Questions and Answers
What year did Wilksa experiment with iron particles for hearing aids?
What are the main types of implantable middle ear devices?
Piezoelectric devices and electromagnetic devices
Electromagnetic devices are MRI compatible.
False
The __________ is a device that used electric current to stimulate the ossicles.
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What is one of the main benefits of the Totally Integrated Cochlear Amplifier (TICA)?
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What is the expected battery life for the Esteem hearing implant?
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Which of the following is a contraindication for the Esteem hearing implant?
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ABI is primarily intended for patients with cochlear nerve problems.
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The Electromagnetic devices pass electric current into a __________.
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What surgical consideration is necessary for the Rion Device E-Type?
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What is a significant disadvantage of the Vibrant Soundbridge?
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Which implant was developed by Cochlear Limited, House Ear Institute, and Huntington Medical Research Institute in 1992?
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What is the main indication for ABI surgery in patients with NF2?
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ABI recipients typically demonstrate poor outcomes in open-set speech understanding.
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Match the following categories of auditory performance (CAP) with their descriptions:
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The ABI surgery may be performed during _____ removal.
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What is a potential complication related to ABI surgery?
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What does PABI stand for?
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Audiology considerations for ABI typically involve measuring thresholds using a descending method.
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What is the incidence of Neurofibromatosis Type 2 (NF2)?
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Study Notes
Middle Ear Implants and Auditory Brainstem Implants
- Implantable middle ear devices are designed for individuals with moderate to severe hearing loss who are unable to achieve adequate benefit from traditional hearing aids or are medically unable to tolerate them.
History of Middle Ear Implants
- Wilska (1935) experimented with iron particles placed on the tympanic membrane (TM) and generated a magnetic field to vibrate the TM.
- Rutschmann (1959) stimulated ossicles by gluing 10mg magnets to the umbo and generated a magnetic field to vibrate the ossicles.
Types of Devices
- Piezoelectric devices: use electric current to change the volume of a piezo-ceramic crystal, producing a vibratory signal.
- Examples: Rion Device E-Type, Totally Integrated Cochlear Amplifier (TICA), Esteem
- Electromagnetic devices: use electric current to create a magnetic field that drives an adjacent magnet attached to the ossicular chain.
- Examples: Otologics Carina Middle Ear Transducer (MET), Soundtec Direct System, Ototronix Maxum, Vibrant Soundbridge
Piezoelectric Devices
- Rion Device E-Type (RDE): partially implanted device with an internal unit (ossicular vibrator and magnetic coil) and external components (microphone, amplifier, external coil, and battery).
- Totally Integrated Cochlear Amplifier (TICA): commercially available in Europe since 1999, used for moderate-severe high-frequency sensorineural hearing loss (SNHL).
- Esteem: uses a sensor to detect vibration from the incus and a driver to deliver amplified signal to the stapes, has a rechargeable battery with a 5.5-year median life.
Electromagnetic Devices
- Otologics Carina Middle Ear Transducer (MET): initially semi-implantable, then totally implantable, consists of an implant, programming system, charger, and remote control.
- Soundtec Direct System: semi-implantable device that converts sound energy to electromagnetic energy to directly stimulate ossicles, with an earmold coil assembly and sound processor.
- Ototronix Maxum: consists of two components: an implant and an integrated processor and coil (IPC), with signals transferred across the TM to the Maxum implant, causing ossicles to vibrate.
Indications and Contraindications
- Ideal candidates for Esteem implant: 18 years or older, stable bilateral moderate to severe SNHL, unaided speech discrimination ≥ 40%, normal middle ear anatomy and function, and adequate space for the implant.
- Contraindications for Esteem implant: history of chronic otitis media, otitis externa, eczema, keloids, cholesteatoma, or destructive middle ear disease.
Surgery and Fitting
- Surgery for Esteem implant: CT scans, create sound processor bed, mastoidectomy and atticotomy, measure intact ossicular chain displacement, resect incus long process and prepare stapes, position sensor and driver transducers, cement transducers in place, and conduct intra-operative testing of components and system.
- Fitting parameters for Esteem implant: prescriptive gain, targets provide guidance in fitting, amplification, and aided HTL.
Risks and Outcomes
- Risks associated with Esteem implant: erosion of sound processor through skin, infection to sound processor pocket, determination during surgery that anatomy doesn't allow enough space for implant, and limited or no benefit.
- Outcomes for Esteem implant: functional gain, speech testing, and quality of life improvements.### Vibrant Soundbridge Implantable Hearing System
- The Vibrant Soundbridge is a semi-implantable hearing device that consists of an external audio processor and an internal vibrating ossicular prosthesis (VORP).
- The external audio processor (SAMBA2) captures sound, processes it, and transmits it through the skin to the internal VORP.
- The VORP conducts sound to the floating mass transducer (FMT), causing the incus to vibrate, which in turn stimulates the inner ear.
- The surgery is similar to cochlear implants, with a small incision and an outpatient procedure that takes around 1.5-2 hours.
- The audio processor is adjustable and has a battery life of 8-10 days.
Candidacy and Contraindications
- Candidates for the Vibrant Soundbridge include adults with bilateral moderate to severe sensorineural hearing loss, with normal middle ear anatomy and realistic expectations.
- Contraindications include conductive or mixed hearing loss, progressive or sudden hearing loss, active otitis media, TM perforation, skin conditions that prevent use of the SAMBA2, and unrealistic expectations.
Audiologic Involvement
- Pre-operative evaluation includes a comprehensive audiogram and speech recognition tests.
- Post-operative evaluation and activation of the device occur around 8 weeks after surgery.
- Follow-up programming may be necessary to fine-tune the device.
Benefits
- High-frequency gain without feedback
- No insertion loss or occlusion effect
- Improved comfort and ease of use
- Distortion-free signal and natural sound quality
- Takes advantage of low-frequency residual hearing
- FMT is designed to be linear
Outcomes
- Patients report improved overall sound quality, sound clarity, and naturalness of speech.
- Satisfaction rates are high for sound quality, comfort, and ease of use.
Implantable Hearing Aids: Summary
- Benefit over conventional hearing aids includes improved sound fidelity.
- Challenges include battery life, size-related issues, perceived benefit, cost, surgical issues, and quantifying benefit.
Bone Conduction Implants
- Bonebridge Implant System and OSIA System are examples of bone conduction implants.
Auditory Brainstem Implants (ABIs)
- ABI is a surgically implanted central neural auditory prosthesis for treatment of profound sensorineural hearing loss in children and adults who are not cochlear implant candidates.
- The device consists of a multielectrode surface array placed within the lateral recess of the 4th ventricle along the brainstem, directly stimulating the cochlear nucleus.
Main Differences: ABI vs CI
- Precise placement of the array is more difficult in ABIs.
- Side effects during activation are expected, such as heart problems.
- Surface tonotopicity of the CN is not predictable, making frequency allocation less precise.
- Outcomes are generally poorer, especially in younger populations.
Indications
- NF2 patients ≥12 years old who are medically and surgically suitable.
- Children 18 months to 5 years old with congenital VIII nerve aplasia and/or cochlear aplasia, bilateral profound sensorineural hearing loss, and strong family support.
Surgical Approaches
- Translabyrinthine and retrosigmoid approaches are used for ABI surgery.
Complications
- Stimulation of facial and glossopharyngeal nerves.
- Non-auditory sensations may occur.
- Initial stimulation should always be administered with emergency medical assistance readily available.
Management
- Recipients are seen 4-8 weeks post-surgery for activation.
- Be cautious of eliciting non-auditory side effects.
- Measure upper stimulation levels at all electrodes.
Other Implantable Options
- Penetrating Auditory Brainstem Implant (PABI)
- Auditory Midbrain Implant (AMI)
- Completely Implantable Cochlear Implants (CICI)
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Description
Learn about implantable middle ear devices and auditory brainstem implants, their history, and benefits for individuals with moderate to severe hearing loss.
