Cochlear Implants
by Cochlear Guest Author

New research shows benefits of using advanced technology

January 27, 2022
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Give your patients access to significantly better sound

Hearing in a noisy world remains one of the biggest challenges for cochlear implant recipients. Speech recognition nearly always involves listening in background noise, often with dynamic sources and different presentation levels.1

In a new real-world study, recipients found speech to be significantly clearer in everyday listening environments when they upgraded their current Cochlear™ SPrint™, ESPrit™, Freedom®, Nucleus® 5 or Nucleus 6 Sound Processor to the Nucleus 7 Sound Processor.2

Superior speech recognition benefits

In real-world acoustic environments, where competing dynamic noise originates from the sides and behind the listener, the Nucleus 7 Sound Processor with ForwardFocus† enabled, provided on average a 7.54 dB superior speech recognition benefit^ compared to the participants’ current sound processor, when used with their preferred program for listening in noise every day.2

Significant self-perceived benefits

The Speech, Spatial and Qualities of Hearing Scale3-5 (SSQ-12*) questionnaire self-perceived results showed that the Nucleus 7 Sound Processor provided significant benefit compared with the participants’ existing sound processors in their daily listening environments.2

Our most advanced sound processing technology

The Nucleus 7 Sound Processor features:

  • SmartSound® iQ with SCAN using dual microphone technology, designed to help your patients automatically hear better in a range of challenging environments. ∞
  • ForwardFocus is designed to reduce distracting noise from behind, making it easier for your patients to focus on face-to-face conversation. †

By accessing a next generation Nucleus 7 Sound Processor, your patients can benefit from advances in technology that help them enjoy clearer conversation, even in challenging and noisy listening environments.

To find out more about the patient benefits of upgrading to the Nucleus 7 Sound Processor, visit our website.

1 Hey M, Hocke T, Böhnke B, Mauger SJ. ForwardFocus with cochlear implant recipients in spatially separated and fluctuating competing signals – introduction of a reference metric. Int J Audiol. 2019;58(12):869-878.

2 Zhang J, Morgan C, Deng XC, Wang Y, Lee M.  Hearing Performance Outcomes in Cochlear Implant Users after Nucleus® 7 Sound Processor Fitting. ACI Alliance Conference Poster. April 2021.

3 Gatehouse S, Noble W. The Speech, Spatial and Qualities of Hearing Scale (SSQ). Int J Audiol. 2004;43(2):85–99.
4 Noble W, Jen-sen NS, Naylor G, Bhullar N, Akeroyd MA. A short form of the Speech, Spatial and Qualities of Hearing scale suitable for clinical use: the SSQ12. Int J Audiol. 2013 Jun; 52(6): 409–412.
5 Liu J, Zhang J, Wang N, Li H, Fu X, Guo X, Fu L. Validation of the Chinese Translation of Speech, Spatial and Other Qualities of Hearing Scale for Parents. CN J. Otol. 2021; April In press. DOI: 10.3969 / j. issn. 1672-2922.2018

* Adults used Adult SSQ-12 and Children used P-SSQ-12. References 3-5.

^ Measured as a group mean SRT improvement.

† 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, WNR and SCAN 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.

In this study, Mandarin-speaking Chinese recipients were assessed using their current sound processor (ESPrit™, Sprint™, Freedom®, Nucleus 5 and Nucleus 6) then again after up to one-month use with the Nucleus 7 Sound Processor.

Author

Cochlear Guest Author

In an effort to keep our content fresh and reflective of a diverse industry, Cochlear Americas features a mix of employees and professional partners to contribute to Cochlear ProNews as Guest Authors.

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Slim Modiolar electrode

Journal Club: Speech recognition as a function of the number of channels in perimodiolar electrode recipients

September 12, 2019
Research updates

By Mary Beth O’Sullivan, Professional Education Manager, Cochlear Americas

Berg, K.A., Noble, J.H., Dawant, B.M., Dwyer, R. T., Labadie, R.F., Gifford, R. H.
Journal of the Acoustic Society of America
145 (3), 1556-1564
March 2019

In today’s busy clinical environment, clinicians who value research-based practice often struggle to keep up with current literature. To help, we’re excited to offer a new ProNews Blog monthly feature – Journal Club! Each month, rotating guest authors will present a current journal article summary.

This month’s Journal Club explores a recent study by the team at Vanderbilt University Medical Center in a March 2019 publication, Speech recognition as a function of the number of channels in perimodiolar electrode recipients. As was pointed out during a recent symposium presentation, the data from this study presents clear and direct clinical implications that can be implemented immediately.

What did the study investigate?
The article presents two different experiments in an effort to examine:

  1. Number of active electrodes required for best outcomes
  2. Effect of increasing the default number of maxima from 8 to 16

Why is this important?
Landmark studies¹⁻³ published decades ago evaluated this same question regarding the number of active electrodes to achieve best outcomes. Since that time, it has been standard practice to make clinical decisions based on those findings – namely that performance does not improve with more than 4-8 active electrodes. However, those benchmark studies used straight electrode arrays – not with perimodiolar arrays where the spread of excitation is minimized through closer proximity to the modiolus. With increasing use of perimodiolar arrays and other advances in CI technology, coding strategies, surgical approaches and candidacy criteria, the authors felt it was time for a fresh look at these questions.

How did they do it?
Below summarizes the key elements of study design and demographics:
• 30 subjects, age 24-87
• Minimum of 6 months of use for Experiment I, 3 months for Experiment II
• Placement of array confirmed and electrode-to-modiolus distance measured via imaging and 3D reconstruction
• All current favorite MAPs were 900 Hz rate/25 ms pw; no changes were made.
• Front end features were disabled with the exception of Autosensitivity Control (ASC) and adaptive dynamic range optimization (ADRO).

I. 11 of the 30 subjects participated in Experiment I. Criteria specific to this experiment required that all 22 electrodes were in scala tympani with at least 18 electrodes active in their current favorite MAP.
• 5 MAPs were created based on the current favorite MAP with varying numbers of electrodes activated: 4, 8, 10, 16 and “all on” (consistent with number in use in the favorite MAP). Loudness was adjusted globally.
• Number of maxima matched number of electrodes up to 16 maxima
• Speech perception was evaluated using CNC words, AzBio sentences in Quiet, and AzBio Sentences at +5 SNR.
• Sound quality ratings were assessed using the quick spectral modulation detection (QMSD) test⁴.

II. All 30 subjects participated in Experiment II. In the “all on” condition (at least 18 electrodes active in their preferred MAP), testing was conducted with two conditions.
• Default 8-maxima MAP and 16-maxima MAP.
• Performance with each MAP was evaluated using CNC words and AzBio sentences at +5 SNR.
• Electrode-to-modiolus distance was available for 23 of the 30 subjects.

Results
Based on the study, the graphs below show that increasing the number of electrodes resulted in improved performance and sound quality. Findings were statistically significant in several areas of statistical analyses with the strongest findings demonstrating that the subjects with the electrodes closest to the modiolus had the best performance. The optimal MAP had all electrodes active (per their favorite MAP) with 16 maxima.

Discussion
The authors hypothesize that perimodiolar electrodes effectively minimize overall charge level requirements which allows better control over the negative effects of channel interaction. This is supported by the findings in this study demonstrating improvements in spectral resolution in the portions of the study that directly assess that feature. It should be noted that by changing the number of maxima to match the number of active electrodes, the participants were utilizing CIS MAPs. The evidence that perimodiolar arrays enable optimal outcomes based on position in the cochlea is great news for patients, and clinicians now have a new and better reference when addressing outcomes when the number of active electrodes is a concern.

Learn more about this exciting clinical strategy by accessing the publication here and stay tuned for next month’s edition of Journal Club!

About our guest author: Mary Beth O’Sullivan is a Professional Education Manager at Cochlear Americas, creating educational opportunities for cochlear implant professionals using research and best practice guidance. Mary Beth has been an audiologist for 20 years, working in clinical settings ranging from large university hospitals to private practice prior to dedicating herself to the education side of the field.

References

  1. Fishman, K.E. Shannon, R. V., and Slattery, W.H. (1997). “Speech recognition as a function of the number of electrodes used in the SPEAK cochlear implant speech processor,” J. Speech lang. Hear Res. 4, 1201-1215.
  2. Friesen, L.M., Shannon, R. V., Baskent, D., and Wang, X. (2001). “Speech recognition in noise as a function of the number of spectral channels: Comparison of acoustic hearing and cochlear implants,” J. Acoust. Soc. Am. 110, 1150-1163.
  3. Shannon, R.V., Cruz, R.J., and Galvin, J.J. (2011). “Effect of stimulation rate on cochlear implant users’ phoneme, word and sentence recognition in quiet and in noise,” Audiol. Neurotol. 16, 113-123.
  4. Gifford, R. H., Hedley-Williams, A., Spahr, A.J. (2014). “Clinical assessment of spectral modulation detection for adult cochlear implant recipients: A non-language based measure of performance outcomes,” Int. J. Audiol. 53, 159-164.
Camille Dunn, AuD

SSD/UHL treatment considerations: Q&A with Camille Dunn, AuD

April 19, 2022

By Camille C. Dunn, PhD, CCC-A, Assistant Research Professor, Director, University of Iowa Cochlear Implant Program Department of Otolaryngology—Head and Neck Surgery

Camille Dunn, AuD

Recently, we met with a diverse group of thought leaders to explore best practices for single-sided deafness (SSD)/unilateral hearing loss (UHL). Hear from Dr. Dunn on her experience treating these patients:

What clinical considerations are in your treatment pathway for SSD/UHL Patients?

We consider an array of treatment options such as osseointegrated solutions, CROS hearing technology and a cochlear implant. We have a document that we go over with patients so that they can have an understanding of what each type of technology can and cannot provide for the patient. We do an extensive interview with the patient to understand their hearing history (i.e. duration of loss, etiology), lifestyle, demographic and other medical factors and goals for seeking treatment for their SSD.  Based upon this interview, we discuss with the patient which of the treatments would be best or most realistic to help them accomplish their listening goals.

Do you think that the counseling process should include discussion on bone conduction and cochlear implant hearing solutions?

It absolutely should include all of the patient options. If the patient is choosing a cochlear implant, they need to understand that hearing with a CI is a lifelong commitment. Different than someone with bilateral severe-to-profound SNHL, the CI will not ever be their “good ear.” The CI will serve to supplement the normal hearing ear to accomplish spatial hearing abilities. They will have to commit to utilizing the CI effectively by doing listening exercises and wearing the CI all waking hours.  As with any type of exercise, consistency is key.

Why is the ability to treat patients with UHL/SSD with cochlear implants important to audiologists, surgeons and patients?

As a medical professional, we are trained to want to provide treatments to our patients. This situation is no different.  Patients coming to our clinic who have had gradual progressive hearing loss (maybe even in both ears) for several years have had a chance to accommodate situations with their gradually changing hearing loss.  For patients with sudden SSD, they often come to our clinics feeling very debilitated and scared. They suddenly cannot localize sound (or understand speech in adverse listening situations). Imagine hearing your child cry for help and you have no idea where to look for your child to provide them help because you cannot localize where the sound is coming from? Imagine working in a warehouse and all of a sudden you have no idea which direction the beeping is coming from warning you that there is a forklift nearby? All of these situations are life-altering for individuals with SSD.  When you let that patient know that there is an option to restore hearing to the deafened ear, you can immediately see a level of calm come over these patients.  

What would you tell a provider that is hesitant to explore CI as a treatment option for UHL/SSD?

I would tell them that there is good reason to be hesitant. When we first started implanting patients with SSD I thought that we were crazy!  I thought that there was no way that a person with normal hearing would want to listen to the sound from a CI in their deafened ear. I was wrong. I would also tell them that counseling these patients and preparing them for a CI is a bit different than what we used to call our traditional CI patients (because what is traditional these days?). Testing these patients for progression and benefit from their CI is a bit different than listeners with standard bilateral SNHL.  I would recommend reaching out their cochlear implant representatives to ask them to guide them through the initial processes of providing care and counseling to these patients so that their patients can have successful outcomes.   

Tell us about your experience at the SSD Thought Leader Meeting and what that means for the industry?

The SSD Thought Leader Meeting provided a dynamic avenue for professionals to come together and discuss their experience working with individuals with SSD who get a CI. I believe that together we accomplished a lot. We all came together to develop a consensus on the best way to, not only better understand the benefits of CI for SSD, but treat, counsel and better understand the needs of these patients. They are different than other listeners who have traditionally gotten a CI and because of that, they need to have their own platform of care.

Hear more from another Thought Leader Meeting attendee, Andrea Overton, AuD, and check out our recent FDA approval for CI for SSD.

Camille Dunn, PhD, joined the Department of Otolaryngology—Head and Neck Surgery at the University of Iowa in 2003 where she is an Associate Professor and the Director of the Cochlear Implant Program.  She received her Master of Science degree in 1998 and Doctor of Philosophy Degree in 2003 both from the University of Nebraska-Lincoln. Dr. Dunn holds her Audiology license from the State of Iowa. She maintains her Certificate of Clinical Competence in Audiology (CCC-A) and is a member of the American Speech-Language-Hearing Association (ASHA) and a Board member on the American Cochlear Implant Alliance (ACIA). She is a Principal Investigator on a NIH-funded grant to determine the impact of intervention on user’s hearing-related functions and disability in their natural environments.

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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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