This document provides a summary of the history of cochlear implantation. It discusses early pioneers in the field in the 1930s-1960s from France, Germany, and the US. Graeme Clark is highlighted for his vision and research starting in 1967 that led to the first cochlear implant in 1978. The document then outlines developments and advances in cochlear implant technology through the 1980s-2000s including improvements to electrodes, processors, surgical techniques, and expanding candidacy criteria for both adults and children. It concludes by discussing future directions including implantable rechargeable batteries, improved electrode-nerve interfaces using neurotrophins, and potential uses of nanotechnology and guidance molecules.

1. The history of
The History of
Cochlear Implantation
Cochlear Implantation
Dr. Dr. h.c. Monika Lehnhardt
St. Petersburg, May 2012

2. Wever EG, Bray CW (1936)
…

3. Charles Eyries, André Djurno,
Otologist in Paris Engineer Co-working with Eyries

4. Fritz Zöllner, Wolf Dieter Keidel,
Otologist in Freiburg Physiologist in Erlangen

8. William House,
Otologist in Los Angeles

9. “In spite of the problems and criticisms, I just had to go on.
A cochlear implant was their only hope of ever hearing.”
Graeme Clark
 Vision for a technology that
would enable the deaf to hear
 Research supported by public
donation, commenced 1967
 First cochlear implant, 1978,
Melbourne Hospital

10. Ernst Lehnhardt

13. Electrode Array in situ

14. Ernst Lehnhardt, 1984
First adult patients in Hannover, Germany

15. Ernst Lehnhardt
with his audiologist Rolf Battmer

16. Ernst und Monika Lehnhardt, 1991 in Moskau

17. Ernst und Monika Lehnhardt mit George Tavartkiladze

18. Soft Surgery

21. Freedom Cochlear Implant
• 4th generation ASIC CMOS internal
chip with
– Increased precision current sources
for accurate nerve stimulation
– 4th generation telemetry with less
internal noise, enabling AutoNRT
– Improved power efficiency
for longer battery life
• Generational mechanical changes for
– improved reliability

22. Freedom Speech Processor
• Dual microphones for high quality
sound capture and support for Pre-
processing
• Dual 16-bit analog to digital converters
for CD quality 96dB dynamic range
processing
• Quad 16 Bit DSP
• In-built Telecoil
• Integrated accessory connector
• IP44 Splash Compliant

25. Cochlear: Система Nucleus 5
Cochlear:
Дистанционное управление
Nucleus CR110
Мониторинг. Контроль. Управление.

26. Exponential Growth-
First Choice Worldwide
2012

27. Broadening Indications
Development of Candidate Selection Criteria United States
(Nucleus Implant Systems)
Adults Children
1985  FDA approval for implantation of candidates
aged 18 years and older
 postlingually deafened
 profound bilateral sensorineuronal deafness
 no benefit from hearing aid
1990  FDA approval for implantation of candidates aged
2 years and older
 profound bilateral sensorineuronal deafness
 little or no benefit from hearing aid
 candidate and family must be well motivated and possess
realistic expectations
1995  Include pre-and perilinguistically deafened adults
 Limited benefit from hearing aids defined as 30%
or
 less in best aided condition on tape recorded tests
of open-set sentences
1998  Limited benefit from hearing aids defined as 40%  18 months and older
or  3-6 months hearing aid trial
less in best aided condition on tape recorded tests  <20% score on MLNT or LNT test
of open-set sentences
2000  Limited benefit from hearing aids defined as 60%  12 months and older
or less in best aided condition on tape recorded  3-6 months hearing aid trial
tests of open-set sentences  Lack of progress in development of
 auditory skills or <30% score on MLNT or LNT test,
depending on age

28. Trend towards bilateral

30. New Surgical Techniques

31. TIKI Technology
Extremely low power
Integrated Circuit
incorporating:
Implantable • Audio pre-processing
Rechargeable
Battery
? • Stimulator module
• Speech processor
• Power management
• High voltage output
switches
High performance
implantable
microphone that will
last a lifetime

32. Suppose the electrodes could be in close contact
with the nerves…

33. Neurotrophins and Auditory Nerve Regeneration
Normal Deafened Regeneration
Outer Haircells
Inner Haircells
Habenula Perforata
Wise et al, The Bionic Ear Institute, 2003.

34. Nanotechnology: Guidance Molecules

35. Thank you for your attention and
please feel free to comment
in my personal weblog
www.monika-lehnhardt.net