Modern rehabilitation medicine has been widely introduced in Japan over the last 60 years and has become increasingly socially important. Originally (since the war), it was indicated for patients with dismemberment, spinal cord injury, poliomyelitis, or cerebral palsy. However, in the recent context of declining birth rates and an aging population, it has come to be indicated for patients with stroke, dysphagia, speech disorder, and so on. Rehabilitation has been developed for disorders that cannot be treated by conventional medical care through diagnosis and treatment based on etiology, pathology, and disease mechanisms. It is difficult to demonstrate scientific evidence of treatment techniques equivalent to therapeutic effects. Therefore, this aspect is qualitatively different from general medical practice. In the field of hearing disorders, diagnostic techniques for hearing loss, hearing aid devices, cochlea implants, and hearing support devices have progressed through recent technological advancements. Consequently, provision of comprehensive rehabilitation has come to be increasingly required, such as early detection of infantile deafness, utilization of artificial cochlea, and hearing supportive services for the elderly. In this review, hearing disorder is defined according to the International Classification of Functioning, Disability and Health by the World Health Organization. We show an outline of rehabilitation for hearing disorders.
After the Medical Act revision in 2001, it has become possible for students with severe hearing impairment to become medical doctors in Japan. However, there is as yet no established educational method or support system for doctors with hearing impairment. We accepted and educated a student, who was the third medical student with profound hearing impairment to be enrolled in Japan. He graduated from the university, passed the national examination, and started clinical training. We retrospectively investigated the problems during these periods, which were 1) education in medical school, 2) national examination, and 3) clinical training. 1) Although we prepared the support of abstract writing on a personal computer, he did not use it and wanted to study by himself. His way of studying was accepted and supported. 2) He was treated properly during the national examination, and was not made to feel his handicap. 3) Two of 70 new patients rejected being treated by a doctor with hearing loss. Therefore, an announcement was made in the hospital bulletin and a sign language translator was employed by the hospital. To realize a barrier-free society in which a doctor with hearing impairment can fully demonstrate his ability, it is essential to accumulate further such experience, in undergraduate medical schools and clinical training hospitals.
The aim of this study was to evaluate the adaptation condition and subjective sound impression under hearing-aid initial fitting during the initial fitting of a hearing aid. Five patients with mild-to-moderate hearing loss were enrolled in this study. Four types of hearing aids were adjusted fitted for each patient in both ears, in order to compare the results among them. The objective evaluation was conducted using the hearing-aid adaptation test (2010) according to the Japanese guideline, and the subjective evaluation was performed by a semantic-differential method. The results revealed that all of the hearing-aids were adapted. In regard to the sound impression, it seemed significantly more “calm” with hearing aids equipped with multichannel compression and noise suppression systems than with those without these systems, and “clear” with hearing aids with wide-frequency bandwidths. However, the sound impression varied among individuals and sound sources. Therefore, subjective evaluation of hearing aids necessitates the use of sound sources with different frequency characteristics, and the wearing of hearing aids needs to be evaluated not only objectively, but also subjectively.
Four deaf-blind patients underwent cochlear implantation at Tokyo Medical University Hospital. Two of the patients were visually impaired, but were able to communicate by reading big letters before the operation. The others had total blindness, and used finger spelling before the operation. All the patients responded well to cochlear implantation. Three patients showed good speech discrimination. They were able to converse without finger spelling or reading after the operation. One barely acquired few semi-closed set discriminations, but is happy being able to perceive environmental sounds. Cochlear implantation is a valuable addition in the rehabilitation of acquired deaf-blind patients.
We investigated the outcome of young cochlear implantees who had undergone the surgery at an early age and reached over the age of 12. Forty-three children underwent cochlear implantation at Tokyo Medical University hospital, and their hearing threshold with cochlear implants (CIs), speech discrimination scores, vocal articulation, and vocabulary were evaluated. The speech discrimination scores and vocal articulation were better in those who had undergone the surgery at the age of 2-3 years. However, there was no significant difference depending on the age at implantation in regard to the hearing threshold with CIs or the vocabulary. Vocabulary was a significant factor in the choice of the educational set up for the mainstream in both primary and secondary junior schools. Thus, early intervention with CI was effective for lingual development and understanding of speech in children with severe to profound deafness. Care should also be taken towards social skill development of these children, in addition to their auditory habilitation.