Cochlear Implants
by Parri Tantillo

Bringing Ease and Convenience to Bimodal Control

August 9, 2023
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Since 2011, Cochlear™ and ReSound have collaborated in the Smart Hearing Alliance to provide hearing solutions for people with all types of hearing loss. Whether the need is for hearing aids, hearing implants, or a combination of the two, our solutions work together seamlessly. Through the Smart Hearing Alliance, we are committed to improving bimodal hearing care in partnership with you. Our solutions are evidence-based and designed to help you effectively meet the changing needs of your patients over time.  

For many people, a bimodal hearing solution with a cochlear implant (CI) on one ear and a hearing aid (HA) on the other is the combination that provides them with their best hearing.1-7

Introducing bimodal control in the Nucleus® Smart App

Every day your bimodal patients are exposed to a range of different hearing environments. If they find themselves in a new environment and want to change their volume, program, or manage a True Wireless™ accessory, controlling two hearing devices requires careful attention to how their hearing devices are connected to and controlled by their Bluetooth® connected device. As a result, patients may choose to only adjust one hearing device.

To help your patients get the most out of their hearing in everyday moments, Cochlear has introduced bimodal control in the Nucleus Smart App. Bimodal control is designed to help your patients quickly and easily manage their compatible ReSound ONE™ or ReSound OMNIA™ hearing aid and compatible Cochlear Sound Processor* in the same app. When a patient chooses to set up bimodal control within the Nucleus Smart App, they will be able to make volume adjustments, change programs, and manage wireless accessories for both devices. Additional device features will continue to be available through the Nucleus Smart App and the ReSound Smart 3D™ app, including Find my Hearing Aid.

With bimodal control in the Nucleus Smart App, it’s never been easier or more convenient for your bimodal patients to make common adjustments to help achieve their best possible hearing experience.

Because when both the hearing aid and CI sound processor are delivering the best possible sound, known bimodal benefits are optimized.

Cochlear’s Bimodal Hearing Evidence Summary summarizes some key insights from research studies about the benefits of bimodal hearing solutions for adult CI users.

Bimodal hearing benefits for speech understanding in quiet and noise

The studies here show that for unilateral cochlear implant users with residual hearing in the non-implanted ear, access to these benefits is possible by fitting a hearing aid to that ear. In addition to hearing better in noise, bimodal hearing is also shown to improve the range and quality of the sound being heard.

  • Kelsall D, Lupo J, Biever A. Longitudinal outcomes of cochlear implantation and bimodal hearing in a large group of adults: A multicenter clinical study. 2021 Am J Otolaryngol. 2021 Jan-Feb; 42(1):102773. doi: 10.1016/j.amjoto.2020.102773 Epub 2020 Oct 22. PMID: 33161258.
  • Hoppe U, Hocke T, Digeser F. Bimodal benefit for cochlear implant listeners with different grades of hearing loss in the opposite ear. Acta Oto-Laryngol 2018, 138, 713–721.
  • Gifford RH, Dorman MF. Bimodal hearing or bilateral cochlear implants? Ask the patient. Ear Hear. 2019 ; 40(3): 501–516.

Bimodal hearing benefits for quality of life

The studies here assess quality of life outcomes using a variety of established self-report scales. They examine the overall well-being of participants in several health-domains including daily hearing function and its impact on everyday life. The evidence shows on average, statistically significant benefits for bimodal hearing users on quality-of-life measures compared to their daily listening condition when using one or two hearing aids or a cochlear implant alone.

  • Buchman CA, Herzog JA, McJunkin JL, et al. Assessment of speech understanding after cochlear implantation in adult hearing aid users: A nonrandomized controlled trial. JAMA Otolaryngol Head Neck Surg. Published online August 27, 2020. doi:10.1001/jamaoto.2020.1584.
  • Sanhueza I, Manrique-Huarte R, Calavia D, Huarte A, Manrique M. Hearing impairment and quality of life in adults with asymmetric hearing loss: Benefits of bimodal stimulation. J Int Adv Otol. 2019 Apr;15(1):62-69. doi: 10.5152/iao.2019.6224. PMID: 31058597; PMCID: PMC6483429.
  • Sladen DP, Carlson ML, Dowling BP, Olund AP, DeJong MD, Breneman A, Hollander S, Beatty CW, Neff BA, Driscoll CL. Cochlear implantation in adults with asymmetric hearing loss: Speech recognition in quiet and in noise, and health related quality of life. Otol Neurotol. 2018 Jun;39(5):576-581. doi: 10.1097/MAO.0000000000001763. PMID: 29683995.

Bimodal hearing delivers functional hearing benefits and improved satisfaction with daily hearing

The evidence shows that a significantly higher number of bimodal hearing users report being satisfied or very satisfied with their hearing ability during a variety of daily listening activities, compared to their satisfaction when using hearing aids. In addition to reduced listening fatigue, the studies below also demonstrated significant and clinically important improvements for hearing speech in daily life, quality of sound, and localization of sounds for bimodal hearing users, compared to when they used one or two hearing aids.

  • Plant K, van Hoesel R, McDermott H, Dawson P, Cowan R. Influence of contralateral acoustic hearing on adult bimodal outcomes after cochlear implantation. Int J Audiol. 2016 Aug;55(8):472-82. doi: 10.1080/14992027.2016.1178857. Epub 2016 May 23. PMID: 27216386.
  • 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 Hear. 2017 Jan;21:2331216517699530. doi: 10.1177/2331216517699530. PMID: 28351216; PMCID: PMC5435367.
  • Lupo JE, Biever A, Kelsall DC. Comprehensive hearing aid assessment in adults with bilateral severe-profound sensorineural hearing loss who present for Cochlear implant evaluation. Am J Otolaryngol. 2020 Mar-Apr;41(2):102300. doi: 10.1016/j.amjoto.2019.102300. Epub 2019 Sep 11. PMID: 31761407.

Bimodal hearing benefits from direct audio streaming

The studies here demonstrate the advantages of direct audio streaming for bimodal users when compared to using a cochlear implant alone. Results indicate wireless audio streaming accessories may offer further improvement in speech understanding in noisy situations when used with bimodal hearing compared to the cochlear implant alone. Performance with direct audio streaming of phone calls to bimodal devices was also shown to improve communication ability on the phone compared when using only an implant.

  • Vroegop JL, Dingemanse JG, Homans NC, Goedegebure A. Evaluation of a wireless remote microphone in bimodal cochlear implant recipients. Int J Audiol. 2017 Sep;56(9):643-649. doi: 10.1080/14992027.2017.1308565. Epub 2017 Apr 10. PMID: 28395552.
  • Wolfe J, Morais M, Schafer E. Speech recognition of bimodal cochlear implant recipients using a wireless audio streaming accessory for the telephone. Otol Neurotol. 2016 Feb;37(2):e20-5. doi: 10.1097/MAO.0000000000000903. PMID: 26756151.

Bimodal hearing benefits for sound localization

In these studies, the degree of binaural benefit for an individual in terms of sound localization is reported. The benefits obtained may be influenced by the level of hearing in each ear and the resulting degree of asymmetry between the ears.

  • Firszt JB, Reeder RM, Holden LK, Dwyer NY; Asymmetric hearing study team. Results in adult cochlear implant recipients with varied asymmetric hearing: A prospective longitudinal study of speech recognition, localization, and participant report. Ear Hear. 2018 Sep/Oct;39(5):845-862. doi: 10.1097/AUD.0000000000000548. PMID: 29373326; PMCID: PMC6103899.
  • Jang JH, Lee JH, Chang SO, Oh SH. Effect of aided hearing in the nonimplanted ear on bimodal hearing. Otol Neurotol. 2014;35: e270-6.

Bimodal hearing benefits for music appreciation

The studies below found that when listening to music, on average bimodal hearing users achieved better hearing performance when wideband frequency amplification was used in the hearing aid compared to narrower frequency bands. Furthermore, recognition of musical instruments was superior with bimodal configuration compared with using either a cochlear implant or hearing aid alone.

  • D’Onofrio KL and Gifford RH. Bimodal benefit for music perception: Effect of acoustic bandwidth. JSLH; 2021, 64: 1341–1353.
  • Duret S, Bigand E, Guigou C, Marty N, Lalitte P, Bozorg Grayeli A. Participation of Acoustic and Electric Hearing in Perceiving Musical Sounds. Front Neurosci. 2021 May 5;15:558421. doi: 10.3389/fnins.2021.558421. PMID: 34025335; PMCID: PMC8131516.
  • Shukor NFA, Lee J, Seo YJ, Han W. Efficacy of Music Training in Hearing Aid and Cochlear Implant Users: A Systematic Review and Meta-Analysis. Clin Exp Otorhinolaryngol. 2021 Feb;14(1):15-28. doi: 10.21053/ceo.2020.00101. Epub 2020 Jul 11. PMID: 32646208; PMCID: PMC7904420.

* For compatibility information and devices visit www.cochlear.com/compatibility and for more information regarding the compatibility of ReSound hearing aids, visit resound.com/compatibility

For more information regarding ReSound hearing aids, visit pro.resound.com.

The Bluetooth® word mark and logos are registered trademarks owned by Bluetooth SIG, Inc. and any use of such marks by Cochlear is under license.

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

1. Farinetti A, Roman S, Mancini J, et al. Quality of life in bimodal hearing users (unilateral cochlear implants and contralateral hearing aids). Eur Arch Otorhinolaryngol (2015 Nov); 272, 3209–3215.

2. Ching TY, Incerti P, Hill M. Binaural benefi ts for adults who use hearing aids and cochlear implants in opposite ears. Ear Hear (2004 Feb); 25, 9–21.

3. Potts LG, Skinner MW, Litovsky RA., et al. Recognition and localization of speech by adult cochlear implant recipients wearing a digital hearing aid in the nonimplanted ear (bimodal hearing). J Am Acad Audiol (2009 Jun); 20, 353–373.

4. Morera C, Cavalle L, Manrique M, et al. Contralateral hearing aid use in cochlear implanted patients: Multicenter study of bimodal benefi t. Acta Otolaryngol (2012 Jun); 132, 1084–1094.

5. Giff ord RH, Dorman MF, McKarns SA, Spahr AJ. Combined electric and contralateral acoustic hearing: Word and sentence recognition with bimodal hearing. Journal of Speech, Language, and Hearing Research. (2007 Aug) 1;50(4):835-43.

6. Sucher CM, McDermott HJ. Bimodal stimulation: benefi ts for music perception and sound quality. Cochlear Implants International. (2009 Jan); 1;10(S1):96-9.

7. Buchman CA, Herzog JA, McJunkin JL, et al. Assessment of Speech Understanding After Cochlear Implantation in Adult Hearing Aid Users: A Nonrandomized Controlled Trial. JAMA Otolaryngol Head Neck Surg. Published online (2020 Aug). doi:10.1001/jamaoto.2020.1584

Related Posts

Clinical Programming Series: Impedances

August 7, 2024
  • Approximately 5 minutes to read
  • Learning objectives:
    • Understand why and how impedances provide valuable clinical information
    • Understand what factors impact impedances
    • Understand how the clinician can use impedance measurements to determine the need for programming changes

Why are we talking about impedances?

As cochlear implant audiologists, the concept of impedances is integral to our clinical lexicon. Due to the growing interest in a more in-depth understanding of impedances, our clinical team has compiled a summary that delves into the science of impedances in cochlear implant care and outlines the essential information for programming cochlear implants.

What are impedances?

When electrical current flows in a conductor (in this case, the cochlea) there is a force that opposes the flow of the electrical current through the cochlea to the spiral ganglion cells.  This is known as resistance. All materials naturally contain some resistance to the flow of an electrical current. Electrode impedances measures this resistance to the flow of electrical current from the cochlear implant electrode to the spiral ganglion cells.

Electrical impedance is calculated as the ratio of the applied voltage (driving force) to the resulting current that flows through the material or solution.

How does Cochlear calculate impedances?

Cochlear calculates the total impedance which includes the Polarization Impedance and the Access Impedance. Polarization Impedance looks at the electrode-electrolyte interface. Polarization impedances are caused by electrochemical effects at the electrode’s electrode-fluid interface. Access Impedance looks at the bulk material around the electrode. High access impedances are caused by the presence of fibrous tissue or new bone growth around the electrode array. To have an accurate understanding of the surface quality change of the electrodes, it’s necessary to assess both Access and Polarization Impedances. Total impedance offers the most complete picture of impedance and its effect on compliance, power requirements, and MAP parameters.

Impedance in a tissue-stimulating system is more complex than a simple material or solution due to the dynamic behavior of the electrode-tissue interface.  Biological processes at a cellular level can change the electrode-tissue interface and therefore also affect the impedance of the system over time frames ranging from seconds to minutes to much longer periods.

Impedance measurements are included in Cochlear™ Nucleus® implants to perform three functions:

  • To confirm the integrity of the electrode contacts through detection of open and short circuits.
  • To ensure the map is set to maintain electrodes in compliance.
  • To provide some insight into the characteristics of the local environment around the electrode to assist with clinical management.

What factors can impact impedances?

Conditions unrelated to a patient’s hearing have been associated with changes in hearing outcomes or impedance.  In these cases, it may take an extended time for clinicians to find out that a recipient is on contributing drug therapy since the recipient may not associate other health conditions with challenges in their hearing. Papers have associated impedance rises to Meniere’s disease and tinnitus1, labyrinthitis2, otitis media3, 4, delayed hearing loss5, and episodes of vertigo2, 6. In these instances, the impedance change is an indicator of some process that is happening in the inner ear. 

There are reports involving bilateral recipients where impedances are seen to rise in a single ear1, and others where the process involves both ears2 suggesting a more systemic involvement. Interestingly one bilateral case with different model implants experienced increased impedance in both implants at the same time2.

A number of papers report on the potential for pharmaceuticals to reduce electrode impedance. In one case treatment with cortisone, antibiotics and widening pulse widths resulted in impedances falling over 25 kohm to under 14 kohm within 24 hours2. 

Why is it important to monitor impedances?

Alterations in impedance can lead to reduced performance in patients. By managing these changes through medical intervention or by adjusting the pulse width, these issues can be addressed, resulting in optimization of the recipient’s programming.

How do we use this information clinically?

Regular measurement of electrode impedances is considered good clinical practice, typically performed at each programming session. For adults and children capable of providing feedback on their cochlear implant’s sound quality, routine monitoring of the impedance profile, alongside speech perception measures and other case information, constitutes a best management approach. This practice establishes a historical record of impedance measurements, facilitating correlation with additional recipient data collected over time. Should any electrodes fall out of compliance, it is common practice to increase the pulse width across the array to return these channels to compliance, rather than deactivating.

Additionally, electrode impedance measurements detect circumstances under which certain electrodes should not be used, such as open or short circuits. Since each electrode interacts with its local environment, impedances can vary from electrode to electrode across the array.  An unexpected impedance pattern calls for a detailed review of the electrode impedance data in context with the recipient’s imaging, programming, medical history, and auditory performance.

Please reach out to your local Cochlear representative to learn more about what impedance measurements can tell you about your patient’s cochlear implant.

1 McNeill, A., & Eykamp, K. (2016). Cochlear Implant Impedance Fluctuation in Meniere’s Disease: A Case Study. Otology & Neurotology, 37(7), 873-877.

2 Neuburger, J., Lenarz, T., Lesinski-Schiedat, A., &  Büchner, A. (2009). Spontaneous increases in impedance following cochlear implantation: Suspected causes and management. International Journal of Audiology, 48(5), 233-239.

3 Vargas, J.L., Sainz, M., Roldan, C., Alvarez, I., & Torre, A. (2012) Long-tern evolution of the electrical stimulation levels for cochlear implant patients. Clinical and Experimental Otorhinolaryngology, 5(4), 194-200.

4 Dixon, J.F., Shinn, J.B., Adkins, M., Hardin, B.D., & Bush, M.L. (2015). Middle Ear Disease and Cochlear Implant Function: A Case Study. Hearing Balance and Communication, 12, 155-158.

5 Scheperle, R.A., Tejani, V.D., Omtvedt, J.K., Brown, C.J., Abbas, P.J., Hansen, M.R., Gantz, B.J, Oleson, J.J, & Ozanne, M.V. (2017). Delayed changes in auditory status in cochlear implant users with preserved acoustic hearing. Hearing Research, 350, 45-57.

6 Plontke, S.K., Götze, G., Rahne, T., & Liebau, A. (2017). Intracochlear drug delivery in combination with cochlear implants. HNO, 65, 19-28.

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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