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Cochlear Implants: Where Weve Been, Where Were Going

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Title: Cochlear Implants: Where Weve Been, Where Were Going


1
Cochlear ImplantsWhere Weve Been, Where Were
Going
  • Amber M. Gardner, Ph.D., CCC-A
  • University of Virginia Health System

2
Early 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

3
Early 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

4
Early 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

5
Early 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

6
Early 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

7
Early 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.

8
Early 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.

9
Early 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.

10
Getting 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

11
Almost 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)

12
Multi-channel Cochlear Implant
Rod Saunders First multi-channel CI patient
(1978)
Courtesy Cochlear
13
Increasing Channels - Speech
  • Channels will increase from 1 to 2, 2 to 4, 4 to
    8 to 32 note the improvement in quality.

14
Increasing Channels - Music
  • First you will hear the song with 4 channels,
    then 8, then 16, then 32 finally you will hear
    the original.

Demo
15
Trends in Candidacy
16
3 FDA Approved CI Manufacturers
  • Cochlear 1985
  • Advanced Bionics 1996
  • MedEl 2001 (1994 European release)

17
Speech Processor (1978)
Courtesy Cochlear
18
Speech Testing (1978)
Courtesy Cochlear
19
Cochlear Portable Speech Processor
1980 2nd Recipient (George Watson)
Courtesy Cochlear
20
Nucleus 22 Device
Courtesy Cochlear
21
Wearable Speech Processor (WSP) 1982
Courtesy Cochlear
22
From WSP to Mini Speech Processor (MSP) 1986
Courtesy Cochlear
23
CI22M (Mini 22 Implant)
  • Magnet
  • Flexible receiver antenna
  • 1988

Courtesy Cochlear
24
MSP to Spectra
  • Introduced in 1988 to go with the CI22M

Courtesy Cochlear
25
CI24M
  • 1997
  • Removable Magnet
  • Monopolar electrodes
  • Telemetry can measure impedances
  • Stimulation rates increased

Courtesy Cochlear
26
Spectra to Sprint
  • 1997
  • Increased number of program slots
  • More flexibility

Courtesy Cochlear
27
Esprit
  • 1998
  • First BTE processor from Cochlear

Courtesy Cochlear
28
Esprit 3G
  • 2002 (24 users)
  • 2004 (22 users)

Courtesy Cochlear
29
Freedom
  • 2005 - New internal external devices
  • Same processor for BTE, bodyworn options
  • New Smart Sound features

Courtesy Cochlear
Courtesy Cochlear
30
System 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
31
Advanced Bionics History
  • Company started by Al Mann in 1993
  • 1996 - received FDA approval for adults
  • 1997 - received FDA approval for pediatrics

32
Advanced Bionics
  • 1.0 1994 (adults)
  • 1.2 1996 (adults), 1997 (pediatrics)
  • CII 2000

Courtesy Advanced Bionics
33
HiRes 90k
  • 2003
  • Titanium (vs. ceramic) housing
  • Removable magnet

Courtesy AB
34
AB Body Worn Processors
Courtesy Advanced Bionics
S-Series 1999
PSP 2001
1.0 - 1994
1.2 - 1996
35
AB BTE Speech Processors
Courtesy Advanced Bionics
Auria Harmony 2003 2006
Platinum BTE 1998
CII BTE 2000
36
MedEl 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)

37
MedEl Internal Devices
  • Combi 40 Introduced 1996

38
Pulsar CI 100 and Sonata
  • Pulsar September 2005 (Ceramic Housing)
  • Sonata September 2007 (Titanium Housing)
  • Magnet fixed

Courtesy MedEl
38
39
Tempo Speech Processor (1999)
  • Lightest BTE Processor
  • Up to 9 Programs
  • One processor multiple wearing options

Courtesy MedEl
39
40
Opus 2 Speech Processor 2007
  • Ergonomic switch free design
  • Wireless FM
  • Fine Tuner bilateral support, volume,
    sensitivity telecoil switches

Courtesy MedEl
41
Future Directions
  • Greater number of bilateral recipients
  • Hybrid/EAS cochlear implants
  • Totally implantable cochlear implants

42
Bilateral CI
  • Benefits
  • Improved localization
  • Improved speech in noise performance
  • Insurance Coverage - class action law-suits

43
Hybrid/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
44
Hybrid/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?

45
Totally Implantable Cochlear Implant (TICI/TIKI)
  • Internal Components
  • Rechargeable battery (lithium ion)
  • Microphone (subcutaneous)
  • Speech processor
  • External Hardware
  • Battery recharger
  • On/Off
  • Volume/Sensitivity

46
TIKI
47
Totally 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...)

48
Totally 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.

49
TIKI 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

50
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