We present the fi rst 2 cases of cochlear implantation in Mongolia using “SONATA” type implant of “MED-EL” Company, Austria. CASE 1: A six years old, female had been diagnosed with bilateral congenital profound hearing loss and had been fi tted with hearing aids for 5 years and received little benefi t from her hearing aids and developed very poor speech and language, used lip reading and have had vocabulary of approximately 10 words. A radiological evaluation showed normal cochlea and auditory nerve. Cochlear implant team including speech therapists and audiologists based on the informed consent of patient’s parent decided that family able to participate in follow-up, speech habilitation programme. Patient implanted with SONATA of MED-EL on 4 August, 2009. Electrodes were inserted fully. After 10 days of switch on of the speech processor the patient showed signs of initial hearing of loud sounds. After 5 months of Auditory Verbal Therapy the vocabulary increased up to 50 words. Hearing, cognition and responses are increasing simultaneously. CASE 2: A 2 years old female. Congenitally deaf in both ears. Fitted with hearing aid for 3 months before the surgery and there was no benefi t from hearing aid. Physically and mentally healthy. Patient implanted with SONATA of MED-EL on 4 August, 2009. Electrodes were inserted fully. On 25th days of switching on of speech processor the patient showed initial hearing of loud sounds. Currently, after 5months of treatment her vocabulary is 2 short words and can recognize 4 syllabeles. She is very active, repeats actions and has open nature, feels comfortable with CI.

BACKGROUND Congenital and acquired hearing loss considered as the most common disability. According to the WHO report, 360 million people worldwide have disabling hearing loss, and 32 million of these are children. Severe to profound sensorineural hearing loss can be treated successfully with cochlear implants. Post implant Auditory Verbal Therapy/ Hearing Implant Rehabilitation is essential for the progress and better outcome. Multidisciplinary team approach, including ENT, audiologist, speech therapy, social worker, coordinator, caregiver /parent is required. The first clinical speech therapy department in Mongolia was established by the School of Dentistry, MNUMS based at the Maxillofacial Surgery Department of the MCNHC in 2006 (G. Ariuntuul, B. Bulgan, U. Azzaya). Where as the very first Cochlear Implanted child in Mongolia was received the surgery and audiology support by A. Ulziibayar, L. Byambasuren, B. Misheel, B. Narantya and the hearing implant rehabilitation treatment successfully conducted by the abovementioned speech team in 2009. Aim: To analyze current situation on speech therapy intervention for patients with hearing loss and deafness. METHODS Retrospective hospital data were collected based on the School of Dentistry, Speech therapy department between January, 2009- February, 2017. In total 70 patients’ information were retrieved for the study. Descriptive method is used for statistical analysis. RESULTS Out of 70 patients, attended speech therapy sessions 38 (54%) were males, 32 (46%) were females; where as 21 (30%) had congenital deafness and 28 (40%) acquired; 21 (30%) patients with hearing loss not known their causes of deafness. From the total of 28 (100%) cases with acquired hearing loss/deafness 11 (39%) patients cause of deafness is due to complication from infectios disease: meningitis.

BACKGROUND. Congenital Cleft Lip and/or Palate (CL/P) is a common craniofacial birth defect and occurs 1 per 500-700 live births in average. Children with CL/P at a higher risk for speech/language problems due to the anatomical and structural differences in the oral and nasal cavities, Velopharyngeal Insufficiency causing speech disorders with articulation, phonation, and resonance, respectively. It leads to long-lasting adverse outcomes, influencing quality of life and causes obstacles in child’s socialization. Speech in 2007 Therapy team of School of Dentistry ( G. Ariuntuul , B. Bulgan, U. Azzaya, B. Batsukh, M. Bat-Erdene), Mongolian National University of Medical Sciences (MNUMS) (former Health Sciences University of Mongolia) established and successfully conducted a first clinical speech therapy sessions for children with clefts in Mongolia based on the Department of Oral and Maxillofacial Surgery (G. Ayanga et al.) of National Maternal and Children’s Health Center (NMCHC). Since 2012 the speech therapy team of School of Dentistry, officially transferred the equipped operating speech room to NMCHC and speech pathologist B. Bulgan, supervised and trained by Ariuntuul G. recruited by NMCHC for a full time position and working as a member of multidisciplinary team till present. OBJECTIVES. To assess and analyze registry data of children with clefts, visited speech therapy sessions of speech pathology team of School of Dentistry, MNUMS during 2007 through 2012. MATERIAL AND METHODS. Registry based retrospective study was conducted to obtain demographic and speech disorder related data of children with clefts, visited speech therapy sessions between 2012-2017 at the NMCHC. RESULTS. In total 203 participants are attended the speech therapy sessions: 103 male (51%), 100 female (49%). Out of total 203 children 144 (71%) had Cleft Lip and Palate (CLP), 44 had cleft palate only (22%), 15 had cleft lip (7%), respectively. Average age for primary cleft surgery was 1y13m, where as for secondary was 4y22m. CONCLUSION. For speech therapy session for children with clefts boys were dominant compared to girls (1:1.03). By the types of clefts children diagnosed with Cleft Lip and Palate was prevalent to attend treatment classes. There is a need in early CL/P diagnosis, using birth screening and furthermore, traning of speech therapists/pathologists are important for development of multidisciplinary team, surgery outcome and improvement of quality of life of children with clefts.

The main goal of this study is to examine the development of auditory perception performances of a cochlear implanted child who receive auditory verbal therapy. Present study included a child with prelinguistic hearing loss who received cochlear implant at the Department of ENT, 1st State Central Hospital and enrolled in Auditory Verbal Therapy (AVT) in the Speech Therapy Unit of “ Aid” Clinic. This hearing impaired child participated in auditory verbal therapy with their mother and/or father for 5 months, and the family was given training programs to apply at home after each therapy session. The auditory perception performances of a child were evaluated before implantation and after: twice every week in total 32 Audio-Verval Therapy sessions were performed with the help of Medel LittlEars Auditory Questionnaire, LIP (Listening Process Profile), Ling’s Five Sound Test, the Multiple Frequency Animal Sound Test (mFAST) and MTP (Monosyllable and Polysyllable Test). The auditory perception performances of a child joining auditory verbal therapy programs increased after 5 months of implantation. According to the Ling’s test all 5 sounds are determined (20-60dB) in 1m distance, but discrimination is observed in frequency range between 40-60 dB for sounds “A”, “U” and “M”. Parents active participation as well as full attendance in the AVT treatment shows progress in auditory development of a child. Furthermore evaluation and data analysis is needed.

This study investigates cochlear implant surgical and Audio Verbal Therapy (AVT) practice patterns of patients with hearing loss (HL) based on data of “Aid” ENT Clinic and Speech Therapy Unit of School of Dentistry, Mongolian National University of Medical Sciences (MNUMS) between 2009-2018. Our aim was to describe and collect related data on surgical interventions, using cochlear implant for patients with severe hearing loss and their involvement in the AVT sessions. Hospital based registry data by audiologistwere retrospectively investigated. Descriptive statistics are used to describe the basic features of the data in the study. In total 78 patients had cochlear implantation surgery with chronological age between 2 months and 55 years. From total subjects 46 (54.59%) were male and 32 (33.41%) female. The distribution of etiology for the hearing loss showed that the majority of hearing loss 47 (60%) had due to infectious diseases, other diseases or injury, 25 (32%) congenital and 6 (8%) unknown causes. Documentation and proper registration is essential for better outcome of cochlear implantation surgery, especially teamwork of speech therapist doing AVT and audiologist in charge of fitting. Furthermore, epidemiological studies are important for evaluation and monitoring of interventions by every specialists included in the treatment team.