Presentation given by HEARing CRC CEO Associate Professor Robert Cowan on new approaches to preserve residual hearing and improve performance for cochlear implant recipients at the New Zealand Audiological Society‘s 38th Annual Conference (2-5 July 2014).
The document provides an overview of cochlear implants, including their history, components, surgical procedure, candidate selection criteria, and post-operative considerations. It discusses the main components of cochlear implants, how they work to directly stimulate the auditory nerve, and the different implant systems from Cochlear, Advanced Bionics, and Med-El. Important aspects like electrode array design and coding strategies used to transmit sound are also summarized.
Pure tone audiometry is used to determine the hearing thresholds of a patient across different frequencies. It involves presenting pure tones through air conduction and bone conduction headphones to measure the softest sounds a patient can detect. The results are plotted on a graph called an audiogram. Interpreting the audiogram can provide information about the type, degree and configuration of any hearing loss. It is an important diagnostic tool but does not assess all aspects of hearing. Masking noise is sometimes used to isolate testing of one ear. Proper technique and interpretation are required to obtain accurate results.
Effective Investigation Reports - Derek Knights - i-SightCase IQ
Investigation Report Writing
The structure of a professional investigation report
How to keep language clear and simple
Words and phrases to avoid
List of elements that must be included
Information that should not be included
How to summarize findings
This document discusses concepts related to loudness perception and discomfort for individuals with hearing loss. It defines key terms like dynamic range, loudness recruitment, most comfortable level, uncomfortable level, and loudness discomfort level. LDL testing involves using tones or noise to determine the level at which sounds become uncomfortably loud. LDLs measured in dB HL must be converted to dB SPL for real-ear comparison to hearing aid output, using RETSPL and RECD values. Comparing measured LDLs to real-ear saturation response can help ensure hearing aid output does not exceed discomfort levels.
rehabilitation of a deaf child (PGIMER CHANDIGARH)abhijeet89singh
This document discusses rehabilitation of deaf children. It defines types of hearing loss and outlines screening protocols for identifying childhood hearing impairment. Investigations for determining the cause of hearing loss are described, including recommended levels of testing. Guidelines are provided for managing and intervening with children who have mild to profound hearing loss, including approaches like hearing aids, remote microphone technology, and cochlear implantation. The importance of ongoing monitoring and family support is emphasized to facilitate a child's development.
Cochlear implants can help those with severe to profound hearing loss by making speech a viable communication option. They improve speech perception, production, and reading outcomes. Candidates undergo testing to determine candidacy and benefit from a hearing aid trial first. Imaging is needed to assess anatomy and rule out contraindications like 8th nerve lesions. Successful implantation requires a collaborative team approach and post-operative rehabilitation. Risks include wound issues, facial nerve stimulation, and device problems.
This document discusses newborn hearing screening and intervention. It notes that hearing loss is the most common birth defect and undetected hearing loss can have negative consequences for child development. Early identification of hearing loss before 6 months of age is important for language acquisition. The document reviews data on language outcomes for children identified with hearing loss before versus after 6 months. It describes South Carolina legislation requiring universal newborn hearing screening and the goals of screening by 1 month, diagnosis by 3 months, and early intervention by 6 months (1-3-6 goals). Data on screening, diagnosis and early intervention rates in South Carolina from 2002-2011 are presented. Opportunities for collaboration between various programs to improve follow-up and outcomes are discussed.
This document discusses electro-acoustic stimulation (EAS), which combines cochlear implantation for high frequencies with acoustic amplification for low frequencies. EAS aims to restore hearing in both high and low frequencies by using electric stimulation to improve hearing in high frequencies and acoustic amplification to improve residual hearing in low frequencies. Studies have found that EAS users score significantly higher on speech tests compared to users of hearing aids alone. The document discusses various EAS devices and features that aim to preserve residual hearing, such as shorter or thinner electrodes. It also covers aspects of the surgery and post-operative programming to optimize the benefits of combined electric and acoustic stimulation.
The document provides an overview of cochlear implants, including their history, components, surgical procedure, candidate selection criteria, and post-operative considerations. It discusses the main components of cochlear implants, how they work to directly stimulate the auditory nerve, and the different implant systems from Cochlear, Advanced Bionics, and Med-El. Important aspects like electrode array design and coding strategies used to transmit sound are also summarized.
Pure tone audiometry is used to determine the hearing thresholds of a patient across different frequencies. It involves presenting pure tones through air conduction and bone conduction headphones to measure the softest sounds a patient can detect. The results are plotted on a graph called an audiogram. Interpreting the audiogram can provide information about the type, degree and configuration of any hearing loss. It is an important diagnostic tool but does not assess all aspects of hearing. Masking noise is sometimes used to isolate testing of one ear. Proper technique and interpretation are required to obtain accurate results.
Effective Investigation Reports - Derek Knights - i-SightCase IQ
Investigation Report Writing
The structure of a professional investigation report
How to keep language clear and simple
Words and phrases to avoid
List of elements that must be included
Information that should not be included
How to summarize findings
This document discusses concepts related to loudness perception and discomfort for individuals with hearing loss. It defines key terms like dynamic range, loudness recruitment, most comfortable level, uncomfortable level, and loudness discomfort level. LDL testing involves using tones or noise to determine the level at which sounds become uncomfortably loud. LDLs measured in dB HL must be converted to dB SPL for real-ear comparison to hearing aid output, using RETSPL and RECD values. Comparing measured LDLs to real-ear saturation response can help ensure hearing aid output does not exceed discomfort levels.
rehabilitation of a deaf child (PGIMER CHANDIGARH)abhijeet89singh
This document discusses rehabilitation of deaf children. It defines types of hearing loss and outlines screening protocols for identifying childhood hearing impairment. Investigations for determining the cause of hearing loss are described, including recommended levels of testing. Guidelines are provided for managing and intervening with children who have mild to profound hearing loss, including approaches like hearing aids, remote microphone technology, and cochlear implantation. The importance of ongoing monitoring and family support is emphasized to facilitate a child's development.
Cochlear implants can help those with severe to profound hearing loss by making speech a viable communication option. They improve speech perception, production, and reading outcomes. Candidates undergo testing to determine candidacy and benefit from a hearing aid trial first. Imaging is needed to assess anatomy and rule out contraindications like 8th nerve lesions. Successful implantation requires a collaborative team approach and post-operative rehabilitation. Risks include wound issues, facial nerve stimulation, and device problems.
This document discusses newborn hearing screening and intervention. It notes that hearing loss is the most common birth defect and undetected hearing loss can have negative consequences for child development. Early identification of hearing loss before 6 months of age is important for language acquisition. The document reviews data on language outcomes for children identified with hearing loss before versus after 6 months. It describes South Carolina legislation requiring universal newborn hearing screening and the goals of screening by 1 month, diagnosis by 3 months, and early intervention by 6 months (1-3-6 goals). Data on screening, diagnosis and early intervention rates in South Carolina from 2002-2011 are presented. Opportunities for collaboration between various programs to improve follow-up and outcomes are discussed.
This document discusses electro-acoustic stimulation (EAS), which combines cochlear implantation for high frequencies with acoustic amplification for low frequencies. EAS aims to restore hearing in both high and low frequencies by using electric stimulation to improve hearing in high frequencies and acoustic amplification to improve residual hearing in low frequencies. Studies have found that EAS users score significantly higher on speech tests compared to users of hearing aids alone. The document discusses various EAS devices and features that aim to preserve residual hearing, such as shorter or thinner electrodes. It also covers aspects of the surgery and post-operative programming to optimize the benefits of combined electric and acoustic stimulation.
Cochlear implant systems involve implantable devices with electrode arrays and sound processors. There are various implant options from manufacturers like Cochlear, Advanced Bionics, and Med-El. The surgeon must consider the patient's condition and available implants to design the best implantation approach. Cochlear's Nucleus implant features a removable magnet for MRI safety and various electrode designs like the Contour Advance perimodiolar electrode or CI422 straight electrode to suit different surgical approaches and patient needs. Proper electrode placement is important for optimal hearing outcomes.
A NOVEL METHOD FOR OBTAINING A BETTER QUALITY SPEECH SIGNAL FOR COCHLEAR IMPL...acijjournal
Cochlear implant devices are known to exist since a long time. The purpose of the present work is to develop a speech algorithm for obtaining robust speech. In this paper, the technique of cochlear implant is first introduced, followed by discussions of some of the existing techniques available for obtaining speech. The next section introduces a new technique for obtaining robust speech. The key feature of this technique lies in the use of the advantages of an integrated approach involving the use of an estimation technique such as a kalman filter with non linear filter bank strategy, using Dual Resonance Non Linear(DRNL) and Single Side Band(SSB) Encoding method. A comparative study of the proposed method with the existing method indicates that the proposed method performs well compared to the existing method.
Electric acoustic stimulation (EAS) combines acoustic hearing preservation with electric stimulation from a cochlear implant. EAS aims to preserve residual low-frequency hearing while providing stimulation for high frequencies not heard. The history of cochlear implants led to the development of EAS. EAS surgery techniques aim to insert the electrode array atraumatically to avoid hearing loss. Outcomes of EAS include successful hearing preservation in 75% of subjects long-term and significantly improved speech perception compared to acoustic hearing alone. EAS also provides benefits for music appreciation and subjective hearing benefits.
Advancement in acoustic reflex measuresUditSaxena19
This document discusses recent advancements in measuring the acoustic reflex. It describes how acoustic reflex measurements can provide more precise information and help diagnose auditory processing disorders. Specifically, it mentions that:
1) Modern reflex measurement technology is more miniature, attractive, easy to use, and cost/time effective compared to older techniques.
2) Reflex thresholds, growth functions, and temporal characteristics like latency and decay can identify problems at the auditory nerve and lower brainstem level.
3) Studies have found elevated thresholds, shallower slopes, and longer latencies in clinical groups using reflex measures.
The document describes the design and construction of a digital hearing aid with recording capabilities. It aims to minimize background noise and allow playback of conversations. Key features include:
- A directional microphone and telecoil input to the amplifier circuit.
- An audio recording system using an IC memory to store up to 60 seconds of playback.
- A testing process that showed improved hearing for users with disabilities, except those who are completely deaf.
The hearing aid was designed and constructed to address issues like noise filtering, sound localization, and social stigma. Test results demonstrated benefits for various levels of impaired hearing. Recommendations include reducing size, improving noise cancellation and feedback management, and increasing storage capacity.
This study used cone beam computed tomography (CBCT) to assess the position of cochlear implant electrodes in 30 children with hearing loss. CBCT was found to provide high quality images with low radiation exposure. The results showed that the electrode array was inserted in the correct place (scala tympani) in 86.6% of children and speech recognition scores were better when the array was in this position versus the incorrect position (scala vestibuli). Closer proximity of the electrode array to the modiolus and greater insertion depth were both correlated with better speech outcomes. CBCT was determined to be an effective method for localizing electrode position and factors related to speech performance.
This document summarizes key points about biometry and optical coherence biometry. It discusses how biometry helps achieve a desired refractive status post-operatively and better vision than before. Common biometry procedures from 1984 like keratometry and ultrasonography are mentioned. The document then focuses on optical coherence biometry, comparing it to ultrasound biometry and discussing its advantages like being non-contact, obtaining multiple measurements along the same axis in one go for more accurate formulas, and greater measurement precision and range for factors like axial length, anterior chamber depth, and lens thickness.
This presentation by Dr. Frank Musiek from the 2016 International Hemispherectomy Conference and Family Reunion addresses how hemispherectomy surgery affects how the brain processes sounds and words.
La dispensa del Workshop tenuto il 23 giugno 2015 a Fiumicino.
* cosa sono i SubBottom Profiler e per quali applicazioni vengono usati
* quale tecnologia permette loro di rilevare gli strati dei fondali marini e di acque interne
* quali caratteristiche tecniche verificare prima di un acquisto
Corso tenuto da Nick Lawrence - sales director - Edgetech.
Edgetech è rappresentata in Italia in esclusiva da Codevintec.
Cochlear implant systems translate acoustic information into electrical impulses to recreate functional hearing. Oticon Medical's new Neuro sound processors use "Coordinated Adaptive Processing" to automatically balance and coordinate advanced sound processing features for optimal speech understanding across environments. This approach captures a wide range of input sounds without compression while using environment detection, directionality, noise reduction, and output compression tailored for each situation. The goal is to provide the richest sound experience possible.
The document discusses a study that evaluated the effectiveness of bilateral versus monaural bone-anchored hearing aid (BAHA) fittings. 25 patients with symmetrical hearing loss were tested on directional hearing and speech recognition in quiet and noise. The results showed improved sound localization and speech understanding in noise with bilateral BAHA fittings compared to monaural fittings.
Audiometry class by Dr. Kavitha Ashok Kumar MSU MalaysiaKavitha Ashokb
1. Pure tone audiometry is an objective test that measures air and bone conduction thresholds to evaluate the type and severity of hearing loss. It is helpful for documentation and diagnosis.
2. Impedance audiometry objectively measures middle ear function through tympanometry and acoustic reflex testing. It can detect middle ear pathologies and is a fast screening test.
3. Otoacoustic emissions are sounds originating from the cochlea that can help diagnose cochlear hearing loss through an objective, noninvasive test done in both children and adults.
The document describes Rehear's over-the-counter hearing aid product. It has 3 key features:
1. An AI-assisted smartphone app that can test hearing without an audiometric booth by using active noise cancellation. Clinical trials showed it correlates highly with standard hearing tests.
2. Ultra-low delay signal processing of 0.2ms to minimize distortion. It has a high sampling rate of 625kHz and 441 channels for accurate sound reproduction.
3. AI-powered active noise cancellation that can optimize noise reduction for different environments while maintaining gain accuracy. This improves sound quality for calls and media streaming.
Recording Distortion Product Otoacoustic Emissions using the Adaptive Noise C...RicardoVallejo30
Assessing the effectiveness of the Path Medical QSCREEN ® Adaptive Noise Cancellation Technology on various DPOAE test parameters (overall test time, overall pass/refer, test time and pass/refer rate per frequency).
Predicted impairment and handicap from exposure to steady state broad-band in...Alexander Decker
This academic article summarizes research on predicting impairment and handicap from exposure to steady-state broad-band industrial noise. The researchers used empirical formulas to predict monaural impairment and hearing handicap values for different exposure levels. They found that both impairment and handicap increase with exposure level, supporting the equal energy hypothesis. The values of hearing handicap were always higher than impairment values.
QoMEX2014 - Analysing the Quality of Experience of Multisensory Media from Me...Jacob Donley
This presentation was given at QoMEX 2014, the 6th International Workshop on Quality of Multimedia Experience.
Abstract:
This paper investigates the Quality of Experience (QoE) of multisensory media by analysing biosignals collected by electroencephalography (EEG) and eye gaze sensors and comparing with subjective ratings. Also investigated is the impact on QoE of various levels of synchronicity between the sensory effect and target video scene. Results confirm findings from previous research that show sensory effects added to videos increases the QoE rating. While there was no statistical difference observed for the QoE ratings for different levels of sensory effect synchronicity, an analysis of raw EEG data showed 25% more activity in the temporal lobe during asynchronous effects and 20-25% more activity in the occipital lobe during synchronous effects. The eye gaze data showed more deviation for a video with synchronous effects and the EEG showed correlating occipital lobe activity for this instance. These differences in physiological responses indicate sensory effect synchronicity may affect QoE despite subjective ratings appearing similar.
Stethoscopes are in use for more than 200 years for medical diagnostics, especially for auscultation in the healthcare domain. Recently, unprecedented growth in mobile technology has revived the use of stethoscopes for Telehealthcare. Digital or electronic stethoscopes are increasingly researched for use in Telehealthcare within the healthcare domain. Cardiovascular diseases have become highly prevalent worldwide, especially in the subcontinent. Improvements in diagnostics will improve the quality of life and prevent the loss of life. This research paper mainly focuses on the acoustical and multiphysics design aspects of the stethoscope for improved acoustical performance. A COMSOL model of the stethoscope chest piece was developed. The model was setup to investigate the effects of geometry, material of construction, noise and input pressure. The sound transmission efficiency of the components was investigated with multiphysics models by coupling the acoustical and structural performances. The effect of ambient noise on the performance was also studied and reported. This COMSOL model wasis further used to investigate the effects of shape, size and material parameters on the performance and improvement in the acoustic transmission and noise isolation. The frequency response of the system was also investigated for resonance and performance in relation to auscultation of cardio, lung and other sounds. Through this research paper the researchers share the initial findings for the development of acoustical and multiphysics design aspects of the stethoscope. The ultimate objective is to leverage the improvement in the acoustics of the stethoscope for use in Telehealthcare.
The document provides information on the features and components of Cochlear Ltd.'s cochlear implant products. It discusses the Nucleus 7, Kanso, and previous generation sound processors. Key details include:
- The Nucleus 7 is the first Made for iPhone sound processor and allows control via smartphone apps. It has rechargeable and disposable battery options.
- The Kanso is a smaller, lighter processor that uses disposable batteries.
- Both transmit sound to the internal implant via an inductive coil and wireless link, stimulating the auditory nerve to allow hearing.
1) The document proposes a single-port wireless transceiver circuit to enable affordable audio-visual communication for small enterprises, addressing the expensive costs of traditional videoconferencing.
2) A key challenge is reducing audio feedback known as the "Larsen effect" that occurs when a microphone picks up sound from its own speaker, causing an annoying acoustic noise.
3) The paper describes an experimental circuit built by the authors that uses a feedback control unit to monitor microphone and speaker levels and suppress the Larsen effect, allowing for clear audio-visual transmission over a single wireless port. Testing showed the acoustic echo was eliminated when this anti-Larsen effect circuit was employed.
This document provides information about bone conducting hearing aid solutions. It discusses the types of hearing loss that can be treated with conventional hearing aids versus bone conducting hearing aids. It provides a brief history of hearing aid development. It then describes the basic structure and mechanism of bone conducting hearing aids, including the BAHA system. It outlines the prerequisites, candidates, operative technique and potential complications of bone conducting hearing aids. Overall, the document serves as an overview of bone conducting hearing aid solutions.
Use of ConeBeam Computed Tomography to determine cochlear length and implant ...HEARnet _
This study aimed to develop a technique for calculating cochlear length and determining cochlear implant electrode position using cone-beam computed tomography (CBCT) scans. The researchers examined CBCT scans of 100 subjects who received cochlear implants with either straight or contour electrode arrays. They calculated cochlear length based on the number of electrodes inserted at 360 degrees. For straight arrays, cochlear length ranged from 27.44 to 35.91 mm. For contour arrays, length ranged from 17.8 to 22.24 mm. The study concluded that CBCT can be used to precisely map electrode position to the cochlear's tonotopic map, which may improve outcomes for cochlear implantation.
Cochlear implant systems involve implantable devices with electrode arrays and sound processors. There are various implant options from manufacturers like Cochlear, Advanced Bionics, and Med-El. The surgeon must consider the patient's condition and available implants to design the best implantation approach. Cochlear's Nucleus implant features a removable magnet for MRI safety and various electrode designs like the Contour Advance perimodiolar electrode or CI422 straight electrode to suit different surgical approaches and patient needs. Proper electrode placement is important for optimal hearing outcomes.
A NOVEL METHOD FOR OBTAINING A BETTER QUALITY SPEECH SIGNAL FOR COCHLEAR IMPL...acijjournal
Cochlear implant devices are known to exist since a long time. The purpose of the present work is to develop a speech algorithm for obtaining robust speech. In this paper, the technique of cochlear implant is first introduced, followed by discussions of some of the existing techniques available for obtaining speech. The next section introduces a new technique for obtaining robust speech. The key feature of this technique lies in the use of the advantages of an integrated approach involving the use of an estimation technique such as a kalman filter with non linear filter bank strategy, using Dual Resonance Non Linear(DRNL) and Single Side Band(SSB) Encoding method. A comparative study of the proposed method with the existing method indicates that the proposed method performs well compared to the existing method.
Electric acoustic stimulation (EAS) combines acoustic hearing preservation with electric stimulation from a cochlear implant. EAS aims to preserve residual low-frequency hearing while providing stimulation for high frequencies not heard. The history of cochlear implants led to the development of EAS. EAS surgery techniques aim to insert the electrode array atraumatically to avoid hearing loss. Outcomes of EAS include successful hearing preservation in 75% of subjects long-term and significantly improved speech perception compared to acoustic hearing alone. EAS also provides benefits for music appreciation and subjective hearing benefits.
Advancement in acoustic reflex measuresUditSaxena19
This document discusses recent advancements in measuring the acoustic reflex. It describes how acoustic reflex measurements can provide more precise information and help diagnose auditory processing disorders. Specifically, it mentions that:
1) Modern reflex measurement technology is more miniature, attractive, easy to use, and cost/time effective compared to older techniques.
2) Reflex thresholds, growth functions, and temporal characteristics like latency and decay can identify problems at the auditory nerve and lower brainstem level.
3) Studies have found elevated thresholds, shallower slopes, and longer latencies in clinical groups using reflex measures.
The document describes the design and construction of a digital hearing aid with recording capabilities. It aims to minimize background noise and allow playback of conversations. Key features include:
- A directional microphone and telecoil input to the amplifier circuit.
- An audio recording system using an IC memory to store up to 60 seconds of playback.
- A testing process that showed improved hearing for users with disabilities, except those who are completely deaf.
The hearing aid was designed and constructed to address issues like noise filtering, sound localization, and social stigma. Test results demonstrated benefits for various levels of impaired hearing. Recommendations include reducing size, improving noise cancellation and feedback management, and increasing storage capacity.
This study used cone beam computed tomography (CBCT) to assess the position of cochlear implant electrodes in 30 children with hearing loss. CBCT was found to provide high quality images with low radiation exposure. The results showed that the electrode array was inserted in the correct place (scala tympani) in 86.6% of children and speech recognition scores were better when the array was in this position versus the incorrect position (scala vestibuli). Closer proximity of the electrode array to the modiolus and greater insertion depth were both correlated with better speech outcomes. CBCT was determined to be an effective method for localizing electrode position and factors related to speech performance.
This document summarizes key points about biometry and optical coherence biometry. It discusses how biometry helps achieve a desired refractive status post-operatively and better vision than before. Common biometry procedures from 1984 like keratometry and ultrasonography are mentioned. The document then focuses on optical coherence biometry, comparing it to ultrasound biometry and discussing its advantages like being non-contact, obtaining multiple measurements along the same axis in one go for more accurate formulas, and greater measurement precision and range for factors like axial length, anterior chamber depth, and lens thickness.
This presentation by Dr. Frank Musiek from the 2016 International Hemispherectomy Conference and Family Reunion addresses how hemispherectomy surgery affects how the brain processes sounds and words.
La dispensa del Workshop tenuto il 23 giugno 2015 a Fiumicino.
* cosa sono i SubBottom Profiler e per quali applicazioni vengono usati
* quale tecnologia permette loro di rilevare gli strati dei fondali marini e di acque interne
* quali caratteristiche tecniche verificare prima di un acquisto
Corso tenuto da Nick Lawrence - sales director - Edgetech.
Edgetech è rappresentata in Italia in esclusiva da Codevintec.
Cochlear implant systems translate acoustic information into electrical impulses to recreate functional hearing. Oticon Medical's new Neuro sound processors use "Coordinated Adaptive Processing" to automatically balance and coordinate advanced sound processing features for optimal speech understanding across environments. This approach captures a wide range of input sounds without compression while using environment detection, directionality, noise reduction, and output compression tailored for each situation. The goal is to provide the richest sound experience possible.
The document discusses a study that evaluated the effectiveness of bilateral versus monaural bone-anchored hearing aid (BAHA) fittings. 25 patients with symmetrical hearing loss were tested on directional hearing and speech recognition in quiet and noise. The results showed improved sound localization and speech understanding in noise with bilateral BAHA fittings compared to monaural fittings.
Audiometry class by Dr. Kavitha Ashok Kumar MSU MalaysiaKavitha Ashokb
1. Pure tone audiometry is an objective test that measures air and bone conduction thresholds to evaluate the type and severity of hearing loss. It is helpful for documentation and diagnosis.
2. Impedance audiometry objectively measures middle ear function through tympanometry and acoustic reflex testing. It can detect middle ear pathologies and is a fast screening test.
3. Otoacoustic emissions are sounds originating from the cochlea that can help diagnose cochlear hearing loss through an objective, noninvasive test done in both children and adults.
The document describes Rehear's over-the-counter hearing aid product. It has 3 key features:
1. An AI-assisted smartphone app that can test hearing without an audiometric booth by using active noise cancellation. Clinical trials showed it correlates highly with standard hearing tests.
2. Ultra-low delay signal processing of 0.2ms to minimize distortion. It has a high sampling rate of 625kHz and 441 channels for accurate sound reproduction.
3. AI-powered active noise cancellation that can optimize noise reduction for different environments while maintaining gain accuracy. This improves sound quality for calls and media streaming.
Recording Distortion Product Otoacoustic Emissions using the Adaptive Noise C...RicardoVallejo30
Assessing the effectiveness of the Path Medical QSCREEN ® Adaptive Noise Cancellation Technology on various DPOAE test parameters (overall test time, overall pass/refer, test time and pass/refer rate per frequency).
Predicted impairment and handicap from exposure to steady state broad-band in...Alexander Decker
This academic article summarizes research on predicting impairment and handicap from exposure to steady-state broad-band industrial noise. The researchers used empirical formulas to predict monaural impairment and hearing handicap values for different exposure levels. They found that both impairment and handicap increase with exposure level, supporting the equal energy hypothesis. The values of hearing handicap were always higher than impairment values.
QoMEX2014 - Analysing the Quality of Experience of Multisensory Media from Me...Jacob Donley
This presentation was given at QoMEX 2014, the 6th International Workshop on Quality of Multimedia Experience.
Abstract:
This paper investigates the Quality of Experience (QoE) of multisensory media by analysing biosignals collected by electroencephalography (EEG) and eye gaze sensors and comparing with subjective ratings. Also investigated is the impact on QoE of various levels of synchronicity between the sensory effect and target video scene. Results confirm findings from previous research that show sensory effects added to videos increases the QoE rating. While there was no statistical difference observed for the QoE ratings for different levels of sensory effect synchronicity, an analysis of raw EEG data showed 25% more activity in the temporal lobe during asynchronous effects and 20-25% more activity in the occipital lobe during synchronous effects. The eye gaze data showed more deviation for a video with synchronous effects and the EEG showed correlating occipital lobe activity for this instance. These differences in physiological responses indicate sensory effect synchronicity may affect QoE despite subjective ratings appearing similar.
Stethoscopes are in use for more than 200 years for medical diagnostics, especially for auscultation in the healthcare domain. Recently, unprecedented growth in mobile technology has revived the use of stethoscopes for Telehealthcare. Digital or electronic stethoscopes are increasingly researched for use in Telehealthcare within the healthcare domain. Cardiovascular diseases have become highly prevalent worldwide, especially in the subcontinent. Improvements in diagnostics will improve the quality of life and prevent the loss of life. This research paper mainly focuses on the acoustical and multiphysics design aspects of the stethoscope for improved acoustical performance. A COMSOL model of the stethoscope chest piece was developed. The model was setup to investigate the effects of geometry, material of construction, noise and input pressure. The sound transmission efficiency of the components was investigated with multiphysics models by coupling the acoustical and structural performances. The effect of ambient noise on the performance was also studied and reported. This COMSOL model wasis further used to investigate the effects of shape, size and material parameters on the performance and improvement in the acoustic transmission and noise isolation. The frequency response of the system was also investigated for resonance and performance in relation to auscultation of cardio, lung and other sounds. Through this research paper the researchers share the initial findings for the development of acoustical and multiphysics design aspects of the stethoscope. The ultimate objective is to leverage the improvement in the acoustics of the stethoscope for use in Telehealthcare.
The document provides information on the features and components of Cochlear Ltd.'s cochlear implant products. It discusses the Nucleus 7, Kanso, and previous generation sound processors. Key details include:
- The Nucleus 7 is the first Made for iPhone sound processor and allows control via smartphone apps. It has rechargeable and disposable battery options.
- The Kanso is a smaller, lighter processor that uses disposable batteries.
- Both transmit sound to the internal implant via an inductive coil and wireless link, stimulating the auditory nerve to allow hearing.
1) The document proposes a single-port wireless transceiver circuit to enable affordable audio-visual communication for small enterprises, addressing the expensive costs of traditional videoconferencing.
2) A key challenge is reducing audio feedback known as the "Larsen effect" that occurs when a microphone picks up sound from its own speaker, causing an annoying acoustic noise.
3) The paper describes an experimental circuit built by the authors that uses a feedback control unit to monitor microphone and speaker levels and suppress the Larsen effect, allowing for clear audio-visual transmission over a single wireless port. Testing showed the acoustic echo was eliminated when this anti-Larsen effect circuit was employed.
This document provides information about bone conducting hearing aid solutions. It discusses the types of hearing loss that can be treated with conventional hearing aids versus bone conducting hearing aids. It provides a brief history of hearing aid development. It then describes the basic structure and mechanism of bone conducting hearing aids, including the BAHA system. It outlines the prerequisites, candidates, operative technique and potential complications of bone conducting hearing aids. Overall, the document serves as an overview of bone conducting hearing aid solutions.
Similar to New Approaches to Preserve Residual Hearing and Improve Performance for Cochlear Implant Recipients (20)
Use of ConeBeam Computed Tomography to determine cochlear length and implant ...HEARnet _
This study aimed to develop a technique for calculating cochlear length and determining cochlear implant electrode position using cone-beam computed tomography (CBCT) scans. The researchers examined CBCT scans of 100 subjects who received cochlear implants with either straight or contour electrode arrays. They calculated cochlear length based on the number of electrodes inserted at 360 degrees. For straight arrays, cochlear length ranged from 27.44 to 35.91 mm. For contour arrays, length ranged from 17.8 to 22.24 mm. The study concluded that CBCT can be used to precisely map electrode position to the cochlear's tonotopic map, which may improve outcomes for cochlear implantation.
How far down does the top down control of speech processing go? - HEARing CRC...HEARnet _
There is evidence that this efferent control may play a role in extracting signals from noise and the detection of target sounds. Here we evaluated the role of attention on the auditory efferent control of the brainstem (using auditory brainstem responses; ABRs) and the cochlear gain (using otoacoustic emissions; OAEs) during passive listening and a task of variable difficulty. We hypothesized that both the ABRs and OAEs would be modulated by attention and that the degree of suppression of OAEs (relative to the passive condition) would increase with task difficulty.
Should i get a hearing aid now - HEARing CRC PhD presentationHEARnet _
This poster describes the development of a patient decision aid to help individuals decide whether to adopt hearing aids. Researchers conducted a survey that found 90% of respondents would prefer to know their chances of success with hearing aids before deciding. The researchers then analyzed an existing data set and conducted a literature review to identify client factors that predict hearing aid success. An online patient decision aid was created incorporating these evidence-based factors to provide individualized predictions of success. The goal is to support informed shared decision making about hearing aids.
Role of infant-directed speech in language development of hearing impaired in...HEARnet _
This document summarizes research on the role of infant-directed speech (IDS) in language development for hearing impaired infants. IDS refers to the exaggerated speech style adults use with infants. For normal-hearing infants, IDS helps with word segmentation, recognition, and learning. However, less is known about the features and benefits of IDS for hearing impaired infants. The current study aims to investigate the features of IDS provided to both normal-hearing and hearing impaired infants between 9-30 months, and determine what features most influence word learning and lexical processing for hearing impaired infants.
Organisational outcomes of person centred hearing care - HEARing CRC PhD pres...HEARnet _
Research Aims:
1.According to senior management, how is ‘success’ defined and evaluated in hearing care organisations in Australia?
a)What are the organisational values used to drive clinical practice and clinical change?
b)What are the measures used to drive clinical practice and clinical change?
c)To what extent it PCC reflected in these values and measures?
2.What short and long term effects does a PCC approach have on the measures?
MEG system for cochlear implants ecipients and auditory entrainment - HEARing...HEARnet _
A novel MEG system has been customized to measure brain activity in cochlear implant recipients. The system uses two groups of irregular gradiometers to reduce electromagnetic interference from cochlear implants. The system will measure speech processing in the brain by analyzing the coherence between brain activity and the temporal envelope of speech. Auditory cortical responses were measured in normal hearing participants using a cochlear implant simulator to evaluate the system's ability to suppress interference from implants.
Longterm effects of conductive hearing loss -HEARing CRC PhD presentationHEARnet _
To establish the impact of persistent conductive hearing
loss in early childhood on longer term listening ability,
speech perception in spatially separated background
noise was measured in school-age children with
documented histories of otitis media with conductive
hearing loss. Children with conductive hearing loss
history showed significantly poorer binaural hearing than
age-matched controls despite having normal hearing at
the time of assessment.
Hearing loss and the acquistion of english plural morphology - HEARing CRC Ph...HEARnet _
Research to gain insight into grammatical knowledge of children
with HL
• Identify effects of language background and HL on
acquisition of English grammar
• Establish norms for iPad paradigm to be used for
assessment or therapy
Hearing, listening and reading: A complex interplay of factors that contribut...HEARnet _
Research Aims:
1.Systematically map the auditory, cognitive, and linguistic abilities of children with listening concerns (as reported by parent/teacher).
2.Investigate how the ability to attend to and process incoming auditory information affects word reading and reading comprehension in school-aged children.
Hearing health of live music sound engineers - HEARing CRC PhD presentationHEARnet _
When listened to for too loud, for too long, music can incur the same hearing damage as experienced by those exposed to occupational noise.1 Rock/pop musicians have been well documented as being ‘at risk’ of such damage,3 yet little has been done to investigate if Live Music Sound Engineers, at the core of the live-music experience, are also at risk.
Evaluating audiological intervention options for people with dementia living ...HEARnet _
This research project aims to explore the communication needs of people with dementia and their family and professional caregivers; and how these needs are currently being addressed in their audiological management.
Development of tone sandhi in mandarin speaking children with Cochlear Implan...HEARnet _
This document discusses a research study that aims to investigate when Mandarin-speaking children with cochlear implants acquire tone sandhi. Tone sandhi refers to tone changes in Mandarin Chinese when two tones are combined. The study hypothesizes that acquisition of tone sandhi will be influenced by age of amplification, chronological age, and whether the child has one or two cochlear implants. One hundred children ages 4-12 will participate in production and perception experiments to test their acquisition of tone sandhi in novel word combinations. The results could provide insights into how age of implantation, therapy, and cochlear implant technology affect tone sandhi learning.
Development of an on-line assessment of speech perception - HEARing CRC PhD p...HEARnet _
Telepractice is routinely used for provision of diagnostic and rehabilitative hearing services. Validation of procedures including audiometry, video-otoscopy, cochlear implant and hearing aid programming and rehabilitation is reported in the literature. Speech perception testing using telepractice is an audiological procedure that is yet to be validated. The current study has developed an APP that can be used to provide on line assessment of speech perception to evaluate device suitability (hearing aids or cochlear implants) and to monitor progress with devices over time.
Benefits of music training for children with hearing loss - HEARing CRC PhD p...HEARnet _
The purpose of the study is to evaluate if music perception and appreciation, speech perception, and social wellbeing are improved after receiving music training.
If there are benefits, we would recommend music training as a complementary means of (re)habilitation.
Efficacy of auditory training in adults with hearing loss and auditory proces...HEARnet _
The biggest challenge for people with hearing loss is to communicate in noise. Even some normal Even some normal hearing older adults have issues understanding speech in noise.
Audiology Students and Patient-Centred Communication - HEARing CRC PhD presen...HEARnet _
1.
Explore key academics’ perceptions of PCC and how clinical communication is taught in Australian graduate audiology programs.
2.
Explore the nature of PCC between patient and student during clinical encounters within a teaching clinic.
3.
Explore students’ perspectives of their PCC skills and how clinical communication is taught.
Artificially enhancing better-ear glimpsing cues to improve understanding of ...HEARnet _
Artificially enhancing better-ear glimpsing cues to improve understanding of speech in noise for listeners with hearing loss cues to improve understanding of speech in noise for listeners with hearing loss
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Role of Mukta Pishti in the Management of Hyperthyroidism
New Approaches to Preserve Residual Hearing and Improve Performance for Cochlear Implant Recipients
1. creating sound valueTM
New Approaches to Preserve Residual
Hearing and Improve Performance for
Cochlear Implant Recipients
Robert Cowan
Carrie Newbold, Silvana Mergen, Dimitra Stathopoulos, Scott Chambers
Chris Miller, Robert Briggs, BinBin Zhang, Gordon Wallace & Stephen O’Leary
The HEARing Cooperative Research Centre, Australia
Depts of Otolaryngology & Audiology, The University of Melbourne, Australia
Royal Victorian Eye and Ear Hospital, Melbourne, Australia
Intelligent Polymer Research Institute, University of Wollongong, Australia
Cochlear Limited
www.hearingcrc.orgcreating sound valueTM
www.hearingcrc.org
2. creating sound valueTM 2
Human “Medical’ Bionics ‘Interface’
‘seamless transition
between the hard
world of electronics
and the soft
world of biology’
Nanowerk, July 17 2007
3. creating sound valueTM
Cochlear Implant (CI)
“cochlear implants, which use multiple electrodes that are implanted
into the cochlea to stimulate auditory nerves, are one of the most
successful medical bionic prosthetics”
4. Modern Cochlear Implant Systems
creating sound valueTM
Med-EL
Neurelec
Advanced
Bionics
Cochlear
7. creating sound valueTM 7
S C
Shepherd et al.,1993
EABR recordings at differing
positions in the cochlea
Outer wall Mid-scala
Peri-cortiPerimodiolar
Improving the Electro-neural Interface - Positioning
9. creating sound valueTM
1994
1995
1997
1998
1999
2001
2003
Perimodiolar Curling Array using hydrogels
concept studies initiated with IPRI
Histology on first perimodiolar designs
Curly with Stylet studies
First bioengineering & insertion studies
Curling and pre-curled arrays
Prototype pre-curled electrode
implanted 3 adult patients
First Contour implants
Contour Array
Phase II Trials
Advance &
AOS Insertion
Applying Polymer Technology to Improve the
Electro-neural Interface
10. creating sound valueTM
Technology: Perimodiolar Positioning
Standard Nucleus 24 electrode Nucleus 24 Contour electrode
Standard Contour
11. creating sound valueTM
Technology: Perimodiolar Positioning
AOS surgical technique critical to atraumatic insertion
Xu et al, 2001
Microfocus
Radiography
12. creating sound valueTM
Standard
insertion
technique
AOS™
insertion
technique
• Flexible, pre-
curved
electrode
• SoftipTM
• Minimal
lateral wall
forces with
AOS1
1 Roland, J.T. Jnr. A model for Cochlear Implant Electrode Insertion and Force Evaluation: Results with a New Electrode Design and Insertion Technique (2005).
• Standard insertion technique
• AOS insertion technique
Electrode insertion: Contour & Contour Advance
13. creating sound valueTM 13
no insertion trauma cochlear structures
ITB5, side section 10
10 Jun 2002
Contour Advance
Advance
Applying Polymer Technology to Improve the
Electro-neural Interface
16. creating sound valueTM
17-19mm perimodiolar
16mm lateral wall
Tip : 0.5 mm
Tip : 0.35 x 0.25mm
Base : 0.8mm
Base : 0.55 x 0.4mm
Nucleus® electrodes
Contour advance
Hybrid-L™ Electrode
Straight Banded array
24mm overall Base : 0.6mm Tip : 0.4 mm17mm lateral wall
17. creating sound valueTM
Nucleus® Hybrid-L CI System
Hybrid L
RW Insertion
Frequency (Hertz)
-10
0
10
20
30
40
50
60
70
80
90
100
110
120
HearingThresholdLevels(dBHL)
125 250 500 1000 2000 4000 8000
HA stimulates
low frequencies
CI stimulates
high frequencies
Shorter electrode to avoid potential for
trauma to apical end of cochlea
18. creating sound valueTM
Unaided Thresholds -Pre-Op & 1 Month Post-Op
1-month post-operative data selected to indicate hearing
preservation with Hybrid-L
20. creating sound valueTM
Clinical Trial – Benefits of Hybrid-L
COMBINED MODE BIMODAL MODE
HA HACI + HA CI
Electroacoustic Acoustic AcousticElectric+ +
Speech &
Noise Front
Localisation
creating sound valueTM
21. creating sound valueTM
Two subjects showed unstable hearing post-operatively; one at 3-months
(coincided with labyrinthitis) and one at 6-months (no clinical signs)
Hearing Stability (all subjects with 6m+ data)
22. creating sound valueTM
Preoperative versus Postoperative Benefit?
Benefit from 20%-34% Benefit from 37%-49%
Benefit greater when acoustic stimulation combined
with electric stimulation compared to electric alone
Electric + Acoustic
Word scores are better postoperatively (electric
alone) compared to preoperatively (HAs).
Electric alone
What is the benefit of adding acoustic to electric stimulation?
23. creating sound valueTM
How does Post-op Combined (EA+A)
use compare with Bilateral Acoustic
Inputs ( A+A)?
Paola Incerti
24. creating sound valueTM
Horizontal Localisation
• N = 14, aged 45 – 81years
• Nucleus CI system
- Hybrid L24 (6)
- CI422 (SRA) (6)
- MRA (1)
- Freedom CA (1)
• MAP parameters
- ACE sound coding
- MP1+2 stim mode
- 25 μsec pulse width
- 7200 Hz total stim rate
• Test condition: EA+A vs A+A
26. creating sound valueTM
Speech Perception
Rader et al (2013) Ear Hear 34:324-32.
Fig. 3. Individual and mean
SRT in dB SNR are shown for
the bimodal (gray bars) and
best-aided EAS (black bars)
listening conditions.
Gifford et al (2013) Ear Hear 34:413-25.
EA + A EA + A
27. creating sound valueTM
Or:
Is hearing preservation in the implanted ear useful?
How does Post-op Combined (EA+A)
use compare with Bimodal (E +A)?
Kerrie Plant
28. creating sound valueTM
• n = 13, aged 55 – 83 years
• Nucleus CI system
-Hybrid L24 (5)
-CI422 (SRA) (7)
-MRA (1)
• Two test conditions:
– EA+A vs E+A
Measures:
• Subjective ratings (SSQ)
• Musical sound quality
ratings
• Speech perception in noise
• Localisation ability
Clinical Trial – Benefits of Hearing Preservation
31. creating sound valueTM
Skarzynski et al (2014) Ear Hear
Skarzynski et al (2014) Cochlear implantation with the Nucleus slim straight electrode
in subjects with residual low-frequency hearing. Ear Hear.
EA + A E + A
n = 30
p = 0.34 p < 0.05
41. creating sound valueTM
Nucleus CI422 Slim Straight electrode
• Prospective study of outcomes for 90 adult
CI422 implant recipients at RVEEH
Photos courtesy of Cochlear
CI422
Recipients
Mean (SD)
Age at implant (years) 61.2 (16.2)
Duration of loss - CI ear
(years)
15.4 (11.8)
Duration of loss -
contralateral ear (years)
16.9 (12.9)
43. creating sound valueTM 43
Hearing Preservation – Slim Straight 422
30% had drop of greater than 30dB in acoustic hearing
44. creating sound valueTM
Preservation of Residual Hearing
• Mean change in hearing thresholds at 500 Hz by
3M post-op is -23.3 dB
• Examining the degree of change to 500 Hz
threshold from pre-op to 3M post-op:
• Is the hearing useful?
– 67.2 % (37) of CI422 recipients had hearing
thresholds of 80 dB or better pre-operatively
– At 3 months post-op, 40.5 % (15) of these 37
had hearing thresholds of 80 dB or better
Degree of Change % of CI422 recipients (n=55)
≤ 10 dB loss at 500 Hz 36.4 %
15 – 25 dB loss at 500 Hz 23.6 %
≥ 30 dB loss at 500 Hz 40.0 %
45. creating sound valueTM 45
Effect of Depth of Insertion
-70
-60
-50
-40
-30
-20
-10
0
300 350 400 450 500 550DegreeofChangeto500Hz
Threshold(dBHL)
Insertion Angle (degrees)
For insertion >360 degrees no apparent increase in hearing loss with
deeper insertion as might be predicted from increase in lateral wall force
47. creating sound valueTM 47
Comparing Speech Perception
PRE-OP
Monaural
Sentence in
Noise (%)
PRE-OP
Binaural
Sentence in
Noise (%)
3M
Monaural
Sentence in
Noise (%)
3M
Binaural
Sentence in
Noise (%)
Hybrid-L24 45.91 56.54 64.94 77.66
CI422 21.40 43.91 58.94 75.53
Pre-op, Hybrid-L24 patients had better pre-op speech perception
in the implanted ear (p=0.003)
No difference post-op between the groups on monaural or binaural
51. creating sound valueTM
Electrode
Handle
Sheath Handle
Split along lateral wall
Sheath opens when pulled
back against electrode handle
MRA Electrode - Concept
• Design goal: thinner electrode for atraumatic
insertion
• Insertion concept: precurved electrode held
straight for insertion by soft polymer sheath
Note: Research device, not approved for clinical use.
53. creating sound valueTM
Electrode array
Auditory Nerve
Cells Bodies
Electro-neural Interface
OSL
+ +
+
+
-
-
-
e-
e-
e-
Lateral Wall
+ +
+
+
-
-
-
e-
e-
e-
Living biological
material
• current spread is through an ‘electrolytic’ medium
• Fibrous tissue sheath may significantly dissipate electric current
• mechanisms to control tissue reaction could be beneficial
55. creating sound valueTM
Eastwood, Chang, Kel, Sly, Richardson and O’Leary. Round window delivery of dexamethasone
ameliorates local and remote hearing loss produced by cochlear implantation into the second turn
of the guinea pig cochlea. Hearing Research 265 (2010) 25–29
studies have confirmed that round window delivery of
dexamethasone can reduce inflammatory response
Effects of dex in Animal Model
Dex-eluting array reduced hearing loss from implantation
in the guinea pig model
56. creating sound valueTM
Passive Drug Delivery from Surface
drug
drug
Cochlear Implant-based Steroid Delivery
drug
drug
drug
drug
drug
Natural diffusion
drug
drug
drug
drug
drug
Pt electrode
Silicone carrier
DEX within silicone
DEX can be incorporated into the silicone
by physical hand-mixing or by solvent casting
58. creating sound valueTM
Electrode Design for Passive Delivery
An augmented Cochlear Nucleus Freedom implant with
Contour Advance electrode
40%w/w
dexamethasone
(DXB, Sanofi) in the
tip & spine regions
of the intra-cochlear
array
59. creating sound valueTM
Shelf Life Validation
No significant difference in purity (demonstrated by amount
of substance recovered), left, and in vitro pharmacokinetics,
right, was evident after normal and accelerated aging.
60. creating sound valueTM
Inner Ear Safety
Mean SGN densities in each turn of implanted
cochleae
Proportion of new Loose Fibrous Tissue, LFT, or
Dense Fibrous Tissue, DFT and bone, NB,
evident in the scala tympani
8 Dunkin-Hartley guinea pigs implanted with electrode
arrays loaded with 50% w/w DXB were compared to a
control group implanted with a drug-free variant
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Meningitis Risk
30 male Hooded-Wistar rats were inoculated with 103, 104, 105 CFU
of Streptococcus pneumoniae to determine the level of innoculum
required to induce meningitis (left).
10 rats were then implanted with a device composed of 50%w/w
DXB and inoculated with 104 CFU Streptococcus pneumoniae 5
days later (right). A control group of n =10 was also included,
implanted with the same device without DXB
62. creating sound valueTM
First Time in Human Study
Centre RVEEH RPAH
Contour Advance with 40%w/w DXB 8 2
Contour Advance (no DXB) 30 6
Objectives: 1. Ease of use and effectiveness
2. Safety in controlled adult population
Subjects:
Evaluation Schedule:
Pre-op Surgery +1wk +2wk +1, 3, 6, 12,
24M
4-point (local)
impedance
X X X X
Speech
perception X 3 & 12M
63. creating sound valueTM
Interim Findings
Passive delivery of DXB is safe for humans, as demonstrated
by in vitro and pre-clinical investigations.
A modified commercial device has been used in a FTIH study
and has demonstrated initial benefits in impedance
64. creating sound valueTM
Controlled Drug Delivery with Hollow Fibre Systems
• Controlled membrane porosity by redox induced conformational change
• Solvated ion flux activated by doping / dedoping process
Polymer doping / dedoping induced release of drug
drug
drug
drug
drug
drug
drug
drug
drug
drug
drug
drug
drug
drug
drug
drug
drug
drug
drug
drug
drug
drug
drug
drug
drug
drug
drug
drug
Cochlear implant based steroid delivery
drug
drug
drug
drug
drug
drug
0
0.01
0.02
0.03
0.04
0.05
0.06
0.07
0.08
0 10 20 30 40
Time / minutes
ABSat554nm
3minPPyPVDF
3minPPyPVDF pulsed potential
65. creating sound valueTMcreating sound valueTM
1. Electrosynthesis of polypyrrole incorporating Dexamethsasone 21-phosphate
disodium salt under different conditions and their relation with Dex release.
Current Density 0.5mA/cm2 1.0mA/cm2 1.5mA/cm2
A. ~81nm B. ~124nm C. ~198nm 5mM
Roughness
(RMS)
D. ~69.8nm E. ~121nm 10mM
F. ~68nm 20mM
Dex Concentration
Tab 1. Film growth condition vs. film roughness ([Py]=0.2M, Q=1C/cm2)
0
10
20
30
40
50
60
70
80
90
0 50 100 150 200 250 300
DexPReleased(%)
Time (min)
A (0.5mA/cm2, Dex 5mM)
B (1.0mA/cm2, Dex 5mM)
C (1.5mA/cm2, Dex 5mM)
D (1.0mA/cm2, Dex 10mM)
E (1.5mA/cm2, Dex 10mM)
F (1.5mA/cm2, Dex 20mM)
Fig 1. Dex release efficiency vs. different film growth conditions
(Potential: -500mV, Drug loading: 380ug/cm2)
• With higher current
density and lower Dex
concentration, higher
roughness obtained
• 80% of Dex released
out of the film with
highest roughness
Drug Elution with Electrical Stimulation
66. creating sound valueTM
CA
MRA
Focus in Electrode Design
Focus of electrode design on:
• preservation of internal cochlear structures
• positioning to reduce spread of current
• designs for electro-acoustic stimuli
MRA MRA
CA
67. creating sound valueTM
• preservation of acoustic residual hearing can be
accomplished with good electrode design and
attention to surgical procedure ~ but outcomes
remain unpredictable
•a drug eluting electrode is a feasible vehicle for
delivery of therapeutic agents into the cochlea,
(but must not compromise insertion characteristics)
• elution rates in passive designs are dependent on
drug loading and processes of formulation
•active systems may enable similar drug load delivery
through a smaller cross-sectional area electrode array
Summary