Early active treatment of acute and chronic suppurative otitis media and secretory otitis media is an important measure to prevent conductive deafness. Tympanoplasty has a certain effect on improving hearing of conductive deafness. The application of total artificial ossicles and partial artificial ossicles obviously improved the hearing effect of tympanoplasty for conductive deafness. With the development of artificial hearing implantation technology, the application of implantable hearing AIDS, bone anchor hearing AIDS and vibrating sound bridge in recent years has opened up new treatment options for conductive deafness and mixed deafness.
Bone anchor hearing aid is an implantable bone conduction hearing system, which is suitable for conductive or mixed hearing impairment and unilateral deafness. The bone anchor hearing aid adopts the form of direct bone conduction. This method is different from the traditional air conduction and bone conduction hearing AIDS in many aspects. When a tiny titanium implant is fixed on the bone behind the ear, it will fuse with human bone. It takes about three months for adults to form bone fusion, and six months for children. Once the bone fusion is formed, a bridge can be fixed on the titanium implant, and then the speech processor can be clamped on it. When the voice processor detects the sound, it will transmit the sound directly to the inner ear through the bone. This process bypasses the outer ear and the middle ear.
Vibrating acoustic bridge is a kind of middle ear implant device, which is more widely used than other hearing AIDS. It is mainly suitable for adults and children with moderate and severe sensorineural deafness, conductive deafness and mixed deafness. Vibrating sound bridge is different from hearing aid, which simply amplifies sound, while vibrating sound bridge converts sound into mechanical vibration; Vibration acoustic bridge is also different from cochlear implant. It sends out electrical signals to stimulate nerve fibers, while vibration acoustic bridge produces mechanical vibration, which is transmitted to middle ear structure or directly to inner ear.
The language and other sound signals heard through the vibrating sound bridge are clear and sound quality is good. In a complex listening environment, people can communicate without barriers if there is a large background noise. You can also hear sounds with a slightly higher frequency, such as children's voices and violin playing. At the same time, after the vibration bridge is implanted, the external auditory canal of the patient is completely open, eliminating the blocking feeling and other discomfort caused by the closed auditory canal; It's also very comfortable and beautiful to wear. [7]
2. Treatment of sensorineural deafness and central deafness
For sensorineural deafness, the emphasis is on prevention, early detection and treatment. At present, the genetic diagnosis of deafness and newborn hearing screening in China have greatly improved the incidence of sensorineural deafness.
(1) Actively prevent and treat deafness caused by acute infectious diseases, do a good job in the prevention, isolation and treatment of infectious diseases, and enhance the resistance of the body (especially children).
(2) For the use of ototoxic drugs, the indications should be strictly controlled, and if there is poisoning, the drug should be stopped immediately, and vitamins and vasodilators should be used.
(3) According to the different causes and stages of the disease, different drugs can be used for comprehensive treatment, such as drugs to enhance neurotrophic and improve cochlear microcirculation, various vasodilators, biological products to promote metabolism, etc.
(4) With the development of electronic technology, computer technology, biomaterial science and biomedical engineering technology, since the end of last century, cochlear implants, vibrating acoustic bridges and bone-anchored hearing AIDS have been applied in clinic abroad. Cochlear implant is suitable for patients with severe to extremely severe sensorineural deafness; Cochlear implant is the only medical device that can restore hearing for deaf patients. Vibrating acoustic bridge and bone anchor hearing AIDS are suitable for patients with moderate and severe sensorineural deafness, conductive deafness and mixed deafness. The above-mentioned three types of implantable hearing devices cover almost all kinds of hearing recovery treatments for patients with different degrees of hearing loss, so that deaf patients with different degrees, even deaf patients, can recover to near normal hearing, so that deaf patients can enter normal schools and even communicate by telephone.
Cochlear implant requires patients to have enough auditory nerve residues, and stimulation electrodes will be inserted into the cochlea. If the patient does not have the acoustic nerve, such as the patient after acoustic neuroma resection, the cochlear implant cannot be accepted. Auditory brainstem implantation can put the stimulation electrode on the patient's brainstem (cochlear nucleus), and the patient can still restore hearing. This technology has matured abroad, and there is no successful case report in China. Indications include bilateral acoustic neuroma, cochlear ossification, internal auditory canal stenosis and auditory nerve hypoplasia. These patients can recover their hearing after auditory brainstem implantation. It is reported that the speech perception ability of patients with auditory brainstem implantation is worse than that of patients with cochlear implant. [8]
refer to
1. Huang, Wang Jibao, edited by Kong. Practical otorhinolaryngology head and neck surgery. Beijing: People's Health Publishing House, 2007: 1005 ~ 1009.
2. Depp, Yu Fei and Kang Dongyang. Diagnostic methods and clinical application of mitochondrial DNA 1555 locus, GJB2 gene and SLC26A4 gene. Chinese journal of otorhinolaryngology head and neck surgery, 2005: 40, 769 ~ 773.
3. Sun Baochun, Depp. Classification of inner ear malformation in sensorineural deafness and its relationship with SLC26A4 and GJB2 genes. PLA Military Medical College of Continuing Education (doctoral thesis), 20 1 1: 05.
4.JacklerRK，LuxforWM，HouseWF。 Congenital malformation of inner ear: classification Basic embryonic development: laryngoscope,1987: 97 (Suppl 40): 2 ~14.
5. Han Demin. Clinical audiology: Journal of Audiology and Speech Pathology, 2007: 15, 1 ~ 3.
6. Zhai suoqiang. Clinical audiological characteristics of deafness: Chinese Journal of Otology, 20 1 1: 236 ~ 240.
7. Zhao Vibrating acoustic bridge implantation: Journal of Audiology and Speech Pathology, 20 1 1: 19, 394 ~ 395.
Wang Liang, Zhang Daoxing and Dong Mingmin. Clinical application of auditory brainstem implantation: Department of Otolaryngology, China Medical Abstracts, 2004: 145 ~ 148.