Cochlear Implants

Clark, Graeme M.

doi:10.1007/b97263

Cited by 270 publications

(4 citation statements)

References 587 publications

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“…Current systems insert intracochlear electrodes in the scala tympani, which allows reliable stimulation of the hearing nerve without relevant complications [6].…”

Section: Current Cochlear Implant Systemsmentioning

confidence: 99%

Cochlear Implant – State of the Art

2017

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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...

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“…Current systems insert intracochlear electrodes in the scala tympani, which allows reliable stimulation of the hearing nerve without relevant complications [6].…”

Section: Current Cochlear Implant Systemsmentioning

confidence: 99%

Cochlear Implant – State of the Art

2017

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“…A major factor in determining EI is the volume and composition of bulk tissue surrounding the implanted electrode array (Tykocinski et al, 2001). Clark (2003) recommends that EI levels should be monitored routinely as an indicator of cochlear tissue changes such as fibrosis and electrode surface roughening. In a study of chronic high-rate stimulation using cats, Xu et al (1997) demonstrated that levels of fibrosis and presence of inflammatory cells were greatest in the cochleae that exhibited the greatest EI levels.…”

Section: Introductionmentioning

confidence: 99%

Exploiting Routine Clinical Measures to Inform Strategies for Better Hearing Performance in Cochlear Implant Users

et al. 2019

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Neuroprostheses designed to interface with the nervous system to replace injured or missing senses can significantly improve a patient’s quality of life. The challenge remains to provide implants that operate optimally over several decades. Changes in the implant-tissue interface may precede performance problems. Tools to identify and characterize such changes using existing clinical measures would be highly valuable. Modern cochlear implant (CI) systems allow easy and regular measurements of electrode impedance (EI). This measure is routinely performed as a hardware integrity test, but it also allows a level of insight into the immune-mediated response to the implant, which is associated with performance outcomes. This study is a 5-year retrospective investigation of MED-EL CI users at the University of Southampton Auditory Implant Service including 176 adult ears (18–91) and 74 pediatric ears (1–17). The trend in EI in adults showed a decrease at apical electrodes. An increase was seen at the basal electrodes which are closest to the surgery site. The trend in the pediatric cohort was increasing EI over time for nearly all electrode positions, although this group showed greater variability and had a smaller sample size. We applied an outlier-labeling rule to statistically identify individuals that exhibit raised impedance. This highlighted 14 adult ears (8%) and 3 pediatric ears (5%) with impedance levels that deviated from the group distribution. The slow development of EI suggests intra-cochlear fibrosis and/or osteogenesis as the underlying mechanism. The usual clinical intervention for extreme impedance readings is to deactivate the relevant electrode. Our findings highlight some interesting clinical contradictions: some cases with raised (but not extreme) impedance had not prompted an electrode deactivation; and many cases of electrode deactivation had been informed by subjective patient reports. This emphasizes the need for improved objective evidence to inform electrode deactivations in borderline cases, for which our outlier-labeling approach is a promising candidate. A data extraction and analysis protocol that allows ongoing and automated statistical analysis of routinely collected data could benefit both the CI and wider neuroprosthetics communities. Our approach provides new tools to inform practice and to improve the function and longevity of neuroprosthetic devices.

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“…Cochlear Implant (CI) is an electronic device that directly stimulates the auditory nerve, transforming the acoustic signal into an electrical signal that will be transmitted through the auditory pathways to the cerebral cortex (1,2) . This device is able to provide the necessary characteristics for speech comprehension, but presents limitations to reproduce and provide all the fine temporal characteristics of the acoustic stimulus.…”

Section: Introductionmentioning

confidence: 99%

Habilidades auditivas musicais e temporais em usuários de implante coclear após musicoterapia

Lima

Iervolino

Schochat

2018

CoDAS

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RESUMO Objetivo Verificar o desempenho das habilidades de percepção musical e das habilidades auditivas temporais de resolução e ordenação pré e pós-musicoterapia em pacientes pós-linguais usuários de implante coclear. Método Participaram do estudo 11 indivíduos (média de idade: 47,64 anos) pós-linguais implantados, que foram submetidos a 10 sessões de musicoterapia, sendo uma por semana. Para a avaliação auditiva, foram utilizados o teste Montreal Battery Evaluation of Amusia e o teste de padrão de frequência (TPF). Todos os participantes passaram por um momento placebo antes da musicoterapia e foram avaliados em três momentos distintos. Resultados Foi observada melhora significativa nos subtestes das habilidades musicais de contorno e melodia após musicoterapia. Não foi observado efeito placebo e nem diferença do TPF após a musicoterapia. Conclusão A musicoterapia foi uma ferramenta útil para melhorar as habilidades auditivas musicais em indivíduos adultos pós-linguais usuários de IC.

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Cochlear Implants

Cited by 270 publications

References 587 publications

Cochlear Implant – State of the Art

Cochlear Implant – State of the Art

Exploiting Routine Clinical Measures to Inform Strategies for Better Hearing Performance in Cochlear Implant Users

Habilidades auditivas musicais e temporais em usuários de implante coclear após musicoterapia

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