Clinical Quick Tips: How to pair a Nucleus® 7 Sound Processor to compatible Apple® devices

By guest author: Wade Colburn

Cochlear introduced our first perimodiolar electrode array in 2000. Perimodiolar arrays reduce the distance to the modiolus to improve performance^1,2 and allow for more focused stimulation^3,4. In a study conducted at Washington University by Holden et al⁵, they showed a correlation between the position of the electrode with respect to the modiolus (often referred to as the “Wrapping Factor”) and CNC word score. The group showed that those electrodes with proper perimodiolar placement had a lower wrapping factor and improved performance.

Cochlear continually innovates with the intent of making perimodiolar electrodes thinner, less traumatic and consistent in placement, and with the ultimate goal of improving patient performance. The perimodiolar advantage has been observed by many clinicians over the years, which is demonstrated by the fact that 2 out of every 3 Cochlear™ Nucleus® implants are perimodiolar⁶.  

Currently, two perimodiolar electrodes are available for purchase, the Contour Advance (CI512) and the new Slim Modiolar (CI532).  Contour Advance has been available since 2005 and is still used among surgeons. The new Slim Modiolar electrode improves upon a few key design elements and redefines any historical assumptions surrounding perimodiolar arrays, such as scalar translocations and limitations on surgical approach. While there are certain patients that can benefit from the stylet-based Contour Advance, the sheath-based Slim Modiolar has shown performance benefits⁷.

The Slim Modiolar electrode redefines the perimodiolar advantage in four major areas:

Performance:

While the performance benefits of a perimodiolar electrode is well understood ^1,2,3,4,5, a recent publication by Shaul et al⁷, demonstrated that in a matched population (post-lingual patients with all electrodes in scala tympani) phoneme score at 12 months was significantly better with Slim Modiolar (79.5% (mean), 14% (SD)) compared to Contour Advance (69.4% (mean), 17% (SD)).

Placement in Scala Tympani:

In multiple published surgical papers on Slim Modiolar, successful scala tympani location was seen in 90 to 100% of the patients ^7,8,9,10. Slim Modiolar redefines the reputation of perimodiolar electrodes and presents an opportunity to combine the benefits of being close to the hearing nerve with consistent scala tympani location.

Preservation of Structures:

The Slim Modiolar is designed with a sheath-based delivery system, which allowed for a 60% reduction in volume compared to Contour Advance, making it designed to preserve the delicate inner ear structures. The thin design and smooth insertion with a sheath delivery showed in a temporal bone study that 98% of the bones that were implanted experienced “no trauma”. The Slim Modiolar is designed to preserve the natural structure of the cochlea.

Preference of Insertion:

Another benefit of the Slim Modiolar electrode is the ability to use the preferred surgical approach, including a round window insertion. Contour Advance design was limited to cochleostomy insertion, but Slim Modiolar is designed to be implanted via round window, extended round window and cochleostomy. In Aschendorff et al⁸, 44% of the cases were performed with round window insertion, 22% with extended round window and 34% with cochleostomy. This study demonstrated that Slim Modiolar could be implanted with all surgical approaches, while still maintaining consistent scala tympani location.

Slim Modiolar electrode (CI532) is designed intentionally to take the great elements of the Contour Advance and improve upon them to create an ideal electrode for your patients. Closer to the hearing nerve has proven to be a benefit and CI532 has redefined the perimodiolar advantage for the better.

To learn more about CI532 and practice insertions in a simulated model, contact your Cochlear representative.

About our guest author:

Wade Colburn is the Product Manager for the Cochlear™ Implant product portfolio within Cochlear Americas.  Wade’s responsibilities include product positioning and messaging, life-cycle management, new product launches and surgical support and training. Wade has recently joined Cochlear and comes from an engineering background within the medical device field, including previous otology experience.

References:

1. Lazard D. S, et al. Pre-, per- and postoperative factors affecting performance of postlinguistically deaf adults using cochlear implants: a new conceptual model over time. PloS one. 2012; 7:e48739

2. Blamey P, et al. Factors affecting auditory performance of postlinguistically deaf adults using cochlear implants: An update with 2251 patients. Audiology & neuro-otology. 2013; 18:36-47.

3. Hughes, ML, Abbas, PJ. Electrophysiological channel interaction, electrode pitch ranking, and behavioral threshold in straight versus perimodiolar cochlear implant electrode arrays. J Acoustic Soc Am. 2006; 119(3):1538-47.

4. Cohen L., Richardson L., Saunders E., Cowan R. Spatial spread of neural excitation in cochlear implant recipients: comparison of improved ECAP method and psychophysical forward masking. Hearing Research. 2003; 179 (1-2):72-87.

5. Holden LK, Finley CC, Firszt JB, Holden TA, Brenner C, Potts LG, et al. Factors affecting open-set word recognition in adults with cochlear implants. Ear Hear. 2013; 34(3):342-60

6. Internal sales data on file.

7. Shaul C, Dragovic AS, Stringer AK, O’Leary SJ, Briggs RJ. Scalar localization of peri-modiolar electrodes and speech perception outcomes. J Laryngol Otol 2018; 1-7. https://doi.org/10.1017/S0022215118001871

8. Aschendorff et al. Clinical investigation of the Nucleus Slim Modiolar Electrode. Audiology & Neurotology. 2017; 22:169-179. https://www.ncbi.nlm.nih.gov/pubmed/29059669

9. Data on File: US Multicenter CI532 Study. 2018.

10. Cuda, D, Murri, A. Cochlear Implantation with the nucleus slim modiolar electrode (CI532): a preliminary experience. European Archives of Oto-Rhino-Laryngology. 20017; 12:4141. https://www.ncbi.nlm.nih.gov/pubmed/29032420

11. EA32 Electrode Insertion Safety and Performance Study Report. Data on File (Document Number: 473386)

The Cochlear™ Nucleus® 7 Sound Processor is the world’s first and only cochlear implant sound processor you can control from your Apple® or Android™ device when using the Nucleus® Smart App.^1,2 Along with the recent release of the Nucleus Smart App for Android, Cochlear has also added a first-of-its-kind control feature called ForwardFocus* available to compatible smartphone users of the app.

ForwardFocus is a user-activated control feature, which helps the wearer to hear better³ in challenging listening environments. When switched on, the ForwardFocus feature reduces distracting noise coming from behind a person, so they can more easily enjoy a face-to-face conversations.⁴

Cochlear’s industry leading technology, SmartSound® iQ (SSiQ) with SCAN**, seamlessly combines multiple sound algorithms to help patients hear their best by automatically and continually monitoring their environment.⁵ ForwardFocus is an additional clinician-enabled user-activated feature, which will work in conjunction with SSiQ to give the user further improved hearing performance in background noise.

Watch the video below to see how ForwardFocus works.

References:

1. FUN2852 Nucleus 7 Professional Sales Aid.

2. D1333702 Support Animation – Pairing Nucleus 7 with an Android Device.

3. CLTD5606 FDA Study (CIR, D1305388) – Sentence in noise comparing Nucleus SCAN and ForwardFocus (S0N0, S0N3)

4. Cochlear Limited. D1376556.CLTD5709 Acceptance and Performance with the Nucleus 7 Cochlear Implant System with Adult Recipients. 2018 Jan; data on file.

5. Mauger SJ, Warren C, Knight M, Goorevich M, Nel E. Clinical evaluation of the Nucleus 6 cochlear implant system: performance improvements with SmartSound iQ. International Journey Of Audiology. 2014, Aug; 53(8): 564-576. [Sponsored by Cochlear].

* ForwardFocus can only be enabled by a hearing implant specialist. It should only be activated for users 12 years and older who are able to reliably provide feedback on sound quality and understand how to use the feature when moving to different or changing environments. It may be possible to have decreased speech understanding when using ForwardFocus in a quiet environment.

** SNR-NR and WNR are approved for use with any recipient ages 6 years and older, who is able to 1) complete objective speech perception testing in quiet and in noise in order to determine and document performance 2) report a preference for different program settings. SCAN is FDA approved for use with any recipient age 6 years old and older, to be used at the discretion of the recipient/parent/caregiver.

Android is a trademark of Google LLC.

Apple, the Apple logo, FaceTime, Made for iPad logo, Made for iPhone logo, Made for iPod logo, iPhone, iPad Pro, iPad Air, iPad mini, iPad and iPod touch are trademarks of Apple Inc., registered in the U.S. and other countries. App Store is a service mark of Apple Inc., registered in the U.S. and other countries.

The Cochlear Nucleus Smart App is available on App Store and Google Play. For compatibility information visit www.cochlear.com/compatibility