Cochlear Implants
by Jamie Schwartz

Clinical Quick Tips: How to pair a Nucleus® 7 Sound Processor to compatible Apple® devices

June 14, 2018
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Do your patients request help pairing their iPhone® to their Nucleus® 7 Sound Processor?

The Nucleus 7 Sound Processor is the first and only Made for iPhone cochlear implant sound processor. Once it is paired with a compatible Apple device, such as an iPhone, iPad® or iPod Touch®, your patients can stream phone calls, music and other entertainment directly to their sound processor. The first app for cochlear implant users.

Once connected to their iPhone, your patients have complete control over their Nucleus 7 Sound Processor using the Nucleus® Smart App.* The Nucleus Smart App allows your patients to:

  • Adjust settings and change programs
  • Access personalized hearing information with the Hearing Tracker functionality
  • Monitor battery life
  • Locate their missing sound processor with the Find my Sound Processor feature

The YouTube the video below can be a helpful resource for you and your team to share with your patients in order to help them to pair their Apple devices with their Nucleus 7 Sound Processor. A few things to note when pairing a Nucleus 7 Sound Processor with Apple devices:

    • Radio waves, from microwaves, wireless routers or TV Streamers, could interfere with pairing Apple devices to a sound processor. If this happens, have your patients move away from these devices and try again.
    • Patients can pair their sound processor with up to five compatible Apple devices, but can only control the sound processor from one device at a time.

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*Nucleus Smart App is compatible with iPhone 5 and iPod touch 6th generation devices (or later) running iOS 10 or higher. It is not designed for use with other Apple devices.
The Nucleus 7 Sound Processor is compatible with iPhone 8 Plus, iPhone 8, iPhone 7 Plus, iPhone 7, iPhone 6s Plus, iPhone 6s, iPhone 6 Plus, iPhone 6, iPhone SE, iPhone 5s, iPhone 5c, iPhone 5, iPad Pro (12.9-inch), iPad Pro (9.7-inch), iPad Air 2, iPad Air, iPad mini 4, iPad mini 3, iPad mini 2, iPad mini, iPad (4th generation) and iPod touch (6th generation) using iOS 10.0 or later.
Apple, the Apple logo, iPhone,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.The Nucleus 7 Sound Processor is compatible with iPhone 8 Plus, iPhone 8, iPhone 7 Plus, iPhone 7, iPhone 6s Plus, iPhone 6s, iPhone 6 Plus, iPhone 6, iPhone SE, iPhone 5s, iPhone 5c, iPhone 5, iPad Pro (12.9-inch), iPad Pro (9.7-inch), iPad Air 2, iPad Air, iPad mini 4, iPad mini 3, iPad mini 2, iPad mini, iPad (4th generation) and iPod touch (6th generation) using iOS 10.0 or later.
Author

Jamie Schwartz

Jamie is the Associate Marketing Manager in the Product and Professional Marketing Department at Cochlear Americas. Jamie is responsible for ProNews blog content as well as professional social posts and calendars. If you are interested in being a guest author for the ProNews blog please contact Jamie by email at jschwartz@cochlear.com.

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Cochlear Case Studies – CI632 case with Dr. Sarah Mowry

May 12, 2021

Cochlear Case Studies is a new series on Cochlear ProNews that highlights relevant clinical and surgical scenarios surrounding the latest hearing industry topics and research. We’re excited to partner with professionals to highlight their experiences surrounding specific patients. This first installment features surgeons, their cases and contributing factors for use of different electrodes.

Case Study

A 52 year old male sustained direct head trauma after falling down a flight of stairs. Immediately after the fall he reported no hearing bilaterally and the left side of his face was paralyzed. He was ultimately transferred to our medical center with a diagnosis of bilateral otic capsule violating fractures with the left side complicated by complete facial paralysis and a dural sinus thrombosis (CT images shown, MRV shown). Audiometry obtained five days after the fall demonstrated bilateral profound sensorineural   hearing loss.

On day six after the fall, the patient was taken to the operating room for a left total facial nerve decompression via a translabyrinthine approach. A complete transection of both the 7th and 8th cranial nerves was identified in the fundus of the IAC, thus precluding placement of a cochlear implant in the left ear. He was brought back to the operating room approximately two weeks later (three weeks from the injury) to attempt placement of a right cochlear implant via a transmastoid approach.

The cochlea was visualized through the facial recess. A formal cochleostomy was created anterior inferior to the round window membrane as the fracture did involve the bony niche overhang. The scala tympani did appear to have some inflammation and granulation tissue; therefore, the depth gauge was inserted into the cochlear duct without removal of the stylet. Placement in the cochlear duct was confirmed with intraoperative X-ray. Once the depth gauge was confirmed in the duct and not in either the IAC or the fracture line, the depth gauge was removed and the CI632 Slim Modiolar Electrode was introduced into the cochlea.

I chose the CI632 for its perimodiolar position, MRI compatibility and slim profile to help minimize trauma in this already traumatized cochlea.  Placement in the perimodiolar position was confirmed with X-ray intraoperatively. Electrical testing of the device was then performed (see tracings). The patient did have robust response of the cochlear nerve to NRT on several electrodes but had no response on others. Activation occurred four weeks postoperatively. He had responses in the low to mid frequencies and was able to detect sound and static with speech sounds.  The patient has had his second stimulation is reporting improved detection and a recognition of speech vs noise!

Image 1. Bilateral otic capsule violating temporal bone fractures. The left fracture transected the entire 7/8th nerve complex in the fundus of the IAC precluding implantation of the left ear. The right fracture spared the IAC and the facial nerve but resulted in pneumolabryinth and profound hearing loss.

Image 2. Air in the right cochlear duct.

Image 3. MRV demonstrating decreased flow in the left transverse and sigmoid sinuses.

Image 4. Audiogram from five days after the injury demonstrating profound bilateral SNHL.

Image 5. Depth gauge in the cochlear duct. The gauge was inserted with the stylet in.

Image 6. Intraoperative skull X-ray demonstrating appropriate coiling of a CI632 electrode into the cochlear duct.

Image 7. Screenshot of a NRT obtained on the day of activation demonstrating variable responsiveness across the electrode array. This may represent injury to the cochlear nerve from shearing forces sustained at the time of fracture.

Image 8. Example of NRT from electrode 22.

Image 9. Screenshot of his progressive map at the end of programing. His pulse width was widened to 37 from 25.

Are you a surgeon who has a case study to share? Contact mcoon@cochlear.com for a chance to be featured on Cochlear ProNews.

About the author: Dr. Mowry is an board certified otology/neurotologist who strives to provide excellent clinical care to patients while promoting the education of the next generation of leaders in the field. She treats both pediatric and adult patients who have dis orders of hearing, balance and the lateral skull base. Her interest in cochlear implants as a young medical student has translated in to a career of service to those with hearing disorders. She is also the residency program director for the University Hospitals Cleveland/Case Western Reserve University Otolaryngology department. She enjoys spending time with family, traveling, cooking and exercising.

Science Spotlight- Longitudinal outcomes of cochlear implantation and bimodal hearing in a large group of adults: A multicenter clinical study

May 5, 2021

Longitudinal outcomes of cochlear implantation and bimodal hearing in a large group of adults: A multicenter clinical study

D. Kelsall, J. Lupo, A. Biever

Rocky Mountain Ear Center

Purpose

To measure preimplant speech recognition scores in 100 adults who showed poor hearing abilities with well fit hearing aids in unilateral hearing aid (HA) and bilateral hearing aid (2HA) listening conditions and postimplant speech understanding at 3-, 6- and 12-months for unilateral cochlear implant (CI) and bimodal (CI+HA) conditions.

Key messages

On average, by 3-months postimplant participants exhibited significant increases in speech recognition in the implanted ear compared to their preimplant performance with a hearing aid. Postimplant, group mean performance progressed significantly on all measures up to 12- months, with the largest and clinically notable advancements in the 3 – 6-month postimplant period.

At 6- and 12-months postimplant, bimodal hearing with the Cochlear™ Nucleus® CI532 implant, Nucleus® 7 Sound Processor and a ReSoundGN hearing aid provided significantly better group mean speech understanding compared to preimplant bilateral hearing aid performance. Counseling should incorporate the potential benefits of an implant in combination with a hearing aid for everyday listening.

Methods

  • Prospective, non-randomized, multicenter controlled trial at 13 clinical sites
  • 100 experienced hearing aid users > 18 years old with postlinguistic onset of bilateral, moderate sloping to profound sensorineural hearing loss
  • Aided CNC word score < 40% in the ear to be implanted and < 50% in the contralateral ear

For all participants, hearing aids were fit to target and baseline speech perception measures completed in unilateral and bilateral listening conditions. All 100 enrolled participants received a Nucleus CI532 implant and a Nucleus 7 Sound Processor. Postimplant, 98/100 participants received a ReSoundGN HA for the contralateral ear. Two individuals had no aidable hearing in the contralateral ear. Daily bimodal hearing (CI+HA) was required for 6-months, then bimodal hearing was optional. At 12-months, participants were tested in the bimodal condition if they brought their HA.

Pre- and postimplant speech recognition in sound field was assessed in unilateral (HA, CI) and bilateral (2HA) /bimodal (CI+HA) conditions for CNC words in quiet at 60 dBA and AzBio sentences at 65 dBA in background noise at +10 and +5 dB SNR. Pre- and postimplant unilateral testing was conducted with the contralateral ear plugged. Bilateral evaluations occurred with 2HAs preimplant and CI+HA at 6-months (compulsory) and 12-months (optional). At the 6-month primary endpoint, CNC word scores for the implanted ear were compared to HA preimplant. All results represent matched pair data.

Table 1: Test measures administered across study intervals.  © 2020 Published by Elsevier Inc.

Results

Ninety-six out of 100 subjects completed the 6-month endpoint visit. One subject withdrew due to an unrelated illness and three subjects underwent revision surgery with the Nucleus CI512 implant.  In this study, subjects were seniors (average of 67 years old) and had a moderate-to-profound hearing loss in the implanted ear and a severe hearing loss in the contralateral ear for approximately 8 years in each ear. On average, 20 years of HA experience was reported for the implanted ear and 19 years for the contralateral ear.

When looking at the implanted ear (Figures 1 & 2), by 6 months after activation the average pre-operative CNC word score of 14.6% more than quadrupled to 60.9% in the implanted ear (improvement of 46.3 percentage points) and AzBio sentence scores at +10 SNR nearly tripled from 14.8% to 42.7% (improvement of 27.9 percentage points).  Compared to preoperative scores, 93% and 73% of subjects performed significantly better on CNC words in quiet and AzBio sentences at +10 dB SNR respectively.  The remainder showed equivalent scores on each test.

Figure 1: Group mean CNC percent correct word scores in quiet for implanted ear (preimplant HA and postimplant CI) for N = 96 at preimplant, postimplant 3- and 6-months and N = 91 at 12-months. Boxplots show the distribution of speech recognition scores with median, quartiles, minimum and maximum values. The mean is indicated with a diamond. Asterisks indicate a significant difference from preimplant at each post implant interval, ***p < 0.001. © 2020 Published by Elsevier Inc.

Figure 2 a, b: Group mean percent correct scores for AzBio sentences in noise at +10 (left) and +5 dB (right) SNR for implanted ear (preimplant HA and postimplant CI). Results are for N = 96 at preimplant and 3-months, N = 94 at 6-months and N = 91 at 12-months. Boxplots show the distribution of speech recognition scores with median, quartiles, minimum and maximum values. The mean is indicated with a diamond. Asterisks indicate a significant difference from preimplant at each post implant interval, ***p < 0.001. © 2020 Published by Elsevier Inc.

Using the bimodal solution of the Nucleus 7 Sound Processor and ReSoundGN hearing aid together (N=94), CNC word scores increased from 28.8% with HAs to 69.2% (improvement of 40.5 percentage points) and the average AzBio sentences +10 SNR score of 31.8% rose to 55.9% (improvement of 24.1 percentage points) as shown in Figures 3 & 4.  Compared to preoperative scores, 87% and 70% of subjects performed significantly better on CNC words in quiet and AzBio sentences at +10 dB SNR respectively.  Equivalent scores were demonstrated by 13% of subjects on CNC words in quiet.

Figure 3: Group mean CNC percent correct word scores in quiet for preimplant bilateral hearing aids condition and bimodal condition (CI + HA) at 6-months postimplant. Results are for N = 94. Boxplots show the distribution of speech recognition scores with median, quartiles, minimum and maximum values. The mean is indicated with a diamond. Asterisks indicate a significant difference from preimplant to the 6-months postimplant interval, ***p < 0.001. © 2020 Published by Elsevier Inc.

Figure 4 a, b: Group mean percent correct scores for AzBio sentences in noise at +10 (left) and +5 dB (right) SNR for bilateral hearing aids condition at preimplant, and bimodal condition (CI + HA) at postimplant. Results are from scores for N = 96 at preimplant, N = 94 at 6-months and N = 83 at 12-months. Boxplots show the distribution of speech recognition scores with median, quartiles, minimum and maximum values. The mean is indicated with a diamond. Asterisks indicate a significant difference from preimplant at each postimplant interval, ***p < 0.001. © 2020 Published by Elsevier Inc.

Conclusions

On average, participants experienced significant increases in speech understanding for words in quiet and sentences in noise while listening with the cochlear implant compared to their HA, and ongoing significant progress remained up to one year postimplant. Participants made most improvements in the first 6 months. Generally, compared to bilateral hearing aids, listening with the Nucleus 7 Sound Processor along with a ReSoundGN hearing aid provided significantly greater speech recognition at 6- and 12- months, especially in more difficult listening in noise conditions. Counseling should incorporate possible benefits of a cochlear implant along with a hearing aid for regular listening. Individuals who obtain limited speech recognition from well fit hearing aids should be referred for a cochlear implant candidacy evaluation.

To read more Science Spotlights visit Cochlear ProNews.

Citation: Kelsall D, Lupo J, Biever A. Longitudinal outcomes of cochlear implantation and bimodal hearing in a large group of adults: A multicenter clinical study. Am J Otolaryngol. 2021 Jan-Feb; 42(1):102773. doi: 10.1016/j.amjoto.2020.102773 Epub 2020 Oct 22. PMID: 33161258

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 article summary is for education and information sharing amongst professionals and partners. Any representations made in relation to medical devices or therapeutic goods are not advertisements. The representations and views expressed in this summary are those of the authors and do not reflect the views of Cochlear. Cochlear does not endorse any particular treatment or research protocol nor off-label use.

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.

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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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