[The cochlear implant--evolution of hearing and language with an artificial inner ear].

One of the most spectacular progresses in modern medicine is the possibility to replace a deaf ear, a sensory organ in total by an implantable electronic prosthesis, a so-called cochlear implant (CI). The CI stimulates the auditory nerve by electrical pulses and thus generates the sensation of hearing along the auditory pathway. One of the most impressive aspects of cochlear implantation is the fact that small children with profound deafness who were able a few years ago to learn spoken language only to very limited extent may achieve nowadays an almost normal language development. Duration and intensity of the training of listening and spoken language vary considerably as a function of etiology and time of deafness. Most important for the development of language is sufficient stimulation of the auditory pathway during early childhood. Early diagnosis of a severe to profound deafness is most important in order to fit hearing aids or a cochlear implant without a time delay. Affected children need intensive training by professionals specialized in education and speech therapy. Adults and adolescents who lost their hearing when language acquisition was established may understand spoken language only a few weeks after receiving a cochlear implant. Several individuals are able to use the telephone. Preliminary results after bilateral cochlear implantation of children and adults show advantages. Not only do these subjects report "better hearing with two CI as compared to hearing with one CI," but some of them developed directional hearing in a rather short time lag after fitting the second implant. And in addition they achieve better speech discrimination in environmental noise.