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."

March 2017  Blake S Wilson  IEEE Pulse

Even as recently as the mid-1980s, many experts in otology and auditory science thought that restoration of useful hearing with crude and pervasive electrical stimulation of the cochlea was a fool’s dream. What the “experts” missed at the time is the brain’s awesome power to process a highly impoverished and otherwise unnatural input and make sense of it. In retrospect, the main task in developing a useful hearing prosthesis for deaf or nearly deaf people was to provide enough information in the right form for the brain to take over and do most of the job. That is not to say that any input would do, as different strategies for stimulation at the periphery produce different results and the initial results were no better than what the experts had predicted. However, once a threshold of quantity and quality of information presented at the periphery was exceeded, the brain could indeed take over and do the rest. Designers needed somehow to exceed the threshold, and that is the story of the modern cochlear implant (CI).

Today, the CI is widely acknowledged as one of the great advances in medicine and something that even the most ardent proponents of CIs could not have foreseen at the beginning. The decades-long path to today included four steps:

  1. the pioneering step to implant the first patients and develop devices that were safe and could be used for many years in patients’ daily lives

  2. the development of devices that provide multiple sites of stimulation in the cochlea to take advantage of the tonotopic (frequency) organisation of the cochlea and the auditory pathways in the brain

  3. the development of processing strategies that utilised these multiple sites far better than before and thereby enabled high levels of speech recognition for the great majority of CI users

  4. stimulation in addition to that provided by a CI on one side, either with a second CI on the opposite side or with acoustic stimulation for people who have useful residual hearing in one or both ears, usually hearing at low frequencies only.

William F HouseWilliam F. House contributed the most in achieving the first of these steps and got us started on this great journey. He persisted in the face of the criticisms, and, without that determination, the development of the CI certainly would have been delayed, if initiated at all.

House was a physician and was assisted by Jack Urban, an electrical engineer, in designing and implementing the earliest devices starting in the mid-1960s. House was working at the House Ear Institute in Los Angeles (founded in 1946 by House’s older half-brother Howard), and Urban was president of an aerospace research company in Burbank. This partnership between a physician and an engineer presaged larger teams that included one or more physicians (usually more) and sometimes a goodly number of engineers, plus auditory and speech scientists, audiologists and oftentimes additional professionals. Many teams worldwide participated in those subsequent efforts. The modern CI most certainly could not have been developed without the engineers or the physicians. Such partnerships are, of course, what biomedical engineering is all about.

The approximate times for completion of the steps are shown below, along with the cumulative number of implant recipients between 1957 and December 2012. The dots in the graph show published data points, and an exponential fit to the data has a correlation higher than 0.99. If that exponential growth continues as expected, a million people will have received a CI or bilateral CIs by early 2020; according to unpublished industry records, the number of recipients had already reached a half million in early 2016.

graphFurther improvements in performance were made with adjunctive stimulation (step 4) for people who had enough residual hearing to benefit from combined electric and acoustic stimulation (EAS) and those receiving a second implant. Both combined EAS and bilateral CIs produced statistically significant increases in speech-reception scores, especially for difficult test items or speech presented in competition with noise or other talkers. In addition, bilateral CIs could reinstate at least some sound-localisation abilities, and combined EAS produced large gains in music reception and appreciation. The sound-localisation abilities are no doubt due to representations of the interaural level differences the brain uses to infer the positions of sounds in the horizontal plane, and the better music reception may be due to representations with the acoustic stimulus of the first several harmonics of periodic sounds, as those harmonics are vital for robust perception of fundamental frequencies and thus melodic contours.

Over the past several years, the development of the modern CI has been recognised by many prestigious awards and honours, including the 2013 Lasker–DeBakey Clinical Medical Research Award and the 2015 Fritz J. and Dolores H. Russ Prize, which is the world’s top award in bioengineering and one of three prizes conferred by the U.S.’s National Academy of Engineering popularly known as the “Nobel Prizes for Engineering.” Similarly, the Lasker awards are second only to the Nobel Prize in Physiology or Medicine for recognising advances in medicine and medical science; in fact, more than a third of Lasker laureates go on to win a Nobel Prize at a later time. The engineering and medical prizes for the CI reflect the partnerships that made the CI possible and indicate the importance of the CI to both fields.

The CI is by far the most effective and most utilised neural prosthesis to date. And thus, not surprisingly, it has become the principal model for the development (or further development) of other types of neural prostheses and a foremost exemplar of the power of engineering to improve human health. With respect to the latter point, the design of the CI is included in most every biomedical engineering program worldwide. In addition, it is a core component of the curricula for budding audiologists, auditory scientists, speech scientists, and otologists. But the path to success hasn’t been easy. Joshua Boger, one of the developers of ivacaftor (a drug for the treatment of cystic fibrosis), offers the following cogent and insightful observation about medical breakthroughs, which certainly captures the experience with CIs as well: “The development of ivacaftor was a high-wire act from beginning to end.… If you are looking for dramatic changes in medicine, you are not looking to be comfortable in research; every breakthrough project I know about has passionate detractors”

Some lessons biomedical engineers can learn from the development of the CI are that the experts are not always correct and that perseverance and teamwork are important. Thanks to the second point, most of today’s CI users can communicate fluently via the telephone, even with previously unfamiliar people at the other end and even with unpredictable and changing topics. That wonderful outcome could not have been reasonably imagined at the outset or, indeed, up to the early 1990s when new processing strategies were introduced into clinical practice and the number of implant recipients began to skyrocket. Although room remains for improvement, the present-day devices “allow children to be mainstreamed into regular schools, adults to have a wide range of job opportunities, and for all recipients to connect in new and important ways with their families, friends, and society at large”. The resulting human and economic benefits have been immense—benefits that were made possible by grit, brilliance, key discoveries, exquisite engineering, and multidisciplinary teams.