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  • Published by Advanced Bionics® Corporation, Valencia, California, USA. © 2005. All rights reserved.

    Production design and editing assistance for this publication were provided by ReMarks Editing, Bainbridge Island, Washington. E: [email protected]

    Advanced Bionics, the Advanced Bionic logo, CLARION, CII Bionic Ear, HiResolution, HiRes, the HiRes logo, HiRes 90K, HiFocus, HiFocus Helix, HiFocus Apex, Auria, Platinum BTE, T-Mic, FireFly, IntelliLink, SoundWave, and Sound Bursts are trademarks or registered trademarks of Advanced Bionics, incorporated in the United States and other countries.

  • Preface. . . . .v

    Foreword . . . .vi

    Acknowledgements. . . . .ix

    Introduction. . . . .x

    List of Research Summaries. . . .xii

    Medical & Surgical Studies. . . .19

    Objective Measures. . . .41

    HiResolution Sound. . . .89

    Novel Processing. . .117

    Bilateral Cochlear Implants. . .141

    Ear-Level System Features. . .155

    Patient Assessment & Training. . .169

    New Study Initiatives. . .185

    Contributing Authors. . .190

    Participating Research Centers. . .194

    Research Staff Worldwide. . .200

    Contents

  • v

    Preface

    This biennial report reflects the hard work, dedication and commit- ment of hundreds of individuals around the globe in the field of audi- tory science and technology. The research represented in this publication was made possible by the efforts of dedicated professionals with the goal of improving the lives of people with hearing impairments and deafness.

    On behalf of everyone at Advanced Bionics, I extend our deepest appre- ciation for the work represented here by the committed men and women of the auditory community. We are proud to be a part of this commu- nity—built on friendships, professional relationships, and mutual respect that is never limited by geographical or disciplinary boundaries.

    To every investigator, researcher, and clinician: We thank you for your immense efforts that advance the science of cochlear implantation. Your commitment to improving outcomes helps all patients achieve their maximum hearing potential.

    Jim Miller President, Auditory Division Advanced Bionics Corporation

  • Foreword

    In 1957 the first cochlear implant operation was performed by Dr Charles Eyriès at the University of Paris in a patient who had become totally deaf in both ears after mastoid surgery. The implantable single channel device was constructed by Professor André Djourno, and consisted of an induction coil capable of stimulating the cochlear nerve with sinusoid current of any frequency. When the device was activated three days later, the patient could discriminate some sounds and understand a few simple words. Subsequently, Djourno developed a transtympanic needle for promontory stimulation, a real-time speech analyzer, and a two-channel stimulator, publishing his findings in a series of papers in the proceedings of the French Society of Biology. Sadly, his research met an untimely end through lack of funds. A few years later, following Djourno’s lead, research groups around the world began to build implantable devices, using the recently available transistors to transmit radio signals through the scalp.

    Cochlear implants became more widely available in the 1980s. Since then they have provided increasing degrees of speech perception for adults with severely impaired hearing and congenitally deaf children. The population able to benefit from cochlear implants continues to expand. Smaller, behind-the- ear processors have been developed, implant reliability has improved, and speech perception has steadily improved. Speech processing strategies with a choice of stimulation patterns allow implants to be tailored to individual users.

    Today’s relatively sophisticated cochlear prostheses have come a long way from Djourno’s first implant. In terms of ability to communicate, they provide huge benefits for thousands of individuals worldwide. Djourno died in 1996, well aware of the impact that his seminal early work has had in the new science of cochlear implantation, reflected in the body of work contained in this research bulletin.

    John Graham, M.D., FRCS Royal National Throat, Nose and Ear Hospital London, UK

    COCHLEAR IMPLANTS: past accomplishments...

    vi

  • vii

    The phenomenal growth of scientific knowledge underlying cochlear implan- tation in its nearly 50-year history has tracked the explosive clinical growth of implantation worldwide. This growth has been beyond the wildest dreams of even the earliest pioneers in the field. While predicting the future of implan- tation has in the past proven unreliable, it should be readily apparent from the pages that follow that the roadmap for the future of implantation looks as remarkable as its history. Given that the original cochlear implants were developed independently in three continents, it is not surprising that this roadmap spans the globe. Signal processing strategies that enhance speech in noise, music, tonal language perception, and binaural listening appear on the near horizon. Streamlined, remote, and self-programming techniques for adults as well as improved methods and technologies for programming young children are all under active investigation. Improved imaging, both in cadaveric temporal bones and in vivo, combined with telemetered physi- ologic and electric field data, provide unprecedented information about the electro-anatomic relationship between electrode arrays and their target neurons. The clinical benefits of such synergy should soon be substantial.

    With its multiple independent current sources, exceedingly fast signal processing speeds, flexible and investigator-friendly research interfaces, and telemetry, the HiResolution Bionic Ear System is an exceptional implanted hardware architecture—favorably positioned to exploit current and future advances in technology and clinical applications. This bulletin provides an overview of worldwide research made possible by this enabling technology—enabling for patients because of the benefits it provides, and enabling to the global research community by its superb capabilities.

    Jay Rubinstein, M.D., Ph.D. Director, Virginia Merrill Bloedel Hearing Research Center Professor of Otolaryngology & Bioengineering University of Washington, Seattle, Washington, USA

    ....future challenges.

  • ix

    Acknowledgements

    Approximately 14 years have passed since the first patient was implanted with the first generation cochlear implant manufactured by Advanced Bionics. At that time, the CLARION® device represented a major step forward in cochlear implant technology by implementing two completely different sound processing strategies (compressed analog and continuous interleaved sampling) in a single processor using transcutaneous transmission. Since that first device, significant advances have been made in electrode technology, sound processing, device program- ming, and miniaturization of the internal and external system components. Today’s HiResolution® Bionic Ear System consists of the HiRes 90K® internal device with HiFocus® electrode, the Auria® behind-the-ear sound processor, and the body-worn Platinum Sound Processor. The system with HiResolu- tion Sound is programmed using the SoundWave™ Professional Suite software.

    This publication is a compilation of reports on studies from around the world with the HiResolution Bionic Ear technology. Included in this work are contri- butions of surgeons and clinicians who describe the everyday benefits expe- rienced by Bionic Ear users—and from researchers who are exploring new applications that will benefit Bionic Ear recipients today and in the future.

    Advanced Bionics is indebted to these investigators for their efforts and will- ingness to allow their research to be summarized in this publication. (An alphabetical index of contributing authors and a list of participating research centers appear at the end of the bulletin.) Advanced Bionics also is grateful to members of its Research and Development and Clinical Research departments for their commitment to furthering cochlear implant technology through collab- orative research—and for their assistance in making this publication possible.

    We hope you enjoy this biennial edition of the Auditory Research Bulletin, and we look forward to working with you, our clinical and scientific collaborators, as we explore further the capabilities of the HiResolution Bionic Ear System.

    Mary Joe Osberger, Ph.D. Global Director, Clinical Research, Auditory Division Advanced Bionics Corporation

  • Introduction

    The HiResolution Bionic Ear System is a unique and technologically inno- vative cochlear implant with built-in flexibility and upgradeability. Its flex- ibility arises from 16 independent circuits that allow each channel to be powered and programmed separately with any type or combination of waveforms, stimulation patterns (simultaneous or nonsimultaneous), and electrode configurations. Its upgradeability lies in the untapped capa- bility of the CII and HiRes 90K implanted electronics. Consequently, recipients have access to HiResolution Sound today—and to new sound processing strategies in the future simply through software upgrades.

    The Auditory Research Bulletin highlights work conducted with clinical patients and research subjects. Each section may include highlights of multicenter studies, investigator-initiated research, or new studies that recently have been

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