{"id":20575,"date":"2022-07-04T08:00:33","date_gmt":"2022-07-04T06:00:33","guid":{"rendered":"https:\/\/lifelonghearing.com\/?p=20575"},"modified":"2025-02-27T11:21:58","modified_gmt":"2025-02-27T11:21:58","slug":"slusni-aparat-ali-slusni-vsadek","status":"publish","type":"post","link":"https:\/\/lifelonghearing.com\/sl\/slusni-aparat-ali-slusni-vsadek\/","title":{"rendered":"Slu\u0161ni aparat ali slu\u0161ni vsadek?"},"content":{"rendered":"

Kdaj so slu\u0161ni vsadki bolj\u0161a re\u0161itev od slu\u0161nih aparatov?<\/h1><\/div>

Rezultati s slu\u0161nimi vsadki in s konvencionalnimi slu\u0161nimi aparati se nenehno izbolj\u0161ujejo, omejitve pri uporabi teh razli\u010dnih sistemov pa se s tem spreminjajo.<\/strong><\/p>\n<\/div>

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“Pribli\u017eno 19 odstotkov prebivalstva ima izgubo sluha, ki zahteva zdravljenje,” pojasnjuje dr. Thomas Keintzel, primarij ORL oddelka na Klinikum Wels-Grieskirchen. “Zdravljenje s slu\u0161nim aparatom je \u0161e vedno zlati standard.” Obi\u010dajni slu\u0161ni aparati oja\u010dajo zvok \u2013 odvisno od vi\u0161ine in jakosti \u2013 tako da ga uporabnik lahko bolje zazna. A to ni dovolj za uspe\u0161no zdravljenje: “Pri pripomo\u010dkih je pomembna tehni\u010dna podpora, in pa ustrezno usposabljanje.”<\/p>\n

Obstajajo tudi nekatera zdravstvena stanja, ki ote\u017eujejo ali onemogo\u010dajo uspe\u0161no uporabo obi\u010dajnih slu\u0161nih aparatov<\/a>. Na primer zo\u017een ali ve\u010dkrat vnet sluhovod, zakostenitev v srednjem u\u0161esu ali izguba ko\u0161\u010dic srednjega u\u0161esa. V nekaterih primerih lahko pomaga operacija, a pri 75 odstotkih vseh te\u017eav je potrebna \u0161e namestitev slu\u0161nega pripomo\u010dka, pravi prim. Keintzel. “Uporaba kostne prevodnosti in aktivnih vsadkov za srednje uho se je uveljavila kot dragocena alternativa obi\u010dajnemu name\u0161\u010danju slu\u0161nih aparatov.”<\/p>\n

Ko samo oja\u010danje ni dovolj<\/h2>\n

Z avdiolo\u0161kega vidika obi\u010dajni slu\u0161ni aparati dose\u017eejo svojo mejo, ko je notranje uho preve\u010d po\u0161kodovano. Poleg pretvarjanja zvo\u010dnih vibracij v \u017eiv\u010dne signale ima notranje uho funkcijo, podobno predoja\u010devalniku. \/ A v primeru senzorinevralne izgube sluha se ta sposobnost postopoma izgublja. Prav zato morajo slu\u0161ni aparati bolj oja\u010dati tihe zvoke kot glasne.<\/p>\n

Ta izguba povzro\u010di “dinami\u010dno redukcijo”. Razlika med najti\u0161jim zvokom (ki ga komaj \u0161e sli\u0161imo) in najglasnej\u0161im zvokom (prag bole\u010dine) se zmanj\u0161a. Posledi\u010dno se izgubi tudi kontrast med razli\u010dnimi zvo\u010dnimi signali: uporabnik lahko \u0161e vedno vse sli\u0161i oja\u010dano, a nekateri zvoki, razumevanje govora in pogovori kljub slu\u0161nemu aparatu postanejo vse bolj iz\u010drpavajo\u010di.<\/p>\n

Pri okvarjenem u\u0161esu pride tudi do motenj pri zvo\u010dnim maskiranjem (\u00bbAuditory masking\u00ab), ki se dogaja, kadar prevladujo\u010di zvok prekrije ti\u0161jega. Vsi ti u\u010dinki skupaj pomenijo: pri izgubi sluha, ve\u010dji od pribli\u017eno 50 decibelov, je govor v hrupnem okolju te\u017eko razumljiv, tudi s slu\u0161nimi aparati.[1]<\/a><\/p>\n

Sodobne tehnologije v obi\u010dajnih slu\u0161nih aparatih pomagajo<\/h2>\n

Obi\u010dajni slu\u0161ni aparati z razli\u010dnimi triki izbolj\u0161ajo akusti\u010dni kontrast, poudarek pa je vedno na razumevanju govora. Frekven\u010dni filtri se uporabljajo za du\u0161enje tistih tonov, ki ali niso bistveni za razumevanje govora ali pa potencialno vsebujejo hrup ozadja. Funkcija odpravljanja hrupa pregleda vsak segment tona za govorne signale in ga ustrezno oja\u010da ali uti\u0161a. Usmerjeni mikrofonski sistemi obdelujejo zvoke iz predvidene smeri sogovornika. Vse te funkcije so vgrajene tudi v govorne procesorje slu\u0161nih vsadkov.<\/p>\n

Tehnologije za izbolj\u0161anje govora pri slu\u0161nih aparatih se nenehno izbolj\u0161ujejo in razumevanje govora omogo\u010dajo tudi uporabnikom z resno okvarjenim notranjim u\u0161esom. Na neki to\u010dki pa tudi vrhunski slu\u0161ni aparati dose\u017eejo svojo mejo. Prim. Keinzel ima nasvet: “V teh primerih se lahko za izbolj\u0161anje razumevanja govora uporabi neposredna elektri\u010dna stimulacija preko pol\u017eevega vsadka.”<\/p>\n

Razumevanje govora je klju\u010dnega pomena!<\/h2>\n

“Isto\u010dasno z nenehnim tehni\u010dnim izbolj\u0161evanjem tako slu\u0161nih aparatov kot slu\u0161nih vsadkov so se premikale tudi meje indikacije,” opisuje prim. Keintzel. \u010ce je razumevanje govora, komunikacija in visoka kakovost \u017eivljenja mogo\u010da s slu\u0161nimi aparati, je te\u017eko upravi\u010diti operacijo. Poleg tega je pri slu\u0161nih vsadkih (PV) potrebna faza privajanja: slu\u0161ni sistem se mora nau\u010diti ustrezno pretvoriti tehni\u010dno ustvarjene signale.<\/p>\n

“Bistveno merilo odlo\u010ditve je lahko razumevanje govora s slu\u0161nim aparatom.” Na splo\u0161no velja, \u010de je razumevanje govora z dobro name\u0161\u010denimi slu\u0161nimi aparati slab\u0161e, kot je mogo\u010de pri\u010dakovati za PV, je priporo\u010dljiva implantacija. Vendar se morate najprej prepri\u010dati, da je slu\u0161ni aparat optimalno nastavljen in primeren za uporabnika.<\/p>\n

\u010ce uporabnik PV \u0161e vedno uporablja slu\u0161ni aparat na drugi strani, bo zdravnik svetoval implantacijo na tej strani, v primeru da slu\u0161ni aparat ne prispeva k izbolj\u0161anju razumevanja govora.<\/p>\n

Pri otrocih je odlo\u010dilen dejavnik razvoj sluha in jezika. “V primeru otrok, ki so se rodili gluhi, ali otrok, ki so oglu\u0161eli, preden so usvojili jezik, mora ta odlo\u010ditev upo\u0161tevati \u0161tevilne dejavnike, kot so stopnja otrokovega razvoja, komunikacijske kompetence itd.” poudarja prim.Keintzel. “V vsakem primeru bi morali star\u0161i enostransko gluhih otrok poznati omejitve enostranskega sluha – zmanj\u0161ano razumevanje govora v hrupnem okolju, nesposobnost usmerjenosti sluha, in vse to v ob\u010dutljivi fazi usvajanja jezika.”<\/p>\n

Kaj lahko pri\u010dakujemo od pol\u017eevega vsadka<\/h2>\n

PV zaobide okvare notranjega u\u0161esa in neposredno stimulira nevronsko strukturo slu\u0161nega organa. Uporabnikovi mo\u017egani se morajo nau\u010diti interpretirati te umetne signale, zato ne gre brez obdobja rehabilitacije in vadbe. Na avstrijskem ORL kongresu leta 2021 je prim.Keintzel demonstriral uspeh implantacije s PV. [2]<\/a> Eno leto po aktivaciji PV tri \u010detrtine vseh uporabnikov razumejo govor enako dobro kot tipi\u010dna oseba z izgubo sluha na ravni 50 decibelov. “Stopnja razumevanja govora, ki jo lahko pri\u010dakujemo pri namestitvi PV, je enaka tisti pri zmerni izgubi sluha,” in to velja tudi za osebe, ki so bile prej popolnoma gluhe.<\/p>\n

Na istem dogodku je prof. dr. dr. Ulrich Hoppe, vi\u0161ji zdravnik v Univerzitetni bolni\u0161nici Erlangen, prikazal primerjavo razumevanja govora med uporabniki PV in slu\u0161nih aparatov. Ve\u010dina uporabnikov PV razume govor v hrupnem okolju enako dobro kot ga razumejo tisti z izgubo sluha od 25 do 50 decibelov s svojimi slu\u0161nimi aparati. Vsi uporabniki PV pa razumejo govor bolje kot tipi\u010dni uporabnik slu\u0161nih aparatov z izgubo sluha 65 decibelov.<\/p>\n

Za kandidata za PV je v vsakem primeru pomemben temeljit premislek, a prav tako pomembna je dovolj hitra odlo\u010ditev. Izku\u0161eni ORL specialist Keintzel pojasnjuje, zakaj je tako: “Zgodnej\u0161a implantacija zahteva kraj\u0161i \u010das rehabilitacije in je povezana z bolj\u0161im delovanjem in znatnim izbolj\u0161anjem kakovosti \u017eivljenja.”<\/p>\n

Nadaljnje informacije in podrobna merila v: 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":"

The results with hearing implants and with conventional hearing aids are constantly improving and the limits of use of these different systems are in a constant change.<\/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":[513],"tags":[514,719,530],"class_list":["post-20575","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-znanost","tag-pv","tag-pv-in-slusni-aparat","tag-slusni-vsadki"],"yoast_head":"\nSlu\u0161ni aparat ali slu\u0161ni vsadek? - Slovenia<\/title>\n<meta name=\"description\" content=\"Dose\u017eki s slu\u0161nimi aparati in slu\u0161nimi vsadki se nenehno spreminjajo. 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