Tài liệu Hội thảo Quốc tế về Nội soi và Phẫu thuật nội soi

<span class='text_page_counter'>(1)</span><div class='page_container' data-page=1></div>
<span class='text_page_counter'>(2)</span><div class='page_container' data-page=2>

KIERTIYOS KOMIN, MD

advisory level of ORL

rajavithi hospital

department of medical services

</div>
<span class='text_page_counter'>(3)</span><div class='page_container' data-page=3>

prevalence

patient selection
surgery & devices
rehabilitation

outcomes

key of success

</div>
<span class='text_page_counter'>(4)</span><div class='page_container' data-page=4>

PREVALENCE

3:1000 in new born!

</div>
<span class='text_page_counter'>(5)</span><div class='page_container' data-page=5>

CONGENITAL HEARING LOSS

60% are hereditary !

70% are nonsyndromatic!

</div>
<span class='text_page_counter'>(6)</span><div class='page_container' data-page=6>

ACQUIRED HEARING LOSS

infection!

progressive!

Meniere’ disease!

otosclerosis!

</div>
<span class='text_page_counter'>(7)</span><div class='page_container' data-page=7>

EARLY DETECTION

+

HABILITATION

OAE!

ABR!

ASSR!

BOA!

</div>
<span class='text_page_counter'>(8)</span><div class='page_container' data-page=8>

HEARING AIDS

fit as soon as possible!

can't remove distortion
from speech!

</div>
<span class='text_page_counter'>(9)</span><div class='page_container' data-page=9>

COCHLEAR IMPLANT

the only device to restore
hearing in total deaf

individual!

</div>
<span class='text_page_counter'>(10)</span><div class='page_container' data-page=10>

<i><b>Candidacy criteria</b></i>

<b>1985</b> <b>1990</b> <b>1998</b> <b>2000</b>
<b>Age of implant</b> <b>18 yrs</b> <b>2 yrs</b> <b>18 mo</b> <b>12mo</b>

<b>Onset of SNHL</b> <b>postlinguistic</b>

<b>postlinguistic adults </b>
<b>pre&postlinguistic </b>

<b>children</b>

<b>pre&postlinguistic </b>
<b>adults & children</b>

<b>pre&postlinguistic </b>
<b>adults & children</b>
<b>Degree of SNHL</b> <b>profound</b> <b>profound</b>

</div>
<span class='text_page_counter'>(11)</span><div class='page_container' data-page=11></div>
<span class='text_page_counter'>(12)</span><div class='page_container' data-page=12></div>
<span class='text_page_counter'>(13)</span><div class='page_container' data-page=13></div>
<span class='text_page_counter'>(14)</span><div class='page_container' data-page=14>

LIMITATION OF AUDIOMETRY

speech perception varied markedly for same pure

tone threshold

!

Aided audiogram: more important

!

Speech perception is

Gold Standard

</div>
<span class='text_page_counter'>(15)</span><div class='page_container' data-page=15></div>
<span class='text_page_counter'>(16)</span><div class='page_container' data-page=16>

CANDIDACY ASSESSMENT

Audiological test!

Language assessment!

Social interactive!

Personal drive!

Expectation!

</div>
<span class='text_page_counter'>(17)</span><div class='page_container' data-page=17>

SURGERY & DEVICES

master cochlea anatomy!

master surgical technique!

</div>
<span class='text_page_counter'>(18)</span><div class='page_container' data-page=18>

cochlea anatomy

 

</div>
<span class='text_page_counter'>(19)</span><div class='page_container' data-page=19>

cochleostomy site

 

avoid damage basilar membrane & spiral ligament 

</div>
<span class='text_page_counter'>(20)</span><div class='page_container' data-page=20></div>
<span class='text_page_counter'>(21)</span><div class='page_container' data-page=21>

Finley et al(2008)

</div>
<span class='text_page_counter'>(22)</span><div class='page_container' data-page=22>

electrode placement effects outcome

 

</div>
<span class='text_page_counter'>(23)</span><div class='page_container' data-page=23>

electrode placement effects outcome

 

</div>
<span class='text_page_counter'>(24)</span><div class='page_container' data-page=24>

electrode insertion

 

</div>
<span class='text_page_counter'>(25)</span><div class='page_container' data-page=25>

number of active electrode

effects

outcome

</div>
<span class='text_page_counter'>(26)</span><div class='page_container' data-page=26>

single vs multiple

channel electrode

The only reason why CI succeed was because of

multiple electrode

(

over 400,ooo user

)!

Single channel:do not consider

!

</div>
<span class='text_page_counter'>(27)</span><div class='page_container' data-page=27>

Minimum 4 electrodes required for understand

speech

(Bob Shannon)

!
!
!
!
!
!
!
!

At least 20 separate hearing channel are

required to hear clearly in the present of

</div>
<span class='text_page_counter'>(28)</span><div class='page_container' data-page=28>

AUDIO VERBAL THERAPY

</div>
<span class='text_page_counter'>(29)</span><div class='page_container' data-page=29>

OUTCOMES -CHILDREN

early implant is essential!

speech improvement!

education in conventional
school!

</div>
<span class='text_page_counter'>(30)</span><div class='page_container' data-page=30>

OUTCOMES-ADULT

can understand more
speech!

better in crowd!

some can use telephone!

</div>
<span class='text_page_counter'>(31)</span><div class='page_container' data-page=31></div>
<span class='text_page_counter'>(32)</span><div class='page_container' data-page=32>

KEY OF SUCCESS

patient selection!

surgery & device!

</div>
<span class='text_page_counter'>(33)</span><div class='page_container' data-page=33>

LIFE LONG COMMITMENT

physician!

multi disciplinary team!

</div>
<span class='text_page_counter'>(34)</span><div class='page_container' data-page=34></div>

<!--links-->