When a cochlear implant is initially implanted in a recipient, and during follow-up tests and checkups thereafter, it is usually desirable to fit the cochlear implant to the recipient. Such “fitting” may include adjustment of the base amplitude or intensity of the various stimuli generated by the cochlear implant from the factory settings (or default values) to values that are most effective and comfortable for the recipient. For example, the intensity or amplitude and/or duration of the individual stimulation pulses provided by the cochlear implant may be mapped to an appropriate dynamic audio range so that the appropriate “loudness” of sensed audio signals is perceived. That is, loud sounds should be sensed by the recipient at a level that is perceived as loud, but not painfully loud. Soft sounds should similarly be sensed by the recipient at a level that is soft, but not so soft that the sounds are not perceived at all.
One aspect of fitting a cochlear implant to a particular recipient is determining at least one most comfortable level (“M level”), also known as a “most comfortable current level”. An M level refers to a stimulation current level applied by a cochlear implant at which the recipient is most comfortable. M levels typically vary from recipient to recipient and may vary from electrode channel to electrode channel in a multichannel cochlear implant.
It is often desirable to employ an objective method of determining M levels for a cochlear implant recipient. One such objective method involves increasing a current level of electrical stimulation applied by a cochlear implant to the recipient until a stapedial reflex (e.g., an involuntary muscle contraction that occurs in the middle ear in response to electrical stimulation) is elicited. The current level required to elicit a stapedial reflex within a recipient (referred to herein as an “electrical stapedius reflex threshold” or “ESRT”) may then be used by a clinician as a starting point for determining an M level corresponding to the recipient. For example, an M level for a cochlear implant recipient may be set to be substantially equal to or slightly offset from an ESRT for the cochlear implant recipient.
Unfortunately, it is often difficult, cumbersome, and time consuming to identify an ESRT for a cochlear implant recipient using conventional techniques.
The accompanying drawings illustrate various embodiments and are a part of the specification. The illustrated embodiments are merely examples and do not limit the scope of the disclosure. Throughout the drawings, identical or similar reference numbers designate identical or similar elements.
Systems and methods for measuring an ESRT in a cochlear implant recipient are described herein. For example, a diagnostic system may 1) direct a display screen to display a graphical user interface that includes a plurality of columns corresponding to a plurality of electrodes disposed on an electrode lead implanted at least partially within a cochlea of a recipient of a cochlear implant, 2) graphically indicate, within the graphical user interface, an initial stimulation level, 3) direct the cochlear implant to step through applying a sequence of stimulation events each having a different stimulation level to an electrode set included in the plurality of electrodes, the sequence of stimulation events beginning with a first stimulation event that has the initial stimulation level, 4) detect, while the cochlear implant is stepping through applying the sequence of stimulation events to the electrode set, user input indicating that a stapedial reflex state within the recipient changes from a first reflex state to a second reflex state, 5) identify a particular stimulation event included in the sequence of stimulation events that corresponds to the change in the stapedial reflex state from the first reflex state to the second reflex state, the particular stimulation event having a particular stimulation level, and 6) graphically present, within one or more columns included in the plurality of columns and corresponding to the electrode set, one or more graphical markers indicating that the stapedial reflex state is the second reflex state at the particular stimulation level.
As used herein, a “stapedial reflex state” refers to whether a stapedial reflex occurs in response to a particular stimulation event. For example, in some scenarios (e.g., when stimulation events are being applied in order of incrementally decreasing stimulation levels), the first reflex state represents a state in which a stapedial reflex occurs in response to one or more stimulation events and the second reflex state represents a state in which the stapedial reflex does not occur in response to one or more stimulation events. In other scenarios (e.g., when stimulation events are being applied in order of incrementally increasing stimulation levels), the first reflex state represents a state in which a stapedial reflex does not occur in response to one or more stimulation event and the second reflex state represents a state in which the stapedial reflex occurs in response to one or more stimulation events.
In some examples, the systems and methods described herein are implemented by a stand-alone diagnostic system that includes a computing module and a base module configured to attach to the computing module and serve as a stand for the computing module. The computing module includes a display screen and a processor configured to direct the display screen to display a graphical user interface that includes a plurality of columns corresponding to a plurality of electrodes disposed on an electrode lead implanted at least partially within a cochlea of a recipient of a cochlear implant. The base module houses an interface unit configured to be communicatively coupled to the processor and to a cochlear implant while the base module is attached to the computing module. In this configuration, the processor may be configured to 1) graphically indicate, within the graphical user interface, an initial stimulation level, 2) direct the cochlear implant to step through applying a sequence of stimulation events each having a different stimulation level to an electrode set included in the plurality of electrodes, the sequence of stimulation events beginning with a first stimulation event that has the initial stimulation level, 3) detect, while the cochlear implant is stepping through applying the sequence of stimulation events to the electrode set, user input indicating that a stapedial reflex state within the recipient changes from a first reflex state to a second reflex state, 4) identify a particular stimulation event included in the sequence of stimulation events that corresponds to the change in the stapedial reflex state from the first reflex state to the second reflex state, the particular stimulation event having a particular stimulation level, and 5) graphically present, within one or more columns included in the plurality of columns and corresponding to the electrode set, one or more graphical markers indicating that the stapedial reflex state is the second reflex state at the particular stimulation level.
The systems and methods described herein may advantageously allow a user to more effectively, efficiently, and accurately identify ESRTs for one or more channels of a multi-channel cochlear implant (i.e., a cochlear implant configured to apply electrical stimulation by way of a plurality of electrodes disposed on an electrode lead). For example, the systems and methods described herein may allow a user to focus his or her visual attention on monitoring for a physical response of the stapedius muscle while a sequence of stimulation events are applied to an electrode set disposed on an electrode lead located within a cochlea of a recipient. To illustrate, in accordance with the systems and methods described herein, the user may continuously look through a surgical microscope at the stapedius muscle to observe when the stapedius muscle twitches or otherwise physically responds to a particular stimulation event without having to divert his or her visual attention to a display monitor, input device, or other component of a computing system being used to record ESRT data. This may allow the user to more precisely determine when an ESRT occurs, which may allow a cochlear implant system to be more accurately programmed, thereby improving operation of the cochlear implant system. Moreover, the systems and methods described herein may reduce the amount of time it takes to perform an ESRT detection procedure (e.g., by minimizing the amount of time it takes for a user to record an occurrence and/or non-occurrence of a stapedial reflex), which may be advantageous for recipients and clinicians alike. These and other advantages and benefits of the systems and methods described herein will be made apparent herein.
As shown, cochlear implant system 100 may include various components configured to be located external to a recipient including, but not limited to, microphone 102, sound processor 104, and headpiece 106. Cochlear implant system 100 may further include various components configured to be implanted within the recipient including, but not limited to, cochlear implant 108 and electrode lead 110.
Microphone 102 may be configured to detect audio signals presented to the user. Microphone 102 may be implemented in any suitable manner. For example, microphone 102 may include a microphone that is configured to be placed within the concha of the ear near the entrance to the ear canal, such as a T-MIC™ microphone from Advanced Bionics. Such a microphone may be held within the concha of the ear near the entrance of the ear canal during normal operation by a boom or stalk that is attached to an ear hook configured to be selectively attached to sound processor 104. Additionally or alternatively, microphone 102 may be implemented by one or more microphones disposed within headpiece 106, one or more microphones disposed within sound processor 104, one or more beam-forming microphones, and/or any other suitable microphone as may serve a particular implementation.
Sound processor 104 may be configured to direct cochlear implant 108 to generate and apply electrical stimulation (also referred to herein as “stimulation current”) representative of one or more audio signals (e.g., one or more audio signals detected by microphone 102, input by way of an auxiliary audio input port, input by way of a clinician's programming interface (CPI) device, etc.) to one or more stimulation sites associated with an auditory pathway (e.g., the auditory nerve) of the recipient. Exemplary stimulation sites include, but are not limited to, one or more locations within the cochlea, the cochlear nucleus, the inferior colliculus, and/or any other nuclei in the auditory pathway. To this end, sound processor 104 may process the one or more audio signals in accordance with a selected sound processing strategy or program to generate appropriate stimulation parameters for controlling cochlear implant 108. Sound processor 104 may be housed within any suitable housing (e.g., a behind-the-ear (“BTE”) unit, a body worn device, headpiece 106, and/or any other sound processing unit as may serve a particular implementation).
In some examples, sound processor 104 may wirelessly transmit stimulation parameters (e.g., in the form of data words included in a forward telemetry sequence) and/or power signals to cochlear implant 108 by way of a wireless communication link 114 between headpiece 106 and cochlear implant 108 (e.g., a wireless link between a coil disposed within headpiece 106 and a coil physically coupled to cochlear implant 108). It will be understood that communication link 114 may include a bi-directional communication link and/or one or more dedicated uni-directional communication links.
Headpiece 106 may be communicatively coupled to sound processor 104 and may include an external antenna (e.g., a coil and/or one or more wireless communication components) configured to facilitate selective wireless coupling of sound processor 104 to cochlear implant 108. Headpiece 106 may additionally or alternatively be used to selectively and wirelessly couple any other external device to cochlear implant 108. To this end, headpiece 106 may be configured to be affixed to the recipient's head and positioned such that the external antenna housed within headpiece 106 is communicatively coupled to a corresponding implantable antenna (which may also be implemented by a coil and/or one or more wireless communication components) included within or otherwise associated with cochlear implant 108. In this manner, stimulation parameters and/or power signals may be wirelessly transmitted between sound processor 104 and cochlear implant 108 via communication link 114.
Cochlear implant 108 may include any suitable type of implantable stimulator. For example, cochlear implant 108 may be implemented by an implantable cochlear stimulator. Additionally or alternatively, cochlear implant 108 may include a brainstem implant and/or any other type of cochlear implant that may be implanted within a recipient and configured to apply stimulation to one or more stimulation sites located along an auditory pathway of a recipient.
In some examples, cochlear implant 108 may be configured to generate electrical stimulation representative of an audio signal processed by sound processor 104 (e.g., an audio signal detected by microphone 102) in accordance with one or more stimulation parameters transmitted thereto by sound processor 104. Cochlear implant 108 may be further configured to apply the electrical stimulation to one or more stimulation sites (e.g., one or more intracochlear regions) within the recipient via electrodes 112 disposed along electrode lead 110. In some examples, cochlear implant 108 may include a plurality of independent current sources each associated with a channel defined by one or more of electrodes 112. In this manner, different stimulation current levels may be applied to multiple stimulation sites simultaneously by way of multiple electrodes 112.
Storage facility 302 may maintain (e.g., store) executable data used by processing facility 304 to perform any of the operations described herein. For example, storage facility 302 may store instructions 306 that may be executed by processing facility 304 to perform any of the operations described herein. Instructions 306 may be implemented by any suitable application, software, code, and/or other executable data instance. Storage facility 302 may also maintain any data received, generated, managed, used, and/or transmitted by processing facility 304.
Processing facility 304 may be configured to perform (e.g., execute instructions 306 stored in storage facility 302 to perform) various operations associated with measuring an ESRT for a cochlear implant recipient. For example, processing facility 304 may 1) direct a display screen to display a graphical user interface that includes a plurality of columns corresponding to a plurality of electrodes disposed on an electrode lead implanted at least partially within a cochlea of a recipient of a cochlear implant, 2) graphically indicate, within the graphical user interface, an initial stimulation level, 3) direct the cochlear implant to step through applying a sequence of stimulation events each having a different stimulation level to an electrode set included in the plurality of electrodes, the sequence of stimulation events beginning with a first stimulation event that has the initial stimulation level, 4) detect, while the cochlear implant is stepping through applying the sequence of stimulation events to the electrode set, user input indicating that a stapedial reflex state within the recipient changes from a first reflex state to a second reflex state, 5) identify a particular stimulation event included in the sequence of stimulation events that corresponds to the change in the stapedial reflex state from the first reflex state to the second reflex state, the particular stimulation event having a particular stimulation level, and 6) graphically present, within one or more columns included in the plurality of columns and corresponding to the electrode set, one or more graphical markers indicating that the stapedial reflex state is the second reflex state at the particular stimulation level. These and other operations that may be performed by processing facility 304 are described in more detail herein.
Diagnostic system 300 may be implemented in any suitable manner. For example, diagnostic system 300 may be implemented by a stand-alone diagnostic system that may be used in or outside a surgical operating room to perform any of the operations described herein.
In the configuration shown in
Display screen 406 may be configured to display any suitable content associated with an application executed by processor 408. Display screen 406 may be implemented by a touchscreen and/or any other type of display screen as may serve a particular implementation.
Processor 408 may be configured to execute a diagnostic application associated with a cochlear implant (e.g., cochlear implant 108). For example, processor 408 may execute a diagnostic application that may be used during a procedure (e.g., an intraoperative or postoperative procedure) associated with the cochlear implant. The diagnostic application may be configured to perform various diagnostic operations associated with the cochlear implant during the procedure. Exemplary diagnostic operations are described herein.
In some examples, processor 408 may direct display screen 406 to display a graphical user interface associated with the diagnostic application being executed by processor 408. A user may interact with the graphical user interface to adjust one or more parameters associated with the cochlear implant and/or otherwise obtain information that may be useful during a procedure associated with the cochlear implant.
Base module 404 may be configured to attach to computing module 402 and serve as a stand for computing module 402.
Interface unit 410 is configured to be communicatively coupled to processor 408 by way of connection 420 while base module 404 is attached to computing module 402. Interface unit 410 is further configured to be communicatively coupled to the cochlear implant while base module 404 is attached to computing module 402. In this manner, interface unit 410 provides an interface between processor 408 and the cochlear implant.
Interface unit 410 may be communicatively coupled to the cochlear implant by way of communications port 416. For example, communications port 416 may be selectively coupled to a coil (e.g., a coil included in a headpiece, such as headpiece 106, or a disposable stand-alone coil) configured to wirelessly communicate with the cochlear implant. Interface unit 410 may communicate with the cochlear implant by transmitting and/or receiving data to/from the cochlear implant by way of the coil connected to communications port 416.
Interface unit 410 may be further configured to generate and provide acoustic stimulation (e.g., sound waves) to the recipient of the cochlear implant. To this end, audio output port 414 is configured to be selectively coupled to a sound delivery apparatus. In some examples, the sound delivery apparatus may be implemented by tubing that has a distal portion configured to be placed in or near an entrance to an ear canal of a recipient of the cochlear implant. While the sound delivery apparatus is connected to audio output port 414, interface unit 410 may transmit the acoustic stimulation to the recipient by way of the sound delivery apparatus.
As shown, audio amplifier 412 may be positioned within a path between interface unit 410 and audio output port 414. In this configuration, audio amplifier 412 may be configured to amplify the acoustic stimulation before the acoustic stimulation is delivered to the recipient by way of audio output port 414 and the sound delivery apparatus. In some alternative examples, amplification of the acoustic stimulation generated by interface unit 410 is not necessary, thereby obviating the need for audio amplifier 412 to be included in base module 404. Hence, in some implementations, base module 404 does not include audio amplifier 412.
In some examples, diagnostic system 400 may be configured to self-calibrate and/or perform in-situ testing. For example, processor 408 may calibrate an amplitude level of acoustic stimulation generated by interface unit 410 before and/or during a procedure in which diagnostic system 400 is used to perform any of the operations described herein. Such self-calibration and in-situ testing may be performed in any suitable manner.
As mentioned, base module 404 may be selectively detached from computing module 402. To illustrate,
In the example of
As shown, a cable 616 of a headpiece 618 is connected to communications port 416. In this configuration, interface unit 410 may wirelessly communicate with cochlear implant 610 by way a coil and/or other electronics included in headpiece 618, which may be similar to headpiece 106.
As also shown, a sound delivery apparatus 620 is connected to audio output port 414. Sound delivery apparatus 620 includes tubing 622 and an ear insert 624. Ear insert 624 is configured to fit at or within an entrance of ear canal 604. Tubing 622 and ear insert 624 together form a sound propagation channel 626 that delivers acoustic stimulation provided by interface unit 410 to the ear canal 604. Tubing 622 and ear insert 624 may be made out of any suitable material as may serve a particular implementation.
In some examples, processor 408 may execute a diagnostic application. In accordance with the diagnostic application, processor 408 may transmit, by way of connection 420, a command (also referred to as a stimulation command) to interface unit 410 for interface unit 410 to apply acoustic stimulation to the recipient. In response to receiving the command, interface unit 410 may generate and apply the acoustic stimulation to the recipient by way of audio output port 414 and sound delivery apparatus 620.
As another example, in accordance with the diagnostic application, processor 408 may transmit, by way of connection 420, a command to interface unit 410 for interface unit 410 to direct cochlear implant 610 to apply electrical stimulation to the recipient by way of one or more electrodes included on electrode lead 612. In response to receiving the command, interface unit 410 may transmit a command to cochlear implant 610 for cochlear implant 610 to generate and apply the electrical stimulation to the recipient by way of the one or more electrodes.
In configuration 600, headpiece 618 is connected directly to communications port 416 by way of cable 616. Hence, in configuration 600, interface unit 410 is configured to directly control cochlear implant 610.
As shown, sound processor 702 is connected to communications port 416 by way of a cable 704. Sound processor 702 is also connected to headpiece 618 by way of cable 616. In this configuration, sound processor 702 may relay data and/or commands between interface unit 410 and cochlear implant 610.
It will be recognized that diagnostic system 400 may be additionally or alternatively implemented in any other suitable manner. For example, diagnostic system 400 may be implemented by a fitting system utilized in a clinician's office and/or by any other appropriately configured system or device.
An exemplary hardware implementation of diagnostic system 400 will now be described in connection with
The hardware implementation of diagnostic system 400 illustrated in
Display screen 406 is located on front side 902 of computing module 402. Various other components are also located on the front side 902 of computing module 402. For example, a fingerprint scanner 914, physical input buttons 916, and a webcam 918 all shown to be included on the front side 902 of computing module 402. It will be recognized that any of these components may be located on any other side of computing module 402 as may serve a particular implementation.
Fingerprint scanner 914 is configured to facilitate authentication of a user of diagnostic system 400. For example, fingerprint scanner 914 may detect a fingerprint of the user and provide processor 408 with data representative of the fingerprint. Processor 408 may process the fingerprint data in any suitable manner (e.g., by comparing the fingerprint to known fingerprints included in a database) to authenticate the user.
Webcam 918 may be configured to facilitate video communication by a user of diagnostic system 400 with a remotely located user (e.g., during or after a surgical procedure). Such video communication may be performed in any suitable manner.
Physical input buttons 916 may be implemented, for example, by a directional pad and/or any other suitable type of physical input button. A user of diagnostic system 400 may interact with physical input buttons 916 to perform various operations with respect to a diagnostic application being executed by processor 408. For example, the user may use the physical input buttons 916 to interact with a graphical user interface displayed on display screen 406.
In some examples, physical input buttons 916 may be configured to be selectively programmed (e.g., as hotkeys) to perform one or more functions associated with the diagnostic application. For example, a particular physical input button 916 may be programmed by a user to start and/or stop acoustic stimulation being applied to a cochlear implant recipient by diagnostic system 400.
In some examples, processor 408 may be configured to wirelessly connect to an input device configured to be used by the user in connection with the diagnostic application. For example, processor 408 may be configured to wirelessly connect (e.g., via Bluetooth and/or any other suitable wireless communication protocol) to a keyboard, mouse, remote control, and/or any other wireless input device as may serve a particular implementation. In this manner, the user may selectively use physical input buttons 916, a touchscreen capability of display screen 406, and/or a wireless input device to interact with diagnostic system 400.
As shown, a hole 920 may be formed within computing module 402 and configured to serve as a handle for diagnostic system 400. A user may grip computing module 402 by placing his or her fingers within hole 920.
As shown, a barcode scanner 922 may be located on left side 906 of computing module 402. Barcode scanner 922 may alternatively be located on any other side of computing module 402. In some examples, barcode scanner 922 may be configured to scan for an activation code included on one or more components associated with a procedure being performed with respect to cochlear implant 510. The activation code may be used to associate (e.g., register) the components with cochlear implant 510.
As illustrated in
As illustrated in
As described above, base module 404 may be configured to serve as a stand for computing module 402 while base module 404 is attached to computing module 402. The stand functionality of base module 404 is illustrated in
As shown, base module 404 includes a top surface 928 configured to selectively attach to back side 904 of computing module 402. Base module 404 may alternatively attach to any other side of computing module 402. Base module 404 further includes a bottom surface 930 configured to be placed on a resting surface 932. Bottom surface 930 is angled with respect to back side 904 of computing module 402. This provides a viewing angle 934 for display screen 406 that is greater than zero degrees with respect to resting surface 932. In some examples, base module 404 may be adjustable to selectively provide different viewing angles for display screen 406 with respect to resting surface 932. This adjustability may be realized in any suitable manner. For example, a user may manually adjust bottom surface 930 to different angles with respect to back side 904 of computing module 402.
Various operations that may be performed by diagnostic system 300 will now be described. It will be recognized that diagnostic system 300 may perform additional or alternative operations to those described herein as may serve a particular implementation.
As mentioned, diagnostic system 300 may direct a display screen to display a graphical user interface that includes a plurality of columns corresponding to a plurality of electrodes disposed on an electrode lead implanted at least partially within a cochlea of a recipient of a cochlear implant. The display screen may be similar to or implemented by any of the display screens described herein. Diagnostic system 300 may direct the display screen to display the graphical user interface in accordance with a diagnostic application being executed by diagnostic system 300.
As shown, each column along an x-axis of graph 1302 is labeled with and corresponds to a particular electrode number. Each electrode number represents an electrode disposed on an electrode lead that has been at least partially implanted within a cochlea of a recipient of a cochlear implant. In the examples provided herein, it will be assumed that sixteen electrodes are disposed on the electrode lead. The most apical electrode (i.e., the electrode that is most distally located on the electrode lead) is labeled “1” in graph 1302. The most basal electrode (i.e., the electrode that is most proximately located on the electrode lead) is labeled “16” in graph 1302. It will be recognized that any number of electrodes may be disposed on the electrode lead as may serve a particular implementation. It will also be recognized that while the columns within graph 1302 are vertically oriented, they may alternatively be horizontally oriented.
The y-axis in graph 1302 represents various stimulation levels of stimulation events that may be applied to an electrode set included in the electrodes disposed on the electrode lead.
Diagnostic system 300 may graphically indicate, within graphical user interface 1300, an initial stimulation level. For example, in graphical user interface 1300, the initial stimulation level is 870 clinical units (CU) and is graphically indicated by a horizontal stimulation level indicator 1320 within graph 1302 and by stimulation level adjustment field 1310. It will be recognized that the initial stimulation level may alternatively be graphically indicated by any other suitable graphical object. In some examples, a user may reposition stimulation level indicator 1320 (e.g., by graphically dragging stimulation level indicator 1320 to a different position within graph 1302). Diagnostic system 300 may detect this repositioning and adjust the initial stimulation level based on the repositioning. For example, in response to a user repositioning stimulation level indicator 1320 to a stimulation level of 700 CU, diagnostic system 300 may set the initial stimulation level to be equal to 700 CU.
The initial stimulation level represents a stimulation level at which a cochlear implant within a recipient is to begin stepping through applying a sequence of stimulation events to an electrode set included within the plurality of electrodes disposed on the electrode lead. As used herein, a stimulation event includes one or more periods of electrical stimulation applied at a particular stimulation level. For example, as will be described herein, a stimulation event may include a set number (e.g., three) of temporally spaced periods of electrical stimulation each applied at the same stimulation level.
The electrode set to which the sequence of stimulation events is applied may include any number of electrodes disposed on the electrode lead. In some examples, a user may interact with graphical user interface 1300 to select electrodes for inclusion in the electrode set. For example, the user may position electrode grouping selector 1308 over a preset electrode grouping number (e.g., sixteen electrodes, four electrodes, or one electrode) to indicate how many electrodes are to be included in the electrode set. In the example of
Stimulation event sequence direction selector 1316 is configured to set a direction (e.g., high to low or low to high) of the stimulation event sequence that is applied by the cochlear implant to the electrode set. For example, in
Auto/manual selector 1318 is configured to set a manner in which the stimulation events are applied to the electrode set. In the example of
In response to a selection by a user of start option 1304, diagnostic system 300 may direct the cochlear implant to step through applying a sequence of stimulation events each having a different stimulation level to the electrode set. At any point during the application of the stimulation events, the user may select stop option 1306 to stop the application of the sequence of events.
The sequence of stimulation events begins with a first stimulation event that has the initial stimulation level. Depending on the sequence direction set by stimulation event sequence direction selector 1316, diagnostic system 300 may direct the cochlear implant to either incrementally increase the stimulation level of each subsequent stimulation event included in the sequence of stimulation events or incrementally decrease the stimulation level of each subsequent stimulation event included in the sequence of stimulation events. Examples of both sequence directions will be provided herein.
While the cochlear implant is stepping through applying the sequence of stimulation events to the electrode set, the user may visually monitor for a stapedial reflex that occurs in response to one or more of the stimulation events. For example, as described above, the user may look through a surgical microscope at the stapedius muscle to observe when the stapedius muscle twitches or otherwise physically responds to a particular stimulation event. If the user detects a change in a stapedial reflex state from a first reflex state to a second reflex state, the user may provide user input indicative of the change. For example, the user may select option 1312 or option 1314, depending on the nature of the change.
Diagnostic system 300 may detect the user input and, in response, identify a particular stimulation event included in the sequence of stimulation events that corresponds to the change in the stapedial reflex state from the first reflex state to the second reflex state. Diagnostic system 300 may graphically present, within one or more columns that correspond to the electrode set, one or more graphical markers indicating that the stapedial reflex state is the second reflex state at a stimulation level of the stimulation event.
Various examples will now be provided. It will be recognized that the examples provided herein are merely illustrative of the many different manners in which the systems and methods described herein may be used to facilitate measurement of an ESRT in a cochlear implant recipient.
Diagnostic system 300 may direct the cochlear implant to apply the stimulation event in any suitable manner. For example, diagnostic system 300 may transmit a command to a sound processor (e.g., sound processor 702) associated with the cochlear implant. The command may direct the sound processor to transmit a command to the cochlear implant for the cochlear implant to apply the stimulation event to the electrode set.
Each period of electrical stimulation 1402 may include one or more pulses of electrical stimulation each having a stimulation level equal to the initial stimulation level associated with stimulation event 1400. This stimulation level is represented in
In some examples, diagnostic system 300 may graphically indicate, within one or more columns of graph 1302, an occurrence of each of the temporally spaced periods of electrical stimulation 1402. To illustrate,
In some examples, the vertical bars may be displayed only during a period of electrical stimulation that is applied by the cochlear implant. Hence, if there are three periods of electrical stimulation during the stimulation event, the vertical bars may be displayed during three discreet and temporally separated time periods (e.g., in a flashing manner).
Diagnostic system 300 may be further configured to audibly indicate an occurrence of each of the periods of electrical stimulation 1402. For example, diagnostic system 300 may present sound (e.g., by way of one or more speakers that are included in or connected to diagnostic system 300) representative of the periods of electrical stimulation 1402. The sound may be presented in a synchronized manner with the presentation of the vertical bars representative of the periods of electrical stimulation 1402.
While the stimulation event having the initial stimulation level of 870 CU is applied by the cochlear implant to the electrode set, the user may monitor for an occurrence of a stapedial reflex. If the user does not provide, within a predetermined amount of time (e.g., a few seconds) subsequent to an occurrence of the stimulation event, user input indicating that no stapedial reflex occurred in response to the stimulation event, diagnostic system 300 may automatically determine that a stapedial reflex did occur in response to the stimulation event. Such user input may be provided by the user selecting option 1314 and/or in any other suitable manner.
The determination that a stapedial reflex occurred in response to the stimulation event is based on stimulation event sequence direction selector 1316 being set to high to low. Alternatively, as will be described below, if stimulation event sequence direction selector 1316 is set to low to high, diagnostic system 300 may automatically determine that that a stapedial reflex did not occur in response to the stimulation event unless user input to the contrary is received within the predetermined amount of time subsequent to the occurrence of the stimulation event.
In response to the determination that the stapedial reflex occurred in response to the stimulation event, diagnostic system 300 may automatically present graphical markers within graph 1302 that indicate that the stapedial reflex occurred in response to the stimulation event. To illustrate,
Upon completion of the first stimulation event (i.e., the stimulation event that has the initial stimulation level), diagnostic system 300 may automatically direct the cochlear implant to apply a second stimulation event that has an incrementally decreased stimulation level compared to the initial stimulation level.
To illustrate,
In this example, diagnostic system 300 again determines that a stapedial reflex occurred in response to the second stimulation event (e.g., by not receiving user input to the contrary). In response, as shown in
Upon completion of the second stimulation event, diagnostic system 300 may automatically direct the cochlear implant to apply a third stimulation event that has an incrementally decreased stimulation level compared to the stimulation level of the second stimulation event. To illustrate,
Once the stimulation level for the third stimulation event has been set, diagnostic system 300 may direct the cochlear implant to apply the third stimulation event to the electrode set. A graphical representation of the third stimulation event may be displayed within the columns of graph 1302, as illustrated by the vertical bars (e.g., vertical bar 1902) shown in
In this example, the user provides user input that a stapedial reflex did not occur in response to the third stimulation event. For example, the user may select option 1314. In response, diagnostic system 300 may direct the cochlear implant to stop applying the sequence of stimulation events. As shown in
In some examples, diagnostic system 300 may use the stimulation level of the stimulation event at which a change in the stapedial reflex state is detected to determine an ESRT for the recipient. For example, in the example just provided, diagnostic system 300 may designate a stimulation level of somewhere between 770 CU and 820 CU as the ESRT for the recipient. In some examples, diagnostic system 300 may store data representative of the ESRT and use this data to perform one or more fitting operations with respect to the recipient. For example, diagnostic system 300 may use the data representative of the ESRT to determine an M level for the recipient. In some examples, the stimulation level associated with the ESRT is designated as also being the M level for the recipient. Alternatively, the M level may be designated as being a certain amount above or below the stimulation level designated as being the ESRT. In some examples, diagnostic system 300 may program a sound processor associated with the cochlear implant to use the M level in a sound processing program that the sound processor uses to direct the cochlear implant to apply electrical stimulation representative of sounds presented to the recipient.
As mentioned, a user may select any number of electrodes to be included in the electrode set to which the stimulation events are applied. For example,
In some examples, diagnostic system 300 may automatically select the number of electrodes included in the electrode set to which the stimulation events are applied. For example, once a first sequence of stimulation events has been applied to an electrode set that includes all sixteen electrodes, diagnostic system 300 may automatically direct the cochlear implant to start applying a new sequence of stimulation events to an electrode set that includes only four electrodes. The new sequence of stimulation events may have an initial stimulation level equal to the stimulation level at which the first sequence of stimulation events stopped being applied. In this manner, a user may more easily determine a refined ESRT for progressively smaller sets of electrodes.
A graphical representation of the first stimulation event may be displayed within the columns of graph 1302, as illustrated by the vertical bars (e.g., vertical bar 2302) shown in
In this example, the user does not provide user input in response to the first stimulation event. Accordingly, diagnostic system 300 automatically determines that a stapedial reflex did not occur in response to the first stimulation event. In response, as shown in
Upon completion of the first stimulation event, diagnostic system 300 may automatically direct the cochlear implant to apply a second stimulation event that has an incrementally increased stimulation level compared to the second stimulation level. To illustrate,
Once the stimulation level for the second stimulation event has been set, diagnostic system 300 may direct the cochlear implant to apply the second stimulation event to the electrode set. A graphical representation of the second stimulation event may be displayed within the columns of graph 1302, as illustrated by the vertical bars (e.g., vertical bar 2502) shown in
In this example, the user provides user input that a stapedial reflex did occur in response to the second stimulation event. For example, the user may select option 1312. In response, diagnostic system 300 may direct the cochlear implant to stop applying the sequence of stimulation events. As shown in
In some examples, diagnostic system 300 may perform an impedance test on the plurality of electrodes disposed on the electrode array prior to performing an ESRT measurement session. If diagnostic system 300 determines that a particular electrode included in the plurality of electrodes has an impedance that is not within a predetermined valid range, diagnostic system 300 may exclude the electrode from being included in the electrode set to which stimulation events are applied. For example, if an impedance of an electrode is too high or too low, it may mean that the electrode is either open or shorted. Hence, the electrode may be excluded from being included in the electrode set to which stimulation events are applied.
In some examples, an excluded electrode may be graphically identified within graphical user interface 1300. For example,
Additional or alternative types of information may be presented within graphical user interface 1300 as may serve a particular implementation. For example, diagnostic system 300 may graphically indicate, within graphical user interface 1300, a compliance level associated with one or more electrodes. The compliance level may represent a maximum stimulation level that may be applied to the one or more electrodes.
In operation 2802, a diagnostic system directs a display screen to display a graphical user interface that includes a plurality of columns corresponding to a plurality of electrodes disposed on an electrode lead implanted at least partially within a cochlea of a recipient of a cochlear implant. Operation 2802 may be performed in any of the ways described herein.
In operation 2804, the diagnostic system graphically indicates, within the graphical user interface, an initial stimulation level. Operation 2804 may be performed in any of the ways described herein.
In operation 2806, the diagnostic system directs the cochlear implant to step through applying a sequence of stimulation events each having a different stimulation level to an electrode set included in the plurality of electrodes, the sequence of stimulation events beginning with a first stimulation event that has the initial stimulation level. Operation 2806 may be performed in any of the ways described herein.
In operation 2808, the diagnostic system detects, while the cochlear implant is stepping through applying the sequence of stimulation events to the electrode set, user input indicating that a stapedial reflex state within the recipient changes from a first reflex state to a second reflex state. Operation 2808 may be performed in any of the ways described herein.
In operation 2810, the diagnostic system identifies a particular stimulation event included in the sequence of stimulation events that corresponds to the change in the stapedial reflex state from the first reflex state to the second reflex state, the particular stimulation event having a particular stimulation level. Operation 2810 may be performed in any of the ways described herein.
In operation 2812, the diagnostic system graphically presents, within one or more columns included in the plurality of columns and corresponding to the electrode set, one or more graphical markers indicating that the stapedial reflex state is the second reflex state at the particular stimulation level. Operation 2812 may be performed in any of the ways described herein.
In some examples, a non-transitory computer-readable medium storing computer-readable instructions may be provided in accordance with the principles described herein. The instructions, when executed by a processor of a computing device, may direct the processor and/or computing device to perform one or more operations, including one or more of the operations described herein. Such instructions may be stored and/or transmitted using any of a variety of known computer-readable media.
A non-transitory computer-readable medium as referred to herein may include any non-transitory storage medium that participates in providing data (e.g., instructions) that may be read and/or executed by a computing device (e.g., by a processor of a computing device). For example, a non-transitory computer-readable medium may include, but is not limited to, any combination of non-volatile storage media and/or volatile storage media. Exemplary non-volatile storage media include, but are not limited to, read-only memory, flash memory, a solid-state drive, a magnetic storage device (e.g. a hard disk, a floppy disk, magnetic tape, etc.), ferroelectric random-access memory (“RAM”), and an optical disc (e.g., a compact disc, a digital video disc, a Blu-ray disc, etc.). Exemplary volatile storage media include, but are not limited to, RAM (e.g., dynamic RAM).
Communication interface 2902 may be configured to communicate with one or more computing devices. Examples of communication interface 2902 include, without limitation, a wired network interface (such as a network interface card), a wireless network interface (such as a wireless network interface card), a modem, an audio/video connection, and any other suitable interface.
Processor 2904 generally represents any type or form of processing unit capable of processing data and/or interpreting, executing, and/or directing execution of one or more of the instructions, processes, and/or operations described herein. Processor 2904 may perform operations by executing computer-executable instructions 2912 (e.g., an application, software, code, and/or other executable data instance) stored in storage device 2906.
Storage device 2906 may include one or more data storage media, devices, or configurations and may employ any type, form, and combination of data storage media and/or device. For example, storage device 2906 may include, but is not limited to, any combination of the non-volatile media and/or volatile media described herein. Electronic data, including data described herein, may be temporarily and/or permanently stored in storage device 2906. For example, data representative of computer-executable instructions 2912 configured to direct processor 2904 to perform any of the operations described herein may be stored within storage device 2906. In some examples, data may be arranged in one or more databases residing within storage device 2906.
I/O module 2908 may include one or more I/O modules configured to receive user input and provide user output. I/O module 2908 may include any hardware, firmware, software, or combination thereof supportive of input and output capabilities. For example, I/O module 2908 may include hardware and/or software for capturing user input, including, but not limited to, a keyboard or keypad, a touchscreen component (e.g., touchscreen display), a receiver (e.g., an RF or infrared receiver), motion sensors, and/or one or more input buttons.
I/O module 2908 may include one or more devices for presenting output to a user, including, but not limited to, a graphics engine, a display (e.g., a display screen), one or more output drivers (e.g., display drivers), one or more audio speakers, and one or more audio drivers. In certain embodiments, I/O module 2908 is configured to provide graphical data to a display for presentation to a user. The graphical data may be representative of one or more graphical user interfaces and/or any other graphical content as may serve a particular implementation.
In some examples, any of the systems, computing devices, and/or other components described herein may be implemented by computing device 2900. For example, storage facility 302 may be implemented by storage device 2906, and processing facility 304 may be implemented by processor 2904.
In the preceding description, various exemplary embodiments have been described with reference to the accompanying drawings. It will, however, be evident that various modifications and changes may be made thereto, and additional embodiments may be implemented, without departing from the scope of the invention as set forth in the claims that follow. For example, certain features of one embodiment described herein may be combined with or substituted for features of another embodiment described herein. The description and drawings are accordingly to be regarded in an illustrative rather than a restrictive sense.