WO2010133705A2 - Instrument auditif pour une stimulation de la fenêtre ronde - Google Patents

Instrument auditif pour une stimulation de la fenêtre ronde Download PDF

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Publication number
WO2010133705A2
WO2010133705A2 PCT/EP2010/064286 EP2010064286W WO2010133705A2 WO 2010133705 A2 WO2010133705 A2 WO 2010133705A2 EP 2010064286 W EP2010064286 W EP 2010064286W WO 2010133705 A2 WO2010133705 A2 WO 2010133705A2
Authority
WO
WIPO (PCT)
Prior art keywords
hearing instrument
round window
audio signals
end portion
contact
Prior art date
Application number
PCT/EP2010/064286
Other languages
English (en)
Other versions
WO2010133705A3 (fr
Inventor
Ranjeeta Ambett
Pierre-Yves Clair
Original Assignee
Advanced Bionics Ag
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Advanced Bionics Ag filed Critical Advanced Bionics Ag
Priority to PCT/EP2010/064286 priority Critical patent/WO2010133705A2/fr
Publication of WO2010133705A2 publication Critical patent/WO2010133705A2/fr
Publication of WO2010133705A3 publication Critical patent/WO2010133705A3/fr

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Classifications

    • H—ELECTRICITY
    • H04—ELECTRIC COMMUNICATION TECHNIQUE
    • H04R—LOUDSPEAKERS, MICROPHONES, GRAMOPHONE PICK-UPS OR LIKE ACOUSTIC ELECTROMECHANICAL TRANSDUCERS; DEAF-AID SETS; PUBLIC ADDRESS SYSTEMS
    • H04R25/00—Deaf-aid sets, i.e. electro-acoustic or electro-mechanical hearing aids; Electric tinnitus maskers providing an auditory perception
    • H04R25/60—Mounting or interconnection of hearing aid parts, e.g. inside tips, housings or to ossicles
    • H04R25/604—Mounting or interconnection of hearing aid parts, e.g. inside tips, housings or to ossicles of acoustic or vibrational transducers
    • H04R25/606—Mounting or interconnection of hearing aid parts, e.g. inside tips, housings or to ossicles of acoustic or vibrational transducers acting directly on the eardrum, the ossicles or the skull, e.g. mastoid, tooth, maxillary or mandibular bone, or mechanically stimulating the cochlea, e.g. at the oval window
    • H—ELECTRICITY
    • H04—ELECTRIC COMMUNICATION TECHNIQUE
    • H04R—LOUDSPEAKERS, MICROPHONES, GRAMOPHONE PICK-UPS OR LIKE ACOUSTIC ELECTROMECHANICAL TRANSDUCERS; DEAF-AID SETS; PUBLIC ADDRESS SYSTEMS
    • H04R2225/00—Details of deaf aids covered by H04R25/00, not provided for in any of its subgroups
    • H04R2225/67—Implantable hearing aids or parts thereof not covered by H04R25/606

Definitions

  • the present invention relates to a hearing instrument comprising an audio signal source (typically a microphone arrangement), an audio signal processing unit for processing the audio signals provided by the audio signal source and an implantable assembly for stimulation of the round window of the cochlea according to the processed audio signals.
  • an audio signal source typically a microphone arrangement
  • an audio signal processing unit for processing the audio signals provided by the audio signal source
  • an implantable assembly for stimulation of the round window of the cochlea according to the processed audio signals.
  • the cochlea provides a second natural window for mechanical stimulation, namely the round window.
  • the round window is closed by a compliant membrane and, besides other purposes, may serve for compensation of static pressures on the inner ear.
  • Mechanical stimulation of the round window membrane is an approach particularly suitable in cases where normal middle ear structures are absent or are severely damaged and cannot be used. It is a benefit of round window stimulation that it does not involve opening of the inner ear, so that the risk of infections resulting from implantation of the hearing aid is lower compared to oval window stimulation which requires opening of the stapes footplate
  • US 2009/0306458 Al relates to a partially implantable hearing aid comprising an electromechanical actuator acting via a coupling element on the round window.
  • the coupling element may have an angled configuration, and it may include a ball and socket joint which can be locked in order to adjust the angle formed by the coupling element.
  • the coupling element comprises at its distal end a stapes prosthesis having a flat distal end.
  • WO 2009/062172 A2 relates to a fully implantable hearing aid comprising an electromechanical actuator acting via a coupling element on the round window.
  • the coupling element comprises a first rod being driven by the actuator in reciprocating manner, a second rod being fixedly connected to a stationary portion of the middle ear anatomy and a third rod touching the round window, with the three rods being connected to each other in a star-like fashion at a central joint which may be a mechanical joint, such as a hinge, or a flexible joint, such as an elastomeric member.
  • the first and the third rod thereby are angled with regard to each other.
  • the distal end of the third rod touching the round window may be formed as a ball.
  • the element used for contacting the round window membrane is made of titanium.
  • pyrocarbon may be used as an implant material for contact with bones.
  • US 2005/0033426 Al relates to an implantable carpometacarpal joint prosthesis made of pyrocarbon.
  • a similar implant is described in US 7,182,787 B2.
  • the article "Kohle am Knochen - Pyrocarbonimplantate in der Hand function - "by M. Strassmair, in Orthopadie und Rheuma 5, 2004, pages 42 to 44, relates to the use of pyrocarbon prosthesis in hand surgery.
  • 71 -B relates to the use of pyrocarbon materials for femorl protheses.
  • US 2008/0044451 Al relates to a dental implant comprising pyrocarbon. Pyrocarbon is also the most widely used material for mechanical heart valves.
  • the invention is beneficial in that, by providing the contact element with a rounded contact surface made of a biocompatible material having an elastic modulus between 5 and 40 GPa and density of 1.5 to 3 g/cm 3 , the contact element is provided with a biocompatible surface having physical properties similar to bone material (which typically has an elastic modulus between 15 and 20 GPa and density of about 2 g/cm 3 ); thereby the round window membrane may be prevented from damages caused by the permanent contact of the round window membrane with the contact element of the electromechanical actuator.
  • the material of the contact surface is a pyrocarbon material (typically, pyrocarbon materials have an elastic modulus between 20 and 25 GPa and a density between 1.7 to 2.0 g/cm 3 ); pyrocarbon materials are particularly well suited for providing a biocompatible, firm and smooth surface for contacting the round window membrane.
  • pyrocarbon materials typically have an elastic modulus between 20 and 25 GPa and a density between 1.7 to 2.0 g/cm 3 ); pyrocarbon materials are particularly well suited for providing a biocompatible, firm and smooth surface for contacting the round window membrane.
  • Fig. 1 is a cross-sectional view of an example of a hearing instrument according to the invention after implantation
  • Fig. 2 is a block diagram of the system of Fig. 1;
  • Fig. 3 is a schematic view of an example of a stimulation assembly of a hearing instrument according to the invention.
  • Fig. 4 is a perspective view of an example of a stimulation assembly of a hearing instrument according to the invention, being shown together with the cochlea and the ossicular chain;
  • Fig. 5 is a perspective side view of an example of a stimulation assembly of a hearing instrument according to the invention.
  • Figs. 6 to 8 show a perspective view of various examples of a pivot element of the stimulation assembly of a hearing instrument according to the invention
  • Fig. 9 is a perspective view of an example of a stimulation assembly when connected to a fixation system allowing three-dimensional adjustment;
  • Fig. 10 is a perspective view of an example of a stimulation assembly of a hearing instrument according to the invention when connected to a single axis fixation system;
  • Fig. 11 is a longitudinal sectional view of the components of Fig. 10;
  • Fig. 12 is a perspective view of a modified embodiment of the components shown in
  • Fig. 13 is a schematic view of an example of a stimulation assembly comprising an angled lever element.
  • Fig. 14 is an enlarged view of the distal end of the lever element of the actuator shown in Figs. 5, 9 or 10 to 12;
  • Fig. 15 is an enlarged view of the contact element used in the example of Fig. 14;
  • Fig. 16 shows an example of another type of actuator using a contact element according to the invention.
  • Fig. 17 is an enlarged view of the contact element used in the example of Fig. 16.
  • Fig. 1 shows a cross-sectional view of the mastoid region, the middle ear and the inner ear of a patient after implantation of an example of a hearing aid according to the invention, wherein the hearing aid is shown only schematically.
  • the system comprises an external unit 10 which is worn outside the patient's body at the patient's head, typically close to the ear, and an implantable unit 12 which is implanted under the patient's skin 14, usually in an artificial cavity created in the user's mastoid.
  • the implantable unit 12 is connected, via a cable assembly 16, to a stimulation assembly 18 comprising an electromechanical actuator 20 for stimulating the round window 24 of the cochlea 26 via a lever element 22.
  • the external unit 10 is fixed at the patient's skin 14 in a position opposite to the implantable unit 12, for example, by magnetic forces created between at least one fixation magnet provided in the external unit 10 and at least one co-operating fixation magnet provided in the implantable unit 12 (the magnets are not shown in Fig. 1).
  • the external unit 10 includes a microphone arrangement 28, which typically comprises at least two spaced-apart microphones 30 and 32 for capturing audio signals from ambient sound, which audio signals are supplied to an audio signal processing unit 34, wherein they undergo, for example, acoustic beam forming.
  • the processed audio signals are supplied to a transmission unit 36 connected to a transmission antenna 38 in order to enable transcutaneous transmission of the processed audio signals via an inductive link 40 to the implantable unit 12 which comprises a receiver antenna 42 connected to a receiver unit 44 for receiving the transmitted audio signals.
  • the received audio signals are supplied to a driver unit 48 which drives the actuator 20.
  • the external unit 10 also comprises a power supply 50 which may be a replaceable or rechargeable battery, a power transmission unit 52 and a power transmission antenna 54 for transmitting power to the implantable unit 12 via a wireless power link 56.
  • the implantable unit 12 comprises a power receiving antenna 58 and a power receiving unit 60 for powering the implanted electronic components with power received via the power link 56.
  • the audio signal antennas 38, 42 are separated from the power antennas 54, 58 in order to optimize both the audio signal link 40 and the power link 56.
  • the antennas 38 and 54 and the antennas 42 and 58 could be physically formed by a single antenna, respectively.
  • the stimulation assembly 18 comprises an electromechanical actuator 20 (which may be formed, for example, by electromagnetic transducer) for driving an output member formed by a rod 62 in a reciprocating manner, a lever element 22 having a first, distal end portion 64 acting on the round window membrane 24, a second, proximal end portion 66 driven by the output member 62 and an intermediate portion 68 connecting the distal end portion 64 and the proximal end portion 66 and being supported by a pivot element 70, and a support member 72 for supporting the actuator 20 via an adjustable actuator fixation portion 74 and for supporting the pivot element 70 (hereinafter, “distal” designates directions towards the round or oval window, and “proximal” designates directions away from the round or oval window towards the skin).
  • an electromechanical actuator 20 (which may be formed, for example, by electromagnetic transducer) for driving an output member formed by a rod 62 in a reciprocating manner
  • a lever element 22 having a first, distal end portion 64 acting on the round window membrane 24, a second,
  • both the pivot element 70 and the actuator 20 are fixed relative to the support member 72.
  • the free end of the output rod 62 is provided with a rounded tip 76 for touching a contact area of the proximal end portion 66 of the lever element 22, with the output rod 62 moving in a direction substantially perpendicular to the direction into which the proximal end portion 66 of the lever element 22 extends.
  • the distal end portion 64 is provided with a rounded contact element 79 extending into a radial direction of (i.e. laterally from) the distal end portion 64 and acting on the round window membrane 24.
  • the contact element 79 of the lever element 22 preferably has a mushroom-like spherical head 83, with the front surface area of the head being substantially equal to the area of the round window membrane 24.
  • the contact element 79 is made of or coated with a biocompatible material having an elastic modulus between 5 and 40 Gpa, preferably between 15 and 25 Gpa, and density of 1.5 to 3 g/cm 3 , preferably 1.7 to 2.3 g/cm 3 .
  • the prefered material of the contact surface is a pyrocarbon material.
  • the pyrocarbon material typically has a Vickers hardness of 150 to 250.
  • the surface roughness Ra of the contact element 79 is less than 0.02 ⁇ m.
  • the support member 72 comprises a first portion 80 for holding the actuator 20 via the actuator fixation portion 74 and a second portion 82 for holding the pivot element 70, with the first portion 80 and the second portion 82 extending in directions which are essentially perpendicular with regard to each other.
  • the first portion 80 and the second portion 82 of the support member 72 have an essentially tubular, preferably cylindrical design, wherein the first portion 80 houses the actuator 20, and the second portion 82 houses the proximal end portion 66 and the intermediate portion 68 of the lever element 22
  • a stimulation assembly 18 wherein the support member 72 comprises an essentially cylindrical second portion 82 and an essentially cylindrical first portion 80 which are oriented perpendicular to each other.
  • the position of the actuator 20 relative to the support member 72 is axially adjustable with regard to the actuation direction (i.e. the direction of the reciprocating movement) of the output rod 62 in order to adjust the loading of the contact element 79 of the distal end portion 64 of the lever element 22 on the round window membrane 24.
  • This may be realized, as shown in Figs. 5 and 9 to 12, by a rotatable adjustment member 84 engaging with a thread provided at the first portion 80 of the support member 72.
  • a rotatable adjustment member 84 engaging with a thread provided at the first portion 80 of the support member 72.
  • the adjustment member 84 is a nut-like element which is screwed onto an outer thread 86 provided at the periphery of the first portion 80 of the support element 72.
  • the axial position of the actuator 20 with regard to the first portion 80 of the support member 72 may be adjusted by rotating the nut 84 accordingly, with the corresponding axial movement of the nut 84 causing the actuator 20 to move axially.
  • the outer surface of the actuator 20 preferably is provided with a structure engaging with a mating counter-structure provided at the actuator fixation portion 74 of the support member 72 in manner that the actuator is axially moveable in the actuation direction of the output member 62, but is prevented from rotation.
  • Such engagement may be provided in a rib-and- groove fashion, for example by providing the outer surface of the actuator 20 with an axially extending rib and providing the inner surface of the actuator fixation portion with a corresponding groove for receiving the rib.
  • the nut-like element 84 is provided with an axially extending lateral slot 85 (see Fig. 9) for allowing the cable assembly 16 connecting the actuator 20 to the implantable unit 12 to pass into a central portion of the nut-like element 84.
  • the pivot element 70 is constructed in a manner so as to have a torsion of the central portion 90 due to the pivoting motion of the lever element 22, while avoiding friction on materials in order to keep wearing of the materials small.
  • the pivot element 70 may be designed in a hub-like manner to be torsioned by the pivoting motion of the lever element 22, with the pivot element 70 being made of a sufficiently elastic material.
  • the pivot element 70 comprises two end portions 88 which are fixed at the support member 72 and a central portion 90 which extends between the end portions 88 and at which the intermediate portion 68 of the lever element 22 is fixed.
  • the end portions 88 of the pivot element 70 are fixed in corresponding holes in the wall of the second portion 82 of the support member 72.
  • the central portion 90 of the pivot element 70 comprises a central opening 92 in which the intermediate portion 68 of the lever element 22 is fixed.
  • the pivot element 70, or at least the central portion 90 thereof may be made of silicone, with the central portion 90 of the pivot element 70 having a rod-like shape.
  • the central portion is made of a suitable metal material and has a wireless design.
  • the central portion 90 of the pivot element 70 has a blade-like shape.
  • the lever element 22 is substantially straight.
  • the distal end portion 64 and the proximal end portion 66 of the lever element 22 may be angled with regard to each other, thereby introducing an additional design parameter, namely the angle between the portions 64 and 66, which can be adjusted for achieving optimal coupling to the round window membrane 24 (when using a straight lever, the movement of the output rod 62 of the actuator 20 is anti- parallel to the movement of the contact element 79 of the lever element 22; by selecting an appropriate angled configuration of the lever element 22, the angle between the movement of the output rod 62 and the movement of the contact element 79 can be adjusted as desired).
  • a schematic example of a stimulation assembly using such a angled lever element 22 is shown in Fi 1 Se.- 13.
  • the support member preferably is made of titanium.
  • the support member 72 is fixed at the patient's skull via an adjustable fixation system 94 by bone screws (in Figs.4 and 9-12 only the bone screw openings 96 of the fixation system 94 are shown, but not the bone screws themselves).
  • the fixation system 94 comprises a linearly driven slide element 98, at which the support member 72 is fixed, and a lockable ball joint 100 at which the slide element 98 is supported.
  • the ball joint 100 forms part of a flange element 102 comprising the bone screw opening 96.
  • the loading on the round window 24 may be adjusted by adjusting the nut 84.
  • An alternative embodiment of a fixation system fixation system 194 is shown in Figs. 10 and 11.
  • the second portion 82 of the support element 72 carries a stopper plate 104 which is adjustable in the axial direction with regard to the support member 72 in order to determine the position of the support member 72 during implantation.
  • the cylindrical second portion 82 of the support member 72 is provided with an outer thread 106, with the stopper plate 104 having a central opening provided with an inner thread 108 engaging with the outer thread 106. Thereby the axial position of the stopper plate 104 can be adjusted by rotating the stopper plate 104.
  • the support member 72 comprises a third portion 110 which forms an axial extension of the second portion 82 beyond the region where the first portion 80 and the second portion 82 are connected to each other.
  • a fixation plate 112 comprising bone screw openings 96 for being fixed at the patient's skull is connected to the third portion 110 of the support member 72 in a manner so as to be axially movable but not rotatable with regard to the third portion 110.
  • the fixation plate 112 comprises a base portion 114 which is slidably received in a receptacle 116 in the third portion 110 of the support member 72.
  • the base portion 114 and the receptacle 116 have a none-circular symmetry, for example, by providing axial grooves engaging with corresponding projections.
  • the fixation system 194 shown in Figs. 10 and 11 allows for adjustment of the position of the stimulation assembly 18 in one direction only, namely along the axial direction of the second portion 82 of the support member 72. Such linear adjustment is achieved by adjusting the axial position of the stopper plate 104 by rotating the stopper plate 104 accordingly.
  • Such design of the fixation system is much simpler than that of Fig. 9. However, it requires a much more precise drilling of the cavity into which the stimulation assembly 18 is to be inserted.
  • An appropriate drilling/implantation method is described in WO 2010/061006 A2 and international application No. PCT/EP2010/056749.
  • the axial position of the stopper plate 104 is adjusted prior to inserting the stimulation assembly into the drilled cavity by using a fork-shaped tool (not shown) engaging with radially extending openings 105 of the stopper plate 104, with the support member 72 being held by hand. After the stimulation assembly 18 has been inserted into the cavity, the stopper plate 104 is fixed to the bone.
  • Fig. 12 a modification of the embodiment of Figs. 10 and 11 is shown, wherein the fixation plate 112 includes a compartment 118 for electronic components, whereby the electronic components can be brought close to the main axis of the stimulation assembly 18.
  • the distal end portion 64 of the lever element 22 carrying the contact element 79 is shown in more detail in Fig. 14.
  • the distal end 64 of the lever element 22 comprises an opening which receives a base portion 81 which carries the spherical head 83 of the contact element 79.
  • the contact element 79 may form the tip of an angled portion of the distal end portion 64 of the lever element 22, rather than extending laterally from the distal end portion 64.
  • the contact element 79 may comprise a shaft portion 81 carrying a spherical head 83, with the base portion 81 being received in an opening in the distal end portion 64.
  • such opening extends laterally with regard to the axial direction of the distal end portion 64, in such alternative embodiment such opening extends axially with regard to the distal end portion 64.
  • the contact element of the present invention may be used not only with an electromechanical actuator of the lever-type discussed so far; rather, as indicated in Fig. 16, it may be used also with an electromechanical actuator 120 which directly drives an actuator rod 122 having an angled distal end portion 164 carrying the contact element 79.

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  • Health & Medical Sciences (AREA)
  • General Health & Medical Sciences (AREA)
  • Otolaryngology (AREA)
  • Neurosurgery (AREA)
  • Physics & Mathematics (AREA)
  • Engineering & Computer Science (AREA)
  • Acoustics & Sound (AREA)
  • Signal Processing (AREA)
  • Prostheses (AREA)
  • Electrotherapy Devices (AREA)

Abstract

L'invention concerne un instrument auditif comportant une source de signaux audio (28), une unité de traitement de signaux audio (34) pour traiter les signaux audio provenant de la source de signaux audio et un ensemble de stimulation implantable (18) pour stimuler la fenêtre ronde (24) d'un patient selon les signaux audio traités, l'ensemble de stimulation comprenant un actionneur électromécanique (20, 120, 220) destiné à être entraîné selon les signaux audio traités, et un élément de contact (79) destiné à être entraîné mécaniquement par l'actionneur et à être en contact direct avec la fenêtre ronde pour faire vibrer la membrane de la fenêtre ronde selon les signaux audio traités, l'élément de contact présentant une surface de contact arrondie destinée à être en contact avec la membrane de la fenêtre ronde, et la surface de contact étant constituée d'une matière biocompatible présentant un module élastique compris entre 5 et 40 GPa et une densité comprise entre 1,5 et 3 g/cm3.
PCT/EP2010/064286 2010-09-27 2010-09-27 Instrument auditif pour une stimulation de la fenêtre ronde WO2010133705A2 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
PCT/EP2010/064286 WO2010133705A2 (fr) 2010-09-27 2010-09-27 Instrument auditif pour une stimulation de la fenêtre ronde

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
PCT/EP2010/064286 WO2010133705A2 (fr) 2010-09-27 2010-09-27 Instrument auditif pour une stimulation de la fenêtre ronde

Publications (2)

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WO2010133705A2 true WO2010133705A2 (fr) 2010-11-25
WO2010133705A3 WO2010133705A3 (fr) 2011-06-30

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Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2011029960A3 (fr) * 2011-01-04 2011-05-05 Advanced Bionics Ag Instrument auditif pour stimulation de la fenêtre ronde
WO2013023693A1 (fr) 2011-08-17 2013-02-21 Advanced Bionics Ag Système de fixation d'actionneur d'instrument auditif implantable

Citations (6)

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Publication number Priority date Publication date Assignee Title
US20050033426A1 (en) 2003-01-07 2005-02-10 Ogilvie William F. Carpometacarpal joint prosthesis
US7182787B2 (en) 2001-12-12 2007-02-27 Bioprofile Trapezium or trapezometacarpal implant
US20080044451A1 (en) 2004-12-07 2008-02-21 Rho-Best Coating Hartstoffbeschichtungs Gmbh Biological Surfaces
WO2009062172A2 (fr) 2007-11-08 2009-05-14 Otologics, Llc Connecteur traversant pour prothèse auditive implantable
US20090306458A1 (en) 2008-03-31 2009-12-10 Cochlear Limited Direct acoustic cochlear stimulator for round window access
WO2010061006A2 (fr) 2010-02-23 2010-06-03 Phonak Ag Gabarit de perçage personnalisé pour l'implantation d'une prothèse auditive

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US5176620A (en) * 1990-10-17 1993-01-05 Samuel Gilman Hearing aid having a liquid transmission means communicative with the cochlea and method of use thereof
EP1435757A1 (fr) * 2002-12-30 2004-07-07 Andrzej Zarowski Dispositif implantable dans une paroi osseuse de l'oreille interne
US7753838B2 (en) * 2005-10-06 2010-07-13 Otologics, Llc Implantable transducer with transverse force application
WO2009111334A2 (fr) * 2008-02-29 2009-09-11 Otologics, Llc Stimulation bimodale améliorée de la cochlée
US8043375B2 (en) * 2008-03-06 2011-10-25 MoiRai Orthopaedic, LLC Cartilage implants

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US7182787B2 (en) 2001-12-12 2007-02-27 Bioprofile Trapezium or trapezometacarpal implant
US20050033426A1 (en) 2003-01-07 2005-02-10 Ogilvie William F. Carpometacarpal joint prosthesis
US20080044451A1 (en) 2004-12-07 2008-02-21 Rho-Best Coating Hartstoffbeschichtungs Gmbh Biological Surfaces
WO2009062172A2 (fr) 2007-11-08 2009-05-14 Otologics, Llc Connecteur traversant pour prothèse auditive implantable
US20090306458A1 (en) 2008-03-31 2009-12-10 Cochlear Limited Direct acoustic cochlear stimulator for round window access
WO2010061006A2 (fr) 2010-02-23 2010-06-03 Phonak Ag Gabarit de perçage personnalisé pour l'implantation d'une prothèse auditive

Non-Patent Citations (2)

* Cited by examiner, † Cited by third party
Title
M. STRASSMAIR: "Kohle am Knochen - Pyrocarbonimplantate in der Handchirurgie", ORTHOPADIE UND RHEUMA, vol. 5, 2004, pages 42 - 44
S.D. COOK: "Wear characteristics of the canine acetabulum against different femoral prosthesis", J. BONE JOINT SURG., vol. 71-B, 1989

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2011029960A3 (fr) * 2011-01-04 2011-05-05 Advanced Bionics Ag Instrument auditif pour stimulation de la fenêtre ronde
WO2013023693A1 (fr) 2011-08-17 2013-02-21 Advanced Bionics Ag Système de fixation d'actionneur d'instrument auditif implantable

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