EP1522208B1 - Partly implanted hearing aid - Google Patents

Partly implanted hearing aid Download PDF

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Publication number
EP1522208B1
EP1522208B1 EP03760752A EP03760752A EP1522208B1 EP 1522208 B1 EP1522208 B1 EP 1522208B1 EP 03760752 A EP03760752 A EP 03760752A EP 03760752 A EP03760752 A EP 03760752A EP 1522208 B1 EP1522208 B1 EP 1522208B1
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EP
European Patent Office
Prior art keywords
patient
casing
auditory canal
external
magnetic piece
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Expired - Lifetime
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EP03760752A
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German (de)
French (fr)
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EP1522208A1 (en
Inventor
Guy Charvin
Stéphane GALLEGO
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MXM SAS
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MXM SAS
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    • H—ELECTRICITY
    • H04—ELECTRIC COMMUNICATION TECHNIQUE
    • H04R—LOUDSPEAKERS, MICROPHONES, GRAMOPHONE PICK-UPS OR LIKE ACOUSTIC ELECTROMECHANICAL TRANSDUCERS; DEAF-AID SETS; PUBLIC ADDRESS SYSTEMS
    • H04R25/00—Deaf-aid sets, i.e. electro-acoustic or electro-mechanical hearing aids; Electric tinnitus maskers providing an auditory perception
    • H04R25/60—Mounting or interconnection of hearing aid parts, e.g. inside tips, housings or to ossicles
    • H04R25/604—Mounting or interconnection of hearing aid parts, e.g. inside tips, housings or to ossicles of acoustic or vibrational transducers
    • H04R25/606—Mounting or interconnection of hearing aid parts, e.g. inside tips, housings or to ossicles of acoustic or vibrational transducers acting directly on the eardrum, the ossicles or the skull, e.g. mastoid, tooth, maxillary or mandibular bone, or mechanically stimulating the cochlea, e.g. at the oval window
    • H—ELECTRICITY
    • H04—ELECTRIC COMMUNICATION TECHNIQUE
    • H04R—LOUDSPEAKERS, MICROPHONES, GRAMOPHONE PICK-UPS OR LIKE ACOUSTIC ELECTROMECHANICAL TRANSDUCERS; DEAF-AID SETS; PUBLIC ADDRESS SYSTEMS
    • H04R2225/00—Details of deaf aids covered by H04R25/00, not provided for in any of its subgroups
    • H04R2225/67—Implantable hearing aids or parts thereof not covered by H04R25/606

Definitions

  • the present invention relates to an acoustic hearing aid for the rehabilitation of patients with partial sensorineural hearing loss.
  • acoustic hearing aids available on the market are categorized into two product categories: earloop devices and in-ear devices.
  • Boundary devices such as the one shown in the document EP 1 011 295 , comprise an arc-shaped housing intended to be housed behind the ear, this housing generally containing one or more sensors such as microphones, a power source of the battery or battery type, and electronic circuits of amplification and analog and / or digital signal processing.
  • the electronic circuits generate a sound signal that is sent into the ear canal of the patient via an acoustic tube held in the ear canal by an ear plug.
  • This in-ear plug also makes it possible to reduce acoustic feedback phenomena between the earpiece and the point of sound emission.
  • these devices have great ease of implementation, good reliability and sufficient performance, due in part to the relatively large volume available, to integrate all the electronic circuits required.
  • these devices have the disadvantage of being painful to wear, and risk falling as a result of certain movements of the head.
  • they are relatively visible and lack aesthetics. They do not completely eliminate the feedback phenomena because the microphone is relatively close to the earpiece, which forces them to be set to under-amplification mode.
  • the intra-auricular plug also has drawbacks, including unpleasant feeling of clogged ear, perception of noise during mastication, and hygiene problems and potentially infections, due to the fact that mouth the auditory canal.
  • in-ear devices are in the form of small housings intended to be inserted directly into the external auditory canal.
  • This case consists of a resin shell, whose shape is adapted by molding to the anatomy of the external auditory canal of each patient.
  • This box brings together in a very small volume the sound sensor, the electronic circuits for amplification and signal processing, the earpiece, the power source (electric battery).
  • the sound sensor the electronic circuits for amplification and signal processing
  • the earpiece the power source (electric battery).
  • the power source electric battery
  • the miniaturization of the microphone and the earphone do not make it possible to obtain sound qualities of good quality.
  • the low volume available makes it difficult or impossible to add additional microphones or more sophisticated signal processing functions. It has a low autonomy due to the use of a battery necessarily small. Because of its small size, handling, especially during settings and battery changes is difficult, which leads to the risk of falling when removed from the ear canal. As for devices with earloop, they cause unpleasant feelings of clogged ear, pose hygiene problems, with risks of infection and premature wear of the device.
  • the first magnetic piece is a magnet.
  • the second magnetic part is a magnet.
  • the first and second magnetic parts are permanent magnets, and the second magnetic part is disposed in the implanted housing so as to have a north-south magnetic axis substantially parallel to the surface of the patient's skin. at said location, and the first magnetic part is disposed in the outer casing so as to have a north-south magnetic axis substantially parallel to the wall of the housing intended to come into contact with the skin of the patient.
  • the second magnetic piece is a magnet and the first magnetic piece comprises two permanent magnets arranged in the outer casing so as to have north-south magnetic axes substantially perpendicular to the wall of the casing intended to contacting the skin of the patient, and in opposite directions, these magnetic axes being spaced from each other by a distance substantially corresponding to the distance between the poles of the second magnetic part.
  • the first magnetic part is a magnet and the second magnetic part comprises two permanent magnets arranged in the implanted housing so as to have north-south magnetic axes substantially perpendicular to the surface of the patient's skin. at said location, and in opposite directions, these magnetic axes being spaced from each other by a distance substantially corresponding to the distance between the poles of the first magnetic part.
  • the second magnetic part comprises at least two permanent magnets arranged in the implanted housing so as to present north-south magnetic axes. substantially perpendicular to the patient's skin surface at said location, and alternately in opposite directions
  • the first magnetic piece comprises as many permanent magnets as the first piece, the magnets of the first magnetic piece being disposed in the housing so as to have north-south magnetic axes substantially perpendicular to the wall of the outer casing intended to come into contact with the skin of the patient, and alternately in opposite directions, the magnetic axes of the magnets disposed in the outer casing being distributed in a plane substantially parallel to said wall in a configuration substantially corresponding to the configuration of distribution of the magnetic axes of the magnets in the implanted housing.
  • the second housing is designed to be implanted in the temporo-occipital zone of the patient's skull.
  • the earpiece is disposed in the outer casing and connected to the patient's external auditory canal by an acoustic tube having an intra-auricular end, the hearing aid device further comprising a system for mechanical anti-feedback damping.
  • the earpiece is placed in the patient's external auditory canal and forms an in-ear end of the link, the link being constituted by an electric cable.
  • the intra-auricular end of the link is maintained in the patient's external auditory canal by means of an intra-auricular support comprising means for centering and maintaining said end in the auditory canal.
  • the outer casing comprises a base and a cover rotatably mounted on the base, and means for locking the angular position of the cover relative to the base, the second magnetic part being fixed to the base, while that the microphone or microphones are attached to the cover.
  • the implanted housing is connected to at least two electrodes for collecting evoked or spontaneous auditory potentials, the implanted housing containing at least one electronic module for collecting and processing a signal connected to the collection electrodes, a transmission module connected to an antenna and to the collection and processing module, for transmitting to the external box the signals produced by the collection module according to the signals collected by the electrodes, and a power supply.
  • one of the collection electrodes is adapted to be disposed on the round window.
  • the implanted housing is further connected to at least one active stimulation electrode intended to be positioned near the patient's inner ear or in the cochlea, the implanted housing containing at least one module stimulation electronics connected to the stimulation electrodes, a transmission module connected to an antenna and the stimulation module, the stimulation module being adapted to generate electrical stimulation signals which are applied to the stimulation electrodes from signals received from the housing external 1 via the transmission module, via the antenna located in the implanted housing.
  • one of the active stimulation electrodes is adapted to be disposed on the round window of the patient's middle ear.
  • the collection electrodes and the stimulation electrodes are at least partially common.
  • the external box further comprises a signal transmission module connected to at least one antenna and to the electronic module.
  • the implanted housing is further connected to at least one electromechanical transducer vibrator intended to be positioned in a bone or cartilaginous zone near the patient's inner ear, the implanted housing enclosing at least one electronic stimulation module connected to the vibrator , a transmission module connected to an antenna and to the stimulation module, the stimulation module being designed to generate electrical stimulation signals which are applied to the vibrator from signals received from the outer casing 1 via the transmission module , via the antenna located in the implanted housing.
  • the Figures 1 and 2 represent respectively in profile view and in section, the head of a patient equipped with a hearing aid device according to the invention, maintained on the skull.
  • This device comprises an external casing 1 equipped with at least one microphone 13a, 13b and enclosing a source of energy, (for example a battery or a battery), and electronic amplification and signal processing circuits, this casing being connected to a device for distributing sound signals in the auditory canal 5 of the patient, this device comprising a earphone 3 and a link 4 between the housing and the inside of the ear canal.
  • a source of energy for example a battery or a battery
  • the case 1 is held according to the invention on the patient's head by means of a magnet housed in a case 2 implanted under the skin and possibly attached to the bone of the skull 7, this magnet being intended to exert a magnetic attraction force on a magnetic part disposed in the outer casing, when the latter is disposed near the implanted casing 2.
  • the housing 2 has a substantially planar shape of small thickness, so as to be inserted under the skin, preferably under the scalp, to be masked by the hair of the patient, even at an advanced stage of baldness.
  • it is implanted for example on the mastoid or on the temporo-occipital bone as represented on the figure 1 .
  • the housing can be easily attached to the patient's head and maintained in all positions and during normal movements thereof.
  • the microphone or microphones on the housing 1 are far enough away from the earpiece, and separated by the horn of the ear that serves as a screen between the reverberated sound from the external ear canal and the microphone.
  • the acoustic feedback effect between the reverberated sound coming from the external auditory canal arriving on the microphone (s) is very attenuated or even suppressed (depending on the amplification and the opening of the mouthpiece, sought) because of the combination of the two means consisting on the one hand of the sufficient distance between the ear canal and the microphones or microphones located near the temporo-occipital zone, and on the other hand the existence of a natural acoustic barrier formed by the ear pavilion.
  • the housing 1 may have a small thickness so as not to show an excess thickness when it is masked by the hair.
  • the link 4 between the housing 1 and the earphone 3 is constituted by an electric cable.
  • the earpiece includes an electroacoustic transducer for insertion into the patient's external auditory canal.
  • this connection 4 is an acoustic tube.
  • the earphone is integrated in the outer casing 1 and extended by the acoustic tube 4 which is waterproof and has a length adapted to reach the bottom of the external auditory canal of the patient.
  • the earpiece contained in the housing is equipped with a mechanical anti-feedback damping device (damping vibrations generated by the earphone). It should be noted that there is no phenomenon of acoustic feedback because the sound waves generated by the earphone are channeled through the acoustic tube.
  • the cable 4 is semi-rigid so as to accurately follow a predefined path between the housing 1 and the bottom of the external auditory canal, for example by bypassing the ear from above, and keeping the earphone 3 in a certain position. position in the external auditory canal.
  • it is not necessary to close the ear canal with a plug to hold the earpiece in place.
  • the link 4 may be flexible and the earpiece 3 or the end of the acoustic tube is maintained and centered in the external auditory canal by an in-ear support 9.
  • the in-ear support 9 comprises a central housing intended to receive the earphone 3 or the end of the acoustic tube, this central housing being connected to an outer tubular element 8c by spacers 8a, 8b delimiting with the outer tubular element vents allowing good ventilation of the ear canal.
  • the tubular element 8c is preferably made of a compressible and / or elastic material, or is molded according to the anatomy of the auditory canal of the patient.
  • the invention makes it possible to maintain on the patient's head a hearing aid device in an almost invisible manner, only the link 4 remaining visible, while being very discreet.
  • the virtual absence of feedback makes it possible, on the one hand, to increase the patient's hearing performance thanks to better amplification and, on the other hand, to reduce the problems of hygiene and occlusion phenomenon (sensation of plugged ear) resulting from the quasi-closing ear plug, which can advantageously be replaced by the open ear support 9.
  • the housing 1 encloses a magnetic part 12, for example a ferromagnetic material, which is arranged against a face of the housing so as to be placed opposite and close to the implanted housing 2, when placing the prosthesis on the patient's head.
  • the housing 1 also contains electronic circuits 11 fed by a thin battery (not shown), and a sensor 13 connected to the electronic circuits.
  • the piece of ferromagnetic material may be housed in the implanted housing 2, and the magnet disposed in the housing 1.
  • the senor 13 must be positioned in a precise orientation relative to the patient's head.
  • certain hearing aid devices comprise a directional microphone or several omnidirectional microphones which must be oriented so as to restore information on the direction of origin of the sounds, these microphones must be positioned precisely so that the prosthesis can restore sound. exact direction of provenance from perceived sounds.
  • the figure 4 represents a hearing aid housing enclosing two microphones 13a, 13b. So that the housing and therefore the microphones are arranged in a precise orientation relative to the patient's head, the permanent magnet 21 is implanted under the skin so as to have a north-south axis (shown in the figure by the arrow 24) oriented in a certain direction parallel to the surface of the skull. Furthermore, the part 12 housed in the housing 1 is replaced by a magnet 12 ', for example a permanent magnet whose north-south axis 22 is oriented in a predefined direction, parallel to the face of the housing intended to come s' apply against the patient's skin. In this way, the casing 1 can only be held on the patient's head in a certain orientation.
  • the permanent magnet 12 ' shown on the figure 4 is replaced by two magnets 12a, 12b whose north-south axes 22a, 22b are oriented perpendicularly to the face of the housing intended to be applied against the skin of the patient, and in opposite directions.
  • the north-south axes 22a, 22b are spaced apart by a distance corresponding to the distance separating the north and south poles of the implanted magnet 2.
  • the casing 1 can also be held on the patient's head in a certain predefined orientation thanks to the embodiment shown on the figure 6 .
  • the implanted housing 2 comprises two magnets 21a, 21b whose north-south axes 24a, 24b are oriented perpendicularly to the surface of the skull, and in opposite directions.
  • the housing 1 then encloses a single magnet 12 'as shown in FIG. figure 4 or two magnets 12a, 12b as shown in the figure 5 or 6 these magnets being arranged in the housing so as to face an implanted magnet 21a, 21b respectively, of the same orientation, when the housing 1 is placed in the desired orientation on the patient's head.
  • the outer casing 1 comprises a circular base 1a in which are housed one or two magnets 12a and 12b, and a lid 1b also of circular shape, in which are fixed the microphones 13a, 13b, and possibly the electronic circuits, and the source of energy.
  • the base is held on the skull of the patient always in the same orientation according to one of the embodiments shown on the Figures 4 to 6 , depending on the respective polarities of the magnetic parts 21, 21a, 21b, while the lid 1b is pivotally mounted on the base 1a, and locked in an angular position relative to the latter by a fixing means, for example consisting of a central screw 25 passing through the lid and screwed into a central pivot provided in the base 1a.
  • a fixing means for example consisting of a central screw 25 passing through the lid and screwed into a central pivot provided in the base 1a.
  • the magnets are totally electrically isolated in the base, so as to avoid any electrical contact with the electronic circuits housed in the cover.
  • the figure 8 shows in broken lines three different positions of the cover relative to the base (the cable 4 rotates while the magnets 12a, 12b remain fixed).
  • the microphone or microphones 13, 13a, 13b can thus be oriented in an optimal manner and with great precision by the practitioner responsible for setting the device or by the patient, following the implantation of the housing 2. Of this In this way, any implantation inaccuracies of the implanted housing 2 are dispensed with, resulting notably from differences in morphology from one patient to another. The patient can thus dispose and remove the housing 1 with great ease, always having the assurance that the microphones will be oriented correctly.
  • the microphone or microphones 13, 13a, 13b can also be arranged at the end of a respective rigid cable, connected to the outer casing 1. If the cable is conformable by the practitioner following the installation of the implanted housing 2, to arrange and correctly orient the microphones or microphones relative to the patient's head, it is not necessary that the outer casing 1 has a portion 1 has steerable.
  • the implanted housing 2 advantageously comprises, in addition to the magnetic parts 21a, 21b, a system for collecting evoked or spontaneous auditory potentials.
  • This system comprises at least two extra-cochlear collection electrodes 35, 36 connected to the housing.
  • This system also comprises an electronic collection module 32 for amplifying and possibly processing the signals from the electrodes, 35, 36, a transfer module 33 including a transmitting antenna for transmitting to the outside for example by electromagnetic waves , via an amplitude or frequency modulation, the signals produced by the collection module 32, a power supply 31 comprising a battery and / or coils capturing the electromagnetic energy coming from an external coil, for example provided in the housing external 1.
  • the housing 1 may also comprise a receiving module connected to a coil / antenna for receiving the signals emitted by the transfer module 33. In this case, the outer coil and the antenna of the receiving module can be fixed to the base 1a or cover 1b of the outer casing.
  • At least one of the collection electrodes 35, 36 is intended to be implanted near the inner ear of the patient, preferably on the round window.
  • the collection module is designed to amplify and treat evoked or spontaneous acoustic potentials.
  • the collection electrodes 35, 36 are implanted under the skin of the patient, also in the temporo-occipital region of the skull, to measure evoked potentials and the collection module 32 is designed to amplify and possibly treat such potentials.
  • the electrodes are for example arranged at the end of flexible tabs 34a, 34b attached to the housing 2.
  • a reference electrode R disposed on the housing 2 and connected to the collection module 32.
  • the housing 2 encloses, alternately or in combination with the collection module 32, a stimulation module 37 connected to at least one active stimulation electrode 38, 39, implanted near the patient's inner ear, for example on the oval window or the round window of the middle ear, or in the cochlea.
  • the stimulation module 37 is connected to at least one neutral stimulation electrode remote from the inner ear.
  • the pacing module is adapted to generate pacing signals from signals received from the outer casing 1 via the transfer module 33.
  • the electrodes 38, 39 may be replaced or combined with an electromechanical transducer vibrator, for example of the piezoelectric type, implanted in a bone or cartilaginous zone, preferably close to the patient's inner ear, to effect electromechanical stimulation.
  • an electromechanical transducer vibrator for example of the piezoelectric type, implanted in a bone or cartilaginous zone, preferably close to the patient's inner ear, to effect electromechanical stimulation.
  • the collection and stimulation electrodes are, according to an advantageous variant, common and can operate alternately in collection mode and stimulation mode.
  • one of the electrodes 38, 39 is positioned on the round window and is both an active stimulation electrode, and alternatively, one of the potential acquisition electrodes. hearing.

Abstract

The invention concerns a hearing aid comprising: an outer housing ( 1 ) containing a signal processing module ( 11 ) connected in input to at least a microphone ( 13 ) and in output to an earphone for transmitting a sound signal into the patient's external auditory canal ( 5 ); at least one first magnetic component ( 12 ) arranged in the outer housing ( 1 ); at least one second magnetic component ( 21 ) arranged in an implantable housing designed to be implanted under the patient's skin, at a site where the outer housing ( 1 ) can be maintained, the first magnetic component being arranged in the outer housing such that a magnetic attraction force is exerted with the second magnetic component when the outer housing ( 1 ) is placed at said site; and a device for delivering sound signals into the patient's external auditory canal comprising the earphone and a connection ( 4 ) between the outer housing ( 1 ) and the auditory canal.

Description

La présente invention concerne une aide auditive acoustique pour la réhabilitation de patients atteints de surdités neurosensorielles partielles.The present invention relates to an acoustic hearing aid for the rehabilitation of patients with partial sensorineural hearing loss.

A l'heure actuelle, les aides auditives acoustiques disponibles sur le marché sont répertoriées en deux catégories de produits : les dispositifs à contour d'oreille et les dispositifs intra-auriculaires.Currently, acoustic hearing aids available on the market are categorized into two product categories: earloop devices and in-ear devices.

Les dispositifs à contour d'oreille, tel que celui montré dans le document EP 1 011 295 , comportent un boîtier en forme d'arc de cercle destiné à être logé derrière l'oreille, ce boîtier renfermant généralement un ou plusieurs capteurs tels que des microphones, une source d'énergie du type pile ou batterie, et des circuits électroniques d'amplification et de traitement de signal analogique et/ou numérique. Les circuits électroniques génèrent un signal sonore qui est envoyé dans le conduit auriculaire du patient par l'intermédiaire d'un tube acoustique maintenu dans le conduit auriculaire par un bouchon intra-auriculaire.
Ce bouchon intra-auriculaire permet en outre de réduire les phénomènes de larsen acoustique entre l'écouteur et le point d'émission du son.Boundary devices, such as the one shown in the document EP 1 011 295 , comprise an arc-shaped housing intended to be housed behind the ear, this housing generally containing one or more sensors such as microphones, a power source of the battery or battery type, and electronic circuits of amplification and analog and / or digital signal processing. The electronic circuits generate a sound signal that is sent into the ear canal of the patient via an acoustic tube held in the ear canal by an ear plug.
This in-ear plug also makes it possible to reduce acoustic feedback phenomena between the earpiece and the point of sound emission.

Outre le fait que les dispositifs à contour d'oreille sont standardisés, ces dispositifs présentent une grande facilité de mise en oeuvre, une bonne fiabilité et des performances suffisantes, dues en partie au volume disponible relativement important, permettant d'intégrer tous les circuits électroniques nécessaires. Toutefois, ces dispositifs présentent l'inconvénient d'être pénibles à porter, et de risquer de tomber à la suite de certains mouvements de la tête. En outre, ils sont relativement visibles et manquent d'esthétique. Ils ne permettent pas d'éliminer totalement les phénomènes de larsen du fait que le microphone est relativement proche de l'écouteur, ce qui les oblige à être réglés en mode de sous-amplification. Par ailleurs, le bouchon intra-auriculaire présente également des inconvénients, notamment de sensation désagréable d'oreille bouchée, de perception de sons parasites lors de la mastication, et des problèmes d'hygiène et potentiellement d'infections, dus au fait qu'il bouche le conduit auditif.
En ce qui concerne la seconde catégorie de dispositifs disponibles sur le marché, les dispositifs intra-auriculaires se présentent sous la forme de petits boîtiers destinés à être insérés directement dans le conduit auditif externe. Ce boîtier est constitué d'une coque en résine, dont la forme est adaptée par moulage à l'anatomie du conduit auditif externe de chaque patient. Ce boîtier rassemble dans un volume très réduit le capteur de son, les circuits électroniques d'amplification et de traitement du signal, l'écouteur, la source d'énergie (pile électrique). Par rapport aux dispositifs à contour d'oreille, ils présentent l'avantage d'être notablement moins visibles et peu encombrants. En contrepartie, ils génèrent des phénomènes de larsen importants, à la fois mécaniques et acoustiques, dus à la proximité du microphone et de l'écouteur, ce qui les obligent à être réglés en un mode de sous-amplification encore plus faible que les dispositifs à contour d'oreille. La miniaturisation du microphone et de l'écouteur ne permettent pas d'obtenir des qualités sonores de bonne qualité.
En outre, le faible volume disponible rend difficile, voire impossible l'ajout de microphones supplémentaires ou de fonctions de traitement de signal plus sophistiquées. Il présente une faible autonomie due à l'usage d'une pile nécessairement de petites dimensions. En raison de sa petite taille, sa manipulation, notamment lors de réglages et de changements de piles est délicate, ce qui entraîne des risques de chute lors de son retrait du conduit auditif. Comme pour les dispositifs à contour d'oreille, ils provoquent des sensations désagréables d'oreille bouchée, posent des problèmes d'hygiène, avec des risques d'infection et une usure prématurée du dispositif.In addition to the fact that devices with earloop are standardized, these devices have great ease of implementation, good reliability and sufficient performance, due in part to the relatively large volume available, to integrate all the electronic circuits required. However, these devices have the disadvantage of being painful to wear, and risk falling as a result of certain movements of the head. In addition, they are relatively visible and lack aesthetics. They do not completely eliminate the feedback phenomena because the microphone is relatively close to the earpiece, which forces them to be set to under-amplification mode. In addition, the intra-auricular plug also has drawbacks, including unpleasant feeling of clogged ear, perception of noise during mastication, and hygiene problems and potentially infections, due to the fact that mouth the auditory canal.
With regard to the second category of devices available on the market, in-ear devices are in the form of small housings intended to be inserted directly into the external auditory canal. This case consists of a resin shell, whose shape is adapted by molding to the anatomy of the external auditory canal of each patient. This box brings together in a very small volume the sound sensor, the electronic circuits for amplification and signal processing, the earpiece, the power source (electric battery). Compared to devices with earloop, they have the advantage of being significantly less visible and compact. In return, they generate significant feedback phenomena, both mechanical and acoustic, due to the proximity of the microphone and the earpiece, which forces them to be set in a mode of sub-amplification even lower than the devices. at the ear. The miniaturization of the microphone and the earphone do not make it possible to obtain sound qualities of good quality.
In addition, the low volume available makes it difficult or impossible to add additional microphones or more sophisticated signal processing functions. It has a low autonomy due to the use of a battery necessarily small. Because of its small size, handling, especially during settings and battery changes is difficult, which leads to the risk of falling when removed from the ear canal. As for devices with earloop, they cause unpleasant feelings of clogged ear, pose hygiene problems, with risks of infection and premature wear of the device.

La présente invention a pour but de supprimer ces inconvénients. Cet objectif est atteint par la prévision d'un dispositif d'aide auditive acoustique, générant au moins un signal sonore et destiné à être fixé sur le corps d'un patient, ce dispositif comprenant un boîtier externe renfermant un module électronique de traitement de signal relié en entrée à au moins un microphone et en sortie à un écouteur conçu pour émettre un signal sonore dans le conduit auditif externe 5 du patient, et une source d'énergie.
Selon l'invention, ce dispositif comprend en outre :

  • au moins une première pièce magnétique disposée dans le boîtier externe,
  • au moins une seconde pièce magnétique disposée dans un boîtier implantable destiné à être implanté sous la peau du patient, en un emplacement du corps où le boîtier externe doit être maintenu, la première pièce magnétique étant disposée dans le boîtier externe pour qu'une force magnétique d'attraction s'exerce avec la seconde pièce magnétique lorsque le boîtier externe est placé au dit emplacement, et
  • un dispositif de distribution de signaux sonores dans le conduit auditif du patient comportant l'écouteur, et une liaison entre le boîtier externe et le conduit auditif du patient, ayant une longueur telle que le microphone peut être maintenu suffisamment éloigné du conduit auditif pour éviter les phénomènes de larsen.
The present invention aims to eliminate these disadvantages. This objective is achieved by the provision of an acoustic hearing aid device, generating at least one audible signal and intended to be fixed on the body of a patient, this device comprising an external housing enclosing an electronic signal processing module connected at the input to at least one microphone and output to an earphone adapted to emit a sound signal in the external auditory canal 5 of the patient, and a source of energy.
According to the invention, this device further comprises:
  • at least a first magnetic part disposed in the outer casing,
  • at least a second magnetic piece disposed in an implantable housing to be implanted beneath the patient's skin, at a location in the body where the outer housing is to be held, the first magnetic member being disposed in the outer housing for magnetic force attraction is exercised with the second magnetic piece when the outer casing is placed at said location, and
  • a device for delivering sound signals into the auditory canal of the patient comprising the earpiece, and a link between the outer casing and the patient's ear canal, having a length such that the microphone can be kept sufficiently far away from the ear canal to avoid feedback phenomena.

Avantageusement, la première pièce magnétique est un aimant.Advantageously, the first magnetic piece is a magnet.

Avantageusement la seconde pièce magnétique est un aimant.Advantageously, the second magnetic part is a magnet.

Selon une particularité de l'invention, les première et seconde pièces magnétiques sont des aimants permanents, et la seconde pièce magnétique est disposée dans le boîtier implanté de manière à présenter un axe magnétique nord-sud sensiblement parallèle à la surface de la peau du patient au dit emplacement, et la première pièce magnétique est disposée dans le boîtier externe de manière à présenter un axe magnétique nord-sud sensiblement parallèle à la paroi du boîtier destinée à venir en contact avec la peau du patient.According to a feature of the invention, the first and second magnetic parts are permanent magnets, and the second magnetic part is disposed in the implanted housing so as to have a north-south magnetic axis substantially parallel to the surface of the patient's skin. at said location, and the first magnetic part is disposed in the outer casing so as to have a north-south magnetic axis substantially parallel to the wall of the housing intended to come into contact with the skin of the patient.

Selon une première variante préférée de l'invention, la seconde pièce magnétique est un aimant et la première pièce magnétique comprend deux aimants permanents disposés dans le boîtier externe de manière à présenter des axes magnétiques nord-sud sensiblement perpendiculaires à la paroi du boîtier destinée à venir en contact avec la peau du patient, et en sens inverses, ces axes magnétiques étant espacés l'un de l'autre d'une distance correspondant sensiblement à la distance entre les pôles de la seconde pièce magnétique.According to a first preferred variant of the invention, the second magnetic piece is a magnet and the first magnetic piece comprises two permanent magnets arranged in the outer casing so as to have north-south magnetic axes substantially perpendicular to the wall of the casing intended to contacting the skin of the patient, and in opposite directions, these magnetic axes being spaced from each other by a distance substantially corresponding to the distance between the poles of the second magnetic part.

Selon une seconde variante préférée de l'invention, la première pièce magnétique est un aimant et la seconde pièce magnétique comprend deux aimants permanents disposés dans le boîtier implanté de manière à présenter des axes magnétiques nord-sud sensiblement perpendiculaires à surface de la peau du patient au dit emplacement, et en sens inverses, ces axes magnétiques étant espacés l'un de l'autre d'une distance correspondant sensiblement à la distance entre les pôles de la première pièce magnétique.According to a second preferred variant of the invention, the first magnetic part is a magnet and the second magnetic part comprises two permanent magnets arranged in the implanted housing so as to have north-south magnetic axes substantially perpendicular to the surface of the patient's skin. at said location, and in opposite directions, these magnetic axes being spaced from each other by a distance substantially corresponding to the distance between the poles of the first magnetic part.

Selon une troisième variante préférée de l'invention, la seconde pièce magnétique comprend au moins deux aimants permanents disposés dans le boîtier implanté de manière à présenter des axes magnétiques nord-sud sensiblement perpendiculaires à surface de la peau du patient au dit emplacement, et alternativement en sens inverses, et la première pièce magnétique comprend autant d'aimants permanents que la première pièce, les aimants de la première pièce magnétique étant disposés dans le boîtier de manière à présenter des axes magnétiques nord-sud sensiblement perpendiculaires à la paroi du boîtier externe destinée à venir en contact avec la peau du patient, et alternativement en sens inverses, les axes magnétiques des aimants disposés dans le boîtier externe étant répartis dans un plan sensiblement parallèle à la dite paroi dans une configuration correspondant sensiblement à la configuration de répartition des axes magnétiques des aimants dans le boîtier implanté.According to a third preferred variant of the invention, the second magnetic part comprises at least two permanent magnets arranged in the implanted housing so as to present north-south magnetic axes. substantially perpendicular to the patient's skin surface at said location, and alternately in opposite directions, and the first magnetic piece comprises as many permanent magnets as the first piece, the magnets of the first magnetic piece being disposed in the housing so as to have north-south magnetic axes substantially perpendicular to the wall of the outer casing intended to come into contact with the skin of the patient, and alternately in opposite directions, the magnetic axes of the magnets disposed in the outer casing being distributed in a plane substantially parallel to said wall in a configuration substantially corresponding to the configuration of distribution of the magnetic axes of the magnets in the implanted housing.

Selon une particularité de l'invention, le second boîtier est conçu pour être implanté dans la zone temporo-occipitale du crane du patient.According to a feature of the invention, the second housing is designed to be implanted in the temporo-occipital zone of the patient's skull.

Selon une autre particularisé de l'invention, l'écouteur est disposé dans le boîtier externe et relié au conduit auditif externe du patient par un tube acoustique comportant une extrémité intra-auriculaire, le dispositif d'aide auditive comportant en outre un système d'amortissement anti-larsen mécanique.According to another particular embodiment of the invention, the earpiece is disposed in the outer casing and connected to the patient's external auditory canal by an acoustic tube having an intra-auricular end, the hearing aid device further comprising a system for mechanical anti-feedback damping.

Alternativement, l'écouteur est placé dans le conduit auditif externe du patient et forme une extrémité intra-auriculaire de la liaison, la liaison étant constituée par un câble électrique.Alternatively, the earpiece is placed in the patient's external auditory canal and forms an in-ear end of the link, the link being constituted by an electric cable.

Avantageusement, l'extrémité intra-auriculaire de la liaison est maintenue dans le conduit auditif externe du patient au moyen d'un support intra-auriculaire comportant des moyens de centrage et de maintien de la dite extrémité dans le conduit auditif.Advantageously, the intra-auricular end of the link is maintained in the patient's external auditory canal by means of an intra-auricular support comprising means for centering and maintaining said end in the auditory canal.

Selon une autre particularité de l'invention, le boîtier externe comprend un socle et un couvercle monté rotatif sur le socle, et des moyens de blocage de la position angulaire du couvercle par rapport au socle, la seconde pièce magnétique étant fixée au socle, tandis que le ou les microphones sont fixés au couvercle.According to another feature of the invention, the outer casing comprises a base and a cover rotatably mounted on the base, and means for locking the angular position of the cover relative to the base, the second magnetic part being fixed to the base, while that the microphone or microphones are attached to the cover.

Selon encore une autre particularité de l'invention, le boîtier implanté est relié à au moins deux électrodes de recueil de potentiels auditifs évoqués ou spontanés, le boîtier implanté renfermant au moins un module électronique de recueil et de traitement de signal relié aux électrodes de recueil, un module de transmission relié à une antenne et au module de recueil et de traitement, pour transmettre vers le boîtier externe les signaux produits par le module de recueil en fonction des signaux recueillis par les électrodes, et une alimentation électrique.According to yet another particularity of the invention, the implanted housing is connected to at least two electrodes for collecting evoked or spontaneous auditory potentials, the implanted housing containing at least one electronic module for collecting and processing a signal connected to the collection electrodes, a transmission module connected to an antenna and to the collection and processing module, for transmitting to the external box the signals produced by the collection module according to the signals collected by the electrodes, and a power supply.

De préférence, l'une des électrodes de recueil est conçue pour être disposée sur la fenêtre ronde.Preferably, one of the collection electrodes is adapted to be disposed on the round window.

Selon une autre particularité de l'invention, le boîtier implanté est en outre relié à au moins une électrode active de stimulation destinée à être positionnée à proximité de l'oreille interne du patient ou dans la cochlée, le boîtier implanté renfermant au moins un module électronique de stimulation relié aux électrodes de stimulation, un module de transmission relié à une antenne et au module de stimulation, le module de stimulation étant conçu pour générer des signaux électriques de stimulation qui sont appliqués aux électrodes de stimulation à partir de signaux reçus du boîtier externe 1 par l'intermédiaire du module de transmission, via l'antenne située dans le boîtier implanté.According to another feature of the invention, the implanted housing is further connected to at least one active stimulation electrode intended to be positioned near the patient's inner ear or in the cochlea, the implanted housing containing at least one module stimulation electronics connected to the stimulation electrodes, a transmission module connected to an antenna and the stimulation module, the stimulation module being adapted to generate electrical stimulation signals which are applied to the stimulation electrodes from signals received from the housing external 1 via the transmission module, via the antenna located in the implanted housing.

De préférence, une des électrodes actives de stimulation est conçue pour être disposée sur la fenêtre ronde de l'oreille moyenne du patient.Preferably, one of the active stimulation electrodes is adapted to be disposed on the round window of the patient's middle ear.

Avantageusement, les électrodes de recueil et les électrodes de stimulation sont au moins partiellement communes.Advantageously, the collection electrodes and the stimulation electrodes are at least partially common.

Selon encore une autre particularité de l'invention, le boîtier externe comprend en outre un module de transmission de signaux relié à au moins une antenne et au module électronique.According to yet another particularity of the invention, the external box further comprises a signal transmission module connected to at least one antenna and to the electronic module.

Avantageusement, le boîtier implanté est en outre relié à au moins un vibrateur transducteur électromécanique destiné à être positionné dans une zone osseuse ou cartilagineuse à proximité de l'oreille interne du patient, le boîtier implanté renfermant au moins un module électronique de stimulation relié au vibrateur, un module de transmission relié à une antenne et au module de stimulation, le module de stimulation étant conçu pour générer des signaux électriques de stimulation qui sont appliqués au vibrateur à partir de signaux reçus du boîtier externe 1 par l'intermédiaire du module de transmission, via l'antenne située dans le boîtier implanté.Advantageously, the implanted housing is further connected to at least one electromechanical transducer vibrator intended to be positioned in a bone or cartilaginous zone near the patient's inner ear, the implanted housing enclosing at least one electronic stimulation module connected to the vibrator , a transmission module connected to an antenna and to the stimulation module, the stimulation module being designed to generate electrical stimulation signals which are applied to the vibrator from signals received from the outer casing 1 via the transmission module , via the antenna located in the implanted housing.

Un mode de réalisation préféré de l'invention sera décrit ci-après, à titre d'exemple non limitatif, avec référence aux dessins annexés dans lesquels :

  • La figure 1 représente schématiquement en vue partielle de profil, la tête d'un patient équipée d'une aide auditive selon l'invention ;
  • La figure 2 représente une vue en coupe d'une partie de la tête du patient montrée sur la figure 1, équipée de l'aide auditive selon l'invention ;
  • La figure 2a représente en vue axiale un support d'écouteur intra-auriculaire, selon l'invention ;
  • La figure 3 montre plus en détail la prothèse représentée sur la figure 1 et le dispositif de fixation de la prothèse selon l'invention ;
  • Les figures 4 à 6 montrent trois variantes selon l'invention du dispositif représenté en détail sur la figure 3 ;
  • La figure 7 montre en coupe une autre variante avantageuse du dispositif selon l'invention ;
  • La figure 8 montre en vue de dessus le dispositif représenté sur la figure 7 ;
  • Les figures 9 et 10 représentent deux autres variantes du boîtier implanté du dispositif selon l'invention.
A preferred embodiment of the invention will be described hereinafter, by way of non-limiting example, with reference to the appended drawings in which:
  • The figure 1 shows schematically in partial profile view, the head of a patient equipped with a hearing aid according to the invention;
  • The figure 2 represents a sectional view of a portion of the patient's head shown on the figure 1 equipped with the hearing aid according to the invention;
  • The figure 2a is an axial view of an in-ear earphone holder, according to the invention;
  • The figure 3 shows in more detail the prosthesis shown on the figure 1 and the device for fixing the prosthesis according to the invention;
  • The Figures 4 to 6 show three variants according to the invention of the device shown in detail on the figure 3 ;
  • The figure 7 shows in section another advantageous variant of the device according to the invention;
  • The figure 8 shows in plan view the device shown on the figure 7 ;
  • The Figures 9 and 10 represent two other variants of the implanted case of the device according to the invention.

Les figures 1 et 2 représentent respectivement en vue de profil et en coupe, la tête d'un patient équipé d'un dispositif d'aide auditive selon l'invention, maintenu sur le crane. Ce dispositif comporte un boîtier externe 1 équipé d'au moins un microphone 13a, 13b et renfermant une source d'énergie, (par exemple une pile ou une batterie), et des circuits électroniques d'amplification et de traitement de signal, ce boîtier étant relié à un dispositif de distribution de signaux sonores dans le conduit auditif 5 du patient, ce dispositif comportant un écouteur 3 et une liaison 4 entre boîtier et l'intérieur du conduit auditif. Comme cela est montré sur la figure 2 qui représente en coupe l'oreille 6 et le conduit auditif 5 du patient, ainsi qu'une partie du crâne 7, le boîtier 1 est maintenu selon l'invention sur la tête du patient au moyen d'un aimant logé dans un boîtier 2 implanté sous la peau et éventuellement fixé à l'os du crâne 7, cet aimant étant destiné à exercer une force magnétique d'attraction sur une pièce magnétique disposée dans le boîtier externe, lorsque ce dernier est disposé à proximité du boîtier implanté 2.The Figures 1 and 2 represent respectively in profile view and in section, the head of a patient equipped with a hearing aid device according to the invention, maintained on the skull. This device comprises an external casing 1 equipped with at least one microphone 13a, 13b and enclosing a source of energy, (for example a battery or a battery), and electronic amplification and signal processing circuits, this casing being connected to a device for distributing sound signals in the auditory canal 5 of the patient, this device comprising a earphone 3 and a link 4 between the housing and the inside of the ear canal. As shown on the figure 2 which represents in section the ear 6 and the auditory canal 5 of the patient, as well as part of the skull 7, the case 1 is held according to the invention on the patient's head by means of a magnet housed in a case 2 implanted under the skin and possibly attached to the bone of the skull 7, this magnet being intended to exert a magnetic attraction force on a magnetic part disposed in the outer casing, when the latter is disposed near the implanted casing 2.

Le boîtier 2 présente une forme sensiblement plane de faible épaisseur, de manière à pouvoir être inséré sous la peau, de préférence sous le cuir chevelu, afin d'être masqué par les cheveux du patient, même à un stade avancé de calvitie. A cet effet, il est implanté par exemple sur la mastoïde ou sur l'os temporo-occipital comme représenté sur la figure 1.The housing 2 has a substantially planar shape of small thickness, so as to be inserted under the skin, preferably under the scalp, to be masked by the hair of the patient, even at an advanced stage of baldness. For this purpose, it is implanted for example on the mastoid or on the temporo-occipital bone as represented on the figure 1 .

En choisissant un aimant dont la force est adaptée, le boîtier peut être fixé aisément sur la tête du patient et maintenu dans toutes les positions et durant des mouvements normaux de celle-ci. Sur le plan fonctionnel, le ou les microphones sur le boîtier 1 se trouvent suffisamment éloignés de l'écouteur, et séparés par le pavillon de l'oreille qui sert d'écran entre le son réverbéré provenant du conduit auditif externe et le microphone. Il en résulte que l'effet larsen acoustique entre le son réverbéré provenant du conduit auditif externe arrivant sur le ou les microphones est très atténué, voire supprimé (selon l'amplification et l'ouverture de l'embout, recherchées) du fait de la combinaison des deux moyens constitués d'une part de l'éloignement suffisant entre le conduit auditif et le ou les microphones situés proche de la zone temporo-occipitale, et d'autre part de l'existence d'une barrière acoustique naturelle formée par le pavillon de l'oreille.By choosing a magnet whose force is adapted, the housing can be easily attached to the patient's head and maintained in all positions and during normal movements thereof. Functionally, the microphone or microphones on the housing 1 are far enough away from the earpiece, and separated by the horn of the ear that serves as a screen between the reverberated sound from the external ear canal and the microphone. As a result, the acoustic feedback effect between the reverberated sound coming from the external auditory canal arriving on the microphone (s) is very attenuated or even suppressed (depending on the amplification and the opening of the mouthpiece, sought) because of the combination of the two means consisting on the one hand of the sufficient distance between the ear canal and the microphones or microphones located near the temporo-occipital zone, and on the other hand the existence of a natural acoustic barrier formed by the ear pavilion.

Grâce aux progrès d'intégration des circuits électroniques, le boîtier 1 peut présenter une faible épaisseur pour ne pas faire apparaître de surépaisseur lorsqu'il est masqué par les cheveux.Thanks to advances in integration of the electronic circuits, the housing 1 may have a small thickness so as not to show an excess thickness when it is masked by the hair.

La liaison 4 entre le boîtier 1 et l'écouteur 3 est constituée par un câble électrique. Dans ce cas, l'écouteur comprend un transducteur électroacoustique destiné à être inséré dans le conduit auditif externe du patient. Alternativement, cette liaison 4 est un tube acoustique. Dans ce cas, l'écouteur est intégré dans le boîtier externe 1 et prolongé par le tube acoustique 4 qui est étanche et qui présente une longueur adaptée pour atteindre le fond du conduit auditif externe du patient. Dans ce cas, l'écouteur contenu dans le boîtier est équipé d'un dispositif d'amortissement anti-larsen mécanique (amortissement des vibrations générées par l'écouteur). Il est à noter qu'il n'apparaît pas de phénomène de larsen acoustique du fait que les ondes sonores générées par l'écouteur sont canalisées par le tube acoustique.The link 4 between the housing 1 and the earphone 3 is constituted by an electric cable. In this case, the earpiece includes an electroacoustic transducer for insertion into the patient's external auditory canal. Alternatively, this connection 4 is an acoustic tube. In this case, the earphone is integrated in the outer casing 1 and extended by the acoustic tube 4 which is waterproof and has a length adapted to reach the bottom of the external auditory canal of the patient. In this case, the earpiece contained in the housing is equipped with a mechanical anti-feedback damping device (damping vibrations generated by the earphone). It should be noted that there is no phenomenon of acoustic feedback because the sound waves generated by the earphone are channeled through the acoustic tube.

De préférence le câble 4 est semi-rigide de manière à suivre précisément un chemin prédéfini entre le boîtier 1 et le fond du conduit auditif externe, par exemple en contournant l'oreille par le dessus, et à maintenir l'écouteur 3 dans une certaine position dans le conduit auditif externe. Ainsi, il n'est pas nécessaire d'obturer le conduit auriculaire par un bouchon pour maintenir l'écouteur en place.Preferably, the cable 4 is semi-rigid so as to accurately follow a predefined path between the housing 1 and the bottom of the external auditory canal, for example by bypassing the ear from above, and keeping the earphone 3 in a certain position. position in the external auditory canal. Thus, it is not necessary to close the ear canal with a plug to hold the earpiece in place.

Alternativement, la liaison 4 peut être souple et l'écouteur 3 ou l'extrémité du tube acoustique est maintenu et centré dans le conduit auditif externe par un support intra-auriculaire 9. Tel que représenté plus en détail sur la figure 2a, le support intra-auriculaire 9 comprend un logement central destiné à recevoir l'écouteur 3 ou l'extrémité du tube acoustique, ce logement central étant relié à un élément tubulaire externe 8c par des entretoises 8a, 8b délimitant avec l'élément tubulaire externe des évents permettant une bonne ventilation du conduit auditif. _Alternatively, the link 4 may be flexible and the earpiece 3 or the end of the acoustic tube is maintained and centered in the external auditory canal by an in-ear support 9. As shown in more detail on the figure 2a , the in-ear support 9 comprises a central housing intended to receive the earphone 3 or the end of the acoustic tube, this central housing being connected to an outer tubular element 8c by spacers 8a, 8b delimiting with the outer tubular element vents allowing good ventilation of the ear canal. _

L'élément tubulaire 8c est de préférence réalisé en un matériau compressible et/ou élastique, ou bien est moulé en fonction de l'anatomie du conduit auditif du patient.The tubular element 8c is preferably made of a compressible and / or elastic material, or is molded according to the anatomy of the auditory canal of the patient.

Par rapport aux boîtiers de l'art antérieur, l'invention permet de maintenir sur la tête du patient un dispositif d'aide auditive d'une manière quasiment invisible, seul la liaison 4 restant visible, tout en étant très discrète. En outre, la quasi-absence de larsen permet d'une part d'augmenter les performances auditives du patient grâce à une meilleure amplification, et d'autre part, de réduire les problèmes d'hygiène et de phénomène d'occlusion (sensation d'oreille bouchée) résultant du bouchon auriculaire quasi-obturant, lequel peut avantageusement être remplacé par le support auriculaire 9 ouvert.Compared to the housings of the prior art, the invention makes it possible to maintain on the patient's head a hearing aid device in an almost invisible manner, only the link 4 remaining visible, while being very discreet. In addition, the virtual absence of feedback makes it possible, on the one hand, to increase the patient's hearing performance thanks to better amplification and, on the other hand, to reduce the problems of hygiene and occlusion phenomenon (sensation of plugged ear) resulting from the quasi-closing ear plug, which can advantageously be replaced by the open ear support 9.

Tel que représenté plus en détail sur la figure 3, le boîtier 1 renferme une pièce magnétique 12, par exemple en une matière ferromagnétique, qui est disposée contre une face du boîtier de manière à pouvoir être placée en regard et à proximité du boîtier 2 implanté, lors de la mise en place de la prothèse sur la tête du patient. Le boîtier 1 renferme également des circuits électroniques 11 alimentés par une pile de faible épaisseur (non représentée), ainsi qu'un capteur 13 relié aux circuits électroniques.As shown in more detail on the figure 3 , the housing 1 encloses a magnetic part 12, for example a ferromagnetic material, which is arranged against a face of the housing so as to be placed opposite and close to the implanted housing 2, when placing the prosthesis on the patient's head. The housing 1 also contains electronic circuits 11 fed by a thin battery (not shown), and a sensor 13 connected to the electronic circuits.

Bien entendu, la pièce en matière ferromagnétique peut être logée dans le boîtier implanté 2, et l'aimant disposé dans le boîtier 1.Of course, the piece of ferromagnetic material may be housed in the implanted housing 2, and the magnet disposed in the housing 1.

Dans certains cas, le capteur 13 doit être positionné selon une orientation précise par rapport à la tête du patient. En effet, certains dispositifs d'aide auditive comportent un microphone directionnel ou plusieurs microphones omnidirectionnels qui doivent être orientés de manière à restituer une information sur la direction de provenance des sons, ces microphones devant être positionnés de manière précise pour que la prothèse puisse restituer des informations exactes de direction de provenance des sons perçus.In some cases, the sensor 13 must be positioned in a precise orientation relative to the patient's head. In fact, certain hearing aid devices comprise a directional microphone or several omnidirectional microphones which must be oriented so as to restore information on the direction of origin of the sounds, these microphones must be positioned precisely so that the prosthesis can restore sound. exact direction of provenance from perceived sounds.

La figure 4 représente un boîtier de prothèse auditive renfermant deux microphones 13a, 13b. Pour que le boîtier et donc les microphones soient disposés selon une orientation précise par rapport à la tête du patient, l'aimant permanent 21 est implanté sous la peau de manière présenter un axe nord-sud (représenté sur la figure par la flèche 24) orienté dans une certaine direction parallèlement à la surface du crâne. Par ailleurs, la pièce 12 logée dans le boîtier 1 est remplacée par un aimant 12', par exemple un aimant permanent dont l'axe nord-sud 22 est orienté dans une direction prédéfinie, parallèlement à la face du boîtier destinée à venir s'appliquer contre la peau du patient. De cette manière, le boîtier 1 ne peut être maintenu sur la tête du patient que dans une certaine orientation.The figure 4 represents a hearing aid housing enclosing two microphones 13a, 13b. So that the housing and therefore the microphones are arranged in a precise orientation relative to the patient's head, the permanent magnet 21 is implanted under the skin so as to have a north-south axis (shown in the figure by the arrow 24) oriented in a certain direction parallel to the surface of the skull. Furthermore, the part 12 housed in the housing 1 is replaced by a magnet 12 ', for example a permanent magnet whose north-south axis 22 is oriented in a predefined direction, parallel to the face of the housing intended to come s' apply against the patient's skin. In this way, the casing 1 can only be held on the patient's head in a certain orientation.

Ce résultat peut également être obtenu grâce au mode de réalisation représenté sur la figure 5. Sur cette figure, l'aimant permanent 12', montré sur la figure 4, est remplacé par deux aimants 12a, 12b dont les axes nord-sud 22a, 22b sont orientés perpendiculairement à la face du boîtier destinée à venir s'appliquer contre la peau du patient, et en sens inverses. En outre, les axes nord-sud 22a, 22b sont espacées d'une distance correspondant à la distance séparant les pôles nord et sud de l'aimant 2 implanté.This result can also be obtained thanks to the embodiment represented on the figure 5 . In this figure, the permanent magnet 12 ', shown on the figure 4 is replaced by two magnets 12a, 12b whose north-south axes 22a, 22b are oriented perpendicularly to the face of the housing intended to be applied against the skin of the patient, and in opposite directions. In addition, the north-south axes 22a, 22b are spaced apart by a distance corresponding to the distance separating the north and south poles of the implanted magnet 2.

Le boîtier 1 peut être également maintenu sur la tête du patient dans une certaine orientation prédéfinie grâce au mode de réalisation représenté sur la figure 6. Dans ce mode de réalisation, le boîtier implanté 2 comprend deux aimants 21a, 21b dont les axes nord-sud 24a, 24b sont orientés perpendiculairement à la surface du crâne, et en sens inverses. Le boîtier 1 renferme alors un seul aimant 12' comme représenté sur la figure 4, ou bien deux aimants 12a, 12b comme représentés sur la figure 5 ou 6, ces aimants étant disposés dans le boîtier de manière à venir en regard d'un aimant implanté 21a, 21b respectif, de même orientation, lorsque le boîtier 1 est placé selon l'orientation souhaitée sur la tête du patient.The casing 1 can also be held on the patient's head in a certain predefined orientation thanks to the embodiment shown on the figure 6 . In this embodiment, the implanted housing 2 comprises two magnets 21a, 21b whose north-south axes 24a, 24b are oriented perpendicularly to the surface of the skull, and in opposite directions. The housing 1 then encloses a single magnet 12 'as shown in FIG. figure 4 or two magnets 12a, 12b as shown in the figure 5 or 6 these magnets being arranged in the housing so as to face an implanted magnet 21a, 21b respectively, of the same orientation, when the housing 1 is placed in the desired orientation on the patient's head.

On peut également prévoir plus de deux aimants implantés et dans le boîtier. Ces aimants sont disposés de manière à ce que leurs axes nord-sud respectifs soient perpendiculaires à la surface de la peau du patient à l'emplacement où le boîtier doit être maintenu. En outre, les différents aimants doivent être répartis dans le boîtier ou fixés à celui-ci selon une configuration correspondant à celle des aimants implantés, en respectant la polarité de ces derniers.It can also provide more than two magnets implanted and in the housing. These magnets are arranged so that their respective north-south axes are perpendicular to the patient's skin surface at the location where the housing is to be maintained. In addition, the different magnets must be distributed in the housing or fixed thereto in a configuration corresponding to that of the implanted magnets, respecting the polarity of the latter.

Selon une variante préférée de l'invention représentée sur les figures 7 et 8, le boîtier externe 1, comprend un socle la de forme circulaire dans lequel sont logés un ou deux aimants 12a et 12b, et un couvercle 1b également de forme circulaire, dans lequel sont fixés les microphones 13a, 13b, et éventuellement les circuits électroniques, et la source d'énergie. Le socle la est maintenu sur le crane du patient toujours dans la même orientation conformément à l'un des modes de réalisation représentés sur les figures 4 à 6, en fonction des polarités respectives des pièces magnétiques 21, 21a, 21b, tandis que le couvercle 1b est monté pivotant sur le socle 1a, et bloqué dans une position angulaire par rapport à ce dernier par un moyen de fixation, par exemple constitué d'une vis centrale 25 traversant le couvercle et vissée dans un pivot central prévu dans le socle 1a. Sur la figure 7, on peut remarquer que les aimants sont totalement isolés électriquement dans le socle, de manière à éviter tout contact électrique avec les circuits électroniques logés dans le couvercle.According to a preferred variant of the invention shown in Figures 7 and 8 the outer casing 1 comprises a circular base 1a in which are housed one or two magnets 12a and 12b, and a lid 1b also of circular shape, in which are fixed the microphones 13a, 13b, and possibly the electronic circuits, and the source of energy. The base is held on the skull of the patient always in the same orientation according to one of the embodiments shown on the Figures 4 to 6 , depending on the respective polarities of the magnetic parts 21, 21a, 21b, while the lid 1b is pivotally mounted on the base 1a, and locked in an angular position relative to the latter by a fixing means, for example consisting of a central screw 25 passing through the lid and screwed into a central pivot provided in the base 1a. On the figure 7 it can be noted that the magnets are totally electrically isolated in the base, so as to avoid any electrical contact with the electronic circuits housed in the cover.

La figure 8 montre en traits interrompus trois positions différentes du couvercle par rapport au socle (le câble 4 tourne tandis que les aimants 12a, 12b restent fixes).
Le ou les microphones 13, 13a, 13b peuvent ainsi être orientés d'une manière optimale et avec une grande précision par le praticien responsable du réglage du dispositif ou par le patient, à la suite de l'implantation du boîtier 2. De cette manière, on s'affranchit d'éventuelles imprécisions d'implantation du boîtier implanté 2, résultant notamment de différences de morphologie d'un patient à l'autre.
Le patient peut ainsi disposer et retirer le boîtier 1 avec une grande facilité, en ayant toujours l'assurance que les microphones seront orientés correctement.The figure 8 shows in broken lines three different positions of the cover relative to the base (the cable 4 rotates while the magnets 12a, 12b remain fixed).
The microphone or microphones 13, 13a, 13b can thus be oriented in an optimal manner and with great precision by the practitioner responsible for setting the device or by the patient, following the implantation of the housing 2. Of this In this way, any implantation inaccuracies of the implanted housing 2 are dispensed with, resulting notably from differences in morphology from one patient to another.
The patient can thus dispose and remove the housing 1 with great ease, always having the assurance that the microphones will be oriented correctly.

Bien entendu, on peut prévoir d'autres modes de fixation du couvercle sur le boîtier (rainures, crantage, plots, etc.), sans pour autant sortir du cadre de l'invention.Of course, one can provide other ways of fixing the cover on the housing (grooves, notching, pads, etc.), without departing from the scope of the invention.

Alternativement ou en combinaison, le ou les microphones 13, 13a, 13b peuvent également être disposés à l'extrémité d'un câble rigide respectif, relié au boîtier externe 1. Si le câble est conformable par le praticien à la suite de la pose du boîtier implanté 2, pour disposer et orienter correctement le ou les microphones par rapport à la tête du patient, il n'est pas nécessaire que le boîtier externe 1 présente une partie 1 a orientable.Alternatively or in combination, the microphone or microphones 13, 13a, 13b can also be arranged at the end of a respective rigid cable, connected to the outer casing 1. If the cable is conformable by the practitioner following the installation of the implanted housing 2, to arrange and correctly orient the microphones or microphones relative to the patient's head, it is not necessary that the outer casing 1 has a portion 1 has steerable.

Tel que représenté sur la figure 9, le boîtier implanté 2 comprend avantageusement, en plus de la ou des pièces magnétiques 21a, 21b, un système de recueil de potentiels auditifs évoqués ou spontanés. Ce système comprend au moins deux électrodes extra-cochléaires de recueil 35, 36 reliées au boîtier. Ce système comprend également un module électronique de recueil 32 permettant d'amplifier, et éventuellement de traiter les signaux provenant des électrodes, 35,36, un module de transfert 33 comprenant notamment une antenne émettrice pour transmettre vers l'extérieur par exemple par ondes électromagnétiques, via une modulation d'amplitude ou de fréquence, les signaux produits par le module de recueil 32, une alimentation électrique 31 comportant une batterie et/ou des bobines captant l'énergie électromagnétique provenant d'une bobine extérieure par exemple prévue dans le boîtier externe 1. Le boîtier 1 peut également comprendre un module de réception connecté à une bobine/antenne pour recevoir les signaux émis par le module de transfert 33. Dans ce cas, la bobine extérieure et l'antenne du module de réception peuvent être fixés au socle 1a ou au couvercle 1b du boîtier externe.As shown on the figure 9 , the implanted housing 2 advantageously comprises, in addition to the magnetic parts 21a, 21b, a system for collecting evoked or spontaneous auditory potentials. This system comprises at least two extra-cochlear collection electrodes 35, 36 connected to the housing. This system also comprises an electronic collection module 32 for amplifying and possibly processing the signals from the electrodes, 35, 36, a transfer module 33 including a transmitting antenna for transmitting to the outside for example by electromagnetic waves , via an amplitude or frequency modulation, the signals produced by the collection module 32, a power supply 31 comprising a battery and / or coils capturing the electromagnetic energy coming from an external coil, for example provided in the housing external 1. The housing 1 may also comprise a receiving module connected to a coil / antenna for receiving the signals emitted by the transfer module 33. In this case, the outer coil and the antenna of the receiving module can be fixed to the base 1a or cover 1b of the outer casing.

Au moins une des électrodes de recueil 35, 36 est destinée à être implantée à proximité de l'oreille interne du patient, de préférence sur la fenêtre ronde. Dans ce cas, le module de recueil est conçu pour amplifier et traiter des potentiels acoustiques évoqués ou spontanés.At least one of the collection electrodes 35, 36 is intended to be implanted near the inner ear of the patient, preferably on the round window. In this case, the collection module is designed to amplify and treat evoked or spontaneous acoustic potentials.

Alternativement, les électrodes de recueil 35, 36 sont implantées sous la peau du patient, également dans la région temporo-occipitale du crane, pour mesurer des potentiels évoqués et le module de recueil 32 est conçu pour amplifier et éventuellement traiter de tels potentiels. A cet effet, les électrodes sont par exemple disposées à l'extrémité de languettes souples 34a, 34b rattachées au boîtier 2. Dans ce cas, on prévoit également une électrode de référence R disposée sur le boîtier 2 et reliée au module de recueil 32.Alternatively, the collection electrodes 35, 36 are implanted under the skin of the patient, also in the temporo-occipital region of the skull, to measure evoked potentials and the collection module 32 is designed to amplify and possibly treat such potentials. For this purpose, the electrodes are for example arranged at the end of flexible tabs 34a, 34b attached to the housing 2. In this case, there is also provided a reference electrode R disposed on the housing 2 and connected to the collection module 32.

Tel que représenté sur la figure 10, le boîtier 2 renferme, alternativement ou en combinaison avec le module de recueil 32, un module de stimulation 37 relié à au moins une électrode active de stimulation 38, 39, implantée à proximité de l'oreille interne du patient, par exemple sur la fenêtre ovale ou la fenêtre ronde de l'oreille moyenne, ou encore dans la cochlée. Dans le cas d'une stimulation monopolaire, le module de stimulation 37 est relié à au moins une électrode de stimulation neutre éloignée de l'oreille interne. Le module de stimulation est conçu pour générer des signaux de stimulation à partir de signaux reçus du boîtier externe 1 par l'intermédiaire du module de transfert 33.As shown on the figure 10 , the housing 2 encloses, alternately or in combination with the collection module 32, a stimulation module 37 connected to at least one active stimulation electrode 38, 39, implanted near the patient's inner ear, for example on the oval window or the round window of the middle ear, or in the cochlea. In the case of monopolar stimulation, the stimulation module 37 is connected to at least one neutral stimulation electrode remote from the inner ear. The pacing module is adapted to generate pacing signals from signals received from the outer casing 1 via the transfer module 33.

Les électrodes 38, 39 peuvent être remplacées ou combinées avec un vibrateur transducteur électromécanique, par exemple de type piézoélectrique, implanté dans une zone osseuse ou cartilagineuse, de préférence proche de l'oreille interne du patient, pour effectuer une stimulation électromécanique.The electrodes 38, 39 may be replaced or combined with an electromechanical transducer vibrator, for example of the piezoelectric type, implanted in a bone or cartilaginous zone, preferably close to the patient's inner ear, to effect electromechanical stimulation.

Dans la réalisation où le boîtier implanté 2 comporte, en combinaison les dispositifs de recueil et de stimulation, tels que décrits en référence aux figures 9 et 10, les électrodes de recueil et de stimulation sont, selon une variante avantageuse, communes et peuvent fonctionner alternativement en mode de recueil et en mode de stimulation. Dans ce cas, selon un mode de réalisation préféré de l'invention, l'une des électrodes 38, 39 est positionnée sur la fenêtre ronde et est à la fois une électrode active de stimulation, et alternativement, une des électrodes de recueil de potentiels auditifs.In the embodiment where the implanted housing 2 comprises, in combination, the collection and stimulation devices, as described with reference to the Figures 9 and 10 , the collection and stimulation electrodes are, according to an advantageous variant, common and can operate alternately in collection mode and stimulation mode. In this case, according to a preferred embodiment of the invention, one of the electrodes 38, 39 is positioned on the round window and is both an active stimulation electrode, and alternatively, one of the potential acquisition electrodes. hearing.

Claims (15)

  1. Acoustic hearing aid generating at least one audible signal and intended to be fitted onto a patient's body, comprising an external casing (1) containing an electronic signal processing module (11) connected as input to at least one microphone (13, 13a, 13b) and as output to an earpiece (3) designed to emit an audible signal in the external auditory canal (5) of the patient, an energy source and a device for distributing audible signals in the patient's auditory canal including the earpiece (3), and a link (4) between the external casing (1) and the patient's auditory canal, having a length such that the microphone can be kept sufficiently far away from the auditory canal to avoid Larsen phenomena, in which the earpiece (3) is placed in the external auditory canal (5) of the patient and forms an intra-auricular end of the link (4), the link (4) being formed by an electrical cable,
    characterized in that it furthermore comprises:
    - at least one first magnetic piece (12, 12', 12a, 12b) placed in the external casing (1); and
    - at least one second magnetic piece (21, 21a, 21b) placed in an implantable casing (2) designed to be implanted under the patient's skin, at a location on the body where the external casing (1) has to be supported, the first magnetic piece being placed in the casing so that an attractive magnetic force is exerted with the second magnetic piece when the external casing (1) is placed at said location,
    in which the first and second magnetic pieces (12', 21) are permanent magnets and the second magnetic piece is placed in the implanted casing (2) so as to have a north-south magnetic axis approximately parallel to the surface of the patient's skin at said location, and the first magnetic piece is placed in the external casing (1) so as to have a north-south magnetic axis approximately parallel to that wall of the casing which is intended to come into contact with the patient's skin.
  2. Acoustic hearing aid generating at least one audible signal and intended to be fitted onto a patient's body, comprising an external casing (1) containing an electronic signal processing module (11) connected as input to at least one microphone (13, 13a, 13b) and as output to an earpiece (3) designed to emit an audible signal in the external auditory canal (5) of the patient, an energy source and a device for distributing audible signals in the patient's auditory canal including the earpiece (3), and a link (4) between the external casing (1) and the patient's auditory canal, having a length such that the microphone can be kept sufficiently far away from the auditory canal to avoid Larsen phenomena, in which the earpiece (3) is placed in the external auditory canal (5) of the patient and forms an intra-auricular end of the link (4), the link (4) being formed by an electrical cable,
    characterized in that it furthermore comprises:
    - at least one first magnetic piece (12, 12', 12a, 12b) placed in the external casing (1); and
    - at least one second magnetic piece (21, 21a, 21b) placed in an implantable casing (2) designed to be implanted under the patient's skin, at a location on the body where the external casing (1) has to be supported, the first magnetic piece being placed in the casing so that an attractive magnetic force is exerted with the second magnetic piece when the external casing (1) is placed at said location,
    in which the second magnetic piece (21) is a magnet and the first magnetic piece comprises two permanent magnets (12a, 12b) placed in the external casing (1) so as to have north-south magnetic axes approximately perpendicular to that wall of the casing which is designed to come into contact with the patient's skin, and in opposite directions, these magnetic axes being spaced apart by a distance corresponding substantially to the distance between the poles of the second magnetic piece (21).
  3. Acoustic hearing aid generating at least one audible signal and intended to be fitted onto a patient's body, comprising an external casing (1) containing an electronic signal processing module (11) connected as input to at least one microphone (13, 13a, 13b) and as output to an earpiece (3) designed to emit an audible signal in the external auditory canal (5) of the patient, an energy source and a device for distributing audible signals in the patient's auditory canal including the earpiece (3), and a link (4) between the external casing (1) and the patient's auditory canal, having a length such that the microphone can be kept sufficiently far away from the auditory canal to avoid Larsen phenomena, in which the earpiece (3) is placed in the external auditory canal (5) of the patient and forms an intra-auricular end of the link (4), the link (4) being formed by an electrical cable,
    characterized in that it furthermore comprises:
    - at least one first magnetic piece (12, 12', 12a, 12b) placed in the external casing (1); and
    - at least one second magnetic piece (21, 21a, 21b) placed in an implantable casing (2) designed to be implanted under the patient's skin, at a location on the body where the external casing (1) has to be supported, the first magnetic piece being placed in the casing so that an attractive magnetic force is exerted with the second magnetic piece when the external casing (1) is placed at said location,
    in which the first magnetic piece (12') is a magnet and the second magnetic piece comprises two permanent magnets (21a, 21b) placed in the implanted casing (2) so as to have north-south magnetic axes approximately perpendicular to the surface of the patient's skin at said location, and in opposite directions, these magnetic axes being spaced apart by a distance corresponding approximately to the distance between the poles of the first magnetic piece (12').
  4. Acoustic hearing aid generating at least one audible signal and intended to be fitted onto a patient's body, comprising an external casing (1) containing an electronic signal processing module (11) connected as input to at least one microphone (13, 13a, 13b) and as output to an earpiece (3) designed to emit an audible signal in the external auditory canal (5) of the patient, an energy source and a device for distributing audible signals in the patient's auditory canal including the earpiece (3), and a link (4) between the external casing (1) and the patient's auditory canal, having a length such that the microphone can be kept sufficiently far away from the auditory canal to avoid Larsen phenomena, in which the earpiece (3) is placed in the external auditory canal (5) of the patient and forms an intra-auricular end of the link (4), the link (4) being formed by an electrical cable,
    characterized in that it furthermore comprises:
    - at least one first magnetic piece (12, 12', 12a, 12b) placed in the external casing (1); and
    - at least one second magnetic piece (21, 21a, 21b) placed in an implantable casing (2) designed to be implanted under the patient's skin, at a location on the body where the external casing (1) has to be supported, the first magnetic piece being placed in the casing so that an attractive magnetic force is exerted with the second magnetic piece when the external casing (1) is placed at said location,
    in which the second magnetic piece comprises at least two permanent magnets (21a, 21b) placed in the implanted casing (2) so as to have north-south magnetic axes approximately perpendicular to the surface of the patient's skin at said location, and alternatively in opposite directions, and the first magnetic piece comprises as many permanent magnets (12a, 12b) as the second piece, the magnets of the first magnetic piece being placed in the casing so as to have north-south magnetic axes approximately perpendicular to that wall of the external casing (1) which is intended to come into contact with the patient's skin, and alternately in opposite directions, the magnetic axes of the magnets placed in the external casing (1) being distributed in a plane approximately parallel to said wall in a configuration corresponding approximately to the configuration in which the magnetic axes of the magnets (21a, 21b) are distributed in the implanted casing.
  5. Hearing aid according to one of Claims 1 to 4, characterized in that the second casing (2) is designed to be implanted in the temporo-occipital zone of the patient's cranium.
  6. Hearing aid according to any one of the preceding claims, characterized in that the intra-auricular end of the link (4) is held in the patient's external auditory canal (5) by means of an intra-auricular support (9) comprising means (8a, 8b, 8c) for centring and holding said end in the auditory canal (5).
  7. Hearing aid according to one of the preceding claims, characterized in that the external casing (1) comprises a base (1b) and a cover (1a) mounted so as to rotate on the base, and means (25) for locking the angular position of the cover in relation to the base, the second magnetic piece (21, 21a, 21b) being fastened to the base, whereas the microphone or microphones (13, 13a, 13b) are fixed to the cover.
  8. Hearing aid according to one of the preceding claims, characterized in that the implanted casing (2) is connected to at least two electrodes (35, 36) for receiving evoked or spontaneous auditory potentials, the implanted casing (2) containing at least one receiving/processing electronic module (32) connected to the receiving electrodes, a transmission module (33) connected to an antenna and to the receiving/processing module for transmitting the signals produced by the receiving module to the external casing (1) according to the signals received by the electrodes, and an electrical power supply (31).
  9. Hearing aid according to Claim 8, characterized in that one of the receiving electrodes (35, 36) is designed to be placed on the round window.
  10. Hearing aid according to one of the preceding claims, characterized in that the implanted casing (2) is furthermore connected to at least one active stimulation electrode (38, 39) intended to be positioned close to the patient's inner ear or in his cochlea, the implanted casing (2) containing at least one electronic stimulation module (37) connected to the stimulation electrodes, a transmission module (33) connected to an antenna and to the stimulation module, the stimulation module (37) being designed to generate electrical stimulation signals that are applied to the stimulation electrodes (38, 39) from signals received from the external casing (1) through the transmission module (33) via the antenna located in the implanted casing.
  11. Hearing aid according to Claim 10, characterized in that one of the active stimulation electrodes (38, 39) is designed to be placed on the round window of the patient's middle ear.
  12. Hearing aid according to one of Claims 8 to 11, characterized in that the receiving electrodes (35, 36) and the stimulation electrodes (38, 39) are at least partially common.
  13. Hearing aid according to one of Claims 8 to 12, characterized in that the external casing (1) furthermore includes a signal transmission module connected to at least one antenna and to the electronic module (11).
  14. Hearing aid according to one of Claims 9 to 13, characterized in that the implanted casing (2) is furthermore connected to at least one electromechanical transducer vibrator intended to be positioned in a bony or cartilaginous zone close to the patient's inner ear, the implanted casing (2) containing at least one electronic stimulation module (37) connected to the vibrator, a transmission module (33) connected to an antenna and to the stimulation module, the stimulation module (37) being designed to generate electrical stimulation signals that are applied to the vibrator from signals received from the external casing (1) through the transmission module (33) via the antenna located in the implanted casing.
  15. Hearing aid according to one of the preceding claims, in which the earpiece (3) comprises an electroacoustic transducer intended to be inserted into the patient's external auditory canal.
EP03760752A 2002-06-21 2003-06-19 Partly implanted hearing aid Expired - Lifetime EP1522208B1 (en)

Applications Claiming Priority (3)

Application Number Priority Date Filing Date Title
FR0207738A FR2841429B1 (en) 2002-06-21 2002-06-21 HEARING AID DEVICE FOR THE REHABILITATION OF PATIENTS WITH PARTIAL NEUROSENSORY DEATHS
FR0207738 2002-06-21
PCT/FR2003/001889 WO2004002193A1 (en) 2002-06-21 2003-06-19 Partly implanted hearing aid

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EP1522208A1 EP1522208A1 (en) 2005-04-13
EP1522208B1 true EP1522208B1 (en) 2010-09-01

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US (1) US7266208B2 (en)
EP (1) EP1522208B1 (en)
AT (1) ATE480108T1 (en)
AU (1) AU2003260612A1 (en)
DE (1) DE60334002D1 (en)
FR (1) FR2841429B1 (en)
WO (1) WO2004002193A1 (en)

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DE60334002D1 (en) 2010-10-14
EP1522208A1 (en) 2005-04-13
ATE480108T1 (en) 2010-09-15
US20060015155A1 (en) 2006-01-19
FR2841429A1 (en) 2003-12-26
US7266208B2 (en) 2007-09-04
FR2841429B1 (en) 2005-11-11
AU2003260612A1 (en) 2004-01-06
WO2004002193A1 (en) 2003-12-31

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