Release date: 2014-07-21
At present, deafness due to deafness has become a major disease that seriously affects the quality of our population. For deaf patients, the cochlear implant opens a skylight that leads to the world of sound.
At the 37th Annual American Academy of Otorhinolaryngology Academic Research held recently, Professor Yang Shiming, director of the Department of Otorhinolaryngology Head and Neck Surgery of the General Hospital of the Chinese People's Liberation Army, was invited to attend more than 2,000 cochlear implants in the department in the past 20 years. As well as the current status report on the current state of artificial hearing implants in China, it has aroused widespread concern from peers.
According to the results of the second sample survey of disabled people in China, the number of hearing and speech disabled patients in China reached 27.8 million, ranking first among the disabled groups in the country. As a result of deafness, it became a major disease that seriously affected the quality of our population. "The treatment of a large number of deaf patients needs to be resolved. Deafness is divided into conductive sputum and sensorineural hearing loss. Among them, sensorineural deafness caused by the regeneration of human inner ear hair cells can account for about 70% of severe deafness. The treatment of deafness is still a worldwide problem," said Yang Shiming.
The sooner the cochlear implant is implanted, the better.
A cochlear implant is an electronic device that converts sound into a certain encoded form by an in vitro speech processor, and directly stimulates the auditory nerve by implanting electrodes in the body to restore or reconstruct the auditory function of the deaf.
In recent years, with the development of electronic technology, computer technology, phonetics, electrophysiology, materials science, and ear microsurgery, cochlear implant technology has also developed rapidly. Cochlear implants are now the world's revolutionary new technology for the treatment of severe sensorineural deafness. After the patients with severe hearing impairment are implanted into the cochlea, they can say goodbye to sign language and lip reading through speech rehabilitation training, and communicate with others and integrate into society like normal people.
It is widely believed in the medical community that the implantation of cochlear implants is by far the most effective method for treating severe deafness. If hearing-impaired children can perform appropriate hearing interventions in early childhood, such as implanting cochlear implants or wearing hearing aids, they can and normally People live and learn together. Most of the newborns with severe hearing impairment are only stunned. If they can get interventional therapy and speech rehabilitation training in time, they can learn to speak. For children with severe deafness, the sooner the cochlear implant is implanted, the better.
Hearing implant technology has brought about a technological revolution in the treatment of deafness, which has enabled hearing in children with pre-linguistic sputum, adult linguistic fistula, and complex middle ear malformation. However, many diseases such as cochlear ossification and small ear malformation have become absolute or relative contraindications due to complex conditions, resulting in many severe hearing-impaired patients in China, who missed the best implantation and rehabilitation because of inoperability. period. On the other hand, auditory neuropathy is the most difficult and complicated type of rickets, and its pathogenesis is unknown. Even if the effect of cochlear implantation is unpredictable, it is necessary to conduct in-depth research on pathogenic mechanisms and therapeutic targets. Yang Shiming pointed out.
"With the improvement of the understanding of cochlear development and inner ear disease, cochlear implants have been solved in most complex cases by adopting new techniques." Yang Shiming introduced that cochlear implants with common cavity deformities still have functional hair. Cells, through the combination of intraoperative CT navigation, make it possible to restore hearing to the cochlear implant; for example, the second implantation technique of the cochlea or the vestibular step implantation ensures the successful implantation of the cochlear ossification patient.
Finding the root cause of auditory neuropathy is the key
Current research data show that the success rate of cochlear implants for the treatment of auditory neuropathy at home and abroad is generally less than 50%. Therefore, even the use of cochlear implants for the treatment of auditory neuropathy still has great uncertainty.
"In the clinical practice of hearing implants for treating rickets, it is difficult to judge the location of the auditory neuropathy because it is difficult to judge. It is difficult for doctors to evaluate the effect of patients after implantation. Therefore, how to reduce the effective implantation of patients with auditory neuropathy has become an international The main problem that needs to be solved in the treatment of upper rickets. To reduce the ineffective implantation of cochlear implants in patients with auditory neuropathy, the key is to identify the main pathogenic parts of auditory neuropathy," said Yang Shiming.
"We found that the key lesions occurred in the inner hair cell ribbon synapse. It is clear that there are synaptic types in which auditory neuropathy is the key pathogenic synapse, and this type of auditory neuropathy is implanted in the cochlear implant. It is possible to reconstruct the damaged hearing function. Therefore, we propose a new classification of synaptic auditory neuropathy, which is used to determine the expected effect of the cochlear implant in the auditory nerve patient, and solves the problem of treatment of auditory neuropathy." Yang Shiming introduced.
Domestic electronic cochlea brings the gospel
As of 2013, about 30,000 patients with severe sensorineural deafness in China have undergone cochlear implant therapy, but for nearly 300,000 potential patients who need surgery, it is tantamount to a drop in the bucket.
At present, China's domestic auditory implant products mainly rely on imports. The domestic cochlear implant market is still occupied by imported products, and the high price of imported cochleas of about 200,000 yuan has discouraged many domestic patients. Therefore, implanted products with China's independent intellectual property rights are imminent.
Local companies are trying to change this pattern. For example, the domestic Norcon-Mornings multi-channel cochlear implant system has completed clinical trials of NSP-60 speech processors and CS-10A implants in vitro in many hospitals in China. And the clinical effect can be comparable with imported products, verifying safety, stability and effectiveness. It has been successfully listed and put into large-scale production. In 2012, it was approved by the Chinese FDA. Now more than 1,000 clinical applications in more than 30 large hospitals in China In 2013, it was certified by the European Union and exported to foreign countries. It became the first internationally recognized Chinese cochlear implant.
In addition, Yang Shiming's research team has proved for the first time in the world that it has self-repairing ability after cochlear hair cell cilia damage, and proposes a new perspective of deafness intervention time window, which provides an important theoretical basis for deafness gene and stem cell therapy. Further research by the research team found that Math1 gene induced hair cell cilia regeneration and improved hearing. At the same time, it successfully developed a nano-gene new vector with complete independent intellectual property rights for inner ear introduction. The development of nano-carrier succeeded in the regeneration of mammalian hair cells. Clinical application is possible.
Source: Technology Daily
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