Clinical Recommendations for Effective Electric-Acoustic Stimulation Treatment for Patients with Severe High-Frequency Hearing Loss

Guest Author: William H. Shapiro, AuD, CCC-A                      

Clinical Associate Professor & Supervisor of Audiology

Department of Otolaryngology, NYU Medical Center

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As an audiologist who has worked with cochlear implants since 1984, I have seen technology explode – particularly in recent years.  I find it amazing to witness how patient performance has improved alongside these technology advancements.  In the early days of cochlear implants (CI), we hoped that patients could distinguish presence vs. absence of sound and maybe tell the differences between speech and environmental noise.  Today, patients are now able to talk on the phone, carry on conversations in noisy environments and connect wirelessly to everyday devices with their CI.  If you had told me 20 years ago that my patients would enjoy wirelessly streaming music – I would not have believed you.

So I was intrigued when Cochlear asked if I would be willing to fit their newest sound processor—the Kanso™ — on patients.

From my perspective, recipients want things to be simple, easy to use and effortless.  I found this to be true when fitting the Kanso.  Recipients were impressed with the ease of use—only one button to push and they were ready to go!  My patients have enjoyed the automaticity of the device, including the automatic scene classification offered by SCAN*.

When counseling on device choice during the candidacy process, I saw patients quickly gravitate toward an off-the-ear option.  In fact, their “eyes would light up” at first glance.  As a center that offers two sound processors, this was a nice opportunity to offer recipients the wearing flexibility to have an off-the-ear option and a behind-the-ear option as their product selections.

My next question was “can this device deliver on performance”?  I wanted to verify that this very simple off-the-ear device was equivalent to the Nucleus 6 sound processor that I have been fitting successfully for the past several years.  Kanso offers dual microphones, SmartSound™ IQ* and access to the same wireless technology as the N6 sound processor. This is a truly remarkable innovation.  In fact, I found that recipients wearing the Kanso demonstrated essentially comparable hearing experience¹ to that of their current N6 sound processor.

To my surprise, retention of the device was not an issue with most of the recipients I fit.  I found that if the recipient was extremely active, using the very transparent retention wire assisted with any concerns that the device may fall off when used during a particular activity.

There was a definite reduction in the time it took to counsel on the device use, wear, and care during the initial fitting.  This was particularly nice for my recipients as the information that I needed to provide on the device operation was straightforward, easy to understand and not overwhelming to them, which is not always the case!   So because of the reduction in time, I was able to focus on other aspects of the fitting process like rehabilitation and use of the wireless accessories. 

A final question I always ask myself is “would I wear it?”  And that answer is “absolutely!”  To me it is important that when I make a recommendation to recipients that it is one that I can personally stand behind which is unequivocally the case with the Kanso.  It is truly an extraordinary product that offers great flexibility and is discreet and easy to use for adult and pediatric patients alike.

1. Jones, Marian, Mauger, Stefan. Cochlear™ Clinical Investigation Report. Acceptance of the CP950/KANSO sound processor with experienced CP810/CP900 series BTE sound processor participants. Version 1.0. Clinical Investigation Plan Number CLTD5591 v.5. Windchill No. 582225. CIR D1072418. Aug 12, 2016.

*SNR-WR, WNR and SCAN are approved for use with any recipient ages 6 years and older, who is able to: 1) complete objective speech perception testing in quiet and in noise in order to determine and document performance: and 2) report a preference for different program settings.
The Kanso™ Sound Processor is water resistant to level IP54 of the International Standard IEC60529. The Kanso 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.

Welcome to Cochlear™ Quick Tips.  The purpose behind Quick Tips is to give you “bite-sized” information that you can use when working with our products.  In this first edition, we will discuss Cochlear™ Nucleus® Depth Gauges.

What is a depth gauge?

• Depth gauges are surgical components that utilize the same materials and have the same handling characteristics as “live” electrode arrays

When should a Depth Gauge be considered?

• To aid in assessing the patency of the cochlea lumen if pre-operative imaging is inconclusive or unavailable
• To assess if insertion depth is adequate
• To assist in determining the most appropriate implant model
• During explant/re-implant procedures

What Depth Gauges are available?

• Cochlear has two types of depth gauges: the Contour Advance Depth Gauge and Straight Depth Gauge

• The Contour Advance Depth Gauge is more commonly used of the two depth gauge options. This is due to its benefits in obstruction/fibrosis/ossification, common cavity, incomplete partition, and cochlear hypoplasia cases

Can I see an example of how this can be used?

Anything else I should know?

• Depth gauges are not approved for use as an implant or stent. 
• Monopolar electrocautery should not be performed with a depth gauge in position.
• The Straight Depth Gauge DOES NOT have the same the same dimensions or handling characteristics as the Slim Straight electrode and does not have a smooth lateral surface or basal support​.  Size differential between slim straight and straight electrode arrays may create false-positive or false-negative feedback with use​. 
• For more information, please reach out to your local Cochlear representative or call Cochlear’s Surgical-on-Call at (877) 279-5411.

To learn more about Cochlear™ Nucleus® Implants, visit our website.