Lecture 11

Hearing and Visual

Prosthetics

Dr. D. Saravanakumar,
Assistant Professor, SMBS,
VIT - Chennai Campus.
Email: [email protected]

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 Hearing Aids

• Conventional hearing aids

• Bone anchored hearing aids (BAHA)

• Implantable hearing aids (vibrant sound bridge)

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 Conventional hearing aids
• A hearing aid is a device to amplify sounds reaching the ear.

• Consists of 3 parts :

a) Microphone: picks up sound & converts them to electrical impulses.

b) Amplifier: magnifies electrical
impulses.
c) Receiver: converts electrical
impulses back to sound.
This amplified sound is then carried through
the earmould to the tympanic membrane.

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 Conventional hearing aids

Types of Hearing Aids

1) Air conduction hearing aid- the amplified sound is

transmitted via the ear canal to the tympanic membrane.
Most of the aids are air conduction type.
They can be of 5 types.

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 Conventional hearing aids

• Body-worn types: most common; microphone and amplifier

along with the battery are in one case worn at the chest
level while receiver is situated at the ear level.
allows high degree of amplification.
useful in severely deaf persons or children with congenital
deafness.

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 Conventional hearing aids

• Behind-the-ear (BTE) types: microphone, amplifier receiver

and battery are all in one unit which is worn behind the ear.
It is coupled to the ear canal with a tubing and an earmould.
useful for slight to moderate cases of hearing loss.

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 Conventional hearing aids

• Spectacles types: it is a modification of “behind-the-ear”

type & the unit is housed in the auricular part of the
spectacle frame.
useful to persons who need both eye glasses for vision and
a hearing aid.

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 Conventional hearing aids

• In-the-ear (ITE) types: The entire hearing aid is housed in an

earmould which can be worn in the ear.
useful in mild to moderate hearing loss.
very popular because of their cosmetic appeal.

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 Conventional hearing aids

• Canal types (ITC & CIC): The hearing aid is so small that the
entire aid can be worn in the ear canal without projecting
into the concha.

For using this aid, it is required that the ear canal should be
large and wide and the patient should have dexterity to
manipulate the minute controls in the aid.
useful in mild to moderate hearing loss.

2 types available- in the canal (ITC) &still smaller and

invisible type, completely in the canal (CIC).

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 Conventional hearing aids

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 Bone conduction hearing aid

2) Bone conduction hearing aid-

instead of a receiver, it has a bone vibrator which snugly
fits on the mastoid & directly stimulates the cochlea.
useful in persons with actively draining ears, otitis externa
or atresia of the ear canal when ear-inserts cannot be
worn.

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 Bone conduction hearing aid

Indications for Hearing Aid

Any individual who has a hearing problem that

cannot be helped by medical or surgical means is a
candidate of hearing aid.

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 Bone conduction hearing aid

Fitting a Hearing Aid

Consideration is given to :

Degree of hearing loss

Configuration of hearing loss (type of frequencies affected)
Type of hearing loss (conductive or sensorineural)
Presence of recruitment
Uncomfortable loudness level

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 Bone conduction hearing aid

Age & dexterity of patient

Condition of the outer and middle ear
Cosmetic acceptance of the aid
Type of earmould
The type of fitting; whether it is monoaural (one aid only),
binaural (one aid for each ear), binaural with y-connection
(one aid but two receivers, one for each ear) or the CROS
type.

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 Bone conduction hearing aid

CROS (contralateral routing of signals) – microphone is

fitted on the side of the deaf ear and the sound thus picked
up is passed to the receiver placed in the better ear.
This is useful for persons with one ear severely impaired &
helps in sound localisation coming from the side of the deaf
ear.
Now bone-anchored hearing aids (BAHA) are being
preferred for single-sided deafness & have replaced the use
of CROS aids.

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 Bone-anchored Hearing Aids (BAHA)

• Based on the principle of bone conduction.

• Has 3 components:
1) Titanium fixture
2) Titanium abutment
3) Sound processor
The titanium fixture is surgically embedded in the skull
bone with abutment exposed outside the skin.
The titanium fixture bonds with the surrounding tissue in a
process called osseointegration.
The sound processor is attached to the abutment once
osseointegration is complete which usually takes 2 to 6
months after implantation.

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 Bone-anchored Hearing Aids (BAHA)

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 Bone-anchored Hearing Aids (BAHA)

Indications for BAHA

when air-conduction hearing aid cannot be used.
- canal atresia, congenital or acquired, not amenable to
trtmnt.
- c/c ear discharge, not amenable to trtmnt
- excessive feedback & discomfort from air-conduction
hearing aid.
Conductive or mixed hearing loss, e.g. otosclerosis &
tympanosclerosis where surgery is contraindicated.
Single-sided hearing loss

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 Bone-anchored Hearing Aids (BAHA)

• BAHA have replaced the use of CROS aids.

• The BAHA device can be implanted on the side of deaf ear,

and it transmits the sound by means of bone conduction to
the contralateral cochlea.

• The BAHA is fixed on the deaf side & collects sound waves to
transmit to healthy cochlea of the other side.

• This process eliminates the head-shadow effect and allows

for hearing from both sides of the head

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 Bone-anchored Hearing Aids (BAHA)

Surgery
 typically performed in a single stage in adults.
 Abt 3 months are allowed for osseointegration bfr the sound
processor can be attached.
 2 stage procedure is recommended in children in whom the
fixture is placed into the bone in the first stage. After abt 6
months to allow for osseointegration, a second stage
operation is done to connect the abutment through the skin
to the fixture.

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 Bone-anchored Hearing Aids (BAHA)

Complications

• Few

• Failure to osseointegrate the implant

• local infections and inflammation at the implant site.

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 Implantable Hearing Aids

• Works on a direct drive principle.

• Rather than delivering acoustic energy into the external

auditory canal (as with traditional hearing aid systems),
direct drive middle ear implant systems use mechanical
vibrations delivered directly to the ossicular chain, while
leaving the ear canal open.

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 Implantable Hearing Aids

Implantable middle ear devices are generally available in 2

types :
Piezoelectric devices: operates by passing an electric
current into a piezoceramic crystal, which changes its volume
and thereby produce a vibratory signal. This piezoelectric
transducer in turn is coupled to the ossicles and drives the
ossicular chain by vibration.
Electromagnetic hearing devices: function by passing an
electric current into a coil, which creates a magnetic flux that
drives an adjacent magnet. The small magnet is attached to
one of the ossicles of the middle ear to convey vibrations to
the cochlea.

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 Implantable Hearing Aids
Vibrant soundbridge device
• Semi-implantable device
• 2 components – internal & external
• The internal component is called VORP (Vibrating Ossicular
Prosthesis) and is made up of 3 parts- receiver, FMT (Floating
Mass Transducer) and a conductor link between the two.
• The external component is called the audio processor which
is worn behind the ear. It contains a microphone that picks
up sound from the environment and transmits it across the
skin by radiofrequency waves to the internal receiver.

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 Implantable Hearing Aids

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 Implantable Hearing Aids

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 Implantable Hearing Aids

Candidacy profile

 Adults aged 18 yrs and older with moderate to severe

sensorineural hearing loss.

 Candidates should have experience of using traditional

hearing aids and should have a desire for an alternative
hearing system.

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 Implantable Hearing Aids

Procedure
The internal device is surgically implanted.
Conducted under general anaesthesia.
The receiver of the implant is positioned under the skin over
the mastoid bone via a std cortical mastoidectomy and
posterior tymapanotomy approach.
The ossicular chain is visualised and the FMT is attached to
the long process of incus.
6 to 8 weeks after the procedure, the patient is fitted with
the external audio processor.

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 Implantable Hearing Aids

Advantages
 A direct drive system provides mechanical energy directly to
the ossicles, bypassing the ear canal and the tympanic
membrane.
 Eliminates occlusion, feedback, discomfort and wax related
problems.
 Provide improved sound quality to the hearing-impaired
subjects.

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 Implantable Hearing Aids

Disadvantages of conventional hearing aids

Cosmetically unacceptable due to visibility
Acoustic feedback
Spectral distortion
Occlusion of external auditory canal
Collection of wax in the canal and blockage of insert
Sensitivity of canal skin to earmoulds
Problem to use in discharging ears

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 IMPLANTS

• Cochlear implants

• Auditory brainstem implants

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 Cochlear implants

• Electronic device that can provide useful hearing and

improved communication abilities for persons who have
severe to profound hearing loss and who cannot benefit
from hearing aids.

• Works by producing meaningful electrical stimulation of the

auditory nerve.

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 Cochlear implants

• Components- external
internal
External component: consists of an external speech
processor and a transmitter.
Internal component: it is surgically implanted and
comprises the receiver/stimulator package with an electrode
array.

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 Cochlear implants

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 Cochlear implants

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 Cochlear implants

Candidacy profile
Used both in children and adults.
Bilateral severe to profound sensorineural hearing loss.
Little or no benefit from hearing aids.
No medical contraindication for surgery
Realistic expectation
Good family & social support toward habilitation
Adequate cognitive function to be able to use the device.

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 Cochlear implants

Outcomes of cochlear implantation

Factors that predict a successful clinical outcome are :
Previous auditory experience (post-lingual pts or prior use
of hearing aids)
Younger age at implantation ( especially for pre-lingual
children)
Shorter duration of deafness
Neural plasticity within the auditory system

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 Cochlear implants

Surgery
 Carried out under general anaesthesia
 There are broadly 2 surgical techniques:
i) The facial recess approach where a simple cortical mastoidectomy is
done first & the short process of the incus and the lateral semicircular
canal are identified.
The facial recess is opened by performing a posterior tympanotomy.
The stapes, promontory and round window are identified.
Cochleostomy is performed antero-inferior to the round window
membrane to a diameter of 1 to 1.6 mm depending on the electrode
used.

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 Cochlear implants

ii) The pericanal technique where a tympanomeatal flap is

elevated to perform a cochleostomy either by endaural or
postaural approach.
a bony tunnel is drilled along the external canal towards the
middle ear.

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 Cochlear implants
Complications of Cochlear Implant Surgery
Early complications
 Facial paralysis
 Wound infection
 Wound dehiscence
 Flap necrosis
 Electrode migration
 Device failure
 CSF leak
 Meningitis

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 Cochlear implants

Late complications
 Exposure of device and extrusion
 Pain at the site of implant
 Migration/displacement of device
 Late device failure
 Otitis media

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 Auditory Brainstem Implant (ABI)

• Designed to stimulate cochlear nuclear complex in the

brainstem directly by placing the implant in the lateral recess
of the fourth ventricle.
• Such implant is needed when CN VIII has been severed in
surgery of vestibular schwannoma.
• ABI help in communication, awareness and recognition of
environmental sounds; however they are not efficient as
multichannel cochlear implants.

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 Auditory Brainstem Implant (ABI)

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 BIONIC EYE

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 Human Eye Structure

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 Eye Defects

• Type 1: By Damage of Retinal Cells

• Type 2: By Damage of Ganglion Cells
• Type 3: By Damage of the optic nerve

• Bionic eye restores the vision lost due to damage of Retinal cells

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 Bionic Eye: Two Approaches

• MARC – Multiple Unit • Silicon Retina

Artificial Retina Chipset
• A retina is simulated on
• The images are captured by silicon
an external camera • The basic blueprint for this
• Processed and then is the human eye itself
transmitted to an implant on • The Silicon retina is
the retina. implanted in the eye
• This in-turn will transmit it to • No external devices required
the ganglion cells and then to
the optic nerve

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 Multiple Unit Artificial Retina Chipset (MARC) – The
Concept

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 MARC System Functionality

[1] Video Camera and Processor

[2] PWM Encoder
[3] Class-E Power Amplifier
[4] RF Telemetry
[5] Clock and Power Recovery
[6] Current Control and Electrode Stimulator

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 Extra-Ocular CMOS Camera & Video Processing

The CMOS Image Sensor

•Cost Effective for IC’s
•Low Power, less volume
•Easily mounted on a pair of
glasses

Video Processing
• Implemented using SRAM Frame buffers, ADC & a FPGA/ CPLD
•Reconfigurable FPGA’s allow flexibility for various Image Processing
Algorithms including Artificial Neural Networks

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 ASK-PWM Encoding

Alternate Mark Inversion

•Each pulse encodes 1 bit of
data
•0’s represented by 50%
duty cycle pulses
•1’s represented by pulses
with alternating larger or
smaller duty cycles (75% &
25% respectively)
symmetric around 50%

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 Class-E Power Amplifier
• The class E amplifier is a highly
efficient switching power amplifier,
typically used at such high frequencies
that the switching time becomes
comparable to the duty time
• The whole circuit performs a damped
oscillation.
• With load, frequency, and duty cycle
(0.5) as given parameters and the
constraint that the voltage is not only
restored, but peaks at the original
voltage, the four parameters (L,L0,C,C0)
are determined.

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 RF Telemetry
• An Inductive Link consists of 2 resonant
circuits
• Mutual Inductance M plays a vital role,
Maximizing it is very important
• As the MARC transmits information via
AM/ASK, fluctuations in the coupling
constant could potentially be perceived as
information by the processing chips
• Primary coil is driven with 0.5-10MHz
signal for Power accompanied by a
10KHz ASK signal which provides data
• It is suitably recovered at the receiving
end

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 Data, Clock & Power Recovery
Data & Clock Recovery Power Recovery
• The low frequency data signal is obtained • The high frequency RF carrier
by a Low Pass filtering envelope is obtained by filtering the
• The first RF signal conveys the output of receiver coil
configuration data which sets the pulse • The sinusoidal signal is then
width, height and period Then the actual amplified to suitable levels and then
Image is transmitted rectified
• ASK demodulator obtains the PWM • Rectification provides the required
scheme. DC voltage power
• Delay Locked Loop (DLL) deciphers the
PWM wave to obtain the Data transmitted
• Clock is defined as the rising edge of the
pulse & no explicit clock recovery circuits
are required

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 Current Controller and Stimulator
• 20 controlled variable current
(CVCS) sources are designed for
retinal simulation
• Each receive clocking & data info
from deciphered PWM wave
• Each CVCS is connected to 5
electrodes through a DEMUX
• Each current source provides sixteen
level (4 bit) linear gray-scale
stimulus
• Thus each of the 100 electrodes are
exited by different currents which
form the desired image pattern

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 Typical Image Formation

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 MARC-3 Chips

The Electrode Array Photograph of MARC-3 Chip

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 Important Aspects

Field of View
• More the number of Ganglion cells stimulated, more is the field of view
• Thus large electrodes and the area becomes a trade-off

Changing Scene and Real-time vision

• The whole process must happen extremely fast so that patients see in
real time
• This is important as any noticeable lag could stimulate the "vestibular-
ocular reflex", making people feel dizzy and sick.

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 Silicon Retina:
The Second Approach
• A silicon chip that faithfully mimics the neural circuitry of a real retina could lead to
better bionic eyes for those with vision loss, researchers claim.

• The circuit is built with the mammalian retina as its blueprint. The chip contains light
sensors and circuitry that functions in much the same way as nerves in a real retina –
they automatically filter the mass of visual data collected by the eye to leave only
what the brain uses to build a picture of the world.

• To make the chip, a model of how light-sensitive neurons and other nerve cells in the
retina connect to process light is created. A silicon version using manufacturing
techniques already employed in the computer chip industry.

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 Changing Scene
• The mammalian brain only receives new information from the eyes
when something in a scene changes.

• This cuts down on the volume of information sent to the brain but is
enough for it to work out what is happening in the world.

• The retina chip performs in the same way

• As well as having the potential to help humans with damaged vision,

future versions of the retina chip could help robots too!

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 The Images

The top image shows the raw output of the

retina chip.

The middle one a picture processed from it.

The third shows how a moving face would

appear.

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 Event-based Temporal Contrast Silicon Retina

• Frames have big disadvantages under real-world conditions for dynamic vision --
small dynamic range and fixed uniform sample rate

• All the pixels from every frame must be processed to extract meaning.
•
• Biology does it differently: retinas extensively use local gain control, they reduce
redundancy dramatically, and ganglion cells only spike when they have something to
say.

• The retina chip pixels respond with precisely-timed events to temporal contrast .

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 How it Works?
• Movement of the scene or of an object with constant reflectance
and illumination causes relative intensity change.
• Thus the pixels are intrinsically invariant to scene illumination and
directly encode scene reflectance change.
• The events are output asynchronously on an Address-Event bus, so
they have much higher timing precision than the frame rate of a
frame-based imager.
• Because the pixels locally respond to relative change of intensity,
the device has a large intra-scene dynamic range.

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 Pixel Architecture

• The pixel is beautifully drawn by Patrick to use quad mirror

symmetry to isolate the analog and digital parts.

• Most of the pixel area is capacitance.

• The chip includes a

fully programmable bias current generator that makes the
chip's operation largely independent of temperature and
process variations

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 Pixel Functionality
• The pixel uses a continuous-time front end
photoreceptor.
• This is followed by a precision self-timed
switched-capacitor differentiator
• The most novel aspects of this pixel are the
capability to self-bias the photoreceptor, and
the idea of self-timing the switch-cap
differentiation.
• This data converter pixel does a data-driven
conversion (like biology, but very different
than the usual ADC architecture).
• Various Interfaces are provided for testing

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