Case report of the first patient with electro-mechanical stimulation of the inner ear: The Vibrant Soundbridge combined with a FLEX20 cochlear implant (original) (raw)
Related papers
Application of electric-acoustic stimulation in patients with profound hearing loss—case study
International Congress Series, 2003
Improvement of cochlear implant technology has resulted in the extension of the selection criteria for cochlear implant candidates. Prelingually deafened children are considered for the implantation even if they still demonstrate some benefits from the use of hearing aids. The aim of the study was to examine speech perception skills in patients with cochlear implant and the hearing aid in contralateral ear. Positive results obtained indicate that patients with combined stimulation perform better than with cochlear implant or hearing aids only.
Combined Electric and Acoustic Stimulation: Successful Treatment Option for Partial Deafness
philjol.org
Cochlear implants are now the treatment of choice for patients with severe to profound hearing loss. Inclusion criteria for cochlear implantation have expanded and a whole array of implantable hearing devices have been introduced over the years. To date, more than 250 cochlear implantations have now been performed in the Philippines (Figure 1). In 2006, the first auditory brainstem implantation, and first vibroplasty or middle ear implantation in the country were done at the Philippine General Hospital (PGH). In 2008, the first electroacoustic stimulation or partial deafness cochlear implantation surgery in the country was performed at the Capitol Medical Center by Professor Joachim Müeller of the University of Würzburg and the author. This concept that cochlear implantation can be performed for patients with residual hearing or only partial deafness is quite novel. There are patients whose low frequency hearing below 1.5 kHz is still be quite good while high frequency hearing loss above 1.5 kHz is in the severe to profound range (Figure 2). For such patients speech discrimination scores will typically fall below 60% at 65 dB sound pressure level (SPL) in the best aided condition. This technological advancement, often called electroacoustic stimulation (EAS), was developed in 1999 after Christoph Von Ilberg demonstrated preserved residual low frequency hearing in a patient who underwent cochlear implantation such that the patient wore a hearing aid in the implanted ear. 1 Currently, EAS devices are available from two manufacturers. Contraindications to the use of EAS are shown in Table 1. Candidates for EAS devices should have stable low frequency hearing. There should be no progressive or autoimmune sensorineural hearing loss. Also there should be no history of meningitis, otosclerosis, or any other malformation that might cause an obstruction. The patient's air-bone gap should be < 15 dB. Finally, there should not be any external auditory canal problems that can impede placement of the ear mould for the acoustic component. There are two main components of the EAS system (Figure 3). The external component is made up of a microphone that picks up sounds and a processor that separately encodes low and high frequency energy. After processing, low frequency energy is converted into an acoustic signal via the loudspeaker located in the ear hook and delivered into the external auditory canal. This acoustic signal will vibrate the tympanic membrane and ossicles so that cochlear fluids as well as the relatively intact structures of the cochlea in the apical region are stimulated. In contrast, high frequency energy is coded into radio-wave-like signals which are transmitted transcutaneously to the internal receiver. There, electric signals are delivered to the electrode array that has been surgically implanted into the cochlea. Thus the auditory nerve receives information using two different pathways from low and high frequency sounds and the auditory nerve signals are then transmitted to the brain.
Electric acoustic stimulation of the auditory system: results of a multi-centre investigation
Acta Oto-Laryngologica, 2008
Conclusion. A high rate of hearing preservation during cochlear implantation for electric acoustic stimulation (EAS) is possible, even when surgery is conducted by a number of different surgeons. Objectives. This study aimed to determine the degree of hearing preservation using surgery for EAS in a European multi-centre clinical investigation. It also aimed to demonstrate the effect of EAS in individuals with residual low frequency hearing, both on speech perception and on subjective quality of life measures. Patients and methods. Eighteen patients with profound high frequency hearing loss were recruited in five participating European centres. Subjects were assessed based on an audiologic test battery, as well as on a subjective hearing aid benefit questionnaire. Each subject underwent attempted hearing preservation cochlear implantation using the MED-EL C40' device with a Medium electrode. Residual ipsilateral hearing and speech discrimination abilities were assessed at defined intervals up to 12 months after the combined electric-acoustic mode was introduced. Results. Results showed that some degree of hearing preservation was possible in 15718 patients. All subjects showed statistically significant benefit on all three speech perception tests over time. These significant benefits were also reflected in the subjective benefit outcomes.
Electroacoustic cochlear stimulation advantages in severe-profound hearing loss
Hearing, Balance and Communication, 2019
Objectives: Electroacoustic stimulation allow very interesting performances mainly in noisy condition for bisyllabic words recognition. In this paper, we studied some very difficult timbric tasks in noise conditions. Methods: We studied 10 adult patients with Hybrid implants (group A-Hybrid implants) and 70 adult patients with traditional ones (group B-Traditional implants). We made the following tests in noise: (1) Bisyllabic words recognition; (2) Voice kinds recognition; and (3) Musical instruments recognition. Results: Mean results in quiet: test 1: 63% for group A, 42% for group B; test 2: 75% group A, 33% group B; test 3: 55% group A, 20% group B. We obtained a p < .05 for tests 2 and 3. Conclusions: Hybrid patients seem to have better results mainly in noisy timbric tasks. This should be explained by the better quality of low frequency stimulation. The presence of good residual hearing on low frequencies should orientate surgeons and audiologists to consider electroacoustic stimulation procedures.
Indication of direct acoustical cochlea stimulation in comparison to cochlear implants
Hearing research, 2016
The new implantable hearing system Codacs™ was designed to close the treatment gap between active middle ear implants and cochlear implants in cases of severe-to-profound mixed hearing loss. The Codacs™ actuator is attached to conventional stapes prosthesis during the implantation and thereby provides acoustical stimulation through a stapedotomy to the cochlea. Cochlear implants (CIs) on the other hand are an established treatment option for profoundly deaf patients including mixed hearing losses that are possible candidates for the Codacs™. In this retrospective study, we compared the clinical outcome of 25 patients with the Codacs™ (≥3 month post-activation) to 54 CI patients (two years post-activation) with comparable pre-operative bone conduction (BC) thresholds that were potential candidates for both categories of devices. The word recognition score (Freiburg monosyllables test) in quiet was significantly (p < 0.05) better in the Codacs™ than in the corresponding CI patients...
European Archives of Oto-Rhino-Laryngology, 2019
Purpose To evaluate the long-term hearing outcomes in cochlear implanted adults with residual hearing at low frequencies, and the proportion of patients using electro-acoustic stimulation (EAS). Methods A monocentric retrospective cohort study was performed in a tertiary referral center. Population demographics, surgical approach, pre-and postoperative hearing at low frequencies, in the implanted and contralateral ear, were recorded as well as duration of EAS use. The percentage hearing preservation was calculated according to the formula S (HEAR-RING group). Results In total, 63 adults (81 ears) with residual hearing underwent cochlear implantation with intent to use EAS processors. Six different types of electrode array were implanted. The mean pure tone audiometry (PTA) shift after cochlear implantation was 16 ± 15 dB HL (range 0-59 dB HL). Half of the implanted ears had minimal hearing preservation or total hearing loss (HL) at 5.5 years and the cumulative risk of total HL was 50% at 7 years. During the follow-up, total HL occurred in 22 ears. The decrease in hearing levels was similar in both implanted and contralateral ear during follow-up (ns, F = 2.46 ± 3, Linear Mixed Model (LMM)). Only 44 patients found a benefit from EAS at the first fitting. At the last visit, EAS processors were fitted in 30% of the cases. The pre-and postoperative mean PTA thresholds were not predictive of EAS use (Cox's proportional hazards analysis). Conclusions Postoperative residual hearing was observed in 93% of implanted ears, but only half of them had an initial benefit from EAS. No predictive factors were found to influence the use of EAS processors.
Otology & Neurotology, 2016
Objective: This study reviewed outcomes of hearing preservation (HP) surgery in a cochlear implant patient population, with clinical follow-up results up to 11 years after implantation. Study Design: Retrospective case review. Setting: Tertiary referral university hospital. Patients: Ninety six patients (103 ears) with partial deafness who underwent HP surgery at the University Hospital Frankfurt since 1999 were included. Electrode carriers were Cochlear Slim Straight, MED-EL Standard, Medium, Flex 20 , and Flex 24. Intervention: Cochlear implantation using the HP surgery technique with either the cochleostomy or round window approach. Main Outcome Measures: Pure-tone averages for low frequencies (125 Hz, 250 Hz, 500 Hz, PTAlow) and speech perception scores of the Freiburg monosyllable and number tests in quiet. PTAlow shifts were used to evaluate HP as complete for 10 dB, partial between 10 and 30 dB, and minimal for !30 dB. Time intervals were: preoperative, postoperative, after 12 months, and long-term (>24 months, mean 51.4 months, range 2-11 years). Impacts of electrode design and surgical approach were analyzed. Results: Postoperatively (n ¼ 103), HP was complete in 32 (31.1%), partial in 49 (47.6%), minimal in 14 (13.
Audiology and Neurotology, 2006
ly lost residual hearing during or immediately after surgery. Freiburger Monosyllabic word understanding scores in a group of patients with complete hearing preservation increased from 13.1% preoperatively to 75% in the electric acoustic stimulation condition. Conclusion: This study documents that complete and partial preservation of ipsilateral hearing after cochlear implantation can be achieved in about 70% of cases over an average period of 27.25 months when using 360° electrode insertions.
Electrical Stimulation of the Auditory System
The Human Auditory System - Basic Features and Updates on Audiological Diagnosis and Therapy, 2019
In many healthcare systems electrical stimulation of the human auditory system, using cochlear implants, is a common treatment for severe to profound deafness. This chapter will describe how electrical stimulation manages to compensate for sensory-neural hearing loss by bypassing the damaged cochlea. The challenges involved in the design and application of cochlear implants will be outlined, including the programming of clinical systems to suit the needs of implanted patients. Today's variety of patient will be reviewed: unilaterally and bilaterally implanted, bimodal users of a cochlear implant as well as a contralateral hearing aid, CROS device users having either asymmetrical hearing loss or single-sided deafness. Alternative devices such as auditory brainstem implants will be described, and additionally the more experimental auditory mid-brain implants and intraneural stimulation approaches. Research that is likely to bring medium term benefits to the clinical application of cochlear implants will also be described.
Otology & Neurotology, 2006
Objective: To assess the conservation of residual hearing in recipients of the Nucleus 24 Contour Advance cochlear implant (CI) and the benefits of combined electrical and acoustic stimulation. Study Design: Prospective multicenter study. Setting: CI clinics in Western Europe. Patients: Adult candidates for conventional cochlear implantation with a minimum preoperative word recognition score of 10% in the ear to be implanted. Intervention: BSoft-surgery^protocol, including a 1-to 1.2-mm anterior and inferior cochleostomy hole with the electrode array, inserted 17 mm using the Badvance-off-stylet^technique. Patients with postoperative pure-tone hearing threshold levels (HTLs) of 80 dB hearing loss or less at 125 and 250 Hz and 90 dB hearing loss or less at 500 Hz were refitted with an inthe-ear hearing aid for combined ipsilateral electrical and acoustic (El-Ac) stimulation. Main Outcome Measures: A questionnaire to collect information regarding surgery. Pure-tone HTLs measured at intervals. Word recognition tested in quiet and sentence recognition tested in noise at 10 and 5 dB signal-to-noise ratio (SNR). Hearing Conservation Results: HTL data were available for 27 patients. HTLs were conserved within 20 dB of preoperative levels for 33, 26, and 19% of patients for 125, 250, and 500 Hz, respectively. However, the recommended soft-surgery protocol was strictly followed in only 12 of 27 patients. For these 12 patients, hearing thresholds were conserved within 20 dB for 50, 50, and 33% of patients. Median threshold increases were 40 dB (250Y 500 Hz) for the whole group and 23 dB for the strict surgery group. Ten patients retained sufficient HTLs to enter the El-Ac user group. Speech Recognition Results: Group mean recognition scores for nine El-Ac users for words presented at 65 dB sound pressure level were 45% for CI alone and 55% for CI + ipsilateral hearing aid (p G 0.05, paired t). For sentences presented in noise at 5 dB SNR, mean word scores were 46% CI alone and 56% CI + ipsilateral hearing aid (p G 0.01, paired t). Conclusion: Hearing was conserved for conventional candidates for cochlear implantation where the recommended soft-surgery protocol was strictly followed. Combined ipsilateral electrical and acoustic stimulation provided considerable benefits for speech recognition in noise, equivalent to between 3 and 5 dB SNR, compared with CI alone. Key Words: Cochlear implantsVHearing aidsVSoft surgeryVElectroacoustic stimulation. Otol Neurotol 27:624 Y 633, 2006.