Cochlear Implants
by Grayson Bishop

Clinical Programming Series: Electric-Acoustic Stimulation

November 18, 2024
Share
  • ‌Approximately 5 minutes to read
  • Learning objectives:
    • Understand the benefits of EAS
    • Understand EAS candidacy
    • Understand current EAS programming parameters

What is Electric-Acoustic Stimulation (EAS)?

Electric-acoustic stimulation (EAS) is a system that utilizes viable postoperative low-frequency hearing thresholds in combination with electrical stimulation for cochlear implant patients. EAS systems are underutilized and have the potential to provide not only better outcomes, but a better patient experience. Manipulation of additional parameters when fitting EAS can provide an even better experience for our patients overall and should be more often applied. 

A brief history of EAS

‌In 2013 the Cochlear™ Nucleus® Hybrid L24 CI system was the first of its kind to receive FDA approval. The Nucleus 6 Sound Processor was capable of providing EAS, giving patients with residual low-frequency hearing the ability to utilize a combined listening experience. As further advancements in both surgery and technology continue to progress, so does the ability to preserve low frequency hearing. Utilizing the EAS system, when appropriate, provides additional benefits compared to traditional electric stimulation.1 Benefits of EAS are improved speech understanding, improved music recognition, improved localization, decreased listening effort, access to binaural low-frequency cues, and providing a more naturalistic sound quality.1,2,3,4,5

Who could be a candidate for EAS?

EAS should be considered for patients who have preoperative thresholds of less than or equal to 60 dB HL through 500Hz. “Functionally aidable” is a term commonly used to describe hearing loss that may receive benefit when fit with an appropriate hearing aid. The recommendation for fitting EAS is for those with low frequency thresholds less than or equal to 70 dB HL postoperatively. 

How do I program a sound processor with an acoustic component?

‌ The utilization of earmolds can be beneficial when fitting a patient with EAS. Clinicians have options when fitting the acoustic component, including domes, however, in the cases where the patient utilized a custom-fit earmold, utilization of this mold with the EAS system can provide better retention, additional comfort, proper venting, increased low frequency sound quality, and address feedback concerns. Should the patient not have a custom earmold, one can be ordered from an outside manufacturer, or the patient can be fit using an appropriate dome. 

The default boundaries for the acoustic component should be set less than or equal to 866 Hz, while the cochlear implant frequency boundaries should be set less than or equal to 438 Hz. This reallocation of lower frequency boundaries may provide additional performance or sound quality benefits, especially in noise2,3 and may also provide the patient with a more natural and preferable listening experience.4 Further manipulation of these boundaries may provide additional benefit. 

‌A study conducted by Gifford et. al, revealed significant speech recognition and subject listening difficulty benefit in those who utilize EAS3. This study showed the less overlap in cutoff frequencies between acoustic and electric stimulation, resulted in better outcomes, with the highest outcomes achieved when the low frequency cutoffs were set closest to the audiometric thresholds. Overall, significant benefits were observed in speech recognition and subjective listening ease for individuals using bimodal and optimally aided EAS conditions, as opposed to those with only a CI. Furthermore, individuals benefited from a low-frequency cutoff program, showing significant improvement in speech recognition and subjective listening difficulty vs the default program.²

For additional information on programming using an acoustic component, check out our Electric-acoustic stimulation (EAS) fitting flow guide.

FUN1979 ISS2 JUN23 EAS Programming GuidelinesDownload
  1. Dunn, C. C., Perreau, A., Gantz, B., & Tyler, R. S. (2010). Benefits of localization and speech perception with multiple noise sources in listeners with a shortelectrode cochlear implant. Journal of the American Academy of Audiology, 21(01), 044-051. 
  2. Gifford, R. H., & Stecker, G. C. (2020). Binaural cue sensitivity in cochlear implant recipients with acoustic hearing preservation. Hearing Research, 390, 107929.
  3. Gifford, R. H., Sunderhaus, L. W., Dawant, B. M., Labadie, R. F., & Noble, J. H. (2022). Cochlear implant spectral bandwidth for optimizing electric and acoustic stimulation (EAS). Hearing Research, 108584.
  4. Parkinson, A. J., Rubinstein, J. T., Drennan, W. R., Dodson, C., & Nie, K. (2019). Hybrid music perception outcomes: implications for melody and timbre recognition in cochlear implant recipients. Otology & Neurotology: Official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology, 40(3), e283. 
  5. Shim, H., Kim, S., Hong, J., Na, Y., Woo, J., Hansen, M., & Choi, I. (2022). Differences in neural encoding of speech in noise between cochlear implant users with and without preserved acoustic hearing. Hearing Research, 108649

Related Posts
60/60

New considerations for recommending a cochlear implant evaluation

March 11, 2021

Every patient’s hearing loss journey is unique, and each patient may require a different treatment option. The continuum of care for hearing loss isn’t a linear pathway so being aware of all technologies to manage your patient’s hearing loss can help you find the best solution for them.

Hearing loss is seen by many to be a communication disorder; it is now known to have much wider-ranging consequences that can significantly impact a person’s quality-of-life. Age-related hearing loss has been shown to also lead to increased accidental falls, hospitalizations, loneliness and social isolation.1 A multi-faceted approach to the treatment of hearing for patients is needed from a collaborative network of providers to meet the needs of your patients.

Innovations in hearing health care have made the way for over-the-counter (OTC) hearing devices and personal sound-amplification products (PSAP’s) enabling patients access outside of the traditional clinical practice. However, hearing care providers are the best professionals to speak to the different hearing solutions for their patients. As a hearing care provider, you have the unique ability to

differentiate your practice by counseling on all hearing loss treatment options and providing comprehensive services to support optimal performance.

If hearing aid technology is not providing your patient the ability to hear and understand speech, a cochlear implant may be the next step. Traditionally, cochlear implants have been considered a treatment option only for those who have lost all of their hearing. Health benefits and improved hearing outcomes2 support the need to shorten the duration of hearing loss and consider cochlear implantation before hearing loss progresses to profound. For patients with hearing losses greater than or equal to 60 dB HL (pure tone average 0.5, 1k, 2kHz) and speech understanding less than or equal to 60%,3 referral for a cochlear implant evaluation should be pursued.

To learn more read this Journal Club or visit www.cochlear.us/THJ

* This provides a recommendation of when an adult may be referred for a cochlear implant

evaluation, but does not guarantee candidacy based on indications. For the approved Cochlear

Nucleus Indications, please refer to the important information booklet or physician’s guides.

References:

1. Deal JA, Reed NS, Kravetz AD, et al. Incident Hearing Loss and Comorbidity: A Longitudinal

Administrative Claims Study. JAMA Otolaryngol Head Neck Surg. 2019;145(1):36–43. doi:10.1001/

jamaoto.2018.2876.

2. Derinsu U, Yüksel M, Geçici CR, Çiprut A, Akdeniz E. Effects of residual speech and auditory deprivation

on speech perception of adult cochlear implant recipients.

3. Zwolan TA, Schvartz-Leyzac KC, Pleasant T. Development of a 60/60 guideline for referring adults for

a traditional Cochlear implant candidacy evaluation. Otol Neurotol 2020;41:895-900.

Nucleus System

Cochlear expands treatment options for individuals with single-sided deafness

March 24, 2022

By Ryan Lopez, Director, Nucleus Product Management & Marketing

In January 2022, Cochlear received FDA approval to treat patients with single-sided deafness (SSD) with the Cochlear™ Nucleus® System. This approval expands treatment options to include both bone conduction solutions and cochlear implants for these patients.

“This indication allows patients experiencing UHL/SSD to get as close to the normal condition as possible as a cochlear implant restores hearing ability to the ear that has hearing loss. This allows me to provide for my patients so they can get back to the condition that they had been used to before their hearing loss.”

-Eric Lupo, MD Rocky Mountain Ear Center

While this is an extremely important landmark, we want to ensure that professionals have the resources they need to provide the best treatment option for each individual’s unique hearing loss and needs. The first step in the counseling process is to help candidates understand the potential impact of single-sided deafness within their daily lives. While individuals with SSD can function well in relatively easy listening situations, bringing awareness to the disruption in their ability to understand speech in adverse listening situations, their ability to localize sound, and the mental fatigue associated with daily listening efforts, is vital.

Age and duration of hearing loss is a key consideration and starting point for determining the best solution for individuals with single-sided deafness. For children under five years of age, Cochlear offers Softbands and SoundArcs™, non-surgical bone conduction solutions. This is important because early access to improving speech understanding is of highest priority. For children ages five to twelve, Cochlear expands the bone conduction offering with the Baha® Connect and Attract Systems, as well as a portfolio of Nucleus cochlear implant solutions. Finally, for individuals twelve and older, in addition to cochlear implants, the Cochlear Osia® System combines the best high frequency amplification with unique piezoelectric stimulation without a percutaneous abutment.

With regard to cochlear implants, one of the core advantages is the restoration of binaural hearing and improved ability to localize. Candidacy is dependent on the presence of a functioning nerve in the impacted ear and a duration of less than 10 years since the onset of the hearing loss. With acoustic neuroma being one of the leading causes of unilateral hearing loss, the FDA has approved Cochlear to remove the acoustic neuroma contraindication from its labeling.

This ensures that individuals with a functioning nerve, pre- or post-acoustic neuroma removal, can still have a cochlear implant option.

With more options come more decision points. This is why we’re committed to partnering with leading professionals in the industry and developing clinical guidance tools to support you and your patients throughout the journey to better hearing

Please reach out to your local Cochlear Representative to learn more about these solutions and clinical guidance resources.

Read more about the treatment pathway for SSD patients here.

Cochlear logo - white

©Cochlear Limited 2024. All rights reserved. ACE, Advance Off-Stylet, AOS, Ardium, AutoNRT, Autosensitivity, Baha, Baha SoftWear, BCDrive, Beam, Bring Back the Beat, Button, Carina, Cochlear, 科利耳, コクレア, 코클리어, Cochlear SoftWear, Contour, コントゥア, Contour Advance, Custom Sound, DermaLock, Freedom, Hear now. And always, Hugfit, Human Design, Hybrid, Invisible Hearing, Kanso, LowPro, MET, MP3000, myCochlear, mySmartSound, NRT, Nucleus, Osia, Outcome Focused Fitting, Off-Stylet, Piezo Power, Profile, Slimline, SmartSound, Softip, SoundArc, True Wireless, the elliptical logo, Vistafix, Whisper, WindShield and Xidium are either trademarks or registered trademarks of the Cochlear group of companies. The names of actual companies and products mentioned herein may be the trademarks of their respective owners.

 

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.

 

Cochlear ProNews is monitored Monday through Friday, excluding some holidays. Questions and inquiries submitted over the weekends or holidays may see a delay in response. For immediate assistance please contact us directly. You are solely responsible for your interactions with other members of our Websites. Cochlear reserves the right, but has no obligation, to monitor disputes or communications between you and other members of our Websites. For a full list of Cochlear’s terms of use, click here.