1. Cochlear Implant
30 years of continuous change
Dr. Dr. h.c. Monika Lehnhardt
Warszawa, November 21st, 2013

2. A look into the history of deafness
Before the 1970s, deafness was considered to be an irrevocable blow of fate.
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.

3. A look into the history of deafness
Quotes of famous people
Aristoteles:
deaf people are not subject to any education
Paulus:
ex auditu fidem (Belief is based on hearing)
St. Augustine:
hearing impairment is a deficiency which impedes belief
Leonardo:
deaf people as “an object for visual perception”

4. A look into the history of deafness
Franciso de Goya`s Ydioma Universal‘
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.

5. A look into the history of deafness
Famous deaf people
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.
•Famous
deaf people
Beethoven’s music became much darker as his hearing loss progressed

6. A look into the history of deafness
•Oralism
- a concept whereby people with hearing impairments
•should be educated using spoken language only
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.

7. 1957, Paris
Charles Eyries,
Otologist in Paris
André Djurno, Engineer
Co-working with Eyries

8. 1963, Germany
Fritz Zöllner,
Wolf Dieter Keidel,
Otologist in Freiburg
Physiologist in Erlangen

9. Early 60ies, USA
William House,
Otologist in Los Angeles

10. Early 80ies
Ernst Lehnhardt, Germany

11. Since 1967
Graeme Clark, Australia
 Vision for a technology that would
enable the deaf to hear
 Research supported by public
donation, 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.”

12. Indication

13. Indication

14. Trend towards bilateral

15. Continous and consequent
Advances in 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

16. Indications
Cochlear’s electrode portfolio
Conventional
Contour Advance Electrode
Extended
Hybrid L24 Electrode
Slim Straight Electrode
Special
Straight Electrode

17. Widest access to MRI
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*.
With magnet
No implant
MRI scan at 1.5 Tesla,
4 minutes scan time
MRI scan at 3.0 Tesla,
4 minutes scan time
~90 mm artefact
Images Courtesy MHH Department of Neuroradiology (Hannover, Germany)
Magnet removed**
~40 mm artefact

18. Speech processors
2013
CP910/CP920
Cochlear™ Nucleus® – a history of innovation
`05
`83
`89
`94
`97
`98
`02
Freedom™
ESPrit 3G
ESPrit™
SPrint™
Spectra
MSP
WSP
The smallest processor
`09
CP810

19. Surgical 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 surgery
Time 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)

20. Soft Surgery

21. Accessibility of Internet
SKYPE (developed in Estonia) :
people establish their own telephone base
Facebook:
> 1.11 billion user - March 2013
> 200 Mio
cost free, as efficient as Windows from Microsoft
Cloud computing in health care –
see SynXplatform presented by Microsoft in March
2011

22. Tele-Practice
The Future has begun

23. Tele-Practice
Registration 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)

24. Tele-Practice
Tele-fitting
Experienced expert maneuvers the
software programme on the hardware
of the less experienced in another
location
Upgrades
fitting of new speech processor via
Internet
connection between the
experienced and less experienced
audiologist
Visualisierung aus einem Beitrag von Medincus Group auf YouTube

25. OtoCube
A revolution in testing and
programming of cochlear implants

26. Tele-Practice
Failure Reporting Online
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

27. Tele-Practice
Rehabilitation & Support
Experienced therapist counsels less
experienced via Skype and video
camera
Todd Houston

28. Tele-Practice
Exchange of experience
Amongst parents via Skype or in
LiveOnline Rooms across countries
and language barriers.
Voskresnyj Poldnik – Sunday
meetings for Russian speaking
parents
Weblogs – Interactive Communities

29. Conclusion
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!
EMPATHY

30. Vision
In twenty years
Totally implantable much smaller devices
will be available at an affordable price
for developing countries
© truelight / Fotosearch.de
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

31. Thank you for your attention
Dziękuję Państwu za uwagę
www.monika-lehnhardt.net