WO2017033205A1 - Implant total de prothèse de l'oreille moyenne - Google Patents

Implant total de prothèse de l'oreille moyenne Download PDF

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Publication number
WO2017033205A1
WO2017033205A1 PCT/IN2016/000217 IN2016000217W WO2017033205A1 WO 2017033205 A1 WO2017033205 A1 WO 2017033205A1 IN 2016000217 W IN2016000217 W IN 2016000217W WO 2017033205 A1 WO2017033205 A1 WO 2017033205A1
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WO
WIPO (PCT)
Prior art keywords
prosthetic
malleus
stapes
tympanic membrane
ear
Prior art date
Application number
PCT/IN2016/000217
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English (en)
Inventor
Suraj Balaji GIRI
Mohammad Azeem Javed AALAM
Nilesh Balaji GIRI
Original Assignee
Giri Suraj Balaji
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 Giri Suraj Balaji filed Critical Giri Suraj Balaji
Publication of WO2017033205A1 publication Critical patent/WO2017033205A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/18—Internal ear or nose parts, e.g. ear-drums
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/18—Internal ear or nose parts, e.g. ear-drums
    • A61F2002/183—Ear parts
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2220/0041—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements using additional screws, bolts, dowels or rivets, e.g. connecting screws
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2250/0004—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof adjustable
    • A61F2250/001—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof adjustable for adjusting a diameter

Definitions

  • This invention relates generally to systems and methods for enhancing hearing in patients suffering from conductive hearing loss and/or sensorineural hearing loss.
  • This type of Middle Ear Implant is referred to as an electro-magnetic or electro-mechanical implant. As the name suggests, it requires two parts: an implanted magnet and an external coil coupled to the microphone. Like any electro-magnetic combination, the external coil can't be too far from the internally implanted magnet.
  • An advantage of this system is that it can achieve very high outputs (up to 130 dB SPL) although in most cases outputs have to be limited to 110 dB SPL (usually because of Food and Drug Administration regulatory concerns).
  • a disadvantage of the electro-magnetic approach is its relatively large size. This means that the Middle Ear Implant implemented in the 1990s and early 2000s could be only partially implanted.
  • a serious drawback is that their maximum output is typically limited to about 110 dB SPL (with maximum use gain on the order of 30-35 dB). Therefore, the devices cannot be fitted on patients with more than moderate sensorineural hearing loss, a range well within the capability of the smaller (completely inside the ear) CIC hearing aids.
  • a small ceramic crystal is implanted on the ossicular chain (usually surgically placed in or near the incudo-stapedial joint). This is physically joined either to an external microphone surgically located in the (posterior) wall of the ear canal or to the patient's tympanic membrane, which serves as the microphone.
  • the bone-anchored hearing aid (BAHA®) has been widely in use since the late 1980s. Designed primarily for patients with conductive or mixed hearing loss (with bone-conduction scores no worse than 45 dB hearing loss), the BAHA is fitted such that only the receiver is implanted in the temporal bone and sound is sent by bone conduction to the relatively intact cochlea.
  • transcutaneous over the skin
  • percutaneous through the skin
  • BAHA BAHA remaining in the market
  • the percutaneous approach which uses an abutment that protrudes through the skin behind the ear, has better mechanical transduction characteristics, which make it suitable for a wider range of patients.
  • biologic materials include autograft or homograft ossicles, cortical bone, teeth, and cartilage.
  • Autograft material has been the incus body, which is often reshaped to fit between the manubrium of the malleus and the stapes capitulum.
  • Autograft materials are not always available, or— as in patients with cholesteatoma— an ossicle may have microscopic squamous epithelium infiltration that precludes such use.
  • Autografts have several disadvantages, including lack of availability in chronically diseased ears, prolonged operative time to obtain and shape the material, resorption and/or loss of rigidity (especially with cartilage), and possible fixation to the walls of the middle ear. Additionally, osteitis may exist within the ossicles, and the risk of residual cholesteatoma may be increased in patients with cholesteatoma.
  • alloplastic materials are the most commonly used materials for ossicular reconstruction today. Alloplastic materials can be classified as biocompatible, bio-inert or bioactive. In the late 1950s and the 1960s, biocompatible material such as polyethylene tubing, Teflon and Proplast were used. Ossicular reconstruction with these materials often resulted in migration, extrusion, penetration into the inner ear or significant middle ear reactivity. For these reasons, use of these solid polymeric substances was eventually abandoned.
  • HDPS high-density polyethylene sponge
  • Plasti-Pore machine-tooled prosthesis
  • Polycel thermal-fused HDPS
  • This latter form permitted coupling with other materials, such as stainless steel, thus lending itself to a wide variety of prosthetic designs.
  • a high incidence of extrusion occurs when either Plasti-Pore or Polycel is placed in contact with the tympanic membrane. Extrusion is reduced considerably when cartilage is placed between a Plasti-Pore or Polycel prosthesis and the tympanic membrane.
  • Sialistic, stainless steel, titanium and gold are other examples of biocompatible materials used for ossicular reconstruction.
  • Bio-inert implants are materials that do not release detectable trace substances.
  • the prototype bio-inert material is dense aluminum oxide ceramic (AI203). This material was popular in Germany and Japan in the 1970s.
  • AI203 dense aluminum oxide ceramic
  • the implant can be fit to the undersurface of the tympanic membrane without cartilage coverage.
  • Bioactive implants react favorably with the body's tissues to promote soft tissue attachment.
  • the attachment is a direct chemical bond to the surface of the material, not merely a mechanical attachment that occurs with bio-inert and biocompatible materials.
  • Bioactive implants were introduced in the 1970s with the hope that this new material would have a lower incidence of extrusion than the porous 95 polyethylene implants.
  • the first of the bioactive implants was bioactive glass (Bioglass and Ceravital).
  • Bioactive glasses enjoy limited use today because of the difficulty in trimming the glass prostheses and their instability in infected environments.
  • Hydroxylapatite is another bioactive material. From a compatibility standpoint, hydroxylapatite is the most promising implant material currently in use. The most common form of hydroxylapatite for middle 100 ear reconstruction is the dense form. The nonporous and homogenous nature of dense hydroxylapatite resists penetration by granulation tissue. This aspect can clearly be seen using scanning electron microscope. Hydroxylapatite can be placed directly under the tympanic membrane without increased risk of extrusion.
  • Ossiculoplasty is defined as the reconstruction of the ossicular chain.
  • reconstruction of stapes is not presented in this article.
  • the ideal prosthesis for ossicular reconstruction should be biocompatible, stable, safe, easily insertable and capable of yielding optimal sound transmission.
  • selection must be based on several factors, including compatibility and ease of configuring the prosthesis during surgery.
  • Conductive hearing loss from ossicular chain abnormalities may result from either discontinuity or fixation of the ossicular chain.
  • discontinuity most commonly occurs because of an eroded incudo-stapedial joint (occurring in approximately 80% of patients with Ossicular discontinuity), an absent incus or an absent incus and stapes superstructure.
  • cholesteatoma Treatment of patients with cholesteatoma poses a unique set of problems.
  • 120 the goals of cholesteatoma removal are developing a safe ear, producing a clean dry ear, and improving or maintaining hearing. These goals sometimes are mutually exclusive.
  • a safe, dry ear may require removal of the posterior external auditory canal. Canal removal reduces middle ear volume, which may affect hearing
  • the normal human middle ear couples sound from the low impedance sound energy in the ear 130 canal through the tympanic membrane and ossicles to the relatively high impedance of fluid within the cochlea.
  • Recent investigations of human middle ear mechanics indicate that traditional teaching of middle ear mechanisms should be modified. To provide a more comprehensive description, both traditional and recent discussions of the physiology of middle ear sound transmission are briefly discussed in this section.
  • the attachment of the tympanic membrane at the annulus amplifies the energy at the malleus because of the elastic properties of the stretched drumhead fibers. Because the annular bone surrounding the tympanic membrane is immobile, sound energy is directed away from the edges of the drum and toward the center of the drum. The malleus receives the redirected sound energy from the edge of the drum because of the central location of the manubrium.
  • the catenary lever provides at least a 2-
  • the ossicular lever is based on the concept that the malleus and incus act as a unit.
  • the malleus and incus rotate around an axis running between the anterior mallear ligament and the incudal ligament.
  • the ossicular lever is the length of the manubrium of the malleus divided by the length of the long 150 process of the incus (approximately 1.3:1). Since the malleus and tympanic membrane act as coupled system, some authors believe that the ossicular lever value of 1.3:1 should be reduced to 1.15:1. The reduction can be supported because of the different areas of curvature of the drum and how its affects on the lever ratio. Together, the ossicular and catenary levers provide a sound pressure advantage of 2.3:1 , which is more than twice that of the ossicular lever acting alone. 155 Hydraulic lever
  • the hydraulic lever acts because of the size difference between the tympanic membrane and the stapes footplate. Sound pressure collected over the area of the tympanic membrane and transmitted to the area of the smaller footplate results in an increase in force proportional to the ratio of the areas (also known as the areal ratio). The average ratio has been calculated to be 20.8:1.
  • the acoustic transformer theory predicts a middle ear gain of approximately 27-34 decibels (dB). This figure is derived as a product of the action of the catenary, ossicular, and hydraulic levers. Implied in the transformer analogy is the expectation that this gain is independent of frequency.
  • Middle ear sound transmission is the result of ossicular coupling, acoustic coupling, and stapes-cochlear input impedance. Middle ear aeration also is considered essential for proper middle ear sound conduction.
  • Ossicular coupling refers to the sound pressure gain that occurs through the actions of the tympanic membrane and the ossicular chain.
  • the pressure gain provided by the normal middle ear with ossicular coupling is frequency dependent.
  • the mean middle ear gain is approximately 20 dB at 250-500 hertz (Hz), it reaches a maximum of about 25 dB around 1 kilohertz (kHz), and it then decreases at about 6 dB per octave at frequencies above 1 kHz.
  • Acoustic coupling is the difference in sound pressures acting directly on the oval and round 185 windows. Movement of the tympanic membrane produces a sound pressure in the middle ear that is transmitted to the oval and round windows. The pressure at each window is different because of the small distance between windows and the different orientation of each window relative to the tympanic membrane. In normal ears, the difference in pressures between the oval and round windows (acoustic coupling) is negligible. c
  • the difference becomes significant and can greatly affect hearing.
  • shielding of the round window results in redirection of all the sound energy into the oval window, such as in Wullstein type IV tympanoplasty.
  • acoustic coupling plays a significant role in sound pressure conduction for cochlear stimulation.
  • Stapes footplate motion is normally impeded by several anatomical structures, including the annular ligament, the cochlear fluids, the cochlear partition, and the round window membrane. Together, these structures result in stapes-cochlear input impedance.
  • the round window impedance contribution is negligible in the normal ear.
  • round window niche is filled with fluid or fibrous tissue, round 200 window impedance increases, thereby increase in stapes-cochlear input impedance. Increases in this impedance cause conductive hearing loss.
  • Ossicular coupling is impaired when the middle ear space (the air space of both the middle ear and the mastoid cavity) is reduced.
  • the middle ear air pressure is less than the pressure in the external canal.
  • Jhe impedance and pressure of the middle ear increase relative to the external canal because the impedance of the middle ear space varies inversely with its volume.
  • the pressure difference between the external canal and the middle ear leads to a subsequent
  • the minimal amount of air required to maintain ossicular coupling within 10 dB of normal has been estimated to be 0.5 ml.
  • Conductive hearing loss may be the result of ossicular erosion or fixation from chronic ear disease, blunt or penetrating trauma, or congenital or neoplastic causes. It may also be associated with inner ear causes. These inner ear causes include superior semicircular canal dehiscence and an enlarged vestibular aqueduct.
  • Ossiculoplasty is used to improve or to maintain the conductive portion of hearing loss.
  • the aim of ossiculoplasty is not to close the air-bone gap per se but to improve the patient's overall hearing (i.e., improve the air conduction score).
  • a patient's perceived hearing improvement is best when the hearing level of the poorer-hearing ear is raised to a level close to that of the better-hearing ear.
  • Hearing loss is frequently categorized as being either “conductive hearing loss” or “sensorineural
  • Conductive hearing loss typically refers to middle ear impairment and generally results from damage to the tympanic membrane and/or middle ear ossicles.
  • Sensorineural hearing loss is frequently attributable to a reduction in function of hair cells within the cochlea. When sufficiently severe, sensorineural hearing loss can be mitigated by implanting electrodes in the cochlea to electrically stimulate the auditory nerve. When less severe, hearing loss can be mitigated by enhanced activation of
  • the prior art describes various electrically driven actuatordevices for physically contacting and mechanically vibrating the middle ear ossicles.
  • Such systems are typically comprised of an implant housing containing implant electronics for driving an array of electrodes, which are 240 surgically inserted, into the cochlea.
  • the implant electronics is typically driven by sound processing electronic circuitry, which is generally, but not necessarily, contained in a housing worn externally by the patient.
  • a microphone carried by the patient supplies electric signals to the input of the sound processing circuitry.
  • Typical sound processing circuitry and implant electronics provide for multiple frequency channels.
  • the said prosthesis is cosmetically most ideal as no part of the prosthesis is visible or palpable 255 externally
  • the said prosthesis will overcome individual hearing requirements of conductive, sensorineural or mixed type of hearing loss.
  • the said prosthesis is made up of 5 components which can be used partially according to the extent of disease in the middle ear.
  • the said prosthetic implant is designed in such a way that it replaces the diseased ear structures with prostheses that have structure and function same as normal human tympanic membrane and Ossicular chain.
  • the prosthetic tympanic membrane has physical properties of elasticity and tensile strength determined according to the degree and type of hearing loss of the patient.
  • the prosthesis has maximum stability and negligible chance of extrusion as it is strongly attached to the tympanic bony sulcus.
  • the proposed prosthesis also promises to give strong structural support to any other types of middle ear and/or inner ear implant.
  • This prosthesis design contains 5 parts 1 st part- Prosthetic annulus ring 275 2 nd part- Prosthetic Ossicular chain
  • 1 s ' part- Prosthetic annulus ring Designed as a "ring inside a ring” so that the diameter of the annulus can be changed from 6mm to 1 1 mm as per need during installation inside the ear. This artificial annulus will fix snugly inside the natural bony annulus of ear in anatomical location of tympanic membrane.
  • 3 rd part- Prosthetic tympanic membrane attached to a ring It is made of inert material with elasticity same as that of natural tympanic membrane and a very high tensile strength, is installed on the 290 prosthetic ring annulus such that, inner border of the prosthetic tympanic membrane is touching the lateral process of prosthetic Malleus.
  • a slender projection coming from tip of handle of prosthetic Malleus pierces the prosthetic tympanic membrane.
  • 5 th part- nut fixer A small lightweight nut is the inserted along the threading on 4 th part (attacher) such that the prosthetic tympanic membrane approximates with the manubrium of prosthetic Malleus.
  • Prosthetic Annulus is a circular ring that fits inside the bony sulcus of tympanic membrane (TM) and which acts as fixator for prosthetic tympanic membrane.
  • This prosthetic annulus is composed of titanium and plastic material used in total ossicular 310 replacement prosthesis (TORP) or partial ossicular replacement prosthesis (PORP). Amount of material required to prepare this prosthetic is estimated below: -
  • the annular fixator will be made up of 4 titanium plates covering 58.33 % of the circumference of annulus with 6 nails for stabilization of annulus fixator in the bony sulcus.
  • Plastic System The plastic material in the annular ring fixator will be approximately of 25 % of 315 surface area.
  • the 2 central plates each measuring 100° initially will measure 70° on its complete expansion, these plates will be with one screw each.
  • the titanium plate will be triangular in shape; this will be achieved by combining 2 titanium sub-plates with a hollow groove inside it them that will contain serrations and the plastic component of the annulus ring. These 2 sub-plates will join at its outer circumference to form triangular sharp ridge and have2 nails in their peripheral ends in peripheral plates
  • Plastic plates It is made up of TORP/PORP material, which will have serrations on their outer circumference that will be complimentary to the serrations present on inner aspect of titanium plate's serrations whereas the serrations present on inner circumference will be complimentary to the serrations present on the fixing screw.
  • Fixing screw It is a star shapedscrew, which has serrations complimentary to the serrations on the plastic plate on inner aspect (As shown in Fig: 5).
  • This defect is for removal of overhanging bone covering the incus and stapes foot plate that occludes the vision while surgery.
  • Prosthetic TM is made up of artificial material that is similar to human TM Composition: Ideal material for TM would be sialistic material.
  • TM thickness of TM will be 3mm antero-inferiorly, which will be tapering to 1mm postero- 370 superiorly, such that the hole of 0.5 mm of diameter is present to accommodate the screw arising from tip of handle of Malleus (As shown in Fig: 6).
  • Circumferentially clipping system will be present that will fix the TM on the annular fixator.
  • Composition It is composed of titanium / sialistic material.
  • Nut A 1 mm diameter hexagonal shaped nut made up of titanium material. It will possess complementary threading to the bolt. This nut will be preceded by rotational movement with the help of key to reach the tip of handle of Malleus fixing the TM over it.
  • Angle between Head-Neck and Manubrium is 100 degree
  • Angle between Manubrium and Lateral process of Malleus is 150 degree 405
  • a perpendicular line Drawn from centre point of MalleUs divides the above angle into 2 components: -
  • the angle between the short process and Head-Neck is 110 degree
  • Composition Ideal material for ossicles would be hydroxyapatite/titanium.
  • Lateral process of incus It is of length 4.7 mm which distally advances and bifurcates in such a way that it 435 forms a Head- Mirror Joint with Prosthetic Stapes.
  • the gap between two long processes of Malleus and Incus is 2.8mm and they are parallel to each other in such a way that Malleus handle liesanterolaterally and incus long process lies posteromedially. Thickness of both long processes is 1 mm.
  • AXIS OF ROTATION The prosthetic incus is arrange in such a way that the axis of rotation of incus with 440 respect to Malleus passes from short process of incus to lateral process of Malleus.
  • Composition Ideal material for ossicles would be hydroxyapatite /titanium.
  • Prosthetic Stapes is a Straight rod like structure which on lateral end forms Head- 450 MirrorJoint with long process of incus and medially forms a Copper-T like joint (there is no Copper but the joint is like Copper T used in contraception) with the Stapes footplate.
  • the long arm of Prosthetic stapes is slightly curved in the posterior aspect (As shown in Fig: 9).
  • This Copper-T is enclosed in a cylindrical tube, which on pulling back opens up the Copper-T Prongs in the inner ear.
  • the stapes is pre-installed at its Head-Mirror Joint with long process of incus.
  • the Medial end has to be Installed Surgically.
  • a 0.6 mm hole is created on Stapes foot plate as done in Routine Stapes Surgeries.
  • the postero-superior defect in the annular fixator provides extra visual area to aid proper installation of Total implant of Middle Ear (T.I.M.E).
  • the prosthetic tympanic membrane is removable which helps in inspection of diseased middle ear in future.
  • This Total implant of Middle Ear can be used in any disease causing permanent Conductive Hearing Loss and/or Sensorineural Hearing Loss.
  • the tensile strength and elasticity of prosthetic tympanic membrane can be adjusted according to severity and type of hearing loss.
  • the annular fixator gives strong and permanent support to prosthetic tympanic membrane, prosthetic ossicular chain and electrodes of cochlear implants.
  • the foresaid prosthesis is made up of 5 components which can be used partially according to the extent of disease in the middle ear.

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  • Health & Medical Sciences (AREA)
  • Otolaryngology (AREA)
  • Pulmonology (AREA)
  • Cardiology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Transplantation (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Vascular Medicine (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Prostheses (AREA)

Abstract

La présente invention concerne généralement des systèmes et propose des procédés pour améliorer l'audition chez des patients souffrant de perte d'audition conductive et/ou de perte d'audition neurosensorielle. Compte tenu du contexte de l'invention, la présentation clinique de patients qui bénéficieraient d'une ossiculoplastie est très variable. La perte d'audition conductive peut être la conséquence de l'érosion ossiculaire ou de la fixation d'une maladie chronique de l'oreille, un traumatisme non tranchant ou pénétrant, ou des causes congénitales ou néoplasiques. Elle peut également être associée à des causes liées à l'oreille interne. Ces causes liées à l'oreille interne comprennent une déhiscence du canal semi-circulaire supérieur et un aqueduc vestibulaire élargi. Ladite prothèse est conçue de sorte qu'une fois implanté, elle fonctionne pendant la durée de vie du patient, sans source externe d'énergie électrique, cette prothèse surmonte toutes les limitations des implants de l'oreille moyenne conçus à ce jour.
PCT/IN2016/000217 2015-08-27 2016-08-25 Implant total de prothèse de l'oreille moyenne WO2017033205A1 (fr)

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IN649MU2015 2015-08-27
IN649/MUM/2015 2015-08-27

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Cited By (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2019183647A1 (fr) * 2018-03-23 2019-09-26 Tshifularo Mashudu Prothèse ossiculaire totale (top)/prothèse stapédienne moderne dans des cas de surdité de transmission
CN112533123A (zh) * 2020-11-27 2021-03-19 徐州市健康研究院有限公司 一种初始压力变刚度调节的圆窗激振式人工中耳作动器
CN114949355A (zh) * 2022-04-12 2022-08-30 宁波大学 一种听骨软骨一体化听小骨植入体及其制造方法

Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8128695B2 (en) * 2008-03-20 2012-03-06 Heinz Kurz Gmbh Medizintechnik Auditory ossicle prosthesis with variable coupling surfaces
WO2013138818A1 (fr) * 2012-03-16 2013-09-19 Tshifularo Mashudu Prothèse d'oreille moyenne partielle ou totale
US8888846B2 (en) * 2009-01-24 2014-11-18 Heinz Kurz Gmbh Medizintechnik Passive ossicle prosthesis comprising applicator

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8128695B2 (en) * 2008-03-20 2012-03-06 Heinz Kurz Gmbh Medizintechnik Auditory ossicle prosthesis with variable coupling surfaces
US8888846B2 (en) * 2009-01-24 2014-11-18 Heinz Kurz Gmbh Medizintechnik Passive ossicle prosthesis comprising applicator
WO2013138818A1 (fr) * 2012-03-16 2013-09-19 Tshifularo Mashudu Prothèse d'oreille moyenne partielle ou totale

Cited By (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2019183647A1 (fr) * 2018-03-23 2019-09-26 Tshifularo Mashudu Prothèse ossiculaire totale (top)/prothèse stapédienne moderne dans des cas de surdité de transmission
CN112533123A (zh) * 2020-11-27 2021-03-19 徐州市健康研究院有限公司 一种初始压力变刚度调节的圆窗激振式人工中耳作动器
CN112533123B (zh) * 2020-11-27 2022-03-25 徐州市健康研究院有限公司 一种初始压力变刚度调节的圆窗激振式人工中耳作动器
CN114949355A (zh) * 2022-04-12 2022-08-30 宁波大学 一种听骨软骨一体化听小骨植入体及其制造方法

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