Cochlear Implants
by Cochlear Guest Author

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

July 24, 2020
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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 3DTM 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.

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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:

  1. 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
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. Clinical Evaluation of the Cochlear Nucleus CI532 Cochlear Implants in Adults Investigator Meeting. 2019 Apr.
  7. 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.
  8. 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.
  9. 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.

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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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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.

man and woman travelling

Three days lost at sea: a Recipient/Audiologist recounts his decision to become a bilateral cochlear implant user

November 28, 2017

reliability

After three days lost somewhere in the Caribbean Sea, Mark Campbell-Foster (AuD. and bilateral Cochlear™ Nucleus® recipient) and his Nucleus® 7 were reunited, thanks to a stranger with an underwater metal detector. 

Vacationing with his mother, Denise, in Aruba recently, Mark’s Nucleus 7 and its Aqua+ spent three days underwater* covered by the island’s white sand which made it impossible for Mark or his mom to locate the lost sound processor.  Luckily, Mark was wearing his Kanso® sound processor on the opposite ear and still had one ear to hear!  Relying on one ear reminded Mark of his decision to become a bilateral Nucleus® cochlear implant (CI) recipient and he shared this story…Mark

As a university junior, Mark Campbell-Foster made the decision to receive his first cochlear implant.  That decision was driven, in large part, by his inability to hear his mom over the television one evening.  Mark and his mom, Denise, have always been close and it was her voice that he says, “his brain remembered the most.”  When he could no longer clearly understand her, he made the decision to receive his first Nucleus cochlear implant. Denied by insurance, Mark’s parents offered to pay for the device out-of-pocket – luckily, a second insurance request was approved and Mark could be implanted during the next school break.

MarkAs a young man faced with the choice between two CI brands, Mark says that he chose Nucleus for what he felts was an “edge on design and the availability of a small headpiece coil.”  Today, he is thankful for the ability to continually upgrade to new technology and, as you read earlier, he is glad that Cochlear now offers the Aqua+ to keep his sound processor dry!

After pursuing an Audiology degree at Northeastern University, Mark made the decision to become a bilateral cochlear implant recipient because he felt he would be more successful on the telephone. At that time, Mark was working at a fast pace clinic, and often had to use the telephone with his cochlear implant. This meant relying on the contralateral hearing aid in the opposite ear whenever someone would speak to him when he was on hold. This made listening challenging. However, Mark feels that the decision to go bilateral was actually made harder for him as an audiologist since he felt his hearing aid provided a qualitative aspect to his hearing that he finds hard to pinpoint in words.

Once implanted, Mark’s friends and family noticed improvements in his ability to communicate, reporting to Mark subtle improvements in the clarity of his speech. From his perspective, Mark felt that the first CI was “the cake” and the second CI became “the icing on the cake.” This allows him to walk into the clinic’s waiting room without worrying whether his next patient was seated on the left or the right side of the room because he knew he would hear them no matter where they were seated.

Able to speak from a point of authority both as a recipient and as an audiologist, Mark routinely works with CI clinics on the east coast and often finds himself counseling patients about the decision to receive a cochlear implant.  Mark was recently recognized as Cochlear’s field team member of the year.

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* The Nucleus® 7 Sound Processor is water resistant to level IP54 of the International Standard IEC60529. The Nucleus 7 Sound Processor with the Aqua+ is water resistant to level IP68 of the International Standard when used with LR44 alkaline or nickel metal hydride disposable batteries.
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