Anpassung von Cochlea-Implantat-Sprachprozessoren

The rehabilitation outcome with the cochlear implant is, among other factors, mainly affected by the fitting of the system to the individual needs of the patient. Accompanying the rapid advances in the technical development of these hearing prostheses and the surgical approach there has been a marked extension of the indication criteria. Children and adults who receive deaf benefit as well as patients with residual hearing who do not attain a sufficient gain in speech intelligibility with the best possible hearing aid can be helped with cochlear implants. Congenitally deaf children are provided with cochlear implants very successfully at the age of one and the bilateral implantation has become standard clinical procedure whenever the indication criteria are fulfilled for both ears. The group of cochlear implant patients is very heterogeneous with respect to their anatomic conditions, listening experiences and particular needs. That is why a wide inventory of methods is necessary to manage appropriately the patient specific fitting of the cochlear implant system. Interactive psychoacoustic procedures, which have proved their worth in audiology and hearing aid fitting, are helpful for adolescents and adults. Especially the categorical loudness scaling can be very helpful. Particularly with small children and uncooperative patients, the audiologists like to base their efforts on the results of objective investigations in the iterative process of fitting. These measurements can be done during surgery as well as in the long-lasting period of fine tuning. The electrically evoked stapedius reflex and the telemetric recording of electrically evoked potentials of the nervus acusticus are especially helpful. Information for the parameter selection that is necessary during the process of fitting is available from the accompanying evaluations on different levels of the auditory processing.