1. Differences in the sensitive phase
of the maturation of the
auditory and visual pathways
Dr. Dr. hc. Monika Lehnhardt
Cernobbio, June 2008

2. „Direct stimulation of the
auditory nerves with resultant
speech perception is not feasible
M. Lawrence, 1964

3. “It is a crime to provide deaf
children with a cochlear implant”
German physiologist R. Klinke, 1988

4. From: “Strabismus und Motilität” Zur Entstehung der Amblyopie. Experimentelle Untersuchungen, G.K. v.
Noorden Ber. Dtsch. Ophthalmol. Ges. 77, 815 – 828 (1980), P. 821, Abb. 4a

5. Presbyopie Presbyacusis
physiological, pathological,
mechanical sensorineural

7. Charles Eyries, André Djurno,
Otologist in Paris Engineer co-working
with Eyries

8. Fritz Zöllner Wolf Dieter Keidel,
Otologist in Freiburg Physiologist in Erlangen

10. History of the Cochlear Implant
 Vision for a technology that
would enable the deaf to hear
 Research supported by public
donation, commenced 1967
 First cochlear implant, 1978,
Melbourne Hospital
“In spite of the problems and criticisms, I just had to go on.
A cochlear implant was their only hope of ever hearing.”
Professor Graeme Clark

11. Prof. Dr. Dr. med. dent. hc. Ernst Lehnhardt

12. The Window
of
Opportunity

13. Sharma et al, 2002
Ear and Hearing, December 2002

14. Sharma et al, 2004
450
400
350 13 month old recipient
P1 latency, ms
300
250
200  At CI activation
150
100 1 week post CI
50 Normal limits 1 month post CI
0
0 5 10 15 20 25 30  3 months post CI
Age  12 months post CI
350
300
P1 latency, ms
250
200
14 month old recipient
150
100
50
Normal limits
0
0 12 24 36
Age
Archives of Otolaryngology – Head & Neck Surgery, May 2004

15. Categories of Auditory Performance
ref: P Govaerts, C De Beukelaer et al., Neurotology and Audiology 2002 (Antwerp)
Children with normal hearing
use of telephone
discrimination of speech sounds
response to speech sounds

16. Govaerts, et al. 2002
Age at Mainstream Integration
100
Percentage of children
80 Age at
implantation
60 Under 2 yrs
40 2 to 4 yrs
20
0
0 3 5 7
Age (in years)
Otology & Neurology, vol 23; 2002

17. Manuel Manrique,
et al (2004)
Reynell
7
"Reynell" age (years)
6
< 2 yrs 5
4
3
2 to 6 yrs 2
1
0
0 1 2 3 4 5 6 7
Chronological age (years)
Laryngoscope, August 2004

18. Svirsky, et al (2004)
Average Language Development
84
Expressive Language Age
72
60
(months)
12-24 months
48
25-36 months
36
37-48 months
24
12
0
0 12 24 36 48 60 70 84
AGE (months)
Audiology and Neuro-Otology, vol. 9, 2004

19. Lone Percy-Smith
E. Danish CI centre, Gentofte Hospital University of
Copenhagen. October 2007
Factors associated with Speech/Language
Outcomes and Social Well-being
for Children with
Cochlear Implant in Denmark
N=168. 91 girls. 77 boys.
Age 1-18yrs. Mean age if CI = 4 years
50 spoken language 85 support sign 30 sign

20. Lone Percy-Smith continued
Summary – Speech and Language Data
tests scored for HA, not CA.
• Strong statistical effect of communication mode
at home
• Clear improvement of sp./lang. dev. for children
exposed to spoken Danish only
• Parent assessments and test responses are highly
positively associated. (auditory capacity and
speech intelligibility)

21. Lone Percy-Smith conclusions
• 64% of CI children had high level of social wellbeing
• 36% of CI children with low level
- 57% operation age >36 mon
- 68% in schools or kindergarten for deaf
- 85% use sign support or sign language
Level of social well being significantly associated with
communication mode.

22. Early implantation
Waltzman S & Roland T. 2005 Pediatrics
‘Cochlear Implantation in Children Younger
than 12 Months’
James A. & Papsin J. 2004 The Laryngoscope
‘Cochlear Implant Surgery at 12 Months
of Age or Younger’.
Colletti V. et al. 2005 The Laryngoscope
‘Cochlear Implantation at under 12 Months:
Report on 10 Patients.’

23. Vision
In 20 years, an implant will
be the treatment of choice for
anyone with a hearing loss
greater than 50 dB
Dr Jay Rubenstein , March 2004

24. Thank you for your attention!