청각재활 - 와우이식

이준호 한양대학교 의과대학 2015 Hanyang Medical Reviews Vol.35 No.2

The first cochlear implant was approved about 30 years ago. It just provided a limited sensation of sound and facilitated lip-reading based communication. Recent advances in the cochlear implant system and surgical techniques have enabled the majority of recipients to communicate orally without visual cues. The cochlear implantation has become a standard means of auditory rehabilitation for profound sensorineural deafness. To evaluate candidacy for cochlear implantation, an objective and behavioural audiological test, imaging and functional studies to identify the status of the cochlea and the auditory nerve, and evaluation of additional medical conditions are needed. Although the cochlear implantation can restore auditory function, sound perceived with the cochlear implant is different from normal hearing. Therefore postoperative rehabilitation is crucial for good speech performance. Nowadays, the indications for cochlear implantation have been extended. Hearing loss patients with residual low-frequency hearing could be candidates for cochlear implantation. Therefore, residual hearing preservation during cochlear implantation has been an important issue. In addition, bilateral cochlear implantation, cochlear implantation for single-sided deafness and fully implantable cochlear implant systems have been receiving more attention. The purpose of this article is to review current knowledge concerning the cochlear implantation.

현재 인공와우를 착용하지 않는 청각장애 청년들이 인식하는 인공와우 경험에 관한 연구

고혜정(Hye Jung Ko),김경미(Kyung Mee Kim) 한국장애인복지학회 2021 한국장애인복지학 Vol.52 No.52

지금까지 인공와우 관련 선행연구들은 말지각력과 말산출력에 초점을 두어 인공와우 시술을 받은 청각장애 아동들의 인공와우 관련 삶을 살펴보지 못하였다. 이에 본 연구는 청소년기 이전에 인공와우 시술을 받았으나 현재 인공와우를 사용하지 않는 청각장애인들의 인공와우 관련 경험을 탐색해보고자 하였다. 이를 위해 20~30대 청각장애 청년 7명을 대상으로 심층면담을 통해 자료를 수집하였다. Colaizzi의 방법으로 분석한 결과 다음과 같은 5가지의 주제를 도출하였다. 그 주제는『인공와우 시술에 대한 낙관적인 안내』,『인공와우에 대한 적응기』,『인공와우로 인한 갈등기』,『손상을 바라보는 새로운 시각』, 『인공와우로부터 해방』이다. 이를 기반으로 실천적 함의를 다음과 같이 제시하였다. 첫째, 의료계에서는 청각장애인의 의사소통에 도움을 주는 공식적인 수어통역 및 문자통역을 의무적으로 활용하여 제3자가 아닌 청각장애인 당사자에게 부작용과 결함 그리고 청각장애의 원인에 따른 인공와우의 정확한 시술 결과 등을 포함한 인공와우 관련 정보를 충분히 제공해야 한다. 그리고 의사의 권유가 아닌 청각장애인 당사자가 결정을 내리도록 지원해야 한다. 둘째, 인공와우는 소리가 들린다 해도 의사소통의 어려움을 해소해주는 완전한 기기가 아니다. 그러므로 인공와우에 대한 건청인의 인식개선이 필요하다. 또한 인공와우를 착용한 청각장애인들은 정확한 의사소통을 위해 수어와 필담이 필요하므로 청각장애인의 개개인의 의사소통 방법에 따라 필요시 수어통역 및 문자통역 서비스를 제공하여야 한다. 셋째, 인공와우를 통해 손실된 청력을 회복시킨다 해도 청각장애의 속성은 온전히 고칠 수 없다. 따라서 청각장애인에게 개인적 책임을 지우는 것이 아니라, 국가와 사회에서 장애를 발생시키는 제반환경에 대해 인식하고 이를 해결해야 하는 사회적 책임을 인식할 필요가 있다. Many studies on cochlear implants were focused on improvement in ability to hear and on speech perception and production. Therefore, there are few studies that have explored the experiences of deaf people who got cochlear implant as children and side effects from cochlear implants. For study, the interviews were conducted with 7 deaf people in depth. The participants got cochlear implants as children, but they don t use it now. The themes are 1) Having expectation for cochlear implants 2) Trying to adapt myself to cochlear implants 3) Raising a question about cochlear implants 4) Looking at deafness in a new way 5) Deciding to stop cochlear implants. It suggests several implications on the findings. First, Doctors must give all information, including any side effects, defects, effects of inner ear anomaly, and so on. For this, it is very important to provide sign language interpreters and communication access realtime translation services for deaf people. Second, deaf people with cochlear implants can hear anything. However, cochlear implants are only a device which can t make deaf people into hearing people. It is important to increase awareness of cochlear implant for hearing people who think that deaf people with cochlear implants might be able to communicate easily. If necessary, deaf people using cochlear implants should be given sign language interpreters and communication access realtime translation services for communication. Third, even thought deafness can be restored with cochlear implants, the nature of deafness can never be fixed. This is not a personal responsibility, but it is our responsibility as a society, and the society need to pay attention to the social issues in the deaf people lives.

선천성 난청 소아들의 인공와우 이식 후 언어 발달: 장기 추적 관찰 결과

류진현,정다정,조현호,이재호,이상흔,이규엽 대한이비인후과학회 2016 대한이비인후과학회지 두경부외과학 Vol.59 No.7

Background and Objectives It is well established that cochlear implantation provides significant benefits for prelingually profound deaf children. However, there are few studies that examined the long-term outcome of cochlear implantation beyond 10 years in prelingually deaf children. The purpose of this study was to examine the long-term benefit of cochlear implantation for children with more than 10 years of experience of using cochlear implantation, regarding auditory performance and academic status. We then determined the age effect of cochlear implantation on auditory performance for prelingually deaf children. Subjects and Method The longitudinal development of auditory performance of 119 deaf children was analyzed after cochlear implantation. Among the 119 children, 58 were included for analysis. Results The children who received cochlear implanst at younger age showed significantly better auditory performance. Age at which implantation had been performed had a significant effect on the development of auditory performance before 4 years of age. Many children continued to demonstrate improvements of auditory performance upto five years of implant use. Some showed development of auditory performance upto 10 years cochlear implantation. Conclusion The present result indicates that speech perception and performance for children continue to improve over time from 5 upto 10 years while using cochlear implant. The use of earlier cochlear implantation was demonstrated to provide better auditory performance. The age at which implantation was performed was one of the important factors influencing the long-term outcome of cochlear implantation. Korean J Otorhinolaryngol-Head Neck Surg 2016;59(7):502-9

보청기와 인공와우 기기에 대한 대학생들의 인식 및 태도: 보청기 효과와 인공와우 효과

허민정 ( Min Jung Heo ),김리석 ( Lee Suk Kim ),안성우 ( Seong Woo Ahn ),부성현 ( Sung Hyun Boo ) 한국특수교육문제연구소 2008 특수교육저널 : 이론과 실천 Vol.9 No.3

본 연구는 보청기와 인공와우 기기에 대한 대학생들의 인식 및 태도를 알아보고, 보청기와 인공와우 기기에 대한 태도와 관련된 변인을 알아보고자 하는 것이다. 이를 위해 114명의 대학생에게 보청기와 인공와우 기기를 착용한 조건과 착용하지 않은 조건에 대해 형용사형 척도를 작성하게 하였고, 보청기와 인공와우 기기에 대한 태도 설문 조사를 시행하였다. 연구결과를 살펴보면 보청기와 인공와우 기기 모두 착용하지 않은 조건보다 착용한 조건에 대해외모, 성격, 성취에서 더 부정적인 평가를 받았다. 성별로 비교한 결과 여성 보다는 남성에대한 평가가 더 부정적이었다. 또한, 보청기보다 인공와우 기기에 대해 사회적 낙인, 개인적견해, 지식에서 더 부정적인 태도가 나타났다. 관련된 변인을 분석한 결과 성별과 안경 혹은콘텍트렌즈 착용 유무가 인공와우 기기 착용자에 대한 사회적 낙인과 상관관계가 있는 것으로 나타났다. 이는 한국의 대학생에서도 보청기나 인공와우 기기에 대한 ‘보청기 효과’와 ‘인공와우 효과’가 있음을 보여주는 결과이며, 보청기보다 더 외형적으로 드러나는 인공와우 기기에 대해 더 부정적인 태도를 가짐을 보여주는 결과라고 할 수 있다. This study aims to investigate the perception and attitude of university students about hearing aid and cochlear implant, and to examine the variables related to their attitudes towards hearing aid and cochlear implant. The subjects were 114 university students, who were asked to see the pictures on wearing conditions and non-wearing conditions of hearing aid and cochlear implant and complete the adjective format scale . Also, they saw the pictures of hearing aid wearer and cochlear implant wearer, and completed the questionnaires about attitude for hearing aid and cochlear implant. Results show that university students show more negative perception about wearing conditions than non-wearing conditions on appearance, personality, and achievement for both hearing aid and cochlear implant. Attitude for cochlear implant was more negative than that for hearing aid on social stigma, viewpoint, and knowledge. As a result of analyzing related factors for attitude about hearing aid and cochlear implant, sex and wearing glasses or contact lenses were related to the social stigma for cochlear implant users. These results show that there exist ‘hearing aid effect’ and ‘cochlear implant effect’ in Korean university students, and their attitudes are more negative for cochlear implant than for hearing aid.

Long Term Outcomes of Early Cochlear Implantation in Korea

서명환,김봉직,장선오,김종선,오승하,Eung Kyung Cho 대한이비인후과학회 2009 Clinical and Experimental Otorhinolaryngology Vol.2 No.3

Objectives. The objective of this study was to compare the long-term auditory performance and language skill depending on the age of cochlear implantation in the Korean population. We especially tried to separate the effect of maturation/ development from that of the age at implantation. Methods. Eighty-six pre-lingual children with profound hearing loss who underwent a cochlear implantation before the age of six and had been followed for more than 3 yr were included in this study prospectively. Categories of Auditory Performance (CAP) and Korean Picture Vocabulary Test (K-PVT) were serially followed up. In order to separate the age at implantation effect, K-PVT results were readjusted to the child’s chronological age in the normal hearing population. Results. When the CAP and K-PVT scores were directly compared without chronological readjustment, we failed to show a significant difference for improvements according to the age at implantation. Early cochlear implantation was associated with better language development, only when the K-PVT scores were readjusted to percentile scores of their chronological age. Conclusion. Early cochlear implantation was associated with better language development even within the critical period. This advantage may be recognized only when the effect of the age at implantation is separated from the effect of maturation/development. Objectives. The objective of this study was to compare the long-term auditory performance and language skill depending on the age of cochlear implantation in the Korean population. We especially tried to separate the effect of maturation/ development from that of the age at implantation. Methods. Eighty-six pre-lingual children with profound hearing loss who underwent a cochlear implantation before the age of six and had been followed for more than 3 yr were included in this study prospectively. Categories of Auditory Performance (CAP) and Korean Picture Vocabulary Test (K-PVT) were serially followed up. In order to separate the age at implantation effect, K-PVT results were readjusted to the child’s chronological age in the normal hearing population. Results. When the CAP and K-PVT scores were directly compared without chronological readjustment, we failed to show a significant difference for improvements according to the age at implantation. Early cochlear implantation was associated with better language development, only when the K-PVT scores were readjusted to percentile scores of their chronological age. Conclusion. Early cochlear implantation was associated with better language development even within the critical period. This advantage may be recognized only when the effect of the age at implantation is separated from the effect of maturation/development.

인공와우이식술 환자에서의 이명: 예비 연구 결과

김동기,박시내,박경호,노혜일,김예원,고창용,박창우,여상원 대한이비인후과학회 2010 대한이비인후과학회지 두경부외과학 Vol.53 No.7

Background and Objectives With the wide use of cochlear implants, there have been many published studies which report that cochlear implants have a suppressive effect on tinnitus in profoundly deaf patients. The aim of this study was to understand the clinical and audiologic characteristics of the tinnitus in patients with cochlear implantation and to observe changes of their tinnitus after cochlear implantation. Subjects and Method A total 23 patients who had undergone cochlear implants in our hospital from August 2003 to December 2006, were included in this study. The patients were divided into tinnitus (n=11) and non-tinnitus groups (n=12) according to the presence of tinnitus at the time of surgery. We compared clinical and audiologic features between the two groups. We also studied changes in tinnitus after surgery in the tinnitus group using validated self-report measures [tinnitus handicap inventory (THI), tinnitus handicap score (THS), and visual analogue scale]. Results There were significant differences between the two groups with respect to the age of cochlear implant recipients, whether or not the subjects had impaired hearing or were wearing hearing aids. Tinnitus was rarely observed in patients under 20 years of age with cochlear implantation (11.1%) in contrast to the higher rates in the patients of 20 years old and over (71.4%). Marked reduction of THI, THS and visual analogue scale of tinnitus were observed in all patients. Conclusion For the adult patients who had undergone cochlear implant surgery and had tinnitus preoperatively, cochlear implants had shown suppressive effect on their tinnitus. Considering the significant prevalence of tinnitus in profoundly deaf patients, tinnitus of these patients should not be overlooked and further studies should be made to define relationship between cochlear implant and tinnitus. Korean J Otorhinolaryngol-Head Neck Surg 2010;53:408-11

인공와우 착용 아동의 작업기억, 문장이해력과 문장인지도 간의 관계

박소현,방정화 한국청각언어재활학회 2011 Audiology and Speech Research Vol.7 No.1

This study was to examine the relations among working memory, sentence comprehension and recognition performance by children with a cochlear implant. 20 subjects, divided in two groups, participated; 10 normal hearing children and 10 children with a cochlear implant. Children were all between 6 and 8 years old. The duration of implant use for all children with a cochlear implant was between 4 and 6 years. In the working memory task, children recalled words under three different processing load conditions (i.e., no-load, single-load, and dual-load conditions). In the sentence comprehension task, children listened sentences and chose one picture that explained the sentences. In the sentence recognition task, children listened the target sentence and repeated it or wrote it down. Results of the memory task showed that two groups were not significantly different. However, the children with a cochlear implant showed poorer performance in recalling words in the dual-load condition than those in the other conditions. On the sentence comprehension and recognition tasks, children with a cochlear implant group showed poorer performance than normal hearing children group. In all the three tasks, there were individual variabilities in children with a cochlear implant group. Results of the relationship among three tasks indicated that scores of dual-load condition task were significantly correlated to those of sentence comprehension and recognition tasks in children with a cochlear implant group. Conclusively, findings suggested that children with a cochlear implant have a similar working memory capacity to that of normal hearing children due to early intervention of auditory, speech and language. In addition, findings from children with a cochlear implant group also indicated that their processing capability, especially a complex process, may influence their language ability.

인공와우 이식자의 듣기연령에 따른 음소위치별 자음정확도

허명진 한국언어치료학회 2016 言語治療硏究 Vol.25 No.2

Purpose: Deaf children have problems with the development of articulation and phonology due to hearing loss that may decrease awareness of speech sound. The speech perception ability of cochlear implanted children was better than that of children with hearing aids. The purpose of this study was to identify the difference of consonant accuracy according to hearing-age for deaf children with cochlear implant. Methods: Fiftytwo deaf children with cochlear implant participated in this study. They ranged in age from 3 to 23 years and had received cochlear implantation at least six months ago. Their hearing-age ranged from 12 to 216 months and hearing levels with cochlear implant were between 20 and 35 dB HL. They had no problem with cognition. The Korean articulation phonological test (U-TAP: Urimal Test of Articulation and Phonation, Shin & Kim, 2007) was used to investigate the accuracy of their consonants. In order to collect speech samples, the subjects were recorded using the R-09HR (Edirol by Roland) in a clinic room. In the analysis, frequency analysis and one-way ANOVA were conducted. Results: Deaf children with cochlear implant got higher consonant accuracy depending on hearing-age, especially after 24 months. According to the consonant place of words, there displayed consonant accuracy increased at word-initial, word-medial and word-final, respecitvely. Conclusions: There was strong relationship between hearing-age and consonant accuracy of children with cochlear implant. The results of this study were similar to articulation development of children with normal hearing. Therefore, if children with hearing impairment would have cochlear implant operation as early as possible, it is expected that they might generate clear articulation as early as possible. 목적: 청각장애아동은 청력손실로 인하여 말소리 인지력이 떨어지면서 조음 및 음운발달이 지체되거나 대치된다. 인공와우 이식자는 인공와우 착용 기간이 길어질수록 말소리 인지력이 높아진다는 선행연구의 결과를 바탕으로, 인공와우 이식자의 조음 및 음운산출이 달라질 것이다. 본 연구에서는 인공와우 이식자가 말소리를들어온 듣기연령에 따라 자음정확도와 조음위치별 자음정확도의 변화를 살펴보고자 한다. 방법: 본 연구 대상자는 인공와우를 이식하고 소리를 들은 지 6개월 이상 된 52명의 청각장애인으로, 이들의 연령은 3세-23세이며, 듣기연령은 12-216개월이었다. 이들은 청각이외에는 다른 감각장애를 동반하지 않으며, 인지적인 문제를갖고 있지 않는 사람들로 하였다. 인공와우 이식자의 자음정확도를 조사하기 위해 우리말조음음운검사(U-TAP)를 조용한 언어치료실에서 실시하였고 모든 언어샘플은 R-09HR(Edirol by Roland) 녹음기로 녹음하였다. 조음정확도 분석의 신뢰도를 높이기 위해 3년 이상의 조음치료 경험이 있는 언어치료사 2명이 분석하였다. 결과자료는 일변량분산분석과 빈도분석으로 처리하였다. 결과: 인공와우 이식자는 듣기연령에 따라 자음정확도가 높아졌으며, 특히 24개월 전에 비해 24개월 이후로 유의하게 향상되었다. 조음위치에 따라 어두- 초성, 어중-초성, 어말-종성 순으로 정확도가 높았으며, 듣기연령에 따라 자음 정확도도 증가하였다. 듣기연령 초기에는 대부분 음소생략이 두드러지게 많았으나 점차 치조음이면서 폐쇄음인 음소로 대치해서 산출하였으며, 양순음과 비음은 25개월이 지나면서 90%이상 정조음을 산출하였다. 결론: 인공와우 이식자의 듣기연령이 증가할수록 자음산출력이 향상되었으며, 이것이 일반아동의 음소발달패턴과 유사하였다. 따라서 청각장애아동이 조기에 인공와우를 이식받는다면 음소 및 음운발달이 이루어져 조음오류가 감소할 것이다. 이것은 청각장애아동의 음운변동에도 영향을 미칠 수 있으므로 인공와우 이식자의 음운변동 패턴의 변화 연구에 대한차후 연구가 이루어져야 할 것이다.

Health-Related Quality of Life in Children With Cochlear Implants From Parents’ Perspective

Rochd Sara,Benhoummad Othmane,Lakhdar Youssef,Salhi Salma,Lhadj Mohamed Amine Ait,Rochdi Youssef,Raji Abdelaziz 대한청각학회 2023 Journal of Audiology & Otology Vol.27 No.3

Background and Objectives: To evaluate the health-related quality of life (HRQoL) in parents of children with cochlear implants and assess influencing factors. These data can enable practitioners to support patients and their families in utilizing the cochlear implant and its benefits to the fullest extent.Subjects and Methods: A retrospective descriptive and analytic study was conducted at the Implantation center Mohammed VI. Parents of cochlear implant patients were asked to fill out forms and answer a questionnaire. Participants included parents of children <15 years old who underwent unilateral cochlear implantation between January 2009 and December 2019, presenting with bilateral severe to profound neurosensory deafness. Participants completed the children with cochlear implantation: parent’s perspective (CCIPP) HRQoL questionnaire.Results: The mean age of the children was 6.49±2.55 years. The mean time between implantation for each patient and this study was calculated as 4.33±2.05 years. There was a positive correlation between this variable and the following subscales: communication, well-being and happiness, and the process of implantation. For these subscales, the score was higher as the delay was greater. Parents of children who received speech therapy before implantation were more satisfied on the following subscales: communication, general functioning, well-being and happiness, implantation process, implantation effectiveness, and support for the child.Conclusions: The HRQoL is better in families of children who received their implant at an early age. This finding raises awareness of the importance of systemic screening in newborns.

측두골 자기공명영상 와우신경 저형성증 및 무형성증에서의 인공와우 이식술

김종양,이정현,이성원,오수희,정종우,이광선 대한이비인후과학회 2007 대한이비인후과학회지 두경부외과학 Vol.50 No.11

Background and Objectives:Identifying cochlear nerve hypoplasia or aplasia is dependent on temporal bone magnetic reso-nance imaging (TBMRI) providing information on the cochlea, internal auditory canal, and the cochlear nerve. The purpose of this study was to review the results of cochlear implantation (CI)TBMRI. Subjects and Method:From April 1999 to April 2005, 321 patients were fited with cochlear implants in our department by two surgeons. The present study focused on four prelingual patients who underwent CI in ears with cochlear nerve hypoplasia or aplasia as sugested by TBMRI. The perceptive and linguistic results were evaluated based on speech perception and production at preimplantation and at 1, 3, 6, 9, 12, and 24 months postimplantation. Results:Pre-operative auditory brainstem responses were ls in 10% and their categories of auditory performance scores were 4 or above. Conclusion:We confirmed cochlear nerve presence in cases of cochlear nerve hypoplasia or aplasia as sugested by TBMRI and made their auditory habilitation posible with cochlear implantation. However, even in cases of cochlear nerve hypoplasia or aplasia suggested by TBMRI, physicians need to confirm coch-lear nerve presence before implantation and to predict the outcome of cochlear implantation. Neck Surg 2007 ;50 :978-82)