1. Cochlear Implant GROUP 6 : Amir Mustakim Ab Rashid Nurdania Abd Rahman
Nur Nadhirah Abdul Hamid
Keerthana a/p Rangasamy

2. History in development
PRESENTATION OUTLINE
Organ of interest
Clinical Needs
History in development
Manufactures &
Examples

3. Organ of Interest (Anatomy & Physiology) #Ear #Cochlea

4. Anatomy of Ear

5. The ear is the organ of hearing and balance
The ear is the organ of hearing and balance. The parts of the ear include:
External or outer ear :
Pinna or auricle – outside part of the ear
External auditory canal or tube – connects the outer ear to the inside or middle ear
Tympanic membrane (eardrum) – divides the external ear from the middle ear
Middle ear (tympanic cavity) :
Ossicles - 3 small bones (Malleus, Incus, Stapes) that are connected and transmit sound waves to the inner ear
Eustachian tube – helps to equalize the pressure in the middle ear
Inner ear :
Cochlea – contains nerves for hearing
Vestibule – contains receptors for balance
Semicircular canals – contains receptors for balance

6. Anatomy of Cochlea

7. Cochlea has a spiral shape
The hollow tube has walls made of bone
The central pillar of cochlea is a conical bony structure called modiolus
The tube of cochlea divided into three chambers :
Scala vestibule –form upper chamber (perilymph)
Scala media (cochlear duct) – separated the other two chamber (endolymph)
Scala tympani – lower most of three chambers (perilymph)
The three scala wrap around inside the cochlea like a spiral staircase
The start of the cochlea (oval and round windows) are located is known as basal end
The inner tip is known as apical end

8. Hollow Tube of Cochlea

10. What is cochlear implant?
Surgically implanted electronic medical device that does the work of damaged parts of the inner ear (cochlea) to provide sound signals to the brain
Not to be confused with hearing aids which simply amplify sound for those hard of hearing
Cochlear implants work to replicate the natural process of the ear

11. Disease related to cochlear failure
1. Autoimmune Inner Ear Disease (AIED)
A syndrome of progressive hearing loss caused by antibodies/immune cells that attack the inner ear
Causes:
Bystander damage : inner ear damage causes cytoknes to be released which provoke additional immune reactions
Cross-reactions : Antibodies T-cells cause inner ear damage because the ear shares common antigens with a harmful substance,virus or bacteria
Genetic factors
Treatment : Steroids, cochlear implant, cell and gene therapy.

12. 2. Meniere's disease
Disorder of the inner ear that cause severe vertigo (balancing problem), ringging in ears (tinnitus), a feeling of fullness and pressure in ear, that will fluctuating hearing loss
Meniere's disease can causes:
Hair cell death
Mechanical changes of the ear
Treatment:
Medication
Surgery
Diet

13. 3. Usher's syndrome
Genetic disease that can cause both hearing and vision loss
Treatment: hearing aids and cochlear implant
4. Mumps
A viral infection causes the salivary glands to become inflamed.
Hearing loss is one of the side effect
The mumps virus damages the cochlea
Treatment:
Vaccination
Hearing aids
cochlear implant

14. Who can they help? Cochlear implants can help people who:
have moderate to profound hearing loss in both ears
have profound hearing loss in one ear with normal hearing in the other ear
receive little or no benefit from hearing aids
score 65% or less on sentence recognition tests done by hearing professional in the ear to be implanted

15. Parts of cochlear implant
Consist of two main parts:
1. Internal part
- The cochlear implant (C)
2. External part
- The speech processor (A, B)

16. How do they work?
A sound processor captures sound and turns it into digital code. The sound processor has a battery that powers the entire system.
The sound processor transmits the digitally-coded sound through the coil on the outside of your head to the implant.
The implant converts the digitally-coded sound into electrical impulses and sends them along the electrode array placed in the cochlea (the inner ear).
The implant's electrodes stimulate the cochlea's hearing nerve, which then sends the impulses to the brain where they are interpreted as sound

17. Benefits of cochlear implant
Hear better with a cochlear implant than with a hearing aid
A previous study has shown that people with cochlear implant achieve an average of 80% sentence understanding, compared with 10% sentence understanding for hearing aids.
Can focus better when in noisy environments
Feel safer in the world as they can hear alarms, people calling out and approaching vehicles.
Talk and hear on the phone
Enjoy music

18. Risk of a cochlear implant
The standard surgical risks of a cochlear implant are all quite rare
Risk are include:
Bleeding
Infection
device malfunction
facial nerve weakness
ringing in the ear
dizziness
Long-term risk of a cochlear implant is meningitis (infection of the fluid around the brain)

20. STORY TIME!

21. 1801, a German, Carl Grapengiesser - Treat a disease of the ear

22. Gersuni and Volokhov(1936)
Main founders
Wester and Bary (1930)
Renaissance
Gersuni and Volokhov(1936)
Stevens and Jones(1939)
Wester and Bary
Tested on a cat
Same result nerve
and stimulus
Gersuni
Found cochlea as place for stimulation
Surgery removal tymphanic membrane, hearing persist
Stevens
-The middle ear could act as a transducer, which obeys the ‘square law’ and convert alternations in the strength of an electrical field into the mechanical vibrations that produce sound.
Electrical energy could be converted into sound by a direct effect on the basilar membrane, which would then vibrate maximally at a point determined by the frequency and these vibrations would stimulate the hair cells
Direct stimulation of the auditory nerve produced a crude hearing sensation.

23. REVOLUTION 1982- Nucleus 22-Wearable speech processor - Rod Saunders
1989- Nucleus 22 wearers upgrade Mini Speech Processor
1997- Starting DSP
1998- Multichannel
Throughout the times improve the processor
-Improvements : Noise filtering
: Speech processing :

24. Examples of Cochlear Implant

25. COCHLEAR ADVANCED BIONIC MED-EL
Est 1977, Austria
Est 1993, California
Est 1981, Australia

26. Behind The Ear (BTE) Company Cochlear Advanced Bionic MED-EL Functions
Sound processor options
Cochlear Nucleas 6
Naida CI Q90
SONNET
Worn on the ear and a small coil is held in place against the head with a magnet
Ability to amplify sound acoustically
Yes No
Ability to use patients low frequency hearing with acoustic amplification; provide better speech understanding and improved sound quality

27. Company
Cochlear
Advanced Bionic
MED-EL
Functions
Automatic Scene Classifier
Yes (SCAN)
Yes (Autosound OS) No
-make it easier to hear when noisy
-automatically choosing the environment and optimizing the sound automatically
Microphone Technology
Dual microphones
To minimizing the background noise
Music Program
Yes
To enjoying the user
Input Dynamic Range (IDR)
Up to 75dB
Up to 80dB
Range between the softest and hardest sound captured by the sound processor

28. Company
Cochlear
Advanced Bionic
MED-EL
Functions
Wireless connectivity available
yes
-ability to connect audio devices wirelessly
- more convenient and easier
Data Logging
Yes
Records how the sound processor being used by the patient in order to provide the audiologist with key of information to help the user get the best of hearing experience
Water Resistant
Processor can be sweat proof and splash proof

29. Off-The-Ear Sound Processing
Company
Cochlear
Advanced Bionic
MED-EL
Functions
Sound processor options
Kanso Sound Processor
Neptune
Rondo
Selection based on the patients needs and preferences for their hearing experience
Ability to amplify sound acoustically No
Ability to use patients low frequency hearing with acoustic amplification; provide better speech understanding and improved sound quality

30. Company
Cochlear
Advanced Bionic
MED-EL
Functions
Automatic Scene Classifier
Yes (SCAN)
Yes (Autosound OS) No
-make it easier to hear when noisy
-automatically choosing the environment and optimizing the sound automatically
Microphone Technology
Dual microphones
Single microphones
Dual microphones; minimizing the background noise
Music Program
Yes
To enjoying the user
Input Dynamic Range (IDR)
Up to 75dB
Up to 80dB
Range between the softest and hardest sound captured by the sound processor

31. Company
Cochlear
Advanced Bionic
MED-EL
Functions
Wireless connectivity available
yes No
-ability to connect audio devices wirelessly
- more convenient and easier
Data Logging
Yes
Records how the sound processor being used by the patient in order to provide the audiologist with key of information to help the user get the best of hearing experience
Water Resistant
Processor can be sweat proof and splash proof

32. Implant Company Cochlear Advanced Bionic MED-EL Functions Implant
CI24RE Profile
HiRes HiRes HiRes
90k k Ultra
Advan
Concert Synchrony
Implant Receiver
Thickness
6.9mm mm
5.5mm 5.5mm 4.5mm
4.5mm mm
Provide more discrete appearances, and less time surgery

33. Company
Cochlear
Advanced Bionic
MED-EL
Functions
MRI Compatible
Yes (3.0 Tesla and 1.5 Tesla)
Yes (1.5 Yes (3.0
Tesla) Tesla, 1.5
Tesla)
Yes ( Yes (3.0
Tesla) Tesla)
Reassurance to get MRI without any concern
Removable magnet for MRI
Yes
No Yes
Removing magnet can provide clearer image for MRI (head)
Number of channels
22 Channels
16 Channels
12 Channels
Higher number of channel could be beneficial with programming problems area in cochlea potentially giving user the best hearing experience

35. References