The cochlear implant industry is buzzing with excitement about how small changes to protocol can mean big improvements for patients and clinics alike.1,2,3 On a recent episode of Cochlear’s Beyond the Decibels podcast, Sandy Porps shared insights from the Michigan Ear Institute, highlighting how these changes have helped patients achieve better performance faster and increased the clinic’s capacity to assist more patients.
While the idea of implementing these changes might seem straightforward, the reality can be challenging. To support clinics in this endeavor, Cochlear has developed various tools and services. Let’s explore some of the protocol changes discussed in Sandy’s podcast and the available support for implementing them.
Evidence-based cochlear implant programming
Over the past 30+ years, cochlear implant programming has evolved significantly. Professionals now emphasize the importance of evidence-based changes for MAPs to ensure optimal patient outcomes. Recommended practices include the use of objective measures like Electrical Stapedius Reflex Testing (ESRT) and Neural Response Telemetry (NRT) for fitting of cochlear implants.4,5,6,7,8 Cochlear’s Custom Sound® Pro fitting software integrates these measures seamlessly into the fitting flow. Additionally, Cochlear’s Population Mean provides guidance on typical MAP levels, facilitating faster programming, especially during initial activation.9 Another tool that can support faster fittings is Smart Nav. When used to test NRT in the operating room, the data can be transferred directly from the OR to the clinical database for use during initial activation. These tools aim to ensure programming is evidence-based, enabling patients to achieve stable MAPs quickly after activation.
Reduced post-operative visit schedule
Research suggests that once cochlear implant programming levels are set, they remain relatively stable over time.10,11 This supports a reduced visit schedule for most patients, simplifying care and freeing up appointment slots for those who need them. While in-person visits may decrease, patients will still require support as they adjust to their cochlear implants. Cochlear’s Recipient Solutions Manager (RSM) program offers new recipients assistance with device usage, accessory optimization, aural rehabilitation at home, and preparation for Remote Care. This program provides support to patients allowing audiologists to focus on achieving the best possible care for patients and focus on patients who need more attention. Learn more about the RSM program here.
Use of telehealth to support care
Cochlear’s Remote Care solutions† are designed to support evidence-based models of cochlear implant care. Remote Check allows clinicians to monitor patient performance without requiring clinic visits, reducing overall care costs and improving efficiency while maintaining patient satisfaction.12,13,14 Remote Assist enables clinicians to make routine MAP adjustments remotely.15 Currently, Remote Care is available in over 140 clinics across the US, with more clinics adopting the service each month. Adding Remote Care solutions can be daunting, but Cochlear is here to help. Contact your Cochlear representative or email Services@Cochlear.com for more information.
Supporting patients for self-managed care
Cochlear is committed to supporting patients for a lifetime of better hearing. By placing patients at the center of all we do, we ensure they can self-manage many aspects of their care. With a Cochlear Account, patients can access device and warranty information through myCochlear™ and place orders via the Online Store. The New Recipient Welcome program connects patients to Cochlear from the start of their journey, providing access to support and assistance as needed. Our award-winning customer service team16 is available to help with troubleshooting, reimbursement, repairs, and upgrades—everything patients may need throughout their hearing journey.
Summary
As Sandy mentioned in the Beyond the Decibels podcast, “We need to change, adapt, and grow.” While change can be challenging, it opens up new possibilities for both clinics and patients. Cochlear is here to support you every step of the way. Discover more about Cochlear’s Care Protocol recommendations here and subscribe to the Beyond the Decibels podcast for more thought-provoking discussions about what’s new in our industry.
1 Berg KA, Holder JT, Gifford RH. (2023) Development of an optimized protocol for cochlear implant care to increase cochlear implant access. Otol Neurotol, 44(8):e635-e640.
2 Holcomb M, Smeal M. (2024) How to teach an “old dog” new tricks: Improving clinical efficiency in a well-established cochlear implant program. Otol Neurotol, 45(10):e735-e742.
3 Porps SL, Bennett DM, Gilden J, Ravelo K, Buck B, Reinhart P, Hong R. (2023) Effects of an evidence-based model for cochlear implant aftercare delivery on clinical efficiency and patient outcomes. Cochlear Implants Int, 24(6):352-334.
4 Cochlear Limited (2023) How well are hearing targets met during NFS streamlined fitting? Clinical Investigation Report D755960.
5 Vaerenberg B, De Ceulaer G, Szlavik Z, Mancini P, Buechner A, Govaerts PJ. (2014) Setting and reaching targets with computer assisted cochlear implant fitting. The Scientific World Journal, 2014(1):646590
6 Botros A, Psarros C. (2010) Neural response telemetry reconsidered. I. The relevance of ECAP threshold profiles and scaled profiles to cochlear implant fitting. Ear & Hear, 31(3):367-79
7 DeGraaff F, Lissenberg-Witte BI, Kaandorp MW, Merkus P, Goverts ST, Kramer SE, Smits C. (2020) Relationship between speech recognition in quiet and noise and fitting parameters, impedances and ECAP thresholds in cochlear implant users. Ear & Hear, 41(4):935-47.
8 Holder JT, Henry MR, MacDonald AE, Gifford RH. (2023) Cochlear implant upper stimulation levels: eSRT vs Loudness Scaling. Otol Neurotol, 44(9):e667-672.
9 Maruthurkkara S, Bennett C. (2014) Development of Custom Sound Pro software utilizing big data and its clinical evaluation. Itn Jour Audiology, 63(2):87-98.
10 Gajadeera EA, Galvin KL, Dowell RC, Busby PA. (2017) Investigation of electrical stimulation levels over 8 to 10 years post-implantation for a large cohort of adults using cochlear implants. Ear & Hear, 38(6):736-45.
11 Busby PA Arora K. (2016) Effects of threshold adjustment on speech perception in Nucleus cochlear implant recipients. Ear & Hear, 37(3):303-11.
12 Sorrentino F, et al (2024) Remote Check as a tele-health instrument for cochlear implant recipients: Analysis of impact and feasibility of application. Am Jour Otolaryngol, 45(4):104294
13 Carner M, et al (2023) Personal experience with the remote check telehealth in cochlear implant users: From COVID-19 emergency to routine service. Eur Arch Otorhinolaryngol, 280(12):5293-5298.
14 Maruthurkkara S, Case S, Rottier R. (2022) Evaluation of Remote Check: A clinical tool for asynchronous monitoring and triage of cochlear implant recipients. Ear & Hear, 43(2):495-506.
15 Maruthurkkara S. (2024) Cochlear implant Remote Assist: Clinical and real-world evaluation. Int J Audiol, 64(3):232-242.
16 Newsweek (2024) World’s Most Trustworthy Healthcare Companies.
† Remote Check and Remote Assist for Nucleus sound processors are intended for ages 6 and older. Remote Check and Remote Assist features are only visible and accessible if they are enabled by a clinician. Clinicians should consider the suitability of the feature before enabling Remote Check and Remote Assist. Remote Check does not replace clinical care and does not involve remote programming of the sound processor. Only available at clinics that have enrolled in Remote Care. For sound processor and app compatibility information visit www.cochlear.com/compatibility.
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.
Views expressed are those of the individual. Consult your hearing health provider to determine if you are a candidate for Cochlear technology. Outcomes and results may vary.
