EUROMEDICA  Hanover 23-24  Mai 2011	Advanced methods of diagnosis, treatment and prophylactics
	European Academy of Natural Sciences, Hanover European Scientific Society, Hanover

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In Russia there are in the order of 1 million children with hearing impairments, the pathology is located at 7-9 rank locus (3,5-4,5%) among the causes of disability. In the Voronezh region the number of children with hearing loss and deafness is over 2000 - about 55.6 people per 10 thousand of child population. According to the results of early hearing screening 20-50 children under 3 years with this pathology are annually detected. Hearing loss leads to maladjustment and life activity limitation. The only way to rehabilitate is a cochlear implantation (CI) – a rapid introduction of the electrode system in the cochlea with a subsequent transformation of audio signals into electrical codes and a direct transfer them to the auditory nerve. CI is a complex method of rehabilitation, carried out by audiologists, aural surgeons, sign language pedagogues, psychologists, and physiologists. Since 2008, the program for the CI was launched in Voronezh Region Children’s Clinical Hospital № 1 under the supervision and with participation of specialists from the Russian Scientific and Practical Centre of Audiology and Hearing Aids of the Federal Agency for Health Care and Social Development.

Materials and methods. 68 children aged 1-13 years with fourth-degree hearing loss and deafness after CI consisted under observation: 39 boys (57%) and 29 girls (43%). Cochlear implants are put to 64 patients, among them 51 – Freedom; Med-el implants are put to 4 patients. are fitted implant company Cochlear, of which 51 - Freedom; 4 patients - implants company Med-El. Most (64) are patients with prelingual deafness. Period of observation after CI is 6 months - 6 years.

A sign language pedagogical examination was conducted before CI. On the surgical stage was used a postaural incision with fascial-periosteal flap on the front-bottom base and an original anchorage of the receiver-stimulator. The electrode was introduced into the cochlea through cohlearstoma imposed by the standard procedure. In the immediate postoperative period, there were no complications. After 5 months 1 patient has an acute otitis media with mastoiditis, docked with conservative methods, later without complications. The speech processor connecting was conducted in 3-4 weeks after surgery. During 1 year 4 tuning sessions were underway, next year – 2 sessions, then 1 session annually. By necessity the number of options was increased individually. The sign language pedagogues and logopedists activities on the development of hearing and speech perception and speech were in three stages: to teach speech and sounds listening, to develop the speech understanding, to form the genuine speech. The subsequent audio-verbal skills examination of the children every 6 months was conducted with a two-words-phrases test (TWP). The Degree of life limitation was estimated during the reexamination in the Bureau of Medical and Social Expertise once a year.

Results and discussion. The effectiveness of rehabilitation depended on previously acquired skills, intelligence, related speech disturbances, the desire and perseverance of parents and child. A year later, the data of objective postoperative speech recognition skill were obtained for 18 patients. TWP index ranged from 60% to 100%. All patients have a well-developed speech and language skills. Children draw upon the healthy children. The greatest results in the speech development have children who has had surgery at the age of 1-3 years, with a postlingval deafness. 8 patients attend regular school (11,8 %), 12 children go to kindergarten (17,6 %) and 7 (10,1 %) are engaged in pre-schools for the hearing impaired. With rapid positive dynamics in the objective condition of patients, the change of social status after the CI is more delayed in time. The decrease in the loss of orientation is faster, slow are communication and learning. As a result of long-term rehabilitation some patients will have no life limitation, but this expectation is early now.

Conclusions. CI offers good prospects for deaf children rehabilitation, for their education, profession, integrating in hearing environment. The Integration into society is gradual, it is dependent on the child biomedical features and his parents motivation.