{"id":20575,"date":"2022-07-04T08:00:33","date_gmt":"2022-07-04T06:00:33","guid":{"rendered":"https:\/\/lifelonghearing.com\/?p=20575"},"modified":"2025-04-16T08:03:38","modified_gmt":"2025-04-16T08:03:38","slug":"slusni-aparat-ili-slusni-implantat","status":"publish","type":"post","link":"https:\/\/lifelonghearing.com\/hr\/slusni-aparat-ili-slusni-implantat\/","title":{"rendered":"Slu\u0161ni aparat ili slu\u0161ni implantat?"},"content":{"rendered":"

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

Rezultati sa slu\u0161nim implantatima i konvencionalnim slu\u0161nim aparatima konstanto se pobolj\u0161avaju i granice kori\u0161\u0107enja ova dva sistema se stalno mjenjaju.<\/strong><\/p>\n<\/div>

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\u201cOko 19 posto populacije pati od gubitka sluha koji zahtjeva lje\u010denje,\u201d obja\u0161njava Dr. Thomas Keintzel, primarni lije\u010dnik ORL odjela na klinici Wels-Grieskirchen. \u201cLije\u010denje slu\u0161nim pomagalima ovdje je jo\u0161 uvijek zlatni standard.\u201d Konvencionalna slu\u0161na pomagala poja\u010davaju zvuk \u2013 ovisno o visini zvuka i glasno\u0107i \u2013 tako da ga korisnici mogu bolje percipirati. No, korisnici tu ne bi trebali stati: \u201cUz podr\u0161ku ure\u0111aja, obuka se nametnula kao bitan \u010dimbenik uspjeha.\u201d<\/p>\n

Ipak, postoje neka medicinska stanja koja ote\u017eavaju ili onemogu\u0107uju uspje\u0161nu upotrebu konvencionalnihslu\u0161nih pomagala<\/a>. Na primjer, to mogu biti su\u017eeni ili opetovano upaljeni u\u0161ni kanal, oko\u0161tavanje u srednjem uhu ili gubitak kostiju srednjeg uha. U nekim slu\u010dajevima, mo\u017ee pomo\u0107i i operacija, no 75 posto svih problema zahtjeva potporu slu\u0161nog aparata, dodaje Prim. Keintzel. Me\u0111utim, uporaba implantata za ko\u0161tanu provodljivost i aktivno srednje uho etablirala se kao vrijedna alternativa konvencionalnom postavljanju slu\u0161nih pomagala.\u201d”<\/p>\n

Kada poja\u010davanje samo nije dovoljno<\/h2>\n

S audiolo\u0161ke to\u010dke gledi\u0161ta, konvencionalna slu\u0161na pomagala dose\u017eu svoje granice kada je unutarnje uho ozbiljno o\u0161te\u0107eno. Osim \u0161to pretvara vibracije zvuka u \u017eiv\u010dane signale, unutarnje uho ima funkciju koja je gotovo ista kao kod \u201cpretpoja\u010dala\u201d (en. preamplifyer). Ovo se naziva kompresija srednjeg uha. U slu\u010daju senzorineuralnog gubitka sluha, ova sposobnost se postepeno gubi. Zato slu\u0161ni aparati moraju poja\u010dati ti\u0161e zvuke vi\u0161e nego glasnije.<\/p>\n

Ovaj gubitak unutarnjeg uha uzrokuje \u201cdinami\u010dko smanjenje\u201d (en. dynamic reduction). Razlika izme\u0111u najti\u0161eg zvuka (koji jedva mo\u017eemo \u010duti) i najglasnijeg zvuka (prag bola) postaje dosta manja. Kao rezultat toga, gubi se i kontrast izme\u0111u razli\u010ditih zvu\u010dnih signala. Korisnik sa poja\u010danjem mo\u017ee jo\u0161 uvijek \u010duti sve s poja\u010danjem, ali odre\u0111eni zvukovi, razumijevanje govora i razgovori postaju iscrpljuju\u0107i unato\u010d slu\u0161nom aparatu.<\/p>\n

O\u0161te\u0107eno uho tako\u0111er do\u017eivljava promjene u vremenskim rezolucijama (takozvano \u201cauditivno maskiranje\u201d) koje se de\u0161ava kada ja\u010di zvuk prikriva ti\u0161i. Sve ovo skupa zna\u010di da od oko 50 decibela gubitka sluha, govor u bu\u010dnom okru\u017eenju postaje sve manje jasan, \u010dak i sa slu\u0161nim pomagalima.[1]<\/a><\/p>\n

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

Konvencionalni slu\u0161ni aparati koriste mnoge trikove kako bi pobolj\u0161ali akusti\u010dni kontrast, dok je fokus na razumijevanju govora. Frekvencijski filteri koriste se za prigu\u0161ivanje tonova koji nisu bitni za razumijevanje govoru ili potencijalno sadr\u017ee mnogo pozadinske buke. Poni\u0161tavanje buke (en. noise cancellation) ispituje svaki segment tona kod govora i u skladu s tim ih poja\u010dava ili sti\u0161ava. Usmjereni mikrofon sustavi obra\u0111uju zvukove iz pretpostavljenog smjera odakle zvuk dolazi. Sve ove funkcije tako\u0111er su integrirane u audio procesore slu\u0161nih implantata.<\/p>\n

Tehnologije za pobolj\u0161anje razumjevanja govora neprestano se razvijaju i omogu\u0107uju \u010dak i korisnicima s ozbiljno o\u0161te\u0107enom funkcijom unutarnjeg uha da razumiju govor pomo\u0107u svojih slu\u0161nih pomagala. U nekom trenutku, \u010dak i najbolji slu\u0161ni aparati dostignu svoj limit. Prim. Keinzel ima savjet za pacijente koji ne osje\u0107aju pobolj\u0161anje: \u201cU tom slu\u010daju, direktna elektri\u010dna stimulacija preko kohlearnog implanatata mo\u017ee biti rje\u0161enje za pobolj\u0161anje razumijevanje govora.\u201d<\/p>\n

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

\u201cUz konstantan tehnolo\u0161ki napredak slu\u0161nih aparata i slu\u0161nih implantata, granice za indikaciju na jedno odnosno drugo rje\u0161enje tako\u0111er su se pomjerile,\u201d opisuje Prim. Keintzel. Ako su razumjevanje govora, komunikacija i dobar kvalitet \u017eivota mogu\u0107i sa slu\u0161nim aparatom, ne postoji nijedan razlog za operaciju. Uz to, slu\u0161anje sa slu\u0161nim implantatom (CI) zahtjeva fazu vje\u017ebe (rehabilitacija): sredi\u0161nji slu\u0161ni sustav mora nau\u010diti pretvarati tehni\u010dki generirane signale u skladu sa tim.<\/p>\n

\u201cNajbitniji kriterij za odluku mo\u017ee biti razumjevanje govora sa slu\u0161nim aparatom.\u201d Op\u0107enito, ako je razumijevanje govora s dobro postavljenim slu\u0161nim pomagalima lo\u0161ije nego \u0161to bi bilo o\u010dekivano sa CI, preporu\u010duje se implantacija. Me\u0111utim, prvo se mora provjeriti da je slu\u0161ni aparat optimalno prilago\u0111en i prikladan za korisnika.<\/p>\n

Ako korisnik implantata i dalje koristi slu\u0161ni aparat na drugoj strani, liije\u010dnik \u0107e savjetovati implantaciju i sa te strane, ukoliko razumjevanje govora ne bude popravljeno.<\/p>\n

Kod djece, odlu\u010duju\u0107i faktor je razvoj sluha i govora. \u201cU slu\u010daju djece koja su ro\u0111ena gluha ili djece koja su oglu\u0161ila prije usvajanja jezika, odluka za implantaciju mora uzeti u obzir mnoge \u010dimbenike, kao \u0161to je stupanj razvoja djeteta, komunikacijske sposobnosti itd.\u201d nagla\u0161ava prom.Keintzel. \u201cU svakom slu\u010daju, za djecu koja su ro\u0111ena jednostrano gluha, roditelji trebaju znati da jednostrani sluh ima neka ograni\u010denja \u2013 smanjeno razumijevanje u glasnom okru\u017eenju, nemogu\u0107nost lociranja odakle zvuk dolazi, \u0161to se sve de\u0161ava tokom osjetljive faze razvoja jezika.\u201d<\/p>\n

\u0160ta o\u010dekivati od kohlearnog implantata<\/h2>\n

Kohlearni implantat prevazilazi defekte u unutarnjem uhu i izravno stimulira neutralne strukture slu\u0161nih organa. Centar za sluh mora nau\u010diti tuma\u010diti umjetne signale, i zato korisnik treba period rehabilitacije i vje\u017ebe. Na austrijskom ORL kongresu 2021. prim.Keintzel demonstrirao je uspjeh kohlearne implantacije. [2] <\/a>Nakon jedne godine od aktivacije umjetne pu\u017enice, tri \u010detvrtine svih korisnika razumjelo je govor isto koliko i tipi\u010dna osoba sa gubitkom sluha od 50 decibela. \u201cDakle, gubitak razumjevanja govora koji se mo\u017ee o\u010dekivati od kohlearne implantacije nije ve\u0107i nego kod umjerenog gubitka sluha\u201d, a to je tako\u0111er rezultat osoba koje su prethodno bile potpuno gluhe.<\/p>\n

Na istom doga\u0111aju, prof.dr.Ulrich Hoppe, vi\u0161i lije\u010dnik na Sveu\u010dili\u0161noj ORL bolnici u Erlangenu pokazao je usporedbu razumjevanja govora izme\u0111u CI korisnika i korisnika slu\u0161nih aparata. Ve\u0107ina korisnika razumije govor u bu\u010dnom okru\u017eenju isto kao i pacijenti s 25 do 50 decibela gubitka sluha uz pomo\u0107 slu\u0161nih pomagala. Zapravo, svi korisnici CI-ja razumiju bolje od tipi\u010dnih korisnika slu\u0161nih aparata koji imaju gubitak sluha od 65 decibela.<\/p>\n

Za CI kandidate, uvijek je va\u017eno temeljito razmatranje, no i brza odluka. Iskusni ORL specijalist Keintzel obja\u0161njava za\u0161to: \u201cRana kohlearna implantacija vodi do kra\u0107eg vremena rehabilitacijei povezana je s boljom izvedbom i zna\u010dajnim pobolj\u0161anjem kvalitete \u017eivota.\u201d<\/p>\n

Dodatne informacije i detaljni kriteriji o 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>\u00a0Wardegna et al, 2015<\/p>\n

[2]<\/a>\u00a0Daten 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 konvencionalnim slu\u0161nim aparatima konstanto se pobolj\u0161avaju i granice kori\u0161\u0107enja ova dva sistema se stalno mjenjaju.<\/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":[417,703,579],"class_list":["post-20575","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-znanost-hr","tag-ci","tag-kohlearni-implantat-i-slusni-aparat","tag-slusni-implantati"],"yoast_head":"\nSlu\u0161ni aparat ili slu\u0161ni implantat? - Croatian<\/title>\n<meta name=\"description\" content=\"Dostignu\u0107a slu\u0161nih pomagala i slu\u0161nih implantata konstantno se mijenjaju. 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