MED-EL Cochlear Implants: State of the Art and a Glimpse Into the Future

Abstract

201areas, MED-EL's research focuses on providing additional pitch information. One means to achieve this could be to increase the information per time unit (information rate) delivered to the cochlea; this can be done by increasing the stimulation rate. Another way would be to add additional information into the stimulation patterns such as temporal as well as spatial fine structure information. This will be further discussed in the development of speech-coding strategies section.In addition, this article provides an overview of the new technology incorporated in the MED-EL MAESTRO CI system, reviews recent research on bilateral cochlear implantation and electric-acoustic stimulation, and describes current research efforts on developing a CI device with drug delivery capability. The MAESTRO CI SystemThe MED-EL MAESTRO CI system comprises the PULSARCI 100 and SONATATI 100 CIs, which incorporate the I 100 electronics platform; the speech processors and the MAESTRO system software, together with the Diagnostic Interface Box II, is the link C ochlear implants (CIs) are a well-known and accepted treatment method for adults and children with severe to profound hearing loss. There has been much progress in the CI field since the article detailing trends in cochlear implantation. 1 Advances in technology, increased confidence in experience, and changes in candidacy have led to CIs being made available to a larger population.Recent CI recipients perform much better than those who received implants many years ago. Back then, CI performance focused on differentiating between the presence and absence of sound or female versus male voice. Expectations for recent CI recipients, however, have changed. Their performances have been tested under increasingly difficult listening conditions. The general experiences in the CI community are that CI users usually perform very well in quiet but worse in noise, and not all CI users are able to enjoy music. For further improvements in these Cochlear implantation is an accepted treatment method for adults and children with severe to profound hearing loss. Confidence in technology has led to changes in individuals who can receive a cochlear implant and changes in expected benefit with a cochlear implant. This article describes the research and development activities at MED-EL, which make possible the implementation of new speech-coding strategies as well as the application of acoustic and electric stimulation via a combined speech processor in MED-EL devices. Research on benefits from bilateral cochlear implantation and electric-acoustic stimulation are also reviewed. Finally, the potential of drug delivery systems is considered as a way to improve cochlear implant outcomes, and results from preliminary evaluations of a hybrid cochlear implant system with drug delivery capabilities are reported. between software and speech processors or implants. The MAESTRO CI system provides fine structure information for CI users (refer to the section on speech-coding strategies). In addition, audiologi...

Effects of Brain-Derived Neurotrophic Factor (BDNF) and Electrical Stimulation on Survival and Function of Cochlear Spiral Ganglion Neurons in Deafened, Developing Cats

“…This variability in outcomes has refocused attention on the importance of auditory nerve survival for CI function and on neurotrophic agents that might be used with a CI to improve auditory nerve survival (for review, see Staecker et al 2010). In fact, human CIs modified for intracochlear drug delivery already have been designed (Hochmair et al 2006) and tested in animals (Paasche et al 2003). However, animal studies examining the long-term effects of potential neurotrophic agents have been quite limited to date.…”

Cochlear implants: A remarkable past and a brilliant future

“…During the past several years, increasing attention has been devoted to representing "fine structure" or "fine frequency" information with CIs (e.g., Smith et al, 2002;Nie et al, 2005;Wilson et al, 2005;Zeng et al, 2005;Hochmair et al, 2006;Arnoldner et al, 2007;Berenstein et al, 2008;Brendel et al, 2008;Buechner et al, 2008;Litvak et al, 2008;Bonham and Litvak, this issue). These recent efforts are reviewed and discussed in Wilson and Dorman (2008b, c).…”

“…Table 3 shows strategies that are currently being evaluated in company-sponsored studies. These strategies include "Fine Hearing" (Hochmair et al, 2006;Arnoldner et al, 2007), HiRes with the "Fidelity™ 120 option" (or "HiRes 120" for short) (Trautwein, 2006;Buechner et al, 2008;Litvak et al, 2008), and MP3000 (Nogueira et al, 2005;. The Fine Hearing strategy also is called the fine structure processing (FSP) strategy, and the MP3000 strategy also is called the psychoacoustic advanced combination encoder (PACE) strategy.…”

Factors influencing neurotrophic effects of electrical stimulation in the deafened developing auditory system

“…Further, ICES has been reported to be additive to the effects of NTs (Kanzaki et al, 2002;Shepherd et al,2005;Pettingill et al, 2007) in reducing SG degeneration. Based on these encouraging findings, new human cochlear implant electrodes that incorporate drug delivery systems already have been designed (Hochmair et al, 2006) and tested in animals (Paasche et al, 2003). However, studies to date have been conducted in rodents and are limited to quite short durations (e.g., 30 days).…”

“…The success of this "electro-acoustic" hearing has re-focused attention on reducing trauma during CI implantation, maintaining residual hearing James et al, 2006), and on the importance of the condition of the cochlea and auditory nerve in CI function. In fact, intra-scalar delivery of drugs (anti-inflammatory agents or neurotrophins) has been proposed in human CI subjects to promote improved SG survival, and CI electrodes modified for drug delivery already have been developed (Hochmair et al, 2006;Paasche et al, 2003;Shepherd and Xu, 2002). However, animal studies examining the effects of potential neurotrophic agents and exploring alternative, less invasive strategies for promoting SG survival have been relatively limited to date.…”