Cochlear Implant – State of the Art

Abstract

Cochlear implants are the treatment of choice for auditory rehabilitation of patients with sensory deafness. They restore the missing function of Thomas Lenarz 1 inner hair cells by transforming the acoustic signal into electrical stimuli in the majority of patients including the use of the telephone. Children can achieve a near to normal speech and language development provided their deafness is detected early after onset and implantation is performed quickly thereafter. The diagnostic procedure as well as the surgical technique have been standardized and can be adapted to the individual anatomical and physiological needs both in children and adults. Special cases such as cochlear obliteration might require special measures and re-implantation, which can be done in most cases in a straight forward way. Technology upgrades count for better performance. Future developments will focus on better electrode-nerve interfaces by improving electrode technology. An increased number of electrical contacts as well as the biological treatment with regeneration of the dendrites growing onto the electrode will increase the number of electrical channels. This will give room for improved speech coding strategies in order to create the bionic ear, i.e. to restore the process of natural hearing by means of technology. The robot-assisted surgery will allow for high precision surgery and reliable hearing preservation. Biological therapies will support the bionic ear. Methods are bio-hybrid electrodes, which are coded by stem cells transplanted into the inner ear to enhance auto-production of neurotrophins. Local drug delivery will focus on suppression of trauma reaction and local regeneration. Gene therapy by nanoparticles will hopefully lead to the preservation of residual hearing in patients being affected by genetic hearing loss. Overall the cochlear implant is a very powerful tool to rehabilitate patients with sensory deafness. More than 1 million of candidates in Germany today could benefit from this high technology auditory implant. Only 50,000 are implanted so far. In the future, the procedure can be done under local anesthesia, will be minimally invasive and straight forward. Hearing preservation will be routine.Keywords: cochlear implant, sensory deafness, diagnostics, surgical procedure, results, complications, future developments SummaryCochlear implants are electronical stimulus prostheses for the functional replacement of the inner ear. Because of the rapid technical development and the good results, they could be established as standard therapy for sensory deafness. Cochlear implantation requires an interdisciplinary team and a quality-controlled concepts that reaches from the indication to the life-long control and that is fixed in the AWMF guideline on cochlear implant [1]. Current cochlear implant systems are partially implantable and equipped with a multitude of additional functions similar to hearing aids for sound pre-processing and noise elimination. The intracochlear position of the electrode allows fo...

Overcoming Limitations of Iontronic Delivery Devices

“…22,38 State of the art bioelectronic devices have been developed providing a fundamental understanding of communication between cells and with their environment. [39][40][41] During the last decade, biosensors such as glucose monitors for diabetics, 42,43 pacemakers, 44,45 and cochlear implants, 46,47 for damaged physiological functions are considered as successful therapies since the patient can return to a healthy lifestyle.…”

Primate optogenetics: Progress and prognosis

“…This is a tall order. Conventional cochlear implants can mediate speech comprehension and have been implanted in nearly half a million people with minimal sequelae (123,124). The adoption of any new technology, including optogenetics, will likely require implantation into macaques.…”

Hörimplantate im Zeitalter der Digitalisierung

“…In der Regel erreichen postlingual ertaubte Patienten ein offenes Sprachverständnis und können telefonieren. Bei Kindern wird bei früher Implantation nach Eintritt der Ertaubung in der Regel eine nahezu normale Sprachentwicklung erreicht [15].…”

“…1 Mio potentielle Kandidaten für ein Cochlea-Implantat, davon sind aktuell ca. 50 000 implantiert [15].…”