Hearing loss that results from the mechanical obstruction of the anatomical pathways of the ear is termed conductive hearing loss (CHL) [24], [25]. The many conditions that cause CHL prevent sounds from being efficiently transmitted down the external ear canal to the cochlea of the inner ear, causing temporary or permanent hearing loss. CHL is the most common type of hearing impairment among infants and young children. Untreated, enduring, unaided CHL in the early stage of life delays language and speech development [26], which reduces the quality of life and leads to poor school performance, alienation in school, low academic achievement, and ultimately low socio-economic level [26]. Therefore, for long-lasting hearing health, and for language development, it is essential to detect CHL in newborns and infants and intervene as early as possible.
Pediatric CHL is often caused by reversible common conditions, such as otitis media and tympanic membrane perforations; 80% of children experience some episode of otitis media before school age [27]. Otitis media is generally treated with antibiotics or tympanostomy tube insertion. Tympanic membrane perforation has a lower incidence rate and is repaired by surgery. The procedure requires general anesthesia and lasts approximately 1-3 hours. Pediatric CHL is also caused by permanent anatomical conditions, such as aural atresia, canal stenosis and ossicular malformation. These conditions are not as common as transient CHL. For instance, congenital aural atresia has a 1:10,000 to 1:20,000 incidence rate [28]-[30], and ossicular malformation has an incident rate of 0.6% in children under 5 [31]. These conditions result in a 40-60 dB permanent hearing loss and are much more difficult to address. Hearing aids can sometimes be placed if there is an existent ear canal. Alternatively, a bone conduction aid can be implanted. Otherwise, surgical options for these pediatric CHL include canalplasty/ossicular chain reconstruction.
Treatment options in canal atresia, stenosis and ossicular malformation have limitations and present challenges for pediatric patients. Lack of the ear canal or opening in atresia and narrowed canal in stenosis do not physically accommodate hearing aids in the external canal; therefore, in-the-canal aids are not practical for atresia and stenosis. The abnormal or unformed boney ear canal is usually accompanied by malformation of the three tiny ear bones: the malleus, incus and stapes. Ossicular chain reconstruction is usually needed at the same time as the canalplasty and attempts to repair or replace the abnormal connections among the three small ear bones. Canaloplasty itself—to surgically create or widen the canal in the ear—has a decades-long history of very disappointing results. These canals typically re-stenose, and the postoperative CHL is little improved. Several anatomical grading systems (based on CT) have been developed, including the Jahrsdoerfer grading scale, to try to select candidates for ear canal surgery who have middle and inner ear anatomy closest to normal morphology [32]. These have the best chance of hearing improvement with canalplasty. However, even with careful selection, re-creating an ear canal and reconstruction of the small ear bones do not usually succeed. Stapedectomy, an operation for stapes fixation in adults [33], tends to be quite successful. However, the underlying condition is not common in children, and therefore stapedectomy has no role for most pediatric patients. Auditory osseointegrated implants (AOI's) are implanted into the superficial bony cortex of the skull to provide an alternative pathway for acoustic transmission and to bypass the child's permanent CHL [34], [35]. The surgery for AOI placement requires approximately one hour of general anesthesia and carries the risk of exposing or even tearing the meninges, which are the fibrous casing of the brain. In addition, the AOI requires a small metal pedestal that protrudes through the scalp, and typically these become overgrown by scalp months to years after the placement and must be repeatedly revised surgically. Because of the limitations of the skull, surgeons typically wait until children are 5 years old to implant AOIs [36]-[38]. An additional issue with AOIs is that many of the children and adolescents refuse to wear them because the external processor protrudes from their scalp and hair approximately 2-3 centimeters.
Few non-invasive conductive hearing aids exist to address CHL and are especially needed for the 5-year interval before the AOI or the canalplasty can be attempted. However, these alternatives have some disadvantages for pediatric patients. For instance, intraoral conduction aids are non-surgical devices to transfer sounds into the cochlea via teeth (for example, SOUNDBITE™ by Sonitus Medical) [39], but they are not practical for newborns and infants with undeveloped teeth. Bone conduction headbands (for example, Softbands) are wearable [40] and do not require surgical and invasive procedures, but these are cumbersome and uncomfortable for children and frequently fall off the child's scalp. MED-EL® company has developed a bone conduction hearing aid, called ADHEAR®, with a rigid piece of plastic, accommodating the sound processor. The rigid part has one adhesive surface that is applied to the skin and must be replaced regularly. The daily removal is cumbersome and peeling off the device is abrasive to the skin. Also, the rigidity of the device can be uncomfortable for pediatric patients.
In a first aspect, the present invention is a flexible conductive hearing aid, including: (i) a flexible substrate, (ii) components, on or in the flexible substrate, including (a) a microphone, configured to produce an electrical signal from sound, (b) electronic circuits, connected to the microphone, configured to amplifying the electrical signal, (c) an actuator, connected to the electronic circuits, configures to produce vibrations in the flexible substrate from the amplified electrical signal, and (d) a power source, connected to the microphone and the electrical circuits. Furthermore, the flexible conductive hearing aid comprise (iii) optionally, a flexible top layer, on the components, and (iv) optionally, a flexible bottom layer, wherein the flexible substrate is on the flexible bottom layer.
In a second aspect, the present invention is a method of treating conductive hearing loss with a flexible conductive hearing aid having a flexible substrate and optional a flexible bottom layer, the method including attaching the flexible conductive hearing aid to skin on a patient's skull, producing an electrical signal from ambient sound, amplifying the electrical signal, to produce an amplified electrical signal, and producing vibrations in the flexible conductive hearing aid from the amplified electrical signal.
“Flexible” means that the material will undergo elastic deformation when manipulated by hand.
New strategies to non-invasively transfer sound into the inner ear and eliminate the need for surgical procedures and cumbersome aids for pediatric patients is needed. Such a device should include soft, ultra-thin, lightweight micro-epidermal actuators (MEAs) attached to the epidermis on the skull which generate enough acoustic vibrations to conduct sound to the cochlea and bypass CHL. Micro-transducers on elastomeric substrates, including flexible speakers and microphones, have been widely shown in the literature [57], [59], [60]. Flexible electronics with a small size and low elastic modulus have been experimentally shown to adhere to skin with natural forces [1], [2]. The mechanism of acoustic transmission into the inner ear via skin-bone has been shown in COCHLEAR® and MED-EL products. However, the device that is needed should significantly reduce the size and weight of the hearing aid and eliminate the need for straps and rigid transducers, minimizing the risks for newborns and infants.
The present invention provides a hearing aid to address CHL, referred to as a flexible conductive hearing aid. This device is non-invasive, stable and unnoticeable on the head. The device does not have any rigid components to exert pressure on the skin and is not abrasive to the skin, but is powerful enough to bypass CHL. Micro-epidermal actuators were design and fabricate to transfer vibrations from the surface of skin to skull and to the cochlea of a person. The actuators and electronics are implemented on a thin flexible substrate to stick behind the ear and bypass conductive hearing loss.
An important element of this innovation is to miniaturize the components needed for hearing aids and to implement them onto the ultrathin, soft and flexible substrate to achieve a pediatric friendly conductive hearing aid. The device is unnoticeable on the skin, reducing the stigma surrounding visible hearing aids. The device is built onto bio-compatible and soft substrates and is optionally wirelessly charged or powered and may not need to be replaced daily. With this device, the size of a novel hearing aid could be as small as 1.5 cm×2.5 cm×300 μm and the weight is less than 120 milligrams. Such a flexible device will stick to skin with an adhesion strength of 1-2 kPa. The device will record sounds in the environments with a small microphone and transmit the amplified signals to the inner ear in the form of vibrations. The sound may be produced, for example, with a piezoelectric, microelectromechanical actuator. The strength of the vibrations may be increased by using multiple actuators. Such a flexible conductive hearing aid is conformal, lightweight and on an ultrathin substrate that moves with facial and natural body motion and, thus stabilizes the hearing aid on the skin and reduces the rubbing noises against the skin.
Preferably, each of the substrate, top layer and optional bottom layer, independently has a thickness of 5 to 500 μm, more preferably 25 to 200 μm, including 30, 40, 50, 60, 70, 80, 90, 95, 100, 110, 120, 130, 140, 150, 160, 170, 180 and 190 μm. Preferably, the layers have a length and width sufficient to contain all the desired components of the component layer, and has a size sufficient for an adult to grasp and place on the skin by hand. Preferably the substrate, top layer and optional bottom layer have a width of 0.25 to 15 cm, more preferably 0.5 to 10 cm, including 0.75, 1, 1.25, 1.5, 1.75, 2, 2.25, 2.5, 2.75, 3, 3.5, 4, 4.5, 5, 6, 7, 8 and 9 cm. Preferably the substrate, top layer and optional bottom layer have a length of 0.25 to 15 cm, more preferably 0.5 to 10 cm, including 0.75, 1, 1.25, 1.5, 1.75, 2, 2.25, 2.5, 2.75, 3, 3.5, 4, 4.5, 5, 6, 7, 8 and 9 cm. The device may have any shape, including rectangular, circular, oval, 2-lobed, 3-lobed, 4-lobed, an irregularly shaped. The weight of the flexible conductive hearing aid will depend on the thickness, size and composition of the various parts and components. Preferably, the flexible conductive hearing aid has a weight of at most 3 g, preferably at most 1.0 g, more preferably at most 500 mg, even more preferably at most 250 mg, including at most 200, 150, 120, 100, 50, 20 or 10 mg, and all ranges therebetween.
Optionally, a biocompatible adhesive may be used on the underside of the substrate or the optional bottom layer, for adhering the flexible conductive hearing aid to skin. Such an adhesive may not be necessary if the weight of the device is low enough and a polymer is used for the substrate or the optional bottom layer, that naturally sticks to skin without an adhesive, such as by fluid capillary forces, van der Waals forces, or other adhesion mechanisms. For example, when PDMS is used and the flexible conductive hearing aid has a weight of at most 120 mg, it may naturally stick to skin. In such a circumstance, an adhesive force of only 1-2 kPa is necessary to keep the device in place on skin during use. Examples of materials used for skin adhesion of a light weight device without an adhesive may be found in [2].
The electronic circuits receive the signal from the microphone, and then amplify and transfer the signal to the actuator. The electronic circuits may carry out other functions, such as filter the signal, managing and delivering power to the device components from the power source, carry out analog-to-digital and digital-to-analog conversions, signal processing, and/or allow for wireless remote control or programming of the device. Although illustrated as a single component, the device may include multiple electronic circuits. The electronic circuits may be electrically connected to each, some and/or all of the components on the device. The electronic circuits may be implemented, for example, as a system-on-a-chip as described in [2]. Alternatively, silicon nanostructures and electrical interconnects may be embedded onto flexible substrates through use of an ultrathin silicon layer with 100-nm thickness and transferred onto the flexible substrate, for example as described in [49]. Interconnects and other structures may be patterned onto the flexible substrate, as described in [51]. These structures allow the flexible conductive hearing aid to benefit from semiconductor materials, microelectronic devices and micro-actuators. These structures may be implemented on flexible substrates for electrical interconnections, antennas, acoustic matching, and wireless chargers. In addition, copper traces and electrical interconnects can be patterned on two different polymer substrates, including PDMS and polyimide [51].
The electronic circuits may also have a charger circuit. The charging circuit is preferably present when the device may be charged wirelessly, and includes a receiving coil, a tank circuit, an AC/DC bridge rectifier, a filter, and optionally batteries. The charging circuit may be wirelessly coupled to a transmitter module including a transmitter coil for wireless powering a hearing aid, or for wirelessly recharging batteries on a hearing aid. A charging circuit is illustrated in
A microphone receives sound from the air and converts the sound into an analog electrical signal. The microphone is powered by electricity from the power source, and will be electrically connected to the power source. Preferably, the microphone is micro-electromechanical systems (MEMS) microphone having a membrane diameter of, for example, 3 mm and a thickness of 2 μm. The microphone may be piezoelectric, condenser, or have a conductive membrane. Examples of suitable microphones are described in [41] and [42]. In another example, a polymer-based micro-membrane with wide bandwidth for a microphone may be used [50].
An actuator convers an electrical signal into vibrations. When integrated onto the flexible substrate, the vibrations can pass through the skin and bone to reach the cochlea and be perceived as sound. Preferably, as shown in
Lightweight micro-epidermal actuators (MEAs) may be designed with an engineered frequency band to cut off unwanted low-frequency vibrations associated with body and facial motions. For example, MEAs may be designed to produce vibrations up to 20 kHz and not to respond to low frequency vibrations below 20 Hz. Preferably, the actuator has an output force level of at least 60 dB, more preferably at least 80 dB, more preferably at least 90 dB, including 60-120 dB, for example 65, 70, 75, 80, 85, 90, 95, 100, 105, 110 and 115 dB. This loudness is comparable to the power of the COCHLEAR™ BAHA® 5 (90-120 dB). Such an actuator is powerful enough to compensate for the loss at the skin-bone interface and bypass CHL.
The strength of the vibrations may be increased by using multiple actuators, such as 2, 3, 4 or more actuators. When multiple actuators are used, they may each be the same, or each actuator may be adapted to provide vibrations at different frequencies, to improve the overall vibration performance across a range of frequencies.
A power source is used to provide power to the various parts of the device, including the electrical circuits and the microphone. The powers source may be electrically connected to additional components, such as the optional antenna. The power source may be, for example, a battery, a capacitor, a thermoelectric device, or a receiver for wireless electric power, or combinations thereof. When the device is adapted to allow for wireless charging, such as by including an antenna, a wireless transmitter may be included with the device as a kit, to provide an alternative magnetic field for charging the batters, or even for running the hearing aid so that batteries are not required. Examples of flexible batteries and receiver for wireless electrical power or charging of batteries may be found in [2], [43], [44] and [45].
The optional antenna may be used to receive wireless electrical power to recharge a battery, or charge up a capacitor, on the device. The optional antenna may also be connected to the electrical circuit for receiving blue tooth, WiFi, or other signals for programing or controlling the device. The antenna is preferably made of any conductive material, such as copper, aluminum, silver and/or gold. Multiple antennas may be used. For example, one antenna may be used to receive signals for programming and control, with a separate second antenna used as a receiver for wireless recharging. Various techniques for forming such conductive structures may be used, such as sputter and evaporation.
A device was produced includes the following components: Micro-electromechanical systems (MEMS) microphone, TL072 integrated circuit (IC), micro-actuators, piezoelectric actuator, other necessary electronic components (resistors, capacitors, transistors, etc.), and electronics lab equipment (oscilloscope, signal generator, voltage source, digital multimeter (DMM)). The flowchart in
The circuit shown in
Bulky actuators based on electromagnetic actuation are a major obstacle to miniaturize the size of conductive hearing aids. These actuators are power hungry and inherently large. To achieve band-aid-like, pediatric-friendly conductive hearing aids, thin-film, micro-epidermal actuators were developed to be attached on skin and generate vibrations. Micro-epidermal actuators include a piezoelectric layer, a brass plate and a flexible substrate. When an alternating electric field is applied to the piezoelectric layer, the brass plate bends, thus generating vibrations on the flexible substrate (such as PDMS). A piezoelectric and brass plate were embedded on to a PDMS layer to achieve micro-epidermal actuators. PDMS is a conformal, biocompatible, elastomer polymer. Mechanical properties of PDMS mostly match those of human skin. This improves energy transmission of vibrations from PDMS to skin.
A high-precision laser Doppler vibrometer (LDV) was used to study the vibrations on micro-epidermal actuators and surface of skin and bone. LDV measures the velocity and calculates displacement and accelerations. Initially an actuator with diameter of 20 mm (brass plate) was taped with a lead zirconate titanite disk having a 15 mm diameter. The PDMS thickness was from 50 to 1000 μm. For thick PDMS, the piezoelectric was covered by PDMS. On thinner devices, the piezoelectric layer was implemented on one side of the PDMS.
A cadaveric skull calvarium (from skullsunlimited.com) was used to study the vibrations. A peak was observed at 3 kHz corresponding to a resonance. Displacement was reduced from 200 nm to 6.5 nm at 5 kHz (by a factor of 30). This reduction is attributed to damping of skull, thick PDMS as well as the mechanical properties of rigid bone. Displacement is lower in rigid bone; however, the force level is higher. The transmission of vibrations was measured at various distances from the center of the actuator at 4 kHz. Displacement is exponentially reduced by increasing distance. The vibrations were reduced from 78 nm displacement to 2.8 nm at a distance of 65 mm. The distance from ear to cochlea in infants is less than this range (roughly 10 mm), in which the damping is insignificant.
Simulations of a microepidermal actuator on a flexible substrate were carried out with ANSYS software to determine the dimensions of piezoelectric actuators for maximal vibration conduction. Laser Doppler vibrometer was also used to measure displacement of vibrations for an actuator placed on a segment of cadaveric skull calvarium. We analyzed a microepidermal actuator with a lead zirconate titanite (PZT-5A) on a brass plate. In the simulation PZT was covered by a polydimethylsiloxane (PDMS) layer as elastomer substrate. The stress and displacement of vibrations on PZT layer, PDMS, skin and bone, were analyzed.
The results show that increasing the diameter of a circular PZT disk from 1 to 14 mm (
High-precision laser doppler vibrometer (LDV) from Vibrations Inc. was used to measure the vibrations on actuators. The vibrations on a volunteer and a piece of bone from a human skull were also measured. The data show the displacement is reduced on a skull by a factor of 50% at the distance of 1 cm from actuator (
A piezoelectric actuator on a flexible substrate was prepared to achieve a micro-epidermal actuator for a noninvasive, flexible adhesive bandages-like conductive hearing aid. A circular lead zirconate titanite (PZT) actuators was prepared on a polydimethylsiloxane (PDMS) substrate (
Two-part liquid components (Sylgard 184 silicone elastomer kit) with weight ratio 10:1 was mixed, and then the liquid mixture was spun on a 3-inch diameter wafer at speed 900 RPM. A 100 μm-thick PZT-5A was fixed on PDMS layer after spin coating, and then the wafer was cured at room temperature (27° C.) for 48 hours. The thickness of PDMS was measured to be 100 μm. The PDMS with actuator was peeled off from the surface of the wafer. For vibration measurement, a 1-mm thick aluminum plate was fixed on four corners, and a high-precision accelerometer (352B from PCB Piezotronics) was vertically bolted on the aluminum plate (
In this example two designs of piezoelectric (PZT) actuators on flexible substrates were developed and measured transmissibility of vibrations using a laser Doppler vibrometer (LDV). Two actuators layered were developed as follows: PZT-Brass-PDMS (PBP) (
Velocity vs. frequency on the PZT (V1) and on the backside of aluminum plate (V2) for two designs were recorded. The velocity on the rigid plate was divided by the velocity on the PZT layer at each frequency to obtain transmissibility (T) of the vibrations (T=V2/V1).
Also measured was the displacement of vibrations on the PZT actuator for PBP design and the displacement of PDMS on the surface of PPBP design at 5 kHz as shown in
It was concluded that the embedded actuator (PPBP design) showed higher transmissibility for velocity. This is attributed to the efficient coupling, lower damping, and security of the PZT actuator within the PDMS. The results show that the PPBP design has a higher transmissibility for velocity due to efficient coupling, lower damping, and security of the PZT actuator within the PDMS. This design will be used in a flexible conductive hearing aids to efficiently transmit vibrations from the actuator to bone and overcome CHL.
A noninvasive, flexible aid to address pediatric conductive hearing loss was prepared. The flexible hearing aid is capable of converting external sounds to vibrations, relying on a microelectromechanical microphone, electronic circuits for amplification and batteries to power the device. These components were printed on a flexible substrate attached to a micro-epidermal actuator for generating vibrations on infants' skin.
The initial design and simulation of the circuit were conducted through Eagle CAD, a circuit design and simulation software. It is modeled to have two stages of amplification, for a total ideal gain of 260. The gain can be tunable. Experimentally, the piezoelectric actuators intended for this device produced larger vibrations at 10 V. With an average peak-to-peak voltage input of 25 mA, it amplified the signal to 6.5 V.
The schematics were then redesigned as a 2-layer printed circuit board (PCB) schematic, barely fitting 48.5×17.1 mm2 (1.91×0.67 in2). The copper layers and silkscreens are printed onto a polyamide substrate with a thickness of approximately 100 μm. Compared to traditional PCBs, the polyamide substrate is flexible, and allows a high degree of bending. This feature is restricted by the rigidity of components soldered to the board. All components of the circuit along with the board are RoHS (Restriction of Hazardous Substances Directive) compliant.
The circuit assembly procedures have been optimized for a heat soldering gun, using lead-free solder paste. The order of soldering goes from high to low heat profiles, with the MEMS (Microelectromechanical System) microphone and the actuator being the final two pieces of the assembly. The circuit was then characterized electrically, with the preliminary frequency-voltage profile shown in
The device is shown in
Batteries may also be charged with a wireless coil. The charger was calculated to work at a resonance frequency of 185 kHz, with an AC/DC converter wiring the DC voltage to the batteries. The extended circuit has been tested on a breadboard, and the batteries were successfully charged. The charger would provide a user-friendly method of charging the hearing aid, which is a step up from the previous circuit that required wire probes. The wireless device is designed to be 50 ×17.1 mm2. A schematic of the device with a wireless charging coil is shown is shown in
A wireless charger has been designed and integrated into the flexible, pediatric hearing aid. This feature will eliminate the need for a rigid port and wires to charge the batteries. This will reduce the burden of removing the hearing aid from the surface of skin to charge or change batteries. The wireless charger will also provide a source for powering the hearing aid and charging the batteries when the infants and pediatric patients are in bed. In this design, a wireless transmitter is placed under the bed to generate an alternative magnetic field (AMF) for the hearing aid. A coil on the perimeter of the hearing aid was also designed to receive AMF and energy. Two coils are electromagnetically coupled with coefficient of k to transfer energy from transmitter module to the receiver coil. AMF induces voltage in the receiver and provides a source of energy for the hearing aid.
In an experiment, the transmitter was able to produce a peak-to-peak voltage of 119 V, at 185 kHz frequency with a DC bias of 30 V. The wireless charger was tested with an external breadboard receiver circuit. Initially, the magnetic field is received by the coil, paired with a parallel capacitor for resonance at 185 kHz. The voltage was converted from AC to DC with a full bridge consisting of Schottky diodes with output of 12.8 V DC and 11.08 mA current. The output power in the receiver was roughly 140 mW. These values were obtained when the receiver coil was placed directly against the transmitter coil. Ripple effects are removed with several capacitors, decreasing the AC peak-to-peak voltage to under 1 V. Batteries on a hearing aid, that were partially charged, were recharged over the course of 30 minutes. The battery voltage was increased from 7 V (partially charged) to 11.5 V (fully charged). The wireless charger was able to recharge the battery to the nominal maximum DC voltage of the battery (11.5 V). The device could also benefit from NFC (Near Field Communication) wireless charge at frequency 13.56 MHz.
The hearing aid was tested as the batteries were charging with wireless charger; it showed that the current consumption was low (<10 mA) from the charger itself. The charging was working properly, without noticeable signal interference to the hearing aid. There was no observable loss of power over the course of 2 hours of device usage and wireless charging. The maximum peak-to-peak voltage of the signal was consistent throughout the testing period. Using Eagle CAD software, the original hearing aid was redesigned to include the receiver coil and charging circuits. This design slightly increased the size of the device, from 48.5×17.1 mm2 (1.91×0.67 in2) to 50×17.1 mm2 (1.97×0.67 in2). A device block diagram and integrated circuit with wireless charger are illustrated in
This invention was made with Government support under of grant no. 1R21DC018894-01A1 awarded by the National Institutes of Health—National Institute on Deafness and Other Communication Disorders (NIH-NIDCD). The Government has certain rights in the invention
Filing Document | Filing Date | Country | Kind |
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PCT/US2022/052241 | 12/8/2022 | WO |
Number | Date | Country | |
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63288457 | Dec 2021 | US |