Cochlear Implants
by Cochlear Guest Author

Clinical Quick Tips: Getting ready for splashing into summer with the Aqua+

July 19, 2018
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Clinical Quick Tips

By guest author: Natasha McDougald

Natasha

Are your patients getting ready for a wild wet summer?  Share the following tips with your patients for them to HearYourWay™ while getting soaked.

  • For Behind the Ear processors use rechargeable batteries while using the Cochlear™ Aqua+*
  • For Kanso®;  the LR44 battery is required for use with the Aqua+
  • Always remember to use a safety line with your processor when exploring the ocean or river since processors don’t float!
  • Want to hear coach’s instructions clearly during swim club with your Cochlear™ Nucleus® 7, Nucleus® 6 or Kanso? Have them use the MiniMicrophone 2+ while coaching from the deck.

Tips for Optimizing Sensitivity and Volume for Aqua+

  • Many recipients may prefer slightly increased volume and sensitivity while wearing their Aqua+
  • Consider having the patient bring their Aqua+ and optimizing a MAP for sensitivity and volume while they are wearing the Aqua+ to create as a manual program OR encourage recipients to utilize remote controls or the Nucleus Smart App since preferred changes are likely to be minimal and temporary.

Share this instructional video with your patients to help answer their questions about using the Aqua+ with their Nucleus 7 Sound Processor:

About our guest author:

Natasha has worked at Cochlear Americas for almost 7 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.  She has presented numerous talks and courses on hearing loss, multiple disabilities, advocating skills and cochlear implantation to audiences in the medical-technology, educational, special needs and family support sectors.

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*Nucleus 7 with Aqua+ is water resistant to level IP68 of the International Standard IEC60529. This water protection rating means that the sound processor with the Aqua+ can be continuously submerged under water to a depth of 3 meters (9 feet and 9 inches) for up to 2 hours. This water protection only applies when you use the Aqua+ and LR44 alkaline or nickel metal hydride rechargeable batteries. The Kanso Sound Processor with the Aqua+ is water resistant to level IP68 of the International Standard IEC60529. This water protection rating means that the sound processor with the Aqua+ can be continuously submerged under water to a depth of 3 meters (9 feet and 9 inches) for up to 2 hours. This water protection only applies when you use the Aqua+ and LR44 alkaline or nickel metal hydride disposable batteries.
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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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Science Spotlight

Science Spotlight: Speech perception and QoL effectiveness CI in a group of adults 65 years or older

January 19, 2021

Hearing and Quality-of-Life Outcomes After Cochlear Implantation in Adult Hearing Aid Users 65 Years or Older

A Secondary Analysis of a Nonrandomized Clinical Trial

Wick CC, Kallogjeri D, McJunkin JL, et al

Assessment of Cochlear Implants for Adult Medicare Beneficiaries Aged 65 Years or Older Who Meet Expanded Indications of Open-Set Sentence Recognition

A Multicenter Nonrandomized Clinical Trial

Zwolan TA, Kallogjeri D, Firszt JB, Buchman CA

Purpose

To explore speech perception and quality-of-life (QoL) effectiveness of cochlear implants (CI) in a group of adults 65 years or older compared with an optimized bilateral hearing aid (HA) condition, and to examine the improvement on the AzBio Sentence Test for Medicare beneficiaries who meet the expanded criteria of a score of 41% – 60% in the best-aided condition.

Key messages

Cochlear implantation is a safe and effective treatment for hearing loss in adults age 65+ who meet both traditional1 and expanded2 Medicare guidelines. Results show significant and meaningful improvements in speech perception and quality-of-life, without an elevated risk profile in this population.

Methods

Wick et al.

  • Non-randomized controlled trial, multicenter, prospective, repeated measures design
  • 13 clinical sites
  • 70 subjects age 65 years and older with postlinguistic onset of bilateral moderate sloping to profound sensorineural hearing loss with an aided CNC word score of ≤40% in the ear to be implanted and ≤50% in the contralateral ear. Note that Wick et al. is a secondary analysis of subjects age ≥65yrs who are part of the larger dataset found in Buchman et al.

All subjects were experienced users of hearing aids and completed objective speech perception testing and subjective QoL surveys prior to implantation. All enrolled subjects were implanted with a CI532 electrode and used a Nucleus® 7 Sound Processor on the implanted ear and a new ReSound hearing aid on the contralateral ear. Subjects were seen by their clinicians at 1m, 3m, 6m and 12m post-activation, with endpoint measurements collected at the 6m visit. Subjects also completed a post-operative high-resolution CT scan to confirm electrode placement.

Zwolan et al.

  • Non-randomized, multicenter, prospective clinical trial
  • 8 clinical sites
  • 34 subjects age 65+ years with bilateral moderate to profound hearing loss and best-aided pre-operative AzBio Sentence Test scores of 41-60%. Note that the current CMS criteria require a score of 40% or poorer.

The study examined speech recognition, telephone communication, hearing device benefit, health utility and quality-of-life in a group of Medicare beneficiaries. Assessments were performed pre-operatively, and at 6m and 12m post-cochlear implantation.  

Results

Wick and colleagues found that CIs provided meaningful improvement in speech perception and QoL in a population of 70 subjects who were age 65+ years at the time of implantation. The subjects demonstrated an estimated marginal mean (EMM) improvement in CNC words scores of 44.1% in the implanted ear alone, and 32.7% in the bimodal condition (CI+HA). Individually, 83% of subjects showed an improvement of 15% or more in the bimodal condition. On AzBio Sentences at +10dB SNR, the EMM score improved by 24.5% in the implanted ear alone and by 21.6% in the bimodal condition (Figure 1).

The Total score on the Speech, Spatial, and Qualities of Sound survey (SSQ49) improved from a baseline score of 2.04 to score 4.97 at 6 months post-CI – a difference of 2.93 points on a 10-point scale. On the Health Utilities Index (possible score range of 0-1.0), the average pre-operative hearing score was low (0.298 with bilateral HAs) and increased to 0.605 after 6 months of using a CI and HA together (change of 0.307). At this 6-month endpoint, 94% of the subjects reported that they were satisfied with their everyday listening condition, compared with only 9% of subjects who were satisfied pre-operatively when using two well-fit HAs.

In addition to the objective and subjective benefit of CI seen in this cohort, the surgery was generally well tolerated with no major adverse events within these first six months. All reported adverse events were minor, and typically associated with a CI, suggesting that this age group of recipients do not seem to present at higher risk for complication when comorbidities are appreciated and managed pre-operatively.

In agreement with the Wick article, Zwolan et al. reported similar speech perception benefits in a group of 31 subjects age 65+ years. The group in this study is further defined by their pre-operative scores of 41-60% on AzBio sentences which is better than the currently approved Medicare guideline. On CNC words, the EMM increased by 43% in the implanted ear alone, and by 36.5% in the best aided condition at six months post-implantation. On AzBio Sentences in quiet, the group demonstrated an EMM increase of 42.4% in the CI alone condition and 32.3% in the best-aided condition (Figure 2). The subjects’ reports of perceived hearing and health benefit also reflected significant and clinically meaningful improvement after receiving a CI.

Conclusions

The results of these two clinical trials of participants ≥ 65 years found clinically important speech understanding improvements in quiet and noise, and notable QoL and hearing satisfaction benefits when using a CI or a CI+HA versus using bilateral HAs. The advantages were seen in subjects who meet the current CMS indication for cochlear implantation, as well as in those who exceed it by as much as 20%. Complications and adverse events were neither major nor prolonged, indicating the risk/benefit profile to be acceptable for this age group. These findings suggest that cochlear implantation in older adults could be extended to those with better pre-operative speech understanding and could contribute to a healthy aging process.

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References

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

Citation:

  1. Wick CC, Kallogjeri D, McJunkin JL, et al. Hearing and Quality-of-Life Outcomes After Cochlear Implantation in Adult Hearing Aid Users 65 Years or Older: A Secondary Analysis of a Nonrandomized Clinical Trial. JAMA Otolaryngol Head Neck Surg. Published online August 27, 2020. doi:10.1001/jamaoto.2020.1585
  2. Zwolan TA, Kallogjeri D, Firszt JB, Buchman CA. Assessment of Cochlear Implants for Adult Medicare Beneficiaries Aged 65 Years or Older Who Meet Expanded Indications of Open-Set Sentence Recognition: A Multicenter Nonrandomized Clinical Trial. JAMA Otolaryngol Head Neck Surg. Published online August 27, 2020. doi:10.1001/jamaoto.2020.2286

Authors & Affiliations:

Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri

Cameron C. Wick, MD (1)

Dorina Kallogjeri, MD, MPH (1,2)

Jonathan L. McJunkin, MD (1)

Nedim Durakovic, MD (1)

Laura K. Holden, AuD (1)

Jacques A. Herzog, MD (1)

Jill B. Firszt, PhD (1,2)

Craig A. Buchman, MD (1,2)

Statistics Editor, JAMA Otolaryngology–Head & Neck Surgery

Dorina Kallogjeri, MD, MPH (1,2)

Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor

Teresa A. Zwolan, PhD (2)

This article is intended to serve as a resource for clinicians to help keep up to date with current clinical literature and is intended for professionals only. Clinical literature is based on research, which may include the experimental use of new or currently available products and technologies. Therefore, literature presented on this blog may represent use of Cochlear products that does not align with the intended use or indications approved by regulatory bodies, also known as off-label use. Cochlear does not condone any off-label use of its products, and it is not Cochlear’s intent to promote off-label use by providing this blog as a resource to clinicians.

This content is meant for professional use. 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. Views expressed are those of the individual. Consult your health professional to determine if you are a candidate for Cochlear technology.

All figures are our own.

For compatibility information and devices visit www.Cochlear.com/compatibility and resound.com/compatibility. For a list of compatible ReSound hearing aids visit www.Cochlear.com/nucleus/compatibility

Dr. Tribulski

Inclusivity in video games

July 8, 2022

By Kathryn Tribulski, AuD

Why those with hearing loss can be left behind in the video game world

Below is a timeline of world events that led to a realization that as providers, we can do so much more in terms of access for our patients:

● March 11th, 2020 the World Health Organization (WHO) declares COVID-19 a global pandemic

            ● March 13th, 2020 COVID-19 is declared a National Emergency

            ● March 19th, 2020 the first state orders a stay at home order[i]

            ● March 20th, 2020 Animal Crossing New Horizons from Nintendo has its world-wide

release[ii]

● March 24th, 2020 Kat Tribulski, AuD, tries desperately to find a Nintendo Switch™…. but there is nothing in a 100-mile radius.

In 2020, many like myself searched for the latest and greatest in escapism through video games.  But those with hearing loss, particularly cochlear implant users, seemed to be left behind. With the world locked down, many turned to technology as a social outlet in addition to a form of escapism.  It was at this point I realized how many of my patients were at yet another deficit with their devices. Hearing loss professionals are often asked to educate device users on integrating technology with phones/tablets and it’s time that we expand this to video game systems.

The psychosocial benefits of video games have been debated; however, recent studies show that video games do not cause harm in terms of psychosocial development.[iii] The unfortunate truth is that those with hearing loss are not granted the same access to this form of escapism and outlet for socialization – video games currently have rating systems including the rating “E for everyone”, which isn’t necessarily true. 

In an article from October 2020, Melanie Ashford shares, “Unlike many other gamers, I am immediately at a disadvantage,” citing footstep noise, bonus level/item noises and chat functions without captions, therefore limiting access to some with hearing loss. It seems that even with the increased technological innovation such as the Nucleus® 7 iPhone compatibility and Bluetooth® streaming capability, there is still more work to be done. 

While I don’t personally have hearing loss, I approached my own video game experience and started to specifically look to see how my cochlear implant patients could access all the auditory functions some games have to offer. In many single player games remote technology like a TV Streamer or a Mini Microphone 2+ allow for auditory access; however, that access can be dependent on the patient’s access to and understanding based on their MAPping and rehabilitation model.

As video games become even more engrained in our culture, all ages of users should have some equity in terms of ability to play. In a recent Captel blog post from December 2021, hearing loss friendly adjustments to game development were shared including touch feedback (vibratory control features), visual cues, dialogue to background noise adjustment options, subtitles and captioning as some integration options to allow access.[iv]  The industry is changing and trying to address these issues; for example in a June 2020 article to The Verge, lead game designer for The Last of Us Part II Emilia Schatz is quoted as stating, “accessibility for us is about removing barriers that are keeping players from completing a game. It’s not about dumbing down a game or making a game easy. What do our players need in order to play the game in parity with everyone else?”.[v]  This game won 43 of the 94 nominations for game awards, so the disability access did not seem to negatively impact its reception – if anything it helped.

Video games are quickly becoming engrained into our culture and research has shown that they are tools used by a variety of generations for connection and growth.[vi] As the world continues to change, those with hearing loss shouldn’t be left behind and it’s our duty as hearing loss professionals to embrace those changes and assist, advocate and educate so that they are not.

Read this Cochlear ProNews article to read more from professionals on increasing access for those with hearing loss.

[i] Staff A. A Timeline of COVID-19 Developments in 2020. AJMC. https://www.ajmc.com/view/a-timeline-of-covid19-developments-in-2020. Published 2022. Accessed May 1, 2022.

[ii] Pearce K, Yip J, Lee J et al. Families Playing Animal Crossing Together: Coping With Video Games During the COVID-19 Pandemic. Games Cult. 2021:155541202110561. doi:10.1177/15554120211056125 and Donald P. Bellisario College of Communications at Penn State. Bellisario.psu.edu. https://www.bellisario.psu.edu/medialab/research-article/animal-crossing-usage-during-the-covid-19-pandemic1. Published 2022. Accessed May 1, 2022.

[iii] Lobel A, Engels R, Stone L, Burk W, Granic I. Video Gaming and Children’s Psychosocial Wellbeing: A Longitudinal Study. J Youth Adolesc. 2017;46(4):884-897. doi:10.1007/s10964-017-0646-z

[iv] Hearing Loss Accessibility Features in Video Games. CapTel. https://www.captel.com/2021/12/hearing-loss-accessibility-features-in-video-games/#:~:text=One%20of%20the%20most%20common%20hearing%20loss%20accessibility,well%20they%20are%20subtitled%20%28among%20other%20accessibility%20questions%29. Published 2022. Accessed May 1, 2022.

[v] The Last of Us Part II isn’t just Naughty Dog’s most ambitious game — it’s the most accessible, too. The Verge. https://www.theverge.com/21274923/the-last-of-us-part-2-accessibility-features-naughty-dog-interview-ps4. Published 2022. Accessed May 1, 2022.https://www.theverge.com/21274923/the-last-of-us-part-2-accessibility-features-naughty-dog-interview-ps4

[vi] Marston H, Kowert R. What role can videogames play in the COVID-19 pandemic?. Emerald Open Research. 2020;2:34. doi:10.35241/emeraldopenres.13727.1

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.

For compatibility information visit www.cochlear.com/compatibility

About the author:

Dr. Kat Tribulski is the Cochlear Implant Coordinator at Nemours Children’s Health in Orlando, FL.  In addition to her role as implant coordinator she is a full-time pediatric audiologist at Nemour’s.  Prior to working at Nemour’s Dr. Tribulski was the Pediatric Cochlear Implant director and Tufts Medical Center and Tufts Children’s Hospital in Boston, MA.  She is currently a member of the ASHA and the ACIA. Dr. Tribulski earned her doctorate in Audiology at Salus University in 2016.  She completed her externship at Eastern Virginia Medical School and The Children’s Hospital of the King’s Daughter in Norfolk, VA with a focus on cochlear implants.  In her free time she enjoys video games, board games and her dog Lilly.

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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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