Methods for detecting multiple health conditions of the cochlea

Abstract

Methods for detecting a plurality of health conditions of a cochlea are disclosed, including: applying a plurality of acoustic stimuli, wherein each of the plurality of acoustic stimuli includes a click comprising a plurality of acoustic pulses modulated at a frequency of a tone; disposing an electrocochleography probe on an outer wall of a cochlea of a recipient; measuring a plurality of cochlear baseline responses based on the plurality of acoustic stimuli via the electrocochleography probe prior to insertion of an electrode array into the cochlea of the recipient; continuously measuring a plurality of cochlear responses based on the plurality of acoustic stimuli via the electrocochleography probe during insertion of the electrode array into the cochlea of the recipient; determining a plurality of electrical response differences between the plurality of cochlear baseline responses and the plurality of cochlear responses; and determining a plurality of health conditions of the cochlea during insertion of the electrode array based on the plurality of electrical response differences.

Description

Technical Field

[0001] This invention relates to hearing aid devices. More specifically, this invention relates to methods for detecting various health conditions of the cochlea. Background Technology

[0002] It is well known that cochlear implantation (CI) surgery, primarily during electrode array insertion, can cause trauma within the cochlea. The scientific and medical community in the field of CI has been attempting to minimize the risk of insertion trauma by improving electrode array design, surgical procedures, and anatomical knowledge.

[0003] Objective measures known for cochlear electrophonation (eCochG) have been shown to reduce the risks of invasive surgery. One component of eCochG is the cochlea microphonics (CM), which is the response of hair cells to acoustic bursts. Typically, eCochG is recorded from sequentially or alternately generated acoustic sine and cosine bursts (i.e., sparse and dense stimuli). CMs are a component of eCochG and are readily detectable from their in-phase responses to stimuli.

[0004] eCochG can be recorded using intracochlear electrodes (electrodes from an electrode array of the cochlear implant during electrode insertion) or extracochlear electrodes (surface electrodes arranged on the outer wall of the cochlea, either in combination with an external recording system or embedded in the CI as a recording, floating external electrode, such as a reference electrode of the CI).

[0005] It has been demonstrated that cochlear comprehension (CM) recorded via the eCochG system can provide surgeons with information about cochlear health during cochlear implantation (CI) surgery. During electrode array insertion, eCochG continuously records in response to an acoustic burst at a frequency preferably 500 Hz via the recording electrode, which serves as the apex electrode of the electrode array (intracochlear eCochG). With electrode array insertion, the recording electrode becomes closer to the excitation center of the hair cells (located at the apex of the cochlea). Subsequently, CM is presumably increased with electrode array insertion until a saturation steady state is reached. In cases where the electrodes are damaging the cochlea (preventing basement membrane vibration, translocation to the scala vestibulae, puncture of the cochlear wall, etc.), CM suddenly decreases. These sudden decreases in CM have been shown to be highly correlated with residual hearing after cochlear implantation surgery in patients.

[0006] eCochG monitoring of CI surgery is known to be effective for non-invasive CI insertion.

[0007] However, a potential drawback of the method described above is that it does not provide feedback to the surgeon regarding the cochlear region damaged by electrode insertion and the depth of electrode insertion at the time of injury. For surgeons, estimating the potential trauma caused by the electrode array when eCochG declines, i.e., when CM measurements decrease, is complex. Summary of the Invention

[0008] One aspect of the present invention is to provide a method for detecting the health status of the cochlea during insertion of an electrode array into a cochlear implant system.

[0009] Another aspect of the present invention is to provide a method for improving the surgical capability of inserting an electrode array into a cochlear implant system, thereby minimizing the reduction of the user's residual hearing after the electrode array is inserted.

[0010] Another aspect of the invention is to provide a personalized and automatic fitting of a cochlear implant frequency distribution map based on the patient's response after surgery.

[0011] One aspect of the invention is achieved by a method for detecting multiple health conditions of the cochlea during insertion of an electrode array of a cochlear implant system into a recipient's cochlea. The method includes: applying multiple acoustic stimuli, each of which comprises a burst of sound at a different frequency. The multiple acoustic stimuli can be applied via a receiver or a vibrator, the receiver being a transducer placed at or within the user's ear canal, and the vibrator configured to apply mechanical vibrations to the user's temporal bone. Each burst of sound comprises multiple acoustic pulses modulated at a single tone selected from a audible frequency range. Cochlear electrodialysis probes are disposed on the outer wall of the recipient's cochlea for measuring multiple cochlear baseline responses based on the multiple acoustic stimuli prior to insertion of the electrode array into the recipient's cochlea.

[0012] For each of the multiple acoustic stimuli, a cochlear electrodialysis probe measures the cochlear baseline response before the electrode array is inserted into the recipient's cochlea. The cochlear baseline response includes the cochlear response based on the acoustic stimulus prior to any possible trauma to the cochlea caused by electrode array insertion. Subsequently, during electrode array insertion into the recipient's cochlea, the cochlear electrodialysis probe continuously measures multiple cochlear responses based on multiple acoustic stimuli. Multiple electrical response differences are determined between the multiple cochlear baseline responses and the multiple cochlear responses. Each of the multiple electrical response differences includes the determined difference between one of the multiple cochlear baseline responses and one of the multiple cochlear responses, where both the cochlear baseline response and the cochlear response are measured based on an acoustic stimulus including the same burst of sound. Multiple health conditions of the cochlea are determined based on the multiple electrical response differences during electrode array insertion.

[0013] Acoustic stimulation can be delivered to the recipient of the electrode array via a loudspeaker or a bone-anchored hearing system.

[0014] Cochlear electrodiagnosis probes can be external cochlear probes. The advantage of using external cochlear probes instead of electrodes from an electrode array as cochlear electrodiagnosis probes (e.g., in an intracochlear system) is improved stability of recorded cochlear responses, as well as enhanced user-friendliness. This is because the signal-to-noise ratio (SNR) of cochlear response recordings by intracochlear probes varies due to the movement of the electrode array during insertion. In practice, when using one or more electrodes as recording electrodes for the cochlear response, a decrease in SNR can be observed during electrode insertion, leading to inaccurate determination of cochlear health and the position of the electrode array within the cochlea. However, the stability and user-friendliness of intracochlear probes are optimized by sequentially applying electrical stimulation to each of the multiple electrodes in the electrode array, performing multiple impedance measurements on each of the multiple electrodes based on the electrical stimulation during insertion of the electrode array into the recipient's cochlea, and determining multiple relevant signals based on multiple impedance measurements and multiple electrical response differences. Impedance measurements will significantly aid in determining health status and the position of the electrode array in cases of SNR decline.

[0015] Alternatively, multiple cochlear baseline responses can be statistically determined based on cochlear baseline responses previously measured or recorded from recipients of the electrode array or other users of the cochlear implant.

[0016] Multiple health conditions of the cochlea can be identified or assessed at different locations in the cochlea by changing the frequency of burst sounds.

[0017] Multiple cochlear baseline responses can correspond to multiple baseline eCochG measures, and multiple cochlear responses correspond to multiple eCochG measures, and each of the multiple electrical responses corresponds to the subtraction between the baseline eCochG measure and the corresponding eCochG measure during electrode insertion.

[0018] Each of the multiple health conditions may include the determination of eCochG or the eCochG trauma index, where the eCochG trauma index indicates the amount of reduction in the measured cochlear microphonic potential caused by the collision between the inserted electrode array and the inner wall of the cochlea.

[0019] Another aspect of the invention is implemented by a system comprising a receiver configured to apply a plurality of acoustic stimuli to a recipient, wherein each of the plurality of acoustic stimuli comprises bursts of sound at different frequencies. Furthermore, the system includes a cochlear implant system comprising an electrode array configured to provide electrical stimulation to the auditory nerve of the recipient's cochlea, the electrode array comprising a plurality of electrodes. Additionally, the system includes a stimulator processor configured to apply electrical stimulation to one or more of the plurality of electrodes. The stimulator processor may be part of the cochlear implant system or part of an external stimulator connected to the processor unit.

[0020] The system of the present invention includes a cochlear electrography probe disposed on the outer wall of a recipient's cochlea, wherein the cochlear electrography probe is configured to measure multiple cochlear baseline responses based on multiple acoustic stimuli before the electrode array is inserted into the recipient's cochlea, and to measure multiple cochlear responses based on multiple acoustic stimuli continuously or sequentially during the insertion of the electrode array into the recipient's cochlea.

[0021] Cochlear electrodialysis probes are medical devices that include sensors for measuring the eCochG response.

[0022] The system of the present invention also includes at least a processor unit connected to a cochlear electrography probe, wherein the processor unit is configured to determine multiple electrical response differences between multiple cochlear baseline responses and multiple cochlear responses, and to determine multiple health conditions at different locations within the cochlea based on the multiple electrical response differences during electrode array insertion.

[0023] The processor unit may be part of a computer connected to the cochlear implant system via a wired or wireless interface, wherein communication between the computer and the cochlear implant system includes multiple cochlear baseline responses and multiple cochlear responses. The processor unit is configured to transmit determined health conditions to a graphical user interface of the computer. Alternatively, the processor unit may be part of a tablet computer, smartphone, or any type of computer device.

[0024] The advantage of the method and system of this invention is that surgeons can monitor the health of the cochlea while inserting an electrode array into the cochlea. With each of multiple acoustic stimuli being applied consecutively to the user, the surgeon can monitor the health of the cochlea and the location of any trauma to the cochlea. For example, if the recipient receives bursts of sound at 250 Hz and 1000 Hz, and the surgeon observes a decrease in the eCochG metric at one or both frequencies—that is, the determined electrical response difference becomes negative—the surgeon may be able to locate whether the trauma has occurred in the apical and / or basal regions of the cochlea.

[0025] Accurate location of a trauma depends on the number of acoustic stimuli. A higher number of acoustic stimuli provides better resolution for trauma location determination, which means improved accuracy in determining the location of the trauma.

[0026] Multiple baseline responses and multiple cochlear responses include measurements of cochlear microphonic potentials.

[0027] The cochlear microphonic potential (CM) is an alternating current (AC) voltage that mirrors the waveform of an acoustic stimulus from the cochlea.

[0028] Acoustic stimulation is provided by a receiver configured to provide multiple stimuli that induce vibrations of the basilar membrane. The multiple stimuli may originate from an ear canal acoustic stimulator (via a speaker driven from a computer or hearing aid device), a middle ear implant stimulator configured to provide ossicular vibration support in the recipient's middle ear, or a bone conduction device configured to provide multiple acoustic stimuli via the recipient's temporal bone.

[0029] The electrode array may include multiple electrodes, and the method of the present invention further includes sequentially applying electrical stimulation to each of the multiple electrodes of the electrode array, performing or recording multiple impedance measurements of each of the multiple electrodes based on the electrical stimulation during insertion of the electrode array into the recipient's cochlea, and determining multiple related signals based on the multiple impedance measurements and multiple electrical response differences.

[0030] Impedance measurement of the electrodes is used to determine whether the corresponding electrode is inside or outside the cochlea. When the electrodes of the electrode array are outside the cochlea, the impedance is not measurable, i.e., the impedance is infinite. When the electrodes of the electrode array are inside the cochlea, the impedance is measurable, i.e., the impedance is finite.

[0031] Multiple cochlear baseline responses can be recorded by cochlear electrography probes before the electrode array is inserted into the recipient's cochlea. However, during or after electrode array insertion, the probe position can be moved to a new probe position in the cochlea while adjusting multiple cochlear baseline responses based on multiple impedance measurements. For example, when the probe position in the cochlea is changed from a first position to a second position, the electrode array will see changes in multiple recorded impedance measurements from when the probe was in the first position to when it was in the second position. These changes in multiple impedance measurements can be used to adapt multiple cochlear baseline responses to the new probe position.

[0032] Each of the multiple related signals is determined by the relationship between one of the multiple impedance measurements and the multiple electrical response differences.

[0033] Multiple impedance measurements can determine the location of the electrode array within the cochlea, and by correlating these measurements with multiple electrical response differences, the cause of the health condition change can be identified. For example, if the electrode array is determined to be located in the basal region and the trauma site is determined to be in the apical region based on multiple electrical response differences, the cause of the trauma may be an error in the cochlear electrodiagraphy probe, since the electrode array has not yet entered the basal region. Therefore, if the electrode array is determined to be located in the apical region and the trauma site is in the apical region, the cause of the trauma may be a collision between the electrode array and the cochlear wall, more specifically, a collision between the tip of the electrode array and the cochlear wall. Thus, if the electrode array is determined to be located in the apical region and the trauma site is in the basal region, the cause of the trauma may be a collision between a portion of the electrode array (not the tip) and the cochlear wall, or an error in the cochlear electrodiagraphy probe.

[0034] Multiple relevant signals can also be determined based on the length of the electrode array, the length of each of the multiple electrodes, and / or the distance between each of the multiple electrodes. This may allow for a more accurate determination of the electrode array's location within the cochlea.

[0035] Multiple impedance measurements include real-time and / or continuous determination of the impedance of each of the multiple electrodes.

[0036] By combining real-time and / or continuous impedance measurements with multiple real-time and / or continuous health statuses, surgeons can stop electrode array insertion upon detection of trauma. This reduces potential damage to the recipient's residual hearing compared to a situation where the surgeon is unaware of the trauma and continues inserting the electrode array.

[0037] An electrode array may include multiple electrodes, such as at least 15 electrodes.

[0038] The stimulator processor is configured to sequentially apply electrical stimulation to each of the plurality of electrodes in the electrode array, and based on the electrical stimulation, the stimulator processor is configured to perform multiple impedance measurements on each electrode during insertion of the electrode array into the recipient's cochlea. The stimulator processor is then configured to determine multiple relevant signals based on the multiple impedance measurements and multiple electrical response differences.

[0039] The first and second states of each electrode in the electrode array can be determined based on each of a plurality of impedance measurements, wherein if the impedance measurement is higher than a first impedance level, the electrode of the electrode array is in the first state, and if the impedance measurement is lower than the first impedance level, the electrode is in the second state.

[0040] If the electrode is in the first state, the electrode in the electrode array is located outside the cochlea; if the electrode is in the second state, the electrode in the array is located inside the cochlea. In the first state, the measured impedance is infinite, meaning the conductance cannot be measured. In the second state, the measured impedance is finite, meaning the conductance can be measured.

[0041] The multiple health conditions include a first health condition and a second health condition, wherein if the corresponding electrical response difference among the multiple electrical response differences is greater than the first response difference threshold, the cochlea is in the first health condition; and if the corresponding electrical response difference among the multiple electrical response differences is less than the first response difference threshold, the cochlea is in the second health condition.

[0042] The multiple health conditions include at least a first health condition and at least a second health condition, wherein the cochlea is in at least a first health condition if a corresponding electrical response difference among the multiple electrical response differences is higher than or equal to a response difference threshold; and the cochlea is in at least a second health condition if a corresponding electrical response difference among the multiple electrical response differences is lower than a response difference threshold.

[0043] The response difference threshold is determined based on one of multiple cochlear baseline responses, wherein the determined electrical response difference and response difference threshold are determined based on the same acoustic stimulus. Thus, the cochlear baseline response, cochlear response, electrical response difference, and response difference threshold are all related to the same acoustic stimulus.

[0044] The determination of multiple health conditions includes determining multiple health conditions in real time or continuously.

[0045] The system of the present invention may include a graphical user interface, wherein the graphical user interface is configured to provide a graphical representation of multiple electrical response differences as functions of insertion time, physiological cochlear position-frequency, and / or insertion depth.

[0046] The system of the present invention may include an alarm unit configured to generate an alarm signal when a first electrical response difference and / or a second electrical response difference is below a first response difference threshold, i.e., when the cochlea is in a second health condition. The alarm unit may be part of a computer including a processor unit. The alarm signal may be transmitted to a graphical user interface (GUI), or the alarm signal may be transmitted as an acoustic alarm sound to a surgeon. The GUI may be configured to convert the alarm signal into a warning message or warning sound, which may be used by the user of the GUI to stop the insertion of the electrode array or to rotate the electrode array.

[0047] The graphical user interface can be configured to provide a graphical representation of multiple related signals as a function of physiological cochlear position-frequency and / or insertion depth.

[0048] The system of the present invention may include a diagnostic unit configured to generate a message including the cause of an alarm signal and / or the status of each electrode in the electrode array. The diagnostic unit is connected to a processor unit and / or an alarm unit.

[0049] The system of the present invention may include a memory storing, for example, a physiological cochlear position-frequency map derived from Greenwood (1961). A graphical user interface is connected to the memory. The physiological cochlear position-frequency map can be customized for the recipient of the cochlear implant system using a 3D image of the recipient's cochlea.

[0050] Bursts can include sweep tones, which are continuous acoustic signals whose frequency varies over time. Sweep tones can cover the entire audible spectrum (20 to 20,000 Hz), but can also use a more limited spectrum, such as two or more tones produced in a continuous manner.

[0051] Sudden sounds can include harmonic complex acoustic signals composed of several tones, such as two or more pure tones. These tones can be composed of the convolution or multiplication of multiple tones.

[0052] The shape of the swept tone or harmonic complex acoustic signal can be adapted to the cochlear electrorecording curve, providing the duration, amplitude of each tone, and timing of when each tone begins. For example, within a first time window of a first time length, the amplitude of one or more tones gradually increases over time; within a second time window of a second time length, the amplitude of one or more tones remains constant over time; and within a third time window of a third time length, the amplitude of one or more tones gradually decreases over time. The second time window follows the first time window, and the third time window follows the second time window.

[0053] Cochlear electrorecording curves can be stored in the system's memory.

[0054] The cochlear electrorecording curve may have at least two time windows of different or equal length, in the first time window of the at least two time windows, one or more sounds gradually change with time at a first rate, and in the second time window of the at least two time windows, one or more sounds gradually change with time at a second rate, wherein the first rate is different from the second rate.

[0055] The position of the cochlear electrodiagraphy probe can be determined based on bursts of sound at different frequencies, i.e., different tones. For each frequency, the cochlear response is measured by the probe, and the maximum cochlear response among the cochlear responses measured at each frequency is determined. The cochlear response may be a subset of multiple cochlear responses. The maximum cochlear response has the highest response amplitude among the multiple cochlear responses. The position of the cochlear electrodiagraphy probe can be determined by extracting the position from a physiological cochlear position-frequency map based on the frequency that provides the maximum cochlear response. The probe position can be determined by a processor unit.

[0056] Physiological cochlear position-frequency diagrams can be stored in the memory of the system of the present invention.

[0057] In bursts of sound, multiple frequencies arrive at the cochlea at different times. For example, the lowest tone of a burst arrives after the highest tone, and the different time shifts between the different tones are known and stored in the memory of the system of the present invention. Cochlear electrodialysis probes measure multiple cochlear responses based on bursts of sound, and the time shifts between the multiple cochlear responses are determined by a processor unit. Based on the time shifts, the processing unit is configured to determine whether the residual hearing of the cochlea has deteriorated during and / or after electrode array insertion. For example, if the time shift has increased, the residual hearing of the cochlea has decreased.

[0058] After the electrode array is inserted, a frequency map of the electrodes in the electrode array can be determined. This frequency map includes the optimal stimulation frequency for each electrode. This frequency map can be determined by the sound processor of the cochlear implant system, which is connected to the electrode array, or by the processor unit of the cochlear implant system, which is connected to the electrode array via the sound processor of the cochlear implant system or via the implant of the cochlear implant system. First, the baseline frequency and baseline cochlear response of a given electrode in the electrode array must be found. This is achieved by applying multiple acoustic stimuli to a user of the cochlear implant system including the inserted electrode array, each of which includes a tone or burst of sound at a different frequency, such as 300 Hz, 350 Hz, 400 Hz, 450 Hz, 500 Hz, 550 Hz, and 600 Hz. Then, the cochlear response, i.e., the eCochG amplitude response, is measured through one or more electrodes of the electrode array for each of the different frequencies. For example, the frequency that provides the highest cochlear response, i.e., the highest eCochG amplitude response, is the baseline frequency, and the highest cochlear response is the baseline cochlear response. The electrode is preferably the apex electrode of the electrode array. For example, the baseline frequency is 400Hz, and the electrode is the vertex electrode, namely electrode number 20.

[0059] The baseline frequency and baseline cochlear response of one electrode can be stored in the system's memory unit or in the memory of the cochlear implant system.

[0060] The electrode mentioned above is referred to as the baseline electrode.

[0061] Next, a single acoustic stimulus is applied to the user, which includes a baseline frequency such as 400 Hz. The cochlear response is measured using a set of electrodes, which includes electrodes in an electrode array that differ from the baseline, such as electrodes different from electrode number 20. For example, this set of electrodes includes electrodes 13, 10, 7, and 3.

[0062] Cochlear response models, including those for the distribution of cochlear response along the cochlea for a given tone, can be derived based on collected data, the general shape of the cochlear response distribution curve along the cochlea, surface images of the cochlea, or 3D field images.

[0063] The cochlear response distribution of the cochlear response model includes the maximum cochlear response, which is centered at the baseline frequency, and equal to the baseline cochlear response. The cochlear response measured for each of the set of electrodes, such as electrodes 13, 10, 7, and 3, matches the assumed frequency, wherein the measured cochlear response is equal to the theoretical cochlear response of the cochlear response model.

[0064] Each electrode in the set of electrodes is matched to the assumed frequency.

[0065] Therefore, the frequency diagram of the electrode array may include the baseline frequency of the baseline electrode and the assumed frequency of the set of electrodes.

[0066] The frequency map of the electrode array can be obtained by applying a curve fitting method to the baseline frequency of the baseline electrode and the assumed frequency of the group of electrodes to determine the assumed frequency of each electrode in the electrode array or the remaining electrodes in the electrode array.

[0067] The cochlear electrodiagram probe disposed on the outer wall can be replaced by using one or more electrodes of a plurality of electrodes of an electrode array as recording electrodes, which are used to measure multiple cochlear baseline responses based on multiple acoustic stimuli on each of the one or more electrodes before the electrode array is inserted into the recipient's cochlea, and to measure multiple cochlear responses continuously based on the plurality of acoustic stimuli during the insertion of the electrode array into the recipient's cochlea.

[0068] Knowing the disadvantages of using an intracochlear probe compared to an external cochlear probe, it is advantageous to combine an intracochlear probe with impedance measurements, thereby improving the accuracy of determining multiple health conditions and locations when experiencing a decrease in SNR as measured by the cochlear response provided by the electrode array.

[0069] To reduce friction during electrode array insertion, thereby minimizing the risk of residual hearing damage when the electrodes contact the cochlear wall, the vibrator can be placed on the same side of the head as the electrode array to be inserted, or on the opposite side of the head. During electrode array insertion, the vibrator induces acoustic waves into the recipient's skull, which reduces friction during insertion. To ensure the acoustic waves do not interfere with measurements of the cochlear response, the frequency of the acoustic waves is chosen to be different from that of burst sounds.

[0070] The vibrator can be mounted on the bridge abutment and connected to a screw embedded in the skull. Alternatively, the vibrator can be attached to the head via magnetic attraction with the implant. Alternatively, the vibrator can be attached to the head via a soft band. Attached Figure Description

[0071] Various aspects of the invention will be best understood from the following detailed description taken in conjunction with the accompanying drawings. For clarity, these drawings are schematic and simplified, showing only the details necessary for understanding the invention while omitting other details. Throughout the specification, the same reference numerals are used for the same or corresponding parts. Features of each aspect may be combined with any or all features of other aspects. These and other aspects, features, and / or technical effects will be apparent from and illustrated in the following figures, wherein:

[0072] Figure 1 A flowchart of the method is shown;

[0073] Figure 2A and2B Different configurations of the system are shown;

[0074] Figure 3 A flowchart of the method is shown;

[0075] Figures 4A-4F The method of the present invention is illustrated in the figure;

[0076] Figures 5A-5C Different examples of the situation during electrode array insertion are shown;

[0077] Figure 6A and 6B The method and system of the present invention are illustrated.

[0078] Figure 7 The method and system of the present invention are illustrated.

[0079] Figure 8A and 8B The graphical user interface is shown;

[0080] Figure 9A and 9B Several different examples of acoustic stimuli are shown;

[0081] Figure 10A and 10B It shows a sudden sound;

[0082] Figure 11A and 11B The cochlear response based on one or more bursts of sound is shown;

[0083] Figure 12A-12D An example is shown of determining the frequency diagram of the electrodes in the electrode array after the electrode array has been inserted.

[0084] Figure 13 The system of the present invention is illustrated. Detailed Implementation

[0085] The detailed description given below, in conjunction with the accompanying drawings, serves as a description of various different configurations. This detailed description includes specific details to provide a thorough understanding of several different concepts. However, it will be apparent to those skilled in the art that these concepts can be implemented without these specific details. Several aspects of the apparatus and method are described by various different blocks, functional units, modules, elements, etc. (collectively, “elements”). These elements may be implemented using other equivalent elements depending on a particular application, design constraints, or other reasons.

[0086] Hearing aids are designed to improve or enhance a user's hearing ability by receiving sound signals from the user's environment, generating corresponding audio signals, possibly modifying those audio signals, and providing the possibly modified audio signals as audible signals to at least one of the user's ears. The audible signals can be provided as sound signals transmitted through the bone structures of the user's head to the user's inner ear as mechanical vibrations.

[0087] Hearing aids are adapted to be worn in any known manner. This may include configuring a unit of the hearing aid to be connected to a fixation device implanted in the skull, such as in a bone-anchored hearing aid, or at least a portion of the hearing aid may be an implantable part.

[0088] A “hearing system” refers to a system comprising one or two hearing aids. A “binaural hearing system” refers to a system comprising two hearing aids adapted to collaboratively provide audible signals to both of the user’s ears, or a bone conduction hearing aid may be part of a bimodal system comprising a cochlear implant and a bone conduction hearing aid. The system may also include an assistive device that communicates with at least one hearing aid, which affects the operation of the hearing aid and / or benefits from the function of the hearing aid. A wired or wireless communication link is established between at least one hearing aid and the assistive device to allow the exchange of information (such as control and status signals, possibly audio signals). The assistive device may include at least one of the following: a remote control, a remote microphone, an audio gateway device, a mobile phone, a broadcasting system, a car audio system, a music player, or a combination thereof. The audio gateway device is adapted to receive multiple audio signals, such as from an entertainment device like a TV or music player, from a telephone device like a mobile phone, or from a computer like a PC. The audio gateway device is also adapted to select and / or combine appropriate signals from the received audio signals (or combinations of signals) to transmit to at least one hearing aid. The remote control is suitable for controlling the functions and operation of at least one hearing aid. The functions of the remote control can be implemented in a smartphone or another electronic device, which may run an application that controls the functions of at least one hearing aid.

[0089] Generally, a hearing aid includes i) an input unit, such as a microphone, for receiving sound signals from the user's surroundings and providing a corresponding input audio signal; and / or ii) a receiver unit for electronically receiving the input audio signal. The hearing aid also includes a signal processing unit for processing the input audio signal and an output unit for providing an audible signal to the user based on the processed audio signal.

[0090] The input unit may include multiple input microphones, for example, for providing direction-dependent audio signal processing. The aforementioned directional microphone system is adapted to amplify a target sound source among multiple sound sources in a user's environment. In one aspect, the directional system is adapted to detect (e.g., adaptively detect) the direction from which a specific portion of the microphone signal originates. This can be achieved using methods conventionally known. The signal processing unit may include an amplifier adapted to apply a frequency-dependent gain to the input audio signal. The signal processing unit may also be adapted to provide other suitable functions such as compression, noise reduction, etc. The output unit may include an output transducer for providing mechanical vibrations to the skull transdermally or through the skin.

[0091] refer to Figure 1 This document illustrates a flowchart illustrating a method 100 for detecting the health status of the cochlea 2 during insertion of the electrode array 4 of a cochlear implant system 6. The method 100 includes: in step 102, applying a plurality of acoustic stimuli 8, each of the plurality of acoustic stimuli 8 comprising bursts of sound at different frequencies; in step 104, positioning a cochlear electrography probe 10 onto the outer wall of the recipient's cochlea; and in step 106, measuring a plurality of cochlear baseline responses based on the plurality of acoustic stimuli 8 via the cochlear electrography probe 10 prior to insertion of the electrode array 4 into the recipient's cochlea 2; subsequently, in step 108, continuously measuring a plurality of cochlear responses 11 based on the plurality of acoustic stimuli 8 via the cochlear electrography probe 10 during insertion of the electrode array 4 into the recipient's cochlea 2; in step 110, determining a plurality of electrical response differences 13 between the plurality of cochlear baseline responses 12 and the plurality of cochlear responses 11; and in step 112, determining a plurality of health statuses 15 of the cochlea 2 during insertion of the electrode array 4 based on the plurality of electrical response differences 13.

[0092] Figure 2A and 2B Different configurations of system 1 for performing method 100 are shown. Both figures illustrate system 1, which includes receivers 3 for applying multiple acoustic stimuli to a recipient. Figure 2A In the middle, receiver 3 is a speaker, and in Figure 2B In this system, receiver 3 is a bone conduction device. System 1 includes an electrode array 4 connected to a stimulator processor 16. The stimulator processor 16 is configured to apply electrical stimulation to each electrode of the electrode array 4. Figure 2A In this context, the stimulator processor 16 is part of the processor unit 17. Figure 2B In this system, the stimulator processor 16 is externally connected to the processor unit 17. Furthermore, the system 1 includes a cochlear electrodialysis probe 10, which is disposed on the outer wall of the recipient's cochlea 2. Figure 2A In this context, probe 10 is part of processor unit 17, and in Figure 2BIn this configuration, the probe 10 is externally connected to the processor unit 17. The probe 10 is configured to measure multiple cochlear baseline responses based on multiple acoustic stimuli before the electrode array is inserted into the recipient's cochlea, and to measure multiple cochlear responses based on multiple acoustic stimuli, either continuously or sequentially, during the insertion of the electrode array into the recipient's cochlea.

[0093] For the system performing method 100, the stimulator processor 16 is not essential.

[0094] Processor unit 17 is configured to determine multiple electrical response differences between multiple cochlear baseline responses and multiple cochlear responses received from probe 10. Based on the multiple electrical response differences, multiple health conditions at different locations in the cochlea are determined during electrode array insertion.

[0095] Figure 3 A flowchart of method 100 is shown, which further includes: step 114, sequentially applying electrical stimulation to each of the plurality of electrodes of electrode array 4; step 116, performing multiple impedance measurements of each of the plurality of electrodes based on the electrical stimulation during insertion of electrode array 4 into recipient cochlea 2; and step 118, determining multiple related signals based on the multiple impedance measurements and multiple electrical response differences.

[0096] Figures 4A-4F The illustration depicts a method 100 for detecting multiple health conditions of the cochlea 2 during insertion of the electrode array 4. The electrode array 4 comprises N electrodes (E0 to EN) distributed along the longitudinal axis of the electrode array 4. Cochlear electrography probes 10 are applied to the outer wall of the cochlea 2 to measure the cochlear response (11, 12) of the cochlea 2 while multiple acoustic stimuli 8, including bursts of sound, are applied. Figures 4A-4F In the example shown, three bursts of sound with three different frequencies (F1, F2, F3) are used. Figure 4A and 4B In the process, without inserting electrode array 4 into cochlea 2, the cochlear baseline response (12A, 12B, 12C) was measured over a time period for each burst of sound.

[0097] exist Figure 4C and 4D In this process, electrode array 4 is inserted into cochlea 2, and multiple acoustic stimuli 8, including three frequencies (F1, F2, F3), are applied simultaneously. The cochlear response (11A, 11B, 11C) is measured for each acoustic stimulus 8 while electrode array 4 is being inserted. The electrical response difference (13A, 13B, 13C) is determined by comparing the measured cochlear responses (11A, 11B, 11C) with the corresponding cochlear baseline responses (12A, 12B, 12C), which are measured simultaneously with the application of acoustic stimuli 8 containing bursts of sound at the same frequencies. The electrical response difference (13A, 13B, 13C) is determined as a function of insertion time 19.

[0098] exist Figure 4E and 4F In this case, electrode array 4 is inserted into cochlea 2, and multiple acoustic stimuli 8 are applied simultaneously. However, in this example, electrode array 4 collides with the inner wall of cochlea 2. The collision between electrode array 4 and the inner wall... Figure 4F The diagram shows a decrease in the electrical response difference 13B determined while an acoustic stimulus 8, including frequency F2, is applied. A decrease in the electrical response difference 13B indicates that the cochlea 2 is in a second health condition, which in this specific example results in lower residual hearing. Method 100 or system 1 is configured to determine multiple health conditions of the cochlea 2, including at least a first health condition and at least a second health condition, wherein the cochlea 2 is in at least a first health condition when the determined electrical response difference 13 is higher than or equal to a response difference threshold 18, and the cochlea 2 is in at least a second health condition when the determined electrical response difference 13 is lower than the response difference threshold 18.

[0099] exist Figure 4F In the example shown, the electrical response difference 13B in response to a sudden drop in vocalization with frequency F2 represents a collision between electrode array 4 and the inner wall region of cochlea 2, which includes hair cells tuned for a frequency range including frequency F2.

[0100] Figures 5A-5C Different examples of collisions between electrode array 4 and the inner wall of cochlea 2 are shown. Figure 5A In this case, the determined electrical response difference 13 drops below the response difference threshold 18 and then increases again above the response difference threshold 18 after a short period of time. In this scenario, the health of the cochlea is characterized by a decrease in the cochlear response 11 over a short period of time, which can lead to a slight reduction in residual hearing in the cochlea.

[0101] exist Figure 5B In the middle, the determined electrical response difference 13 decreased to below the response difference threshold 18 and was in comparison. Figure 5A In the example shown, the response difference increases again above the threshold of 18 after a longer time period. In this case, the health of the cochlea is characterized by a decrease in the cochlear response over a longer time period, which can lead to a more severe reduction in residual hearing compared to examples where the cochlear response decreases over a shorter time period.

[0102] exist Figure 5C In this case, the determined electrical response difference 13 rapidly decreases below the response difference threshold and does not increase again above the response difference threshold 18. In this situation, the health of the cochlea is characterized by a permanent decrease in the cochlear response 11, which results in a permanent reduction in residual hearing in the cochlea 2.

[0103] The measurement of the cochlear response 11 and the determination of the electrical response difference 13 can be performed continuously while the electrode array 4 is inserted into the cochlea 2, and the determined electrical response difference 13 can be visualized through a graphical user interface. The graphical user interface can receive data from the processing unit 17 and / or the probe 19, including the measured cochlear response 11, the measured cochlear baseline response 12, and / or the determined electrical response difference 13. This data is continuously updated. The graphical user interface facilitates immediate cessation of insertion when a decrease in the electrical response difference 13 is observed. This immediate response will result in a reduction in residual hearing loss, as further damage to residual hearing is avoided.

[0104] Figure 6A and 6B Method 100 and a system configured to perform multiple impedance measurements are illustrated. A stimulator processor 16 is connected to an electrode array 4 and sequentially applies electrical stimulation to each of the plurality of electrodes (E0 to EN) of the electrode array 4. For each electrode (E0 to EN), an impedance measurement 20 is performed simultaneously with insertion of the electrode array 4 into the cochlea 2. The impedance measurement 20 is performed via the electrodes (E0 to EN) and the processor unit 17. Figure 6A In this configuration, electrodes E0 to E4 are located inside the cochlea, while the remaining electrodes are located outside the cochlea. Figure 6B In this configuration, impedance is measurable for electrodes E0 to E4, but not for the remaining electrodes. Therefore, processor unit 17 is configured to determine whether the electrodes (E0 to EN) of electrode array 4 are in a first state or a second state. If the measured impedance 20 is higher than a first impedance level 21, the electrodes (E0 to EN) are in the first state; if the measured impedance 20 is lower than the first impedance level 21, the electrodes (E0 to EN) are in the second state. When the electrodes (E0 to EN) are in the first state, they are inside the cochlea; and when the electrodes (E0 to EN) are in the second state, they are outside the cochlea.

[0105] Figure 7 The method 100 and system 1 are shown in more detail how they determine multiple correlation signals, which include information about why the electrical response difference 13 is observed to decrease. Processor unit 17 receives multiple cochlear responses 11 and cochlear baseline responses 12 from cochlear electrography probe 10 and is configured to determine multiple electrical response differences 13 from these responses for each of the multiple acoustic stimuli 8. Furthermore, processor unit receives at least the length of electrode array 4 and / or the distance between each of the electrodes (E0 to EN) of electrode array 4 from memory unit 22. Additionally, processor unit 17 receives outputs from each of the electrodes (E0 to EN) of electrode array 4 for measuring the impedance of each electrode (E0 to EN). The impedance 20 measured for each electrode (E0 to EN) and the multiple electrical response differences 13 are used to determine multiple correlation signals 118. The multiple correlation signals are then transmitted to graphical user interface 24.

[0106] For example, a decrease in electrical response difference 13 is detected for a given burst sound including frequency F. This decrease indicates a collision between electrode array 4 and a region of the inner wall of cochlea 2, including hair cells tuned for a frequency range containing frequency F. A first collision location within the cochlea is then determined by extracting the location from a physiological cochlear position-frequency map based on frequency F. Then, for example, a second location of the apex electrode E0 of the plurality of electrodes of electrode array 4 is determined. The second location of the apex electrode E0 is determined based on multiple impedance measurements 20 and the distance between each of the plurality of electrodes. For example, assuming five electrodes (E0 to EN) have measurable impedance, this means that five electrodes (E0 to EN) are within cochlea 2. The distance between each of the plurality of electrodes is constant at 2 mm. The length of electrode array 4 within cochlea 2 can be determined to be 10 mm (5*2 mm). The second location of the apex electrode is then determined by extracting the location from a physiological cochlear position-frequency map based on the length of electrode array 4 within the cochlea.

[0107] For example, if the first collision position is greater than the second position of the vertex electrode E0, it means that the vertex electrode E0 of the electrode array 4 has not yet passed the first position. Therefore, the relevant signal includes information about the error in the probe 10.

[0108] In another example, the first collision position is equal to the second position of the vertex electrode, meaning that the vertex electrode of electrode array 4 is located at the collision point. Therefore, the relevant signal includes information about the vertex electrode E0 colliding with the cochlea 2.

[0109] In another example, the first collision position is smaller than the second position of the vertex electrode, meaning that the vertex electrode of electrode array 4 has passed the collision point. Thus, the relevant signal includes information about a portion of electrode array 4 (excluding the vertex electrode E0) colliding with the cochlea 2.

[0110] Figure 8A and 8B A graphical user interface (GUI) is shown, displaying information about the relevant signals (25A, 25B, 25C, 25D) on a graph of the cochlea 2. Furthermore, the GUI 24 includes the estimated location of each electrode of the electrode array 4 within the cochlea 2. Figure 8A In this process, electrode array 4 is fully inserted into cochlea 2, and three collisions between electrode array 4 and the cochlea have been detected by system 1. The location and content of the relevant signals at this given location are marked with markers (25A, 25B, 25C). Figure 8B In the middle section, electrode array 4 was only partially inserted into cochlea 2. A collision was detected, but marker 25D indicates that an error had occurred in the probe.

[0111] Figure 9A and9B Different examples of multiple acoustic stimuli 8, including burst sounds, are shown. Figure 9A A burst sound is illustrated, which comprises a swept tone with a continuous acoustic signal, wherein the frequency varies over time. In this specific example, the burst sound includes frequencies F1, F2, and F3. Figure 9B A burst sound with a harmonic complex acoustic signal is shown, which includes the convolution or multiplication of different tones. In this example, the burst sound includes a mixture of frequencies F1 and F2.

[0112] Figure 10A and 10B The image shows how the burst sound 26 is shaped by cochlear electrorecording curve 30. Curve 30 is configured to adjust the shape of the burst sound 26 differently in different time windows (W1, W2, W3), and each time window (W1, W2, W3) has a given length (T1, T2, T3). Figure 10A In the context of the burst sound 26, the burst sound 26 includes a sweep tone, and in this specific example, the burst sound includes frequencies F1 and F2. In the first time window W1, curve 30 has an increasing profile, which adjusts the amplitude A of the burst sound 26 to have an increasing amplitude. In the second time window W2, curve 30 has a constant profile, which adjusts the amplitude A of the burst sound 26 to have a constant amplitude. In the third window W3, curve 30 has a decreasing profile, which adjusts the amplitude A of the burst sound 26 to have a decreasing amplitude. Figure 10B A similar example is shown, but for a burst sound 26 that includes a harmonic complex acoustic signal. In this specific example, the burst sound 26 includes frequencies F1 and F2.

[0113] Figure 11A The location of the cochlear response within the cochlea 2 based on acoustic stimulation 8 including a sweeping tone is shown. At time t=0, the cochlear response 11 is measured against frequency F1; at time t=1, the cochlear response 11 is measured against frequency F2; and at time t=2, the cochlear response 11 is measured against frequency F3. In this example, each of the plurality of electrical response differences 13 is determined sequentially, and the speed of possible collisions between the detection electrode array 4 and the cochlea 2 depends on the scan time from the start frequency to the end frequency (in this example, from frequency F1 to frequency F3).

[0114] Figure 11B The location of the cochlear response within the cochlea 2 based on acoustic stimulation 8, which includes harmonic complex acoustic signals, is shown. At time t = 0, the cochlear response 11 is measured for frequencies F1 and F2. In this example, each of the multiple electrical response differences 13 for frequencies F1 and F2 is determined simultaneously. In this example, the speed at which a possible collision occurs between the detection electrode array 4 and the cochlea 2 is independent of the scan time from the start frequency to the end frequency. Therefore, compared to bursts of sound including swept tones, the advantage of using bursts of sound including harmonic complex acoustic signals is that possible collisions are detected more quickly.

[0115] Figure 12A-12D An example is shown where the frequency diagram of the electrodes of electrode array 4 is determined after the insertion of electrode array 4 has been completed. Figure 12A In the process, the baseline frequency and baseline cochlear response of a given electrode of electrode array 4 are determined. This is achieved by applying multiple acoustic stimuli 8 to a user of a cochlear implant system 6 including the inserted electrode array 4, each of which includes bursts of sound at different frequencies such as 300 Hz, 350 Hz, 400 Hz, 450 Hz, 500 Hz, 550 Hz, and 600 Hz. The cochlear response 11, i.e., the cochlear amplitude response, is then measured through one or more electrodes of the electrode array for each of the different frequencies. For example, the frequency at which the highest cochlear response, i.e., the highest eCOchG amplitude response, is provided on any electrode (E0 to EN) is the baseline frequency, and this highest cochlear response is the baseline cochlear response. One electrode is preferably the apex electrode of the electrode array. For example, if the baseline frequency is 400 Hz, the apex electrode is electrode number 20.

[0116] The baseline frequency and baseline cochlear response of one electrode can be stored in the system's memory unit or in the memory of the cochlear implant system.

[0117] The electrode mentioned above is referred to as the baseline electrode.

[0118] exist Figure 12B In this process, a single acoustic stimulus 8 is applied to the user, wherein the single acoustic stimulus 8 includes a baseline frequency such as 400 Hz. The cochlear response 11 is measured by a set of electrodes (E3, E7, E10, E13), which includes electrodes of electrode array 4 that are different from the baseline electrodes, such as electrodes different from electrode number 20.

[0119] exist Figure 12C In this context, the cochlear response model 27, which describes the distribution of the cochlear response along the cochlea for a given tone, can be derived based on collected data, the general shape of the cochlear response distribution curve along the cochlea, a surface image of the cochlea, or a 3D field image. The cochlear response distribution of the cochlear response model 27 includes a maximum cochlear response 28, which is centered at the baseline frequency and equal to the baseline cochlear response.

[0120] exist Figure 12D In this process, the cochlear response 11 measured for each of the electrodes in the set of electrodes (E3, E7, E10, E13) is matched with the assumed frequencies (fh1, fh2, fh3, fh4), wherein the measured cochlear response 11 is equal to the theoretical cochlear response (11A, 11B, 11C, 11D) of the cochlear response model 27.

[0121] Each electrode in the set of electrodes (E3, E7, E10, E13) is matched with the assumed frequency (fh1, fh2, fh3, fh4).

[0122] Therefore, the frequency diagram of electrode array 4 may include the baseline frequency of the baseline electrode and the assumed frequencies (fh1, fh2, fh3, fh4) of the group of electrodes (E3, E7, E10, E13).

[0123] The frequency diagram of electrode array 4 can be obtained by applying a curve fitting method to the baseline frequency of the baseline electrode and the assumed frequencies (fh1, fh2, fh3, fh4) of the group of electrodes (E3, E7, E10, E13) to determine the assumed frequencies (fh1, fh2, fh3, fh4) of each electrode of electrode array 4 or the remaining electrodes of electrode array 4.

[0124] Figure 13 The system 1 is shown to include a vibrator 50 configured to induce acoustic waves into the recipient's skull, which reduces friction as they are inserted into the electrode array. To ensure that the acoustic waves do not interfere with the measurement of the cochlear response, the frequency of the acoustic waves is chosen to be different from the frequency of the burst.

[0125] Unless explicitly stated otherwise, the singular forms “a” and “the” as used herein include the plural forms (i.e., meaning “at least one”). It should be further understood that the terms “having,” “comprising,” and / or “including” as used in the specification indicate the presence of the stated features, elements, components, and / or steps, but do not preclude the presence or addition of one or more other features, elements, components, and / or steps. It should be understood that, unless explicitly stated otherwise, when an element is referred to as “connected” or “coupled” to another element, it may be a direct connection or coupling to the other element, or there may be intermediate inserting elements. The term “and / or” as used herein includes any and all combinations of one or more of the listed related items. Unless explicitly stated otherwise, the steps of any method disclosed herein do not necessarily have to be performed in the exact order disclosed.

[0126] It should be understood that references to "an embodiment," "an embodiment," "an aspect," or "may" in this specification mean that a particular feature, structure, or characteristic described in connection with that embodiment is included in at least one embodiment of the invention. Furthermore, particular features, structures, or characteristics may be suitably combined in one or more embodiments of the invention. The foregoing description is provided to enable those skilled in the art to implement the various aspects described herein. Various modifications will be apparent to those skilled in the art, and the general principles defined herein may be applied to other aspects.

[0127] The scope of this invention should be determined based on the claims.

Claims

1. A system for detecting multiple health conditions of the cochlea during insertion of an electrode array of a cochlear implant system into the cochlea of ​​a recipient, the system comprising: A receiver configured to apply a plurality of acoustic stimuli, each of the plurality of acoustic stimuli including a burst of sound, the burst of sound comprising a plurality of acoustic pulses modulated at a single tone of a frequency; Cochlear external cochlear electrodiagnosis probe, which is configured to be placed on the outer wall of the recipient's cochlea; as well as The processor unit is configured as follows: Before inserting the electrode array into the recipient's cochlea, the cochlear electrocochleography probe measures multiple cochlear baseline responses based on multiple acoustic stimuli; During the insertion of the electrode array into the recipient's cochlea, multiple cochlear responses are continuously measured based on multiple acoustic stimuli via the external cochlear electrodiagramation probe. Determine multiple electrical response differences between multiple cochlear baseline responses and multiple cochlear responses; and Multiple health conditions of the cochlea during electrode array insertion were determined based on multiple electrical response differences.

2. The system of claim 1, wherein the plurality of baseline responses and the plurality of cochlear responses include measurements of cochlear microphonic potentials.

3. The system according to any of the preceding claims, wherein: The receiver is configured to deliver multiple acoustic stimuli to the recipient's ear canal, or The receiver includes a bone conduction device configured to provide multiple acoustic stimuli to the recipient's temporal bone.

4. The system of claim 1 or 2, wherein the electrode array comprises a plurality of electrodes, wherein the system is configured to: Electrical stimulation is sequentially applied to each of the multiple electrodes in the electrode array via a stimulator processor connected to the electrode array. Multiple impedance measurements are performed on each of the multiple electrodes based on the electrical stimulation during the insertion of the electrode array into the recipient's cochlea; Multiple related signals are determined based on multiple impedance measurements and multiple electrical response differences.

5. The system of claim 4, wherein the system is configured to determine the plurality of related signals based on the length of the electrode array, the length of each of the plurality of electrodes, and / or the distance between each of the plurality of electrodes.

6. The system of claim 4, wherein the plurality of impedance measurements comprises real-time impedance measurement of each of the plurality of electrodes.

7. The system of claim 4, wherein the system is configured to: determine a first state and a second state of each of the plurality of electrodes based on each of a plurality of impedance measurements, wherein, If the impedance measurement is higher than the first impedance level, the electrodes of the electrode array are in a first state, and if the impedance measurement is lower than the first impedance level, the electrodes are in a second state.

8. The system of claim 7, wherein the system is configured to: if the electrode is in a first state, determine that the electrode of the electrode array is located outside the cochlea, and if the electrode is in a second state, determine that the electrode of the plurality of electrodes is located inside the cochlea.

9. The system according to any one of claims 1, 2, and 5-8, wherein the plurality of health conditions includes at least a first health condition and at least a second health condition, wherein, The system is configured to: determine that the cochlea is in at least a first health condition if a corresponding electrical response difference among a plurality of electrical response differences is higher than or equal to a response difference threshold; and wherein the system is configured to: determine that the cochlea is in at least a second health condition if a corresponding electrical response difference among a plurality of electrical response differences is lower than a response difference threshold.

10. The system according to any one of claims 1, 2 and 5-8, wherein the system is configured to determine multiple health conditions in real time.

11. A system for detecting the health status of the cochlea, comprising: A receiver configured to apply multiple acoustic stimuli to a recipient, wherein each of the multiple acoustic stimuli includes a burst of sound, the burst of sound comprising multiple acoustic pulses modulated with a single tone at a frequency; Cochlear implant system, which includes An electrode array configured to provide electrical stimulation to the auditory nerve of a recipient's cochlea, the electrode array comprising a plurality of electrodes; A cochlear electrodiagnostic probe is positioned on the outer wall of the recipient's cochlea, wherein the cochlear electrodiagnostic probe is configured as follows: Multiple cochlear baseline responses were measured based on multiple acoustic stimuli before the electrode array was inserted into the recipient's cochlea; Multiple cochlear responses were measured continuously based on multiple acoustic stimuli during electrode array insertion into the recipient's cochlea; A processor unit connected at least to a cochlear electrography probe, wherein the processor unit is configured to determine multiple electrical response differences between multiple cochlear baseline responses and multiple cochlear responses, and to determine multiple health conditions at different locations within the cochlea based on the multiple electrical response differences during electrode array insertion.

12. The system of claim 11, wherein the stimulator processor is configured to: Electrical stimulation is sequentially applied to each of the multiple electrodes in the electrode array; Based on the electrical stimulation, multiple impedance measurements are performed on each electrode during insertion of the electrode array into the recipient's cochlea; and Multiple related signals are determined based on multiple impedance measurements and multiple electrical response differences.

13. The system of claim 12, wherein a first state and a second state of each of the plurality of electrodes are determined based on each of a plurality of impedance measurements, wherein, If the impedance measurement is higher than the first impedance level, one of the electrodes is in a first state; and if the impedance measurement is lower than the first impedance level, the electrode is in a second state.

14. The system of any one of claims 11-13, comprising a graphical user interface, wherein the graphical user interface is configured to provide a graphical representation of a plurality of electrical response differences as a function of insertion time, physiological cochlear position-frequency, and / or insertion depth, and wherein the graphical user interface is configured to receive an alarm signal and generate an alarm for a user of the graphical user interface.

15. The system of any one of claims 11-13, comprising a graphical user interface, wherein the graphical user interface is configured to provide a graphical representation of a plurality of related signals as a function of physiological cochlear position-frequency and / or insertion depth, and wherein the graphical user interface is configured to receive an alarm signal and generate an alarm for a user of the graphical user interface.

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