Cochlear Implants
by Cochlear Guest Author

New evidence supports the performance benefits of ForwardFocus

September 19, 2019
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Nucleus 7

By Amy Donaldson, Professional Education Manager

Your patients now have the freedom to focus on what matters – connecting with others.

Incorporated as a standard feature on the Nucleus® 7, ForwardFocus* is a revolutionary setting that goes beyond the state-of-the art scene analysis and adaptive directional microphones of SmartSound iQ® and allows users to enable maximum focus on what matters most to them. It is specially designed for the most challenging listening environments, such as listening to speech in a busy restaurant. 

ForwardFocus is intelligently designed to attenuate distracting noise from behind the listener, making it easier to enjoy face-to-face conversation and maximizing understanding of speech from the front.¹  It differs from the automated directionality in SmartSoundiQ by providing a more focused listening experience.  In an internal study using roving background noise, an average improvement of 2.9 dB was seen for speech recognition thresholds in noise over the default SCAN** program.1 In that same study, 88% of Nucleus 7 recipients recommended ForwardFocus for use in cafes and restaurants.

Evidence supporting the use of ForwardFocus in challenging listening environments is emerging beyond Cochlear’s internal studies.  A recent study from Germany compared ForwardFocus to BEAM (the directional microphone utilized within SmartSound iQ).2  A significant improvement of 5.8 dB was seen using the ForwardFocus program in 3-talker babble (noise presented from fixed positions of 90°, 180° and 270°), bringing performance closer to normal than with BEAM. 

Using ForwardFocus, recipients demonstrated statistically significant improvement in both conditions of spatially separated noise.1  This can result in an improved and controlled listening experience as rear-facing noise is reduced.

ForwardFocus must be enabled in Custom Sound fitting software before it can be used by the recipient.  This is because in certain situations (for example, if the recipient needs to hear sound from behind), ForwardFocus is not the best option.  Recipients must be instructed on the use of ForwardFocus and should be able to manually enable and disable this feature, something made even easier with the introduction of the Nucleus Smart App for Apple Watch®. This new feature allows for convenience control at their fingertips with a discreet tap. Patients can change programs, see battery status, adjust volume and select audio source, making it easier to use than ever before!

For more information about using ForwardFocus with your patients, please consult the ForwardFocus Clinician Quick Guide.

Encourage your patients to download the Nucleus Smart App now from Apple® App Store or on Google Play!

About the author: Amy Donaldson is an Audiologist and Professional Education Manager for Cochlear Americas.  She received her Master’s Degree in Audiology from the State University of New York at Buffalo and her AuD from the University of Florida.  She was privileged to begin her career as a pediatric audiologist and gain extensive clinical experience in implantable hearing devices at the University of Michigan in Ann Arbor and at the Manchester Cochlear Implant Programme in the United Kingdom.  After working for several years as an Educational Audiologist and Technical Support Audiologist in the hearing aid industry, she returned to hearing implants and Cochlear in 2011.

References

  1. Cochlear Limited. D1376556.CLTD5709 Acceptance and Performance with the Nucleus 7 Cochlear Implant System with Adult Recipients. 2018 Jan; data on file.
  2. Hey M, Hocke T, Böhnke B, Mauger SJ (2019) ForwardFocus with cochlear implant recipients in spatially separated and fluctuating competing signals – Introduction of a reference metric. Int J Audiol, 57(2).

*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.

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

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

Android is a trademark of Google LLC. 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.

Google Play and the Google Play logo are trademarks of Google LLC.

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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Elizabeth Preston, AuD

Pediatric wear time case study with Elizabeth Preston, AuD

January 18, 2022

By Elizabeth Preston, AuD, CCC-A

Background

The importance of consistent wear time has been drilled into me as a pediatric audiologist and it is important to have conversations with families about this regularly. Conversations around wear time are easier if the stage is set early. The sooner we stress the importance of device use and the impact it has on language outcomes for the child, the better.1-3 We use a co-treat model in our clinic, so a speech language pathologist (SLP) who is LSL certified is always seeing the family on the same day as the audiology appointments for young children especially during the first year after cochlear implantation. There are many advantages to having this model; one of those advantages is having both the audiologist and SLP  discussing device use and stressing the importance of wear time.

I was also always using the “10 hours a day” (children wear their device at least 10 hours per day) reference for getting a full day of use in. In our clinic, we now use “80% of the day” to take into consideration increase in awake time as a child gets older.4 A child quickly outgrows being awake 10-12 hours a day. To help providers start the conversation about wear time and its importance, we have posted the below figure in each treatment room. We feel it is an easy visual for families to read and understand and we are often asked about it.

Case study

I’d like to share the story of Gwen (name has been changed) to give an example of how taking the time to have hard conversations around wear time helped her outcomes in the long run. Gwen had an uneventful pregnancy/birth and she passed her newborn hearing screening in both ears.  However, her parents were concerned by two months of age about her lack of responses to sound, so they asked their pediatrician for a referral for a diagnostic auditory brainstem response (ABR).  Due to COVID, that testing was a bit delayed. A no-response ABR was obtained in both ears at 6 months of age and hearing aids were fit by seven months of age. There is a positive family history of hearing loss as her father has been diagnosed with Waardenburg Syndrome.

Gwen was referred for a cochlear implant (CI) evaluation and later she was bilaterally implanted. Gwen struggled to maintain consistent wear time from the very beginning. We had several conversations discussing strategies the family could use, discussing daily routines and where the family could improve upon their efforts. We also discussed different retention options to help keep the processors on. They tried wearing the Kanso® 2 Sound Processors and utilizing the HugFits™. To complicate our efforts, the family was also getting advice from a family member who is Deaf and encouraging them to focus more on sign language than on consistent device use . Our message remained consistent: If Gwen is going to talk, she needs to wear her devices consistently and be spoken to. We encouraged the family that they could choose to teach sign language along with spoken language if they wanted her to learn both languages.

Data also helped inform our counseling strategy. At initial activation, wear time started at 40-50% of her waking hours. Unfortunately, it reduced to 10% after three months of device use, which also meant she was not making much progress with her listening and her speech. Her parents were not seeing the benefit of keeping them on.

After many discussions with the family to find a solution that would work for them to keep the devices on, Gwen’s wear time has improved. This was a team effort including the parents, audiologist, speech language pathologist and early interventionist. She has begun to make great progress with her spoken language as well as learning a few signs and her parents are now seeing the benefits of having the devices on. There is still work to do; however, Gwen is on the right trajectory and we will continue to support her and her parents through this journey.

Results

By taking time to work as a team and talk through different strategies to address the struggles and celebrate the successes, Gwen’s wear time improved and she began to make quick progress with her listening and spoken language. These conversations were often hard and we didn’t always feel equipped to answer all the questions, but we did not shy away and we believe this is what has made the difference.

Helpful takeaways:

  1. Start the wear time conversation at the very beginning of discussions about the cochlear implant
  2. Discuss retention options early to have a plan and possibly start practicing that plan prior to surgery (e.g., wearing a headband to get used to having it on prior to activation)
  3. Celebrate the small successes
  4. Make sure everyone on the team is using the same messaging and working together
  5. Keep the conversations focused on the family coming up with strategies if possible (prompting may be necessary to start ideas flowing)
  6. Review datalogging so that timely conversations can happen with family and between appointments if needed
  7. Keep conversations as positive as possible and validate the family’s feelings

No matter how young infants are when implanted, they will not close the gap with their normal hearing peers without wearing their devices 80% or more of their awake time. If we meet the family where they are and offer our support, their child will be more likely to succeed.

To hear more from Dr. Preston, listen to her pediatric-focused AudiologyOnline course.

About the author: Dr. Elizabeth Preston just finished up as Pediatric Cochlear Implant Audiologist, Audiology Clinic Manager and Clinical Assistant Professor at The Children’s Cochlear Implant Center at UNC. She earned her degrees from Texas Tech Health Sciences Center and has over 16 years of clinical experience. Her career as an audiologist has focused on working with children who are deaf or hard of hearing gain access to spoken language through listening.  She began her career as a diagnostic audiologist, fitting hearing devices for children with varying degrees of hearing loss.  As the Audiology Clinic Manager with UNC’s Cochlear Implant Team, she helped children in her region gain access to cochlear implants and receives high-quality follow-up services.  This included participating in clinical research and working to broaden the number of children who have access to services. Dr. Preston also provides training to professionals and graduate students throughout the United States to improve the diagnosis and treatment of children who are deaf or hard of hearing.

References

  1. Gagnon EB, Eskridge H, Brown KD. (2020, March)Pediatric cochlear implant wear time and early language development. Cochlear Implants Int. 21(2):92-97. doi: 10.1080/14670100.2019.1670487. Epub 2019 Sep 29. PMID: 31566100.
  2. Gagnon EB, Eskridge H, Brown KD, Park LR. (2021, April). The impact of cumulative cochlear implant wear time on spoken language outcomes at age 3 Years. J Speech Lang Hear Res. 64(4):1369-1375. doi: 10.1044/2020_JSLHR-20-00567. Epub 2021 Mar 30. PMID: 33784469.
  3. Wiseman KB, Warner-Czyz AD, Kwon S, Fiorentino K, Sweeney M. (2021, Jul-Aug). Relationships between daily device use and early communication outcomes in young children with cochlear Implants. Ear Hear. 42(4):1042-1053. doi: 10.1097/AUD.0000000000000999. PMID: 33974791.
  4. Jenco, Melissa. (2016, June). AAP endorses new recommendations on sleep times. The official Newsmagazine of the American Academy of Pediatrics. https://www.aappublications.org/news/aapnewsmag/2016/06/13/Sleep061316.full.pdf

In the United States, the Cochlear Nucleus Implant System is approved for use in children 9 to 24 months of age who have profound sensorineural hearing loss in both ears and demonstrate limited benefit from appropriate hearing aids. Children 2 years of age or older may demonstrate severe to profound hearing loss in both ears.

 In the Canada, the Cochlear Nucleus Implant System (CI500 and CI600 Series) is approved for use in children 9 to 24 months of age who have profound sensorineural hearing loss in both ears and demonstrate limited benefit from appropriate hearing aids. Children 2 years of age or older may demonstrate severe to profound hearing loss in both ears.

family reading together

Survey reveals hearing loss can significantly affect relationships and families in the U.S.

May 1, 2019

Research updates

State of Hearing Report highlights the physical, emotional and societal challenges of hearing loss

Centennial, Colo. (May 1, 2019) — Three in four U.S. adults aged 65 years and older believe hearing loss is unavoidable and an inevitable part of aging, according to a new global report released to recognize Better Hearing and Speech Month in May.

The State of Hearing Report also highlights how hearing loss can affect a person’s day-to-day-life, self-esteem and ability to communicate as their families feel the strain. In the U.S., 57 percent of respondents said it could cause social isolation and 86 percent said it could affect relationships.

Sponsored by Cochlear, the global leader in implantable hearing solutions, the State of Hearing Report was a global survey to evaluate the challenges faced by people with hearing loss. Respondents in the U.S. included 1,269 adults, including 208 people aged 60 years and older. Notably, nearly 60 percent of people in the U.S. report having a close family member who has moderate to profound hearing loss, with more than one in three of those respondents stating that the hearing loss has had some level of impact on their communication.

“Results from the State of Hearing Report echo what physicians and advocacy groups who support those with hearing loss have known for many years – that hearing loss can have a profound impact on an individual’s personal, family and even professional life,” said Barbara Kelley, Executive Director, Hearing Loss Association of America. “These findings shine a spotlight on the serious need for additional education for the 48 million Americans who have some degree of hearing loss, but are unaware of options that will address their hearing loss and allow them to better function in their day-to-day lives.”

Despite 95 percent of U.S. respondents recognizing that the ability to hear is important for overall quality of life, only 41 percent have had a hearing test in the last two years, the report reveals. Among U.S. respondents over the age of 65 years, 87 percent said they knew where to get their hearing tested, but only 50 percent had acted to do so.

“As a practicing cochlear implant surgeon, I see first-hand both the burden debilitating hearing loss can have on a person and their family, but also the apathy with which they manage it,” said Brian Kaplan, M.D., Chairman, Department of Otolaryngology and Director, Cochlear Implant Program, Greater Baltimore (Md.) Medical Center, and Cochlear Medical Advisor. “There are millions of people in the U.S. who could benefit from the use of a hearing device, such as a cochlear implant or hearing aid, and I hope that more education around the true effect of hearing loss will drive patients and providers to seek proper diagnostic testing and treatment.”

Hearing loss is a significant public health issue in the U.S. and around the globe. According to the World Health Organization (WHO), hearing loss affects 466 million people worldwide,1 and one in three people over the age of 65 live with severe to profound forms of the condition.1 WHO figures also predict the total number of people living with hearing loss will nearly double by 2050, and this increase will be most noticeable amongst older people.1 Moreover, as the prevalence rates rise, the global cost of unaddressed hearing loss has been estimated at $750 billion per year.1

“At Cochlear, we are driven by our mission to improve the lives of people with hearing loss. There is increasing evidence of the importance of hearing to overall health, especially as people age,” said Patricia Trautwein, AuD, Vice President, Marketing and Product Management, Cochlear Americas. “With almost a quarter of people 65 to 74 years of age suffering disabling hearing loss, it is more important than ever to understand the impact of untreated hearing loss on people’s health, our communities and the economy to ensure people turn to treatment sooner.”

The research of Cochlear’s State of Hearing Report coincides with the launch of its Sounds Inevitable campaign, which highlights the misperceptions many people have about hearing loss being an inevitable part of aging, leading to irregular hearing check-ups and delayed treatment.

About State of Hearing Report

The State of Hearing Report 2019 is the result of a five-minute, online survey among a representative sample of n=7,275 adults aged 18 year and older in five countries, including Australia, Germany, Japan, the United Kingdom and the United States. Important global trends emerged about perspectives of how hearing affects individuals and communities after speaking with more than 7,200 people, including more than 1,000 aged 60 years and older with hearing loss. In the U.S., the nationally representative cohort included n=1,061 general population respondents and 208 respondents aged 60 years and older. The survey was fielded between December 12-30, 2018.

About Cochlear Limited (ASX: COH)

Cochlear is the global leader in implantable hearing solutions. The company has a global workforce of more than 3,500 people and invests more than AUD$160 million each year in research and development. Products include cochlear implants, bone conduction implants and acoustic implants, which healthcare professionals use to treat a range of moderate to profound types of hearing loss.

Since 1981, Cochlear has provided more than 550,000 implantable devices, helping people of all ages, in more than 100 countries, to hear.

References
  1. World Health Organization. Deafness & Hearing Loss Factsheet. Available at https://www.who.int/news-room/fact-sheets/detail/deafness-and-hearing-loss [Last accessed Feb 2019]
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.
© Cochlear Limited 2019. All rights reserved. Cochlear, Hear now. And always, Nucleus, Baha, the elliptical logo and marks bearing an ® or ™ symbol, are either trademarks or registered trademarks of Cochlear Bone Anchored Solutions AB or Cochlear Limited (unless otherwise noted).
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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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