It’s the biggest innovation in the history of hearing solutions. An implant where even the microphone is implanted under the skin but that still offers the superior hearing of a cochlear implant. TICI UNICO, the totally implantable cochlear implant is here.

But how exactly did we get to this point? We talked to the people who made TICI a reality, from the CEO who dreamed of it her entire career, to the R&D engineers who bought it to life.

Ingeborg Hochmair, MED-EL CEO

A Long-Term Dream

The idea of a totally implantable cochlear implant started right at the beginning of our work, in the 1970s. We first considered having either a totally implantable or a partially implantable prothesis and then looked into the feasibility of both. And a totally implantable cochlear implant just was not feasible at that point.

We officially started developing TICI on August 3, 2009. This was after around six years of investigating the feasibility of a totally implantable cochlear implant.

A Fascinating Challenge

The development of TICI was challenging the whole way along—but in a positive way. The new microphone was the most prominent component we needed to develop, but there were many other processes to be worked out as well. It was a fascinating technical development.

The launch of TICI UNICO means a lot to me personally. It’s a totally new category of an implant and the realization of a dream that I’ve had for a very long time. And I do indeed hope that it will open the door to hearing for many more people than we currently help with cochlear implants.

A New Era for Professionals and Candidates

TICI will enable professionals to offer a hearing solution that works 24/7, is easy to use, and easier to explain to candidates. With fewer external components, there will be less need for service, repairs, and ongoing device management, reducing the burden for both professionals and users.

Counselling may evolve in some areas, but the overall cochlear implant process will remain largely unchanged. By eliminating many of the practical challenges and reducing stigma, TICI could make it easier to help more people choose and benefit from cochlear implantation.

Giving Thanks

I would like to thank many, many people. The large development team that developed the implant and the technology with all its components, processes and so on. And all the other members of the MED-EL team that made TICI UNICO possible.

I would also like to thank the professionals who provided their input into TICI—those first surgeons and audiologists that put their trust in us and dealt with the feasibility study as well as the pivotal study.

And a very special thank you goes to the brave, pioneering patients who took part in those clinical studies.

Watch: Experience From a TICI UNICO Recipient

Martin Kerber, Former Project Lead and Head of R&D Systems

Taking on the Virtually Impossible

I first got involved in TICI in 2003, which is when we started looking into implantable microphones. I was attracted to the project because no one had done it before, like Christopher Columbus sailing to unknown shores. But it seemed possible, so I thought: let’s try it!

The biggest challenge in developing a totally implantable cochlear implant was the subcutaneous microphone. There were papers out there claiming that you lose 10dB sound level with each millimeter of skin tissue on top of a microphone, insinuating that it is virtually impossible to design a subcutaneous microphone with reasonable performance. However, we showed it is possible with a clever design.

Long-Term Testing

The battery was the second big challenge, but I’m really proud of the design and performance. We have very robust test data; we have tested these batteries 24/7 for many years. Charge-discharge cycles up to 15,000 times, deep discharging, shorting, dropping, shaking, crushing, all kinds of misuse. And we have real-time cycle test data of far over 10 years—I started these tests in 2012, and the same batteries are still running one cycle every day!

Incredible Potential

Now that TICI is here, I feel like we’ve landed on the moon! And I am proud to be part of making this happen.

TICI has the potential to supersede all existing CIs, maybe even high-power hearing aids, because it is invisible. The stigma of the necessity to wear hearing aids or audio processors disappears completely.

Watch: How TICI UNICO Works

Gerhard Mark, Senior R&D Engineer and Project Lead

A Technically Complex Project

I’ve been involved with TICI since the very beginning. The opportunity to contribute to the first fully implantable cochlear implant was incredibly exciting. I was also drawn to the technical complexity of the project and the chance to work closely with experts from many different disciplines. Projects like this can only succeed through strong teamwork.

I’m the project lead for the fully implantable device and whole system. A large part of my work involved coordinating the development activities across different disciplines and helping ensure that all parts of the system worked together as one successful product.

An Ever-Evolving Regulatory Landscape

One of the biggest challenges was the long development timeline. Over the years, regulatory requirements evolved continuously, which meant we had to adapt both our development processes and parts of the design. At the same time, the project team kept growing, making coordination, communication, and alignment increasingly important.

There were certainly difficult moments and many challenges along the way, but I always believed that TICI would become reality. For every obstacle, we eventually found a way forward. I feel proud of what we have achieved together. A project like TICI is never the work of one person. Without the talent, dedication, and commitment of the entire team, we would not be where we are today.

Results That Matter

It has been remarkable to see the project evolve from an ambitious vision into a fully implantable cochlear implant system. What affected me most was the close connection we built with the study participants and the opportunity to follow their individual journeys. Hearing about their progress, successes, and personal experiences made all the years of development feel very real and very meaningful.

I see TICI UNICO as the beginning rather than the end of the journey. Totally implantable cochlear implants open up many new possibilities, and there are still countless ideas that could become reality in future generations of these systems. That is what makes the future so exciting.

Benjamin Dietze, Senior Development Engineer and Project Lead

Developing the Totally Implantable Microphone

I joined MED-EL back in 2011 to help develop the implantable microphone and have been involved with TICI ever since.

What really fascinated me was the question of how you can make a microphone implantable. A normal microphone in air is, by design, not hermetically sealed. An implantable microphone has to be biocompatible and hermetically sealed at the same time—and that brings some real technological challenges that we had to solve.

I later became part of the project-leadership team for the TICI UNICO implant. I kept working on the microphone while also contributing to implant development, technical and regulatory documentation, device approval, patient measurements during clinical studies, and internal and supplier audits for our quality management.

Multi-Level Challenges

The challenges came on several levels.

Technically, we had to develop an implantable microphone, essentially integrate the functionality of an audio processor into the implant, create a highly reliable implantable battery, and design low-power implant electronics.

On the regulatory side, there were no approved TICIs yet, so many aspects were not covered by existing standards, and these had to be discussed and evaluated with authorities from scratch.

Organizationally, a project this complex needs a lot of time and many people brought together at the right moment—while still staying flexible enough to react well to unexpected developments.

A Major Milestone

Seeing TICI become commercially available feels truly amazing. I am so proud that we completed the first CI that can be used invisibly, without any external devices—a major milestone for cochlear implants and a big step forward in everyday comfort and quality of life.

It took a wonderful team and many years of development and clinical testing to make a mature, fully implantable CI a reality.