by Michaela Coon

New TECH Talk: Implant reliability and a new standard

October 17, 2019

Dr. Brian Kaplan, cochlear implant surgeon and Senior Vice President of Clinical Strategy & Innovation at Cochlear, reviews the challenges clinicians have faced over the years to obtain consistent reliability data from manufacturers. As a result, this affected their ability to answer patients’ questions regarding implant safety and reliability.

The lack of a standard definition for an implant failure magnified the differences in manufacturers’ reporting methods and the need for consistency. Traumas, life stages and legacy products were also classified differently within these reliability reports.

As explained by Dr. Kaplan, a new AAMI standard calculates overall failure rates of the implant, regardless of the cause, and an assessment for external sound processors for the first time¹. The report also covers the life cycle of the entire product portfolio and legacy products.

This AAMI standard can provide clinicians with the tools to confidently make decisions and to provide patients with an honest assessment of overall failure rates within the entire cochlear implant system through a standardized method for manufacturers to report reliability data¹.

Watch now to learn more about reliability reporting and how the new standard can impact you.

For more TECH Talk videos from industry experts, subscribe to the ProNews Blog and visit our TECH Talks page.

References:

AAMI:2017 CI86 Cochlear Implant Systems: Requirements for safety, functional verification, labeling and reliability reporting.

Supporting the benefits of bimodal hearing: ReSound ENZO Q™ and the Smart Hearing Alliance

July 24, 2020

By Natasha McDougald, Product Manager, Bimodal and Hybrid Hearing

Discussions around the importance of acoustic input from both ears in individuals with hearing loss started as a key discussion with Schroers and team in 1985.¹ Since then, research has occurred in both the acoustic and electric (cochlear implant) arena, with recent articles discussing electric and acoustic hearing contributing to the bimodal condition.

Dr. Jennifer Schumacher, audiologist with GN Hearing, recently authored a white paper supporting the benefits of bimodal hearing. She highlights key benefits of patients in the bimodal condition in the everyday listening environment, and speaks to recent research showing speech understanding improvements with the addition of a hearing aid when compared to using a cochlear implant alone in both quiet and noisy environments.^2-4

Real-world benefit was not just limited to speech performance outcomes, but also improvements in rated satisfaction with sound quality and spatial perception.⁵ These outcomes parallel the results in Cochlear’s Multicenter Study featuring the Slim Modiolar electrode, where patients experienced a 40 percentage point gain in CNC words in quiet and a 24 percentage point improvement in noise.⁶

Additionally, subjects in the Cochlear study demonstrated an improvement in reported satisfaction with their hearing performance. Pre-operatively, only 9% of subjects reported satisfaction using bilateral hearing aids. Post-operatively, 95% of subjects reported satisfaction in their overall listening ability while wearing a bimodal solution in a device use questionnaire.⁶

Speech Understanding with Cochlear Implant and Hearing Aid (N=94)

**p = < 0.001

Moreover, while some patients fit bimodally will see benefit, the amount varies from person to person, and others may be appropriately suited for bilateral cochlear implants. Factors that may affect this outcome include a consistent practice of fitting the other ear acoustically for unilateral cochlear implant recipients, and the amount of hearing benefit gained from the acoustic input.

Schumacher mentions that participants at the New York University School of Medicine study by Neuman et al. in 2017 were more likely to discontinue hearing aid use when they had poorer mid-to high-frequency hearing loss in the non-implanted ear and no significant increase in speech understanding with addition of the hearing aid. She postulates beyond the factors discussed that optimal fitting of the hearing aid may assist in success with bimodal hearing.⁷

The author introduces the Smart Hearing Alliance, a collaboration between Cochlear and ReSound that aims to develop hearing solutions that meet the advanced innovation needs of both patients and professionals. Cochlear and ReSound have released an updated fitting flow with simple steps designed to maximize audibility, incorporating loudness balancing driven by conversational speech, and supports selection by the hearing healthcare provider of various fitting rationales including the ReSound proprietary Audiogram+. Instruction is also provided to enable direct wireless streaming and assist in wireless accessory setup.

The Smart Hearing Alliance’s implementation of connectivity allows patients to take advantage of direct streaming to both ears from compatible smartphones. Further, use of wireless accessories has been confirmed by independent studies increase a bimodal patient’s speech understanding via mobile phone and to supply signal-to-noise ratio improvements, which could aid speech understanding in noisy environments.^8-9

The new ReSound ENZO Q™ behind-the-ear hearing aid for severe-to-profound hearing losses may be uniquely suited to the needs of a bimodal patients. It offers an upgraded chip allowing direct connectivity to compatible Apple® or Android™ smartphones* and has an IP rating standard of 68 and completely nanocoated to assist in resistance to moisture and to increase durability. To provide high quality amplification of the wide range of everyday sounds, the ReSound ENZO Q 98 model features an increased input dynamic range extending to 113 dB SPL as well as 145 SPL peak output. Bimodal patients who want to travel less, or are served by a separate cochlear implant audiologist and HCP, can use the ReSound Smart 3D^TM app on their compatible smartphones to take advantage of ReSound Assist Live for live synchronous support or remote hearing aid fine-tuning requests via the asynchronous ReSound Assist feature. These types of remote features may be especially useful for patients and their clinicians when navigating this new patient care paradigm.

To stay up to date on the latest industry topics, subscribe to Cochlear ProNews and read the article now.

About the author: Natasha has worked at Cochlear Americas for almost 9 years partnering with clinicians and surgeons at the University of Miami, UCSF, Stanford, UC Davis and UCSF Benioff Children’s Hospital of Oakland to bring cochlear implants to pediatric and adult patients. Extremely passionate, Natasha is professionally and personally invested in the implantable hearing industry and strives to forward the cause of those affected by hearing loss.

References:

Schroers, K.K & Olsen, W.O. (1985). Comparison of Monaural and Binaural Hearing Aid Use on a Trial Period Basis. Ear and Hearing, 6(4), 198-202
Potts LG, Skinner MW, Litovsky RA, Strube MJ, Kuk F. Recognition and localization of speech by adult cochlear implant recipients wearing a digital hearing aid in the nonimplanted ear (bimodal hearing). Journal of the American Academy of Audiology. 2009;20(6):353-73.
Ching TY, Incerti P, Hill M. Binaural benefits for adults who use hearing aids and cochlear implants in opposite ears. Ear and Hearing. 2004;25(1):9-21.
Ching TY, Van Wanrooy E, Dillon H. Binaural-bimodal fitting or bilateral implantation for managing severe to profound deafness: A review. Trends in Amplification. 2007;11(3):161-92.
Schafer EC, Amlani AM, Paiva D, Nozari L, Verret S. A meta-analysis to compare speech recognition in noise with bilateral cochlear implants and bimodal stimulation. International Journal of Audiology. 2011;50(12):871-80.
Clinical Evaluation of the Cochlear Nucleus CI532 Cochlear Implants in Adults Investigator Meeting. 2019 Apr.
Neuman AC, Waltzman SB, Shapiro WH, Neukam JD, Zeman AM, Svirsky MA. Self-reported usage, functional benefit, and audiologic characteristics of cochlear implant patients who use a contralateral hearing aid. Trends in Hearing. 2017;21:1-14.
Wolfe J, Morais M, Schafer E. Speech recognition of bimodal cochlear implant recipients using a wireless audio streaming accessory for the telephone. Otology & Neurotology. 2016;37(2):20-5.
Vroegop JL, Dingemanse JG, Homans NC, Goedegebure A. Evaluation of a wireless remote microphone in bimodal cochlear implant recipients. International Journal of Audiology. 2017;56(9):643-9.

The Cochlear Nucleus 7 Sound Processor is compatible with iPhone, iPad and iPod touch. 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.

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

App Store is a service mark of Apple Inc., registered in the U.S. and other countries.

Android and Google Play are registered trademarks of Google Inc.

The Android robot is reproduced or modified from work created and shared by Google and used according to terms described in the Creative Commons 3.0 Attribution License.

Connecting with patients during COVID-19: Q&A with Alison Vega, AuD

June 17, 2020

Alison Vega, audiologist and Owner of Ascent Audiology & Hearing, discusses her 20 years of audiology experience and how her personal patient care has evolved in the current healthcare landscape.

What initially drew you to field of audiology and working with hearing implants?

I originally went to college to become a high school guidance counselor to help people find their path and reach their goals. When I began studying psychology at Western Washington University, I didn’t find my passion right away. So, I read Time Magazine’s “Top 10 professions of the next decade” and saw that audiology was #1 on the list (in 1995).

I knew nothing about audiology, but my family owned nursing homes and they contracted with speech language pathologists and audiologists to come in and work with patients. I enrolled in an Intro to Communication Disorders class the next semester and I was hooked! I finally felt like I found my niche and was encouraged by mentors to earn my AuD (even though I said that I would never go on for a doctorate). I was invited to attend Utah State University and I was one of three that graduated in their inaugural class!

I worked for an ENT group for seven years after graduation. During my time there I learned about the causes of hearing loss and treatment options, most of which they didn’t perform. I decided to open my multi-disciplinary private practice in 2011 and have achieved my goal offering treatment without limits. Adding cochlear implant services was always a dream. I talked to a rep at a conference one year who told me that I should consider adding cochlear implant services to my office. She told me about a Cochlear Provider Network of private practice audiologists that work with surgeons. I was so excited! I think I said yes before she even asked me if I wanted to join – I pretty much invited myself.

What Cochlear resources or services do you and your patients find most helpful during their cochlear implant journey?

I love using the aural rehabilitation program booklet that helps with sound identification. I think this is a wonderful resource! It gives patients tangible and easy-to-use lessons that are important at the beginning of the hearing journey. One of my patients uses it during a coffee date with her daughter every week – they go through a few lessons and her daughter helps identify sounds. It is really sweet.

How has the COVID pandemic changed the way you deliver care?

I have definitely changed the way that I work with patients, including phone call frequency. At first it was just to check in and to triage their level of need for a face-to-face appointment. Before COVID-19, I didn’t call patients because I didn’t have time and I couldn’t charge for it. Now, it is the only connection that I have with my patients. In a strange way, the physical distance has brought us emotionally closer because we are sharing this bizarre experience.

How will telehealth change the clinical care landscape?

I think our previous perceived barriers of telehealth, such as billing, are now broken with the recent changes in Medicare coverage. I think telehealth will be a staple of my business in the future. Telehealth allows for a more casual appointment, giving a feeling of friendship, like patients are allowing me into their home. I believe patients like it because it takes away the logistics of getting to the office and stress that they may have around making the appointment. They feel like I am going the extra mile to help them, when telehealth is actually easier for me too! When I am meeting with a patient, I am able to stay on task better and be more efficient.

How have you been leveraging social media to serve patients?

I really began to pay more attention to my social media channels this January. I still don’t know how to do much, but I am trying to create organic content weekly. My goal is that patients will use my Facebook page as a real-time way to see what’s going on at my clinic, such as, “We are closed today for the holiday…. Here is how you can reach us….. This is the plan…”

Any specific patient stories during the COVID crisis?

At the beginning of the crisis, I decided that we should call everyone in our database over the age of 80 to check in – not so much for appointments, but to see if they had a support system or to see if we could physically help them with anything. Thankfully, most patients were fine. I did call one patient and found out that he lives alone and his son lives in California. When I asked “Is there anything I can do for you? Anything at all?” He asked me “Can you bring me facial tissue?” Then he asked if I would bring him Almond Milk, because the food bank won’t bring him that. I was so touched that he needed these things from me that I agreed to all of them. So, I drove to his house and put his mail, the tissue and the milk on his front doorstep. I knocked on the door and told him that I was there and leaving the items. He yelled from inside “Thank you! Now go away!” It made me smile.

I also have gotten creative about how to serve patients in the parking lot for those desiring a physical visit amidst the shutdown, still following guidance. I kept my clinic open during the shutdown but I continued to see patients in the parking lot. Most patients needed hearing aid repairs or cleanings and some needed to order replacement devices. I had at least 6-10 patients a day! I found myself performing hearing aid programming with the devices in the patients’ ears, but while they were sitting in their cars. Sometimes to get physically closer to the patient I had to put my laptop on the hood the car so that I could make the programming adjustments and, with their window rolled down, I asked them if they liked the programming changes. It isn’t exactly best practice, but it got the job done and I have happy patients. Again, they see me going above and beyond standard services and it means so much to them. That’s really my goal.

Anything else to add?

Another project that I tackled during quarantine was a newsletter. I felt like if anyone was ever going to read mail, it was now. So, I snapped a selfie of myself and my kids, wrote a little blurb about focusing on all that is going right in the world and in our lives, added a crossword puzzle and a little healthcare snippet on telehealth options. The big wins here were that it helped me clean up my database and some patients sent ME thank you cards! We received a lot of mail back and we were able to figure out who had moved or what addresses we had wrong in the system. It was also like a lifeline to some of my older patients who don’t have a lot of family who send them letters. I am thinking about doing this quarterly.

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About the author: Alison Vega, Au.D., is the owner of Ascent Audiology & Hearing. She specializes in the diagnosis and treatment of hearing loss. A native to the Northwest, Dr. Vega has over 20 years of experience in audiology. She earned her bachelor’s degree at Western Washington University and her doctorate in audiology (Au.D.) at Utah State University. Dr. Vega opened her private practice in 2011 so that she could bring a broader scope of comprehensive evaluations and innovative treatment options to the greater Olympia area.

Dr. Vega was named the Outstanding Young Professional in 2005 and she received the 40 under 40 award in 2013. She serves on the board for the Washington Center for the Performing Arts as well as the board of Hearing and Speech for the Department of Health. Dr. Vega is a member of the Academy of Doctors of Audiology, the American Academy of Audiology, the Washington Academy of Audiology, and the Washington Audiology Alliance.

This reflects the views of Dr. Vega.