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Electro Acoustic Stimulation ( EAS )

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Electro Acoustic Stimulation ( EAS )

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Electro Acoustic Stimulation ( EAS )

  1. 1. ELECTRO ACOUSTIC STIMULATION - Dr. Satya Kiran Avvaru
  2. 2. EAS
  3. 3. Nomenclature
  4. 4. Introduction Expanding criteria of CI Why cant hearing aids be used ? Problem of high freq HL Concept of preservation (? residual hearing) in CI
  5. 5. 1. residual hair cells 2. neural tissues 3. endocochlear potentials 4. the travelling wave 5. inner ear & middle ear transformer mech. 6. vestibular system What is to be preserved?
  6. 6. Hearing preservation - post op PTA (250,500,750,1000 Hz) within 10dB of pre op PTA - post op PTA (250,500,1000,2000 Hz) within 10dB of pre op PTA % of HP = [PTA post op – PTA pre op ] / [120 – PTA pre op] X 100
  7. 7. - Standard CI technique – residual hearing is lost in 50% of recipients - Hearing conservation – increasingly realistic & desired goal in CI surgery - Lesser traumatic insertion achieved in several ways..
  8. 8. Hearing preservation - Devices Manufacturer Electrode Electrode length HP principle Route & Degree of insertion Cochlear Hybrid S 8 Hybrid S 12 6 mm (0.2-0.4 dia, 6 ch) 10 mm 10 mm (10 ch) Short electrode Cochleostomy (190200) Cochleostomy Cochlear Hybrid L 24 16 mm (22 ch) Short electrode Cochleostomy RW (270) Cochlear CI 422 Slim 25 mm (0.3-0.6 mm dia, 22 + 2 el) Thin electrode (straight, lateral wall electrode) Cochleostomy RW(270450 ) Med El FLEX EAS 2124 mm (19 el = 7 pairs + 5) Shorter, thin electrode Cochleostomy RW (CCC) Advanced Bionics Mid scala 18.5 mm Shorter, thin ( mid scala) RW Cochleostomy
  9. 9. Hearing preservation techniques • Optimal electrode length controversy • Partially inserted standard electrodes • Softer & thinner electrodes • Preservation with full insertion of standard electrode • Optimal insertion depth angle • Minimized forces on outer cochlear wall • Minimized drilling Methods Alternate methods
  10. 10. “Soft surgery” features - identify RW membrane - site, size & seal of cochleostomy - elimination of bone dust & blood (? lubricant) - low speed drilling while cochleostomy - no suctioning of perilymph - perioperative steroids - careful insertion of electrode array - ? cochleostomy / RW / Extended or peri RW technique
  11. 11. What is EAS ? EAS – a combination of 2 technologies : cochlear implant for high frequencies acoustic amplification for low frequencies Together, they cover full range of hearing for children & adults.
  12. 12. Electric + Acoustic stimulation = CI (i) + HA (c) = CI (i) + HA (i) + HA (c) Effects : 1. Improved SDS 2. Improved SNR 3. Music appreciation Bimodal hearing Combined hearing
  13. 13. Restoring the hearing potential EAS – can help to regain hearing in both high and low frequencies electric stimulation improve hearing in high-frequency acoustic amplification can improve your residual hearing in the low frequencies
  14. 14. HA Vs EAS monosyllable speech score test. HA users score – 21% EAS users score – 71% an average of 50% points higher in speech understanding & sound quality
  15. 15. EAS Vs Electric only stimulation EAS benefits : - in music with pitch discrimination - interval perception - song recognition - in overall quality of life
  16. 16. Audio processor 3rd generation AP acoustic unit & customized ear mould acoustic stimulation across low freq electric stimulation in high freq with 48dB acoustic amplification across low freq the ideal solution for candidates with partial deafness SONNET EAS MED EL
  17. 17. Internal implant is the ideal choice for EAS soft, flexible (FLEX EAS) electrodes to help preserve your residual natural hearing MRI Safe at 3.0 Tesla - Without Magnet removalSYNCHRONY MED EL
  18. 18. Synchrony features Unparalleled MRI Safety Smallest Titanium Implant Proven Stability Choice for Any Cochlea
  19. 19. FREEDOM HYBRID is the ideal choice for EAS shorter electrode avoids potential for trauma to apical end of cochlea HYBRID COCHLEAR
  20. 20. Hybrid L 24 peri-scalar electrode
  21. 21. How to select EAS device?
  22. 22. How to select EAS device? Do off an ASSR ; Radio imaging Anticipate the insertion depth angle required Select the most suitable electrode
  23. 23. Accessories Wired accessories • Audio cable • TV / Hi-Fi cable • Ear phones • Lapel microphone • FM cable Wireless accessories • Mic lock Hybrid acoustic component
  24. 24. Activation b/w 2-6 wk post implantation both electric stimulation & acoustic amplification are activated initial period of adaptation to combined stimulation is common as expected. When ? What ? Why ?
  25. 25. How safe ? - FDA approved the Cochlear Nucleus Hybrid L24 Cochlear Implant System for commercial release - on 21 March, 2014
  26. 26. Pitfalls o Patient related inability to take the advantage of combined stimulus o Lack of long term results o Need for revision implants
  27. 27.  In children (1-2 yr) – use of u/l short electrode in situations tested  Unilateral deafness + intractable debilitating tinnitus  SSD  Electrode Vs hearing threshold
  28. 28. • EAS – benefit of improved SD, hearing in noise, music appreciation • Residual hearing preservation – desirable & achievable • Aspects of electrode design & surgical technique • Ongoing investigations of strategies & programming post implantation
  29. 29. References - Cochlear implants 3rd edition – Susan B. Waltzman - Peter Luke Santa Maria, Michael Brian Gluth, Yongqing Yuan, et al. Hearing preservation surgery for cochlear implantation: A Meta-analysis. Otology & Neurotology 2014; 35:e256- e269. - Nneka Eze, Dan Jiang, Alec Fitzgerald O’Connor. Inner ear energy exposure while drilling a cochleostomy. Acta Oto-Laryngologica 2014; 134: 1109-1113. - Ling Zhou, MD; David R. Friedmann, MD; Claudiu Treaba, Meng, MBA et al. Does cochleostomy location influence electrode trajectory and intracochlear trauma? The Laryngoscope 2014. - www.medel.com - www.cochlear.com - Talks @ ISOCON 2014, Chennai - Talks @ CIGICON 2014, AIIMS, New Delhi
  30. 30. ACQUIRE SHARE DISTRIBUTE KNOWLEDGE & SURGICAL SKILLS knowledge and love are the only two things which increase by sharing
  31. 31. - Dr. SATYA KIRAN

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