Every member of the Bratislava Cochlear Implant team remembers the date July 8, 1994 when the first cochlear implantation has been done in the ORL department in old building on Zochova street in Bratislava. Prof. Ernst Lehnhardt (Hannover) was so kind to do the first surgery and to teach Prof. Milan Profant this surgical technique. This was also commemorative day for Martin who became the first cochlear implant user in Slovakia and who thanks to his diligence but also thanks to his restored hearing with cochlear implant graduated from the Technical University where he works today as an assistant in the Mathematic-Physical Faculty.
There were several years of preparation prior to the first CI in Bratislava. Preparation of audiological tests for patients with minimal auditory capabilities, selection of suitable candidates, acquainting with new technologies, surgical technique, ways of rehabilitation have been done by the CI team members. Together with author of Slovak speech audiometry Zdenko Bargar MD we have created tests of minimal auditory capabilities which we recorded in the Slovak TV with voluntary help of professional speakers. Possibility to use the most modern implants of that period as Nucleus 22 (Cochlear), Pulsar (Medel) was a great advantage for us. We also have received significant help from the CI centers in abroad (Warsaw). Cochlear Implant team achieved a lot of experience in the hearing loss diagnosis, surgical techniques and rehabilitation. Individual protocol for the CI patient management has been created. From early beginning Cochlear implant team covered the full range of the program. Otologists (Milan Profant, Zuzana Kabátová), audiologists and otoneurologists (Milan Jäger, Zuzana Kabátová) Phoniaters (Štefan Šimko), speech therapeutist (Ľudovika Šimková, Dagmar Gregorová), audiological nurses (Gabika Petríková, Iveta Bonková, Helenka Struková), technicians (Kamil Seginko, Marek Polák) worked hard even in their free time to complete the task. Later on other colleagues joined the group (Lukáš Varga, Zuzana Pospíšilová, Ľubica Šuchová, Baja Bercíková, Richard Lapoš, Ivan Fekete). Each candidate was evaluated not only as a deaf person but also as a human being with his/her personal and professional problems, with the life that the deafness has changed so much.
First two cochlear implantations have been done in children with acquired deafness after meningitis respectively head trauma followed by implantations in post lingually deaf adults. Later on, children with prelingual deafness were included in the CI program in Bratislava. Today we have 310 implanted children mostly with congenital deafness and 260 adults. There are significant changes in selection criteria from the time of our first cochlear implantation. While in the early period only completely deaf adults and children were implanted. Later on – with good results and more experience – also patients with residual hearing have been implanted to give them a chance for significant improvement of their communication skills. Indication criteria have been broadened to implant children and adults bilaterally and also to select patients with unilateral deafness and tinnitus. Electro-acoustic stimulation has also been included into our program. Important milestones in our program were years 1999 – when the first child under the age of 2 was implanted and year 2000 with the first bilateral implantation. Our oldest patient was implanted in her age of 82 years. The surgical technique has also changed. Complicated flaps and incisions have been replaced by simple retro auricular incision. Cochleostomy was replaced by round window approach in majority of cases, monitoring of the facial nerve is the standard. Cochlear malformations are diagnosed and operated in our department. In 2010 we have done our first brainstem implant in 12 years old girl with fibromatosis and bilateral schwannoma.
The government of Slovakia fully support the CI program in the country. For all indications (unilateral, bilateral) the implants are fully covered by insurance companies that fully respect the decisions of indication committee.
In 1997 we have done first hearing testing of the newborns in the Maternity hospital across the street. Our results convinced people in the Ministry o Health to publish a resolution on compulsory universal hearing screening in Slovakia from year 2006. All 72 Newborn departments have been equipped with the Otoacoustic Emission devices and all newborns in Slovakia (55-60.000) have been tested.
In years 2009-2010 the scientific team of the Univ. ORL department (Prof. Profant) and Slovak Academy of Sciences (Prof. Klimeš) has been built to study the genetics of hearing loss. From the first scientific goal to study mitochondrial diabetes and adjacent sensorineural hearing loss complete genetic program has developed. Several grants and international publications are the outcome of this scientific activities.
For effective and successful rehabilitation in children several international tests and methods have been translated into Slovak language (e.g. CAP, Little Ears etc.). Rehabilitation is focused on developing of speech and hearing capabilities. Training contains activities as sound detection and discrimination, understanding of speech and non-speech sounds. Parents are fully integrated into the rehabilitation program.
The program continues in full size. Our cochlear implant team helped other centers in Slovakia to start their activities. Nowadays the CI program is provided in 3 cities (Bratislava, Ružomberok, Košice) and in 5 departments.
