Hearing loss, which is seen in 3 to 4 of every thousand children born in our country and in the world, can also occur in adults due to age or as a result of diseases affecting the inner ear. It is possible to eliminate hearing loss with today's modern implant technologies, but it is important that the treatment process, which starts with a correct diagnosis, is carried out by a specialist team and carried out in cooperation with the patient and their relatives.
Chief Physician and ENT Specialist of Diyarbakır Dicle University Medical Faculty Hospital, one of the largest health institutions in South East Anatolia. Dr. Mehmet Akdağ stated that adult and newborn patients with hearing loss have undergone a successful treatment process in the ENT Clinic of the hospital, thanks to their experienced team, from diagnosis. Expressing that the clinic, which has been working specifically and experienced in ear and ear diseases for many years, has created various algorithms in the approach to patients and diseases based on scientific and current data, Akdağ continued: “Within the framework of our treatment algorithms, which stages our patients will go through and which treatments will be applied in advance. determined. When our patients apply to our outpatient clinic, necessary evaluations are made and they are directed to appropriate treatment methods. In patients or diseases that do not fully comply with these algorithm patterns or where there is uncertainty in the treatment options, a decision is made by discussing in the council where we have two surgeons-audiologists and specialist doctors working specifically on ear diseases.
Saying that a strong team of six faculty members, eight research assistants, audiologists and audiometrists work in the clinic, Akdağ said that patients who come with hearing loss are first welcomed by the research assistant and the responsible faculty member, thanks to the regular and systematic work program, which patient is followed by which faculty member throughout the process. He stated that it was determined from the beginning. Emphasizing that the hospital management strategy is to provide competitive and high quality service with the aim of patient satisfaction within the framework of legal regulations, Akdağ stated that they increase their success day by day by using high technology and working multi-disciplinary within the framework of scientific rules in terms of both diagnosis and treatment.
Infants and pediatric patients commonly present with the complaint of inability to speak.
Saying that adult patients apply with complaints such as inability to understand what is spoken and tinnitus, Akdağ stated that complaints such as not speaking and language development being behind their peers are common in infants and pediatric patients. Stating that the options were decided according to the patient's complaint, expectations and the results of the hearing tests, Akdağ stated that they evaluated the controversial cases in terms of treatment or hearing amplification within the implant council. Patients are followed up in our polyclinic and audiology units in order to increase the benefit from the device after appropriate device or surgery.
ENT specialist working in the clinic, Prof. Dr. Müzeyyen Yıldırım Baylan said that it is very important to raise awareness of patients and families about the importance of amplification and rehabilitation. Stating that patients who do not benefit from hearing aids are evaluated in terms of suitability for cochlear implantation, Baylan said that the inner ear structures, psychological and neurological developments of the patients are examined radiologically. Baylan continued as follows: “We are operating patients who comply with medical and SSI rules for cochlear implantation within 15 days to 1 month. After the surgery, the device is activated by the audiologists after 2-4 weeks, in accordance with the recovery period of the patient. After this stage, our patients continue their rehabilitation given by the audiology unit and educational institutions. In terms of the recovery of the surgical field, monthly-3-month-6-month follow-up examinations are performed in our polyclinic.”
“The working principles of hearing aids, cochlear implants and bone conduction implants are different”
Summarizing the working principle of conventional hearing aids as amplifying the external sound and sending it to the middle ear, and from there to the inner ear and brain, Baylan stated that they recommend conventional hearing aids to patients with mild-moderate-severe sensorineural (neural) or mixed hearing loss. Stating that they evaluated patients with advanced-to-very advanced neurosensory-mix type hearing loss who did not benefit from conventional hearing aids in terms of cochlear implantation, Baylan said that the cochlear implant works by converting sound waves into electrical energy and directly stimulating the auditory nerve. Baylan pointed out that bone conduction implants activate the auditory system by transmitting sound waves directly to the inner ear through the skull bone. Baylan continued: “Every patient who does not benefit from using a hearing aid for at least 3 months and whose speech development cannot be achieved despite instrumentation and educational rehabilitation should be implanted as early as possible. Hearing pathways and hearing areas in the brain should be stimulated as soon as possible. However, this period can be after 1 year at the earliest for babies. In addition, for implantation surgery in both infant and adult patients, the health conditions must be suitable for anesthesia and surgical intervention. The operation takes an average of two hours.”
Pointing out the importance of rehabilitation and education for the patient to perceive and interpret the sounds heard by the patient with cochlear implantation and to ensure language development, Baylan stated that a significant part of the patients managed to achieve the same education level as their normal peers, and that in cases where rehabilitation is not given the necessary importance, the language development of the patients falls behind compared to their peers. Baylan said, “For this reason, cochlear implantation is not just a process of surgical placement of the device, it is necessary to perform the processes before and after it, and our patients should be highly motivated to comply with these processes.”
Giving examples of successful cases, Baylan stated that in a patient with progressive hearing loss due to auditory neuropathy who had to leave his education in high school, he was able to develop an excellent speech understanding performance after implantation and the patient was prepared for university exams again. In another example, he stated that they applied implants to a child who was at the limit of age, and that they saw that the patient, who was very active, maladaptive, constantly crying and exhibiting hyperactive behaviors, came to a completely normal and healthy point in the six months after the operation. Baylan said, “When I see the effects and results it has created, I think that it is a wonderful miracle to regain one's sense of hearing. As a team, we feel indescribable happiness every time we encounter these miracles.”
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