Cochlear Implants
by Jamie Schwartz

ForwardFocus can help your Nucleus® 7 patients hear better in noisy environments

October 10, 2018
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Nucleus 7

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

ForwardFocus

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.

 

Cochlear logo

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
Author

Jamie Schwartz

Jamie is the Associate Marketing Manager in the Product and Professional Marketing Department at Cochlear Americas. Jamie is responsible for ProNews blog content as well as professional social posts and calendars. If you are interested in being a guest author for the ProNews blog please contact Jamie by email at jschwartz@cochlear.com.

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Nucleus System

Cochlear expands treatment options for individuals with single-sided deafness

March 24, 2022

By Ryan Lopez, Director, Nucleus Product Management & Marketing

In January 2022, Cochlear received FDA approval to treat patients with single-sided deafness (SSD) with the Cochlear™ Nucleus® System. This approval expands treatment options to include both bone conduction solutions and cochlear implants for these patients.

“This indication allows patients experiencing UHL/SSD to get as close to the normal condition as possible as a cochlear implant restores hearing ability to the ear that has hearing loss. This allows me to provide for my patients so they can get back to the condition that they had been used to before their hearing loss.”

-Eric Lupo, MD Rocky Mountain Ear Center

While this is an extremely important landmark, we want to ensure that professionals have the resources they need to provide the best treatment option for each individual’s unique hearing loss and needs. The first step in the counseling process is to help candidates understand the potential impact of single-sided deafness within their daily lives. While individuals with SSD can function well in relatively easy listening situations, bringing awareness to the disruption in their ability to understand speech in adverse listening situations, their ability to localize sound, and the mental fatigue associated with daily listening efforts, is vital.

Age and duration of hearing loss is a key consideration and starting point for determining the best solution for individuals with single-sided deafness. For children under five years of age, Cochlear offers Softbands and SoundArcs™, non-surgical bone conduction solutions. This is important because early access to improving speech understanding is of highest priority. For children ages five to twelve, Cochlear expands the bone conduction offering with the Baha® Connect and Attract Systems, as well as a portfolio of Nucleus cochlear implant solutions. Finally, for individuals twelve and older, in addition to cochlear implants, the Cochlear Osia® System combines the best high frequency amplification with unique piezoelectric stimulation without a percutaneous abutment.

With regard to cochlear implants, one of the core advantages is the restoration of binaural hearing and improved ability to localize. Candidacy is dependent on the presence of a functioning nerve in the impacted ear and a duration of less than 10 years since the onset of the hearing loss. With acoustic neuroma being one of the leading causes of unilateral hearing loss, the FDA has approved Cochlear to remove the acoustic neuroma contraindication from its labeling.

This ensures that individuals with a functioning nerve, pre- or post-acoustic neuroma removal, can still have a cochlear implant option.

With more options come more decision points. This is why we’re committed to partnering with leading professionals in the industry and developing clinical guidance tools to support you and your patients throughout the journey to better hearing

Please reach out to your local Cochlear Representative to learn more about these solutions and clinical guidance resources.

Read more about the treatment pathway for SSD patients here.

Slim Modiolar electrode

Is hearing preservation possible with the Slim Modiolar electrode?

November 7, 2019

By Wade Colburn, Product Manager – Cochlear Implants

As we become more confident in cochlear implant outcomes, more patients with residual hearing are being evaluated for cochlear implant candidacy. The questions that often arise include:

  1. How do we manage these patients?
  2. What electrodes should be used to preserve and maximize acoustic hearing?

The perimodiolar electrode is a rapidly growing category of electrodes, but has historically been categorized as an electrode for traditional cochlear implant candidates with limited residual hearing. With the introduction of the Slim Modiolar electrode, an electrode with a slim atraumatic design with consistent in placement within scala tympani and close to the modiolus1-3, the question stands – is hearing preservation possible with the Slim Modiolar?

Progress in Preservation

Preservation is not easily defined, but it is well understood that there are two types of preservation: structural and functional.

Structural preservation, meaning the limited disruption of the cochlea and consistent scala tympani placement, is the first step to functional hearing preservation.

Functional preservation maintains residual hearing that can be amplified acoustically. Combining electric and acoustic hearing has been attributed to improvements in sound quality, music and speech in background noise.3

A recently published consensus paper that considered the standardization of hearing preservation and other metrics defined functional hearing as patients with a pure tone average (PTA) > 80 dB HL at 125, 250 and 500 Hz.4

Structural Preservation

During the development of the Slim Modiolar electrode researchers looked to take the great hearing outcomes of the Contour Advance, and improve upon them by focusing on key design goals:

• Goal: Thin, atraumatic design

Result: With the world’s thinnest full length perimodiolar electrode, the Slim Modiolar takes up to 60% less volume in scala tympani.5 This was achieved by developing a sheath-based system.

• Goal: Insertion via round window

Result: With approval for round window and extended round window insertions, Slim Modiolar allows for the ability to obtain the access to the cochlea desired.

• Goal: Consistent scala tympani placement

Result: The importance of scala tympani placement is well understood. With the Slim Modiolar electrode, consistent scala tympani placement is achieved with a range of studies showing anywhere between 89 to 100% placement within the scala tympani.3,6

Since the introduction of the Slim Modiolar, outcomes evidence collected has demonstrated successful achievement of atraumatic insertions and structural preservation. For example, in a large bone study, the Slim Modiolar Electrode was able to preserve the delicate structures of the cochlea, with no intracochlear trauma in 98% of the specimens.1,2

Functional Preservation

In his publication, Surgical Experience and Early Outcomes With a Slim Perimodiolar Electrode, Dr. David Friedmann from NYU explores some implications of functional preservation – specifically 6-month speech perception on CNC word (N=94).7

The evidence presented is based on a subset of the 237 Slim Modiolar recipients implanted at NYU since Slim Modiolar was launched in 2016.

Some key findings include:
• 43/94 patients with preoperative unaided LF-PTA < 80 dB7
• 16/43 (17 ears) (37%) patients maintained a LF-PTA mean thresholds at 250 and 500 Hz better than 80 dB at initial activation6
• Average threshold shifts 20.1 dB at initial activation7

Based on presented outcomes, Friedmann states, “Hearing preservation is possible with a number of patients utilizing acoustic low frequency hearing in conjunction with electric stimulation from their CI.”

Setting a New Benchmark

According to a growing compendium of evidence, the Slim Modiolar redefines what is possible with a perimodiolar electrode. With proven structural preservation and published functional preservation6 in traditional cochlear implant candidates, it opens the door for further research to be done showing that preservation is possible with the Slim Modiolar.

The Slim Modiolar electrode array is available on the newly released Profile Plus CI600 series (CI632).

To learn more about the Slim Modiolar electrode please watch this video now or visit our website.

About the author: Wade is the Product Manager for 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, but comes from an engineering background with the medical device field, including previous otology experience. 

References:

  1. Cochlear Limited. 588021.CI532 Temporal Bone Usability Test Report. 2014; Data on file.
  2. Cochlear Limited. 415680. EA32 Electrode Insertion Safety and Performance Study. 2015; Data on file.
  3. Clinical Evaluation of the Cochlear Nucleus CI532 Cochlear Implants in Adults Investigator Meeting. 2019 Apr.
  4. Cochlear Limited. 028-M270-03. Hi-Focus Mid-Scala Electrode brochure and Flex 2. Data on file. https://www.advancedbionics.com/content/dam/ab/Global/en_ce/documents/professional/HiFocusMid-Scala_Electrode_Brochure.pdf
    https://s3.medel.com/downloadmanager/downloads/maestro_2013/en-GB/22676.pdf Aug. 2016
  5. Adunka O, Gantz B, Dunn C, Gurgel R, Buchman C. Minimum Reporting Standards for Adult Cochlear Implantation. Otolaryngol Head Neck Surg. 2018 Aug;159(2):215-219. doi: 10.1177/0194599818764329. Epub 2018 Mar 20.
  6. Friedmann et al. Surgical Experience and Early Outcomes With a Slim Perimodiolar Electrode. NYU Cochlear Implant Center. Otology & Neurotology, Vol 40, No. 3,2019.
  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
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This material is intended for health professionals. If you are a consumer, please seek advice from your health professional about treatments for hearing loss. Outcomes may vary, and your health professional will advise you about the factors which could affect your outcome. Always read the instructions for use. Not all products are available in all countries. Please contact your local Cochlear representative for product information.

 

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