Dr. Dr. h.c. Monika Lehnhardt

Warszawa, November 21st, 2013

Cochlear ImplantCochlear Implant30 years of continuous change

Before the 1970s, deafness was considered to be an irrevocable blow of fate.

A look into the history of deafnessA look into the history of deafness

Congenital deafness resulted in muteness and educational support relied on visual perception and feeling of vibrations. It was rather an exception that a deaf born infant would learn to listen and talk.

The reason for deafness was seen to be retro-cochlear, which we know is not the case in 95 percent of the deaf population.

Parents felt guilty or ashamed to have a deaf child and would try to hide it away.

Quotes of famous people

Aristoteles: deaf people are not subject to any education

A look into the history of deafnessA look into the history of deafness

St. Augustine: hearing impairment is a deficiency which impedes belief

Leonardo: deaf people as “an object for visual perception”

Paulus: ex auditu fidem (Belief is based on hearing)

A look into the history of deafnessA look into the history of deafness

In 1797, five years after he lost his hearing, Goya published the “Ydioma universal” – a sign language for the deaf, which is in the Museo del Prado in Madrid now and another 5 years later, in 1812, he completed a drawing showing the alphabet for the deaf-mute.

Franciso de Goya`s Ydioma Universal‘

Famous people suffering from deafness included artist Francisco de Goya, composer Ludwig van Beethoven and Czech composer Bedrich Smetana. They all suffered from their condition, which was reflected in their art.

Beethoven’s music became much darker as his hearing loss progressed

•Famous deaf people

A look into the history of deafnessA look into the history of deafnessFamous deaf people

•Oralism - a concept whereby people with hearing impairments •should be educated using spoken language only

A look into the history of deafnessA look into the history of deafness

Abbé de l’Epée (1712 – 1789) was the founder of the first school for the deaf in 1770 in France. In America Thomas Gaullaudet founded the first school for the deaf in the year 1816.

In 1970 finger alphabet was reintroduced for classes in deaf schools in Germany. Sign language was banned in France until 1976 and in Austria the ban was lifted only in 1984.

1957, Paris1957, Paris

Charles Eyries, Otologist in Paris

André Djurno, Engineer Co-working with Eyries

Fritz Zöllner, Otologist in Freiburg

Wolf Dieter Keidel, Physiologist in Erlangen

1963, Germany1963, Germany

William House, Otologist in Los Angeles

Early 60ies, USAEarly 60ies, USA

Early 80iesEarly 80ies

Ernst Lehnhardt, Germany

Vision for a technology that would enable the deaf to hear

Research supported by publicdonation, commenced 1967

First cochlear implant, 1978,Melbourne Hospital

“In spite of the problems and criticisms, I just had to go on. A cochlear implant was their only hope of ever hearing.”

Since 1967Since 1967

Graeme Clark, Australia

IndicationIndication

IndicationIndication

Trend towards bilateralTrend towards bilateral

Continous and consequent Continous and consequent Advances Advances in Technologyin Technology

Introduction of automated processes to reduce manual work and herewith risk of human failure to improve the reliability of devices and reduce cost of production

IndicationsIndications

Conventional

Special

Contour Advance Electrode Slim Straight Electrode

Hybrid L24 Electrode Straight Electrode

Cochlear’s electrode portfolio

Extended

MRI scan at 1.5 Tesla, 4 minutes scan time

Removable magnet with all implants, for access to 3.0 Tesla MRI5.Only Nucleus implants give access to optimal image quality.

1.5 Tesla, with magnet in place5*.3.0 Tesla, with magnet removed5*.

Images Courtesy MHH Department of Neuroradiology (Hannover, Germany)

~40 mm artefact~90 mm artefact

No implant With magnet Magnet removed**

MRI scan at 3.0 Tesla, 4 minutes scan time

Widest access to MRIWidest access to MRI

Speech processorsSpeech processors

Spectra

WSP

ESPrit 3G

MSP

SPrint™

ESPrit™

Freedom™

`83`89

`94`97

`98`02

`05 CP810`09

2013CP910/CP920

The smallest processor

Cochlear™ Nucleus® – a history of innovation

Surgical techniquesSurgical techniques

Techniques have changed significantly over the last 30 years

incision size, flap shape, approaches, insertion of the electrode array, suturing, imaging techniques, computer aided surgeryTime for surgery reduced from 3 hours to 1 ½

In the future possibly robots will “do the job” faster and more reliable

(David Proops, Suzdal, December 2011)

Soft SurgerySoft Surgery

Accessibility of InternetAccessibility of Internet

SKYPE (developed in Estonia) : people establish their own telephone base

Facebook: > 1.11 billion user - March 2013

cost free, as efficient as Windows from Microsoft

Cloud computing in health care –see SynXplatform presented by Microsoft in March 2011

> 200 Mio

Tele-PracticeTele-Practice The Future has begunThe Future has begun

Tele-PracticeTele-PracticeRegistration Online

￭ No need of manually filling in cards, mailing, collecting, copying …

￭ Central Computing of data at an independent organization to get

reliable statistics about CI recipients (e.g. Switzerland, Belgium,

Netherlands, Denmark, Sweden)

Tele-PracticeTele-Practice

Experienced expert maneuvers the software programme on the hardware of the less experienced in another location

fitting of new speech processor via Internet connection between the experienced and less experienced audiologist

Upgrades

Tele-fitting

Visualisierung aus einem Beitrag von Medincus Group auf YouTube

OtoCubeOtoCube A revolution in testing and programming of cochlear implants

Tele-PracticeTele-Practice

CI systems will report about their functionality and about eventual problems online and will receive online instructions how to fix the problem or suggest competent resources where to find a solution

Failure Reporting Online

Tele-PracticeTele-Practice

Experienced therapist counsels less experienced via Skype and video camera

Rehabilitation & Support

Todd Houston

Amongst parents via Skype or in LiveOnline Rooms across countries and language barriers.

Voskresnyj Poldnik – Sunday meetings for Russian speaking parents

Tele-PracticeTele-PracticeExchange of experience

Weblogs – Interactive Communities

ConclusionConclusion

EMPATHY

Tele-Practice is not meant to replace but to complement traditional clinical care to enhance quality and ensure a broader reach and coverage at reasonable costs

Free human resources and have them concentrate on providing what can only be provided by human beings: Empathy for people in need!

VisionVision

© truelight / Fotosearch.de

Totally implantable much smaller devices will be available at an affordable price for developing countries

The current CI recipient base will have new devices, which they can program themselves. They will do their trouble shooting and get guidance for problem solving online

Deafness will not be the most frequent deficit in new born babies in highly developed countries any longer – gene manipulation and regeneration of hair-cells have already appeared on the horizon

In twenty years

Thank you for your attention

www.monika-lehnhardt.net

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