1 Adventures in Bionic Hearing Adventures in Bionic Hearing Robert V. Shannon, Ph.D. House Research Institute Los Angeles, California [email protected]Robert V. Shannon, Ph.D. House Research Institute Los Angeles, California [email protected]Eisen Otol&Neurotol 2003, “Djourno, Eyries, and the First Implanted Electrical Neural Stimulator to Restore Hearing” Eisen Otol&Neurotol 2003, “Djourno, Eyries, and the First Implanted Electrical Neural Stimulator to Restore Hearing” First cochlear implant: 1957, Paris First cochlear implant: 1957, Paris
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Adventures in Bionic Hearing
Adventures in Bionic Hearing
Robert V. Shannon, Ph.D.House Research InstituteLos Angeles, California
Eisen Otol&Neurotol 2003, “Djourno, Eyries, and the First Implanted Electrical Neural
Stimulator to Restore Hearing”
Eisen Otol&Neurotol 2003, “Djourno, Eyries, and the First Implanted Electrical Neural
Stimulator to Restore Hearing”
First cochlear implant: 1957, ParisFirst cochlear implant: 1957, Paris
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Normal Cochlea has:Active mechanical spectral analysis3-4,000 mechano-transducers (IHC)
~30,000 Nerve Fibers
Cochlear Implant Improvement over Time
0
102030405060708090
100
Per
cen
t C
orr
ect
Sentences Words
3M/House
F0F2
F0F1F2
MPEAK
SPEAK/Clarion
N24/CII/Med-El
CII/3G
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ABIABI
ICIICI
PABI
AMIAMI
INCIINCI
CICI
Dormanet al.2008
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5
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Noise-Band Processor(4 bands)
Noise-Band Processor(4 bands)
Bandpass Filters300, 713, 1509, 3043, 6000 Hz
Bandpass Filters300, 713, 1509, 3043, 6000 Hz
Envelope Extraction:Half-wave
Rectifier + LPF
Envelope Extraction:Half-wave
Rectifier + LPF
Amplitude Manipulation
Unit
Amplitude Manipulation
Unit
0 6000 Hz0 6000 Hz
1
2
4
3 +
Bandpass Filters
Bandpass Filters
NoiseNoise
NoiseNoise
NoiseNoise
NoiseNoise
Number of Channels DEMO
1 2 4 8 16 32 Orig1 2 4 8 16 32 Orig
7
8
9
10
Instrumental Music - No vocals
4 8 16 32 Original
Summary of Cochlear Implants
Summary of Cochlear Implants
• High level of speech performance in postlingually deaf adults
• Poor music perception
• Poor speech understanding in noise
• Children able to achieve mostly normal language development
• New directions in Cochlear Implants• Bilateral implants• Implants to supplement LF hearing• CIs in Single Sided Deafness• More electrodes/photolithographic arrays• Penetrating intraneural VIIIn electrodes
• High level of speech performance in postlingually deaf adults
• Poor music perception
• Poor speech understanding in noise
• Children able to achieve mostly normal language development
• New directions in Cochlear Implants• Bilateral implants• Implants to supplement LF hearing• CIs in Single Sided Deafness• More electrodes/photolithographic arrays• Penetrating intraneural VIIIn electrodes
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Electrode in Cochlea –Nerve Far Away
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Two Electrodes – Major Interference
Electrode in Nerve – Highly Local
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Electrode in Nerve – Highly Local
Middlebrooks & Snyder JARO 2007
ACOUSTIC
dBdB
Comparison of spread of activation from acoustic, CI and intraneural stimulation as measured in ICComparison of spread of activation from acoustic, CI and intraneural stimulation as measured in IC
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Middlebrooks & Snyder JARO 2007
Middlebrooks & Snyder JARO 2007
CIACOUSTIC
dB
Comparison of spread of activation from acoustic, CIand intraneural stimulation as measured in ICComparison of spread of activation from acoustic, CIand intraneural stimulation as measured in IC
Middlebrooks & Snyder JARO 2007
Middlebrooks & Snyder JARO 2007
CIACOUSTIC Intraneural
dB
Comparison of spread of activation from acoustic, CI and intraneural stimulation as measured in ICComparison of spread of activation from acoustic, CI and intraneural stimulation as measured in IC
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Intraneural Electrodes
Intraneural Electrodes
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32 Channel Microwire Array From UCI32 Channel Microwire Array From UCI
Rigid carrier for insertion
Minimize diameter to minimize injury
Dissolvable?
Develop surgical approach
Holder/inserter tool for surgeon
Rigid carrier for insertion
Minimize diameter to minimize injury
Dissolvable?
Develop surgical approach
Holder/inserter tool for surgeon UCI Microwire array comparedTo human hair
UCI Microwire array comparedTo human hair
VIIIa VIIIvVIIIa VIIIv
Snyder UCSFSnyder UCSF
Micro-CT of Electrode Inserted in Human Temporal Bone
Micro-CT of Electrode Inserted in Human Temporal Bone
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Device DevelopmentDevice Development
• Developing the next generation cochlear implant• Reducing electrode-neuron distance is key• Penetrating microelectrodes into the nerve is the best
way to decrease distance
• Steps necessary for human trials• Short and long term animal models to check safety of
insertion and stimulation (UCI & HRI: NIH contract)• Human surgical approach (HRI)
3D modeling of auditory, vestibular and facial nervesCharacterize the variation in anatomy across patientsInsertion tool development
• Integrate research with company to bring to market• Estimated timeline: 3-5 years
• Developing the next generation cochlear implant• Reducing electrode-neuron distance is key• Penetrating microelectrodes into the nerve is the best
way to decrease distance
• Steps necessary for human trials• Short and long term animal models to check safety of
insertion and stimulation (UCI & HRI: NIH contract)• Human surgical approach (HRI)
3D modeling of auditory, vestibular and facial nervesCharacterize the variation in anatomy across patientsInsertion tool development
• Integrate research with company to bring to market• Estimated timeline: 3-5 years
Beyond the CochleaBeyond the Cochlea
• If speech pattern recognition is so robust, can we achieve good speech recognition by stimulating higher up in the system?
• Surely there is a point of diminishing returns – the higher in the system we stimulate the more intrinsic processing we bypass
• If speech pattern recognition is so robust, can we achieve good speech recognition by stimulating higher up in the system?
• Surely there is a point of diminishing returns – the higher in the system we stimulate the more intrinsic processing we bypass
• Some speech token discrimination, but no recognition
• Thresholds low and stable
• Full loudness growth on all electrodes
• Pitch differences between electrodes
• Some speech token discrimination, but no recognition
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Summary of Prostheses Up to 2003
Summary of Prostheses Up to 2003
• CI does well – open set recognition is common
• ABI and PABI benefit from implant but obtain little-no open set speech recognition
• Even when basic info is in correct place (matching pitch and loudness patterns) NF2 ABI patients are not able to use it for speech recognition – why not?
• Is ABI already too high in the system - past the point of diminishing returns?
• CI does well – open set recognition is common
• ABI and PABI benefit from implant but obtain little-no open set speech recognition
• Even when basic info is in correct place (matching pitch and loudness patterns) NF2 ABI patients are not able to use it for speech recognition – why not?
• Is ABI already too high in the system - past the point of diminishing returns?
VittorioCollettiVerona
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Video of 3 year old with ABIVideo of 3 year old with ABI
• Mondini type I with VIIIn aplasia
• Diagnosed at 2yr 3mo
• Implanted with ABI at 2yr 7mo
• Video shows testing over one year of auditory development
• Not typical – best of 35 ABI children
• Mondini type I with VIIIn aplasia
• Diagnosed at 2yr 3mo
• Implanted with ABI at 2yr 7mo
• Video shows testing over one year of auditory development
• Not typical – best of 35 ABI children
Video: Testing Over the First Year of ABI Use
Video: Testing Over the First Year of ABI Use
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Eisenberg et al. O&NO 2008
Eisenberg et al. O&NO 2008
• Goldenhar Syndrome – absence of IAM
• ABI at 3y3m, evaluated at 6 and 12 months
• Goldenhar Syndrome – absence of IAM
• ABI at 3y3m, evaluated at 6 and 12 months
New Results in NF2 ABIsNew Results in NF2 ABIs
• Some NF2 ABIs are able to understand speech similar to the best CIs (Warsaw, Würtzburg)
• 100% open set sentences in quiet• Conversational use of telephone• 50% Speech recognition at +3dB
SNR
• So good speech recognition ispossible with NF2 and an ABI
• Some NF2 ABIs are able to understand speech similar to the best CIs (Warsaw, Würtzburg)
• 100% open set sentences in quiet• Conversational use of telephone• 50% Speech recognition at +3dB
SNR
• So good speech recognition ispossible with NF2 and an ABI
RobertBehr:Fulda
RobertBehr:Fulda
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ConclusionsConclusions
• Cochlear implants provide sufficient sensory information for people to recognize speech and for young children to learn speech and language
• Cochlear implants do not provide sufficient sensory detail to allow music perception, voice quality, or speech recognition in noise
• ABI allows good speech recognition in some patients and even good speech and language development in some children
• Such prosthetic devices restore significant hearing and advance our understanding of the way sensory systems and the brain work together
• Cochlear implants provide sufficient sensory information for people to recognize speech and for young children to learn speech and language
• Cochlear implants do not provide sufficient sensory detail to allow music perception, voice quality, or speech recognition in noise
• ABI allows good speech recognition in some patients and even good speech and language development in some children
• Such prosthetic devices restore significant hearing and advance our understanding of the way sensory systems and the brain work together