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Barbara M, Margani V, Volpini L, Filippi C, Covelli E, Monini S, Elfarargy HH. On the battery life of a totally implantable active middle ear device: a retrospective study in a single implanting center. Acta Otolaryngol 2023; 143:6-11. [PMID: 36594700 DOI: 10.1080/00016489.2022.2161625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Totally-implantable active middle ear devices (AMED) rely on a non-rechargeable battery encased with the implantable sound processor that needs to be replaced with a minor surgical procedure after its depletion. OBJECTIVES This study aimed to investigate the most significant factors affecting the implant's battery life. MATERIALS AND METHODS The implanted subjects (29 patients) were divided into three groups; group A with 17 patients who underwent one battery change surgery; group B with ten patients who underwent two battery changes; and group C with two patients and three surgeries. The battery life was put in correlation with several variables, including daily use and the auditory threshold. RESULTS The battery life ranged from 26 to 67 months, with a mean of 48.93 ± 13.47. Pearson's correlation coefficient revealed that the battery life was statistically correlated only with the mean post-implantation bone conduction thresholds (p-value <.0001). CONCLUSIONS Although the non-rechargeable battery system of the AMED under study overcomes the drawbacks of daily charging, it needs to be surgically changed after its depletion. The different rates of battery life were shown to mainly depend on the post-implantation BC thresholds, which in some cases showed a deterioration concerning the pre-implanting values.
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Affiliation(s)
- Maurizio Barbara
- Department of Neuroscience, Mental Health, and Sensory Organs, Sant Andrea University Hospital, Sapienza University, Rome, Italy
| | - Valerio Margani
- Department of Neuroscience, Mental Health, and Sensory Organs, Sant Andrea University Hospital, Sapienza University, Rome, Italy
| | - Luigi Volpini
- Otorhinolaryngology Department, Liverpool University Hospitals NHS Foundation Trust, UK
| | - Chiara Filippi
- Department of Neuroscience, Mental Health, and Sensory Organs, Sant Andrea University Hospital, Sapienza University, Rome, Italy
| | - Edoardo Covelli
- Department of Neuroscience, Mental Health, and Sensory Organs, Sant Andrea University Hospital, Sapienza University, Rome, Italy
| | - Simonetta Monini
- Department of Neuroscience, Mental Health, and Sensory Organs, Sant Andrea University Hospital, Sapienza University, Rome, Italy
| | - Haitham H Elfarargy
- Otorhinolaryngology Department, Kafrelsheikh University, Kafrelsheikh, Egypt
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Craddock LC, Hodson J, Gosling A, Cooper S, Morse RP, Begg P, Prokopiou A, Irving RM. Comparison of an Implantable Middle Ear Microphone and Conventional External Microphone for Cochlear Implants: A Clinical Feasibility Study. Otol Neurotol 2022; 43:1162-1169. [PMID: 36240742 PMCID: PMC7613807 DOI: 10.1097/mao.0000000000003713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES All commercially available cochlear implant (CI) systems use an external microphone and sound processor; however, external equipment carries lifestyle limitations. Although totally implantable devices using subcutaneous microphones have been developed, these are compromised by problems with soft tissue sound attenuation, feedback, and intrusive body noise. This in vivo pilot study evaluates a middle ear microphone (MEM) that aims to overcome these issues and compares hearing performance with that of an external CI microphone. DESIGN Six adult participants with an existing CI were implanted with a temporary MEM in the contralateral ear. Signals from the MEM were routed via a percutaneous plug and cable to the CI sound processor. Testing was performed in the CI microphone and MEM conditions using a range of audiometric assessments, which were repeated across four visits. RESULTS Performance of the MEM did not differ significantly from that of the CI on the assessments of Auditory Speech Sounds Evaluation loudness scaling at either 250 or 1000 Hz, or in the accuracy of repeating keywords presented at 70 dB. However, the MEM had significantly poorer aided sound-field thresholds, particularly at higher frequencies (≥4000 Hz), and significantly poorer performance on Arthur Boothroyd words presented at 55 dB, compared with the CI. CONCLUSION In this pilot study, the MEM showed comparable performance to that of an external CI microphone across some audiometric assessments. However, performance with the MEM was poorer than the CI in soft-level speech (55 dB) and at higher frequencies. As such, the benefits of MEM need to be considered against the compromises in hearing performance. However, with future development, MEM is a potentially promising technology.
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Affiliation(s)
| | - James Hodson
- University Hospitals Birmingham NHS Foundation Trust, UK
- Health Data Science Team, Research Development and Innovation, Institute for Translational Medicine, University Hospitals Birmingham NHS Foundation Trust
| | - Amy Gosling
- University Hospitals Birmingham NHS Foundation Trust, UK
| | - Stacey Cooper
- University Hospitals Birmingham NHS Foundation Trust, UK
| | | | - Philip Begg
- University Hospitals Birmingham NHS Foundation Trust, UK
- University of Kentucky, USA
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Mallegni N, Molinari G, Ricci C, Lazzeri A, La Rosa D, Crivello A, Milazzo M. Sensing Devices for Detecting and Processing Acoustic Signals in Healthcare. BIOSENSORS 2022; 12:835. [PMID: 36290973 PMCID: PMC9599683 DOI: 10.3390/bios12100835] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/27/2022] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
Acoustic signals are important markers to monitor physiological and pathological conditions, e.g., heart and respiratory sounds. The employment of traditional devices, such as stethoscopes, has been progressively superseded by new miniaturized devices, usually identified as microelectromechanical systems (MEMS). These tools are able to better detect the vibrational content of acoustic signals in order to provide a more reliable description of their features (e.g., amplitude, frequency bandwidth). Starting from the description of the structure and working principles of MEMS, we provide a review of their emerging applications in the healthcare field, discussing the advantages and limitations of each framework. Finally, we deliver a discussion on the lessons learned from the literature, and the open questions and challenges in the field that the scientific community must address in the near future.
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Affiliation(s)
- Norma Mallegni
- Department of Civil and Industrial Engineering, University of Pisa, 56122 Pisa, Italy
| | - Giovanna Molinari
- Department of Civil and Industrial Engineering, University of Pisa, 56122 Pisa, Italy
| | - Claudio Ricci
- Department of Civil and Industrial Engineering, University of Pisa, 56122 Pisa, Italy
| | - Andrea Lazzeri
- Department of Civil and Industrial Engineering, University of Pisa, 56122 Pisa, Italy
| | - Davide La Rosa
- ISTI-CNR, Institute of Information Science and Technologies, 56124 Pisa, Italy
| | - Antonino Crivello
- ISTI-CNR, Institute of Information Science and Technologies, 56124 Pisa, Italy
| | - Mario Milazzo
- Department of Civil and Industrial Engineering, University of Pisa, 56122 Pisa, Italy
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Battery Lifespan of an Implantable Middle Ear Device. Audiol Res 2022; 12:485-492. [PMID: 36136856 PMCID: PMC9498673 DOI: 10.3390/audiolres12050049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/29/2022] Open
Abstract
Background: The Carina system (Cochlear Ltd., Sydney, Australia) is a totally implantable device providing acoustic amplification in adult patients with moderate-to-severe sensorineural or mixed hearing loss. One of the main concerns about such a totally implantable device has been represented by the subcutaneous battery lifespan. The aim of this article is to report the analysis of battery performances in a series of Carina-implanted patients after a long follow up. Methods: In this retrospective study, the technical data of a series of patients implanted with the Carina middle ear implant in our clinic have been analysed, extracting the data from the log of telemetric measures. Results: The mean lifespan cutback was 0.43 h/years (from 0 to 0.71 h/year), with a strong negative significant correlation between the follow-up period and the percentage of battery residual lifespan. Conclusion: The lifespan of the Carina’s battery seems consistent with the manufacturer statement of a pluri-decennial lifespan, avoiding the need of an early surgical substitution and providing a full day of use of the system even after up to 12 years from the implantation.
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Lailach S, Zahnert T. Results and Quality of Life after Implantation of Active Middle Ear Implants. Laryngorhinootologie 2022; 101:S3-S35. [PMID: 35605611 DOI: 10.1055/a-1647-8616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The provision of implantable hearing aids represents an area with high development and innovation potential. On the one hand, this review article provides an overview of current indication criteria for the treatment with active middle ear implants. On the other hand, outcome parameters as well as functional results after implantation of active middle ear implants are demonstrated and discussed. The focus is mainly placed on audiological results as well as the subjective health status. "Patient Reported Outcome Measures" (PROMs) have become an integral part of the evaluation of hearing implant treatment. Due to low evidence level criteria, the study situation regarding audiological as well as subjective outcome parameters is not satisfactory. The lack of an international consensus on accepted outcome parameters makes a meta-analytical analysis of results immensely difficult. In the studies published to date, patients with sensorineural hearing loss and patients with conductive or mixed hearing loss offered better speech recognition after implantation of an active middle ear implant compared to conventional hearing aids. Current analyses show a significant improvement in general as well as hearing-specific quality of life after implantation of an active middle ear implant. To date, no validated, hearing-specific quality-of-life measurement instruments exist for assessing the success of fitting in children. Especially in children with complex malformations of the outer ear and the middle ear, excellent audiological results were shown. However, these results need to be substantiated by quality-of-life measurements in future.
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Affiliation(s)
- Susen Lailach
- Universitätsklinikum Dresden Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie (Klinikdirektor: Prof. Dr.med. Dr. h.c. Thomas Zahnert) Dresden
| | - Thomas Zahnert
- Universitätsklinikum Dresden Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie (Klinikdirektor: Prof. Dr.med. Dr. h.c. Thomas Zahnert) Dresden
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D'hondt C, Verhaert N, Wouters J. Directional Response of a subcutaneous hearing implant microphone. Hear Res 2021; 421:108412. [PMID: 34969577 DOI: 10.1016/j.heares.2021.108412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 10/26/2021] [Accepted: 12/06/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Christiane D'hondt
- KU Leuven, University of Leuven, Department of Neurosciences, Research Group ExpORL, Onderwijs en Navorsing 2, Herestraat 49, bus 721, 3000, Leuven, Belgium; Cochlear Technology Centre Belgium, Schaliënhoevedreef 20i, 2800, Mechelen, Belgium.
| | - Nicolas Verhaert
- KU Leuven, University of Leuven, Department of Neurosciences, Research Group ExpORL, Onderwijs en Navorsing 2, Herestraat 49, bus 721, 3000, Leuven, Belgium; University Hospitals Leuven, Department of Otolaryngology, Head and Neck Surgery, Herestraat 49, 3000 Leuven, Belgium.
| | - Jan Wouters
- KU Leuven, University of Leuven, Department of Neurosciences, Research Group ExpORL, Onderwijs en Navorsing 2, Herestraat 49, bus 721, 3000, Leuven, Belgium.
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A Miniature, Fiber-Optic Vibrometer for Measuring Unintended Acoustic Output of Active Hearing Implants during Magnetic Resonance Imaging. SENSORS 2021; 21:s21196589. [PMID: 34640909 PMCID: PMC8512570 DOI: 10.3390/s21196589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/26/2021] [Accepted: 09/28/2021] [Indexed: 12/03/2022]
Abstract
Making use of magnetic resonance imaging (MRI) for diagnostics on patients with implanted medical devices requires caution due to mutual interactions between the device and the electromagnetic fields used by the scanner that can cause a number of adverse events. The presented study offers a novel test method to quantify the risk of unintended output of acoustically stimulating hearing implants. The design and operating principle of an all-optical, MRI safe vibrometer is outlined, followed by an experimental verification of a prototype. Results obtained in an MRI environment indicate that the system can detect peak displacements down to 8 pm for audible frequencies. Feasibility testing was performed with an active middle ear implant that was exposed to several pulse sequences in a 1.5 Tesla MRI environment. Magnetic field induced actuator vibrations, measured during scanning, turned out to be equivalent to estimated sound pressure levels between 25 and 85 dB SPL, depending on the signal frequency. These sound pressure levels are situated well below ambient sound pressure levels generated by the MRI scanning process. The presented case study therefore indicates a limited risk of audible unintended output for the examined hearing implant during MRI.
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Djinović Z, Pavelka R, Tomić M, Sprinzl G, Müller JG, Traxler H. Experimental study of an implantable fiber-optic microphone on human cadavers. Hear Res 2021; 410:108351. [PMID: 34551371 DOI: 10.1016/j.heares.2021.108351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 08/17/2021] [Accepted: 09/01/2021] [Indexed: 11/18/2022]
Abstract
In this paper, we present the results of an experimental study about a novel fiber optical vibrometer, aimed to be used as a totally implantable fiber-optic microphone for hearing aids. The sensor head, implanted inside the human cadaver middle ear, detects the amplitude of the incus vibrations, which are produced by an external acoustical source. The probe beam of coherent vertical cavity surface emitting laser (VCSEL) radiation is directed to the incus and the phase-modulated reflected beam is captured and demodulated. The problem of interferometric fading was solved using two quasi-quadrature signals, passively produced by the 3 × 3 single-mode fiber-optic coupler, processed by a special embedded algorithm. The implanted optoelectronic module works with very low-power consumption, performs real-time signal processing and outputs an analogue signal proportional to the incus vibration. The amplitude of the incus vibrations at different sound pressure levels (SPL) from 40 to 90 dB and at frequencies from 100 Hz to 10 kHz were measured by the implanted system. The system was evaluated on five cadaver skulls. The measured amplitudes were in the range of 1 pm to 5 nm, depending on the subjected skull and the applied sound pressure.
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Affiliation(s)
- Zoran Djinović
- ACMIT Gmbh, Viktor Kaplan Str. 2, Wiener Neustadt 2700, Austria.
| | - Robert Pavelka
- ENT specialist, Grünbeckgasse 15, Wiener Neustadt 2700, Austria
| | - Miloš Tomić
- Institute of Technical Sciences of SASA, Kneza Mihaila 35, Belgrade 11000, Serbia
| | - Georg Sprinzl
- University Hospital St. Pölten, Dunantplatz 1, St. Pölten 3100, Austria
| | - Julia Gertrud Müller
- Medical University of Vienna, Department of Anatomy, Centre for Anatomy and Cell Biology, Waehringerstrasse 13, Vienna 1090, Austria
| | - Hannes Traxler
- Medical University of Vienna, Department of Anatomy, Centre for Anatomy and Cell Biology, Waehringerstrasse 13, Vienna 1090, Austria
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Lailach S, Müller C, Lasurashvili N, Seidler H, Zahnert T. [Active hearing implants in chronic otitis media]. HNO 2021; 69:447-463. [PMID: 31712875 DOI: 10.1007/s00106-019-00775-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In patients with inadequate hearing improvement after tympanoplasty and failure of conventional hearing aid fitting, active hearing implants provide an alternative treatment option. Active middle ear implants function as a vibromechanical bypass of the stiffness and damping effect of a poorly oscillating tympanic membrane and the (reconstructed) ossicular chain. The selection of the hearing system depends on the maximum output levels of the hearing system and the anatomical conditions in mostly multiply operated ears. The development of variable coupling elements for active middle ear implants led to an extension of the indications to include not only purely sensorineural hearing loss but also mixed and conductive hearing loss in patients, as the transducer can now be coupled to the (mobile) stapes or the round window membrane. The article provides an overview of current clinical study results and recommendations on the indications for active hearing implants in patients with chronic otitis media.
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Affiliation(s)
- S Lailach
- Klinik und Poliklinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf-Hals-Chirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
| | - C Müller
- Klinik und Poliklinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf-Hals-Chirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - N Lasurashvili
- Klinik und Poliklinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf-Hals-Chirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - H Seidler
- Klinik und Poliklinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf-Hals-Chirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - T Zahnert
- Klinik und Poliklinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf-Hals-Chirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
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Fully Implantable Active Middle Ear Implants After Subtotal Petrosectomy With Fat Obliteration: Preliminary Clinical Results. Otol Neurotol 2021; 41:e912-e920. [PMID: 32658109 DOI: 10.1097/mao.0000000000002797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES In patients with chronic middle ear disease, especially after revision surgery for ventilation problems and mixed hearing loss, active middle ear implants may provide an alternative treatment option. The fully implantable active middle-ear implant (FI-AMEI) is designed for implantation in a ventilated mastoid with an intact posterior canal wall. Until now, there have been no reports on audiometric results after implantation of a FI-AMEI in a fat-obliterated cavity after subtotal petrosectomy (SPE). STUDY DESIGN Retrospective case review. SETTING Tertiary referral center. PATIENTS Twelve patients were included after numerous previous tympanoplasty surgeries for severe mixed hearing loss and FI-AMEI implantation. INTERVENTION In five patients, the FI-AMEI was implanted in a cavity, with fat obliteration, after SPE. Seven patients received FI-AMEI implantation after intact canal wall (ICW) surgery. MAIN OUTCOME MEASURE(S) Audiometric results (pure-tone audiometry, Freiburger monosyllables) are demonstrated for 12 patients after an observation period of 3 months. RESULTS The improvement in monosyllable score was 40 to 85% for the 12 patients. Free-field-aided thresholds showed high heterogeneity. CONCLUSION FI-AMEI implantation combined with SPE provides an alternative approach to hearing rehabilitation to non-FI-AMEI implantation. Studies with a high number of patients and long-term observation periods are necessary to statistically verify these results.
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Didczuneit-Sandhop B, Langer J. [Use of the Carina active middle ear implant in otosclerosis patients]. HNO 2021; 69:828-834. [PMID: 33415345 DOI: 10.1007/s00106-020-00984-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2020] [Indexed: 10/22/2022]
Abstract
Patients with otosclerosis can suffer from different grades of combined hearing loss. In addition to surgery (stapedectomy), conventional hearing aids can be used in the treatment of otosclerosis. In cases of severe conductive components in addition to sensorineural hearing loss, treatment with normal hearing aids can be difficult or impossible. In these patients, implantable hearing systems such as cochlear implants represent a possible alternative. The totally implantable Carina middle ear system can be used in patients with even high-grade sensorineural hearing loss. Based on two exemplary cases, the option of using the Carina system in otosclerosis patients and post-implantation results are reported.
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Affiliation(s)
- B Didczuneit-Sandhop
- Klinik für Hals-Nasen-Ohrenheilkunde, Gesichts- und Halschirurgie, Städtisches Klinikum Brandenburg GmbH, Brandenburg an der Havel, Deutschland
| | - J Langer
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, AMEOS Klinikum Halberstadt, Gleimstr. 5, Halberstadt, Deutschland.
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Banakis Hartl RM, Jenkins HA. Implantable Hearing Aids: Where are we in 2020? Laryngoscope Investig Otolaryngol 2020; 5:1184-1191. [PMID: 33364411 PMCID: PMC7752069 DOI: 10.1002/lio2.495] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/29/2020] [Accepted: 10/29/2020] [Indexed: 12/04/2022] Open
Abstract
Beginning in the late 20th century, implantable hearing aids were developed and used as an alternative for individuals who were unable to tolerate conventional hearing aids. Since that time, several devices have been developed, with four currently remaining on the international market (Med-el Vibrant Soundbridge, Envoy Esteem, Ototronix MAXUM, and Cochlear Carina). This review will briefly examine the history of middle ear implant development, describe current available devices, evaluate the benefits and limits of the technology, and consider the future directions of research in the field of implantable hearing aids.
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Affiliation(s)
| | - Herman A. Jenkins
- Department of OtolaryngologyUniversity of Colorado School of MedicineAuroraColoradoUSA
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In-situ sensitivity of a totally-implantable microphone. Hear Res 2020; 395:108018. [PMID: 32712510 DOI: 10.1016/j.heares.2020.108018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 05/16/2020] [Accepted: 06/05/2020] [Indexed: 11/22/2022]
Abstract
One of the key components of fully-implantable hearing devices is the implantable microphone. A crucial parameter when characterizing implantable microphones is the acoustic sensitivity, as it is one of the input parameters for the fitting algorithm and influences the achievable gain. The aim of our study was to investigate the sensitivity of an implanted subcutaneous microphone over time to answer two research questions: (1) How does the sensitivity change once the microphone is implanted under the skin (pre-op versus in-situ)? and (2) How does the sensitivity change from short-term to mid-term? We have measured the in-situ microphone sensitivity in three subjects implanted with a fully-implantable active middle ear implant from 2 weeks up to 20 weeks after implantation with a research software. The microphone sensitivity changed after implantation with clinically relevant changes around the resonance frequency of the microphone. Based on our results, it is essential to measure the in-situ microphone sensitivity at the time of initial fitting of the implant. Once implanted no clinically relevant changes in the microphone sensitivity were observed over time, with a clear decrease in variability over time.
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Cuda D, Murri A, Mainardi A, Forli F, Berrettini S, Bruschini L. Binaural hearing restoration with a bilateral fully implantable middle ear implant. Eur Arch Otorhinolaryngol 2020; 278:2239-2246. [PMID: 32833054 DOI: 10.1007/s00405-020-06290-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 08/11/2020] [Indexed: 10/23/2022]
Abstract
AIM The fully implantable middle ear implant (C-FI-MEI) is designed for patients with moderate-to-severe sensorineural hearing loss or those with mixed hearing loss. To analyze the audiological post-operative results of subjects bilaterally implanted with C-FI-MEI. MATERIALS AND METHODS Retrospective study: 14 patients with bilateral, moderate-to-severe, sensorineural or mixed hearing loss were treated. This clinical sample included 14 cases bilaterally implanted (13 sequentially, 1 simultaneously). The evaluation at each follow-up after surgery included otologic examination, a structured interview, and different audiological tests composed of pure tone audiometry, speech in quiet and in noise test, and localization task. The mean follow-up was 67.2 ± 33 months. RESULTS There were no significant differences between pre and post-operative pure tone averages. The patients showed no significant differences between pre-operatively aided and C-FI-MEI implant-aided conditions in terms of word recognition score. Speech perception in noise under different loudspeaker arrangements and localization tests demonstrated a binaural advantage in bilaterally implanted patients. The mean daily use time was 17.4 and 16.7 h, respectively, for right and left side. CONCLUSION The results for the 14 patients, bilaterally implanted with C-FI-MEI, suggest that bilateral implantation of fully implantable middle ear hearing devices is an effective procedure. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Domenico Cuda
- Department of Otorhinolaryngology, "Guglielmo da Saliceto" Hospital of Piacenza, Via Cantone del Cristo 40, 29121, Piacenza, Italy
| | - Alessandra Murri
- Department of Otorhinolaryngology, "Guglielmo da Saliceto" Hospital of Piacenza, Via Cantone del Cristo 40, 29121, Piacenza, Italy.
| | - Anna Mainardi
- Department of Otorhinolaryngology, "Guglielmo da Saliceto" Hospital of Piacenza, Via Cantone del Cristo 40, 29121, Piacenza, Italy
| | - Francesca Forli
- ENT Audiology and Phoniatric Unit, University Hospital of Pisa, Pisa, Italy
| | - Stefano Berrettini
- ENT Audiology and Phoniatric Unit, University Hospital of Pisa, Pisa, Italy
| | - Luca Bruschini
- ENT Audiology and Phoniatric Unit, University Hospital of Pisa, Pisa, Italy
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Cebulla M, Hagen R, Rak K, Geiger U. Intraoperative determination of coupling efficiency of Carina ® middle ear implant by means of auditory evoked potentials. Int J Audiol 2020; 59:962-967. [PMID: 32692265 DOI: 10.1080/14992027.2020.1781941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The Carina® implant system is a fully implantable active middle ear implant, which can be coupled to various structures in the middle ear, depending on the nature of the hearing loss and the middle ear anatomy. Currently, there is only one method for determining the coupling efficiency of the actuator of this implant system, and this is limited to incus coupling. DESIGN The proposed method is based on the intraoperative recording and evaluation of auditory brainstem responses (ABRs) while directly stimulating the hearing system via the actuator. The acoustic stimulation was achieved using an optimised broadband chirp stimulus (CE-Chirp®). STUDY SAMPLES This study included 10 subjects having moderate to severe sensorineural or mixed hearing loss. RESULTS The intraoperative ABR measurements show, that it is possible to derive reliable AEP thresholds via the actuator of the implant. The ABR thresholds correlate well with preoperative BC PTA4 thresholds (r = 0.87) while the postoperative OC-direct thresholds (in situ audiogram via the implant) correlate with r = 0.77. CONCLUSION The results demonstrated that the direct actuator stimulation allow for reliable intraoperative ABR measurements and that the proposed method can be used to estimate the coupling efficiency of the actuator and facilitate its positioning.
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Affiliation(s)
- Mario Cebulla
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital Würzburg, Wurzburg, Germany
| | - Rudolf Hagen
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital Würzburg, Wurzburg, Germany
| | - Kristen Rak
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital Würzburg, Wurzburg, Germany
| | - Ute Geiger
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital Würzburg, Wurzburg, Germany
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A Transcutaneous Active Middle Ear Implant (AMEI) in Children and Adolescents: Long-term, Multicenter Results. Otol Neurotol 2020; 40:1059-1067. [PMID: 31356489 DOI: 10.1097/mao.0000000000002340] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Evaluation of the long-term safety and performance of an active middle ear implant (AMEI) in the treatment of hearing loss in children and adolescents with a primary focus on improvement in speech discrimination. STUDY DESIGN Prospective, multicentric, single-subject repeated-measures design in which each subject serves as his or her own control. SUBJECTS Thirty-one pediatric subjects aged 5 to 17 years. INTERVENTION Implantation of an active middle ear implant. METHODS Improvement in word recognition scores, speech reception thresholds (SRT) in quiet and noise, in addition to air conduction, bone conduction, and sound field thresholds were evaluated in two age groups. RESULTS Residual hearing did not change over time and speech intelligibility significantly improved and remained stable after 36 months. Children aged 5 to 9 improved in WRS from 21.92 to 95.38% and in SRT in quiet and in noise respectively from 62.45 dB SPL (sound pressure level) and +1.14 dB SNR to 42.07 dB SPL and -4.45 dB SNR. Adolescents aged 10 to 17 improved in WRS from 12.78 to 84.71% and in SRT in quiet and in noise respectively from 63.96 dB SPL and +3.32 dB SNR to 35.31 dB SPL and -4.55 dB SNR. CONCLUSIONS The AMEI, under investigation, is a safe treatment for children and adolescents, and significantly improved audiological performance that remains stable on the long-term scale (up to 36 mo postimplantation). In general, all adult-related issues and questions regarding safety and performance can also be applied to the pediatric population, as no apparent specific issues developed.
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Lau K, Scotta G, Barauna I, da Silva VC, Peixoto MC, Ray J. Surgical and audiological outcomes of a fully implantable middle ear implant: early results from a retrospective multicentre study. Eur Arch Otorhinolaryngol 2020; 277:2721-2727. [PMID: 32372259 DOI: 10.1007/s00405-020-05986-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 04/15/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE This paper reports the surgical and audiological outcomes of a large series of patients who received a fully implantable middle ear implant (MEI): carina (Cochlear, Australia). METHODS This is a multicentre retrospective study involving three tertiary referral centres. Patient data were collected for the first 42 consecutive patients who were fitted with the MEI between 2014 and 2019 (Sheffield from February 2017 to January 2019; São Paulo from April 2015 to September 2017; Porto from December 2014 to May 2017). The main outcome measures included surgical results, free field speech testing with speech recognition thresholds (SRT) and audiological gain. RESULTS There was one major complication due to infection resulting in a brain abscess and explantation of the device. Three other patients had minor skin infections; no other complications were reported. Results show a functional gain of 19.5 dB (p < 0.05) with the MEI versus unaided condition. SRT improved from 57.4 dB to 44.6 dB with the MEI (p < 0.05). CONCLUSIONS This fully implanable active MEI offers a reliable option for patients with moderate-to-severe sensorineural or mixed hearing losses especially for those do not tolerate or cannot use conventional hearing aids. It provides significant improvement in hearing as shown in the audiological outcomes. The surgery is relatively straightforward but there is a steep learning curve. The devices are well tolerated by all patients.
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Affiliation(s)
- Kimberley Lau
- Department of Otolaryngology, Sheffield Teaching Hospitals, Sheffield, UK. .,ENT Department, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, UK.
| | - Gianluca Scotta
- Department of Otolaryngology, Sheffield Teaching Hospitals, Sheffield, UK.,ENT Department, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, UK
| | | | - Victor Correia da Silva
- Auditory Implant Unit, Department of Otorhinolaryngology, Hospital CUF Porto, Porto, Portugal
| | - Maria Conceição Peixoto
- Auditory Implant Unit, Department of Otorhinolaryngology, Hospital CUF Porto, Porto, Portugal
| | - Jaydip Ray
- Department of Otolaryngology, Sheffield Teaching Hospitals, Sheffield, UK.,ENT Department, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, UK
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Fierens G, Verhaert N, Benoudiba F, Bellin MF, Ducreux D, Papon JF, Nevoux J. Stability of the standard incus coupling of the Carina middle ear actuator after 1.5T MRI. PLoS One 2020; 15:e0231213. [PMID: 32271819 PMCID: PMC7144975 DOI: 10.1371/journal.pone.0231213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 03/18/2020] [Indexed: 11/18/2022] Open
Abstract
Limited data is available concerning the safety of active middle ear implants (AMEI) during Magnetic Resonance Imaging (MRI). Measurements in temporal bones are the gold standard for preclinical assessment of device safety. In this study the coupling stability of an actuator as used in a fully implantable AMEI was determined in temporal bones. Eleven temporal bones were implanted with the actuator according to the manufacturer’s surgical guidelines. The actuator was coupled on the incus short process as recommended for sensorineural hearing loss. Temporal bones were exposed 10 times to the MRI magnetic field by entering the MRI suite in a clinically relevant way. Computed Tomography (CT) images were acquired before and after the experiment to investigate the risk of actuator dislocation. Based on the electrical impedance of the actuator, the loading of the actuator to the incus was confirmed. Relative actuator displacement was determined on the CT images by comparing the initial with the final actuator position in 3D space. Impedance curves were analyzed after each exposure to check the loading of the actuator to the ossicles. Analysis of CT images with a 0.30.6 mm in-plane resolution indicate no actuator displacement. The maximum detected change in impedance for all actuators was 8.43 Ω at the actuator’s resonance frequency. Impedance curves measured when the actuator was retracted from the short process after the experiment still indicate the presence of a clear resonance peak. No actuator displacement or dislocation could be detected in the analysis of CT images and the measured impedance curves. Impedance curves obtained when the actuator was retracted from the incus short process still show a clear resonance peak, indicating the device is still functional after the MRI exposures.
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Affiliation(s)
- Guy Fierens
- ExpORL Research group, Department of Neurosciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Nicolas Verhaert
- ExpORL Research group, Department of Neurosciences, KU Leuven - University of Leuven, Leuven, Belgium.,Department of Otolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Farida Benoudiba
- AP-HP, Hôpital Bicêtre, Service de Neuroradiologie, Le Kremlin-Bicêtre, France
| | - Marie-France Bellin
- Université Paris-Saclay, Faculté de Médecine Université Paris-Sud, Le Kremlin-Bicêtre, France.,AP-HP, Hôpital Bicêtre, Service de Radiologie Générale, Le Kremlin-Bicêtre, France
| | - Dennis Ducreux
- AP-HP, Hôpital Bicêtre, Service de Neuroradiologie, Le Kremlin-Bicêtre, France.,Université Paris-Saclay, Faculté de Médecine Université Paris-Sud, Le Kremlin-Bicêtre, France
| | - Jean-François Papon
- Université Paris-Saclay, Faculté de Médecine Université Paris-Sud, Le Kremlin-Bicêtre, France.,AP-HP, Hôpital Bicêtre, Service d'Oto-Rhino-Laryngologie, Le Kremlin-Bicêtre, France
| | - Jérôme Nevoux
- Université Paris-Saclay, Faculté de Médecine Université Paris-Sud, Le Kremlin-Bicêtre, France.,AP-HP, Hôpital Bicêtre, Service d'Oto-Rhino-Laryngologie, Le Kremlin-Bicêtre, France
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Abstract
The Envoy Esteem and the Carina system are the 2 totally implantable hearing devices. The Esteem is designed for patients with bilateral moderate to severe sensorineural hearing loss who have an unaided speech discrimination score of greater than and equal to 40%. The Carina system is designed for patients with moderate to severe sensorineural hearing loss or those with mixed hearing loss. The Esteem offers a technologically advanced method to provide improvements in hearing and is available in the United States, whereas the Carina system is currently not available in the United States.
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Abstract
OBJECTIVES Active middle ear implants (AMEI) have been used to treat hearing loss in patients for whom conventional hearing aids are unsuccessful for varied biologic or personal reasons. Several studies have discussed feedback as a potential complication of AMEI usage, though the feedback pathway is not well understood. While reverse propagation of an acoustic signal through the ossicular chain and tympanic membrane constitutes an air-conducted source of feedback, the implanted nature of the device microphone near the mastoid cortex suggests that bone conduction pathways may potentially be another significant factor. This study examines the relative contributions of potential sources of feedback during stimulation with an AMEI. DESIGN Four fresh-frozen, hemi-sectioned, human cadaver specimens were prepared with a mastoid antrostomy and atticotomy to visualize the posterior incus body. A Carina active middle ear implant actuator (Cochlear Ltd., Boulder, CO) was coupled to the incus by two means: (1) a stereotactic arm mounted independently of the specimen and (2) a fixation bracket anchored directly to the mastoid cortical bone. The actuator was driven with pure-tone frequencies in 1/4 octave steps from 500 to 6000 Hz. Acoustic sound intensity in the ear canal was measured with a probe tube microphone (Bruel & Kjær, Nærum, Denmark). Bone-conducted vibration was quantified with a single-axis laser Doppler vibrometer (Polytec Inc., Irvine, CA) from both a piece of reflective tape placed on the skin overlying the mastoid and a bone-anchored titanium screw and pedestal (Cochlear Ltd., Centennial, CO) implanted in the cortical mastoid bone. RESULTS Microphone measurements revealed ear-canal pressures of 60-89 dB SPL, peaking in the frequency range below 2 kHz. Peak LDV measurements were greatest on the mastoid bone (0.32-0.79 mm/s with mounting bracket and 0.21-0.36 mm/s with the stereotactic suspension); peak measurements on the skin ranged from 0.05 to 0.15 mm/s with the bracket and 0.03 to 0.13 mm/s with stereotactic suspension. CONCLUSION AMEI produce both air- and bone-conducted signals of adequate strength to be detected by the implanted device microphone, potentially resulting in reamplification. Understanding the relative contribution of these sources may play an important role in the development of targeted mitigation algorithms, as well as surgical techniques emphasizing acoustic isolation.
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Prochazka A. Neurophysiology and neural engineering: a review. J Neurophysiol 2017; 118:1292-1309. [PMID: 28566462 PMCID: PMC5558026 DOI: 10.1152/jn.00149.2017] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 05/30/2017] [Accepted: 05/30/2017] [Indexed: 12/19/2022] Open
Abstract
Neurophysiology is the branch of physiology concerned with understanding the function of neural systems. Neural engineering (also known as neuroengineering) is a discipline within biomedical engineering that uses engineering techniques to understand, repair, replace, enhance, or otherwise exploit the properties and functions of neural systems. In most cases neural engineering involves the development of an interface between electronic devices and living neural tissue. This review describes the origins of neural engineering, the explosive development of methods and devices commencing in the late 1950s, and the present-day devices that have resulted. The barriers to interfacing electronic devices with living neural tissues are many and varied, and consequently there have been numerous stops and starts along the way. Representative examples are discussed. None of this could have happened without a basic understanding of the relevant neurophysiology. I also consider examples of how neural engineering is repaying the debt to basic neurophysiology with new knowledge and insight.
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Affiliation(s)
- Arthur Prochazka
- Department of Physiology, University of Alberta, Edmonton, Alberta, Canada
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Lefebvre PP, Gisbert J, Cuda D, Tringali S, Deveze A. A Retrospective Multicentre Cohort Review of Patient Characteristics and Surgical Aspects versus the Long-Term Outcomes for Recipients of a Fully Implantable Active Middle Ear Implant. Audiol Neurootol 2017; 21:333-345. [PMID: 28052264 PMCID: PMC5348730 DOI: 10.1159/000454666] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 11/22/2016] [Accepted: 11/22/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To summarise treatment outcomes compared to surgical and patient variables for a multicentre recipient cohort using a fully implantable active middle ear implant for hearing impairment. To describe the authors' preferred surgical technique to determine microphone placement. STUDY DESIGN Multicentre retrospective, observational survey. SETTING Five tertiary referral centres. PATIENTS Carina recipients (66 ears, 62 subjects) using the current Cochlear® Carina® System or the legacy device, the Otologics® Fully Implantable Middle Ear, with a T2 transducer. METHODS Patient file review and routine clinical review. Patient outcomes assessed were satisfaction, daily use and feedback reports at the first fitting and ≥12 months after implantation. Descriptive and statistical analysis of correlations of variables and their influence on outcomes was performed. Independently reported preferred methods for microphone placement are collectively summarised. RESULTS The average implant experience was 3.5 years. Satisfaction increased significantly over time (p < 0.05). No correlation with covariates examined was observed. Feedback significantly decreased over time, showing a significant correlation with microphone location, primary motivation, gender, age at implantation, and contralateral hearing aid use (p < 0.05). Patient satisfaction was inversely correlated with reports of system feedback (p < 0.05). The implantable microphone was most commonly on the posterior inferior mastoid line, in 42/66 (65%) cases, correlating with less likelihood for feedback and consistent with author surgical preference. CONCLUSION Carina recipients in this study present as satisfied consistent daily users with very few reports of persistent feedback. As microphone location is an influencing factor, a careful surgical consideration of microphone placement is required. The authors prefer a posterior inferior mastoid line position whenever possible.
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Affiliation(s)
| | | | - Domenico Cuda
- Otorhinolaryngology Unit, “Guglielmo de Saliceto” Hospital, Piacenza, Italy
| | - Stéphane Tringali
- Otorhinolaryngology Unit, “Guglielmo de Saliceto” Hospital, Piacenza, Italy
- Department of Otolaryngology-Head and Neck Surgery, Hospices Civils de Lyon, Lyon-Sud Hospital, Pierre-Bénite, Marseille, France
| | - Arnaud Deveze
- Department of Otolaryngology and Skull Base Surgery, Ramsay-Générale de Santé, Hospital Clairval, Marseille, France
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