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Use of artificial intelligence (AI) is a burgeoning field in otolaryngology and the communication sciences. A virtual symposium on the topic was convened from Duke University on October 26, 2020, and was attended by more than 170 participants worldwide. This review presents summaries of all but one of the talks presented during the symposium; recordings of all the talks, along with the discussions for the talks, are available at https://www.youtube.com/watch?v=ktfewrXvEFg and https://www.youtube.com/watch?v=-gQ5qX2v3rg . Each of the summaries is about 2500 words in length and each summary includes two figures. This level of detail far exceeds the brief summaries presented in traditional reviews and thus provides a more-informed glimpse into the power and diversity of current AI applications in otolaryngology and the communication sciences and how to harness that power for future applications.

Cochlear implants are among the most successful neural prosthetic devices to date but exhibit poor frequency selectivity and the inability to consistently activate apical (low frequency) spiral ganglion neurons. These issues can limit hearing performance in many cochlear implant patients, especially for understanding speech in noisy environments and in perceiving or appreciating more complex inputs such as music and multiple talkers. For cochlear implants, electrical current must pass through the bony wall of the cochlea, leading to widespread activation of auditory nerve fibers. Cochlear implants also cannot be implanted in some individuals with an obstruction or severe malformations of the cochlea. Alternatively, intraneural stimulation delivered via an auditory nerve implant could provide direct contact with neural fibers and thus reduce unwanted current spread. More confined current during stimulation can increase selectivity of frequency fiber activation. Furthermore, devices such as the Utah Slanted Electrode Array can provide access to the full cross section of the auditory nerve, including low frequency fibers that are difficult to reach using a cochlear implant. However, further scientific and preclinical research of these Utah Slanted Electrode Array devices is limited by the lack of a chronic large animal model for the auditory nerve implant, especially one that leverages an appropriate surgical approach relevant for human translation. This paper presents a newly developed transbullar translabyrinthine surgical approach for implanting the auditory nerve implant into the cat auditory nerve. In our first of a series of studies, we demonstrate a surgical approach in non-recovery experiments that enables implantation of the auditory nerve implant into the auditory nerve, without damaging the device and enabling effective activation of the auditory nerve fibers, as measured by electrode impedances and electrically evoked auditory brainstemresponses. These positive resultsmotivate performing future chronic cat studies to assess the long-term stability and function of these auditory nerve implant devices, as well as development of novel stimulation strategies that can be translated to human patients. [ABSTRACT FROM AUTHOR]

Use of artificial intelligence (AI) is a burgeoning field in otolaryngology and the communication sciences. A virtual symposium on the topic was convened from Duke University on October 26, 2020, and was attended by more than 170 participants worldwide. This review presents summaries of all but one of the talks presented during the symposium; recordings of all the talks, along with the discussions for the talks, are available at https://www.youtube.com/watch?v=ktfewrXvEFg and https://www.youtube.com/watch?v=-gQ5qX2v3rg. Each of the summaries is about 2500 words in length and each summary includes two figures. This level of detail far exceeds the brief summaries presented in traditional reviews and thus provides a more-informed glimpse into the power and diversity of current AI applications in otolaryngology and the communication sciences and how to harness that power for future applications. [ABSTRACT FROM AUTHOR]

To date, objective measurements and psychophysical experiments have been used to measure frequency dependent basilar membrane (BM) delays in humans; however, in vivo measurements have not been made. This study aimed to measure BM delays by performing intracochlear electrocochleography in cochlear implant recipients. Sixteen subjects with various degrees of hearing abilities were selected. Postoperative Computer Tomography was performed to determine electrode locations. Electrical potentials in response to acoustic tone pips at 0.25, 0.5, 1, 2, and 4 kHz and clicks were recorded with electrodes at the frequency specific region. The electrode array was inserted up to the characteristic cochlear frequency region of 250 Hz for 6 subjects. Furthermore, the array was inserted in the region of 500 Hz for 15 subjects, and 1, 2, and 4 kHz were reached in all subjects. Intracochlear electrocochleography for each frequency-specific tone pip and clicks showed detectable responses in all subjects. The latencies differed among the cochlear location and the cochlear microphonic (CM) onset latency increased with decreasing frequency and were consistent with click derived band technique. Accordingly, BM delays in humans could be derived. The BM delays increased systematically along the cochlea from basal to apical end and were in accordance with Ruggero and Temchin, 2007. [ABSTRACT FROM AUTHOR]

Purpose: The round window approach has become the most preferred option for cochlear implant (CI) insertion, however, sometimes it may not be possible due to the (in)visibility of the round window membrane (RWM). We addressed the prevalence, consequences and indicators of difficult detection of the RWM in cochlear implant surgery. Methods: This study retrospectively analysed the operative reports and preoperative high resolution axial-computed tomography (CT) scans of a consecutive cohort of patients who underwent a CI insertion. The main outcomes were surgical outcomes of the RW approach, and assessment of radiological markers. Results: The operative reports showed that RWM insertion was feasible in 151 out of 153 patients. In 18% of the patients the RWM was difficult to visualize. All these patients had at least one intraoperative event. The chorda tympani nerve (CTN) or posterior canal wall was affected in 8% of the 153 patients and the fallopian canal in 6%. These patients had a facial-chorda tympani nerve distance on the CT scan that was considerably smaller than normal patients (1.5 mm vs 2.3 mm). In addition, a prediction line towards the anterolateral side of the RWM was found to be more prevalent in these patients' CT scans (sensitivity 81%, specificity 63%). Conclusion: The RW approach is feasible in almost all patients undergoing CI surgery. Difficult visualisation of the RWM seems to lead to at least one intraoperative event. Radiological measures showed that these patients had a smaller facial recess and a more anteriorly placed facial nerve, which can be used to better plan a safe insertion approach. [ABSTRACT FROM AUTHOR]

The direct hearing device (DHD) is a new auditory prosthesis that combines conventional hearing aid and middle ear implant technologies into a single device. The DHD is located deep in the ear canal and recreates sounds with mechanical movements of the tympanic membrane. A critical component of the DHD is the microactuator, which must be capable of moving the tympanic membrane at frequencies and magnitudes appropriate for normal hearing, with little distortion. The DHD actuator reported here utilized a voice coil actuator design and was 3.7 mm in diameter. The device has a smoothly varying frequency response and produces a precisely controllable force. The total harmonic distortion between 425 Hz and 10 kHz is below 0.5 % and acoustic noise generation is minimal. The device was tested as a tympanic membrane driver on cadaveric temporal bones where the device was coupled to the umbo of the tympanic membrane. The DHD successfully recreated ossicular chain movements across the frequencies of human hearing while demonstrating controllable magnitude. Moreover, the micro-actuator was validated in a short-term human clinical performance study where sound matching and complex audio waveforms were evaluated by a healthy subject.

The ubiquity of vibration sensors and accelerometers, as well as advances in microfabrication technologies, have led to the development of implantable devices for biomedical applications. This work describes a piezoelectric microelectromechanical systems accelerometer designed for potential use in auditory prostheses. The design includes an aluminum nitride bimorph beam with a silicon proof mass. Analytic models of the device sensitivity and noise are presented. These lead to a minimum detectable acceleration cost function for the sensor that can be used to optimize sensor designs more effectively than typical sensitivity maximizing or electrical noise minimizing approaches. A fabricated device with a $1~\mu \text{m}$ thick, $100~\mu \text{m}$ long, and $700~\mu \text{m}$ wide beam and a $400~\mu \text{m}$ thick, $63~\mu \text{m}$ long, and $740~\mu \text{m}$ wide proof mass is tested experimentally. Results indicate accurate modeling of the system sensitivity up to the first resonant frequency (1420 Hz). The low-frequency sensitivity of the device is 1.3 mV/g, and the input referred noise is 36.3 nV/ $\sqrt {\mathrm{Hz}}$ at 100 Hz and 11.8 nV/ $\sqrt {\mathrm{Hz}}$ at 1 kHz. The resulting minimum detectable acceleration at 100 Hz and 1 kHz is $28~\mu \text{g}/\sqrt {\mathrm{Hz}}$ and $9.1~\mu \text{g}/\sqrt {\mathrm{Hz}}$ , respectively. A brief explanation of the use of the validated cost function for sensor design is provided, as well as an example comparing the piezoelectric sensor design to another from the literature. It is concluded that a traditional single-resonance design cannot compete with the performance of acoustic sensors; therefore, novel device designs must be considered for implantable auditory prosthesis applications. [ABSTRACT FROM AUTHOR]

State-of-the-art hearing aids (HAs) try to overcome the deficit of poor speech intelligibility (SI) in noisy listening environments using digital noise reduction (NR) techniques. The application of time-frequency masks to the noisy sound input is a common NR technique to increase SI. The binary mask with its binary weights and the Wiener filter with continuous weights are representatives of a hard- and a soft-decision approach for time-frequency masking. In normal-hearing listeners, the ideal Wiener filter (IWF) outperforms the ideal binary mask (IBM) in terms of SI and speech quality with perfect SI even at very low signal-to-noise ratios. In this paper, both approaches were investigated for hearing-impaired (HI) listeners. Perceptual and auditory model-based measures were used for the evaluation. The IWF outperformed the IBM in terms of SI. Quality-wise, there was no overall difference between the NR algorithms perceived. Additionally, the processed signals were evaluated based on an auditory nerve model using the neurogram similarity metric (NSIM). The mean NSIM values were significantly different for intelligible and unintelligible sentences. The results suggest that a soft-mask seems to be promising for application in HAs. [ABSTRACT FROM AUTHOR]

Objective: We aim to extract and denoise the attended speaker in a noisy two-speaker acoustic scenario, relying on microphone array recordings from a binaural hearing aid, which are complemented with electroencephalography (EEG) recordings to infer the speaker of interest. Methods: In this study, we propose a modular processing flow that first extracts the two speech envelopes from the microphone recordings, then selects the attended speech envelope based on the EEG, and finally uses this envelope to inform a multichannel speech separation and denoising algorithm. Results: Strong suppression of interfering (unattended) speech and background noise is achieved, while the attended speech is preserved. Furthermore, EEG-based auditory attention detection (AAD) is shown to be robust to the use of noisy speech signals. Conclusions: Our results show that AAD-based speaker extraction from microphone array recordings is feasible and robust, even in noisy acoustic environments, and without access to the clean speech signals to perform EEG-based AAD. Significance: Current research on AAD always assumes the availability of the clean speech signals, which limits the applicability in real settings. We have extended this research to detect the attended speaker even when only microphone recordings with noisy speech mixtures are available. This is an enabling ingredient for new brain–computer interfaces and effective filtering schemes in neuro-steered hearing prostheses. Here, we provide a first proof of concept for EEG-informed attended speaker extraction and denoising. [ABSTRACT FROM AUTHOR]

Despite many considerable technical advances in the field of hearing aids and cochlear implants, people using auditory prostheses still have major problems with speech understanding in the presence of interfering sounds and with directional hearing. Both abilities are dependent on sound stream segregation in real-world listening environments. In this paper, two timely and important issues related to sound stream segregation in auditory prostheses are addressed, namely, the coding of monaural and binaural cues. Several state-of-the-art signal processing algorithms used in cochlear implants (CIs) and in hearing aids (HAs) are introduced. A review is given of some recent proposals to improve temporal coding in monaural CIs, and of recent work to improve the transmission of binaural cues in both HAs, CIs, and combined acoustic and electric hearing (bimodal hearing). The ultimate aim is to improve speech and music perception, and, additionally, the preservation of binaural cues to preserve directional hearing. [ABSTRACT FROM PUBLISHER]

Implantable bonebridge（BB） is suitable for patients over 5 years with conductive/mixed hearing loss and unilateral deafness, and the surgical approach depends on the anatomical structure of the patient's ear. Recent studies have shown that compared with other implantable hearing devices, implantable BB have more efficient hearing gain and lower incidence of complications. However, the postoperative effect of implantable BB on unilateral deafness patients and the poor compensation of low-frequency hearing threshold need to be further studied. This article reviews the clinical research on implantable BB, so as to provide some reference for clinicians to select hearing devices for patients individually., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

This paper provides a summary of the experience to date with (1) combined electric and acoustic stimulation of the auditory system (combined EAS) for persons with some residual hearing at low frequencies, and (2) a procedure called "partial deafness cochlear implantation" (PDCI) for persons with higher levels of residual hearing at low frequencies, including persons with normal or nearly normal hearing at 500 Hz and lower frequencies. The paper also presents new results on the dependence of outcomes according to the levels of the residual hearing. In broad terms, both combined EAS and PDCI are highly beneficial treatments, especially for speech reception in noise. In some cases synergistic effects are found, in which the speech reception score for combined EAS or PDCI is greater than the sum of the scores for electric or acoustic stimulation only. In addition, the new results demonstrate that patients with high levels of residual hearing (PDCI levels) receive benefits from cochlear implantation that are at least as great as the benefits received by patients with lower levels of residual hearing. This finding strongly supports the concept of providing cochlear implants for persons with substantial residual hearing at low frequencies; indeed, a "point of diminishing returns" has yet to be identified. [ABSTRACT FROM AUTHOR]

We developed and validated silicon-based neural probes for neural stimulating and recording in long-term implantation in the brain. The probes combine the deep reactive ion etching process and mechanical shaping of their tip region, yielding a mechanically sturdy shank with a sharpened tip to reduce insertion force into the brain and spinal cord, particularly, with multiple shanks in the same array. The arrays’ insertion forces have been quantified in vitro. Five consecutive chronically-implanted devices were fully functional from 3 to 18 months. The microelectrode sites were electroplated with iridium oxide, and the charge injection capacity measurements were performed both in vitro and after implantation in the adult feline brain. The functionality of the chronic array was validated by stimulating in the cochlear nucleus and recording the evoked neuronal activity in the central nucleus of the inferior colliculus. The arrays’ recording quality has also been quantified in vivo with neuronal spike activity recorded up to 566 days after implantation. Histopathology evaluation of neurons and astrocytes using immunohistochemical stains indicated minimal alterations of tissue architecture after chronic implantation. [ABSTRACT FROM PUBLISHER]

Persons lacking functional auditory nerves cannot benefit from cochlear implants, but an auditory brainstem implant (ABI) utilizing stimulating electrodes adjacent to or on their cochlear nucleus (CN) can restore some hearing. We are investigating the feasibility of supplementing these surface electrodes with penetrating microstimulating electrodes within the ventral CN (VCN), and how the two types of electrodes can be used synergistically. Multiunit neuronal responses evoked by VCN electrical stimulation with surface electrodes and microelectrodes were recorded in the inferior colliculus (ICC) of five cats. The findings are consistent with those from patients with type II neurofibromatosis who received ABIs with both surface and microelectrodes. The patients described percepts from their microelectrodes as more similar to pure tones than those from their surface electrodes, consistent with the greater tonotopic selectivity of microelectrodes in the cats' VCN. Also, the patients describe percepts from their surface electrodes as louder than those from the microelectrodes, while in the cat, the neuronal activity evoked in the ICC by the surface electrodes tended to be greater. This concordance helps to validate our cat model as a means of investigating the synergistic use of surface and penetrating electrodes in a clinical ABI. [ABSTRACT FROM AUTHOR]

Abstract: Localized cell and drug delivery to the cochlea and central auditory pathway can improve the safety and performance of implanted auditory prostheses (APs). While generally successful, these devices have a number of limitations and adverse effects including limited tonal and dynamic ranges, channel interactions, unwanted stimulation of non-auditory nerves, immune rejection, and infections including meningitis. Many of these limitations are associated with the tissue reactions to implanted auditory prosthetic devices and the gradual degeneration of the auditory system following deafness. Strategies to reduce the insertion trauma, degeneration of target neurons, fibrous and bony tissue encapsulation, and immune activation can improve the viability of tissue required for AP function as well as improve the resolution of stimulation for reduced channel interaction and improved place-pitch and level discrimination. Many pharmaceutical compounds have been identified that promote the viability of auditory tissue and prevent inflammation and infection. Cell delivery and gene therapy have provided promising results for treating hearing loss and reversing degeneration. Currently, many clinical and experimental methods can produce extremely localized and sustained drug delivery to address AP limitations. These methods provide better control over drug concentrations while eliminating the adverse effects of systemic delivery. Many of these drug delivery techniques can be integrated into modern auditory prosthetic devices to optimize the tissue response to the implanted device and reduce the risk of infection or rejection. Together, these methods and pharmaceutical agents can be used to optimize the tissue–device interface for improved AP safety and effectiveness. [Copyright &y& Elsevier]

Abstract: We designed a non-linear functional model of the outer hair cell (OHC) functioning in the filtering system of the cochlea and then isolated from it two second-order structures, one employing the mechanism of the somatic motility and the other the hair bundle motion of the OHC. The investigation of these circuits showed that the main mechanism increasing the sensitivity and frequency selectivity of the filtering system is the somatic motility. The mechanism of the active hair bundle motion appeared less suitable for realization of the band-pass filtering structures due to the dependence of the sensitivity, natural frequency and selectivity on the signal intensity. We combined three second-order filtering structures employing the mechanism of the somatic motility and the lateral inhibition to form a parallel-type filtering channel of the sixth order with the frequency characteristics of the Butterworth-type and Gaussian-type. The investigation of these channels showed that the Gaussian-type channel has the advantage over the Butterworth-type channel. It is more suitable for realization of a filter bank with common lateral circuits and has less distorted frequency characteristic in the nonlinear mode. [Copyright &y& Elsevier]

A central auditory prosthesis based on microstimulation within the ventral cochlear nucleus (VCN) offers a means of restoring hearing to persons whose auditory nerve has been destroyed bilaterally and cannot benefit from cochlear implants. Arrays of silicon probes with 16 stimulating sites were implanted into the VCN of adult cats, for up to 314 days. Compound neuronal responses evoked from the sites in the VCN were recorded periodically in the central nucleus of the contralateral inferior colliculus (ICC). The threshold and growth of most of the responses were stable for at least 250 days after implantation of the arrays. The responses evoked from the deepest and shallowest electrode sites did exhibit some changes over time but none of the thresholds exceeded 10 μA. The thresholds and growth of the compound responses from most of the stimulating sites were very stable over time, and comparable to those of chronically implanted single-site iridium microelectrodes. Multiunit neuronal activity evoked from the stimulating sites in the VCN was recorded along the dorsolateral-ventromedial (DLVM) axis of the ICC. The distribution, span and degree of overlap of the multiunit activity demonstrated the utility of the multisite, multishank array configuration as a means of accessing the neuronal populations in the VCN that encode various acoustic frequencies. These findings are encouraging for the prospects of developing an auditory prosthesis employing multisite silicon microprobes. [ABSTRACT FROM AUTHOR]

A polymeric micro-cantilever array has been developed that mimics the biological front-end processing in the mammalian cochlea, and is intended for use in applications of auditory prostheses. Made of optical epoxy polymer molded over a silicon substrate, the micro-cantilevers have similar mechanical performance as the basilar membranes in the mammalian ears. The polymeric cantilevers, which are transparent, are used as optical waveguides to guide and modulate a light beam, which is initiated from a light emitting diode (LED) and collected by a photo diode, to produce a signal suitable for human hearing when the sound wave excites them. The polymeric cantilevers have Q10 values of 9.38, 10.11, 11.56, and 14.01 for resonant frequencies at 286, 720, 2868, and 6948 Hz, respectively. These values are similar to those obtained by direct measurement of the basilar membrane. Furthermore, they have a linear dynamic range of more than 80 dB sound pressure level (SPL) with less than 15% total harmonic distortion (THD). This polymeric micro-cantilever array has low power consumption, short processing time, high sensitivity, high frequency resolution, small size, is insensitive to electromagnetic interference, and is suitable for a totally implantable device in the human ear. [Copyright &y& Elsevier]

Background and Objective: An auditory prosthesis refers to a device designed to restore hearing. Some parameters of the auditory prosthesis, such as mass, implanted position, and degree, need to be repeatedly designed and optimized based on the realistic geometry of the ear. Numerous auditory prostheses designs were based on animal or specimen experiments involving many complex instruments, and the experimental specimens had low repeatability. The finite element method (FEM) can overcome these disadvantages and be carried out on the computer with substantial flexibility in modifying the prosthetic parameters to optimize them. This narrative review aims to analyze the recent advances in the design and optimization of auditory prostheses using the FEM and provides suggestions for future development., Methods: The literature on the design of auditory prostheses using the FEM has been extensively studied using the PubMed and Web of Science databases, including different ear models and relevant parameters of different auditory prostheses that need to be designed and optimized., Key Content and Findings: The process of designing and optimizing a prosthesis using the FEM includes building an ear model and a prosthesis model to simulate the implantation process. The related parameters of the prosthesis can be designed and modified conveniently. The post-implantation response could be used as an indicator to evaluate the prosthesis's performance., Conclusions: The review concluded that the FEM had been widely studied in designing and optimizing middle ear implants and cochlear implants and obtained good results. FEM can be utilized to explore more effective directions for auditory prosthesis design and optimization in the future., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://atm.amegroups.com/article/view/10.21037/atm-22-2792/coif). The authors have no conflicts of interest to declare., (2022 Annals of Translational Medicine. All rights reserved.)

Significance: Optoacoustic-induced vibrations of the hearing organ can potentially be used for a hearing device. To increase the efficiency of such a hearing device, the conversion of the light energy into vibration energy within each type of irradiated tissue has to be optimized. Aim: To analyze the wavelength-dependency of optoacoustic-induced vibrations within the tympanic membrane (TM), and to define the most efficient and best-suited optical stimulation parameters for a novel auditory prosthesis. Approach: Single nanosecond laser pulses, continuously tunable in a range of visible to near-infrared, were used to excite the guinea pig TM. The induced vibrations of the hearing organ were recorded at the malleus using a laser Doppler vibrometer. Results: Our results indicate a strong wavelength-dependency of the vibration's amplitude correlating with the superposition of the absorption spectra of the different specific tissue components. Conclusions: We investigated the spectrum of the vibrations of the hearing organ that were induced optoacoustically within a biological membrane embedded in air, in an animal model. First applications for these results can be envisioned for the optical stimulation of the peripheral hearing organ as well as for research purposes. [ABSTRACT FROM AUTHOR]

The impulse patterns of single auditory nerve fibres in cats with normal hearing and in deafened cats were studied during electrical stimulation of the cochlea at different locations. In the case of extracochlear round-window membrane stimulation, cats with normal hearing showed lowest thresholds (32 dB re 1 μA rms) for sinusoidal stimulation in the frequency range 50-300 Hz. These thresholds were independent of the acoustically determined characteristic frequencies of the fibres. The fibres of acutely deafened cats (by Neomycin) showed no spontaneous activity and could be activated only electrically with similar current values as in normal hearing cats. The action potentials were highly synchronized with the electrical signal up to 12.8 kHz. Intracochlear electrical stimulation was performed using a human multichannel cochlear implant electrode array. The excitation thresholds of the fibres for current stimulation showed poor place dependency when using different electrodes (monopolar) in the first turn of the cochlea with a remote indifferent electrode inside the middle ear. Better localization could be obtained when using bipolar stimulation with electrode pairs (electrode distance 0.75 mm) in the scala tympani. With parallel bipolar stimulation at two different locations (distance 1.5 mm) using two independent current sources a clear interaction could be observed in the firing pattern of single fibres. The measured gain and phase relations between current signal and neuronal response allowed the calculation of a model describing the summation of current density vectors acting on an excitable nerve membrane model. On the basis of these measurements, input networks were calculated to improve the channel separation of multichannel cochlear implants.