Otec popisuje, jak vybral kochle\u00e1rn\u00ed implant\u00e1t pro svou dceru<\/h1><\/div>Dr. Christian Schmidt MBA, otec d\u00edt\u011bte s kochle\u00e1rn\u00edm implant\u00e1tem, popisuje, kter\u00e9 faktory byly pro n\u011bj a jeho \u017eenu rozhoduj\u00edc\u00ed p\u0159i v\u00fdb\u011bru syst\u00e9mu CI pro jejich dceru.<\/strong><\/p>\n<\/div>![](\"https:\/\/lifelonghearing.com\/cs\/wp-content\/uploads\/sites\/8\/2022\/11\/serialoderparallel_featured-1200x559-1.jpg\" "\\"serialoderparallel_featured-1200×559\\"")
<\/span><\/div><\/div><\/div><\/div><\/div>\u201eCo pr\u00e1v\u011b \u0159ekl l\u00e9ka\u0159? Jak\u00fd implant\u00e1t doporu\u010dil? Co myslel t\u00edm, \u017ee paraleln\u00ed a s\u00e9riov\u00fd implant\u00e1t jsou stejn\u00e9? Pro\u010d si neud\u011bl\u00e1 v\u00edce \u010dasu, aby n\u00e1m to podrobn\u011b vysv\u011btlil?\u201c Kdy\u017e jsme na\u0161\u00ed dce\u0159i sd\u011blili diagn\u00f3zu ztr\u00e1ty sluchu, vydali jsme se na klikatou cestu d\u017eungl\u00ed zcela nov\u00fdch informac\u00ed a museli jsme naj\u00edt cestu ven.<\/p>\n
Nejprve chci \u0159\u00edci, \u017ee n\u00e1s spole\u010dnost MED-EL p\u0159esv\u011bd\u010dila sv\u00fdmi kochle\u00e1rn\u00edmi implant\u00e1ty. Tyto implant\u00e1ty maj\u00ed 24 dvojit\u00fdch kontakt\u016f ve 12 r\u016fzn\u00fdch pod\u00e9ln\u00fdch poloh\u00e1ch a samostatn\u00fd zdroj energie pro ka\u017ed\u00fd z t\u011bchto kontakt\u016f. Proto\u017ee jsou zdroje nap\u00e1jen\u00ed nez\u00e1visl\u00e9, znamen\u00e1 to, \u017ee lze zpracov\u00e1vat jak s\u00e9riov\u00e9, tak paraleln\u00ed k\u00f3dov\u00e1n\u00ed. Douf\u00e1me, \u017ee v\u00fdzkum v budoucnu p\u0159inese st\u00e1le dokonalej\u0161\u00ed stimula\u010dn\u00ed strategie \u2013 implant\u00e1t na\u0161\u00ed dcery je ka\u017edop\u00e1dn\u011b otev\u0159en\u00fd ob\u011bma syst\u00e9mov\u00fdm p\u0159\u00edstup\u016fm.<\/p>\n
Co znamen\u00e1 s\u00e9riov\u00e9 nebo paraleln\u00ed?<\/h2>\n
Pojmy \u201es\u00e9riov\u00fd\u201c a \u201eparaleln\u00ed\u201c jsou zn\u00e1m\u00e9 z oblasti po\u010d\u00edta\u010d\u016f. Tok proudu, kter\u00fd p\u0159en\u00e1\u0161\u00ed data a informace, m\u016f\u017ee prob\u00edhat bu\u010f s\u00e9riov\u011b, jeden po druh\u00e9m p\u0159es jeden kontakt, nebo sou\u010dasn\u011b paraleln\u011b p\u0159es n\u011bkolik kontakt\u016f. Druh\u00fd zp\u016fsob m\u016f\u017ee p\u0159enos informac\u00ed urychlit: v\u00edce informac\u00ed za krat\u0161\u00ed dobu. V souvislosti s kochle\u00e1rn\u00edmi implant\u00e1ty (zkr\u00e1cen\u011b CI) se s\u00e9riov\u00fd a paraleln\u00ed tok proudu vztahuje tak\u00e9 na zp\u016fsob, jak\u00fdm drobn\u00e9 proudov\u00e9 impulsy stimuluj\u00ed nervov\u00e1 vl\u00e1kna ve vnit\u0159n\u00edm uchu neboli hlem\u00fd\u017edi.<\/p>\n
Syst\u00e9m CI se skl\u00e1d\u00e1 z implant\u00e1tu, kter\u00fd nen\u00ed vid\u011bt, a zvukov\u00e9ho procesoru, kter\u00fd se nos\u00ed zevn\u011b. Zvukov\u00fd procesor m\u016f\u017ee b\u00fdt bu\u010f jednojednotkov\u00fd procesor ve tvaru ploch\u00e9ho disku, nebo procesor za uchem (BTE), kter\u00fd vypad\u00e1 t\u00e9m\u011b\u0159 jako b\u011b\u017en\u00e9 naslouch\u00e1tko. Procesor sn\u00edm\u00e1 zvukov\u00e9 vlny pomoc\u00ed mikrofonu, pot\u00e9 tyto analogov\u00e9 informace digit\u00e1ln\u011b zpracov\u00e1v\u00e1 a prost\u0159ednictv\u00edm c\u00edvky je p\u0159en\u00e1\u0161\u00ed do implant\u00e1tu. Implant\u00e1t p\u0159iprav\u00ed sign\u00e1ly pro kontakty elektrod, odkud jsou v podob\u011b mal\u00fdch elektrick\u00fdch pulz\u016f p\u0159ivedeny do vnit\u0159n\u00edho ucha.<\/p>\n
V z\u00e1vislosti na v\u00fdrobci je k soustav\u011b elektrod, \u201eelektrodov\u00e9mu kabelu\u201c, kter\u00fd vede z implant\u00e1tu do hlem\u00fd\u017ed\u011b ve vnit\u0159n\u00edm uchu, p\u0159ipojeno 16 a\u017e 24 elektrodov\u00fdch kontakt\u016f. Tato elektroda se obvykle zav\u00e1d\u00ed tzv. kulat\u00fdm ok\u00e9nkem do scala tympani, bub\u00ednkov\u00e9ho kan\u00e1lku hlem\u00fd\u017ed\u011b. Vedle scala tympani se nach\u00e1z\u00ed Cortiho org\u00e1n, vlastn\u00ed sluchov\u00fd org\u00e1n. Ve zdrav\u00e9m uchu Cortiho org\u00e1n z\u00e1sobuje sluchov\u00fd nerv podn\u011bty. U CI jsou tyto podn\u011bty nahrazeny drobn\u00fdmi proudov\u00fdmi impulzy z elektrody implant\u00e1tu. U b\u011b\u017en\u00fdch CI se to d\u011bje s\u00e9riov\u011b, jeden puls za druh\u00fdm, ale u nejnov\u011bj\u0161\u00edch CI technologi\u00ed je vys\u00edl\u00e1no n\u011bkolik puls\u016f paraleln\u011b.<\/p>\n
Elektroda: srovn\u00e1n\u00ed r\u016fzn\u00fdch v\u00fdrobc\u016f<\/h2>\n
Rakousk\u00fd v\u00fdrobce CI MED-EL pou\u017e\u00edv\u00e1 podle sv\u00e9 bro\u017eury 24 elektrodov\u00fdch kontakt\u016f, co\u017e je o dva v\u00edce ne\u017e australsk\u00fd Cochlear. P\u0159esn\u011b \u0159e\u010deno, implant\u00e1ty MED-EL maj\u00ed 24 kontakt\u016f na 12 r\u016fzn\u00fdch pozic\u00edch pod\u00e9l p\u0159ibli\u017en\u011b 31 milimetr\u016f dlouh\u00e9ho elektrodov\u00e9ho pole. Tyto kontakty se ozna\u010duj\u00ed jako dvojit\u00e9 kontakty, ka\u017ed\u00fd s vlastn\u00edm nap\u00e1jec\u00edm vodi\u010dem. Naproti tomu Cochlear m\u00e1 22 kontakt\u016f v r\u016fzn\u00fdch pozic\u00edch, ale ne v\u0161echny jsou pou\u017eity v r\u00e1mci jednoho stimula\u010dn\u00edho sezen\u00ed.<\/p>\n
R\u016fzn\u00fdmi testy bylo zji\u0161t\u011bno, \u017ee optim\u00e1ln\u00ed vzd\u00e1lenost mezi jednotliv\u00fdmi stimula\u010dn\u00edmi body zaji\u0161\u0165uje p\u0159ibli\u017en\u011b 12 kontakt\u016f. Z fyzik\u00e1ln\u00edch d\u016fvod\u016f m\u016f\u017ee ka\u017ed\u00fd proudov\u00fd impuls, bez ohledu na to, jak mal\u00fd je, podl\u00e9hat ur\u010dit\u00e9mu rozptylu. V\u00fdsledn\u00e9 \u201eproudov\u00e9 pole\u201c stimuluje nejen v p\u0159esn\u00e9m m\u00edst\u011b kontaktu, ale stimuluje hlem\u00fd\u017e\u010f i \u0161\u00ed\u0159eji. Proto v\u00edce ne\u017e 12 elektrodov\u00fdch kontakt\u016f nem\u016f\u017ee p\u0159in\u00e9st \u017e\u00e1dn\u00e9 v\u00fdznamn\u00e9 zlep\u0161en\u00ed.<\/p>\n
Kolik zvuk\u016f mohu sly\u0161et?<\/h2>\n
Po srolov\u00e1n\u00ed je bub\u00ednkov\u00fd kan\u00e1l, ve kter\u00e9m le\u017e\u00ed CI elektroda, dlouh\u00fd p\u0159ibli\u017en\u011b 31 mm. Zdrav\u00e9 vnit\u0159n\u00ed ucho m\u00e1 v Cortiho org\u00e1nu asi 30 000 vl\u00e1skov\u00fdch bun\u011bk, kter\u00e9 jsou zodpov\u011bdn\u00e9 za generov\u00e1n\u00ed nervov\u00fdch impuls\u016f p\u0159i sly\u0161en\u00ed. P\u0159i CI je k dispozici maxim\u00e1ln\u011b 24 elektrod na d\u00e9lce n\u011bkdy men\u0161\u00ed ne\u017e 31 milimetr\u016f. Ve srovn\u00e1n\u00ed s 30 000 se to m\u016f\u017ee zd\u00e1t nedostate\u010dn\u00e9.<\/p>\n
S 30 000 vl\u00e1skov\u00fdmi bu\u0148kami dok\u00e1\u017ee zdrav\u00e9 ucho rozli\u0161it v\u00edce ne\u017e tis\u00edc t\u00f3n\u016f. S CI v\u00edce ne\u017e 100. Podle p\u0159\u00edslu\u0161n\u00fdch marketingov\u00fdch prospekt\u016f v\u0161ak lze s CI sly\u0161et \u201ev\u00edce\u201c pomoc\u00ed takzvan\u00fdch \u201evirtu\u00e1ln\u00edch kontakt\u016f\u201c, kter\u00e9 se vytv\u00e1\u0159ej\u00ed pomoc\u00ed s\u00e9riov\u00e9 nebo paraleln\u00ed technologie.<\/p>\n
\u00a0V\u00edce v\u00fd\u0161ek d\u00edky virtu\u00e1ln\u00edm elektrod\u00e1m<\/h2>\n
Odborn\u00edci hovo\u0159\u00ed o virtu\u00e1ln\u00ed elektrod\u011b tehdy, kdy\u017e fyzicky neexistuje jako elektrodov\u00fd kontakt. Vytv\u00e1\u0159\u00ed se superpozic\u00ed elektrick\u00fdch pol\u00ed dvou sousedn\u00edch kontakt\u016f.<\/p>\n
Pod\u00edvejme se nap\u0159\u00edklad na dva sousedn\u00ed kontakty A a B: pokud je do bodu A p\u0159iveden \u201eelektrick\u00fd proud\u201c, dojde ke stimulaci nervov\u00fdch vl\u00e1ken (nebo gangliov\u00fdch bun\u011bk) v oblasti kontaktu a ozve se p\u0159\u00edslu\u0161n\u00fd t\u00f3n. Pokud je m\u00edsto toho stimulov\u00e1n bod B, bude stimulov\u00e1na oblast v okol\u00ed tohoto kontaktu a bude sly\u0161et odpov\u00eddaj\u00edc\u00ed t\u00f3n. Pokud v\u0161ak aktivujeme oba kontakty sou\u010dasn\u011b, elektrick\u00e9 pole obou kontakt\u016f se bude p\u0159ekr\u00fdvat. P\u0159i stejn\u00e9m rozlo\u017een\u00ed mezi poli vznikne maximum pole p\u0159ibli\u017en\u011b uprost\u0159ed mezi ob\u011bma kontakty. S ohledem na nervovou stimulaci se vytvo\u0159\u00ed tzv. virtu\u00e1ln\u00ed elektroda. Pokud je jeden kontakt stimulov\u00e1n v\u00edce ne\u017e druh\u00fd, pak se maximum posune ve sm\u011bru tohoto kontaktu. Op\u011bt se tak vytvo\u0159\u00ed nov\u00e1 virtu\u00e1ln\u00ed elektroda nebo nov\u00fd t\u00f3n.<\/p>\n
Tento princip nelze odstup\u0148ovat tak, jako u p\u0159irozen\u00e9ho sluchu. Pokud v\u0161ak r\u016fzn\u011b zkombinujete r\u016fzn\u00e9 s\u00edly impuls\u016f na re\u00e1ln\u00fdch kan\u00e1lech, m\u016f\u017eete mezi dv\u011bma kontakty odvodit n\u011bkolik virtu\u00e1ln\u00edch elektrod a vytvo\u0159it nov\u00e9 sly\u0161iteln\u00e9 t\u00f3ny.<\/p>\n
Virtu\u00e1ln\u00ed kan\u00e1ly \u2013 s\u00e9riov\u00e9 nebo paraleln\u00ed<\/h2>\n
P\u0159i paraleln\u00ed stimulaci je proud p\u0159iv\u00e1d\u011bn sou\u010dasn\u011b na dva sousedn\u00ed kontakty. Pro skute\u010dn\u00e9 elektrick\u00e9 spojen\u00ed mus\u00ed existovat odpov\u00eddaj\u00edc\u00ed velk\u00fd po\u010det zdroj\u016f proudu.<\/p>\n
P\u0159i s\u00e9riov\u00e9 stimulaci se syst\u00e9m virtu\u00e1ln\u00edch elektrod dosahuje stimulac\u00ed sousedn\u00edch kontakt\u016f postupn\u011b \u2013 jeden po druh\u00e9m. Pot\u00e9 se simuluje t\u00f3n pomoc\u00ed dvojit\u00e9ho impulzu. Na sousedn\u00edch kontaktech dojde ke dv\u011bma pulz\u016fm v rychl\u00e9m sledu, kter\u00e9 jsou od sebe vzd\u00e1leny v \u0159\u00e1du mikrosekund.<\/p>\n
Tento efekt si m\u016f\u017eete p\u0159edstavit jako podobn\u00fd star\u00fdm film\u016fm nebo flipbook\u016fm, kdy na\u0161e oko vn\u00edm\u00e1 rychle po sob\u011b jdouc\u00ed obr\u00e1zky jako jeden pohybliv\u00fd obraz.<\/p>\n
Kolik kan\u00e1l\u016f pot\u0159ebujeme ke sly\u0161en\u00ed?<\/h2>\n
Metoda sekven\u010dn\u00ed stimulace pro CI zahrnuje superpozici pol\u00ed v rychl\u00e9m sledu za sebou. Proud je nejprve p\u0159iveden do kontaktu A, kter\u00fd je pot\u00e9 op\u011bt vypnut. Ihned pot\u00e9 se aplikuje stimulace na kontakt B. T\u00edmto zp\u016fsobem se uprost\u0159ed dvou fyzicky existuj\u00edc\u00edch kontakt\u016f vytvo\u0159\u00ed maximum pole, kter\u00e9 n\u00e1sledn\u011b vytvo\u0159\u00ed virtu\u00e1ln\u00ed elektrodu \u2013 pouze s m\u00edrn\u00fdm \u010dasov\u00fdm zpo\u017ed\u011bn\u00edm.<\/p>\n
Rozs\u00e1hl\u00e9 studie proveden\u00e9 na dosp\u011bl\u00fdch u\u017eivatel\u00edch CI uk\u00e1zaly, \u017ee s\u00e9riov\u00fdm zp\u016fsobem lze vn\u00edmat 127 a\u017e 161 r\u016fzn\u00fdch t\u00f3n\u016f. P\u0159i paraleln\u00edm p\u0159\u00edstupu z\u00e1vis\u00ed po\u010det v\u00fd\u0161ek na po\u010dtu mo\u017en\u00fdch kontaktn\u00edch p\u00e1r\u016f a po\u010dtu \u00farovn\u00ed v\u00fd\u0161ek proudu a po\u010dtu \u00farovn\u00ed v\u00fd\u0161ek proudu. V\u00fdzkum prok\u00e1zal a\u017e 460 v\u00fd\u0161ek: v praxi byla v z\u00e1vislosti na strategii k\u00f3dov\u00e1n\u00ed potvrzena hodnota a\u017e 250 v\u00fd\u0161ek.<\/p>\n
P\u0159\u00ednosy paraleln\u00ed stimulace a dal\u0161\u00ed rozhodovac\u00ed krit\u00e9ria<\/h2>\n
Syst\u00e9my CI s paraleln\u00ed stimulac\u00ed umo\u017e\u0148uj\u00ed v\u00edce a soub\u011b\u017en\u00fdch \u201evirtu\u00e1ln\u00edch kan\u00e1l\u016f\u201c. Umo\u017e\u0148uj\u00ed tak\u00e9 k\u00f3dov\u00e1n\u00ed, kter\u00e9 vyu\u017e\u00edv\u00e1 paraleln\u00ed syst\u00e9m v n\u00edzk\u00e9m a\u017e st\u0159edn\u00edm p\u00e1smu a spol\u00e9h\u00e1 na s\u00e9riov\u00fd syst\u00e9m ve vysokofrekven\u010dn\u00edm p\u00e1smu. To umo\u017e\u0148uje napodobit p\u0159irozen\u00fd sluch. Paraleln\u00ed zdroje proudu tak\u00e9 zvy\u0161uj\u00ed spolehlivost syst\u00e9mu a jeho bezpe\u010dnost. Podle m\u00e9ho n\u00e1zoru je mo\u017enost paraleln\u00ed stimulace nejd\u016fle\u017eit\u011bj\u0161\u00edm rozli\u0161ovac\u00edm znakem mezi r\u016fzn\u00fdmi kochle\u00e1rn\u00edmi implant\u00e1ty.<\/p>\n
Druh\u00fdm d\u016fle\u017eit\u00fdm faktorem pro m\u00e9 rozhodov\u00e1n\u00ed byl charakter a d\u00e9lka elektrody. Tato d\u00e9lka je tak\u00e9 odpov\u011bd\u00ed na ot\u00e1zku: \u201ePro\u010d n\u011bkte\u0159\u00ed u\u017eivatel\u00e9 CI sly\u0161\u00ed hlasy jako kdyby mluvil Mickey Mouse, zat\u00edmco jin\u00ed sly\u0161\u00ed relativn\u011b jasn\u011b?\u201c Samoz\u0159ejm\u011b existuj\u00ed i r\u016fzn\u00e9 dal\u0161\u00ed mo\u017en\u00e9 faktory pro rozhodov\u00e1n\u00ed, ale ty jsou a\u017e na konci m\u00e9ho osobn\u00edho \u017eeb\u0159\u00ed\u010dku, nap\u0159\u00edklad funkce jako p\u0159ipojen\u00ed Bluetooth nebo aplikace pro iPhone.<\/p>\n
Jak jsme pochopili, v\u00fdrobce Cochlear st\u00e1le pracuje se s\u00e9riovou stimulac\u00ed a m\u00e1 22 kontakt\u016f na krat\u0161\u00ed elektrod\u011b s pouze jedn\u00edm nap\u00e1jec\u00edm zdrojem. MED-EL m\u00e1 24 dvojit\u00fdch kontakt\u016f na 12 r\u016fzn\u00fdch pod\u00e9ln\u00fdch pozic\u00edch na del\u0161\u00ed elektrod\u011b, ale pro ka\u017ed\u00fd z t\u011bchto kontakt\u016f poskytuje samostatn\u00e9 nap\u00e1jen\u00ed. A to tak\u00e9 umo\u017e\u0148uje paraleln\u00ed stimulaci.<\/p>\n
Vybrali jsme si tedy CI od spole\u010dnosti MED-EL p\u0159edev\u0161\u00edm proto, \u017ee je to v sou\u010dasn\u00e9 dob\u011b jedin\u00fd syst\u00e9m s mo\u017enost\u00ed paraleln\u00ed stimulace.<\/p>\n<\/div><\/div><\/div><\/div><\/div><\/p>\n","protected":false},"excerpt":{"rendered":"
Dr. Christian Schmidt MBA, otec d\u00edt\u011bte s CI, popisuje, kter\u00e9 faktory byly pro n\u011bj a jeho man\u017eelku rozhoduj\u00edc\u00ed p\u0159i v\u00fdb\u011bru syst\u00e9mu CI pro jejich dceru.<\/p>\n","protected":false},"author":4,"featured_media":31890,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[500],"tags":[423,422],"class_list":["post-22229","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-zivot","tag-ci-users","tag-hearing-implant-reliability"],"yoast_head":"\n
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Dr. Christian Schmidt MBA, otec d\u00edt\u011bte s kochle\u00e1rn\u00edm implant\u00e1tem, popisuje, kter\u00e9 faktory byly pro n\u011bj a jeho \u017eenu rozhoduj\u00edc\u00ed p\u0159i v\u00fdb\u011bru syst\u00e9mu CI pro jejich dceru.<\/strong><\/p>\n<\/div> \u201eCo pr\u00e1v\u011b \u0159ekl l\u00e9ka\u0159? Jak\u00fd implant\u00e1t doporu\u010dil? Co myslel t\u00edm, \u017ee paraleln\u00ed a s\u00e9riov\u00fd implant\u00e1t jsou stejn\u00e9? Pro\u010d si neud\u011bl\u00e1 v\u00edce \u010dasu, aby n\u00e1m to podrobn\u011b vysv\u011btlil?\u201c Kdy\u017e jsme na\u0161\u00ed dce\u0159i sd\u011blili diagn\u00f3zu ztr\u00e1ty sluchu, vydali jsme se na klikatou cestu d\u017eungl\u00ed zcela nov\u00fdch informac\u00ed a museli jsme naj\u00edt cestu ven.<\/p>\n Nejprve chci \u0159\u00edci, \u017ee n\u00e1s spole\u010dnost MED-EL p\u0159esv\u011bd\u010dila sv\u00fdmi kochle\u00e1rn\u00edmi implant\u00e1ty. Tyto implant\u00e1ty maj\u00ed 24 dvojit\u00fdch kontakt\u016f ve 12 r\u016fzn\u00fdch pod\u00e9ln\u00fdch poloh\u00e1ch a samostatn\u00fd zdroj energie pro ka\u017ed\u00fd z t\u011bchto kontakt\u016f. Proto\u017ee jsou zdroje nap\u00e1jen\u00ed nez\u00e1visl\u00e9, znamen\u00e1 to, \u017ee lze zpracov\u00e1vat jak s\u00e9riov\u00e9, tak paraleln\u00ed k\u00f3dov\u00e1n\u00ed. Douf\u00e1me, \u017ee v\u00fdzkum v budoucnu p\u0159inese st\u00e1le dokonalej\u0161\u00ed stimula\u010dn\u00ed strategie \u2013 implant\u00e1t na\u0161\u00ed dcery je ka\u017edop\u00e1dn\u011b otev\u0159en\u00fd ob\u011bma syst\u00e9mov\u00fdm p\u0159\u00edstup\u016fm.<\/p>\n Pojmy \u201es\u00e9riov\u00fd\u201c a \u201eparaleln\u00ed\u201c jsou zn\u00e1m\u00e9 z oblasti po\u010d\u00edta\u010d\u016f. Tok proudu, kter\u00fd p\u0159en\u00e1\u0161\u00ed data a informace, m\u016f\u017ee prob\u00edhat bu\u010f s\u00e9riov\u011b, jeden po druh\u00e9m p\u0159es jeden kontakt, nebo sou\u010dasn\u011b paraleln\u011b p\u0159es n\u011bkolik kontakt\u016f. Druh\u00fd zp\u016fsob m\u016f\u017ee p\u0159enos informac\u00ed urychlit: v\u00edce informac\u00ed za krat\u0161\u00ed dobu. V souvislosti s kochle\u00e1rn\u00edmi implant\u00e1ty (zkr\u00e1cen\u011b CI) se s\u00e9riov\u00fd a paraleln\u00ed tok proudu vztahuje tak\u00e9 na zp\u016fsob, jak\u00fdm drobn\u00e9 proudov\u00e9 impulsy stimuluj\u00ed nervov\u00e1 vl\u00e1kna ve vnit\u0159n\u00edm uchu neboli hlem\u00fd\u017edi.<\/p>\n Syst\u00e9m CI se skl\u00e1d\u00e1 z implant\u00e1tu, kter\u00fd nen\u00ed vid\u011bt, a zvukov\u00e9ho procesoru, kter\u00fd se nos\u00ed zevn\u011b. Zvukov\u00fd procesor m\u016f\u017ee b\u00fdt bu\u010f jednojednotkov\u00fd procesor ve tvaru ploch\u00e9ho disku, nebo procesor za uchem (BTE), kter\u00fd vypad\u00e1 t\u00e9m\u011b\u0159 jako b\u011b\u017en\u00e9 naslouch\u00e1tko. Procesor sn\u00edm\u00e1 zvukov\u00e9 vlny pomoc\u00ed mikrofonu, pot\u00e9 tyto analogov\u00e9 informace digit\u00e1ln\u011b zpracov\u00e1v\u00e1 a prost\u0159ednictv\u00edm c\u00edvky je p\u0159en\u00e1\u0161\u00ed do implant\u00e1tu. Implant\u00e1t p\u0159iprav\u00ed sign\u00e1ly pro kontakty elektrod, odkud jsou v podob\u011b mal\u00fdch elektrick\u00fdch pulz\u016f p\u0159ivedeny do vnit\u0159n\u00edho ucha.<\/p>\n V z\u00e1vislosti na v\u00fdrobci je k soustav\u011b elektrod, \u201eelektrodov\u00e9mu kabelu\u201c, kter\u00fd vede z implant\u00e1tu do hlem\u00fd\u017ed\u011b ve vnit\u0159n\u00edm uchu, p\u0159ipojeno 16 a\u017e 24 elektrodov\u00fdch kontakt\u016f. Tato elektroda se obvykle zav\u00e1d\u00ed tzv. kulat\u00fdm ok\u00e9nkem do scala tympani, bub\u00ednkov\u00e9ho kan\u00e1lku hlem\u00fd\u017ed\u011b. Vedle scala tympani se nach\u00e1z\u00ed Cortiho org\u00e1n, vlastn\u00ed sluchov\u00fd org\u00e1n. Ve zdrav\u00e9m uchu Cortiho org\u00e1n z\u00e1sobuje sluchov\u00fd nerv podn\u011bty. U CI jsou tyto podn\u011bty nahrazeny drobn\u00fdmi proudov\u00fdmi impulzy z elektrody implant\u00e1tu. U b\u011b\u017en\u00fdch CI se to d\u011bje s\u00e9riov\u011b, jeden puls za druh\u00fdm, ale u nejnov\u011bj\u0161\u00edch CI technologi\u00ed je vys\u00edl\u00e1no n\u011bkolik puls\u016f paraleln\u011b.<\/p>\n Rakousk\u00fd v\u00fdrobce CI MED-EL pou\u017e\u00edv\u00e1 podle sv\u00e9 bro\u017eury 24 elektrodov\u00fdch kontakt\u016f, co\u017e je o dva v\u00edce ne\u017e australsk\u00fd Cochlear. P\u0159esn\u011b \u0159e\u010deno, implant\u00e1ty MED-EL maj\u00ed 24 kontakt\u016f na 12 r\u016fzn\u00fdch pozic\u00edch pod\u00e9l p\u0159ibli\u017en\u011b 31 milimetr\u016f dlouh\u00e9ho elektrodov\u00e9ho pole. Tyto kontakty se ozna\u010duj\u00ed jako dvojit\u00e9 kontakty, ka\u017ed\u00fd s vlastn\u00edm nap\u00e1jec\u00edm vodi\u010dem. Naproti tomu Cochlear m\u00e1 22 kontakt\u016f v r\u016fzn\u00fdch pozic\u00edch, ale ne v\u0161echny jsou pou\u017eity v r\u00e1mci jednoho stimula\u010dn\u00edho sezen\u00ed.<\/p>\n R\u016fzn\u00fdmi testy bylo zji\u0161t\u011bno, \u017ee optim\u00e1ln\u00ed vzd\u00e1lenost mezi jednotliv\u00fdmi stimula\u010dn\u00edmi body zaji\u0161\u0165uje p\u0159ibli\u017en\u011b 12 kontakt\u016f. Z fyzik\u00e1ln\u00edch d\u016fvod\u016f m\u016f\u017ee ka\u017ed\u00fd proudov\u00fd impuls, bez ohledu na to, jak mal\u00fd je, podl\u00e9hat ur\u010dit\u00e9mu rozptylu. V\u00fdsledn\u00e9 \u201eproudov\u00e9 pole\u201c stimuluje nejen v p\u0159esn\u00e9m m\u00edst\u011b kontaktu, ale stimuluje hlem\u00fd\u017e\u010f i \u0161\u00ed\u0159eji. Proto v\u00edce ne\u017e 12 elektrodov\u00fdch kontakt\u016f nem\u016f\u017ee p\u0159in\u00e9st \u017e\u00e1dn\u00e9 v\u00fdznamn\u00e9 zlep\u0161en\u00ed.<\/p>\n Po srolov\u00e1n\u00ed je bub\u00ednkov\u00fd kan\u00e1l, ve kter\u00e9m le\u017e\u00ed CI elektroda, dlouh\u00fd p\u0159ibli\u017en\u011b 31 mm. Zdrav\u00e9 vnit\u0159n\u00ed ucho m\u00e1 v Cortiho org\u00e1nu asi 30 000 vl\u00e1skov\u00fdch bun\u011bk, kter\u00e9 jsou zodpov\u011bdn\u00e9 za generov\u00e1n\u00ed nervov\u00fdch impuls\u016f p\u0159i sly\u0161en\u00ed. P\u0159i CI je k dispozici maxim\u00e1ln\u011b 24 elektrod na d\u00e9lce n\u011bkdy men\u0161\u00ed ne\u017e 31 milimetr\u016f. Ve srovn\u00e1n\u00ed s 30 000 se to m\u016f\u017ee zd\u00e1t nedostate\u010dn\u00e9.<\/p>\n S 30 000 vl\u00e1skov\u00fdmi bu\u0148kami dok\u00e1\u017ee zdrav\u00e9 ucho rozli\u0161it v\u00edce ne\u017e tis\u00edc t\u00f3n\u016f. S CI v\u00edce ne\u017e 100. Podle p\u0159\u00edslu\u0161n\u00fdch marketingov\u00fdch prospekt\u016f v\u0161ak lze s CI sly\u0161et \u201ev\u00edce\u201c pomoc\u00ed takzvan\u00fdch \u201evirtu\u00e1ln\u00edch kontakt\u016f\u201c, kter\u00e9 se vytv\u00e1\u0159ej\u00ed pomoc\u00ed s\u00e9riov\u00e9 nebo paraleln\u00ed technologie.<\/p>\n Odborn\u00edci hovo\u0159\u00ed o virtu\u00e1ln\u00ed elektrod\u011b tehdy, kdy\u017e fyzicky neexistuje jako elektrodov\u00fd kontakt. Vytv\u00e1\u0159\u00ed se superpozic\u00ed elektrick\u00fdch pol\u00ed dvou sousedn\u00edch kontakt\u016f.<\/p>\n Pod\u00edvejme se nap\u0159\u00edklad na dva sousedn\u00ed kontakty A a B: pokud je do bodu A p\u0159iveden \u201eelektrick\u00fd proud\u201c, dojde ke stimulaci nervov\u00fdch vl\u00e1ken (nebo gangliov\u00fdch bun\u011bk) v oblasti kontaktu a ozve se p\u0159\u00edslu\u0161n\u00fd t\u00f3n. Pokud je m\u00edsto toho stimulov\u00e1n bod B, bude stimulov\u00e1na oblast v okol\u00ed tohoto kontaktu a bude sly\u0161et odpov\u00eddaj\u00edc\u00ed t\u00f3n. Pokud v\u0161ak aktivujeme oba kontakty sou\u010dasn\u011b, elektrick\u00e9 pole obou kontakt\u016f se bude p\u0159ekr\u00fdvat. P\u0159i stejn\u00e9m rozlo\u017een\u00ed mezi poli vznikne maximum pole p\u0159ibli\u017en\u011b uprost\u0159ed mezi ob\u011bma kontakty. S ohledem na nervovou stimulaci se vytvo\u0159\u00ed tzv. virtu\u00e1ln\u00ed elektroda. Pokud je jeden kontakt stimulov\u00e1n v\u00edce ne\u017e druh\u00fd, pak se maximum posune ve sm\u011bru tohoto kontaktu. Op\u011bt se tak vytvo\u0159\u00ed nov\u00e1 virtu\u00e1ln\u00ed elektroda nebo nov\u00fd t\u00f3n.<\/p>\n Tento princip nelze odstup\u0148ovat tak, jako u p\u0159irozen\u00e9ho sluchu. Pokud v\u0161ak r\u016fzn\u011b zkombinujete r\u016fzn\u00e9 s\u00edly impuls\u016f na re\u00e1ln\u00fdch kan\u00e1lech, m\u016f\u017eete mezi dv\u011bma kontakty odvodit n\u011bkolik virtu\u00e1ln\u00edch elektrod a vytvo\u0159it nov\u00e9 sly\u0161iteln\u00e9 t\u00f3ny.<\/p>\n P\u0159i paraleln\u00ed stimulaci je proud p\u0159iv\u00e1d\u011bn sou\u010dasn\u011b na dva sousedn\u00ed kontakty. Pro skute\u010dn\u00e9 elektrick\u00e9 spojen\u00ed mus\u00ed existovat odpov\u00eddaj\u00edc\u00ed velk\u00fd po\u010det zdroj\u016f proudu.<\/p>\n P\u0159i s\u00e9riov\u00e9 stimulaci se syst\u00e9m virtu\u00e1ln\u00edch elektrod dosahuje stimulac\u00ed sousedn\u00edch kontakt\u016f postupn\u011b \u2013 jeden po druh\u00e9m. Pot\u00e9 se simuluje t\u00f3n pomoc\u00ed dvojit\u00e9ho impulzu. Na sousedn\u00edch kontaktech dojde ke dv\u011bma pulz\u016fm v rychl\u00e9m sledu, kter\u00e9 jsou od sebe vzd\u00e1leny v \u0159\u00e1du mikrosekund.<\/p>\n Tento efekt si m\u016f\u017eete p\u0159edstavit jako podobn\u00fd star\u00fdm film\u016fm nebo flipbook\u016fm, kdy na\u0161e oko vn\u00edm\u00e1 rychle po sob\u011b jdouc\u00ed obr\u00e1zky jako jeden pohybliv\u00fd obraz.<\/p>\n Metoda sekven\u010dn\u00ed stimulace pro CI zahrnuje superpozici pol\u00ed v rychl\u00e9m sledu za sebou. Proud je nejprve p\u0159iveden do kontaktu A, kter\u00fd je pot\u00e9 op\u011bt vypnut. Ihned pot\u00e9 se aplikuje stimulace na kontakt B. T\u00edmto zp\u016fsobem se uprost\u0159ed dvou fyzicky existuj\u00edc\u00edch kontakt\u016f vytvo\u0159\u00ed maximum pole, kter\u00e9 n\u00e1sledn\u011b vytvo\u0159\u00ed virtu\u00e1ln\u00ed elektrodu \u2013 pouze s m\u00edrn\u00fdm \u010dasov\u00fdm zpo\u017ed\u011bn\u00edm.<\/p>\n Rozs\u00e1hl\u00e9 studie proveden\u00e9 na dosp\u011bl\u00fdch u\u017eivatel\u00edch CI uk\u00e1zaly, \u017ee s\u00e9riov\u00fdm zp\u016fsobem lze vn\u00edmat 127 a\u017e 161 r\u016fzn\u00fdch t\u00f3n\u016f. P\u0159i paraleln\u00edm p\u0159\u00edstupu z\u00e1vis\u00ed po\u010det v\u00fd\u0161ek na po\u010dtu mo\u017en\u00fdch kontaktn\u00edch p\u00e1r\u016f a po\u010dtu \u00farovn\u00ed v\u00fd\u0161ek proudu a po\u010dtu \u00farovn\u00ed v\u00fd\u0161ek proudu. V\u00fdzkum prok\u00e1zal a\u017e 460 v\u00fd\u0161ek: v praxi byla v z\u00e1vislosti na strategii k\u00f3dov\u00e1n\u00ed potvrzena hodnota a\u017e 250 v\u00fd\u0161ek.<\/p>\n Syst\u00e9my CI s paraleln\u00ed stimulac\u00ed umo\u017e\u0148uj\u00ed v\u00edce a soub\u011b\u017en\u00fdch \u201evirtu\u00e1ln\u00edch kan\u00e1l\u016f\u201c. Umo\u017e\u0148uj\u00ed tak\u00e9 k\u00f3dov\u00e1n\u00ed, kter\u00e9 vyu\u017e\u00edv\u00e1 paraleln\u00ed syst\u00e9m v n\u00edzk\u00e9m a\u017e st\u0159edn\u00edm p\u00e1smu a spol\u00e9h\u00e1 na s\u00e9riov\u00fd syst\u00e9m ve vysokofrekven\u010dn\u00edm p\u00e1smu. To umo\u017e\u0148uje napodobit p\u0159irozen\u00fd sluch. Paraleln\u00ed zdroje proudu tak\u00e9 zvy\u0161uj\u00ed spolehlivost syst\u00e9mu a jeho bezpe\u010dnost. Podle m\u00e9ho n\u00e1zoru je mo\u017enost paraleln\u00ed stimulace nejd\u016fle\u017eit\u011bj\u0161\u00edm rozli\u0161ovac\u00edm znakem mezi r\u016fzn\u00fdmi kochle\u00e1rn\u00edmi implant\u00e1ty.<\/p>\n Druh\u00fdm d\u016fle\u017eit\u00fdm faktorem pro m\u00e9 rozhodov\u00e1n\u00ed byl charakter a d\u00e9lka elektrody. Tato d\u00e9lka je tak\u00e9 odpov\u011bd\u00ed na ot\u00e1zku: \u201ePro\u010d n\u011bkte\u0159\u00ed u\u017eivatel\u00e9 CI sly\u0161\u00ed hlasy jako kdyby mluvil Mickey Mouse, zat\u00edmco jin\u00ed sly\u0161\u00ed relativn\u011b jasn\u011b?\u201c Samoz\u0159ejm\u011b existuj\u00ed i r\u016fzn\u00e9 dal\u0161\u00ed mo\u017en\u00e9 faktory pro rozhodov\u00e1n\u00ed, ale ty jsou a\u017e na konci m\u00e9ho osobn\u00edho \u017eeb\u0159\u00ed\u010dku, nap\u0159\u00edklad funkce jako p\u0159ipojen\u00ed Bluetooth nebo aplikace pro iPhone.<\/p>\n Jak jsme pochopili, v\u00fdrobce Cochlear st\u00e1le pracuje se s\u00e9riovou stimulac\u00ed a m\u00e1 22 kontakt\u016f na krat\u0161\u00ed elektrod\u011b s pouze jedn\u00edm nap\u00e1jec\u00edm zdrojem. MED-EL m\u00e1 24 dvojit\u00fdch kontakt\u016f na 12 r\u016fzn\u00fdch pod\u00e9ln\u00fdch pozic\u00edch na del\u0161\u00ed elektrod\u011b, ale pro ka\u017ed\u00fd z t\u011bchto kontakt\u016f poskytuje samostatn\u00e9 nap\u00e1jen\u00ed. A to tak\u00e9 umo\u017e\u0148uje paraleln\u00ed stimulaci.<\/p>\n Vybrali jsme si tedy CI od spole\u010dnosti MED-EL p\u0159edev\u0161\u00edm proto, \u017ee je to v sou\u010dasn\u00e9 dob\u011b jedin\u00fd syst\u00e9m s mo\u017enost\u00ed paraleln\u00ed stimulace.<\/p>\n<\/div><\/div><\/div><\/div><\/div><\/p>\n","protected":false},"excerpt":{"rendered":" Dr. Christian Schmidt MBA, otec d\u00edt\u011bte s CI, popisuje, kter\u00e9 faktory byly pro n\u011bj a jeho man\u017eelku rozhoduj\u00edc\u00ed p\u0159i v\u00fdb\u011bru syst\u00e9mu CI pro jejich dceru.<\/p>\n","protected":false},"author":4,"featured_media":31890,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[500],"tags":[423,422],"class_list":["post-22229","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-zivot","tag-ci-users","tag-hearing-implant-reliability"],"yoast_head":"\n<\/span><\/div><\/div><\/div><\/div><\/div>Co znamen\u00e1 s\u00e9riov\u00e9 nebo paraleln\u00ed?<\/h2>\n
Elektroda: srovn\u00e1n\u00ed r\u016fzn\u00fdch v\u00fdrobc\u016f<\/h2>\n
Kolik zvuk\u016f mohu sly\u0161et?<\/h2>\n
\u00a0V\u00edce v\u00fd\u0161ek d\u00edky virtu\u00e1ln\u00edm elektrod\u00e1m<\/h2>\n
Virtu\u00e1ln\u00ed kan\u00e1ly \u2013 s\u00e9riov\u00e9 nebo paraleln\u00ed<\/h2>\n
Kolik kan\u00e1l\u016f pot\u0159ebujeme ke sly\u0161en\u00ed?<\/h2>\n
P\u0159\u00ednosy paraleln\u00ed stimulace a dal\u0161\u00ed rozhodovac\u00ed krit\u00e9ria<\/h2>\n