Apparatus and methods for acoustically or mechanically stimulating a cochlea and intracochlear recording of mechanically or acoustically evoked auditory potentials in the cochlea

Abstract

An apparatus for acoustic or mechanical stimulation of a cochlea and measurement of acoustically or mechanically evoked electrophysiologic responses from the cochlea is provided. In one example, the apparatus includes an acoustic stimulator for generating an acoustic signal and an electrophysiologic response measuring device positioned proximal the cochlea or within the cochlea for measuring an acoustically evoked electrophysiologic response to the acoustic signal. Methods of utilizing the apparatus for diagnostic and therapeutic procedures related to hearing impairment are also provided.

1 . An apparatus for acoustic stimulation and electrophysiologic response measurement of a cochlea or auditory nerve, comprising:
 a stimulator, wherein the stimulator generates one of an acoustic and a mechanical signal; and   an electrophysiologic response measuring device positionable within a cochlea, wherein the measuring device measures an electrophysiologic response by the cochlea or auditory nerve to the stimulating signal, wherein the electrophysiologic response includes a cochlear microphonic potential.   
   
   
       2 . The apparatus of  claim 1  wherein the stimulator comprises a speaker that generates the acoustic signal. 
   
   
       3 . The apparatus of  claim 1  wherein the stimulator comprises one of:
 a vibrotactile stimulator for generating a mechanical signal and for applying the signal to a portion of the patient's inner ear;   a direct drive system for the ossicular chain;   a bone anchored hearing aid; and   a bone conduction hearing aid.   
   
   
       4 . The apparatus of  claim 1  wherein the electrophysiologic response measuring device comprises a modified cochlear implant. 
   
   
       5 . The apparatus of  claim 1  wherein the electrophysiologic response measurement device comprises a diagnostic intracochlear device that is not a cochlear implant and that is usable for diagnostic purposes alone or in combination with intracochlear drug delivery. 
   
   
       6 . The apparatus of  claim 1  wherein the electrophysiologic response is correlated with a behavioral audiometric response of a subject. 
   
   
       7 . The apparatus of  claim 1  wherein the electrophysiologic response measurement device is positioned within the cochlea for measurement of the electrophysiologic response and is thereafter withdrawn from the cochlea. 
   
   
       8 . The apparatus of  claim 1  wherein the electrophysiologic response includes a summating potential. 
   
   
       9 . The apparatus of  claim 1  wherein the electrophysiologic response includes a compound action potential (CAP). 
   
   
       10 . The apparatus of  claim 1  wherein the cochlear microphonic is recorded for a cochlear implant recipient who has lost residual hearing. 
   
   
       11 . The apparatus of  claim 1  wherein the electrophysiologic response comprises at least one acoustically or mechanically evoked intracochlear recording for a cochlear implant recipient during implantation and at least one acoustically or mechanically evoked intracochlear recording for the cochlear implant recipient after implantation. 
   
   
       12 . The apparatus of  claim 1  wherein the electrophysiologic response measurement device is configured to measure cochlear trauma caused by insertion of the device into the cochlea. 
   
   
       13 . The apparatus of  claim 1  wherein the electrophysiologic response measurement device is configured to deliver diagnostic electrical stimulation to the cochlea. 
   
   
       14 . An apparatus for acoustic stimulation and electrophysiologic response measurement of a cochlea or auditory nerve, comprising:
 a stimulator, wherein the stimulator generates one of an acoustic and a mechanical signal; and   an electrophysiologic response measuring device positionable within a cochlea, wherein the measuring device measures an electrophysiologic response by the cochlea or auditory nerve to the stimulating signal and wherein the electrophysiologic response measurement device comprises a diagnostic device configured to be inserted in the cochlea for diagnostic purposes and thereafter withdrawn from the cochlea.   
   
   
       15 . A method of measuring a cochlear electrophysiologic response to an acoustic signal, comprising:
 stimulating a cochlea with one of an acoustic signal and a mechanical signal; and   measuring an electrophysiologic response by the cochlea or auditory nerve to the acoustic signal using an electrophysiologic response measuring device positionable within the cochlea, wherein the electrophysiologic response comprises a cochlear microphonic potential.   
   
   
       16 . The method of  claim 15  wherein stimulating the cochlea comprises acoustically stimulating the cochlea with an acoustic stimulator. 
   
   
       17 . The method of  claim 15  wherein stimulating the cochlea comprises using one of:
 a vibrotactile stimulator for generating a mechanical signal and for applying the signal to a portion of the patient's inner ear;   a direct drive system for the ossicular chain;   a bone anchored hearing aid; and   a bone conduction hearing aid.   
   
   
       18 . The method of  claim 15  wherein the electrophysiologic response measuring device comprises a modified cochlear implant modified. 
   
   
       19 . The method of  claim 15  wherein the electrophysiologic response measurement device comprises a diagnostic intracochlear device that is not a cochlear implant and that is usable for diagnostic purposes alone or in combination with intracochlear drug delivery. 
   
   
       20 . The method of  claim 15  comprising correlating the electrophysiologic response with a behavioral audiometry response of a subject. 
   
   
       21 . The method of  claim 15  wherein the electrophysiologic response measurement device is positioned within the cochlea and is thereafter withdrawn from the cochlea. 
   
   
       22 . The method of  claim 15  wherein the electrophysiologic response includes a summating potential. 
   
   
       23 . The method of  claim 15  wherein the electrophysiologic response includes a compound action potential (CAP). 
   
   
       24 . The method of  claim 15  wherein the cochlear microphonic potential is recorded for a cochlear implant recipient who has lost residual hearing. 
   
   
       25 . The method of  claim 15  comprising:
 determining a hearing impairment in the cochlea based on the measured electrophysiologic response; and   selecting a therapy based on the determined hearing impairment.   
   
   
       26 . The method of  claim 25  wherein the therapy is selected from the group consisting of a cochlear implant, a drug, a gene therapy, a stem cell therapy, and combinations thereof. 
   
   
       27 . The method of  claim 25  wherein selecting a therapy based on the determined hearing impairment includes determining whether or note electric-acoustic stimulation therapy is feasible or not. 
   
   
       28 . The method of  claim 15  comprising measuring, using the electrophysiologic measurement device, cochlear trauma caused by insertion of the device into the cochlea. 
   
   
       29 . The method of  claim 15  comprising delivering, using the electrophysiologic response measurement device, electrical stimulation to the cochlea.