PDF(Pubmed)
Abstract：
Cochlear implants (CI) represent incredible devices that restore hearing perception for those with moderate to profound sensorineural hearing loss. However, the ability of a CI to restore complex auditory function is limited by the number of perceptually independent spectral channels provided. A major contributor to this limitation is the physical gap between the CI electrodes and the target spiral ganglion neurons (SGNs). In order for CI electrodes to stimulate SGNs more precisely, and thus better approximate natural hearing, new methodologies need to be developed to decrease this gap, (i.e., transitioning CIs from a far-field to near-field device). In this review, strategies aimed at improving the neural-electrode interface are discussed in terms of the magnitude of impact they could have and the work needed to implement them. Ongoing research suggests current clinical efforts to limit the CI-related immune response holds great potential for improving device performance. This could eradicate the dense, fibrous capsule surrounding the electrode and enhance preservation of natural cochlear architecture, including SGNs. In the long term, however, optimized future devices will likely need to induce and guide the outgrowth of the peripheral process of SGNs to be in closer proximity to the CI electrode in order to better approximate natural hearing. This research is in its infancy; it remains to be seen which strategies (surface patterning, small molecule release, hydrogel coating, etc.) will be enable this approach. Additionally, these efforts aimed at optimizing CI function will likely translate to other neural prostheses, which face similar issues.
摘要：
耳蜗植入物（CI）代表了令人难以置信的设备，可以恢复中度至重度感觉神经性听力损失的人的听力感知。然而,aCI恢复复杂听觉功能的能力受到所提供的独立于感知的频谱通道数量的限制。造成这种限制的主要原因是CI电极和目标螺旋神经节神经元（SGN）之间的物理间隙。为了使CI电极更精确地刺激SGN，从而更好地接近自然听觉，需要开发新的方法来缩小这一差距，(即，将CI从远场设备转换为近场设备)。在这次审查中,旨在改善神经-电极界面的策略根据它们可能产生的影响大小和实施它们所需的工作进行了讨论。正在进行的研究表明，目前限制CI相关免疫反应的临床努力在改善设备性能方面具有巨大潜力。这可以根除密集的，围绕电极的纤维胶囊，增强天然耳蜗结构的保存，包括SGNS。从长远来看,然而,优化的未来设备可能需要诱导和引导SGN外围过程的生长，使其更接近CI电极，以便更好地接近自然听力。这项研究处于起步阶段；哪些策略(表面图案化，小分子释放，水凝胶涂层，等。)将启用这种方法。此外,这些旨在优化CI功能的努力可能会转化为其他神经假体，面临类似的问题。
