Cochlear Implants in Developing Countries - Vula - University of ...
Cochlear Implants in Developing Countries - Vula - University of ...
Cochlear Implants in Developing Countries - Vula - University of ...
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Establish<strong>in</strong>g a CI Programme <strong>in</strong> aDevelop<strong>in</strong>g CountryAudiologists are key members <strong>of</strong> a unitstart<strong>in</strong>g to do CIs <strong>in</strong> a develop<strong>in</strong>g country.Limited audiological service and <strong>in</strong>sufficientrehabilitative resources are thereforethe greatest challenges. Audiologists (orspecially tra<strong>in</strong>ed hear<strong>in</strong>g health providers)should be well versed with assess<strong>in</strong>ghear<strong>in</strong>g <strong>in</strong> young children as well as <strong>in</strong>severely hear<strong>in</strong>g impaired adults. Detailedknowledge <strong>of</strong> anatomy, physiology, electricalstimulation, CI technology andrehabilitation is required, and the audiologistmust be educated and be familiarwith the specific CI system to be used.Intensive, hands-on tra<strong>in</strong><strong>in</strong>g with regard toprogramm<strong>in</strong>g s<strong>of</strong>tware, <strong>in</strong>tra-operativemonitor<strong>in</strong>g, programm<strong>in</strong>g (MAPp<strong>in</strong>g) andtrouble-shoot<strong>in</strong>g are essential.An ear surgeon with knowledge <strong>of</strong>audiology has to be part <strong>of</strong> the CI teamfrom the beg<strong>in</strong>n<strong>in</strong>g. He/she should befamiliar with middle ear and mastoidsurgery; surgery for CI <strong>in</strong> itself is not verycomplicated and <strong>in</strong> most <strong>in</strong>stances isperformed on ears with normal grossanatomy. Multiple CI courses for surgeonsare available worldwide 5 .The major CI brands are the predom<strong>in</strong>antlyused <strong>in</strong> the develop<strong>in</strong>g world, ma<strong>in</strong>lybecause <strong>of</strong> their extensive experience andthe support and services that the providers<strong>of</strong>fer. There is an ongo<strong>in</strong>g debate as towhether a more affordable CI would bemore appropriate for low-<strong>in</strong>come countriesas it might be <strong>of</strong> lower quality and notas reliable. However, the prices <strong>of</strong> devicesand accessories will have to be reduced tomake CIs accessible to patients <strong>in</strong> thedevelop<strong>in</strong>g world.ConclusionsCIs have been a major advance <strong>in</strong> thetreatment <strong>of</strong> deafness. Despite the remarkableoutcomes <strong>of</strong> CIs <strong>in</strong> adult and paediatricpatients, its availability as well as therequired specialised services rema<strong>in</strong>limited <strong>in</strong> the develop<strong>in</strong>g world.References1. Muller AMU, Wagenfeld DJH.<strong>Cochlear</strong> <strong>Implants</strong> <strong>in</strong> South Africa.ENT News, 2003;12(2):57-622. Sharma A, Dorman MF, Spahr AJ. Asensitive period for the development <strong>of</strong>the central auditory system <strong>in</strong> childrenwith cochlear implants: Implicationsfor age <strong>of</strong> implantation. Ear Hear2002;23(6):532-93. Muller AMU, Wagenfeld DJH.Paediatric cochlear implantation. CME:SA Journal <strong>of</strong> CPD: Community ENT,2003;21(11):628-324. Peters BR, Litovsky R, Park<strong>in</strong>son A,Lake J. Importance <strong>of</strong> age and postimplantationexperience <strong>in</strong> speechperception measures <strong>in</strong> children withsequential bilateral cochlear implants. JOtol Neurotol 2007;28(5):649-575. http://www.entandaudiologynews.com/diary/AuthorTalita le RouxLecturer <strong>in</strong> AudiologyAudiologist: UP <strong>Cochlear</strong> Implant UnitDepartment <strong>of</strong> Communication Pathology<strong>University</strong> <strong>of</strong> PretoriaSouth Africatalita.leroux@up.ac.zaAuthor and EditorClaude Laurent, MD, PhDPr<strong>of</strong>essor <strong>in</strong> ENTENT Unit, Department <strong>of</strong> Cl<strong>in</strong>ical Science<strong>University</strong> <strong>of</strong> UmeåUmeå, Swedenclaude.laurent@ent.umu.se5