlier, the course of deafness is worse than that of the elderly, and the effect is poor after operation. In addition, the listening environmentin the postoperative life and work can also affect the effect of cochlear implants.3. surgical contraindication: absolute contraindications, including serious inner ear malformations, such as Micheal, no deformity of cochlear malformation; auditory nerve defect; severe mental disorders; cannot be combined with language training; serious mental disease; acute and chronic inflammation of the middle ear and mastoid are not clear; the relative contraindications, including general condition cannot control the difference; epilepsy; rehabilitation training is not reliable.Secretory otitis media and glue ear are not contraindications to operation. Chronic otitis media with perforation of the tympanic membrane can be selected for one-stage or staged surgery if the inflammation is controlled. One-stage surgery refers to the repair of the middle ear mastoid lesion and the repair of the tympanic membrane with the repair of the tympanic membrane (or the mastoid cavity, the temporalis muscle, the packing and the closing of the external auditory canal). Staged surgery involves debridement of the lesion, repair of the perforation of the tympanic membrane or closure of the external auditory canal, and cochlear implantation 3~6 months later.Two. Preoperative evaluation1. medical history collection: to understand the cause of the disease through medical history collection and examination. Emphasis should be placed on the ear disease process and the pathogenesis of deafness, should understand the patient'shearing, tinnitus and vertigo history history, ear poison contact history, history of noise exposure, systemic acute and chronic ear infection history, past history, developmental factors (local or systemic malformations, mental development etc.), family history of deafness hearing aid, wear history and other reasons, such as epilepsy, mental conditions etc.. Deaf children should also include: mother's pregnancy history, child birth history, children's growth history, speech development history.Patients should also understand the language ability (such as pronunciation characteristics, articulation) and language comprehension and communication skills (such as oral, written, sign language, lip reading, guessing).The 2. ear examinations include the auricle, the external auditory canal, the tympanic membrane, and the eustachian tube.3.: the subjective audiometry audiology examination: children under 6 years old with pediatric behavioral audiometry, including behavioral observation audiometry, visual reinforcement audiometry and game audiometry; the acoustic immitance determination: including tympanogram and stapedius reflex; the auditory brainstem response (auditorybrainstemresponse, ABR) 40Hz, related potential (or ASSR); the otoacoustic emission (TEOAE and DPOAE); the speech audiometry: speech audiometry for language detection threshold and language recognition threshold; speech recognition tests including verbal test vocabulary and children speech testing List-1 6 hearing; for matching: the need for professional division of hearing hearing aid fitting, generally need to dobinaural, hearing threshold test and speech recognition test selection, and auditory language Short training for 3 to 6 months; the vestibular function examination (vertigo History); the promontory stimulation test: test including threshold, dynamic range and frequency discrimination, discrimination and interval duration discrimination and psychophysical examination.Audiological assessment criteria: the language of deaf patients: pure tone air conduction threshold determination of >80dBHL (0.5, 1, 2, the average value of 4kHz, WHO standard). If a good ear helps to open phrase recognition not up to 30%, and the hearing loss is greater than or equal to 75dB can also consider the use of cochlear [see the U.S. Food and Drug Administration (FoodandDrugAdministration, FDA) of the standard; prelingually deaf patients: for infants need a comprehensive assessment of multiple objective audiometry and behavioral audiometry including: ABR check the acoustic output without auditory reaction (120dBSPL); 40Hz potential detection frequencies above 2kHz maximum sound output when no response frequencies below 1kHz >100dB; multi frequency steady-state frequency audiometry 2kHz response rate 105dBHL; DPOAE the binaural frequency have no reaction; a help the sound field audiometry 2kHz frequency threshold did not enter the auditory language area (banana Figure), speech recognition (word) score less than 70%, that children can not be effectively help from hearing aids; for there is no residual hearing of the patients, such as the promontory with clear auditory response could be considered for cochlear implant surgery. If there is no auditory response to the stimulation of the promontory, the patient or parent should be informed of the situation and bearthe risk of operation.4. imaging evaluation: imaging examination is a critical examination for selecting patients. Routine CT scan of the temporal bone should be performed routinely. If necessary, cranial MRI, three-dimensional reconstruction of the cochlea and the inner ear tract scan should be performed.5. language ability: to have a certain language experience or ability of the patients should do verbal ability assessment (the structure and function of the language), including speech intelligibility, vocabulary, comprehension ability, grammar ability, expression ability and communication ability; for less than 3 years old, uncooperative children, was evaluated by using "parent-child game" video observation method, in order to determine the current status of patients with language ability.Evaluation of 6. psychological, intelligence and learning ability: the lack of language ability of children over the age of 3, the optional learning ability test, those under the age of 3 can choose Grey Faith psychological behavior development scale. The spirit of mental retardation (the learning ability evaluation of suspected <68 IQ points, Grey Faith test spirit development quotient <70) or abnormal psychological behavior, patients should be advised to the authority of the observation, diagnosis and identification of further. The social cultural mental retardation can be considered a cochlear implant; instead of social culture or mental retardation, hyperactivity and autism and other psychiatric patients with mental retardation, should explain to parents of such diseases maybring great difficulties to the rehabilitation of patients, help parents establish objective psychological expectations.SevenPediatric or internal medicine evaluation: a general physical examination and related examinations.8. family conditions and rehabilitation conditions: received professional training or language training teacher regularly guide families can auditory language training for children at home, otherwise it should be sent to schools or institutions with rehabilitation for deaf children.Three, the preparation of auditory language rehabilitationShould the parents of deaf children and teachers, understand the patients after cochlear implantation auditory and language rehabilitation training importance, especially for the prelingually deaf children after rehabilitation training and rehabilitation should be how to prepare for the choice of location. Preoperative rehabilitation training should be aimed at different children's age and level of hearing and speech rehabilitation training features, the content should be defined and established concepts of things patients auditory understanding as the key for the postoperative rehabilitation training and commissioning on good behavior and learning experience psychological preparation.。
