AUDITORY BRAIN STEM IMPLANTS

TANIA BARMAN 1651210021

Introduction:
An auditory brainstem implant (ABI) is a surgically implanted electronic device that provides a sense of sound to a person who is profoundly deaf, due to sensorineural hearing impairment (due to illness or injury damaging the cochlea or auditory nerve, and so precluding the use of a cochlear implant). The auditory brain stem implant uses similar technology as the cochlear implant, but instead of electrical stimulation being used to stimulate the cochlea, it is instead used to stimulate the brain stem of the recipient. Only about a thousand recipients have been implanted with an auditory brain stem implant, due to the nature of the surgery required to implant the device (as it requires brain surgery to implant the device) and the reduced effectiveness of the implant (most auditory brain stem implant recipients only have an awareness of sound - recipients won't be able to hear musical melodies, only the beat). In the United States ABIs are only approved for adults (18 & over) and only for patients with neurofibromatosis type II (NF2). In Europe, ABIs have been used in children and adults, and in patients with NF2 as well as other auditory complications, such as auditory nerve aplasia and cochlea ossification. Speech

perception in non-NF2 patients on average has been reported to be higher than that of NF2 patients

HISTORY:
The auditory brainstem was first implanted in humans in 1979 at the House Ear Institute, CA, USA. This original ABI consisted of two ball electrodes which were implanted near the surface of the cochlear nucleus. A changefrom a percutaneous connection to a wireless transcutaneous connection, and from ball electrodes to flat electrodes were the only changes to theimplant until 1991, where 25 people had received the ABI. In the US in 1992 an eight electrode implant developed by C ochlear Limited, the House Ear Institute and Huntington Medical Research Institute. An electrode array with 21 electrodes developed by Cochlear Limited was developed for the European market at the same time.The processor for both the eight and 20 electrode implants used Nucleus 22 ABI (Cochlear Limited) external speech processors. Since 1999 a 21 electrode array implant has been used with the Nucleus 24 ABI (Cochlear Limited) speech processor.A 12 electrode array implantt with a speech processor based on the C40+ cochlear implant (Med-El) [ and a 16 electrode array implant with the Clarion-1.2 cochlear implant (Advanced Bionics)have also been Developed

ADITORY BRAIN STEM RESPONSE

The auditory brainstem response (ABR) test gives information about the inner ear (cochlea) and brain pathways for hearing. This test is also sometimes referred to as auditory evoked potential (AEP). The test can be used with children or others who have a difficult time with conventional behavioral methods of hearing screening. The ABR is also indicated for a person with signs, symptoms, or complaints suggesting a type of hearing loss in the brain or a brain pathway. The ABR is performed by pasting electrodes on the headsimilar to electrodes placed around the heart when an electrocardiogram is runand recording brain wave activity in response to sound. The person being tested rests quietly or sleeps while the test is performed. No response is necessary. ABR can also be used as a screening test in newborn hearing screening programs. When used as a screening test, only one intensity or loudness level is checked, and the baby either passes or fails the screen.

WHAT IS ABI????
This procedure is used to treat deafness caused by damage to the vestibulocochlear nerve due to tumours or surgery. In people with vestibulocochlear nerve damage, hearing is not improved by hearing aids or cochlear implants. Auditory brain stem implants are electrodes placed in a part of the brain (the cochlear nucleus) responsible for processing sound signals carried to it from the ear through the vestibulocochlear nerve. This nucleus lies in the lower part of the brain, called the brain stem. Removal of vestibulocochlear nerve tumours and placement of auditory brain stem implants is often done at the same time. The surgeon makes an incision in the skin of the side of the head, and removes some of the bone behind the ear. This exposes the tumour so that it can be removed and also allows access to the

brain stem beneath it. Sometimes the surgeon approaches the brain stem through the back of the head. People with auditory brain stem implants wear an external receiver and speech processor. This device converts sounds into electrical signals, which are then sent to the implant. The MED-EL Auditory Brainstem Implant (ABI) is a solution for individuals with hearing loss due to a non-functioning auditory nerve (Neurofibromatosis Type 2). Bypassing both the inner ear and the auditory nerve, the MED-EL ABI stimulates the cochlear nucleus (CN) and provides users with a variety of hearing sensations to assist with sound awareness and communication. An ABI consists of two components, the external audio processor and the implant. The audio processor is either an OPUS 2 or OPUS 1. The implant consists of an electronics housing and an implantable soft silicone matrix with a 12 contact electrode array. The 5.5 3.0 mm matrix is the active interface between the stimulation electronics and the neural tissue. An additional reference electrode is used for advanced telemetry measurements providing added functional reliability and control. The soft silicone matrix with a 12 contact electrode array is surgically inserted directly onto the brainstem. The implant stimulates the cochlear nucleus, which enables the recipient to distinguish a variety of sounds. Following surgery and the postoperative healing period of 14 days, the user is required to undergo an intensive training period with a qualified audiologist to learn how to interpret sounds and understand speech. Generally, it is important to realise that speech understanding with an ABI is not on the same level as speech understanding for cochlear implant recipients. Extensive training is all the more crucial for this reason, allowing the recipient to gain the best benefit from an ABI and to make the most of this advanced technology.

CONCLUTION:
An auditory brainstem implant (ABI) is a surgically implanted electronic device that provides a sense of sound to a person who is profoundly deaf, due to sensorineural hearing impairment (due to illness or injury damaging the cochlea or auditory nerve, and so precluding the use of a cochlear implant).