The present invention relates to medical implants, and more specifically to a novel clover shape attachment for securing an implantable floating mass transducer to the incus bone in the middle ear of a patient.
A normal ear transmits sounds as shown in
Hearing is impaired when there are problems in the ear's ability to transduce external sounds into meaningful action potentials along the neural substrate of the cochlea 104. To improve impaired hearing, various types of hearing prostheses have been developed. For example, when a hearing impairment is related to the operation of the middle ear 103, a conventional hearing aid or a middle ear implant (MEI) device may be used to provide acoustic-mechanical vibration to the auditory system.
But implanting the FMT 110 with such a coupling cap 204 can be difficult. Because the FMT 110 and the coupling cap 204 are so small, they can be hard to handle and manipulate with standard non-custom surgical tools. It can be difficult for the surgeon to correctly place the coupling cap 204 coaxially onto the FMT 110 at a right angle. In other cases, the coupling cap 204 is initially placed correctly onto the FMT 110, but then gets pushed askew or off during the surgery (the holding force of the clamping fingers on the coupling cap 204 is limited). Or the surgeon may accidentally damage the FMT 110 and/or the coupling cap 204. These problems can arise due to various factors, for example, stress or poor lighting, and they can become quite time consuming to correct.
In addition, the arrangement as shown in
Nor is it the case that a conventional adhesive material can simply be added to increase the bonding force between the FMT 110 and the coupling cap 204. There is no way to apply the same amount of adhesive material in the same repeatable way to bond the FMT 110 and the coupling cap 204 so as to provide a consistent and predictable effect in the operating performance of the implanted FMT 110. The adhesive material also has elastic properties that generated undesired linear and non-linear damping in the mechanical stimulation signal that is coupled between the FMT 110 and the coupling cap 204. In addition, evaporating the dilutant component of the adhesive material during surgery takes significant time and requires complicated sterile-safe procedures and other procedures that ensure that the toxic dilutant safely and completely evaporates. The only acceptable adhesive for use in an implantation application is fibrin glue, which is only intended for use with tissue, not mechanical components such as an FMT 110. A further challenge is to achieve an acceptably precise alignment of the coupling cap 204 with the FMT 110.
Embodiments of the present invention are directed to an implantable transducer such as an FMT that converts an electrical stimulation signal into a corresponding mechanical stimulation signal. The transducer has an elongated shape with a transducer end surface having a transducer drive surface adapted to produce the mechanical stimulation signal, and a transducer adhesive feature adapted to intra-operatively receive adhesive material. A separate coupling cap has a coupling end face with a coupling adhesive feature adapted to engage the transducer adhesive feature with the adhesive material and a coupling drive surface adapted for distortion-free coupling of the mechanical stimulation signal from the transducer drive surface to the coupling cap. A signal delivery surface of the coupling cap delivers the mechanical stimulation signal to an adjacent cochlear surface for sensation as sound.
At least one adhesive feature may be an adhesive recess adapted to receive the adhesive material, in which case, the other adhesive feature may be an adhesive projection adapted to engage the adhesive recess. The adhesive recess may be located at a radial center of the end faces. Or the adhesive recess may be located around a circumference of the end faces. The transducer drive surface and the coupling drive surface may be flat. The adhesive features may be rougher than the drive surfaces to promote adhesive bonding with the adhesive material.
Applying the adhesive material may include applying heat of between 60° C. and 80° C. to promote evaporation of volatile components of the adhesive material, and/or reducing air pressure around the middle ear transducer arrangement.
Embodiments of the present invention are directed to a middle ear transducer arrangement with a vibroplasty coupling cap that is adapted for use with an adhesive material in a controlled consistent way that is reproducible and predictable, especially in that is distortion-free engagement between the drive surfaces of the transducer and the coupling cap to couple the mechanical stimulation signal free from damping and distortion.
A separate coupling cap 302 includes a signal delivery surface 307 for delivering the mechanical stimulation signal from the transducer 301 to an adjacent cochlear surface for sensation as sound. A coupling end face includes a coupling adhesive feature 306 that is adapted to engage the transducer adhesive feature 304 and the adhesive material to fixedly connect the coupling cap 302 and the transducer 301. A coupling drive surface 305 is adapted for distortion-free engagement with the transducer drive surface 303 to couple the mechanical stimulation signal from the transducer 301 to the coupling cap 302.
Intra-operatively during the surgery to implant the transducer arrangement, the surgeon may decide to attach a coupling cap 302 to the transducer 110. Alternatively, it may be desirable to attach the coupling cap 302 to the transducer 301 during the manufacturing process. Rather than simply allowing the adhesive material to form a smooth bonding layer between the transducer 301 and the coupling cap 302, it is preferred to avoid distributing adhesive material over the entire connecting area. That is, the transducer drive surface 303 and the coupling drive surface 305 preferably should contact each other directly without adhesive to allow direct coupling of the mechanical stimulation signal from the transducer 301 to the coupling cap 302 without damping or other linear or non-linear distortion caused by the elastic properties of the adhesive material.
In the specific embodiment shown in
In one embodiment the transducer adhesive feature 304 may be coated with an adhesive friendly material, such as for example silicone. In
During surgery, a protective shipping sheet is removed from the coupling drive surface 305 and coupling adhesive feature 306 of the coupling cap 302. The transducer drive surface 303 and the coupling drive surface 305 are gently pressed together by the surgeon. This brings the coupling adhesive feature 306 at least partially into contact with the transducer adhesive feature 304. In some cases the surgeon will be able to perfectly align the coupling cap 302 and transducer 301 perfectly so that the coupling adhesive feature 306 and transducer adhesive feature 304 are lying exactly upon one another. But in most cases the coupling cap 302 and transducer 301 will be slightly misaligned so that the most protruding point of the coupling adhesive feature 306 projection (i.e., the center) contacts the transducer adhesive feature 304. This binds the coupling adhesive feature 306 to the adhesive friendly surface of the transducer adhesive feature 304 first and simultaneously avoids binding to the transducer drive surface 303 and promotes self-alignment. This self-alignment characteristic aids handling during surgery and provides form-locking fitting. After removal of the protective shipping sheet, the coupling adhesive feature 306 is exposed to air and a chemical curing process begins. Typically this chemical curing takes less than a minute during which the coupling cap 302 will self-align and afterwards the shrunken adhesive feature 306 exerts a compressive force, thereby fixedly connecting the transducer 301 and coupling cap 302 which are then ready for placement by the surgeon as for example shown in
The adhesive material may be any suitable dilutable medical grade adhesive, as for example available from Nusil Technology or Applied Silicone. Before dispensing the adhesive material onto the adhesive feature, it may be useful to dilute it with a suitable volatile substance such as N-Heptan. Then in a further step, the coupling cap 302 with the adhesive material thereon may be heated up to 60° C. to 80° C. for up to 3 hours. This ensures that the toxic dilution substance entirely evaporates. It has further been found that by heating up to 80° C. this evaporation process can be shortened to 20 minutes, effectively keeping the manufacturing time acceptably short. In addition or alternatively, it may be useful to reduce the air pressure around the transducer 301 and coupling cap 302 after joining them with the adhesive material in order to reduce the dilutant evaporation time and temperature further. This has the additional advantage of promoting the release of any micro air-bubbles that might be contained within the adhesive material. In one specific embodiment, an adhesive feature was formed from medical grade silicone diluted with N-Heptan in a ratio of 1:0.5 and then dispensed with 50 psi to achieve a proper fit into the tight manufacturing tolerances such as a 0.02 mm height of the adhesive feature after heating and evaporation (i.e. after the adhesive feature shrinks and obtains its final size).
A transducer and coupling cap such as those described above can be provided in a surgical kit for the surgeon to use during implantation surgery. If the surgeon decides during the surgery that a coupling cap is needed to properly couple the mechanical stimulation signal to the round window, then it is easy and reliable to attach the coupling cap to the transducer with a predictable amount of adhesive material without creating undesired damping and distortion. The arrangement is safe and convenient to handle without undesirably increasing the outside diameter of the transducer.
Although various exemplary embodiments of the invention have been disclosed, it should be apparent to those skilled in the art that various changes and modifications can be made which will achieve some of the advantages of the invention without departing from the true scope of the invention.
This application claims priority from U.S. Provisional Patent Application 61/836,243, filed Jun. 18, 2013, which is incorporated herein by reference.
Filing Document | Filing Date | Country | Kind |
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PCT/US14/42606 | 6/17/2014 | WO | 00 |
Number | Date | Country | |
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61836243 | Jun 2013 | US |