Design, Fabrication, and Evaluation of a Parylene Thin-Film Electrode Array for Cochlear Implants

On the Design, Fabrication, and Characterization of a Novel Thin-Film Electrode Array for Use in Cochlear Implants

Thin-film electrode arrays (TFEAs) have been developed as an alternative to conventional electrode arrays (CEAs) used in cochlear implants. However, TFEAs produced by microfabrication techniques have not yet been used clinically because their structural and mechanical properties are far from those of CEAs. The aim of this study is to design, fabricate, and investigate the mechanical and tribological behavior and evaluate the performance of different TFEA designs. Finite Element Analysis (FEA) is performed to determine the elastic properties of several designs. A custom-build experimental setup is designed to observe the tribological behavior in different speeds and environments where frictional (lateral) and vertical force (normal force) are measured on a flat surface and within artificial cochlea. According to the FEA results, the maximum stiffness of the CEA is 37.93 mN/mm and 0.363 mN/mm and TFEA-4 has a maximum stiffness of 39.08 mN/mm and 0.306 mN/mm in the longitudinal and transverse axes, respectively. It is shown experimentally that adding a dummy wire to the carrier of the EA enhances both its longitudinal and transverse stiffness, thereby postponing the initiation of dynamic sliding due to the elevated buckling limit. It is also revealed that the type of TFEA support structure affects both normal and frictional forces, as well as the coefficient of friction.

How the Past Shapes the Future and What to Do About It: A Discussion at CI 2021 Virtual With Panelists: Teresa Caraway, Ph.D., C.C.C.-S.L.P.; Cliff Megerian, M.D.; Debara Tucci, M.D., M.S., M.B.A.; Peter Thomas, J.D.; Jason Wigand, Au.D

ABSTRACT

This report summarizes the highlights of a lively discussion between leaders in the cochlear implant (CI) field who also bring significant leadership experience at the practice and health system levels, as well as policy and research perspectives. The discussion revealed several areas in which established patterns of practice should be reconsidered to facilitate wider acceptance of the CI as part of an integrated continuum of hearing healthcare. The importance of continued innovation to advance outcomes, lower cost, and increase access was emphasized. Trends in healthcare funding, which increasingly reward quality at lower cost, will also challenge longstanding assumptions that have influenced program design. Proactive efforts that pursue consistent value in the episode of surgical care while establishing innovative delivery models for audiological and rehabilitation services are the best hope for a future of equitable access and expanding impact.

Parylene C as an Insulating Polymer for Implantable Neural Interfaces: Acute Electrochemical Impedance Behaviors in Saline and Pig Brain In Vitro

Parylene is used as encapsulating material for medical devices due to its excellent biocompatibility and insulativity. Its performance as the insulating polymer of implantable neural interfaces has been studied in electrolyte solutions and in vivo. Biological tissue in vitro, as a potential environment for characterization and application, is convenient to access in the fabrication lab of polymer and neural electrodes, but there has been little study investigating the behaviors of Parylene in the tissue in vitro. Here, we investigated the electrochemical impedance behaviors of Parylene C polymer coating both in normal saline and in a chilled pig brain in vitro by performing electrochemical impedance spectroscopy (EIS) measurements of platinum (Pt) wire neural electrodes. The electrochemical impedance at the representative frequencies is discussed, which helps to construct the equivalent circuit model. Statistical analysis of fitted parameters of the equivalent circuit model showed good reliability of Parylene C as an insulating polymer in both electrolyte models. The electrochemical impedance measured in pig brain in vitro shows marked differences from that of saline.

Magnetic stimulation allows focal activation of the mouse cochlea

Cochlear implants (CIs) provide sound and speech sensations for patients with severe to profound hearing loss by electrically stimulating the auditory nerve. While most CI users achieve some degree of open set word recognition under quiet conditions, hearing that utilizes complex neural coding (e.g., appreciating music) has proved elusive, probably because of the inability of CIs to create narrow regions of spectral activation. Several novel approaches have recently shown promise for improving spatial selectivity, but substantial design differences from conventional CIs will necessitate much additional safety and efficacy testing before clinical viability is established. Outside the cochlea, magnetic stimulation from small coils (micro-coils) has been shown to confine activation more narrowly than that from conventional microelectrodes, raising the possibility that coil-based stimulation of the cochlea could improve the spectral resolution of CIs. To explore this, we delivered magnetic stimulation from micro-coils to multiple locations of the cochlea and measured the spread of activation utilizing a multielectrode array inserted into the inferior colliculus; responses to magnetic stimulation were compared to analogous experiments with conventional microelectrodes as well as to responses when presenting auditory monotones. Encouragingly, the extent of activation with micro-coils was ~60% narrower compared to electric stimulation and largely similar to the spread arising from acoustic stimulation. The dynamic range of coils was more than three times larger than that of electrodes, further supporting a smaller spread of activation. While much additional testing is required, these results support the notion that magnetic micro-coil CIs can produce a larger number of independent spectral channels and may therefore improve auditory outcomes. Further, because coil-based devices are structurally similar to existing CIs, fewer impediments to clinical translational are likely to arise.

Achieving long-term stability of thin-film electrodes for neurostimulation

Implantable electrodes that can reliably measure brain activity and deliver an electrical stimulus to a target tissue are increasingly employed to treat various neurological diseases and neuropsychiatric disorders. Flexible thin-film electrodes have gained attention over the past few years to minimise invasiveness and damage upon implantation. Research has previously focused on optimising the electrode's electrical and mechanical properties; however, their chronic stability must be validated to translate electrodes from a research to a clinical application. Neurostimulation electrodes, which actively inject charge, have yet to reliably demonstrate continuous functionality for ten years or more in vivo, the accepted metric for clinical viability. Long-term stability can only be achieved if the focus switches to investigating how and why such devices fail. Unfortunately, there is a field-wide reluctance to investigate device stability and failures, which hinders device optimisation. This review surveys thin-film electrode designs with a focus on adhesion between electrode layers and the interactions with the surrounding environment. A comprehensive summary of the abiotic failure modes faced by such electrodes is presented, and to encourage investigation, systematic methods for analysing their origin are recommended. Finally, approaches to reducing the likelihood of device failure are offered. STATEMENT OF SIGNIFICANCE: Neural electrodes that can deliver an electrical stimulus to a target tissue are widely used to treat various neurological diseases. Essential to the function of these electrodes is the ability to safely stimulate the target tissue for extended periods (> 10 years); however, this has not yet been clinically achieved. The key to achieving long-term stability is an increased understanding of electrode interactions with the surrounding tissue and subsequent systematic analysis of their failure modes. This review highlights the need for a change in the approach to investigating electrode failure, and in doing so summarizes the common ways in which neural electrodes fail, methods for identifying them and approaches to preventing them.

Robotics, automation, active electrode arrays, and new devices for cochlear implantation: A contemporary review

In the last two decades, cochlear implant surgery has evolved into a minimally invasive, hearing preservation surgical technique. The devices used during surgery have benefited from technological advances that have allowed modification and possible improvement of the surgical technique. Robotics has recently gained popularity in otology as an effective tool to overcome the surgeon's limitations such as tremor, drift and accurate force control feedback in laboratory testing. Cochlear implantation benefits from robotic assistance in several steps during the surgical procedure: (i) during the approach to the middle ear by automated mastoidectomy and posterior tympanotomy or through a tunnel from the postauricular skin to the middle ear (i.e. direct cochlear access); (ii) a minimally invasive cochleostomy by a robot-assisted drilling tool; (iii) alignment of the correct insertion axis on the basal cochlear turn; (iv) insertion of the electrode array with a motorized insertion tool. In recent years, the development of bone-attached parallel robots and image-guided surgical robotic systems has allowed the first successful cochlear implantation procedures in patients via a single hole drilled tunnel. Several other robotic systems, new materials, sensing technologies applied to the electrodes, and smart devices have been developed, tested in experimental models and finally some have been used in patients with the aim of reducing trauma in cochleostomy, and permitting slow and more accurate insertion of the electrodes. Despite the promising results in laboratory tests in terms of minimal invasiveness, reduced trauma and better hearing preservation, so far, no clinical benefits on residual hearing preservation or better speech performance have been demonstrated. Before these devices can become the standard approach for cochlear implantation, several points still need to be addressed, primarily cost and duration of the procedure. One can hope that improvement in the cost/benefit ratio will expand the technology to every cochlear implantation procedure. Laboratory research and clinical studies on patients should continue with the aim of making intracochlear implant insertion an atraumatic and reversible gesture for total preservation of the inner ear structure and physiology.

Effects of different electrodes used in bone-guided extracochlear implants on electrical stimulation of auditory nerves in guinea pigs

Objective:

Conventional cochlear implants provide patients who are deaf with hearing via electrical intracochlear stimulations. Stimulation electrodes are inserted into the cochlea through a cochleostomy or round window membrane (RWM) approach. However, these methods might induce cochlear ossificans and loss of residual hearing by damaging inner ear structures. To avoid an invasive electrode insertion, we developed a novel bone-guided extracochlear implant that stimulated the auditory nerves between the cochlear bones and the RWM to prevent cochlea damage. Power consumption plays an important role in wireless implantable electronic devices. Therefore, we aimed to investigate the effects of different electrodes on the stimulating threshold currents of the auditory nerve and the power consumption of bone-guided extracochlear implants using a commercial stimulator.

Materials and Methods:

Inert aurum (Au) electrodes were compared with biocompatible platinum (Pt) and iridium oxide (IrO_x) electrodes in practical implantable applications. IrO_x electrodes were used for their high-charge storage capacity, low impedance, and biocompatibility. The electrodes were fabricated via sputtering and were experimentally characterized with cyclic voltammetry and then examined using in vivo tests.

Results:

Based on electrical auditory brainstem responses, IrO_x electrodes yielded lower acoustic nerve-stimulating threshold currents (132 μA) compared with Au electrodes (204 μA). IrO_x electrodes also had a lower acoustic nerve stimulating threshold current (132 μA) compared with Pt electrodes (168 μA).

Conclusion:

As expected, IrO_x electrodes were beneficial in the development of multielectrode bone-guided extracochlear implants, with the lowest acoustic nerve-stimulating threshold and current consumptions compared with Au and Pt electrodes.

A New Approach for Noise Suppression in Cochlear Implants: A Single-Channel Noise Reduction Algorithm

The cochlea “translates” the in-air vibrational acoustic “language” into the spikes of neural “language” that are then transmitted to the brain for auditory understanding and/or perception. During this intracochlear “translation” process, high resolution in time–frequency–intensity domains guarantees the high quality of the input neural information for the brain, which is vital for our outstanding hearing abilities. However, cochlear implants (CIs) have coarse artificial coding and interfaces, and CI users experience more challenges in common acoustic environments than their normal-hearing (NH) peers. Noise from sound sources that a listener has no interest in may be neglected by NH listeners, but they may distract a CI user. We discuss the CI noise-suppression techniques and introduce noise management for a new implant system. The monaural signal-to-noise ratio estimation-based noise suppression algorithm “eVoice,” which is incorporated in the processors of Nurotron^® Enduro^TM, was evaluated in two speech perception experiments. The results show that speech intelligibility in stationary speech-shaped noise can be significantly improved with eVoice. Similar results have been observed in other CI devices with single-channel noise reduction techniques. Specifically, the mean speech reception threshold decrease in the present study was 2.2 dB. The Nurotron society already has more than 10,000 users, and eVoice is a start for noise management in the new system. Future steps on non-stationary-noise suppression, spatial-source separation, bilateral hearing, microphone configuration, and environment specification are warranted. The existing evidence, including our research, suggests that noise-suppression techniques should be applied in CI systems. The artificial hearing of CI listeners requires more advanced signal processing techniques to reduce brain effort and increase intelligibility in noisy settings.

A 3D Microscaffold Cochlear Electrode Array for Steroid Elution

In cochlear implants, the electrode insertion trauma during surgery can cause damage residual hearing. Preserving the residual hearing is an important challenge and the localized administration of drugs, such as steroids, is one of the most promising ways, but remains a challenge. Here, a microscaffold cochlear electrode array (MiSCEA) consisting of a microfabricated flexible electrode array and a 3D microscaffold for steroid reservoir is reported. The MiSCEA without loaded drug is tested by measuring the electrically evoked auditory brainstem response of the cochlea in guinea pigs (n = 4). The scaffold is then coated with steroid (dexamethasone) encapsulated in polylactic-co-glycolic acid and the continuous release of the steroid into artificial perilymph during six weeks is monitored. The steroid-containing scaffolds are then implanted into guinea pigs (n = 4) and threshold shifts are analyzed for four weeks by measuring the acoustically evoked auditory brainstem response. The threshold shifts tend to be lower in the group implanted with the steroid-containing MiSCEAs. The feasibility of 3D MiSCEA opens up the development of potential next-generation cochlear electrode with improved steroid release dynamics into cochlea.

Development and Clinical Introduction of the Nurotron Cochlear Implant Electrode Array

As the only medical device used in the treatment for deafness, the cochlear implant has benefited to more than half a million individuals worldwide. However, the device has limited penetration due to its high cost, especially in low- and middle-income countries. China alone has 27.8 million deaf people, but less than 100,000 of them have received a cochlear implant. The Nurotron Venus device was developed to address the need for an affordable yet safe and effective cochlear implant. The present study describes the design, development, and evaluation of the Nurotron intracochlear electrode array. The standard array is 22 mm in length from the round window marker to the apical tip of the carrier and has 24 electrodes, with a surface area of 0.32 mm2 and center-to-center spacing of 0.85 mm. The Nurotron array has been tested to meet the mechanical, chemical, and electrical requirements specified by the ISO Standard 14708-07. Human temporal bone and clinical trial results showed that the Nurotron array is easy to insert (7.8/10 rating with 10 indicating the highest ease of use) and has a low complication rate (12.5%) of severe insertion trauma while achieving high device stability and reliability (6 array failures in 43,000 patient years of experience). As a critical component, the Nurotron array has contributed to the high level of Nurotron implant speech performance, equivalent to that produced by other existing devices. The Nurotron device has benefited 10,000 deaf people and helped reduce the unit cost from US$25,000 in 2011 to US$4,620 in 2017 through the Chinese Government Tender Program. New, slim, and micromachined electrodes are being developed to further improve performance and accessibility.