{"id":20575,"date":"2022-07-04T08:00:33","date_gmt":"2022-07-04T06:00:33","guid":{"rendered":"https:\/\/lifelonghearing.com\/?p=20575"},"modified":"2025-05-14T08:09:46","modified_gmt":"2025-05-14T08:09:46","slug":"slusni-aparat-ili-slusni-implant","status":"publish","type":"post","link":"https:\/\/lifelonghearing.com\/bs\/slusni-aparat-ili-slusni-implant\/","title":{"rendered":"Slu\u0161ni aparat ili slu\u0161ni implant?"},"content":{"rendered":"

Kada su slu\u0161ni implantati bolje rje\u0161enje od slu\u0161nih aparata?<\/h1><\/div>

Rezultati sa slu\u0161nim implantatima i sa konvencionalnim slu\u0161nim aparatima se stalno pobolj\u0161avaju, a granice upotrebe ovih razli\u010ditih sistema se stalno mijenjaju.<\/strong><\/p>\n<\/div>

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“Otprilike 19 posto populacije pati od gubitka sluha koji zahtijeva lije\u010denje,” obja\u0161njava dr. Thomas Keintzel, primarni ljekar ORL odjela na klinici Wels-Grieskirchen. “Lije\u010denje slu\u0161nim aparatima je ovdje jo\u0161 uvijek zlatni standard.” Standardni slu\u0161ni aparati poja\u010davaju zvuk – ovisno o visini i ja\u010dini zvuka – tako da ga korisnik mo\u017ee bolje percipirati. Ali, korisnici ne bi trebali stati na tome: “Pored podr\u0161ke za ure\u0111aje, trening je bitan faktor uspjeha.”<\/p>\n

Me\u0111utim, postoje neka medicinska stanja koja ote\u017eavaju ili onemogu\u0107uju uspje\u0161nu upotrebu konvencionalnih slu\u0161nih pomagala<\/a>. To su na primjer, su\u017een ili vi\u0161e puta inficiran u\u0161ni kanal, oko\u0161tavanja u srednjem uhu ili gubitak kostiju srednjeg uha. U nekim slu\u010dajevima mo\u017ee pomo\u0107i i operacija, ali 75 posto svih problema zahtijeva podr\u0161ku slu\u0161nog ure\u0111aja, navodi prim. Keintzel. \u201eMe\u0111utim, upotreba ko\u0161tane provodljivosti i aktivnih implantata srednjeg uha pokazala se kao vrijedna alternativa konvencionalnoj ugradnji slu\u0161nog aparata.”<\/p>\n

Kada samo poja\u010danje zvuka nije dovoljno<\/h2>\n

Sa audioolo\u0161ke ta\u010dke gledi\u0161ta, konvencionalni slu\u0161ni aparati dosti\u017eu svoje granice kada je unutra\u0161nje uho ozbiljno o\u0161te\u0107eno. Osim pretvaranja zvu\u010dnih vibracija u nervne signale, unutra\u0161nje uho ima funkciju koja slu\u017ei kao “predpoja\u010danje” zvuka. Ovo se naziva kompresija unutra\u0161njeg uha. U slu\u010daju sensineuralnog gubitka sluha, ova sposobnost se progresivno gubi. Zato slu\u0161ni aparati moraju vi\u0161e da poja\u010davaju tihe zvukove od onih glasnih.<\/p>\n

Ovaj gubitak kompresije uha o\u0161te\u0107enog sluha uzrokuje “dinami\u010dku redukciju”. Razlika izme\u0111u najti\u0161eg zvuka (koji se jedva mo\u017ee \u010duti) i najglasnijeg zvuka (prag bola) postaje manja. Kao rezultat toga, gubi se i kontrast izme\u0111u razli\u010ditih akusti\u010dnih signala. Korisnik i dalje mo\u017ee \u010duti sve s funkcijom poja\u010danja zvuka, ali odre\u0111eni zvukovi, razumijevanje govora i razgovori postaju sve vi\u0161e iscrpljuju\u0107i unato\u010d slu\u0161nom aparatu.<\/p>\n

O\u0161te\u0107eno uvo tako\u0111e do\u017eivljava promene u vremenskoj rezoluciji (tzv. “auditivno maskiranje”), \u0161to se de\u0161ava kada preovla\u0111uju\u0107i zvuk prikriva onaj slabiji. Sve ovo zajedno zna\u010di da od oko 50 decibela gubitka sluha, govor u glasnom okru\u017eenju postaje sve manje razumljiv, \u010dak i sa slu\u0161nim aparatima.[1]<\/a><\/p>\n

Moderne tehnologije u konvencionalnim slu\u0161nim aparatima poma\u017eu<\/h2>\n

Konvencionalni slu\u0161ni aparati uz pomo\u0107 razli\u010ditih trikova pobolj\u0161avaju akusti\u010dni kontrast, a fokus je uvijek na razumijevanju govora. Frekvencijski filteri se koriste za prigu\u0161ivanje tonova koji nisu neophodni za razumijevanje govora ili potencijalno sadr\u017ee mnogo pozadinske buke. Funkcija smanjenja buke (“noise cancelling”) ispituje svaki segment visine govornog signala i u skladu s tim ga poja\u010dava ili uti\u0161ava. Usmjereni mikrofonski sistemi obra\u0111uju zvukove iz pretpostavljenog smjera odakle zvuk dolazi. Sve ove funkcije su tako\u0111er integrirane u audio procesore slu\u0161nih implantata.<\/p>\n

Tehnologije za pobolj\u0161anje govora koje se stalno razvijaju omogu\u0107avaju \u010dak i korisnicima s te\u0161ko o\u0161te\u0107enom funkcijom unutra\u0161njeg uha da razumiju govor pomo\u0107u svojih slu\u0161nih aparata. U nekom trenutku, \u010dak i trenutni vrhunski slu\u0161ni aparati dosti\u017eu svoje granice. Prim. Keinzel ima savjet za pacijente koji vi\u0161e ne osje\u0107aju pobolj\u0161anje: “U tom slu\u010daju, direktna elektri\u010dna stimulacija kroz kohlearni implantat mo\u017ee se koristiti za bolje razumijevanja govora.”<\/p>\n

Razumijevanje govora je klju\u010dno!<\/h2>\n

\u201eUz dalji razvoj slu\u0161nih aparata i slu\u0161nih implantata, pomjerile su se i granice indikacije\u201c, opisuje prim. Keintzel. Ako su razumijevanje govora i komunikacija dobri, a dobar kvalitet \u017eivota mogu\u0107 i uz slu\u0161ne aparate, malo je opravdanja za CI operaciju. Osim toga, slu\u0161anje sa slu\u0161nim implantom (ili CI) zahtijeva fazu vje\u017ebanja: centralni slu\u0161ni sistem mora nau\u010diti da obradi ove tehni\u010dki prikupljene signale.<\/p>\n

“Bitan kriterij za odluku mo\u017ee biti razumijevanje govora sa slu\u0161nim aparatom.” Op\u0107enito, ako je razumijevanje govora sa slu\u0161nim pomagalima lo\u0161ije nego \u0161to bi se o\u010dekivalo sa CI, preporu\u010duje se implantacija. Me\u0111utim, prvo morate biti sigurni da je slu\u0161ni aparat optimalno postavljen i prikladan izbor za korisnika.<\/p>\n

Ako CI korisnik i dalje koristi slu\u0161ni aparat na drugom uhu, doktor \u0107e savjetovati implantaciju i na drugoj strani, u slu\u010daju da slu\u0161ni aparat ne dovede do pobolj\u0161anja razumijevanja govora.<\/p>\n

Kod djece, razvoj sluha i jezika je odlu\u010duju\u0107i faktor. \u201eU slu\u010daju djece ro\u0111ene gluhe ili djece koja su oglu\u0161ila prije usvajanja jezika, ova odluka mora uzeti u obzir mnoge faktore, kao \u0161to su stupanj razvoja djeteta, komunikacijske kompetencije itd.\u201c nagla\u0161ava prim.Keintzel. \u201eZa djecu ro\u0111enu s o\u0161te\u0107enjem sluha na jednoj strani, roditelji bi trebali poznavati ograni\u010denja jednostranog sluha \u2013 smanjeno razumijevanje govora u glasnom okru\u017eenju i nemogu\u0107nost lokalizacije zvuka. Sve to se de\u0161ava u osjetljivoj fazi usvajanja jezika.”<\/p>\n

\u0160ta o\u010dekivati \u200b\u200bod kohlearnog implanta<\/h2>\n

CI zaobilazi defekte u unutra\u0161njem uhu i direktno stimuli\u0161e neuralnu strukturu organa sluha. Centar za sluh mora nau\u010diti interpretirati ove umjetne signale, zbog \u010dega je korisniku potreban period rehabilitacije i vje\u017ebe. Na austrijskom ORL kongresu 2021. godine, Prim.Keintzel je pokazao uspjeh kohlearne implantacije. [2]<\/a> Jednu godinu nakon aktivacije CI, tri \u010detvrtine svih korisnika razumije jednako dobro kao i osobe o\u0161te\u0107enog sluha sa gubitkom sluha od 50 decibela. \u201eDakle, smanjenje razumijevanja govora koji se mo\u017ee o\u010dekivati \u200b\u200bod ugradnje kohlearnog implantata nije ve\u0107e nego kod umjerenog gubitka sluha\u201c, \u0161to je rezultat i kod osoba koje su prethodno bile potpuno gluve.<\/p>\n

Na istom kongresu, prof. dr. Ulrich Hoppe, vi\u0161i ljekar u ORL Univerzitetskoj bolnici u Erlangenu, uporedio je razumijevanje govora izme\u0111u CI i korisnika slu\u0161nih pomagala. Ve\u0107ina CI korisnika razumije govor u bu\u010dnim okru\u017eenjima isto kao i pacijenti sa o\u0161te\u0107enjem sluha od 25 do 50 decibela sa svojim slu\u0161nim aparatima. Dakle, svi korisnici CI bolje razumiju od tipi\u010dnih korisnika slu\u0161nih pomagala s gubitkom sluha od 65 decibela.<\/p>\n

Za CI kandidate va\u017eno je da pa\u017eljivo razmisle, ali i da brzo donesu odluku. Iskusni ORL specijalista Keintzel obja\u0161njava za\u0161to: “Rana kohlearna implantacija zahtjeva kra\u0107e vreme rehabilitacije i povezana je s boljim rezultatima i zna\u010dajnim pobolj\u0161anjem kvalitete \u017eivota.”<\/p>\n

Dodatne informacije i detaljne o ovoj temi u: Keintzel T, Limits of conventional hearing aid provision, Jatros Pneumologie & HNO, Universimed-Verlag, 01\/2022, pp34-36.<\/em><\/p>\n

\n

[1]<\/a> Wardegna et al, 2015<\/p>\n

[2]<\/a> Daten nach Reichell 2015, aus: Kie\u00dfling et al; Versorgung mit H\u00f6rger\u00e4ten und H\u00f6rimplantaten; Thieme-Verlag 2018; ISBN 978-3-13-240200-3<\/p>\n<\/div><\/div><\/div><\/div><\/div>\n","protected":false},"excerpt":{"rendered":"

Rezultati sa slu\u0161nim implantatima i sa konvencionalnim slu\u0161nim aparatima se stalno pobolj\u0161avaju, a granice upotrebe ovih razli\u010ditih sistema se stalno mijenjaju.<\/p>\n","protected":false},"author":4,"featured_media":31917,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[418],"tags":[417,721,579],"class_list":["post-20575","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-science","tag-ci","tag-kohlearni-implant-i-slusni-aparat","tag-slusni-implantati"],"yoast_head":"\nSlu\u0161ni aparat ili slu\u0161ni implant? - Bosnian<\/title>\n<meta name=\"description\" content=\"Dostignu\u0107a i uspjesi sa slu\u0161nim aparatima i slu\u0161nim implantatima se stalno mijenjaju. 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