Title: Cochlear Implants: Where Weve Been, Where Were Going
1Cochlear ImplantsWhere Weve Been, Where Were
Going
- Amber M. Gardner, Ph.D., CCC-A
- University of Virginia Health System
2Early Attempts
- Alessandro Volta early 1800s became the first
to stimulate the auditory system electrically - Two metal rods in his ears (approx. 50V)
- a boom within the head followed by a sound
similar to that of boiling thick soup
3Early Attempts
- Realization made over the next 50-60 years that
since sound is more of an alternating signal,
stimulating with DC wasnt going to produce an
adequate hearing sensation - Duchenne 1885 used an alternating current
- the beating of a flys wings between a pane of
glass and a curtain - Improving, but not there yet
4Early Attempts
- Brenner 1868 published study that revealed
hearing sensation was better using negative
polarity. Also found that a reduction of
unpleasant side effects could be achieved with
correct placement of the electrodes
5Early Attempts
- 1930s thermonic valve (vacuum tube) was
introduced and this allowed greater precision in
electrical stimulation - Wever Bray (1930) electrical response recorded
near the auditory nerve of a cat was similar
(freq. amplitude) to sounds to which the ear
had been exposed
6Early Attempts
- Gersuni Volokhov (1936) First to demonstrate
that with electrical stimulation hearing
sensation still remained after removal of
tympanic membrane ossicles theorized the
cochlea was the site of stimulation
7Early Attempts
- Stevens Jones (1939) Listed several
mechanisms that produced hearing when the cochlea
was stimulated electrically - Electrical energy could be converted into sound
by a direct effect on the basilar membrane that
would vibrate maximally at a point determined by
the frequency these vibrations would stimulate
the hair cells - Direct stimulation of the auditory nerve produced
a crude hearing sensation.
8Early Attempts
- 1940s 1950s Researchers began to realize that
if more precise hearing sensations were to be
produced stimulation of the auditory nerve fibers
must be more localized vs. widespread current.
9Early Attempts
- 1950 Lundberg stimulated the auditory nerve
during a neurosurgical operation. Used a
sinusoidal current - patient only heard noise. - 1957 Djourno Eyries placed a wire directly
on the auditory nerve (cholesteatoma surgery).
Initially pt. just heard a roulette wheel a
cricket but was eventually able to differentiate
pitch and identify several words.
10Getting Closer
- Doyle et al (1964) inserted an electrode array (4
electrodes) into the cochlea of a deaf patient - Patient was able to repeat phrases
- Simmons (1966) inserted an electrode array into
the cochlea with more precision (closer to the
modiolus) - Patient had ability to determine signal duration
length and tonality was achieved
11Almost There
- Early 1970s - Michelson and House - insertion of
electrode array through scala tymani driven by
implantable receiver stimulators. - 1972 speech processor developed to interface
with the House 3M single electrode implant was
commercially marketed. - Single channel devices - very poor speech
understanding (especially in open set)
12Multi-channel Cochlear Implant
Rod Saunders First multi-channel CI patient
(1978)
Courtesy Cochlear
13Increasing Channels - Speech
- Channels will increase from 1 to 2, 2 to 4, 4 to
8 to 32 note the improvement in quality.
14Increasing Channels - Music
- First you will hear the song with 4 channels,
then 8, then 16, then 32 finally you will hear
the original.
Demo
15Trends in Candidacy
163 FDA Approved CI Manufacturers
- Cochlear 1985
- Advanced Bionics 1996
- MedEl 2001 (1994 European release)
17Speech Processor (1978)
Courtesy Cochlear
18Speech Testing (1978)
Courtesy Cochlear
19Cochlear Portable Speech Processor
1980 2nd Recipient (George Watson)
Courtesy Cochlear
20Nucleus 22 Device
Courtesy Cochlear
21Wearable Speech Processor (WSP) 1982
Courtesy Cochlear
22From WSP to Mini Speech Processor (MSP) 1986
Courtesy Cochlear
23CI22M (Mini 22 Implant)
- Magnet
- Flexible receiver antenna
- 1988
Courtesy Cochlear
24MSP to Spectra
- Introduced in 1988 to go with the CI22M
Courtesy Cochlear
25CI24M
- 1997
- Removable Magnet
- Monopolar electrodes
- Telemetry can measure impedances
- Stimulation rates increased
Courtesy Cochlear
26Spectra to Sprint
- 1997
- Increased number of program slots
- More flexibility
Courtesy Cochlear
27Esprit
- 1998
- First BTE processor from Cochlear
Courtesy Cochlear
28Esprit 3G
- 2002 (24 users)
- 2004 (22 users)
Courtesy Cochlear
29Freedom
- 2005 - New internal external devices
- Same processor for BTE, bodyworn options
- New Smart Sound features
Courtesy Cochlear
Courtesy Cochlear
30System 5
- Launched Sept. 8, 2009
- Internal device thinner, but same technology
platform - External thinner, more water resistant,
autophone, 2 way remote control
Courtesy Cochlear
Courtesy Cochlear
Courtesy Cochlear
31Advanced Bionics History
- Company started by Al Mann in 1993
- 1996 - received FDA approval for adults
- 1997 - received FDA approval for pediatrics
32Advanced Bionics
- 1.0 1994 (adults)
- 1.2 1996 (adults), 1997 (pediatrics)
- CII 2000
Courtesy Advanced Bionics
33HiRes 90k
- 2003
- Titanium (vs. ceramic) housing
- Removable magnet
Courtesy AB
34AB Body Worn Processors
Courtesy Advanced Bionics
S-Series 1999
PSP 2001
1.0 - 1994
1.2 - 1996
35AB BTE Speech Processors
Courtesy Advanced Bionics
Auria Harmony 2003 2006
Platinum BTE 1998
CII BTE 2000
36MedEl History
- 1975 - Hochmairs begin development of cochlear
implant - 1977 - Multi-channel CI implanted in Vienna
- 1989 - MedEl is founded
- 1991 - Industry first BTE speech processor
(trials) - 1994 - European approval of MedEl system
- 2001 - FDA approval of MedEl system
- 2003 - FDA approval of MRI compatibility (.2
Tesla)
37MedEl Internal Devices
38Pulsar CI 100 and Sonata
- Pulsar September 2005 (Ceramic Housing)
- Sonata September 2007 (Titanium Housing)
- Magnet fixed
Courtesy MedEl
38
39Tempo Speech Processor (1999)
- Lightest BTE Processor
- Up to 9 Programs
- One processor multiple wearing options
Courtesy MedEl
39
40Opus 2 Speech Processor 2007
- Ergonomic switch free design
- Wireless FM
- Fine Tuner bilateral support, volume,
sensitivity telecoil switches
Courtesy MedEl
41Future Directions
- Greater number of bilateral recipients
- Hybrid/EAS cochlear implants
- Totally implantable cochlear implants
42Bilateral CI
- Benefits
- Improved localization
- Improved speech in noise performance
- Insurance Coverage - class action law-suits
43Hybrid/EAS
- EAS - Electric-Acoustic Stimulation
- Combination of CI HA
- High frequency information - shorter electrode
array - Low frequency information - HA (typically mild to
moderate HL) - Still in clinical trials in US
- Approved in Europe (2007)
- All 3 companies still in US trials
MedEl Duet
Courtesy MedEl
43
44Hybrid/EAS
- European trial data indicates patients are
performing significantly better with EAS than CI
alone or HA alone - Noted especially in music speech in noise
- Points to consider
- Risk of damage to residual hearing acuity during
original insertion of electrode array - What is the course of action if hearing acuity
changes and HA is no longer beneficial -
additional surgery with new/standard array?
45Totally Implantable Cochlear Implant (TICI/TIKI)
- Internal Components
- Rechargeable battery (lithium ion)
- Microphone (subcutaneous)
- Speech processor
- External Hardware
- Battery recharger
- On/Off
- Volume/Sensitivity
46TIKI
47Totally Implantable Cochlear Implant (TICI/TIKI)
- Benefits
- No external parts
- able to hide deafness
- no cables, mics... to break
- Able to hear 24hrs a day (in shower, while
sleeping...)
48Totally Implantable Cochlear Implant (TICI/TIKI)
- Disadvantages
- Larger internal device - more surgical
time/larger incision - Battery will have to be replaced (approx. 6yrs)
- Replace only battery or entire device?
- Hear body noises (breathing, swallowing). Some
people are unable to adjust to these.
49TIKI Results
- 3 patients implanted Melbourne
- Able to have invisible hearing or use 3G
processor - Hearing acuity
- TIKI - Mild to moderate HL (improving to mild HL
after 6 months) - 3G - Hearing WNL
- Speech discrimination - CNC Lists
- TIKI - 33 (Improved as compared to pre-op)
- 3G - 77
50Thank you