Cochlear Implants
by Cochlear Guest Author

CI532: The Perimodiolar Advantage

January 22, 2019
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By guest author: Wade Colburn

Wade Colburn

 

 

Cochlear introduced our first perimodiolar electrode array in 2000. Perimodiolar arrays reduce the distance to the modiolus to improve performance1,2 and allow for more focused stimulation3,4. In a study conducted at Washington University by Holden et al5, they showed a correlation between the position of the electrode with respect to the modiolus (often referred to as the “Wrapping Factor”) and CNC word score. The group showed that those electrodes with proper perimodiolar placement had a lower wrapping factor and improved performance.

Cochlear continually innovates with the intent of making perimodiolar electrodes thinner, less traumatic and consistent in placement, and with the ultimate goal of improving patient performance. The perimodiolar advantage has been observed by many clinicians over the years, which is demonstrated by the fact that 2 out of every 3 Cochlear™ Nucleus® implants are perimodiolar6.  Cochler Slim Modiolar Electrode

Currently, two perimodiolar electrodes are available for purchase, the Contour Advance (CI512) and the new Slim Modiolar (CI532).  Contour Advance has been available since 2005 and is still used among surgeons. The new Slim Modiolar electrode improves upon a few key design elements and redefines any historical assumptions surrounding perimodiolar arrays, such as scalar translocations and limitations on surgical approach. While there are certain patients that can benefit from the stylet-based Contour Advance, the sheath-based Slim Modiolar has shown performance benefits7.

The Slim Modiolar electrode redefines the perimodiolar advantage in four major areas:

Performance:

While the performance benefits of a perimodiolar electrode is well understood 1,2,3,4,5, a recent publication by Shaul et al7, demonstrated that in a matched population (post-lingual patients with all electrodes in scala tympani) phoneme score at 12 months was significantly better with Slim Modiolar (79.5% (mean), 14% (SD)) compared to Contour Advance (69.4% (mean), 17% (SD)).

Placement in Scala Tympani:

In multiple published surgical papers on Slim Modiolar, successful scala tympani location was seen in 90 to 100% of the patients 7,8,9,10. Slim Modiolar redefines the reputation of perimodiolar electrodes and presents an opportunity to combine the benefits of being close to the hearing nerve with consistent scala tympani location.

Preservation of Structures:

The Slim Modiolar is designed with a sheath-based delivery system, which allowed for a 60% reduction in volume compared to Contour Advance, making it designed to preserve the delicate inner ear structures. The thin design and smooth insertion with a sheath delivery showed in a temporal bone study that 98% of the bones that were implanted experienced “no trauma”. The Slim Modiolar is designed to preserve the natural structure of the cochlea.

Preference of Insertion:

Another benefit of the Slim Modiolar electrode is the ability to use the preferred surgical approach, including a round window insertion. Contour Advance design was limited to cochleostomy insertion, but Slim Modiolar is designed to be implanted via round window, extended round window and cochleostomy. In Aschendorff et al8, 44% of the cases were performed with round window insertion, 22% with extended round window and 34% with cochleostomy. This study demonstrated that Slim Modiolar could be implanted with all surgical approaches, while still maintaining consistent scala tympani location.

Slim Modiolar electrode (CI532) is designed intentionally to take the great elements of the Contour Advance and improve upon them to create an ideal electrode for your patients. Closer to the hearing nerve has proven to be a benefit and CI532 has redefined the perimodiolar advantage for the better.

To learn more about CI532 and practice insertions in a simulated model, contact your Cochlear representative.

 

About our guest author:

Wade Colburn is the Product Manager for the Cochlear™ Implant product portfolio within Cochlear Americas.  Wade’s responsibilities include product positioning and messaging, life-cycle management, new product launches and surgical support and training. Wade has recently joined Cochlear and comes from an engineering background within the medical device field, including previous otology experience.

 

 

References:
  1. Lazard D. S, et al. Pre-, per- and postoperative factors affecting performance of postlinguistically deaf adults using cochlear implants: a new conceptual model over time. PloS one. 2012; 7:e48739
  2. Blamey P, et al. Factors affecting auditory performance of postlinguistically deaf adults using cochlear implants: An update with 2251 patients. Audiology & neuro-otology. 2013; 18:36-47.
  3. Hughes, ML, Abbas, PJ. Electrophysiological channel interaction, electrode pitch ranking, and behavioral threshold in straight versus perimodiolar cochlear implant electrode arrays. J Acoustic Soc Am. 2006; 119(3):1538-47.
  4. Cohen L., Richardson L., Saunders E., Cowan R. Spatial spread of neural excitation in cochlear implant recipients: comparison of improved ECAP method and psychophysical forward masking. Hearing Research. 2003; 179 (1-2):72-87.
  5. Holden LK, Finley CC, Firszt JB, Holden TA, Brenner C, Potts LG, et al. Factors affecting open-set word recognition in adults with cochlear implants. Ear Hear. 2013; 34(3):342-60
  6. Internal sales data on file.
  7. Shaul C, Dragovic AS, Stringer AK, O’Leary SJ, Briggs RJ. Scalar localization of peri-modiolar electrodes and speech perception outcomes. J Laryngol Otol 2018; 1-7. https://doi.org/10.1017/S0022215118001871
  8. Aschendorff et al. Clinical investigation of the Nucleus Slim Modiolar Electrode. Audiology & Neurotology. 2017; 22:169-179. https://www.ncbi.nlm.nih.gov/pubmed/29059669
  9. Data on File: US Multicenter CI532 Study. 2018.
  10. Cuda, D, Murri, A. Cochlear Implantation with the nucleus slim modiolar electrode (CI532): a preliminary experience. European Archives of Oto-Rhino-Laryngology. 20017; 12:4141. https://www.ncbi.nlm.nih.gov/pubmed/29032420
  11. EA32 Electrode Insertion Safety and Performance Study Report. Data on File (Document Number: 473386)
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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Journal Club: Musical training improves the ability to understand speech-in-noise in older adults

October 30, 2019
Research updates

By Justin Piraino, Au.D, Sr. Manager Data Strategy and Analytics, Cochlear Americas

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 Canadian study published in the Neurobiology of Aging, Musical training improves the ability to understand speech-in-noise in older adults.As an audiologist and individual with hearing loss (hearing aid and cochlear implant user), any way to improve the ability to hear in noise for patients or myself is certainly worth my attention.  This research can encourage patients who aren’t feeling successful with their hearing loss treatment to engage in rehabilitation exercises.

What did the study investigate?

This study looked at the causal impact of music lessons on older adults. The researchers were interested to determine whether the causal relationship between short-term musical training and performance on auditory test improved hearing and therefore could be suggested to improve hearing in non-musicians.

Why is this important? 

These findings support the idea that musical training provides a causal benefit to hearing abilities. Importantly, these findings suggest that musical training could be used as a foundation to develop auditory rehabilitation programs for older adults.

How did they do it?

Below summarizes the key elements of study design and demographics:

  • A three-arm, single-blind longitudinal training study with random assignment
  • 34 individuals aged between 55 and 75
  • Participants were randomized into three groups using a stratified covariate-adaptive procedure. The groups include:
    • Piano training group (Music)
    • Video game training group (Video)
    • No-contact control group (No-contact)
  • Participants took part in three testing sessions:
    • The pre-training session (Pre) took place before the intervention, the mid-training session (Mid) took place three months after the start of the intervention and the post-training session (Post) took place six months after the onset of the intervention. During the Pre, Mid and Post sessions, participants completed a series of auditory and cognitive assessments.

Results

Based on the study, six months of self-directed music lessons improved the ability to understand speech in background noise in older adults.

This improvement was related to an increased positivity over frontal-left electrodes from 200 to 1000 ms after the onset of a word. These results suggest that musical training can be used to improve the ability to understand speech-in-noise in older adults by improving how older adults process speech and deploy their attentional resources to speech stimuli.

Discussion

The most critical finding from this study is that music lessons improved the ability to understand speech in noise for older adults.

First, it demonstrates that musical training may have a causal role in improving hearing abilities in older adults. This provides support for previous cross-sectional work demonstrating that older musicians have an advantage in understanding speech in noise compared with older non-musicians1.

Second, it highlights that the brain remains plastic in older adults and is susceptible to modification based on one’s life experiences. In the current context, this is critical as hearing difficulties in older adults are nearly universal2, and one of the most commonly reported hearing difficulties is understanding speech in noisy environments.

Accordingly, the results of this study demonstrate that music-based auditory rehabilitation is likely to be successful in older adults in improving their hearing abilities.

Learn more about musical rehabilitation implications by accessing the publication here and stay tuned for next month’s edition of Journal Club!

References

  1. Parbery-Clark, A., Anderson, S., Hittner, E., Kraus, N., 2012. Musical experience offsets age-related delays in neural timing. Neurobiol. Aging 33, 1483.e1-4.
  2. Gates, G.A., Mills, J.H., 2005. Presbycusis. Lancet 366, 1111e1120.

*All figures and tables are from the reviewed article.

Yellow ear

What is Normal Hearing? Why a simple and consistent answer is needed

October 29, 2020

By Patti Trautwein, MA, AuD, Vice President, Product Management & Marketing, Cochlear Americas

Less than 25% of people get their hearing screened annually and more than 37 million (15%) Americans have hearing loss.1-2  Less than 30% of people who can benefit from hearing aids1, 2 and approximately 8% from cochlear implants have them.3 

As an audiologist, this data can be frustrating. There have been tremendous advancements in technology in the last few decades, including more treatment options with devices that are smaller, smarter and deliver better outcomes. Despite these advances, why haven’t the growing number of people with hearing loss accessed treatment?  Recent clinical and market investigations have identified awareness, acceptance, cost and stigma as primary obstacles to adopting hearing devices.4

A recent article by Christopher Spankovich reviewed the history of defining hearing loss using the audiogram versus other measures such as speech or objective measures, explaining how the past five decades encapsulated the rationale for 15- 25 dB HL as the limit for normal hearing.5 Importantly, the author noted strong correlation between pure tone average and perceived hearing difficulty. Most interesting, Spankovich reported that when asking audiologists what normal hearing is, “not surprisingly, you get a variety of responses.” 

How does the variability across clinicians transcend to the general population’s understanding of normal hearing? 

For example, Cochlear’s industry research highlights how people described hearing and noted the variability. Some used words such as mild, moderately severe, significant or deaf, while others used percentages of loss or percentages of hearing remaining.

So, do people know what is normal hearing? The team decided to go out on the street to find out:

Raising awareness of a simple metric, such as 20 dB PTA, for normal hearing may help the general population understand hearing health. Further, it may provide guidance on when to seek clinical evaluation, treatment and even what type of treatments to consider. This becomes increasingly important as the options expand to include over-the-counter devices in addition to hearing aids or hearing implants, making it more important for consumers to get the support of an audiologist or ENT. A simple and consistent metric streamlines to the process for consumers and allied health providers to monitor and act on hearing health, as they are likely to do with other health considerations such as vision or cholesterol.  

Is this a call to action for hearing health care providers to align on the simple answer that the general public can understand?  Please share the video with your colleagues and start the conversation so we can work together to improve access to appropriate hearing healthcare.

To learn more, subscribe to Cochlear ProNews.

About the author: Patricia’s 25 years in the hearing healthcare industry includes roles in research and clinical studies, product management, education and training, sales and marketing. As Cochlear America’s VP of Marketing, Patricia is responsible for the marketing strategy, communications and public relations, brand ambassador program and product management. Her organization is responsible for positioning Cochlear Americas growth strategy, cultivating opportunities in new and existing customer markets and growing demand for Cochlear’s hearing solutions in the region.

References:

1. Abrahms, H and Kihm, J (2015) MT9 reveals renewed encouragement as well as obstacles for consumers with hearing loss. Hearing Review https://www.hearingreview.com/practice-building/marketing/introduction-marketrak-ix-new-baseline-hearing-aid-market (accessed on Sept 14, 2020)  

2. Quick Statistics About Hearing. (2020, October 2). NIDCD. https://www.nidcd.nih.gov/health/statistics/quick-statisticshearing#:~:text=One%20in%20eight%20people%20in,based%20on%20standard%20hearing%20examinations.&text=About%202%20percent%20of%20adults,54%20have%20disabling%20hearing%20loss.

3. Holder, J., Reynolds, S., Sunderhaus, L., Gifford, R. (2018) Current Profile of Adults Presenting for Preoperative Cochlear Implant Evaluation Trends in Hearing Jan-Dec.

4. Kochin, S. (2007) MarkeTrak VII: Obstacles to adult non-user adoption of hearing aids, he Hearing Journal: April 2007 – Volume 60 – Issue 4 – p 24-51

5. Spankovich, C. (2020) Some observations on normal hearing and hearing loss.  Audiology Today Sep/Oct 2020 pgs. 32-41.

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