Page 62 - Spring2019

The Remarkable Cochlear Implant
Coda
Although the present-day CIs are wonderful, considerable room remains for improvement and for greater access to the technology that has already been developed.
The modern CI is a shared triumph of engineering, medi- cine, and neuroscience, among other disciplines. Indeed, many members of our spectacular ASA have contributed mightily in making a seemingly impossible feat possible (see Box) and, in retrospect, the brave first steps and coopera- tion among the disciplines were essential in producing the devices we have today.
References
Busby, P. A., Tong, Y. C., and Clark, G. M. (1993). The perception of tempo- ral modulations by cochlear implant patients. The Journal of the Acoustical Society of America 94(1), 124-131.
Dorman, M. F., Cook, S., Spahr, A., Zhang, T., Loiselle, L., Schramm, D., Whittingham, J., and Gifford, R. (2015). Factors constraining the benefit to speech understanding of combining information from low-frequency hearing and a cochlear implant. Hearing Research 322, 107-111.
Dorman, M. F., Gifford, R. H., Spahr, A. J., and McKarns, S. A. (2008). The benefits of combining acoustic and electric stimulation for the recogni- tion of speech, voice and melodies. Audiology & Neurotology 13(2), 105- 112.
Dubno, J. R., Eckert, M. A., Lee, F. S., Matthews, L. J., and Schmiedt, R. A. (2013). Classifying human audiometric phenotypes of age-related hearing loss from animal models. Journal of the Association for Research in Otolar- yngology 14(5), 687-701.
Eisenberg, L. S. (2015). The contributions of William F. House to the field of implantable auditory devices. Hearing Research 322, 52-66.
Emmett, S. D., Tucci, D. L., Bento, R. F., Garcia, J. M., Juman, S., Chios- sone-Kerdel, J. A., Liu, T. J., De Muñoz, P. C., Ullauri, A., Letort, J. J., and Mansilla, T. (2016). Moving beyond GDP: Cost effectiveness of cochlear implantation and deaf education in Latin America. Otology & Neurotology 37(8), 1040-1048.
Emmett, S. D., Tucci, D. L., Smith, M., Macharia, I. M., Ndegwa, S. N., Na- kku, D., Kaitesi, M. B., Ibekwe, T. S., Mulwafu, W., Gong, W., and Francis, H. W. (2015). GDP matters: Cost effectiveness of cochlear implantation and deaf education in sub-Saharan Africa. Otology & Neurotology 36(8), 1357-1365.
Fayad, J. N., Otto, S. R., Shannon, R. V., and Brackman, D. E. (2008). Co- chlear and brainstem auditory prostheses “Neural interface for hearing restoration: Cochlear and brain stem implants.” Proceedings of the IEEE 96, 1085-1095.
Gifford, R. H., Dorman, M. F., Shallop, J. K., and Sydlowski, S. A. (2010). Evidence for the expansion of adult cochlear implant candidacy. Ear & Hearing 31(2), 186-194.
Helms, J., Müller, J., Schön, F., Moser, L., Arnold, W., Janssen, T., Rams- den, R., von Ilberg, C., Kiefer, J., Pfennigdorf, T., and Gstöttner, W. (1997). Evaluation of performance with the COMBI 40 cochlear implant in adults: A multicentric clinical study. ORL Journal of Oto-Rhino-Laryngology and Its Related Specialties 59(1), 23-35.
House, W. F. (2011). The Struggles of a Medical Innovator: Cochlear Implants and Other Ear Surgeries: A Memoir by William F. House, D.D.S., M.D. Cre- ateSpace Independent Publishing, Charleston, SC.
Hüttenbrink, K. B., Zahnert, T., Jolly, C., and Hofmann, G. (2002). Move- ments of cochlear implant electrodes inside the cochlea during insertion: An x-ray microscopy study. Otology & Neurotology 23(2), 187-191.
Lim, H. H., Adams, M. E., Nelson, P. B., and Oxenham, A. J. (2017). Restor- ing hearing with neural prostheses: Current status and future directions. In K. W. Horch and D. R. Kipke (Eds.), Neuroprosthetics: Theory and Practice, Second Edition. World Scientific Publishing, Singapore, pp. 668-709.
Moore, D. R., and Shannon, R. V. (2009). Beyond cochlear implants: Awak- ening the deafened brain. Nature Neuroscience 12(6), 686-691.
Müller, J., Schön, F., and Helms J. (2002). Speech understanding in quiet and noise in bilateral users of the MED-EL COMBI 40/40+ cochlear im- plant system. Ear & Hearing 23(3), 198-206.
Saunders, J. E., Barrs, D. M., Gong, W., Wilson, B. S., Mojica, K., and Tucci, D. L. (2015). Cost effectiveness of childhood cochlear implantation and deaf education in Nicaragua: A disability adjusted life year model. Otology & Neurotology 36(8), 1349-1356.
Contributions by Members of the Acoustical Society of America
Members of the ASA contributed mightily to the de- velopment of the modern CI. Two examples among many are that the citations for 14 Fellows of the ASA have been for contributions to the development and that 556 research articles and 95 letters that include the keywords “cochlear implant” have been published in The Journal of the Acoustical Society of America as of September 2018. Additionally, Fellows of the ASA have served as the Chair or Cochair or both for 14 of the 19 biennial “Conferences on Implantable Audi- tory Prostheses” conducted to date or scheduled for 2019. These conferences are the preeminent research conferences in the field; in all, 18 Fellows have par- ticipated or will participate as the Chair or Cochair. Interestingly, the citations for nine of these Fellows were not for the development and that speaks to the multidisciplinary nature of the effort.
In thinking back on the history of the CI, I am reminded of the development of aircraft. At the outset, many experts stat- ed categorically that flight with a heavier-than-air machine was impossible. The pioneers proved that the naysayers were wrong. Later, much later, the DC-3 came along. It is a clas- sic engineering design that remained in widespread use for decades and is still in use today. It transformed air travel and transportation, like the modern CI transformed otology and the lives of the great majority of its users. The DC-3 was sur- passed, of course, with substantial investments of resources, high expertise, and unwavering confidence and diligence. I expect the same will happen for the CI.
60 | Acoustics Today | Spring 2019