The Nucleus Hybrid L24 Cochlear Implant System is a device approved by the FDA to treat sensorineural hearing loss. It combines a cochlear implant and hearing aid to provide electrical stimulation for high frequencies and acoustic hearing for low frequencies. The internal implant converts sound to electrical signals that are transmitted to electrodes in the cochlea. This helps patients with good low-frequency hearing but poor high-frequency hearing by preserving natural hearing and improving sound perception. While it provides benefits over conventional hearing aids, limitations include inability to transmit rapid sounds and high medical costs.

2. The Nucleus Hybrid L24 Cochlear
Implant System for sensorineural
hearing loss
Presentation By :
Indu Nath. S
M Pharm part II
Pharmacy Practice

3. Contents
Introduction
Physiology of
hearing
Hearing loss
Sensorineural
hearing loss
The Nucleus
Hybrid L24
Cochlear
Implant System
Advantage
Limitation Conclusion References

4. Introduction
 The ear is the organ of hearing and
balancing.
 It is supplied by the 8th cranial nerve,
i.e. the cochlear part of the
vestibulocochlear nerve which is
stimulated by vibrations caused by
the sound waves.
 The ear has three divisions, namely
external ear, middle ear and inner ear.

5. Physiology of hearing

7. Hearing loss
Hearing loss ,hearing impairment, or deafness, is a
partial or total inability to hear.10 % of adults has
some hearing loss and one third of individuals over
the age of 65 have a hearing loss of sufficient
magnitude and require hearing aid.
Results from disorder of the auricle, external
auditory canal, middle ear, inner ear, or central
auditory pathway.
Lesions in the auricle, external auditory canal, or
middle ear cause conductive hearing losses.
Lesions in the inner ear or eighth nerve cause
sensorineural hearing losses.

8. Types of hearing loss
Hearing
loss
Conducti
ve
Sensorin
eural
Mixed

9.  Hearing impairments are categorized by their type,
severity, ad the onset of age.
 Conductive hearing loss: a conductive hearing
impairment occurs when the sound is not reaching the
inner ear and the cochlea.
 External ear canal malformation, dysfunction of the ear
drum or malfunction of the bones of the middle ear.
 Other reasons include trauma and infections.
 Mixed hearing loss: conductive and sensorineural
hearing loss in combination is termed mixed hearing
loss.
 Otosclerosis involving the ossicles and cochlea, head
trauma, chronic otitis media, middle ear tumors and
inner ear malformations.

10. Sensorineural hearing loss
Sensorineural hearing loss is
the most common form of
hearing loss and occurs when
there is a lesion in the inner
ear or eighth cranial nerve
(vestibulocochlear nerve) .
It may be caused by aging,
heredity, exposure to loud
noise, ototoxic drugs, viral
infections and certain other
illnesses .
Sensorineural hearing loss can
be mild, moderate, or severe,
including total deafness.
Sensorineural hearing loss can
be treated with hearing aids
and also with cochlear
implants.

11. Sensorineural hearing loss

12. • Epidemiology:
 Gender: Males affected by hearing loss at an age earlier age
than females
 Age : Older people are affected. Onset of age is over 40
years
• Causes :
 Presbycusis (related to aging)
 Noise induced hearing loss
 Cranial nerve 8 disease
o Meniere's disease
o Acoustic neuroma
 Viral
 Micro vascular disease
o Diabetes mellitus
o Hyperlipidemia

13.  Ototoxic medications
 Endocrine disease
o Hypothyroidism
 Autoimmune hearing loss
 Congenital deafness
 Trauma
o Temporal bone fracture involving Cochlea or vestibule
• Signs and symptoms:
 Tinnitus
 Pain with loud noise exposure
 Impaired word understanding
 Loud patient's voice
 Hearing difficult in noisy environments

14. • Management:
 Formal audiology testing
 Acute hearing loss
o High dose steroids
o Carbogen Inhalation (5% CO2 and
95% Oxygen)
 Chronic hearing loss
o Cochlear implants

15. The Nucleus Hybrid L24 Cochlear
Implant System
The U.S. Food and Drug
Administration approved the
first implantable device for
people 18 and older with
severe or profound
Sensorineural hearing loss of
high-frequency sounds in both
ears.
The Nucleus Hybrid L24
Cochlear Implant System may
help those with this specific
kind of hearing loss who do
not benefit from conventional
hearing aids.

16. The hybrid system is mainly
used for candidates who have
good low-frequency hearing
but very poor high-frequency
hearing.
The hybrid works on the
concept of combining
electrical stimulation for high
frequency sound with
acoustic hearing for low
frequency information in the
same ear.

17. Components of a cochlear implant
 The basic part of this includes:
 External part
• Micro phone and sound processor
• Transmitter
 Internal part
• A receiver and stimulator
• Array of electrodes.

19.  The Nucleus Hybrid L24 Cochlear Implant
System combines the functions of a cochlear
implant and a hearing aid.
 This electronic device consists of an external
microphone and sound processor that picks up
sounds from the environment and converts them
into digital code.
 The sound processor transmits the digitally coded
sound via the coil to the implant just under the
skin.
 The implant converts the digitally coded sound to
electrical signals and sends them along the
electrode array, which is positioned in the
cochlea.
 The implants electrodes stimulate the cochlea’s
hearing nerve fibers, which relay the sound
signals to the brain to produce hearing sensations.

21. Advantages
Helps those with Sensorineural
hearing loss who do not benefit
from conventional hearing aids.
No loss of residual natural hearing
Reduce the risk of infection and
complications while improving the
patients ability to hear.
Preserve low frequency hearing
Minimal invasive surgery.

22. Limitations
Rapid fluctuations in
sounds are not well
transmitted by
cochlear implant.
Surgical issues like
tinnitus, vertigo.
Medical costs ,
device, processor
and accessories are
expensive.

23. conclusion
 Sensorineural hearing loss is the most common
form of hearing loss and occurs when there is a
lesion in the inner ear or eighth cranial nerve
(vestibulocochlear nerve) .
 The Nucleus Hybrid L24 Cochlear Implant
System is the first approved device by the FDA
for Sensorineural hearing loss.
 The hybrid L24 implant provides a better
treatment option for suitable candidates with
high frequency hearing loss.

24. References
 E. Murugasu. Recent advances in the treatment of sensorineural
deafness. Ann Acad Med Singapore 2005;34:313-21.
 Harrison’s Principle of Internal Medicine, Vol 1 by Longo, Fauci
Kasper, Hasper, Jamesoli Page No: 179-183 ,18 th edition.
 www.fda.gov
 www.medscape.com
 www.nlm.nih.gov/medlineplus/ency/article/003291.html
 emedicine.medscape.com/article/856116-overview
– All data were collected from various sources.. only
for educational purpose.