\\n\\n
These books synthesize perspectives of renowned scientists from the world’s most prestigious institutions - from Fukushima Renewable Energy Institute in Japan to Stanford University in the United States, including Columbia University (US), University of Sidney (AU), University of Miami (USA), Cardiff University (UK), and many others.
\\n\\nThis collaboration embodied the true essence of Open Access by simplifying the approach to OA publishing for Academic editors and authors who contributed their research and allowed the new research to be made available free and open to anyone anywhere in the world.
\\n\\nTo celebrate the 50 books published, we have gathered them at one location - just one click away, so that you can easily browse the subjects of your interest, download the content directly, share it or read online.
\\n\\n\\n\\n\\n"}]',published:!0,mainMedia:null},components:[{type:"htmlEditorComponent",content:'
IntechOpen and Knowledge Unlatched formed a partnership to support researchers working in engineering sciences by enabling an easier approach to publishing Open Access content. Using the Knowledge Unlatched crowdfunding model to raise the publishing costs through libraries around the world, Open Access Publishing Fee (OAPF) was not required from the authors.
\n\nInitially, the partnership supported engineering research, but it soon grew to include physical and life sciences, attracting more researchers to the advantages of Open Access publishing.
\n\n\n\nThese books synthesize perspectives of renowned scientists from the world’s most prestigious institutions - from Fukushima Renewable Energy Institute in Japan to Stanford University in the United States, including Columbia University (US), University of Sidney (AU), University of Miami (USA), Cardiff University (UK), and many others.
\n\nThis collaboration embodied the true essence of Open Access by simplifying the approach to OA publishing for Academic editors and authors who contributed their research and allowed the new research to be made available free and open to anyone anywhere in the world.
\n\nTo celebrate the 50 books published, we have gathered them at one location - just one click away, so that you can easily browse the subjects of your interest, download the content directly, share it or read online.
\n\n\n\n\n'}],latestNews:[{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"},{slug:"introducing-intechopen-book-series-a-new-publishing-format-for-oa-books-20210915",title:"Introducing IntechOpen Book Series - A New Publishing Format for OA Books"}]},book:{item:{type:"book",id:"5214",leadTitle:null,fullTitle:"High Performance Concrete Technology and Applications",title:"High Performance Concrete Technology and Applications",subtitle:null,reviewType:"peer-reviewed",abstract:"Concrete is widely used because of its versatility, affordability, and availability of raw materials, strength, and durability. Urban development that took place through the world in the last few decades yielded significant developments for concrete technology. The term high-performance concrete (HPC) is relatively new, and it refers to many properties such as strength, durability, sound and heat insulation, waterproofing, and side advantages such as air purification, self-cleaning, etc. Researchers and engineers are constantly working for improving concrete properties. This book provides the state of the art on recent progress in the high-performance concrete applications written by researchers and experts of the field. The book should be useful to graduate students, researchers, and practicing engineers in related fields.",isbn:"978-953-51-2651-5",printIsbn:"978-953-51-2650-8",pdfIsbn:"978-953-51-5786-1",doi:"10.5772/61562",price:119,priceEur:129,priceUsd:155,slug:"high-performance-concrete-technology-and-applications",numberOfPages:214,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"4f7096ba0b4812663b72c918c4a4eff7",bookSignature:"Salih Yilmaz and Hayri Baytan Ozmen",publishedDate:"October 5th 2016",coverURL:"https://cdn.intechopen.com/books/images_new/5214.jpg",numberOfDownloads:26661,numberOfWosCitations:39,numberOfCrossrefCitations:34,numberOfCrossrefCitationsByBook:6,numberOfDimensionsCitations:60,numberOfDimensionsCitationsByBook:7,hasAltmetrics:0,numberOfTotalCitations:133,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"October 23rd 2015",dateEndSecondStepPublish:"January 14th 2015",dateEndThirdStepPublish:"April 15th 2016",dateEndFourthStepPublish:"May 15th 2016",dateEndFifthStepPublish:"July 18th 2016",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6,7",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"75636",title:"Associate Prof.",name:"Salih",middleName:null,surname:"Yilmaz",slug:"salih-yilmaz",fullName:"Salih Yilmaz",profilePictureURL:"https://mts.intechopen.com/storage/users/75636/images/system/75636.jpg",biography:"Dr. Yılmaz graduated from the Department of Civil Engineering of Middle East Technical University, Turkey, in 2001 and received his PhD in Civil Engineering from Pamukkale University in 2007. After serving for Pamukkale University as a research assistant and lecturer, he transferred to Katip Celebi University, where Dr. Yılmaz founded the Department of Civil Engineering and Earthquake Engineering Research Center of Izmir Katip Celebi University in 2012 and 2014. He served Katip Celebi and Pamukkale University as faculty member, and the University of Texas at Austin as research associate. Dr. Yılmaz involved in several research projects at national and international level and provided consultancy for many companies. Dr. Yilmaz is now serving the society as a practicing structural and geotechnical engineer. Dr. Yilmaz interested in foundation based structural damages, seismic performance of existing buildings and geotechnical structures, soil improvement and foundation strenthening and artificial intelligance applications in geotechnical engineering.",institutionString:"Earthquake Engineering Association of Turkey",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"1",institution:null}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:{id:"198122",title:"Dr.",name:"Hayri Baytan",middleName:null,surname:"Ozmen",slug:"hayri-baytan-ozmen",fullName:"Hayri Baytan Ozmen",profilePictureURL:"https://mts.intechopen.com/storage/users/198122/images/system/198122.png",biography:"Dr. Hayri Baytan Ozmen is currently an associate professor in the Department of Civil Engineering, Usak University, Turkey. He graduated from the Civil Engineering Department of the Middle East Technical University, Turkey, in 2001. He received his PhD in the same field from Pamukkale University in 2011. His research interests includes reinforced concrete structures, earthquake engineering, seismic evaluation, and retrofit. He has more than sixty-five research papers published in international journals and conferences and has conducted and been involved in more than ten national and international research projects. He performed seismic evaluation or design of seismic retrofit systems for more than 150 RC buildings and provided consultancy for structural engineering studies. He is the editor in chief of an international journal on materials and structural engineering.",institutionString:"Usak University",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"1",institution:{name:"Usak University",institutionURL:null,country:{name:"Turkey"}}},coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"1348",title:"Concrete Technology",slug:"concrete-technology"}],chapters:[{id:"51720",title:"Microstructure of Concrete",doi:"10.5772/64574",slug:"microstructure-of-concrete",totalDownloads:4843,totalCrossrefCites:15,totalDimensionsCites:19,hasAltmetrics:0,abstract:"Concrete is a composite material that consists of a binding medium and aggregate particles and can be formed in several types. It may be considered to consist of three phases: a cement paste, the aggregate, and the interfacial transition zone (ITZ) between them. In addition to ordinary Portland cement, the essential components of the base of concrete are aggregates and water. For practical requirements, additives and admixtures can be added to these raw materials to improve some desirable characteristics. The following requirements should be considered in producing high performance concrete (HPC): (i) low water/cement (w/c) ratio; (ii) fine aggregate; (iii) large quantity of mineral additives, silica fume, and fly ash; (iv) high dosage of superplasticizer; and (v) high-pressure steam curing. The microstructure of high performance concrete (HPC) is more homogenous than that of normal concrete (NC) due to the physical and chemical contribution of the additives (silica fume and fly ash) as well as it is less porous due to reduced w/c ratio with the addition of a superplasticizer. Inclusion of additives (individually or in combination) helped in improving the strength and durability of concrete mixes due to the additional reduction in porosity of cement paste and an improved interface between it and the aggregate.",signatures:"Ameer A. Hilal",downloadPdfUrl:"/chapter/pdf-download/51720",previewPdfUrl:"/chapter/pdf-preview/51720",authors:[{id:"180518",title:"Dr.",name:"Ameer",surname:"Hilal",slug:"ameer-hilal",fullName:"Ameer Hilal"}],corrections:null},{id:"51837",title:"Spalling Prevention of High Performance Concrete at High Temperatures",doi:"10.5772/64551",slug:"spalling-prevention-of-high-performance-concrete-at-high-temperatures",totalDownloads:2319,totalCrossrefCites:2,totalDimensionsCites:6,hasAltmetrics:0,abstract:"In recent year, the use of high performance concrete (HPC) has significantly increased in applications such as prestressed concrete structures, bridges, large-span roof structures, and containers for hazardous fluids or nuclear wastes due to its outstanding structural performance and higher durability. However, its fire resistance performance remains a concern, especially in relation to explosive spalling in a fire. Therefore, it is essential to understand the spalling properties (mechanism, influencing factors, and prevention measures, etc.) of high performance concrete exposed to high temperature, so that the safety of a structural fire design involving HPC can be ensured. This report presents a state-of-the-art review for the prevention measures and explosive spalling of high performance concrete under fire situations.",signatures:"Hyoung-Seok So",downloadPdfUrl:"/chapter/pdf-download/51837",previewPdfUrl:"/chapter/pdf-preview/51837",authors:[{id:"180148",title:"Prof.",name:"Hyoung-Seok",surname:"So",slug:"hyoung-seok-so",fullName:"Hyoung-Seok So"}],corrections:null},{id:"51383",title:"Fracture Theory Under Freeze-Thaw Cycles and Freeze-Thaw Resistance of Alkali-Slag Concrete",doi:"10.5772/63810",slug:"fracture-theory-under-freeze-thaw-cycles-and-freeze-thaw-resistance-of-alkali-slag-concrete",totalDownloads:1936,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Despite the widespread research on alkali-activated concrete, its fracture properties under freeze-thaws are rarely studied; the response surface methodology (RSM) theory has not been put forward; and unstable fracture toughness, KICS, influenced by freeze-thaws and slag content has not been researched. The purpose of this article is to investigate the calculation method of alkali-slag concrete (ASC) fracture parameters and provide theoretical support for RSM model of ASC prepared with Na2SiO3 and NaOH composite activator. The influence law of freeze-thaw and slag content on unstable fracture toughness, KICS, is put forward. Results show that after crack mouth opening displacement (CMOD) is measured, other fracture parameters including concrete effective fracture length; crack tip opening displacement (CTOD); and stress intensity factors KICC,KICC, and KICS from closure stress σ(w) can be obtained according to double-K fracture criterion and DL/T 5332-2005 “Hydraulic concrete fracture test procedures”. RSM principles and advantages, its optimization content and procedure, the data processing software Design-Expert and verification analysis procedure of RSM model are put forward. Since the ASC structure is compact, characterized for water and air penetration resistance, its antifreezing characteristic is desirable.",signatures:"Qixuan Li",downloadPdfUrl:"/chapter/pdf-download/51383",previewPdfUrl:"/chapter/pdf-preview/51383",authors:[{id:"180213",title:"Mr.",name:"Qixuan",surname:"Li",slug:"qixuan-li",fullName:"Qixuan Li"}],corrections:null},{id:"51780",title:"High-Performance Concrete and Fiber-Reinforced High- Performance Concrete under Fatigue Efforts",doi:"10.5772/64387",slug:"high-performance-concrete-and-fiber-reinforced-high-performance-concrete-under-fatigue-efforts",totalDownloads:2321,totalCrossrefCites:2,totalDimensionsCites:4,hasAltmetrics:0,abstract:"Fatigue is the process of mechanical degradation of a material, which leads to its collapse. Repeated load applications with a maximum value lower than the one that provokes the static failure of the material, causes internal damage in the material that, progressively, reduces its mechanical capacity until it finally collapses. The increasingly widespread use of high-strength concretes permits the construction of more lightweight structures. This implies that the variable loads (which are the causes of fatigue) represent an ever larger percentage of the total load. In consequence, fatigue is an increasingly important factor in concrete structures. In some cases, it even begins to be the dimensioning load of the structure. In addition, the presence of fibers within the concrete modifies the fatigue response of the concrete. In this chapter, the classic theory of fatigue is presented in detail and the most recent developments in the study of concrete fatigue are discussed.",signatures:"Miguel A. Vicente, Jesús Mínguez, José A. Martínez and Dorys C.\nGonzález",downloadPdfUrl:"/chapter/pdf-download/51780",previewPdfUrl:"/chapter/pdf-preview/51780",authors:[{id:"181643",title:"Prof.",name:"Miguel",surname:"Vicente",slug:"miguel-vicente",fullName:"Miguel Vicente"},{id:"182032",title:"Prof.",name:"Jesus",surname:"Minguez",slug:"jesus-minguez",fullName:"Jesus Minguez"},{id:"182033",title:"Prof.",name:"Jose Antonio",surname:"Martinez",slug:"jose-antonio-martinez",fullName:"Jose Antonio Martinez"},{id:"182034",title:"Prof.",name:"Dorys",surname:"Gonzalez",slug:"dorys-gonzalez",fullName:"Dorys Gonzalez"}],corrections:null},{id:"52009",title:"Elevated Temperature Performance of Multiple-Blended Binder Concretes",doi:"10.5772/64415",slug:"elevated-temperature-performance-of-multiple-blended-binder-concretes",totalDownloads:1942,totalCrossrefCites:1,totalDimensionsCites:2,hasAltmetrics:0,abstract:"Concretes that contain binary-blended binders (BBB) and ternary-blended binders (TBB) incorporating thermally activated alum sludge ash (AASA), silica fume (SF), ground-granulated blast-furnace slag (GGBS) and palm oil fuel ash (POFA) are exposed to temperatures as high as 800 °C. The water-binder ratio of the multiple-blended binder (MBB) concretes was 0.30, and the total binder and polypropylene (PP) fibre contents were 493 and 1.8 kg/m3, respectively. The elevated temperature performance of the MBB concretes is evaluated in terms of the mass loss, compressive strength, ultrasonic pulse velocity (UPV) and surface cracks. The concrete strength deteriorated significantly due to elevated temperature up to 800 °C, but the residual strength of the BBB containing 15 % AASA was higher than that of the control and 20 % AASA concretes. High-temperature exposure decreased measured UPV values. The concrete weight loss was more pronounced for TBB concretes. The elevated temperature performance of all of the TBB concretes was better than that of the BBB concretes with the same AASA replacement levels. It was observed that PP fibres help reduce spalling. BBB concrete containing 15 % AASA combined with either SF or GGBS or POFA exhibits superior performance at elevated temperature than Portland cement concrete at the same mix design proportion.",signatures:"Haider M. Owaid, Roszilah Hamid and Mohd Raihan Taha",downloadPdfUrl:"/chapter/pdf-download/52009",previewPdfUrl:"/chapter/pdf-preview/52009",authors:[{id:"180233",title:"Associate Prof.",name:"Roszilah",surname:"Hamid",slug:"roszilah-hamid",fullName:"Roszilah Hamid"},{id:"186596",title:"Dr.",name:"Haider",surname:"Owaid",slug:"haider-owaid",fullName:"Haider Owaid"}],corrections:null},{id:"51592",title:"Energy-Efficient Technologies in Cement Grinding",doi:"10.5772/64427",slug:"energy-efficient-technologies-in-cement-grinding",totalDownloads:5778,totalCrossrefCites:1,totalDimensionsCites:3,hasAltmetrics:0,abstract:"In this chapter an introduction of widely applied energy-efficient grinding technologies in cement grinding and description of the operating principles of the related equipments and comparisons over each other in terms of grinding efficiency, specific energy consumption, production capacity and cement quality are given. A case study performed on a typical energy-efficient Horomill® grinding technology, is explained. In this context, grinding circuit is introduced and explanations related to grinding and classification performance evaluation methodology are given. Finally, performance data related to Horomill® and high-efficiency TSV™ air classifier are presented.",signatures:"Ömürden Genç",downloadPdfUrl:"/chapter/pdf-download/51592",previewPdfUrl:"/chapter/pdf-preview/51592",authors:[{id:"180144",title:"Dr.",name:"Ömürden",surname:"Genç",slug:"omurden-genc",fullName:"Ömürden Genç"}],corrections:null},{id:"51861",title:"Concretes with Photocatalytic Activity",doi:"10.5772/64779",slug:"concretes-with-photocatalytic-activity",totalDownloads:2833,totalCrossrefCites:8,totalDimensionsCites:15,hasAltmetrics:0,abstract:"This chapter is a short review about the modified concretes with photocatalytic activity. In the beginning, the photocatalysis process is explained; the authors are focused on the mechanism of organic contamination and nitrogen oxide decomposition. Next the three main methods for concretes modification are presented: the first group is when the concrete is covered by thin layer of TiO2 materials, e.g., paints or TiO2 suspensions. The second group is the concretes with thick layer of photoactive concrete on the top. The third group constitutes concretes modified in mass with TiO2. The two main methods for photocatalytic activity of the modified concrete determination were shown: an air purification by a nitrogen oxide decomposition and the self-cleaning properties by dyes decomposition. Also in this chapter the mechanical properties of the modified concrete are presented. In the end, the examples of the buildings made of photocatalytic concretes are shown.",signatures:"Magdalena Janus and Kamila Zając",downloadPdfUrl:"/chapter/pdf-download/51861",previewPdfUrl:"/chapter/pdf-preview/51861",authors:[{id:"180824",title:"Associate Prof.",name:"Magdalena",surname:"Janus",slug:"magdalena-janus",fullName:"Magdalena Janus"}],corrections:null},{id:"51975",title:"High-Performance Alkali-Activated Cement Concretes for Marine Engineering Applications",doi:"10.5772/64525",slug:"high-performance-alkali-activated-cement-concretes-for-marine-engineering-applications",totalDownloads:2268,totalCrossrefCites:3,totalDimensionsCites:5,hasAltmetrics:0,abstract:"The contribution covers results of studies on the alkali-activated cement concretes intended for marine engineering applications. Such properties as strength, wear, corrosion, freeze-thaw, weather resistance and many others have been studied, and the results are reported and discussed in detail. The obtained results suggested to draw a conclusion on high potential of the alkali-activated cement concretes for marine engineering applications, since in their performance properties these concretes are highly advantageous over other concretes used as marine concretes and big savings can be expected in the future due to the longer span of service life. The results are supported by long-term observations in real conditions. The above advantages are attributed to more perfect micro- and macrostructure of the alkali-activated cement stone. The authors have summarized their own experience and results collected by PhD and DSc students under their supervision dedicated to assessment of durability of these concretes, in particular, for marine engineering applications. In order to bring these advanced materials into practice of construction worldwide, two rilem (International Union of Laboratories and Experts in Construction Materials, Systems and Structures) committees have been founded: “Alkali-activated Materials” (2010–2013) and “Durability Testing of Alkali Activated Materials” (2013–ongoing).",signatures:"Pavel V. Krivenko, Hai Lin Cao, Lu Qian Weng and Oleg N.\nPetropavlovskii",downloadPdfUrl:"/chapter/pdf-download/51975",previewPdfUrl:"/chapter/pdf-preview/51975",authors:[{id:"180922",title:"Prof.",name:"Pavel",surname:"Krivenko",slug:"pavel-krivenko",fullName:"Pavel Krivenko"},{id:"181088",title:"Prof.",name:"Hai Lin",surname:"Cao",slug:"hai-lin-cao",fullName:"Hai Lin Cao"},{id:"181089",title:"Prof.",name:"Lu Qian",surname:"Weng",slug:"lu-qian-weng",fullName:"Lu Qian Weng"},{id:"188895",title:"Ph.D.",name:"Oleg",surname:"Petropavlovskii",slug:"oleg-petropavlovskii",fullName:"Oleg Petropavlovskii"}],corrections:null},{id:"51409",title:"Application of Polypropylene Fibrillated Fibres for Reinforcement of Concrete and Cement Mortars",doi:"10.5772/64386",slug:"application-of-polypropylene-fibrillated-fibres-for-reinforcement-of-concrete-and-cement-mortars",totalDownloads:2423,totalCrossrefCites:2,totalDimensionsCites:6,hasAltmetrics:0,abstract:"Polypropylene fibres have been applied for reinforcement of cement mortars and concrete for many years. The fibres restrict crack propagation and positively affect several concrete parameters. To improve the adhesion of polypropylene to cement matrix, geometrically deformed or modified fibres are commonly used. Good results are obtained by application of fibrillated fibres with the net-like structure obtained from the polypropylene types. The fibrillated polypropylene fibres were produced. The fibres were chopped to specified lengths and used for the reinforcement of concrete and cement mortars. The parameters of fresh concrete and mechanical parameters of reinforced concrete and mortar were determined. It was stated that the fibres do not affect the compressive strength of the reinforced concrete and mortar. The beneficial effect of fibres on the compressive strength of concrete is revealed after freezing and thawing cycles. The fibres influence the bending strength of the mortars. For mortars reinforced with fibrillated fibres a significant increase in the bending strength is observed. 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The global burden of disabling hearing impairment is estimated at 466 million people (6.1% of the world’s population) where 432 million (93%) of these are adults (242 million males, 190 million females) and 34 million (7%) children. It is estimated that the number of people with deafness will grow to 630 million by 2030 and maybe over 900 million by 2050 [1].
Hearing impairment has a significant bearing on many aspects of an individual’s life, including their socioeconomic status, mental well-being, education and employment opportunities. Older people with moderate or more severe hearing loss were more likely to feel depressed and suffer with poor mental health [2]. The deaf child cannot listen to her or his mother and focus on an activity simultaneously since both inputs must be processed visually. In addition, the deaf child is unaware of sounds of the outside environment, and thus, is centered on self and own activities. This has consequences on the child’s development of language, social skills and cognition [3].
Hearing impairment results from damage or disease anywhere along the auditory pathway. Surgical restoration of hearing involves procedures that range from ossicular reconstruction to implantation of devices which serve to assist the functioning of the auditory pathway. The prosthetic devices currently being used for restoration of hearing are classified based on their mode of action in Figure 1.
Classification of hearing prosthetic devices.
The first prosthetic used for the management of deafness on record in human history was the
Hearing impaired individuals usually seek help only when they have reached a stage that they can no longer ignore their hearing loss. Often, it is not the individual themselves, but the family member/caretaker who notes that the concerned individual is struggling with their hearing impairment. In either situation, the pre-audiometric assessment which involves collection of relevant medical history and clinical examination of the hearing-impaired person is an important first step of the auditory rehabilitation process. It is important to identify patients in whom medical or non-prosthetic surgical management of their hearing loss should be attempted prior to dispensing of the hearing device. After the clinical assessment, the candidacy process involves a complete audiological evaluation using the following tests.
The simplest and most widely used auditory prosthetic solution is the Hearing Aid. The first electronic hearing aids in the mid-19th century were large instruments that sat on a table. The subsequent invention of the transistor and miniature electron tubes made the hearing aid small enough to fit behind the ear. In the late 1960s the introduction of minicomputers opened the doors to real-time signal processing for people with hearing loss. Although not fast enough, these were computer-controlled analog systems which were used for amplification in hearing aid devices. In 1975, Daniel Graupe developed the first digital hearing aid in which high speed digital-array processors were used. This made it possible to process audio signals digitally in real time. Finally, in the early 1980s, the Central Institute of the Deaf (CID) developed the first practical wearable digital hearing aid which set precedent to the current type of aids in use [4].
The modern digital hearing aid is a marvel of sophisticated engineering and miniaturization. The microphone is the first component to receive the sound signal and it converts this energy into electricity. These microphones may be unidirectional, bidirectional or omnidirectional. A more sophisticated type of an omnidirectional microphone is an “adaptive directional microphone” which works together with the hearing aid’s noise reduction technology to highlight speech sounds and important environmental sounds while suppressing background noise. These small signals generated by the microphone are sent to the amplifier which makes them more powerful. Compression amplifiers are used to amplify the signal while avoiding distortion and decreasing its dynamic range and can represent sound in either an analogue (mimicking acoustic waveforms) or digital (representing signals as a string of numbers) manner. The signal then goes through a filter which is used to change the relative amplitude of the high, mid and low frequency characteristics of a signal. Thus, the sound signal can be altered by the user or clinician to suit the type of hearing loss. Finally, the receiver converts this modified and amplified electrical signal back into sound with the help of electromagnetism which is similar to how headphones work. The hearing aid performs all these functions with the help of electrical power from a detachable battery. Based on where they are worn, hearing aids are classified as body (pocket aids), spectacle, behind-the-ear (BTE), in-the-ear (ITE), in-the-canal (ITC) and completely-in-canal (CIC). BTE are further classified based on location of the receiver as receiver-in-the-aid (RITA) where the receiver lies within the hearing aid case or receiver-in-the-ear (RITE) where the receiver lies within the ear canal.
The primary mode of action of a hearing aid involves amplification of the input sound signal accompanied by frequency specific sound signal modulation to produce a tailormade output sound signal aimed at supporting the targeted hearing impairment. Hearing aid technology has seen rapid growth in the past 50 years and these advances can be broadly classified into three generations, all of which are currently commercially available. The first generation were simple analog hearing aids which were adjusted with screwdriver-controlled potentiometer trimmers according to the degree of hearing loss. An analog hearing aid consists of a microphone, preamplifier, a tone controller (or automatic gain controller - AGC), an amplifier and a receiver. In such devices, an acoustic signal is converted by the microphone into an electric signal which is amplified by a preamplifier and the frequency is shaped by the tone controller. This signal is then again amplified and converted into an acoustic output signal by the receiver. These were followed by second generation analog devices which could be digitally programmed by dedicated devices or computers. This involved coding of certain parameters of the analog components such as tone control and allowing these settings to be stored in a memory that can be modified or retrieved according to user preference. Digital hearing aids, which represent the third-generation, differ from the analog devices in that the amplified electronic signals are converted into digital signals which are processed by the Digital Signal Processor (DSP) before being converted back to analog electronic signals. Thus, these devices usually have an analog-to-digital converter, a digital signal processor and a digital-to-analog converter, of which the latter function is often embedded within the receiver in the newer devices. The entire system is built on a single integrated circuit that contains all the electronic parts i.e. transistors, capacitors and resistors [5].
CROS are hearing aids worn bilaterally where the hearing aid on the affected side transmits the acoustic signal to the receiver in a hearing aid worn on the better hearing ear. In patients who have hearing loss in the better hearing ear, the hearing aid in the better ear can also be used to provide amplification to that ear in addition to the CROS input. This configuration is called BiCROS [6].
In the 1st century, Pliny the Elder, a Roman scientist, was the first to remark about the potential of sound conduction through solid bodies. Several centuries later, Cardano demonstrated a method by which sound may be transmitted to the ear by means of the shaft of a spear held between one’s teeth [7]. About a hundred years later, in the 1600s, it was Hieronymus Capivacci, an Italian physician, who realized the clinical significance of Cardano’s observations. Using the same experiment he determined that if the patient heard the sound it indicated disease of the tympanic membrane, while if the patient could not hear the sound it indicated a lesion of the auditory nerve [8]. In 1757, Johann Jorissen, a German physician, published the first known dissertation dealing exclusively with hearing through teeth. But it was only in 1821, when the first primitive bone conduction device was developed by Jean-Marie Gaspard Itard, a French ear specialist who postulated that sound was conducted through the bones of the entire skull [9]. Using the concepts of the carbon microphone and the magnetic receiver (earphone) in 1920, Joseph Prenn of Boston, patented a mechanical bone-conductive ear [10]. However, it was Frederick Kranz of Illinois, who in 1925, patented the first real bone conduction vibrator which was handheld initially, and later attached to a headband and set the tone for bone conduction technology [11]. With the help of the Sonotone Company, Hugo Lieber developed a small wearable bone conduction receiver in 1933 [12]. Another idea was to fix the bone conduction device in eye glasses. From the 1960s to the 1990s, four different companies – Amplivox, Akumed, Otarion & Oticon made bone conduction eyeglasses which became the most widely used bone conduction hearing devices of that time. The idea to implant the vibrator into the mastoid bone originated in Sweden, after the pioneering work of the anatomist, Per-Ingvar Brånemark in bone rheology, where Anders Tjellström fitted the first 3 patients with the BAHA implant in 1977 [13].
Bone conduction devices are prosthetic devices that aid hearing by converting sound energy into vibrational energy. The vibrations that are produced are transmitted to the skull bone, and then to the inner ear bypassing a hearing impairment in the external or middle ear, thus overcoming the air conduction defect. Below is a basic classification of bone conduction devices (BCD) based on their mode of action:
The
This is a conventional skin-drive non-implantable BCD that is designed to be worn behind the head with the BAHA sound processor attached to the connector disc just behind the ear.
This is a conventional skin-drive non-implantable BCD that consists of a bone conduction processor fitted on a soft headband and is indicated in the pediatric population with hearing loss as part of their pre-implant assessment till formal surgery.
This is a conventional skin-drive non-implantable BCD consisting of an adhesive adapter which is placed behind the pinna on the mastoid skin and a bone conduction processor which gets attached to that adapter.
The semi-implantable BCDs have several advantages over the conventional BCDs which include a lack of static skin compression and preservation of the high frequency signals. These BCDs are further classified as
The
The BAHA CONNECT system was the first commercially available bone conduction device. This direct-drive percutaneous system consists of a titanium implant which is osseointegrated into the skull, along with a sound processor which transmits these vibrations through a percutaneous abutment which connects the sound processor to the implant. The skin is left intact around the abutment using
The Oticon PONTO 4 system is a direct-drive percutaneous device that consists of three parts – a 4 mm titanium implant that is surgically implanted into the skull, an abutment that is seamlessly placed percutaneously through the skin and a sound processor that clicks easily to the abutment and sits discreetly behind the ear. In addition to its remarkably small size, the PONTO 4 system also connects wirelessly to the internet using an IFTTT network.
The
The BAHA ATTRACT system is a skin-drive passive transcutaneous device that transmits sound vibrations to the inner ear through a magnetic connection between the sound processor and the implant. The magnet which lies on the inside to the skin is attached to the underlying skull bone with a screw, and the BAHA sound processor is attached to a magnet plate on the skin via a soft pad to equalize the force distribution over the attachment surface. This BCD offers the benefit that there is no skin penetrating abutment, thus providing a good esthetic outcome with no need for daily care.
The Medtronic ALPHA 2 MPO system is a skin-drive passive transcutaneous device that consists of a surgically implanted internal plate containing two airtight sealed magnets and the external digital sound processor coupled to the base plate containing twin magnets corresponding to the internal ones. In order to overcome the skin problems related to high static skin pressure, it uses a larger surface area so that the static force is widely distributed alleviating dermal compression [14].
In
The BONEBRIDGE is a direct-drive active transcutaneous system that consists of an external audio processor and an internal bone conduction implant. The internal component has a receiver coil, a magnet, a demodulator, and a cylindrically shaped bone-conduction floating mass transducer (BC-FMT) secured to the bone by two titanium screws. The power to drive the FMT is transmitted transcutaneously to the internal coil, processed by the demodulator and then relayed to the BC-FMT, which then transduces the signals into mechanical energy. Osseointegration of the titanium screws, however, is not thought to be crucial.
The OSIA System is a direct-drive active transcutaneous system that uses a Piezo-Power transducer which sits within the OSI200 implant, and is positioned under the skin to send sound to the cochlea. The OSI200 implant is positioned on top of the bone and connected to the osseointegrated BI300 Implant which gives an important single-point transmission for sound to the skull. The system has a fitting range of 55 dB SNHL. The transducer functions on the principle of the “piezoelectric effect” which is the ability of certain materials to generate vibrations when provided with an electrical charge.
This in-the-mouth BCD is neither direct-drive nor skin-drive. The vibrations are generated by a piezoelectric transducer and are transmitted through the teeth to the skull. SoundBite by Sonitus was mainly developed for single sided deafness patients. A microphone is placed behind the deaf ear and sound is sent wirelessly to an in-the-mouth transducer transmitting vibrations to the upper molar teeth. These vibrations are transmitted to the skull bone and received by the healthy cochlea. This device is currently only available for investigational use for the management of single sided deafness and is not available commercially [15].
Alvar Wilska, a Finnish physiologist, is credited with the first attempt at mechanical stimulation of the auditory system with the help of an electromagnetic driver. In 1935, he sprinkled iron filings on to the tympanic membrane of a patient lying on his side and placed a ear-phone over the man’s ear that produced no sound, but an electromagnetic signal, and the patient reported hearing. Subsequently, in 1959, Rutschmann devised a method of fixing a tiny permanent magnet to the tympanic membrane at the umbo with water soluble glue. By introducing an alternating current he produced pure tones in the range of 2 kHz to 10 kHz [16]. In 1973, Goode and Glattke refined this work by introducing an electromagnetic coil on the postauricular skin to drive the magnet fixed on the umbo. Heide reported an important modification to these previous studies in 1988, by replacing the postauricular transducer with an in-the-canal electromagnetic induction coil located millimeters from a magnet fixed at the umbo [17]. Prior to this in 1986, Maniglia at Case Western Reserve University had already begun investigating one of the first contactless electromagnetic based middle ear implant systems. In that same year, Kartush and Tos, at the Michigan Ear Institute, collaborated with Smith & Nephew Richards, to create an electromagnetic-based partially implantable middle ear device that used an in-the-canal electromagnetic coil with a custom ear mold housing [18]. The use of piezoelectric crystals in middle ear implants became evident in 1984, when the RION device became the first commercially approved piezoelectric-based middle ear device to be implanted. Since this time, several additional middle ear implants have used this technology, including the Impex TICA and the Envoy Esteem. This was roughly a century after Piezoelectricity was first discovered by Jacques and Pierre Curie in 1880 after observing that certain solid substrates develop an electrical charge proportional to an applied mechanical stress. In 1996, Geoffrey Ball pioneered development of the VIBRANT SOUNDBRIDGE which became the first FDA approved Active Middle Ear Implant (AMEI) system for implantation in patients with SNHL, receiving approval in August 2000 [19].
These can be classified as
The VIBRANT SOUNDBRIDGE (VSB) is currently the most widely implanted middle ear device worldwide. This AMEI consists of an externally worn processor that contains the microphone, electronic signal processor and battery and an implantable part called the Vibrating Ossicular Prosthesis (VORP). This VORP contains a magnet (that enables the external part to be coupled), a receiver unit, a demodulator (that filters the signal received), a conductor link for the electrical signal and a floating mass transducer (FMT). Sound signal received by the external audio processor is transmitted transcutaneously to the implanted device generating vibratory movements of the FMT and conduction of sound to the inner ear. The FMT coupled to the Incus is the original indication devised for patients with a healthy middle ear and moderate–severe sensorineural hearing loss in the higher frequencies with a discrimination >50% at conversational intensity who were not satisfied with their hearing aid or who had repeated external otitis. The VSB is the only AMEI approved for use in children since 2009. It is indicated in children with external auditory canal atresia and bilateral malformations of the ossicular chain who have sensorineural conductive or mixed hearing loss and meet the same audiological criteria as for adults.
This is a totally implantable AMEI which consists of two parts, the electronic capsule that contains the microphone, the batteries, the digital processor and the connector, and the middle ear transducer that contains the receiver unit and the electromechanical transducer. All these parts are placed beneath the skin with no need for externally worn processors. This AMEI is indicated for adults with moderate to severe SNHL with a hearing threshold between 30 and 85dBHL especially in the higher frequencies.
The CODACS implant is a semi-implantable device that is still in a preliminary phase and is gradually being used in some European centers. This AMEI is indicated for patients with severe to profound mixed hearing loss due to otosclerosis either as a primary indication or after stapedial surgery has failed.
The Envoy ESTEEM implant is a fully implantable device which is indicated in patients with moderate to severe and severe sensorineural hearing loss. The system uses two piezoelectric transducers (PZTs). Sound is received via a PZT sensor that picks up eardrum vibrations and transforms them into an electric signal. This signal is filtered, modified, amplified and transferred to a PZT driver which mechanically drives the stapes thus conducting sound to the inner ear. The sound processor also contains a power source, which is an implantable lithium iodide battery [22]. For candidacy, hearing thresholds should be stable and between 35 and 85dBHL for audiometric frequencies of 500-4000 Hz with a word recognition score of 40% or greater. It is currently indicated only in patients older than 18 years.
The history of the cochlear implant dates back to the first attempts at electrical hearing. The Italian scientist Alessandro Volta (1800) was the first to demonstrate that electric stimulation could directly evoke auditory sensations in humans when he invented the battery [23]. However electric stimulation of the auditory system was not subsequently reported for another 150 years until modern electronic technology appeared. SS Stevens and his colleagues conducted a series of studies to re-examine the electric stimulation of hearing using vacuum based tube oscillators and an amplifier, a copper wire serving as an electrode. They identified three mechanisms that were responsible - the first mechanism was called an “electromechanical effect” by Kiang & Moxon in 1972 in which electrical stimulation causes the hair cells in the cochlear to vibrate, resulting in a perceived tonal pitch at the signal frequency it was acoustically stimulated; the second mechanism occurs due to the tympanic membrane’s conversion of the electric signal into an acoustic signal, resulting in a tonal pitch perception but at the doubled signal frequency; while, the third mechanism is due to direct electric activation of the auditory nerve. However, it was Andreev who first gave direct evidence of electric stimulation of the auditory nerve when hearing sensations were reported with electric stimulation in a deaf patient whose middle and inner ears were damaged [24]. The modern era of cochlear implants began when Djourno and Eyries successfully performed the electric stimulation of hearing in two deafened patients in 1957 [25]. Their success led to a frenzied increase in attempts to restore hearing to deaf people on the US west coast in the 1960 and 1970s. Although their methods were crude, these studies identified critical problems and limitations that needed to be considered and overcome for successful implementation of electric hearing. In 1984, the House 3 M single-electrode implant became the first Food and Drug Administration (FDA) approved device. This was followed by the Ineraid or Symbion device developed by the University of Utah, the Laura device developed by the University of Antwerp, and the Digisonix MX20 developed by the MXM laboratories in France. These devices were later phased out and are no longer commercially available [26]. At present, there are three major cochlear implant manufacturers including Med-El Corporation, Austria; Cochlear Corporation, Australia and Advanced Bionics, USA. In addition to its design, implantation criteria have evolved over the past decades. Niparko provides a detailed account of these evolving criteria in patient selection as well as the surgical, cost-utility, educational, pre and post-operative issues in cochlear implants [27]. Most notably, the audiological criteria for cochlear implantation has relaxed from bilateral total deafness (<110 dB HL) in the early 1980s to severe hearing loss (>70db HL) in the 1990s, and then to current suprathreshold speech based criteria (<50% open-set sentence recognition with properly fitted hearing aids).
The essential components of a cochlear implant are as follows – a microphone converts sound into an electrical signal for input to the speech processor. The processor transforms this electrical input into a set of stimuli for the implanted array of electrodes. These stimuli are sent to the electrodes via a transcutaneous link which involves encoding of the stimulus information for efficient radiofrequency transmission from an external transmitting coil to an internal (implanted) receiving coil. The signal received by the internal coil is decoded to specify the electrical stimuli for the electrode array. These electrical stimuli that stimulate the hair cells have signal characteristics which determine the sound quality of the perceived stimulus.
The SYNCHRONY cochlear implant system consists of the SYNCHRONY 2 cochlear implant with the Sonnet 2 BTE or Rondo 2 sound processor. The implanted device has a removable magnet that may be temporarily taken out by a cochlear implant surgeon in the event that the MRI (up to 3.0 Tesla) is needed for the head. Med-El offers the largest selection of electrode options within the cochlear implant industry. Traditional electrode options include the standard array, medium array, compressed array and split electrodes array. The newest options include the FLEX 24, 28 and FLEX SOFT electrodes. The Sonnet 2 is a redesigned BTE sound processor for greater ease of use, better esthetics and improved reliability. It recognizes the ambient environment or scene and automatically adjusts settings to match it. The Rondo 2 is a unique sound processor option different from the Sonnet 2. It has innovative wireless charging, simple on/off button and automatically controls volume level for the recipient with up to 18 hours of battery life. The device is small and compact and sits on the head, just behind and above the ear and more comfortable to wear with glasses as compared to any BTE system.
The HiRes Ultra 3D cochlear implant has a multi-magnet assembly which automatically provides alignment to the 3D MRI field, allowing adult and pediatric users to undergo 3.0 Tesla MRIs safely, without any preparation surgery or head bandaging. This unique magnet assembly is composed of four rotatable magnets encased in a revolving disc allowing alignment with the 3D MRI field. There is no need for head bandaging or possible surgical removal of the magnet. The electrode array options in Advanced Bionics include the HiFocus Mid-Scala electrode array – which is designed to lie in the center of the scala tympani in order to remain reasonable proximal to the modiolus (and cochlear neural elements) while not making physical contact with the delicate cochlear structures necessary to maintain residual hearing; and, the HiFocus Slim J electrode array – which is designed to be placed in the scala tympani toward the lateral cochlear wall away from the cochlear structures. The Naída CI Connect is a design-integrated solution which turns the Naída CI Q90 sound processor into a Bluetooth headset which allows for hands-free calling and direct audio streaming from any compatible device.
Built on the same design of the predecessor Profile series, Profile Plus provides easier access to MRI at 1.5 Tesla and 3.0 Tesla without the need for compression or magnet removal. The Profile Plus is available with the following electrode types: Slim Modiolar (CI632), Slim Straight (CI622), Slim 20 (C624) & Contour Advance (CI612). The Contour advance electrode array has a perimodiolar design and a soft tip which is designed to reduce trauma to the delicate cochlear structures during insertion using the Advanced Off-Stylet (AOS) technique. The Straight array is recommended for patients with cochlear anomalies like the common cavity and in situations where there is fibrous tissue growth in the cochlea (bacterial meningitis). The Cochlear NUCLEUS 7 Sound Processor is the smallest and lightest BTE hearing solution with built-in connectivity featuring direct streaming with a compatible Apple and Android device without attaching anything to the sound processor. The Kanso 2 Sound Processor is the smallest and lightest off-the ear solution available that has built-in technology offering direct streaming, control and connectivity with a compatible device.
Current clinical guidelines for implant candidacy represent a composite assessment of the individual’s age (>12 months), hearing loss history, aided and unaided audition (comprehensive audiometric assessment), the socioeconomic and family support of the patient likely to influence the use of the device; and an awareness of potential benefits and constraints of current implantable technologies. These can be estimated via high resolution imaging complemented by thorough audiometric assessment and a multidisciplinary team-based preoperative counseling or intervention.
Hitselberger and House performed the first implantation of an ABI in 1979 [28]. It was a single spherical electrode implanted adjacent to the cochlear nucleus following removal of bilateral vestibular schwannomas of a patient with Neurofibromatosis Type 2 (NF2). In 1992, Cochlear Ltd. in conjunction with the Huntington Medical Research Institute developed the first multichannel electrode array devices which have, in most cases, provided patients with greater benefits than the earlier devices [29].
Although in the earlier years the most frequent indication of an ABI was NF2, a genetic disorder with an autosomal dominant inheritance pattern in which the patient develops benign vestibular schwannomas on both eighth cranial nerves; in recent years, the indications for the ABI have expanded to include bilateral cochlear ossification, unilateral vestibular schwannoma with deafness in the contralateral ear that is not amenable to a cochlear implant, congenital cochlear nerve aplasia or hypoplasia, complete cochlear ossification, malformation of the inner ear, and bilateral traumatic avulsions or absence of the cochlear nerve [30]. The current ABI system utilizes 12 platinum disk electrodes aligned on a flexible silicone and polyester mesh backing for implantation into the lateral recess of the fourth ventricle on the cochlear nucleus of the brain. This bypasses a non-functioning auditory nerve and allows signals to be sent to the brain.
The first reported attempt at stimulation of the inferior colliculus (IC) of the midbrain for hearing restoration was in 1962 by Simmons and colleagues at Stanford University during a tumor removal operation [31]. The second attempt at stimulating the surface of the IC happened much later in 2005 and involved using an ABI array in a NF2 patient to assess if the limited performance with cochlear nucleus stimulation secondary to tumor related damage could be overcome by stimulation in a higher auditory center and they were successful in eliciting a response at much higher thresholds than what is used in cochlear nucleus stimulation [32]. In 2006, Thomas and Minoo Lenarz at the Hannover Medical University developed the first human prototype Auditory Midbrain Implant (AMI) array for penetrating stimulation across the tonotopic gradient of the central nucleus of the IC [33].
The AMI is a type of central auditory prosthesis that targets midbrain regions beyond the cochlear nucleus, particularly the central nucleus of the Inferior Colliculus (ICC). There are several properties of the ICC that make it a logical choice for a prosthetic target including being a converging center for almost all ascending auditory projections, possessing tonotopic anatomical organization in addition to spatial organization for speech perception. The Cochlear Ltd. CI array was reduced in dimensions to create an AMI array that was small enough to insert into the ICC with the goal of stimulating its different layers. The AMI electrode array measures 6.4 mm long and a diameter of 0.4 mm and possesses 20 linearly spaced platinum ring electrodes. A distal Dacron mesh prevents over insertion of the electrode into the ICC during implantation and anchors the electrode array onto the surface of the inferior colliculus to minimize movement after positioning. The other components of the AMI system are similar to the Cochlear NUCLEUS CI system consisting of behind-the-ear microphone and processor that transmits the electromagnetic signals to the receiver stimulator implanted under the skin.
Vestibular disorders are widely prevalent and can cause significant morbidity in the form of incapacitating symptoms, missed work days and even the inability to leave one’s home. Advancements in the treatment of vestibular disorders are lacking and the surgical treatment of vestibular disorders has remained unchanged in the past two decades. Over the same duration, neural prosthesis have been developed that substitute one modality for another in order to restore a missing sense. Current research in vestibular neurostimulation has finally made possible the clinical reality of treating a wide range of vestibular disorders with electric stimulation.
Vestibular implantation is useful in recurrent acute vertigo attacks (in which central compensation does not occur), for chronic bilateral hypofunction and for Meniere’s disease, in which vertiginous attacks may be precipitated by an acute loss of vestibular tone. These are ideal candidates for a “pacemaker”-style vestibular implant that replaces the missing neural impulses during attacks. This implant bypasses the vestibular end organs to directly stimulate the vestibular nerve. The goal of vestibular implantation is to provide vestibular functionality and or reduce symptomatology by programmed stimulation of the vestibular nerve. This device consists of a modified Nucleus Freedom system. The receiver-stimulator has a modified trifurcating array of 9 electrodes. Each electrode is implanted 2.5 mm into the perilymphatic space of the semicircular canal adjacent to the ampullary nerve which is the site of stimulation.
It would be expected that future devices will meet the existing basic requirements which include wearing comfort, cosmetic appeal, long battery life and customizable frequency-cum-level dependent gains for ideal hearing rehabilitation. There is extensive ongoing research in different aspects of hearing technology, some of which are described here. The micro-electrical–mechanical systems (MEMS) microphone allows for a further reduction in size as well as the possibility of multiple microphones on a single device. This will be very useful for noisy environments for selecting a target source while rejecting other competing sounds thus improving directionality of the hearing device [34]. Silicon microfabrication of microphones making them more sensitive and with lower thermal noise was inspired by the ears of the parasitoid fly,
Bluetooth is one such technology that hearing device manufacturers are increasingly making available in their devices. This makes the hearing device compatible with any Bluetooth enabled technology across manufacturers allowing for handsfree usage of phone and other sound devices. Future hearing devices may contain sensors already existent in smart watches and other wearable devices which may collect information and present it via an auditory speech signal tailored to the wearer. There is evidence that auditory evoked electrical responses change depending on which sound source an individual is attending to [37]. This has been referred to as cognitively controlled hearing aids and research is ongoing in this field at present. The possibilities for improving the bone conduction device in the future are endless. A better housing design and improved transducer technology can improve conventional BCDs. This would be a significant advantage since they are non-invasive and a lower-cost alternative. Expanding surgical criteria to children below a certain age with smaller devices would likely offer them better hearing at a younger age and improved socio-linguistic development. Development of more patient optimized and powerful transducers will expand current indications for implantation.
A variety of approaches to regeneration or repair of auditory sensory and related structures are being investigated to restore hearing. Future hearing devices may be developed consisting of an acoustic hearing aid and a linked implanted component capable of eluting chemicals or signals for enhancement of this regenerative process. Drug delivery would be enabled through the implant, to preserve neurons or even promote the growth of neurites (toward the electrode array) from existing neurons or regeneration of neurons and associated structures [38, 39]. In 2002, the Free Electron Laser was used to conduct initial experiments on optical stimulation of a peripheral nerve [40]. This concept was later transferred to the cochlea and stimulation units have been further miniaturized and an implantable unit for stimulation in cat models is currently under work [41]. Necessary safety studies are underway that has led to the development of an optogenetic implant unit that is being used in clinical trials. The feasibility of supplementing the ABI array of surface electrodes with penetrating microstimulating electrodes has been demonstrated in animal studies and human trials involving using this combination is currently ongoing. The initial results of the first AMI patients have been encouraging in terms of the ability to implant the array into the auditory midbrain safely and to restore some hearing function. Future work in this area will needed to overcome the primary limitation of midbrain stimulation which is optimal placement of the electrode array. Research is also currently underway on creating a totally implantable vestibular implant in which all the components of the implant could be internalized. Advances in miniaturization, microelectromechanical systems (MEMS), nanotechnology, battery technology and circuit energy efficiency could help realize this goal. A vestibular brainstem implant could prove helpful for bilateral vestibular hypofunction and such a device could be potentially combined with an auditory brainstem device [29].
Thus, there are new development efforts in this field that will either significantly improve prosthetic performance or change the face of auditory prosthesis altogether. There is also the possibility that auditory prostheses will be integrated with other peripheral and central prostheses (eg. vestibular and deep brain implants) to treat not just one symptom but to address its whole spectrum. Finally, the progress in neuroscience, particularly in non-invasive brain monitoring will allow a full account of individual variability in both the optimization & the performance of prosthetic hearing devices.
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',metaTitle:"Publication Agreement - Monograph",metaDescription:"IntechOpen aims to guarantee that original material is published while at the same time giving significant freedom to our authors. For that matter, we uphold a flexible copyright policy meaning that there is no transfer of copyright to the publisher and authors retain exclusive copyright to their work.",metaKeywords:null,canonicalURL:"/page/publication-agreement-monograph",contentRaw:'[{"type":"htmlEditorComponent","content":"When submitting a manuscript, the Author is required to accept the Terms and Conditions set out in our Publication Agreement – Monographs/Compacts as follows:
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\\n\\nThe Author shall obtain written informed consent for publication from those who might recognize themselves or be identified by others, for example from case reports or photographs.
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\\n\\nIntechOpen has the right to terminate this Publication Agreement for quality, program, technical or other reasons with immediate effect, including without limitation (i) if the Author and/or any Co-Author commits a material breach of this Publication Agreement; (ii) if the Author and/or any Co-Author (being a private individual) is the subject of a bankruptcy petition, application or order; or (iii) if the Author and/or any Co-Author (as a corporate entity) commences negotiations with all or any class of its creditors with a view to rescheduling any of its debts, or makes a proposal for, or enters into, any compromise or arrangement with any of its creditors.
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\\n\\nIntechOpen is granted the authority to enforce the rights from this Publication Agreement on behalf of the Author and Co-Authors against third parties, for example in cases of plagiarism or copyright infringements. In respect of any such infringement or suspected infringement of the copyright in the Work, IntechOpen shall have absolute discretion in addressing any such infringement that is likely to affect IntechOpen's rights under this Publication Agreement, including issuing and conducting proceedings against the suspected infringer.
\\n\\nIntechOpen has the right to include/use the Author and Co-Authors names and likeness in connection with scientific dissemination, retrieval, archiving, web hosting and promotion and marketing of the Work and has the right to contact the Author and Co-Authors until the Work is publicly available on any platform owned and/or operated by IntechOpen.
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\\n\\nThird Party Rights: A person who is not a party to this Publication Agreement may not enforce any of its provisions under the Contracts (Rights of Third Parties) Act 1999.
\\n\\nEntire Agreement: This Publication Agreement constitutes the entire agreement between the parties in relation to its subject matter. It replaces all prior agreements, draft agreements, arrangements, collateral warranties, collateral contracts, statements, assurances, representations and undertakings of any nature made by, or on behalf of, the parties, whether oral or written, in relation to that subject matter. Each party acknowledges that in entering into this Publication Agreement it has not relied upon any oral or written statements, collateral or other warranties, assurances, representations or undertakings which were made by or on behalf of the other party in relation to the subject matter of this Publication Agreement at any time before its signature (known as the "Pre-Contractual Statements"), other than those which are set out in this Publication Agreement. Each party hereby waives all rights and remedies which might otherwise be available to it in relation to such Pre-Contractual Statements. Nothing in this clause shall exclude or restrict the liability of either party arising out of any fraudulent pre-contract misrepresentation or concealment.
\\n\\nWaiver: No failure or delay by a party to exercise any right or remedy provided under this Publication Agreement or by law shall constitute a waiver of that or any other right or remedy, nor shall it preclude or restrict the further exercise of that or any other right or remedy. No single or partial exercise of such right or remedy shall preclude or restrict the further exercise of that or any other right or remedy.
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\\n\\nNo partnership: Nothing in this Publication Agreement is intended to, or shall be deemed to, establish or create any partnership or joint venture or the relationship of principal and agent or employer and employee between IntechOpen and the Author or any Co-Author, nor authorize any party to make or enter into any commitments for, or on behalf of, any other party.
\\n\\nGoverning law: This Publication Agreement and any dispute or claim, including non-contractual disputes or claims arising out of, or in connection with it, or its subject matter or formation, shall be governed by and construed in accordance with the law of England and Wales. The parties submit to the exclusive jurisdiction of the English courts to settle any dispute or claim arising out of, or in connection with, this Publication Agreement, including any non-contractual disputes or claims.
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\n\nCORRESPONDING AUTHOR'S GRANT OF RIGHTS
\n\nSubject to the following Article, the Author grants to IntechOpen, during the full term of copyright, and any extensions or renewals of that term, the following:
\n\nThe foregoing licenses shall survive the expiry or termination of this Publication Agreement for any reason.
\n\nThe Author, on his or her own behalf and on behalf of any of the Co-Authors, reserves the following rights in the Work but agrees not to exercise them in such a way as to adversely affect IntechOpen's ability to utilize the full benefit of this Publication Agreement: (i) reprographic rights worldwide, other than those which subsist in the typographical arrangement of the Work as published by IntechOpen; and (ii) public lending rights arising under the Public Lending Right Act 1979, as amended from time to time, and any similar rights arising in any part of the world.
\n\nThe Author, and any Co-Author, confirms that they are, and will remain, a member of any applicable licensing and collecting society and any successor to that body responsible for administering royalties for the reprographic reproduction of copyright works.
\n\nSubject to the license granted above, copyright in the Work and all versions of it created during IntechOpen's editing process, including all published versions, is retained by the Author and any Co-Authors.
\n\nSubject to the license granted above, the Author and Co-Authors retain patent, trademark and other intellectual property rights to the Work.
\n\nAll rights granted to IntechOpen in this Article are assignable, sublicensable or otherwise transferrable to third parties without the specific approval of the Author or Co-Authors.
\n\nThe Author, on his/her own behalf and on behalf of the Co-Authors, will not assert any rights under the Copyright, Designs and Patents Act 1988 to object to derogatory treatment of the Work as a consequence of IntechOpen's changes to the Work arising from the translation of it, corrections and edits for house style, removal of problematic material and other reasonable edits as determined by IntechOpen.
\n\nAUTHOR'S DUTIES
\n\nWhen distributing or re-publishing the Work, the Author agrees to credit the Monograph/Compacts as the source of first publication, as well as IntechOpen. The Author guarantees that Co-Authors will also credit the Monograph/Compacts as the source of first publication, as well as IntechOpen, when they are distributing or re-publishing the Work.
\n\nThe Author agrees to:
\n\nThe Author will be held responsible for the payment of the agreed Open Access Publishing Fee before the completion of the project (Monograph/Compacts publication).
\n\nAll payments shall be due 30 days from the date of issue of the invoice. The Author or whoever is paying on behalf of the Author and Co-Authors will bear all banking and similar charges incurred.
\n\nThe Author shall obtain in writing all consents necessary for the reproduction of any material in which a third-party right exists, including quotations, photographs and illustrations, in all editions of the Work worldwide for the full term of the above licenses, and shall provide to IntechOpen, at its request, the original copies of such consents for inspection or the photocopies of such consents.
\n\nThe Author shall obtain written informed consent for publication from those who might recognize themselves or be identified by others, for example from case reports or photographs.
\n\nThe Author shall respect confidentiality during and after the termination of this Agreement. The information contained in all correspondence and documents as part of the publishing activity between IntechOpen and the Author and Co-Authors are confidential and are intended only for the recipients. The contents of any communication may not be disclosed publicly and are not intended for unauthorized use or distribution. Any use, disclosure, copying, or distribution is prohibited and may be unlawful.
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\n\nThe Author and Co-Authors confirm and warrant that the Work does not and will not breach any applicable law or the rights of any third party and, specifically, that the Work contains no matter that is defamatory or that infringes any literary or proprietary rights, intellectual property rights, or any rights of privacy.
\n\nThe Author and Co-Authors confirm that: (i) the Work is their original work and is not copied wholly or substantially from any other work or material or any other source; (ii) the Work has not been formally published in any other peer-reviewed journal or in a book or edited collection, and is not under consideration for any such publication; (iii) Authors and any applicable Co-Authors are qualifying persons under section 154 of the Copyright, Designs and Patents Act 1988; (iv) Authors and any applicable Co-Authors have not assigned, and will not during the term of this Publication Agreement purport to assign, any of the rights granted to IntechOpen under this Publication Agreement; and (v) the rights granted by this Publication Agreement are free from any security interest, option, mortgage, charge or lien.
\n\nThe Author and Co-Authors also confirm and warrant that: (i) he/she has the power to enter into this Publication Agreement on his or her own behalf and on behalf of each Co-Author; and (ii) has the necessary rights and/or title in and to the Work to grant IntechOpen, on behalf of themselves and any Co-Author, the rights and licences in this Publication Agreement. If the Work was prepared jointly by the Author and Co-Authors, the Author confirms that: (i) all Co-Authors agree to the submission, license and publication of the Work on the terms of this Publication Agreement; and (ii) the Author has the authority to enter into this biding Publication Agreement on behalf of each Co-Author. The Author shall: (i) ensure each Co-Author complies with all relevant provisions of this Publication Agreement, including those relating to confidentiality, performance and standards, as if a party to this Publication Agreement; and (ii) remain primarily liable for all acts and/or omissions of each Co-Author.
\n\nThe Author agrees to indemnify IntechOpen harmless against all liabilities, costs, expenses, damages and losses, as well as all reasonable legal costs and expenses suffered or incurred by IntechOpen arising out of, or in connection with, any breach of the agreed confirmations and warranties. This indemnity shall not apply in a situation in which a claim results from IntechOpen's negligence or willful misconduct.
\n\nNothing in this Publication Agreement shall have the effect of excluding or limiting any liability for death or personal injury caused by negligence or any other liability that cannot be excluded or limited by applicable law.
\n\nTERMINATION
\n\nIntechOpen has the right to terminate this Publication Agreement for quality, program, technical or other reasons with immediate effect, including without limitation (i) if the Author and/or any Co-Author commits a material breach of this Publication Agreement; (ii) if the Author and/or any Co-Author (being a private individual) is the subject of a bankruptcy petition, application or order; or (iii) if the Author and/or any Co-Author (as a corporate entity) commences negotiations with all or any class of its creditors with a view to rescheduling any of its debts, or makes a proposal for, or enters into, any compromise or arrangement with any of its creditors.
\n\nIn the event of termination, IntechOpen will notify the Author of the decision in writing.
\n\nIntechOpen’s DUTIES AND RIGHTS
\n\nUnless prevented from doing so by events beyond its reasonable control, IntechOpen, at its discretion, agrees to publish the Work attributing it to the Author and Co-Authors.
\n\nUnless prevented from doing so by events beyond its reasonable control, IntechOpen agrees to provide publishing services which include: managing editing (editorial and publishing process coordination, Author assistance); publishing software technology; language copyediting; typesetting; online publishing; hosting and web management; and abstracting and indexing services.
\n\nIntechOpen agrees to offer free online access to readers and use reasonable efforts to promote the Publication to relevant audiences.
\n\nIntechOpen is granted the authority to enforce the rights from this Publication Agreement on behalf of the Author and Co-Authors against third parties, for example in cases of plagiarism or copyright infringements. In respect of any such infringement or suspected infringement of the copyright in the Work, IntechOpen shall have absolute discretion in addressing any such infringement that is likely to affect IntechOpen's rights under this Publication Agreement, including issuing and conducting proceedings against the suspected infringer.
\n\nIntechOpen has the right to include/use the Author and Co-Authors names and likeness in connection with scientific dissemination, retrieval, archiving, web hosting and promotion and marketing of the Work and has the right to contact the Author and Co-Authors until the Work is publicly available on any platform owned and/or operated by IntechOpen.
\n\nMISCELLANEOUS
\n\nFurther Assurance: The Author shall ensure that any relevant third party, including any Co-Author, shall execute and deliver whatever further documents or deeds and perform such acts as IntechOpen reasonably requires from time to time for the purpose of giving IntechOpen the full benefit of the provisions of this Publication Agreement.
\n\nThird Party Rights: A person who is not a party to this Publication Agreement may not enforce any of its provisions under the Contracts (Rights of Third Parties) Act 1999.
\n\nEntire Agreement: This Publication Agreement constitutes the entire agreement between the parties in relation to its subject matter. It replaces all prior agreements, draft agreements, arrangements, collateral warranties, collateral contracts, statements, assurances, representations and undertakings of any nature made by, or on behalf of, the parties, whether oral or written, in relation to that subject matter. Each party acknowledges that in entering into this Publication Agreement it has not relied upon any oral or written statements, collateral or other warranties, assurances, representations or undertakings which were made by or on behalf of the other party in relation to the subject matter of this Publication Agreement at any time before its signature (known as the "Pre-Contractual Statements"), other than those which are set out in this Publication Agreement. Each party hereby waives all rights and remedies which might otherwise be available to it in relation to such Pre-Contractual Statements. Nothing in this clause shall exclude or restrict the liability of either party arising out of any fraudulent pre-contract misrepresentation or concealment.
\n\nWaiver: No failure or delay by a party to exercise any right or remedy provided under this Publication Agreement or by law shall constitute a waiver of that or any other right or remedy, nor shall it preclude or restrict the further exercise of that or any other right or remedy. No single or partial exercise of such right or remedy shall preclude or restrict the further exercise of that or any other right or remedy.
\n\nVariation: No variation of this Publication Agreement shall have effect unless it is in writing and signed by the parties, or their duly authorized representatives.
\n\nSeverance: If any provision, or part-provision, of this Publication Agreement is, or becomes invalid, illegal or unenforceable, it shall be deemed modified to the minimum extent necessary to make it valid, legal and enforceable. If such modification is not possible, the relevant provision or part-provision shall be deemed deleted. Any modification to, or deletion of, a provision or part-provision under this clause shall not affect the validity and enforceability of the rest of this Publication Agreement.
\n\nNo partnership: Nothing in this Publication Agreement is intended to, or shall be deemed to, establish or create any partnership or joint venture or the relationship of principal and agent or employer and employee between IntechOpen and the Author or any Co-Author, nor authorize any party to make or enter into any commitments for, or on behalf of, any other party.
\n\nGoverning law: This Publication Agreement and any dispute or claim, including non-contractual disputes or claims arising out of, or in connection with it, or its subject matter or formation, shall be governed by and construed in accordance with the law of England and Wales. The parties submit to the exclusive jurisdiction of the English courts to settle any dispute or claim arising out of, or in connection with, this Publication Agreement, including any non-contractual disputes or claims.
\n\nPolicy last updated: 2018-09-11
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On September, 29th 2006 he has won a post PhD fellowship from the university of Bologna (from October 2006 to October 2008), at the competitive examination he was ranked first in the industrial engineering area. He extensively served as referee for several international journals. He is author/coauthor of more than 100 research papers. He has been involved in some projects supported by MURST and European Community. 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