 And I'm really, really excited about our presentation today. And before we actually introduce our presenter, I would like to thank our chapter member, friends Kovacs for making this presentation possible. He contacted more. It's our presenter to ask if he would be interested in doing this. And they've been carrying on a conversation for several months now to make this happen today. So, for those of you who saw the title, I mean, I'm thinking that you were probably like I am and you're wondering what's brain computer interface or BCI technology. So BlackRock NeuroTech has been using this technology in a wide variety of situations. One of them that they've been really working on is in mobility issues. And Moritz is overseeing a program that they have that's for hearing and it's called here again. And Moritz, would you like to share your presentation? Are you just going to talk? I forgot to ask you. I will share my presentation for the introduction. Let me stop sharing and make sure you can share. Okay. There you go. Okay, perfect. Let's see. Okay, can everyone see the title slides and presentation mode? We are just seeing the title slide. It's perfect. Okay. Fantastic. Well, thank you so much and and friends for having me here. Very nice to meet you all. Please let me know if I need to speak up or speak more slowly, same as Ann. I will talk to you a little bit about our project to develop an auditory nerve implants as part of our efforts to develop brain computer interfaces. I generally kept this presentation to a general public, but I'm more than happy to address also deeper technical questions after the presentation. So about my background, you can probably hear it from my accent. I grew up in Germany. I am currently leading the here again business unit at BlackRock Neurotech, which focuses on applications of brain computer interface technology to restore or convey hearing to improve also the hearing quality of existing auditory implants and prosthetics. By training, I am an engineer with a strong focus on bioengineering, microelectromechanical systems and materials. So we'll briefly give an introduction about our company and brain computer interfaces in general before then diving more into the auditory applications. So BlackRock is a privately held company that was founded back in 2008 and Salt Lake City, Utah. Originally under a different name as a spin off from the University of Utah, where the so called Utah electrode array was developed, which is a microelectrode array that was designed to be implanted into the brain. The goal to exchange signals and information between machines, computers, and the human nervous system through like an array of small electrodes that transmit or convert electrical charge into ionic currents, which is the information mechanism that is used in the human nervous system. We currently are just above 100 employees. We, we are one of the first if not the first company that actually developed brain computer interfaces that were implanted in humans. As Anne mentioned, our primary focus for several years was motor and sensory restoration for quadriplegic patients. To date, we have about 32 BCI participants so 32 patients that were implanted with our technology current seventh still active at this point. With over 30,000 days of implantation duration cumulatively. In general, our mission is to restore human function and remedy neurological diseases. Our marketing team likes to go let make help people walk talk see in here again. In the marketing department, I would like to share a three minute video that presents the company and also shows some of our patients that were implanted with our technology and it's truly impressive to see what they were able to do again so all of the patients in this suffered a spinal cord injury that left them paralyzed from the neck or the chest down typically and using that technology were able through prosthetics robotic limbs sensors able we were able to restore sensory function and motor function. So, let's quickly see if the video plays with sounds. Can you hear the sound or do I need to change something on zoom. I don't hear any sound. Okay, when you check when you shared your PowerPoint in zoom. There's a checkbox at the bottom there for audio and video. Okay, let me see. Oh, here we go. Yes. That robotic hand went closed like that. Man, I come back. I want to come out of that chair so bad. I said my goal is to feed myself chocolate. I firmly believe that we're at the onset of a revolution. I was able to move the mouse around on the screen like it was me moving my hand with a mouse. It felt pretty awesome. I only imagine where the technology can lead. We provide a neural interface platform that has a wide range of application. What we want to achieve and enable is that people can move again, feel again, talk again, hear again. I think we'll have people playing the piano and being concert violinist. Come on. Seriously? I think it goes back to the fundamental question of what you want to do with a time that you're given. We're just at the right point and things are really taking off. Understanding our brain and also curing disabilities and mental health issues like depression is the real final frontier. Okay, so this was a brief video that showed a little bit of what was achieved so far already with this type of technology. Although this presentation is mostly focused on hearing applications. I'm more than happy to take also any questions at the end of the presentation about all the other applications that we're working on. Okay, so as already mentioned brain computer interfaces have a variety of applications. Just some of the key areas that we're focusing are our move again talk again program which restores motor function sensory function but also allows people with locked in syndrome for example to communicate again. Through basically typing words or thinking about sentences that then get translated and are being able to be displayed on Microsoft Word or Outlook and so it helps with communication. Then here again, which is the business units that I am leading that focuses on brain computer applications for the auditory system. And a third big business units in our company that looks at the treatment of epilepsy monitoring and treatment of epilepsy. On the next slides. I think you're all more than aware of this so I'm not going to spend too much time on it but there are different reasons for hearing loss, three main categories sensory neural conductive or mixed. I'm not going to do to take any questions there but I think you're all more than familiar with it so I'm going to jump right into the technology here. So there are different types of auditory implants and I want to clarify I'm mostly focusing on implants now, not on hearing aids. So the most successful neural prosthetic today is the cochlear implants with over 1 million cochlear implants being implanted as of last year worldwide. So there is a patient prosthetic or an implant that conveys sound or speech information through stimulating the auditory nerve from within the cochlear a smaller group of implants are the brainstem implants. There is a device that has been developed to address the needs of patients that do not benefit from a cochlear implant due to a malformation of the cochlear destruction of the cochlear due to an accident for example. There is a combination of cochlear implants and acoustic stimulation so basically a combination of a cochlear implant and a hearing aids which is called yes, where the cochlear implant conveys more high pitch frequency information, whereas the hearing aid and there is a combination where that conveys low pitch information. And then we have two implants. Well, we don't, there exists, there are two implants that exists that purely work through mechanical stimulation. Those are more used for conductive hearing loss. The middle ear implant that translates mechanical energy so basically the sound waves directly into the into the middle or inner ear and then the bone conduction implant which I think is a brilliant piece of engineering that vibrates the cranial bone to transmit sound information directly to middle or inner ear. So why with the successful cochlear implant why is there a motivation or a need to develop a different type of implant. So an apologies if this is all too familiar to some of you but I'm just going to briefly explain how a cochlear implant works and what have been technical limitations over the last decades that have not been addressed yet. So a cochlear implant works by wearing a speech processor that is equipped with a microphone behind the ear that collects sound information processes it and transmits energy and information through a radio frequency and RF coil through the scalp to an implantable ear. You can see the receiving coil here is number seven that then delivers or generate small currents or charge that are guided through a cable to an array of contacts or an electrode array that is implanted in the cochlear which is this snail house shape structure like from there the current stimulates through the liquids inside of the cochlear and the bony wall the bony structure of the cochlear, the auditory nerve fibers that you can see it's this yellow part here. The cochlear has a tonotopy so it means that the nerve fibers connecting at the very or like the proximal end of the cochlear are sensitive to high frequencies and as you move along you move more and more towards lower frequencies. And so when you deliver a charge shown here by this red shaded area from let's say this electrode, those are just platinum rings that deliver charge. You can see that this charge spreads and through the liquids and the bony wall to reach electrically excitable nerve cells. And this is also, this is how it works so basically after like discharge activates the nerve cells and creates action potentials that are then passed along to the midbrain the cortex and travel along to the auditory pathway. But as you can see here as well this is also the limitation of these implants. It is limited in a way of the frequency resolution that you can convey. So you, it's basically imagining. a sharp image compared to a pixelated image so you're basically digitizing information and sound information. So now one could say, well this is an easy thing to address we just add more electrodes more contacts and therefore we can convey more precisely and frequencies at a much higher resolution to the auditory system. This however is not possible just due to the physical limitations of these electrode contacts being immersed in a fluid environment first that has a very high electrical conductivities so the current spreads. And then it has to overcome material of high electrical resistance which is the bone structure of the cochlear until it reaches the fibers so you have. If you stimulate one single electrode you have charge and current bleeding into neighboring areas and activating more than just a very small population of nerve fibers. So this is till today like the fundamental limitation that cochlear implants have and results in experiences and for for certain individuals to have difficulties hearing in noisy environments with a cochlear implant or listening to harmonic pitches like music, for example. We can address or like what is our plan to address this as you saw from the presentation we started by developing very very small implantable electrode arrays, several orders of magnitude smaller than contacts from a cochlear implant and our device was specifically interfaced directly with neurons and with neural tissues so be it the brain or nerves in the peripheral nervous system, one of those nerves being the auditory nerve. So our effort here is to replace the electrodes array from conventional cochlear implants with our micro electrode array that has very very small contacts just as a like an order of magnitude to compare our electrode contacts are just a fraction in size compared to the diameter of a human hair there are about five to five to 10 times smaller. So real really small delicate structures which then allow to very selectively activate specific nerve fibers and specific regions of either the brain or or the nerve. In principle it works the same way sound is collected by a microphone through a speech processor or sound processor that is worn behind the ear and transmitted through an RF coil to an implantable stimulator and then delivered not to the cochlear but directly to the auditory or cochlear nerve to stimulate. This idea has been in the field or has been discussed in the field for years now. The limitation here was always the electrode nerve interface that is typically one of the major material and engineering challenges when developing brain computer interfaces. So much for the motivation. Now let's dive a little bit into the technology. The brain computer interfaces whether it is a system to restore moral function or sensory function or for hearing applications all have kind of the same structure. You have an electrode array which is basically the interface between your solid state technical electrically conducting system and the nervous system of the human body. The neural signal stage which is a device that does initial signal processing and also often serves as a connector between the electrode array and then any computer processing system, which is the neural signal this then interfaces with software applications prosthetic limbs, any of it so how would that look for an auditory prosthetic. So in this way we're only transmitting information in a single direction. So we have speech or sound that is collected by microphone and processed in a sound processor that then is transmitted to through an RF link to an implantable stimulator. That is then transmitted to the electrode array that stimulates the nervous tissue. This is such a device look like so at the very beginning of our studies, we still worked with percutaneous connectors that we also still use for our motor and sensory applications. This is the so called Utah electrode array so this is the actual interface that that delivers charge either from a solid state conductive system to the biological tissue or vice versa. So as you can see here, it's an array of in this case 100 silicon based micro needles. This is the portion where I mentioned that this is just a fraction of a human hair and diameter in size. That is then penetrating the nervous tissue and that the very tip of each of these columns or pillars. We have our micro electrodes that then delivers the charge. This is a cortical array that we use for motor applications, and for the peripheral system for the nerves we had to especially also for the auditory nerve we had to make a couple of modifications. One of the modifications is to have a slanted shape of our electrodes. The reason for that is that you can assume a nerve to be to have a circular cross sectional area. And we want to make sure that we interface with the entire cross sectional area of the nerve. This is the reason why we have kind of this stepped or sloped geometry. This device specifically has been developed for the auditory nerve. It has fewer electrodes fewer contacts to reason for that is just at the dimension of the auditory nerve, which is about one to one point five millimeter in diameter. And apologies I'm still not quite used to the imperial system of measurements so I'm going to talk in millimeters. And that because the surgery is a little more complex than inserting a device into the motor cortex for example we had to add a couple of handling features that make it easier for the surgeon or the medical personnel to manipulate this array. The device how it looks right now. It is done with our partner on the project and I'll talk a little more about our consortium and partners in a bit, but we're working with Medell, one of the main cochlear implant companies based in Austria Europe. You can see we're using exactly the same technology in terms of processor coil and stimulator as a conventional cochlear implants so from the outside. It's impossible to tell whether someone is wearing a CI or cochlear implant or an auditory nerve implant with only the difference being here that little electrode array that is implanted into the auditory nerve. So I'd like then to move on and talk a little bit about the process and well now we have an idea we have a concept, we have developed the prototype, but how do you get clearance and how do you test it. The next step is always for any medical device, especially when it's as invasive as neural implants, you have to do some basic testing on animal models. So the very first one was not safety or efficacy it was more a proof of concept. And so this is work that was done by our partners at the University of Minnesota. We wanted to demonstrate that you can indeed have more targeted stimulation when stimulating directly from within the auditory nerve compared to stimulating from within the cochlear. So they used a guinea pig model. There one micro electrode array was implanted into the auditory nerve. And another electrode array was implanted into the auditory mid brain or inferior colliculus. The electrode array that was implanted in the auditory nerve delivered charge and stimulated the nerve at different locations, whereas the electrode array that was implanted in the mid brain, recorded the response of the auditory system collected basically action potentials or as we call them like to call spikes as a response to the stimulation. And why is this important. The cochlear as mentioned before has a very well defined tonotopy. You have high frequency sensitivity at the proximal and or at the entrance of the cochlear. And you have low frequency sensitivity at the distal and so all the way up at the end of that snail house shaped structure. In the auditory nerve, it's not that clear we need to know which electrode and would still and located in which area of the nerve would stimulate specific frequencies in order for us to develop stimulation algorithms and in order to convey sound and speech information in a reliable way. And so this experiment was done as a proof of concept, and to map the tonotopy of the auditory nerve. And we saw exactly what we're anticipating. I hope I won't lose anyone in this it gets a little more scientific here. But what you can see here in that little pixelated diagram is the number of spikes or action potentials that were recorded from the mid brain. And so, by stimulating a single electrodes and slowly increasing the current level or the amount of electrical charge that we deliver. You can see that it first activates a very specific frequency is just one pixel as you increase the current. This becomes more like the activation pattern becomes more of a funnel shaped structure. And this makes sense because if you increase the current you deliver more charge you will activate more nerve fibers, more neurons and the vicinity of the electrodes, hence also activating different frequencies for the sound information. So that proves two things. First, we can very selectively stimulates a very, very narrow frequency band with very, very few current or little current. In comparison, here we saw activation thresholds of about 20 micro amps and then some micro amperes and certain applications even less as a comparison cochlear implants require at least a factor, or an order of magnitude higher to activate neurons just because the charge has to overcome the bony wall of the cochlear so cochlear implants typically stimulated several hundreds of micro amps. And the other thing that we learned from this is the tonal top of the auditory nerve, which is based, which is coded here in different colors. So you have low frequencies that are located in the center portion of the auditory nerve and then similar to the cochlear, looking at the cross section, you slowly when you spiral out to the outer surfaces outer area of the nerve. You increasingly become sensitive to higher frequencies. The next step in order to move towards a clinical trial is you have to demonstrate safety and efficacy of the device. So for this reason, with our partners, we are working on cat models and non human primates models, the cat models are mostly for safety. So this is a model where you can relatively easy relatively easily access the auditory nerve and implant the device. One of the limitations here, however, is it doesn't really mimic the use case very well cats do not walk upright. It's just to scrape off anything foreign on their body so we had and the anatomy of the skull is substantially different compared to a human obviously so even the skull is so small that we cannot place our sound processor the microphone and even the implantable skull. So we have to be a little creative there. And what our partners at the University of Utah and West Virginia University came up with was a backpack system so the cat would work where all the electronics in a backpack with a cable then leading to a connector that sits on the top of the head. We still do have to conduct a couple of experiments on non human primates. And this is just to mimic the end use case and the best way possible. So this is the next slide, why we were kind of want to show to you why we use this this model. And this is just really the very similar anatomy between, in this case, research macaque models and the human anatomy. So you can see here this is a cochlear the small structure is that little dark shaded area. You have the internal auditory canal. I see really similar. Same with the labyrinth and the sigmoid sinus so those are important because these are the landmarks that the surgeons are using when performing a surgery and exposing the auditory nerve. So I would like to the last portion of the presentation is very exciting results. We did just two months ago conduct our first experiments in patients and humans in an intraoperative setting. So this was not a chronic study yet. But we were able. So this was work that was done directly between us black rock and the medical high school in Hanover, which is home to the biggest hearing center in Europe. What we did is, we recruited volunteers, patients that had to go through an acoustic neuroma surgery so this is basically a surgery that removes cancerous tissue or tumors that are located on the auditory nerve or the vestibular nerve that runs right parallel to the auditory nerve. Patients that have to undergo this procedure. In this case the auditory nerve is exposed already and they have agreed to a couple of minutes of additional anesthesia time for us to insert the micro electrode array stimulate the auditory nerve and record the responses of the brain stem. As a result from this electrical stimulation. So this proved to us. Yes, it works in humans we can activate the auditory pathway by stimulating directly from within the nerve. It is a safe procedure surgeons are comfortable in planting the device. And so this is a study that is still ongoing, but we've had very very promising results over the last two weeks. So, as a setup you can see we have our little electrode array implanted into the nerve. Since this is an intraoperative acute study the device only remains implanted for less than 30 minutes. We have a percutaneous connector that is temporarily attached to the skull. And that then is connected to one of our stimulator devices. This is a big table top device, nothing compared to the final product but this just offers us a very good precision of charge delivery. In order to record the responses from the auditory system to the stimuli. We placed auditory brain stem recording electrodes so those are just needle electrodes are placed behind the ear and on the forehead that record brain activity as a response to to our stimuli delivered into the auditory nerve. I will show you some of the data, yet that we collected, especially our growth functions and the auditory brain stem responses, but this. I'm not allowed to share that yet since our partners would like to publish on this this will make quite a bit of noise in the community so I will not steal their show on this. So this is like a final overview of the next steps in order to get to a clinical trial or plan is to implant for at least a year and at least three or six patients. The study will be conducted in Germany at the hearing center. We did have to go and are still going through several steps. So, one was cadaveric studies and this is basically establishing very basic device dimensions, working with the surgeons to on the usability to make sure that this is safe this is a rapid procedure that we don't lose there. We did then also and I talked about that intraoperative experiments first just by stimulating the surface of the auditory nerve, and then just recently also from within the auditory nerve. Our models are still ongoing. So these are very time consuming because we need to keep these devices implanted for several months, consistently monitor vitals draw blood analyze for any infection and you foreign body reaction. Our partners also working on computational models and stimulation strategies to make sure that once the device is implanted, we know exactly which electrode needs to be stimulated in what way to convey a higher speech resolution. I'm going to conclude just by some acknowledgments and and and our partners on this project so this all started with funding from the US National Institute of Health, specifically through the brain initiative. Since the start of this project, there was quite a bit of interest and investment has been flowing into this project from several several sides, but on the academic side we're working with the University of Minnesota in Germany, MHH. So the here in center the medical has gone and over the International Neuroscience Institute, the University of West Virginia, the University of Utah, quite a big team. And then on the industrial side, we are currently partnering up with Medell, who's one of the major cochlear implant manufacturers and that brings me to the end of my presentation. Thank you so much for for your attention. Wow. This is really exciting. I mean, this is cutting edge right out there. Technology and I know that I was very excited to hear your presentation I'm sure everybody else is here too. And let's go ahead and open this up to questions. If you'd like to ask that you please go ahead and raise your hand. And we'll call on people. And we have more rest. Stop sharing the screen. Yeah. So, Jeanine, please ask your question. unmute yourself and ask your question. Hi. No audio. There you go. Yeah, can hear you. I think this is fantastic dreams of this for decades. I know a lot of people like me who have impaired auditory nerve. My question is two questions actually with something like this work if you have intact auditory nerve, but the five is a damaged as mine were from medication. That's the first question. Okay, yes. And second question. The most important reason for this is in all of the tests you're doing. The human clinical trials before and after you do this. Are you testing them for their word recognition this speech to see if there's an improvement. Yes. Thank you for the questions. So to your first question. Yes, there has to be at least a residual function left off the auditory nerve. So individuals without an auditory nerve or an auditory nerve that is not working will not be eligible for this implant. To your second question. Yes. There is a lot of data out there from speech tests. I assume you're familiar. I mean, there are different sentences tests speech recognition and noise. So we will conduct the same tests on the participants and volunteers of our study in order to benchmark and compare the performance of our device. And then we will do auditory brainstem implants and cochlear implants and the first in our first study. Yes. This is perfect because I just felt in some way their cochlear implants were not quite totally effective. The problem is really the auditory nerve. All the things you mentioned about the frequency resolution limitations. I realize that. So it's great that your bypass and you can have a direct implant into the auditory nerve stem. I have a question for you. I heard you say something about hair cells and auditory nerve very close together. And it's my understanding that there are only hair cells on the cochlea and the auditory nerve doesn't have hair cells. Moritz is that accurate. So the hair cells are basically the energy converter between mechanical engine energy that travels through the cochlear. So by vibrating these hair cells generates action potentials in the receptors of the auditory nerve neurons so basically they convert the mechanical energy information into action potentials that then travel through the auditory nerve. Thanks. Who's next here. Carol agate. Please unmute yourself. Oh, there. All right. In lay terms. Just how does the result of this procedure differ from that of the cochlear implants and doesn't have promise of actually restoring the same hearing as someone who does not have any hearing loss. Very good question. So the, the surgical procedure is at this point, more invasive compared to a cochlear implants. And the reason for this is that we are using existing approaches from neurosurgery or your neurology in order to to get our device implanted. So leads me to your second question that this has the potential to restore hearing or improve the hearing beyond cochlear implants. It definitely has the potential, but we are currently still at the very beginning of our developments, whereas the cochlear implants technology and industry have now had 40 years of development with several research groups and research institutions improving on the device. So, I would say just from the physical point of view, it absolutely has the potential to improve the hearing experience over cochlear implants. And this is not something that we will see in the very first study, which is just a proof of concept, because in the next step we will then move to higher channel counts higher number of electrodes to really fine tune this and convey more information. And in the same, in the same process, there will also be, and there's already interest from the surgeons that we are working with to refine and develop a surgical procedure that is more optimized to the implantation of our device and that may not be as invasive as the studies that we're currently conducting. Jim Schroeder. Okay, I have several questions, some of which you probably can't answer. I guess my first question. I'll give you the questions then you can answer. My question is, would you anticipate that some of the total hearing loss would be by bi bi laterally have these implants. Secondly, would you anticipate that the rehabilitation or for an implant would be somewhat analogous to that of a cochlear implant, it would take time for people to understand speech, the way they, they didn't pass. And then third question is about the the surgeon is the neurosurgeon technology, similar to that of a cochlear implant surgeon, or would the skill set for the surgeon have to be fundamentally different. And third question is, is, is your company publicly traded, or is it privately held like Medaille is. Thank you. Okay, yeah, happy to answer all of those. So to your first question about bilateral implants. I heavily depends on the surgical procedure on the outcomes that we see with our first generation of patients in our clinical trial. We will start with unilateral implants. We will not see a reason why someone would not benefit from bilateral implants. The second question remind me that was rehabilitation rehabilitation yes. He is similar to a cochlear implants. So, after the implantation. The patients will obviously have to go through an initial healing process, and then still attend sessions with audiologists where the device will be programmed and or fitted because the engineers we can only do so much and the precision at the end it's still the surgeon that places it into the nerve and so you will never have the implant and this applies also to cochlear implants. It's never at the absolute perfect optimal or reproducible location. And so, during these fitting procedures this is where you will identify which electrodes need to be programmed into a certain way just to account for that patients to patient capability but the process itself, the patient journey will be very very similar. The third question was. I remember the fourth was whether our company is publicly traded. It was about the neurosurgeon. Yes, so we are working with a team of three surgeons. And only one of them is a neurosurgeon. The other two surgeons are neurotologists so basically ent surgeons that do cochlear implants on almost a daily or weekly basis so the skill set for this procedure would be the skill set of an ent surgeon and it doesn't have to be a neurosurgeon in this case. And we are still privately held. We're VC funded, but not publicly traded. Okay Jim you're good. Okay friends. I'm very patient and very persistent thank you for working with us. I don't know much about cochlear stuff at this point, but I understand that read somewhere that 30% of cochlear candidates are not eligible for some reasons the medical reason or whatever that is. Perhaps this would, this procedure would, would make those people more eligible because I don't know why. But the second question I had was, have you done any simulation or any kind of cadaver type of studies as to characterize your system in terms of frequency responsibility and cross talk and whatever the audio terminology we come up with. Just to get to get to get us an idea of course you can be it's not the final version but I just want to know where the state of the art is in terms of what you better plan to do. Yeah, thank you for your questions. So, in terms of simulation and and ongoing studies to demonstrate the improved frequency resolution. We're currently still limited to the animal models. So this is where we had these two pairs of electrodes, one implanted in the nerve one in the midbrain. This is the best evidence we have so far with cadaveric studies we unfortunately cannot get this information, just because the tissue is is dead is has been fixed. The signals won't travel through that tissue also. We see that the mechanical and electrical properties of nerve tissue from cadaveric studies is substantially different so there's limitations there. We are currently and this is a test that will be conducted in three weeks from now. I'll be traveling to Germany for another intraoperative surgery, where we'll use a couple of tricks to determine whether we indeed do have independent narrow band frequency activation, the ultimate test will however be to talk to a patient and get direct feedback. Your first question was remind me again sorry I'm having. I heard that I read somewhere that cochlear people with the cochlea do not qualify for cochlear implant. I don't know if 30% is really the number. But in order to be eligible for a cochlear implant you have to meet several factors. So one is a certain degree of hearing loss where a hearing aid just wouldn't wouldn't help. It also depends on the nature of this hearing loss so typically it's sensory neural. So it's not the type of hearing loss where the sound way where your inner ear is intact and the sound waves just can travel all the way to the inner ear, but that the damage really or like is done to the hair cells or within the cochlear. So if those criteria fulfilled then there's still anatomical questions for example the shape of the cochlear, although cochlear implant companies are getting better and better to address those. I'll be the first one in line to have any go public. Thank you. Okay, Tom Watson. Okay, hi folks. I can't see me. There I am. Okay. One big question. Based on various tests over the years it seems that my auditory nerve itself is the problem for my hearing loss which has just gone to the stage where even with the AIDS I can't hear words. Thus, the, when I was tested for a cochlear implant. That wasn't a good solution. So I'm just curious what is the expected timeline for dealing with issues with a nerve itself is basically out of order. Sounds like some of this technology might address that. That's a good question. And I will be careful in my answer because 10 years, 50 years. Yeah, I'm, what are we looking at. I'm not a physician but I would say it really depends on why the auditory nerve or how the auditory nerve is impacted if certain portions or location closer to the brainstem is intact and working. Then this current technology, maybe possibility. Like if really an auditory nerve is non functional or missing. To my knowledge, the only implant that is currently on the market but with very limited or like uncertain outcome is the auditory brainstem implants. I know that certain groups are working on a new type called the auditory mid brain implants that is directly implanted into the mid brain. But in terms of time. It's a difficult question. I can tell you this on average from concept from concept to a marketed medical device. So I would say if someone comes up with a solution for missing or non functional auditory nerves, other than the brainstem implant. If someone would come up with it tomorrow than the earliest would be 10 years from now that would be my, my guess. It's a difficult question to answer. Okay, you're good Tom. Okay, so Joe hell for it just it's, it's a rare condition so there doesn't seem to be much happening with either bypassing their nerve or regenerating nerves. And I'm at the point where my family life expectancy says my expectancy is zero years. So that's why I was interested in that. So this is the to be as much as 40 more years. Yeah, I mean what one one comment there is. And this is not my area of expertise, but going attending several conferences on on hearing. I could see how a pharmaceutical approach for nerve restoration would probably be faster than an actual device story implants. And I know that there is a lot a lot of research currently going on. I have friends who are dealing with their issues and they're so desperate that they're willing to be participants in clinical studies research studies. So if somebody's doing that kind of study might pass the coin and see if you want to try that. I don't know who's doing it myself. Thank you. Kind of on the line of Tom's thinking there. Do you do you know ahead of time if that nerve is going to be receptive to an implant. Or do you know is that a test that you're saying well it may be damaged it may be just fine. We're not certain. So there are a series of tests that are currently standard already for cochlear implant surgeries, because in order to receive a cochlear implant the nerve has to be functional and intact. So we would and we are already, especially for these intraoperative studies that I mentioned, we are doing this full array of tests. First before the surgery to have a good sense of the nerve being functional, but then the real final test actually is performed during the surgery and so this is there are two tests that are typically done. The first one is the ANTS test. Don't ask me what it stands for but it is very small version of a cochlear implant does just with three electrode context that is inserted into the cochlear. And in the same concepts, as we're using for our intraoperative studies right now, you measure the responses from the brainstem as a response to stimulating from within the cochlear. And then the second test is called a placement test where the surgeon places a small paddle electrode so this is really how to describe it. It's a flat piece of silicone of rubber with platinum contacts that is placed on the surface of the auditory nerve and then stimulates the nerve and if you can see a response then then you know the nerve is in good shape it's able to carry signals. Those would be the check marks that you would need to fulfill in order to get either a cochlear implant or an auditory nerve implant. Thank you very much. Janine. I mentioned something that I went through 50 years ago. You're talking about a paddle kind of thing that stimulates the auditory nerve. I had my healing tested, and then for eight weeks, five days a week for 45 minutes. I had electrical stimulation electrodes placed the bones here and the backbone over here behind the ear. Eight weeks, five days a week, 45 minutes. My hearing had worked like the technician was tested before and after. And guess what? It was a 25% improvement. I don't think the company was well known. I don't know. I have the machine. If I have contact with you, I cannot mention it to you. I would love to know more about this Janine. Yes. I'm happy to share my email address in the chat, if anyone. The reason we knew about it was because my father was a physician and he knew this guy that was experimenting with it. That's, that sounds amazing actually. And 25% is quite substantial. Yeah, I couldn't believe it. Well, I was 18 then. Okay, so who else has a question? Well, you all are thinking about it. I have a question. So why was the University of Hanover picked to do the surgeries rather than one of the hospitals in the United States? I have a question. There are several reasons. So one is that, well, Hanover in Europe is at least in Europe the biggest hearing center. And it is closely working with the International Neuroscience Institute, which is a private neurosurgery clinic. And I don't know of any hospital that is as well equipped in surgical equipment as the INI. But the other reason is also that there are two reasons. So the surgeon we're working with in Hanover. He is very, very well known in the field in terms of ENT surgery, I would say he is the key opinion leader. When you go to conferences, people want to take pictures with them just like a rock star. And there is a little bit of knowledge there. And finally, the person that initially started this project, Hubert Lim from the University of Minnesota used to be a postdoctoral student from the surgeon. They kind of came up with the idea together, along with Florian Salzbacher, who is one of our co-founders. So those are all reasons for Hanover being the first site of clinical trials. But since we do have funding from the NIH, the requirement is as well for us to conduct the same trials pretty short, shortly after at the University of Minnesota Hospital. What's the name of the famous rock star surgeon? Professor Linatz, Thomas Lennards. Can you put his name in the chat? Thanks. Dr. Salmat, Mimi you're up. Good morning, everyone. I don't have a question. I am a clinical audiologist, and I want to sincerely thank you for your effort for a person that has been in the field over 43 years. I have a lot of patients, and I see that how evolutionary this process would be. And thank you for your effort. And if I can be of any help just providing subjects in the future, I will be glad to do that. Thank you and congratulations again. Thank you so much, Mimi. It means a lot hearing this. Thank you. Okay, so come on. There have to be some other people who are just waiting to see if somebody else asked their question. I don't think that I told Morris to stay all day. So there might be a limitation in that too, because he has other things to do. So I'm going to step in for him in case he asks. It's all good friends. Okay, everybody. So we're going to end the question and answer period. And Morris, of course, you know, I'm just over the moon excited and happy that you were able to come talk to us. And if you ever want to do that again, please let me know. We'll continue to advertise it broadly. We happen to have a YouTube channel. And so our this will be recorded today and it'll be available to other people to see to gain knowledge about this leading edge research. Thank you. Anyway, other way that we can help you please feel free to reach out and thanks for coming. You're welcome to stay we have a little bit of chapter business. You're also free to go when we won't be insulted. Okay. Yeah, thank you so much. Thank you. Thanks to all of you and I will gladly share any major new developments in the future with you once once available. Thanks. All the best. Thank you so much. Weekend. So we have a little we have some announcements here. One is that I want to thank everybody who came to the walk for hearing, and it was really, really wonderful to see everybody in person and chat with everybody and it seems since we didn't meet in June in July, it really seems like a long time ago. Thank you to all of those of you who were preparing to come to our picnic that we ended up having to cancel, because it was over 100 degrees that day. I don't know if we'll be able to reschedule one later in the fall. It's a lot of work to be able to get an open space based on the schedule of the venue where we were meeting, but we will try. So we have the convention as the first time I've attended convention since the pandemic. And of course it was wonderful to see everybody. I was very, very active in three different presentations one was a leadership training for chapter leaders. And we also had all of you who are part of the DV chapter already know, I sit on the HLA get in the hearing loop committee, and we have our annual meeting at the convention for manufacturers and stallers researchers and advocates. And also Sherry Parazoli, Juliet Sturkins and I gave a presentation about the new tools that we've created for hearing loop accessibility, and you can see the picture up in the right I'm holding up our new handbook. Here's the handbook, it's over 150 pages, and I can completely absolutely tell you, it was a complete labor of labor of love on my part, and took five years to create. If I'd had any idea how long and extensive it had been, I probably would have completely passed on that. But you know, fools rush in right. Now we have a really wonderful all in one document completely inclusive for everybody. And Sherry Parazoli and I got the HLA get in the hearing loop award at the convention. And this is the latest this is the blurb that's recently been published for people to see who the award nominees were and what we got a nomination for. I'm really proud of this so I wanted to share my joy with all of you. We have upcoming events. So, historically, September has always been the month that we talk about emergency planning, because in California, it's, you know, earthquake season, and I give that presentation and we'll be having it again. This year, on September 2. On October 7. Frank's also been able to have a contact Johns Hopkins about some hearing research we're hoping to the, we can make that connection come to fruition. November we're not exactly sure what's going to happen. But in December Gail Hannon is going to be here. I think that you might remember that she was going to be here last year at this time. But she got sick. So she couldn't come and she's going to be talking about the book she co authored with Sherry e birds, which is called the way I hear it a life with hearing loss. Now Sherry and Gail were hoping to be able to reschedule earlier in the year, but by the time we coordinated times everything the slots that they were available weren't available for us to have them give a presentation so please remember to come and listen. Gail is just wonderful no matter what she's talking about and I'm sure that there will be wonderful humor that she's noted for. I'd like to remind everybody that we have a YouTube channel and all of our presentations for the last several years at least beginning with the pandemic are all on there. For people who would be interested in the programs committee. So, I'm on it. So here, Chiba, who's not here today is on the, who's the lead for that Alan could sir. And Jim Schroeder. So if anybody else would like to join us please contact so here. And all of you know I'm a diet in the will advocate and I'm always looking for people to who might be interested in advocating with me. I'm currently working on a project with Robin Miller for the East Bay chapter to get part of a school that they're doing a new construction on it and getting it looped. So I have some wonderful advocacy news to share with you for. Oh gosh, I'm thinking five years plus. For those of you who don't know I do at least eight outreach events in the community every year and meals on wheels approached me about were there hearing devices for doorbells for people with hearing loss. Since then I've been trying to actually really make contact with the executive director, and to talk to them about that to hopefully be able to have a project that we could co partner to provide doorbells for the clients who have meals on wheels who are hearing and their demographic is people over 60 so you imagine that's a lot of people. So this past week I gave my first presentation to them about hearing loss awareness was very well received. The conversation has started. The executive director for meals on wheels also sits on the commission for aging for our county, and she's in the process of introducing me to the lead of that committee and so we're really starting some doors are opening to raise awareness throughout our county and so that's really exciting for me. So Tom, we have a question. Yeah, simple one. Could you put the location of the YouTube video in the track please. Yeah, Alan. Yeah, that one. Yeah. I'm just going to mention to you with your computer you can take screenshots of slides all the time. So I frequently take screenshots of slides that I want to know the information about. So I'm just mentioning that to you to your awareness of. Hang on a second. Okay. I also have a new website since the beginning of the year we'd like to remind everybody that we are a member organization, and that even though our meetings are open to the public. It's nice to have our membership increase so that you're showing us that our programming and the things that we're doing are a value to you. So that's all I have to say today. Is there anybody else who has any special news that they'd like to share something wonderful happening for them. This is your time to speak up Susan back hi, and unmute yourself please. You're still mute. Okay the bottom left hand corner with a microphone. Click on that with your mouse. I'm sorry. Hello. You think I know by now. I just wasn't quick enough on the phone to get the picture of the YouTube site. Can you show it again. Uh huh. And Alan, on our website. We have a link to the YouTube channel right. Alan are you there. Oh Alan put it in the chat. But anyway so if you have some things we have almost everything on our website so please make sure to go visit there. Claudia. Hi, I'm new to nice to meet you and I'm really new to HLAA. I'm in Oakland so I've gone to a few of the Oakland chapter meeting East Bay chapter meeting but gotten to know Robin Miller fairly well and she recommended I try this one out as well. I grew up with a severe to profound hearing loss from birth. And I've recently written a memoir about that experience of growing up with a hearing loss and the impact of that. Gail Hanan has done a blurb for me for that book which is exciting. It's coming out next May 2024. And it's also about my relationship with my complicated German refugee family and but really just the honest painful truth. About what that's like living with a hearing loss and the impact of that. And also the changes that have happened from the very big primitive hearing aids I wore when I was a little kid to the sophisticated hearing aids that they have now and closed captioning and more awareness of hearing disabilities and all of that. And I grew up very isolated in the mainstream world where I struggled, and I did not meet other people with hearing loss or deafness and tell them later in my adulthood. So this is kind of my foray into getting to know more people who've gone through a similar experience that I did because I was very alone with it when I was growing up. So anyway I just wanted to introduce myself and say hello and that I'm really glad to be here. You're not alone anymore you've got all of us. Yes, thank you that means welcome and thanks for coming. I'd like to just mention to you that we have many chapter members with cochlear implants. And so I have two of them Susan Beck has them Bob Zastrow to name a few. And so if you have any questions or interested in that we're all open to talk about our experience with you just so that you know for you, Claudia or anybody else that's here. So we're at the bewitching hour. It's 1131. We would be remiss if we didn't thank our captioner who provided these excellent wonderful captions today, and also the state of California for providing them for free for us. Thank you very much. And we'll see you again next month.