3. Summary

c. Availability of different types of elastic electrode arrays, including Cochlear CI422 slim

Further works on developing the program of treatment of partial deafness had been continued in the Institute of Physiology and Pathology of Hearing simultaneously with different forms of activities aimed at popularizing this method on different continents. Promotion of this treatment method included, of course, presentations on all major global and continental scientific congresses, supplemented by "live" demonstration surgeries performed by H. Skarżyński in Asia, Europe, and America. Simultaneously, for the needs of spreading clinical knowledge and providing an optimal training program, the Institute has started a series of international surgical training workshops called the window approach workshops (WAW). Since the beginning of the WAW program till 2016, there had already been 24 editions, with more than 3500 ear surgeons from all over the world participating. The WAW program includes hands-on training, patient assessment, and demonstration surgeries. Since 2010, the Institute actively participates also in the Live International Otolaryngology Network (LION) yearly global broadcast, with H. Skarżyński presenting surgeries of partial deafness treatment with various types of electrodes and implant systems. These regularly organized live surgical training broadcasts involve demonstrations of surgeries transmitted from several centers from the whole world simultaneously—from Australia, Asia, Europe, and Americas. These broadcasts

enjoy always a very wide audience of surgeons and other medical specialists.

Presentation of the Polish School of treatment of partial deafness had been preceded by a huge work and contribution of an international group of leading specialists involved in implementation of the program of treatment of total deafness. The program had been spearheaded by such eminent researchers and surgeons as W. House and T. Balkany in the USA, Ch. Chouard in France, K. Burian in Austria, E. Lehnhardt in Germany, and G. Clark and W. Gibson in Australia. The leader and many members of the team of the Institute of Physiology and Pathology of Hearing had been visiting these leading members of the international community of specialists involved in treatment of total deafness programs. Many of these leaders had participated in conferences organized by the Institute in Poland. Practical preparations for initiation of the program of treatment of deafness in Poland had been initiated by H. Skarżyński with the support of the Foundation of Medical Development "Homo-Homini" in 1991. Following these preparations, first surgeries of treatment of total deafness in Poland had been performed by H. Skarżyński on 16 and 17 July 1992. They had reverberated widely in Polish society and mass media as well as in science and medicine [15, 16]. Further progress of the Polish program of treatment of total deafness has brought about further groundbreaking events and overcoming further barriers and limitation, including the gradual widening of indications for treatment of deafness with cochlear implants. It had been a foundation for the program of treatment of partial deafness. In its initial stage, in the years 2002–2008, the program had involved combining the electric hearing with the preserved natural hearing up to the level of 500 Hz. In following years electrical complementation had been extended to the level of 750 Hz and 1000 Hz. The top achievement had been first in the world publications, in 2014 and 2015, in which Skarżyński et al. had presented the possibility of treatment of partial deafness with preservation of natural hearing up to 1500

straight electrode designed by Skarżyński [14].

156 Advances in Clinical Audiology

At the turn of the twenty first century, the problem of preservation of the nonfunctional residual hearing and thus preservation of the intact inner ear structure had been addressed by several research teams in the world. The trend started by the team of the Institute of Physiology and Pathology of Hearing, especially first results from children and adults published since 2000, had brought about the realization that an intact inner ear might in future be useful when novel, yet unknown techniques for preservation/restoration of good hearing at any age become available. Particularly noteworthy are in this context studies of the research groups from Frankfurt, von Ilberg et al. [19]; Iowa City, Gantz [20]; Kansas City, Staecker [21]; Vienna, Baumgartner et al. [22]; Melbourne, Briggs [23]; Antwerp, Van de Heyning et al. [22, 24]; and Matsumoto, Usami et al. [25]. Until present day these centers have developed various programs of partial deafness treatment with residual hearing up to 250 and 500 Hz in adults and make preparations for conducting similar surgeries in children. Present indications for acoustic and electric stimulation of the damaged inner ear have been included in the newest concept published by Skarżyński et al. in 2014 [17], presented in Figure 1.

A crucial issue in development of the Polish School in modern science had been the search for standardized method of assessment of the results of therapy achieved by different research groups in various groups of patients different with regard to their size and qualities. On the initiative of Skarżyński and the team of the Institute of Physiology and Pathology of Hearing, a global HearRing group had initiated the works that resulted in developing the first scientific scale which was published in 2012 by Skarżyński et al. [26]. This scale enables archiving and comparing the results of growing groups of patients provided with cochlear implants. Participation of several tens of prominent researchers from the whole world in development of this scale was not only helpful in its elaboration; it facilitates its steady popularization in modern science and medicine [27].

Figure 1. The newest concept of complementation of damaged hearing in indicated ranges: (a) acoustic complementation with hearing aids and middle ear implants (acoustic stimulation, AS), (b) electric support for the effective electric-natural hearing (partial deafness treatment-electronatural stimulation, PDT-ENS), (c) electric complementation of the preserved hearing only in the low-frequency range up to 500 Hz (partial deafness treatment-electric complement, PDT-EC), (d) combined electric and acoustic stimulation with a hearing aid and cochlear implant (partial deafness treatment-electroacoustic stimulation, PDT-EAS), and (e) only electric stimulation with preservation of the inner ear structure and nonfunctional residual hearing (partial deafness treatment-electric stimulation, PDT-ES).

A final argument summarizing the position of the international scientific community toward strengthening of the Polish School is personal citations and awards and distinctions bestowed for these achievements by the various international scientific and expert groups. Erixon et al. in the Ear and Hearing, which has one of the highest Impact Factor journals in this field, have written in 2015: "Skarzynski et al. (2012) called the first group electrical complement patients and the second group electro-acoustic stimulation patients" [28]. Von Ilberg with an international group of collaborators in a multicenter study published in the Audiology and Neurotology in 2011 [19] has mentioned: "The most expanded indication for electro-acoustic stimulation (EAS) has been reported by the Warsaw group, who implanted candidates with markedly better acoustic hearing in the frequencies between 125 and 500 Hz. Some of the recipients showed extremely sloping audiograms, using the natural preserved acoustic LFH, without the need of any additional acoustic amplification." The same paper mentions further "a small number of studies reporting on children fitted with EAS have recently been published by Skarzynski et al." In its summary it says "Skarzynski and his group have demonstrated convincing results in their first studies on children" and further "however, Skarzynski stressed that this kind of surgery on children should not be attempted without significant successful experience with adults" and still further "by introducing this method, it became possible to improve hearing preservation, with rates going up to 95–100% in most EAS candidates." Guimares et al. in the Brazilian Journal of Otorhinolaryngology in 2015 have said: "Some classifications for hearing preservation have been proposed to assess the degree of preservation of residual hearing, and the most commonly employed is that proposed by Skarzynski (…)" [29].

It should be underlined that the real effects of the Polish School are shown by the increasing abilities of Polish patients in their sustained development of hearing, speech, learning of languages, and development of artistic potential—vocal and musical. The best example of this success is their achievements demonstrated during the first International Music Festival "Beats of Cochlea" [30].

From among nearly two hundred distinctions and awards won by H. Skarżyński and his team in Poland and internationally in relation to the implementation and promotion of the Polish School, three awards are particularly noteworthy. The first is the '21st Century Award—chief award in the global competition "21st Century Achievement Award Winners" in the category "Healthcare" for the System of Remote Fitting and Rehabilitation in Washington in 2010, in relation to the development and implementation of the telemedical care for patients with partial deafness. The second is the golden medal in the global Prix Galien competition—the first award considered as "Oscar" or "Nobel" of the medical world, awarded for creation of the first "National Network of Teleaudiology" for patients after cochlear implantation, in Monte Carlo in 2014. The third personal distinction of the international community has been the highest citation for H. Skarżyński, as one of the four scientists from the whole world, for his contribution to the development of science and medicine and providing the optimal possibilities of communication of the modern societies. This award has been given to H. Skarżyński in recognition of his leadership and inspirational example for the international society through establishment of the internationally known medical center dedicated to the surgical treatment of hearing disorders and tireless advocacy for people with hearing disorders all over the world.

## 4. Conclusions

A final argument summarizing the position of the international scientific community toward strengthening of the Polish School is personal citations and awards and distinctions bestowed for these achievements by the various international scientific and expert groups. Erixon et al. in the Ear and Hearing, which has one of the highest Impact Factor journals in this field, have written in 2015: "Skarzynski et al. (2012) called the first group electrical complement patients and the second group electro-acoustic stimulation patients" [28]. Von Ilberg with an international group of collaborators in a multicenter study published in the Audiology and Neurotology in 2011 [19] has mentioned: "The most expanded indication for electro-acoustic stimulation (EAS) has been reported by the Warsaw group, who implanted candidates with markedly better acoustic hearing in the frequencies between 125 and 500 Hz. Some of the recipients showed extremely sloping audiograms, using the natural preserved acoustic LFH, without the need of any additional acoustic amplification." The same paper mentions further "a small number of studies reporting on children fitted with EAS have recently been published by Skarzynski et al." In its summary it says "Skarzynski and his group have demonstrated convincing results in their first studies on children" and further "however, Skarzynski stressed that this kind of surgery on children should not be attempted without significant successful experience with adults" and still further "by introducing this method, it became possible to improve hearing preservation, with rates going up to 95–100% in most EAS candidates." Guimares et al. in the Brazilian Journal of Otorhinolaryngology in 2015 have said: "Some classifications for hearing preservation have been proposed to assess the degree of preservation of residual

nonfunctional residual hearing (partial deafness treatment-electric stimulation, PDT-ES).

Figure 1. The newest concept of complementation of damaged hearing in indicated ranges: (a) acoustic complementation with hearing aids and middle ear implants (acoustic stimulation, AS), (b) electric support for the effective electric-natural hearing (partial deafness treatment-electronatural stimulation, PDT-ENS), (c) electric complementation of the preserved hearing only in the low-frequency range up to 500 Hz (partial deafness treatment-electric complement, PDT-EC), (d) combined electric and acoustic stimulation with a hearing aid and cochlear implant (partial deafness treatment-electroacoustic stimulation, PDT-EAS), and (e) only electric stimulation with preservation of the inner ear structure and

hearing, and the most commonly employed is that proposed by Skarzynski (…)" [29].

of Cochlea" [30].

158 Advances in Clinical Audiology

It should be underlined that the real effects of the Polish School are shown by the increasing abilities of Polish patients in their sustained development of hearing, speech, learning of languages, and development of artistic potential—vocal and musical. The best example of this success is their achievements demonstrated during the first International Music Festival "Beats

