The first fully implanted cochlear implant reaches patients
spectrum.ieee.org56 points by rbanffy 4 days ago
56 points by rbanffy 4 days ago
There's a good thread on Reddit from a recipient of this implant talking about his experience: https://www.reddit.com/r/Cochlearimplants/comments/1wu4zjz/t...
In related news, 2 companies have begun human trials on genetic therapy for the most common cause of hearing loss (GJB2). I'm sure cochlear implant companies are a bit nervous about this development!
Wow, I only knew of the Decibel Tx (now Regeneron) work on this. I'm excited for this because my wife and I carry mutations in GJB2 that we did pre-implantation genetic screening to avoid in our daughter. At the time, the only one that was in trials was the OTOF-fixing one, but that is non-degenerative unlike the GJB2 stuff.
A quick LLM search reveals that there's quite a few of these trying to fix this. A summary after some accompanied google.
* Skylark - https://www.clinicaltrialsarena.com/news/first-patient-skyla...
* Sensorion - https://www.sensorion.com/en/fiches-produits/gjb2-gt-2/
* Eli Lilly bought one - https://investor.lilly.com/news-releases/news-release-detail...
And an unfortunate update is that Regeneron (which acquired Decibel Therapeutics and all their gene-therapy lines regarding hearing loss) has mostly put their efforts behind the working OTOF one. Ah well, hope the others succeed. While I do have one precious daughter from the embryo selection process, we don't have that many embryos to work with.
If anyone else affected is interested, the notes I took and wrote while we were doing our embryo-selection process are here: https://wiki.roshangeorge.dev/w/IVF
When I first heard about Cochlear Implants I thought this is magic. That we can replace a part of the body that does some calculation mechanically with a real time computer simulation of it blew my mind.
Nowadays these implants must be quite common. At least I encounter people wearing ones regularly. If their life can get more convenient with an implantable version this is fantastic news.
The technology is amazing, for sure. But the success of the current CI tech is also a testament to how fantastically adaptable the human brain is.
A normal cochlea has 15-20.000 tonotopically mapped hair cells that turn mechanical movement into electric signals which the brain then turn into meaningful sound. The fact that the brain can also make sense of the electrical signals coming out of just twelve to sixteen little electrical contacts placed along a silicon noodle that gets shoved into the cochlea, and turn this crude signal into into speech and music, is nothing short of mind blowing!
Should not it sound like a vocoder (which makes robotic voices)? I doubt one can hear any music this way though. Why they do not use more electrodes then?
A vocoder is a good approximation for what a cochlear implant's speech processor does.
There's been one person who was implanted, who had their natural hearing return for unknown reasons. So they can hear both cochlear, and quite well naturally in the same ear.
This let researchers at Arizona State University ask basically: what sounds most like the cochlear input? The various samples involving their research about 15 years ago are probably your best bet for what it sounds like.
Some people with musical training before retain the ability to hear arbitrary melodies with perfect pitch. Some do not.
There is basically no polyphony.
This probably sounds really obvious, but I underestimated how isolating even slight deafness can be.
Have a really nice chatty senior (70s) at my volunteering job who was very jovial with everyone, always cheered me up because I worry about the amount elder-loneliness in my town sometimes. He lost some of his hearing over the years, and even with decent hearing aids and people taking his hearing into account he participates much less in conversation during our breaks.
I can definitely believe it. According to every audiologist I’ve been to, my hearing is normal for my age, though on the lower end of the expected range for some frequencies.
However if I’m in a noisy restaurant it always seems like everyone else at the table can hold the conversation just fine but I can’t hear a damn thing they’re saying. It’s very isolating. I can’t understand how they do it.
My father uses hearing aids but even with them I can see him sort of just receding from a conversation sometimes.
Have you looked into auditory processing disorder? One of the main features is having difficulty locating or separating sounds, especially when there's several competing sounds.
I have heard of it, but other than giving something a name, what can be done about it?
Having the label to look for helps you find people dealing with the same problem, and share tips.
Looking into it a bit, seems some people experience relief with low-gain hearing aids, and others find help with a variety of practice/training methods or coping techniques.
Somewhat counterintuitively, I also find that earplugs help a great deal. I use Loop brand, but there are other comparable noise reduction earplugs. They smooth out a lot of the sharper sounds that I find uncomfortable, and make it easier to pick out details from a loud environment.
It’s pretty terrible. I started losing my hearing in my mid 30s. Best guess is genetics. My loss right now in my early 50s would be termed moderate, not quite severe but it continues to get worse.
Hearing aids have come a long way but all of the ones I’ve used still basically suck when it comes to understanding speech. Part of it, I think, is that my loss isn’t bad enough that fully closed ear pieces are recommended and as such background noise is still free to obfuscate conversation.
It basically makes conversation in anything but a quiet room extremely difficult. My brain works overtime trying to fit possible words to what I hear. Sometimes I fail with pretty humiliating results.
It doesn’t take much before you just stop trying to talk with people. Especially with the younger crowd because they tend to speak the quietest. It varies by individual, but at least older people who’ve had some loss themselves will speak louder to compensate.
The worst is restaurants. Usually I can guess what’s being said by the server, but not always. Accents increase difficulty.
I used to be pretty out going, joked a lot with people. Now I avoid most conversations when I can.
So I think thos would be something that needs to be started at a young age with lots of exposure training. My father in law is deaf and has a cochlear implant but often removes at points because it gets overwhelming for him to hear all the noise all the time. This seems like it would not afford him the luxury of that.
I don't blame your father-in-law: We live in an increasingly loud world, where people casually make sounds above the threshold of pain. I just started carrying earplugs in my pocket for this reason.
More recently: I've been in movie theaters where the dialog is played over the threshold of pain, and on a cruise where the microphone for a drawing clinic was set over the threshold of pain.
I recently impulse bought a pair of these for $6, and it's been a game-changer: https://www.amazon.com/dp/B01K9RHZ3S
The special part isn't the earplugs (and they're good!), the special part is the little carry case so they can live in my pocket 24/7. I use them more often than expected: loading the dishwasher, vacuuming, movie theaters, mowing, discount stores (acoustic tiles cost more), using an electric leaf blower, digging with a shovel (hitting rocks), riding in a car with bass, etc etc
Naturally, you can use any small carry case and earplugs. I just needed that 'permission' lol
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You may be interested to hear: some experts suggest "age-related hearing loss" is essentially a myth, and it's actually caused by our loud industrial lifestyle.
https://acoustics.org/hearing-loss-in-old-age-isnt-due-to-no...
https://www.researchgate.net/publication/312608404_Noise-ind...
https://www.sfu.ca/sonic-studio-webdav/handbook/Presbycusis....
Yes, it's coming out that driving around at high speeds with the windows down is a major contributor.
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I figured it out years ago when I came across an anecdote somewhere that explained that elderly people in remote, non-industrialized societies had no age-related hearing loss.
> driving around at high speeds with the windows down
That's been well known for decades. I wish I knew that when I was younger. I avoided rock concert and gunshot sounds with earplugs, but always drove with the window down. My left ear is much worse than my right.
I also don't listen to loud music anymore. Sigh.
I wear ear protection whenever I vacuum or use power tools.
I am not an expert but it might be the problem with microphone or sound processing and not actual noise. For example, my smartphone mic picks up lot of noise from wind even if the wind is not strong, while human's ears somehow reduce or suppress the wind noise.
Also, modern smart speakers use arrays of microphones and medical devices might be using some outdated tech.
I haven’t kept up to date with cochlear implants, but their capabilities used to be pretty crude. The bitdepth of sound being profoundly reduced to just 5 or 6 bits equivalent.
It wouldn’t take much to just sound like jumbled noise.
From what I have been told by my father in law it sounds very digitized on his implant. I think it takes some level of therapy for the brain to build the pathways for it to not sound like a jumble of noise anyways and actually interpret speech. It is incapable of really giving the richness of music or other forms of noises. Interestingly enough his implant can connect to bluetooth so if he wanted to he can listen to podcasts.
> Interestingly enough his implant can connect to bluetooth so if he wanted to he can listen to podcasts.
At that point does it sound better or the same? That's how to know if it's an issue with the microphone or the "everything else."
Yeah i think we can appreciate it as naturally hearing as sometimes we just want a quiet space. Those are getting harder to find.
You can turn it off.
I was pleasantly surprised to see that it seems to be MRI conditional without too much drama. One of the requirements is that it’s turned off, which the user does from their controller.
Edit: getting specific details on its MRI safety is the same as it is for all medical companies. Set language and region (this somehow affect MRI safety?) and then hunt for implant. But not all implants are listed in all regions. Because ‘medical professionals’ want to hunt shitty websites and trawl model numbers.
Just list the documents ordered by implant type, then name. Please.
> This seems like it would not afford him the luxury of that.
An "off" switch seems like a really stupid thing to forget to include, doesn't it?
Even if we ignore our intuition and consider only what's in TFA, there's this testimony near the end of the article (emphasis added):
> This was echoed by Diana Grosser, a volunteer who received a TICI Unico in 2024 as part of the clinical trial. “The most meaningful change is freedom,” she said. “I can sometimes forget that I’m deaf, live more freely with my children, swim or ride my motorcycle without worrying about my processor pressing, slipping, or getting lost. I can even choose to hear at night, which gives me additional safety.”
They think the lithium ion battery inside will need to be replaced in 15 years.
I feel like implants like this should require an open connectivity standard between the stimulator in the cochlea and the processor.
A friend has a bone anchored hearing aid, with an osteointegrated post. The two different companies that make BAHAs use different posts. Which requires more surgery if they want to change brands. It could trivially be made compatible and swappable instead.
There is no vendor lock-in quite like prosthetic vendor lock-in.
Trusting a company for 15 years to keep making a replacement product seems crazy.
Not quite; they estimate that the battery will hold at least 24 hours of charge after 15 years. Charging it back up takes one hour, and in the context of cochlear implants these are very good numbers. I think most people would be okay with a (let's say) 20-year reimplant cadence given the benefits of this technology - but this obviously depends on which country you happen to live in. I'm lucky enough to live in a place where cochlear implants (and the surgery) is free to whoever needs it.
I kinda view Lithium batteries as road flares with good PR. So that inside my body next to my brain seems..sketchy.
The other issue is that cutting it out and replacing it is the only option when the battery dies or goes wrong. If the product/company dies in the meantime, you have a bunch of scar tissue and no hearing. Replacing the "normally inside" bits of a cochlear implant is really high risk of not working as intended, so changing brands isn't a small ask. You really get to do this once. So putting the processor inside and tightly integrated with the nerve stimulation seems inadvisable. At least with the processor separated, you have a chance a compatible replacement processor could be made and exchanged without huge risks.
> I kinda view Lithium batteries as road flares with good PR. So that inside my body next to my brain seems..sketchy.
From "Trends in Cardiac Pacemaker Batteries" (2004) [0]
The first implanted cardiac pacemaker used nickel-cadmium rechargeable battery, later on zinc-mercury battery was developed and used which lasted for over 2 years. Lithium iodine battery invented and used by Wilson Greatbatch and his team in 1972 made the real impact to implantable cardiac pacemakers. This battery lasts for about 10 years and even today is the power source for many manufacturers of cardiac pacemakers.
This is slightly conspiratorial but I suspect that hearing aid vendors lock-in people the same way through neural adaption.
If someone has profound high frequency deafness, no amount of amplification will help. High frequencies carry a lot of the information about consonants and are how we distinguish "t" from "s" etc.
So modern hearing aids do frequency remapping. A low frequency signal is produced within the range of hearing when those high frequency inputs are detected. The sharp 2500 and 6000 Hz peaks of an aspirated "t" become a sort of raspy tone at 1500 Hz, for example.
This is why they say you need to wear your hearing aids for at least some weeks before you notice a benefit. You're relearning language with the extra DSP sounds added. If you grow up with and wear hearing aids most of the time, your brain will be fully adapted to the DSP-speech.
Which is proprietary to the manufacturer. Every manufacturer uses a different algorithm. There's several ways to remap - the classic time vs. frequency multiplexing question. This (along with different noise reduction algorithms) explains why hearing aids from two different manufacturers can sound so very different.
I am being quasi-conspiratorial about it being an intentional lock-in. But one does wonder. In practice the method used by the hearing aids you grew up with is probably the only method you can make full use of.
Not to knock the technology. It's quasi-miraculous for some types of partial deafness. With plain amplification even at 95 dB my WRS is like 60%, while with hearing aids set at much lower 80 dB output average I get 100%.
Lots of information (albeit from the audiologist's perspective) about frequency lowering here: https://www.audiologyonline.com/articles/fitting-guide-frequ...
Yeah, this desperately needs regulation. Any medical device that gets implanted in a patient's body requires the full designs to be part of the public record. Might fix all those unsecured wireless connections they love to leave in as well...
Like the bionic eye. We have a famous early-adopter in the country where I life. Sadly, she learnt quickly that going for this sort of tech was a bad idea, because the company producing/maintaining the thing went out of bussiness by now. Imagine the feeling. You have experimental tech inside your body, and nobody is able to maintain it these days.
> They think the lithium ion battery inside will need to be replaced in 15 years.
Pacemaker batteries have a 10 year replacement cycle and are lithium based, but don't get recharged (Just replaced). The concept of having to do this on a schedule is not that far fetched.
I have a IV port implant. The needles to use with it are licensed and very tightly controlled. It's not a prosthetic, but it is a part of my body I can't actually use without a company's permission.
Is it viable as anything but subscription service? I mean if you want technical staff with expertise to continue working on it they need to continue getting paid. It's a gamble that your one time payment (however large) will be responsibly managed by the company owners once the flow of new clients dries up. And once you are on the hook what's stopping the company from playing some ads for users tiers platinum and lower?
Given that MED-EL, the company mentioned in the article, has been around since 1990 and is constantly expanding, I would assume that this is indeed viable.
I live in Innsbruck, Austria, where MED-EL is headquartered. Like most people I know, I too have briefly worked there in 2008. I currently live 5 minutes on foot from where the entrance used to be back then, before it was walled off, they massively expanded the building and added another building behind it, where in 2008 a bunch of office containers with clean rooms used to be. There is now a raised walk way to the other side where they used to rent just a few units back then and now co-opted the building, plus a patch work of smaller rental spaces all around.
The implants themselves are not cheap and (at least at the time?) eventually needed to replaced. From what I recall, some of the technology involved was also licensed out or sold for other applications. Ultimately, I would also guess that all the licensing, approval and red-tape involved in actually making implants for humans also kind of limits competition quite a bit.
> and (at least at the time?) eventually needed to replaced.
All cochlear implants from any of the cochlear implant companies have a % chance of needing to be replaced. Failure rate is something like 4% in the first 10 years, and 10% in the first 20 years.
> Given that MED-EL, the company mentioned in the article, has been around since 1990 and is constantly expanding, I would assume that this is indeed viable.
I think currently it is viable because MED-EL is not a publicly traded company or in the hands of some private equity or some MBA. I know that there are serious concerns how MED-EL will develop when the Hochmaiers are not in charge anymore.
It's like in Ghost in the Shell where your augmenting cybernetic parts needs to be returned after service periods ends
> what's stopping the company from playing some ads for users tiers platinum and lower?
Any sane government
Have we had one of those this millennium?
Do you imply we had one a 1000 years ago?
And yes, we currently have quite a few sane ones, especially in the EU. None of them is perfect, but it's definitely the most humane it has ever been by a long shot.
I imply that I don't know enough about world governments before 2001 to have an opinion on how sane they were.
No, the ads played by medical devices will be entirely self-interest: they will whisper in your ear that it’s time already for your next colonoscopy, and that 988 is available for your crisis, and your 2FA login code is as follows… and remember that flu/COVID vaccines are now available, and don’t forget your PCP appointment that is coming in 23.5 hours! Also you have an outstanding balance of $300,000 so please blink thrice to debit your checking account.
You could share the same concern about any cochlear implant, I suppose. There are three (Med-El, Advanced Bionics, and Cochlear) and all are quite stable and provide great support.
Amazing: the tech industry is so morally bankrupt that it manages to make healthcare look altruistic!
As I understand, the novelty is that they put external components, including a lithium battery, under the skin. Is that a good idea? You cannot easily replace them, and what if something happens to the battery?
We are routinely implanting pacemakers in people's bodies. I don't think this is fundamentally different.
Battery tech used in these devices is most likely very different from consumer electronics and I assume they can't just catch fire inside your body.
This is nice, hopefully they don't start selling cheaper implants supported by spotify ads imagine an ad that is streamed directly to your auditory nerve you can't turn it off or change the volume
This could be game-changing technology for people who need it.
Imagine implanting a lithium ion battery in your head
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