Cochlear Implants
by Cochlear Guest Author

New considerations for recommending a cochlear implant evaluation

March 11, 2021
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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.

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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Camille Dunn, AuD

SSD/UHL treatment considerations: Q&A with Camille Dunn, AuD

April 19, 2022

By Camille C. Dunn, PhD, CCC-A, Assistant Research Professor, Director, University of Iowa Cochlear Implant Program Department of Otolaryngology—Head and Neck Surgery

Camille Dunn, AuD

Recently, we met with a diverse group of thought leaders to explore best practices for single-sided deafness (SSD)/unilateral hearing loss (UHL). Hear from Dr. Dunn on her experience treating these patients:

What clinical considerations are in your treatment pathway for SSD/UHL Patients?

We consider an array of treatment options such as osseointegrated solutions, CROS hearing technology and a cochlear implant. We have a document that we go over with patients so that they can have an understanding of what each type of technology can and cannot provide for the patient. We do an extensive interview with the patient to understand their hearing history (i.e. duration of loss, etiology), lifestyle, demographic and other medical factors and goals for seeking treatment for their SSD.  Based upon this interview, we discuss with the patient which of the treatments would be best or most realistic to help them accomplish their listening goals.

Do you think that the counseling process should include discussion on bone conduction and cochlear implant hearing solutions?

It absolutely should include all of the patient options. If the patient is choosing a cochlear implant, they need to understand that hearing with a CI is a lifelong commitment. Different than someone with bilateral severe-to-profound SNHL, the CI will not ever be their “good ear.” The CI will serve to supplement the normal hearing ear to accomplish spatial hearing abilities. They will have to commit to utilizing the CI effectively by doing listening exercises and wearing the CI all waking hours.  As with any type of exercise, consistency is key.

Why is the ability to treat patients with UHL/SSD with cochlear implants important to audiologists, surgeons and patients?

As a medical professional, we are trained to want to provide treatments to our patients. This situation is no different.  Patients coming to our clinic who have had gradual progressive hearing loss (maybe even in both ears) for several years have had a chance to accommodate situations with their gradually changing hearing loss.  For patients with sudden SSD, they often come to our clinics feeling very debilitated and scared. They suddenly cannot localize sound (or understand speech in adverse listening situations). Imagine hearing your child cry for help and you have no idea where to look for your child to provide them help because you cannot localize where the sound is coming from? Imagine working in a warehouse and all of a sudden you have no idea which direction the beeping is coming from warning you that there is a forklift nearby? All of these situations are life-altering for individuals with SSD.  When you let that patient know that there is an option to restore hearing to the deafened ear, you can immediately see a level of calm come over these patients.  

What would you tell a provider that is hesitant to explore CI as a treatment option for UHL/SSD?

I would tell them that there is good reason to be hesitant. When we first started implanting patients with SSD I thought that we were crazy!  I thought that there was no way that a person with normal hearing would want to listen to the sound from a CI in their deafened ear. I was wrong. I would also tell them that counseling these patients and preparing them for a CI is a bit different than what we used to call our traditional CI patients (because what is traditional these days?). Testing these patients for progression and benefit from their CI is a bit different than listeners with standard bilateral SNHL.  I would recommend reaching out their cochlear implant representatives to ask them to guide them through the initial processes of providing care and counseling to these patients so that their patients can have successful outcomes.   

Tell us about your experience at the SSD Thought Leader Meeting and what that means for the industry?

The SSD Thought Leader Meeting provided a dynamic avenue for professionals to come together and discuss their experience working with individuals with SSD who get a CI. I believe that together we accomplished a lot. We all came together to develop a consensus on the best way to, not only better understand the benefits of CI for SSD, but treat, counsel and better understand the needs of these patients. They are different than other listeners who have traditionally gotten a CI and because of that, they need to have their own platform of care.

Hear more from another Thought Leader Meeting attendee, Andrea Overton, AuD, and check out our recent FDA approval for CI for SSD.

Camille Dunn, PhD, joined the Department of Otolaryngology—Head and Neck Surgery at the University of Iowa in 2003 where she is an Associate Professor and the Director of the Cochlear Implant Program.  She received her Master of Science degree in 1998 and Doctor of Philosophy Degree in 2003 both from the University of Nebraska-Lincoln. Dr. Dunn holds her Audiology license from the State of Iowa. She maintains her Certificate of Clinical Competence in Audiology (CCC-A) and is a member of the American Speech-Language-Hearing Association (ASHA) and a Board member on the American Cochlear Implant Alliance (ACIA). She is a Principal Investigator on a NIH-funded grant to determine the impact of intervention on user’s hearing-related functions and disability in their natural environments.

kanso 2

Expert opinion: Kanso® 2 Sound Processor first impressions

October 15, 2020

By Allison M. Biever, AuD, CCC-A, Rocky Mountain Ear Center

Background

I have been involved in the cochlear implant field for 28 years.  How fulfilling it is to be a part of someone’s hearing journey! I was initially drawn to the field of Speech and Language Pathology and enrolled in the master’s program at CU Boulder in 1989.  After switching majors, it was natural that audiology would have a special place for me, since I was raised by a mother who was born with moderate-to-severe sensorineural hearing loss. 

Why off-the-ear?

Kanso 2

During the COVID-19 pandemic, patients have frequently complained about how hard it is to keep their behind-the-ear processor on when they are also wearing a mask.  One of my cochlear implant patients wears her Nucleus® 7 Sound Processor, the bow of her eyeglasses, a mask and an oxygen tube behind her ear.  She told me, “There isn’t enough room for everything I have to wear behind my ear!”. Having an off-the-ear option for cochlear implant recipients is a big deal. 

Patients who have had a sudden hearing loss and have never had to wear a hearing aid are often very uncomfortable with the feel of something behind the ear.  Some patients have malformed pinnas or pinnas that are close to their heads, making a behind-the-ear sound processor a non-viable option.  Cochlear implant recipients who have tried both a behind-the-ear processor and an off-the-ear option will frequently tell me that the off-the-ear option is considerably more comfortable. 

Initial experience with Kanso® 2 Sound Processor

In mid-July, I was invited to participate in a controlled market release of the Kanso 2 Sound Processor. This amazing sound processor has already changed the lives of the recipients I have been seeing in our clinic.  At activation, I have been fitting both the Nucleus® 7 Sound Processor and the Kanso 2 Sound Processor to our newly implanted recipients.  Our activations are typically conducted a few weeks after surgery. Almost half of the patients returned for their follow-up visits two weeks later wearing the Kanso 2 Sound Processor.  The patients reported it was more comfortable to wear and at two weeks device retention was not an issue.

The Kanso 2 Sound Processor is the diameter of a “Loonie”, which is the Canadian one-dollar coin.  Unlike the first generation Kanso Sound Processor, Kanso 2 Sound Processor is rechargeable and can be controlled from a smartphone+ so that changes can be made to improve auditory performance if needed.  The recipient can check battery life, change volume, master volume, bass, treble or sensitivity.  Recipients can change programs or initiate streaming to an accessory simply by manipulating the app on their smartphone.+ 

Advanced connectivity and beyond

Additionally, recipients who have compatible Apple® or Android™ devices can stream directly to their Kanso 2 Sound Processor, creating an environment for easier phone conversations. Although the technology is similar between the Nucleus 7 Sound Processor and the Kanso 2 Sound Processor, more patients are finding ease of charging the device, ease of putting the device on and overall comfort to be superior with Kanso 2 Sound Processor.  I have also fit several elderly adults with fine motor difficulties and vision deficits who have reported ease of use. 

On average, the Kanso 2 Sound Processor requires less time for counseling because there are fewer parts to manipulate and discuss with the newly-activated recipient.  The entire processor can be placed in a charging case each night for ease of charging.

Smart has never been so simple

One of my favorite features of the Kanso 2 Sound Processor is the “buttonless” design.  Frequently, when patients are given multiple programs, they will inadvertently touch the button on their sound processor and change the program without being aware they have made a change. The simplicity of the Kanso 2 Sound Processor is spectacular!  The recipient can just tap the processor three times to turn it off and twice to turn it on.  I love that it has become so incredible easy for recipients to use.  If I had to choose one processor to use for many of my patients, I would choose the Kanso 2 Sound Processor because of its simplicity.

To learn more about Cochlear’s latest innovations please view this webinar and read this interview.

About the author: Dr. Allison Biever received her bachelor’s degree from the University of Alberta in 1989 and her master’s degree in Audiology at the University of Colorado in 1992, after which time she worked as a fellow in the first cochlear implant program in Colorado. In 2005 she received her Au.D. from Central Michigan University, completing a doctoral thesis that examined the impact of residual hearing on cochlear implantation in children.

Her focus at the Rocky Mountain Ear Center has been helping people regain their hearing through the miraculous technology of cochlear implants. She was awarded the LaFawn Biddle Award and the Hands & Voices Families First Award for her outstanding service to the deaf and hard of hearing community. In addition to her work in the clinic, she is also a prominent researcher in the field of cochlear implants, an instructor for Institute for Cochlear Implant Training (ICIT) and is on the board for the Listen Foundation. Allison enjoys hiking and spending time with her husband and three daughters. She is also an avid runner and Boston Marathon participant.

+The Cochlear Kanso 2 Sound Processor, Nucleus 7 Sound Processor and Nucleus Smart App are compatible with Apple and Android devices, for compatibility information visit www.cochlear.com/compatibility

Apple is a service mark of Apple Inc., registered in the U.S. and other countries.

Android and Google Play are registered trademarks of Google Inc.The Android robot is reproduced or modified from work created and shared by Google and used according to terms described in the Creative Commons 3.0 Attribution License.

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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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