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Viewpoint |

The Evolving Science of Cochlear Implants

Graeme M. Clark, AC, FRS, FAA1 ; Jonathan C. M. Clark, MBBS, PhD1 ; John B. Furness, FAA, PhD2
[+] Author Affiliations
1 Information and Communications Technology (ICT) Centre of Excellence for Life Sciences, University of Melbourne, Parkville, Victoria, Australia
2Department of Anatomy and Neuroscience, University of Melbourne, Parkville, Victoria, Australia
JAMA. 2013;310(12):1225-1226. doi:10.1001/jama.2013.278142.
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Graeme M. Clark and colleagues describe the evolving science of cochlear implants and the histopathology associated with a patient who had his implant removed when it failed in 1983 and again in 1998. Dr Clark has been awarded the 2013 Lasker-DeBakey Clinical Medical Research Award for his pioneering work in cochlear implant development.

In 1978, the first multichannel cochlear implant was developed in Australia and a prototype was surgically implanted in a 48-year-old patient (MC-1). After a series of clinical trials, the US Food and Drug Administration approved the use of the Australian cochlear implant in adults in 1985, and subsequently, the agency has approved the device for use in infants as young as 6 months of age. During the past 3 decades, more than 300 000 patients have had their hearing restored with cochlear implants. In this Viewpoint, we describe how the assessment of the temporal bone of MC-1, the first patient to receive a cochlear implant, is aiding the further development of the device.

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Figure 1.
Postmortem Histologic Findings in Connective Tissue Sheath Adjacent to the Cochlear Implant Electrode Array in Patient MC-1

A, Heterotopic bone formation (asterisk) and black particulate matter (black arrowhead) engulfed by macrophages in tissue surrounding the CI-24 electrode (Masson trichrome, original magnification x 40). B, Multinucleate giant cell (blue arrowhead) and macrophages containing foreign black particles (black arrowhead) in tissue surrounding the CI-22 electrode (hematoxylin-eosin, original magnification x 40).

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Figure 2.
Position of Cochlear Implant Electrode Array in Patient MC-1 and Placement of High-Density Microarray in Future Patients

Three-dimensional reconstruction (right) of the patient's cochlea from histologic sections shows the lateral position of the CI-24 electrode tract (orange). In future patients, a thin-film, high-density electrode microarray (green) could be placed in a perimodiolar position, closer to the spiral ganglion, for fine temporo-spatial patterns of nerve stimulation.7

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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