June 2017JAMA Otolaryngol Head Neck Surgery

To date, no randomised clinical trial on the comparison between simultaneous and sequential bilateral cochlear implants (BiCIs) has been performed. A multicentre randomised clinical trial was conducted at 5 tertiary referral centres among 40 participants eligible for BiCIs. Main inclusion criteria were postlingual severe to profound hearing loss, age 18 to 70 years, and a maximum duration of 10 years without hearing aid use in both ears. The simultaneous BiCI group received 2 cochlear implants during 1 surgical procedure. The sequential BiCI group received 2 cochlear implants with an interval of 2 years between implants.

First, the results 1 year after receiving simultaneous BiCIs were compared with the results 1 year after receiving sequential BiCIs. Second, the results of 3 years of follow-up for both groups were compared separately. The primary outcome measure was speech intelligibility in noise from straight ahead. Secondary outcome measures were speech intelligibility in noise from spatially separated sources, speech intelligibility in silence, localisation capabilities, and self-reported benefits assessed with various hearing and quality of life questionnaires.

This study shows comparable objective and subjective hearing results 1 year after receiving simultaneous BiCIs and sequential BiCIs with an interval of 2 years between implants. It also shows a significant benefit of sequential BiCIs over a unilateral cochlear implant. Until 3 years after receiving simultaneous BiCIs, speech intelligibility in noise significantly improved compared with previous years.

This is the video of the performance of Mandy Harvey, who lost her hearing completely at 18 years of age. Truly inspiring. Video here: Mandy Harvey on AGT

Mandy Harvey

March 2017 The Weekend Sun

Jack Coombs is a different kid since The Weekend Sun last caught up with him February 2015.

Back then Jack, who has a genetic hearing trait, along with his family were on a journey to regain sound in his life after receiving two cochlear implants. Jack was learning to develop his language to that of a hearing child – a bumpy mission for all involved. But fast-forward to March 2017 – and Jack bounces up to the gate to Maungatapu School. The five-year-old, who has just started school, can both hear and talk proficiently. “He's doing really, really well,” says mother Kirstin Johnson-Coombs, whose older son Reid was born with a severe hearing loss and used hearing aids until he was 11 then received bilateral cochlear implants, while oldest sibling, daughter Mackenzie has no hearing woes.

Jack Coombs“Obviously Jack’s had many assessments along the way but now he's talking at a four-and-half-year-old level, which is fantastic,” says Kirstin. “So you can completely understand him – and in saying that, he is quite a chatterbox.” Kirstin says Jack's already picking up phrases from other kids at school, which is a good indicator his hearing is on track.

But things weren't always so bright. Reid's hearing prompted an audiologist to screen Jack at birth and he was diagnosed with a hearing loss. In 2013 Jack, aged about 18 months, received one cochlear implant – and responded immediately. And one year of rehabilitation via The Hearing House followed, with treatment slowly activating his brain's electrodes, allowing him to gradually hear. In 2014 Jack received a second implant at age two-and-a-half. “When he had his first cochlear implant he got to the stage where he would recognise his name. After his second implant, we'd take the first one off and he wouldn't recognise his name again.”  Jack received another year of rehabilitation for his new implant. “Without his cochlear implants, he's deaf.”

Kirstin says the implants are fantastic – enabling Jack to have life with sound. “The first three or four months with implants took him a while to learn more language but then it just flowed.”

And so Jack's behaviour has changed too – from a toddler who couldn't understand and be understood – to a five-year-old keen to join school. “Now he's a lot more independent – even in the last few weeks he's changed quite a bit – he's taken to school like a duck to water.”

Now everyone at school knows and loves Jack at Maungatapu Primary School – Kirstin puts down to the school's support and Jack's siblings passing through the gates before him. “He has a really cool personality – and with his journey, he's come a long way.”

So what now for Jack? The Hearing House still helps Jack with hearing mapping and equipment. But his case has been transferred to Kelston Deaf Education Centre in Auckland for rehabilitation and a resource teacher, who comes into Jack's school three times a week to help him. “He'll be doing normal schoolwork just like everyone else – he'll be learning how to read and write just like all of the others kids.” Kirstin says they've had so much support – from The Hearing House, Ministry of Education and Kelston Deaf Education Centre – and met so many amazing people.

“We've started a support group for parents with children with hearing difficulties,” says Kirstin, who is also a NZ Federation for Deaf Children Executive Committee member.

2017 GineersNow, Science Robotics and Live Science 

Researchers from the University of Bern, Switzerland have created a robot that drills holes in a patient’s skull to aid doctors in Cochlear Implant surgery.   The procedure involved in this microsurgery is performed by a lot of doctors to a lot of patients per year, but that doesn’t remove the fact that it’s a very, very delicate surgery. One wrong move and they could cause permanent damage to the patient. And of course, where precision and care is the critical part of a job, it’s always handy to let a robot, programmed to have much, much less margin of error than humans, to do the job. This is where the skull drilling robot comes in. The robot performs the most crucial and delicate part of the surgery: drilling the skull at the exact location and the right depth to access the correct part of the cochlea they need. The creation of the robot is not only useful for this type of surgery, but also provides a platform for other microsurgeries to prove that robots can be used in surgery planning systems, stereo vision, live detection of tissue types etc.

Drilling RobotFor the first time, the robot successfully performed this tricky, delicate operation. A 51-year-old woman who was completely deaf in both ears due to a rare autoimmune disease received a cochlear implant in her right ear. "The patient is progressing well with speech and language training, and is expressing high satisfaction on the benefits of having a cochlear implant," said study lead author Stefan Weber, director of the ARTORG Center for Biomedical Engineering Research at the University of Bern in Switzerland. "Six months after the surgery, she is even able to partially communicate via telephone, which is a big step for her personal freedom.” 

The most delicate, trickiest part involves placing the 0.01-inch-to-0.04-inch-wide (0.3 to 1 millimeter) electrode array in an opening that is typically 1.2 inches (30 mm) in diameter, according to the researchers. "When discussing much-needed surgical innovations for use in ear, nose and throat procedures, our surgeon colleagues would repeatedly mention that gaining access to the inner ear in a minimally invasive manner was a major hurdle that had not been resolved," Weber said. "This spurred us on to research and design a way to enable ear, nose and throat surgeons to perform keyhole surgery to access the inner ear.” Most of the procedure is still completed manually by humans. However, the robot is responsible for one of the operation's riskiest steps: drilling a microscopic hole in the skull bone surrounding the ear without causing heat-related injury to nearby nerves. "The drill needs to pass between nerves at a distance of less than 1 millimeter," Weber said.

The researchers developed a robotic drill with the highest degree of accuracy reported yet for such a medical device, straying as little as about 0.015 inches (0.4 mm) in 99.7 percent of all drilling attempts, the scientists said. A camera also helped track the robot with 25-micron accuracy; in comparison, the average human hair is about 100 microns wide. Moreover, the research team designed stainless-steel drill bits with grooves and cutting edges that are optimised for cutting into bone and transporting away bone chips, thus helping to minimise the amount of heat generated during drilling. A rim on the outside of the drill also reduces friction between the bit and the surrounding tissue while it rotates. During the procedure, there were several pauses during drilling to limit the accumulation of heat, and during each pause, bone chips were washed off the drill bits to keep them from adding to friction during drilling, the researchers said. In addition, before surgery, the researchers used computed tomography (CT) scans of the patient's skull before, during and after the surgery to verify that the robot would steer clear of delicate areas. During surgery, the scientists also used electrodes attached to facial muscles to look for any damage to facial nerves. 

"We are very excited about the results and that we were able to demonstrate such a complex technology in the operating room," Weber said. "It adds to the mounting evidence in many other areas that robots can potentially do things in surgery in a way a human surgeon would not be able to carry out without technology.” The researchers are working with a surgical robotics manufacturer and an implant manufacturer to begin commercial development of their technology. "This will allow the development of the surgical robotics platform into a medical technology product that hospitals can buy for their surgical departments," Weber said. However, Weber cautioned that this new approach is only "the very first stage of changing how hearing surgery is done by ear, nose and throat surgeons. We think there is plenty of potential, but it will take lots more work before more hard-of-hearing people can have their hearing restored with new technology."