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The Warsaw Voice » Other » July 1, 2009
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Helping the Children of a Lesser God
July 1, 2009   
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Scientists and physicians working at the Institute of Physiology and Pathology of Hearing in Warsaw have developed the world's first system that makes it possible to remotely control inner-ear implants in patients at any location in the world.

The system, called Telefitting, has earned its inventors a gold medal at the recent World Exhibition of Innovation, Research and New Technologies in Brussels.

The full name of the invention is "a system for the remote adjustment of speech processors in cochlear implants." The system, which uses the most modern information and communication technology (ICT) tools, makes it possible to provide medical care to cochlear implant patients without requiring them come to the institute.

Cochlear implants are surgically implanted electronic prostheses that take over the function of damaged sensory cells in the inner ear.

Aiding the deaf and hard of hearing
Prof. Henryk Skarżyński, the founder and director of the Institute of Physiology and Pathology of Hearing, performed Poland's and Central Europe's first cochlear implant operation on a deaf patient in 1992. Skarżyński also heads the International Center of Hearing and Speech in Kajetany near Warsaw, which performs an average of 35 surgical procedures involving cochlear implants daily. Since 2003, the center has also performed many middle-ear implant operations.

Skarżyński is a pioneer in middle-ear reconstructive procedures. He was the first surgeon in Poland to prove that it is possible to restore hearing to totally deaf people, even those who have been deaf since birth. The Institute of Physiology and Pathology of Hearing is now one of the world's leading otolaryngology centers and performs the most complex reconstructive procedures, with implants inserted into the middle ear, inner ear, brainstem and temporal bone.

The institute's team, in conjunction with partners from Germany and Austria, performed their first auditory brainstem implant procedure in 1998. It was the fourth surgery of this kind in the world.

"The system for the remote adjustment of the speech processor in the cochlear implant was not our first award-winning design," Skarżyński says. "In recent years we have won more than 10 international awards at the most important innovation exhibitions in Brussels, Paris and Geneva. We received these awards in recognition of our well-prepared ideas that have been put into practice in various areas, especially in telemedicine where we use the latest ICT tools. We have advanced technology and extensive clinical experience resulting from the fact that we have performed the world's largest number of operations to improve hearing in patients over the past six years."

Assisting from afar
As regards the Telefitting system, some attempts at remote adjustment have been made in Australia, Germany and Spain, Skarżyński says, but the Polish team was the first to develop the system and successfully put it into practice.

For several years the number of implant operations performed in Poland has been larger than anywhere else in the world, according to Skarżyński.

"We have patients from different parts of Poland and from abroad who need post-operative care; we have a well-developed ICT base and have pioneered several telemedicine programs," Skarżyński says. "We also provide various well-developed organizational forms of assistance to implant patients. As a result, we were able to launch the Telefitting program and check its operation-first between the International Center of Hearing and Speech in Kajetany and the Medical Therapy Center in Łeba and then between the centers in Warsaw and Kajetany, and subsequently other centers in Poland. Before we had shown our system in Brussels, we presented our results at international conferences in various countries in Europe, America and Asia."

The speech processor is an external part of a cochlear implant. It is located behind the patient's ear and is powered by tiny batteries, just like a hearing aid. It picks up sound from the environment, converts it into electrical impulses and transmits them through skin to an internal part of the implant. From this part, the electric impulses are sent through an internal cable to an array of miniature electrodes in the cochlea, the auditory portion of the inner ear. The electrodes stimulate individual fibers of the auditory nerve.

Scientists working at the institute say that long-term and well-coordinated medical care and rehabilitation are needed for the implant patient to achieve the best possible results after surgery. It is necessary to tune the parameters of electrical stimulation of the auditory nerve to the patient's needs. The patient needs speech therapy and consultations with educators and psychologists may also be needed. With the innovative speech processor adjustment system, the device can be programmed remotely.

The inventors say the main reason why they wanted to develop the system for the remote programming of the speech processor was that a large percentage of implant patients are children, many of whom live far from the institute. It is difficult to work with a young patient after a long journey and the results of tests are less reliable in such cases. Paradoxically, the absence of the patient at the institute may improve the comfort and quality of work for the specialist programming the speech processor, and thus also improve the patient's future comfort. This also concerns the institute's foreign patients, the number of whom is rising all the time.

The system was put into daily clinical practice in Poland in 2008. By April this year 1,549 implant patients were covered by the system. Thanks to the successful implementation of the system, the institute has received a grant for the development of a nationwide network of auditory "telerehabilitation" centers. Work to build more centers in various regions of Poland and in Grodno, Belarus, Odessa and Kiev, Ukraine, and Moscow got under way earlier this year.

Ewa Dereń

90 Percent Success Rate
Otosurgery, or surgery of the ear, has entered a new era these days, according to Prof. Henryk Skarżyński, the founder and director of the Institute of Physiology and Pathology of Hearing in Warsaw and manager of the International Center of Hearing and Speech in Kajetany near Warsaw. Thanks to the rapid development of surgical methods, today it is possible to help almost every patient, Skarżyński says.

According to Skarżyński, "socially adequate" hearing can be restored to around 90 percent of the patients who undergo reconstructive procedures at the Institute of Physiology and Pathology of Hearing in Warsaw. According to the professor, progress made in this area over the past five years is far greater than in any other medical specialty.

Turning on the Sound
The cochlear implant is one of the greatest medical and technological achievements of the last 30 years, according to Prof. Henryk Skarżyński, head of the International Center of Hearing and Speech in Kajetany near Warsaw.

Skarżyński performed Poland's first cochlear implant operation on a completely deaf patient on July 16, 1992. Since then the Warsaw institute has turned on the sound or turned up for volume for many people who are either congenitally death or who have lost all or part of their hearing and for whom traditional hearing aids have proven ineffective.

"Once they've had the operation, these people can function in society on an equal footing with everyone else; they can work and study normally, and enjoy life to the full," Skarżyński says.

Awards and Accolades
The Telefitting system for the remote adjustment of cochlear implants developed by scientists from the Institute of Physiology and Pathology of Hearing in Warsaw has won many international awards and prizes.

In addition to the gold medal at the 57th World Exhibition of Innovation, Research and New Technologies in Brussels, the system won a gold medal of the Polish Success Academy (2008), an award from the Romanian Minister of Education and Scientific Research (Brussels 2008), and an award from the Minister of Science and Higher Education at the 14th Invention Fair in Warsaw (2009).

The Institute of Physiology and Pathology of Hearing boasts a long list of accolades including a Belgian Order of Invention.

The Telefitting system developed by researchers and physicians at the Institute of Physiology and Pathology of Hearing in Warsaw is an example of a telemedicine service. Telemedicine is a rapidly developing application of clinical medicine where medical information is transferred via telephone, the internet or other networks for the purpose of consulting, and sometimes remote medical procedures or examinations.
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