Cochlear Implants
by Cochlear Guest Author

Connect without compromise: Apple® and Android™ streaming capabilities

September 24, 2019
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Nucleus 7

By Natasha McDougald, Product Manager – Bimodal and Hybrid Hearing

Giving patients sound at their fingertips is now easier than ever.

With the introduction of direct streaming and control with compatible Apple® and Android™ devices and True Wireless™, they don’t need to add an attachment to their sound processor to connect to the world around them.

Users can conveniently use their compatible iPhone® or Android to stream sound, such as phone calls and music, directly to their Nucleus® 7 sound processors using Made for iPhone and Android Streaming for Hearing Aids (ASHA) technology.

Android Streaming

Did you know we created the first cochlear implant sound processor with direct to device control and accessibility for Apple and Android compatibility?

Nucleus Smart App for Apple Watch

This new feature allows for convenient control at your fingertips with a discreet tap. Patients can:

  • Change programs
  • See battery status
  • Adjust volume
  • Select audio source

The Apple Watch app also includes controls for ForwardFocus**, which is a feature to aid wearers in challenging listening environments. It’s intelligently designed to attenuate distracting noise from behind the listener, making it easier to enjoy face-to-face conversation and maximizing frontward focus.¹

Using ForwardFocus**, recipients demonstrated statistically significant improvement in both conditions of spatially separated noise2.  This can result in an improved and controlled listening experience as rear-facing noise is reduced.

Hear the Difference

The Mini Microphone 2+, Phone Clip and TV Streamer afford patient access to ultimate wireless connectivity.

Stay tuned for more innovations to help you and your patients connect without compromise!

To learn more about wireless connectivity options or how to pair a device please visit our TECH Talks page.

About the 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.

*The Cochlear Nucleus 7 Sound Processor is compatible with Apple and Android devices, for compatibility information visit www.cochlear.com/compatibility.

**ForwardFocus can only be enabled by a hearing implant specialist. It should only be activated for users 12 years and older who are able to reliably provide feedback on sound quality and understand how to use the feature when moving to different or changing environments. It may be possible to have decreased speech understanding when using ForwardFocus in a quiet environment.

References

  1. Cochlear Limited. D1376556.CLTD5709 Acceptance and Performance with the Nucleus 7 Cochlear Implant System with Adult Recipients. 2018 Jan; data on file.
  2. Cochlear Limited D1376556 Acceptance and Performance with the Nucleus 7 Cochlear Implant System with Adult Recipients. June 2018, Data on file

The Cochlear Nucleus 7 Sound Processor is compatible with iPhone, iPad and iPod touch. Apple, the Apple logo, FaceTime, Made for iPad logo, Made for iPhone logo, Made for iPod logo, iPhone, iPad Pro, iPad Air, iPad mini, iPad 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., 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.

The Cochlear Nucleus Smart App is available on App Store and Google Play. For complete smartphone compatibility information, please visit www.cochlear.com/compatibility.

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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Related Posts
GN ReSound

Recent Innovation powering the Smart Hearing Alliance

September 7, 2020

By Natasha McDougald, Product Manager: Sound Processors, Bimodal and Connectivity

The Smart Hearing Alliance

Ears work as a team and there are advantages to hearing well with both ears. For some people with a cochlear implant, having a ReSound hearing aid on the other ear provides the best possible hearing through a bimodal solution. Bimodal hearing in general may improve speech recognition in noise, including locating where sounds are coming from, while also providing superior sound quality compared with using a cochlear implant alone.1-4

The Smart Hearing Alliance, a unique collaboration between Cochlear and ReSound, makes it easy to provide a bimodal solution for your patients.  The partnership provides connectivity solutions that work with both the ReSound hearing aid and the cochlear implant. ReSound and Cochlear share wireless technology, so your clients can stream directly to their cochlear implant and hearing aid simultaneously from compatible iOS or Android™ devices, or from a range of wireless accessories with no need for intermediary devices. With more sound to both ears and superior sound quality compared to using a cochlear implant alone4, recipients can take phone calls, enjoy music, TV or ZOOM chat with a friend in a busy chattering home environment.

The Cochlear™ Nucleus® Kanso® 2 Sound Processor

Cochlear has expanded its sound processor portfolio through a series of approvals such as the Kanso 2 Sound Processor, allowing clinicians to fit either an off-the-ear or traditional-behind-the-ear sound processor without compromising performance-enhancing algorithms or direct connectivity to smartphones.  The innovative Kanso 2 Sound Processor introduces a built-in rechargeable battery designed for all-day hearing~, paired with the highest dust and water resistance for a cochlear implant sound processor for added peace of mind for your patients.+

The ReSound ONE™ hearing aid

On August 18, 2020, GN Hearing globally unveiled ReSound ONE™ hearing aid, a new hearing aid* that solves one of the most enduring challenges for people with hearing loss. For the first time, this unique solution places an additional microphone inside the ear canal, allowing people relying on hearing aids to experience the world with their own ears while preserving the comfort of an RIE device.* Now every patient may enjoy the benefit of superior sound quality and hear conversations better in noisy environments. At launch, ReSound ONE will be bimodally compatible with the True Wireless™ accessories. Linking capabilities for direct bimodal streaming from compatible Apple and Android devices, are expected to be available with a service release of Custom Sound Pro later this year.

Complementary innovation to improve the patient experience

Cochlear and ReSound have been collaborating on technology development, product solutions, design and engineering capabilities since 2011, and these new hearing devices benefit from this complementary approach.

Bimodal built-in rechargeability:  For the first time, bimodal patients can experience the convenience and simplicity of a cochlear implant sound processor and hearing aid with integrated rechargeable batteries.

User-activated algorithms for challenging environments:   Patients wearing the Kanso 2 Sound Processor and ReSound ONE hearing aid will have the control to focus on sounds in front of them, using two pre-processing strategies: ForwardFocus^ from Cochlear and a clinician-programmed narrow beam vis Adaptive Directionality from GN Hearing.  These enhanced operating modes are designed to improve speech recognition, giving patients the control to increase hearing focus. 

Automatic setting adjustment:  Noise Tracker II, Environmental Optimizer II and Soft Switching from GN Hearing uniquely complements Cochlear’s Smart Sound IQ with SCAN#, allowing the hearing devices to automatically adjust settings and microphone directionality to improve the listening experience.

Quality care from anywhere: The impact of the COVID-19 global pandemic has irrevocably changed the healthcare landscape and has necessitated a change in how hearing healthcare services are provisioned.  The Smart Hearing Alliance has addressed these challenges through the development of hearing devices that include built-in connectivity for remote care delivery.

For example, GN Hearing pioneered the remote hearing care vision, by introducing ReSound Assist in 2017.  ReSound Assist allows varying levels of care, including Live Assistance for face-to-face video appointments, incorporating real-time feedback from patients, or Remote Fine-Tuning for sending adjustments anytime.  Cochlear has the only FDA approval for remote programming. It also received expedited approval in April 2020 for Remote Check, a convenient, at-home testing tool that allows patients to complete a hearing review with a Kanso 2 or Nucleus 7 Sound Processor using an  iPhone® or iPod touch® without having to travel to the clinic.**

Clinicians fitting Smart Hearing Alliance solutions are positioned to deliver an enhanced bimodal experience with proven hearing satisfaction, facilitating care today and in the future. 5

To learn more visit ReSound or watch this webinar on Cochlear’s latest innovations.

About the author: Graduating in Management Information Systems, Natasha McDougald began her career as a system analyst working with tech companies in the Silicon Valley.  Personal circumstances became a catalyst for career change; transitioning from desktop-based computers to tiny embedded biomedical computers known as cochlear implants.  Natasha has worked at Cochlear Americas for over 9 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.

+ The Kanso 2 Sound Processor is dust and water resistant to level of IP68 of the International Standard IEC60529. The Kanso 2 Sound Processor with Aqua+ is dust and water resistant to level of 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 up to 3 meters (9 feet and 9 inches) for up to 2 hours.  The Aqua+ accessory should be used when participating in prolonged water activities.

* Microphone in ear and two standard directional microphones, directionality features, wireless audio streaming.

^ForwardFocus can only be enabled by a hearing implant specialist. It should only be activated for users 12 years and older who are able to reliably provide feedback on sound quality and understand how to use the feature when moving to different or changing environments. It may be possible to have decreased speech understanding when using ForwardFocus in a quiet environment.

#It is recommended that SNR-NR, WNR and SCAN be made available to any recipient, ages 6 and older, who is able to 1) complete objective speech perception testing in quiet and noise in order to demonstrate and document performance and 2) report a preference for different program settings.

**The Remote Check feature of the Nucleus Smart App is available on iPhone and iPod touch. For compatibility information visit www.cochlear.com/compatibility.

~All day hearing is defined as 16 hours, expected battery life is up to 18 hours. Battery life may vary by individual.

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

References

1. Ching TY, Incerti P, Hill M. Binaural benefits for adults who use hearing aids and cochlear implants in opposite ears. Ear Hear (2004 Feb); 25, 9–21.

2. Morera C, Cavalle L, Manrique M, et al. Contralateral hearing aid use in cochlear implanted patients: Multicenter study of bimodal benefit. Acta Otolaryngol (2012 Jun); 132, 1084–1094.

3. Potts LG, Skinner MW, Litovsky RA., et al. Recognition and localization of speech by adult cochlear implant recipients wearing a digital hearing aid in the nonimplanted ear (bimodal hearing). J Am Acad Audiol (2009 Jun); 20, 353–373.

4. Farinetti A, Roman S, Mancini J, et al. Quality of life in bimodal hearing users (unilateral cochlear implants and contralateral hearing aids). Eur Arch Otorhinolaryngol (2015 Nov); 272, 3209–3215

5.  Clinical Evaluation of the Cochlear Nucleus CI532 Cochlear Implants in Adults Investigator Meeting. 2019 Apr.

A Deeper Dive into Nucleus® SmartNav Intraoperative Testing

October 21, 2024
  • Approximately 5 minutes to read
  • Learning objectives:
    • Understanding Placement Check in the SmartNav System
    • Interpreting impedance measurements
    • Utilizing Neural Response Telemetry

Intraoperative testing using tools such as Nucleus® SmartNav may provide surgeons and audiologists valuable real-time insights regarding the surgery, device function, and neural response to stimulation. The operating room (OR) is also a unique environment that requires quick decision-making and interpretation of the information available to the surgical team. This article will help provide surgeons and audiologists a better understanding of Placement Check, Impedance telemetry and Neural Response Telemetry (NRT) in the OR and interpretation of those results.

What is Placement Check?

The Placement Check algorithm is an extremely valuable new tool which helps surgeons confirm proper placement of the electrode array. To do this, Placement Check analyzes trans-impedance patterns between electrodes across the electrode array. This is performed by delivering stimulation through each electrode and recording the subsequent current level on all other intracochlear electrodes. The algorithm expects specific patterns of current flow in a normal cochlea. To ensure any potential issue with placement is identified, Placement Check is designed to be very sensitive and will automatically detect anomalies where there is a high probability of a fold or even subtle variations in expected current patterns. When a potential issue is identified, SmartNav’s Placement Check indicates the range of electrodes likely effected. In these situations, imaging may be considered to further confirm placement of the array, especially in cases of abnormal anatomy where current flow within the cochlea may also be atypical. 

What do Impedances tell us?

The purpose of the impedance measurement is to ascertain the electrical status of individual electrodes. The impedance of an electrode not only reflects the electrical status of the electrode but also the resistance to the flow of electrical current through surrounding tissues (i.e. fluid, fibrous tissue, bone). Normal impedances will be reflected as ‘green’ in SmartNav and will have impedance values less than 30 kOhms. Normal impedance findings confirm normal electrical function of implant electrodes. 

How to interpret Impedance anomalies in the OR

Incidence of electrode anomalies is rare, occurring in only 0.7% of electrodes.1 In addition to this, Goehring et al reported 82% of electrodes with abnormal intraoperative impedance resolved by the postoperative interval.² However, understanding the difference between open circuits and short circuits and potential for resolution is important in the OR. 

  • Open Circuits are defined as where the continuity has been broken by an interruption in the path for electrons to flow. Gushers, abnormal anatomy, or air bubbles are thought to contribute to prevalence of open circuits, making them more common intraoperatively and also more likely to resolve by postoperative fitting. 2,3
    • A short circuit is when there is little or no resistance to the flow of electrons between two electrodes and occurs rarely in only 8% of cases where electrode anomalies are observed intraoperatively. 2,3 
    • Multiple electrode anomalies or a high ECE2 (MP2) may also affect SmartNav’s ability to obtain Placement Check. In some cases, this may be resolved through reconditioning the electrode by repeating the Impedance and Placement Check measures.

Abnormal impedance findings should be evaluated case-by-case with consideration to type of electrode anomaly (open vs short), number of electrodes affected, anatomy, potential air bubbles, or other potential contributing intraoperative factors. For support with intraoperative questions, contact our Surgical On-Call team at (877) 279-5411. 

What information does Neural Response Telemetry (NRT) provide?

SmartNav has the ability to perform AutoNRT and/or Advanced NRT. The NRT measurement records the synchronous neural response, also referred to as the Evoked Compound Action Potential (ECAP) occurring in response to electrical stimulation in the cochlea. NRT is present in approximately 96% of patients, and in conjunction with other measures, can provide added confidence for postoperative counseling and activation.4  

What if my patient does not have NRT responses? 

NRT is a peripheral neural response and is not considered a test of hearing. Neural Response Telemetry recording parameters are also more limited compared to those which can be utilized when programming. Some patients may require different parameters in their MAP to hear with their cochlear implant.  In addition to this, Absent NRT responses are not an indication of device malfunction. If NRT is unexpectedly absent, impedances and Placement Check should be confirmed, and imaging may be considered to further evaluate placement of the electrode array. 

The intraoperative measurements discussed including Placement Check, Impedances and Neural Response Telemetry provide valuable information during surgery.  Although tools such as SmartNav are designed with an intuitive workflow, interpretation may be required if atypical findings present. Understanding the differences between these measures, potential results, and implications will optimize the surgical experience and deliver added assurance that surgery was successful. For more information about SmartNav, please reach out to your local Cochlear Representative or visit this website: https://www.cochlear.com/us/en/professionals/connected-care/surgical-care

1. Mehta N, Chu P, Birman C.S. To Use the Back-up Cochlear Implant or Not?  Using Intraoperative Impedance to Guide Your Decisions.  Otol Neurotol. 2022; 43:e408-e413. 

2. Goehring JL, Hughes ML, Baudhuin JL, Lusk RP. How well do cochlear implant intraoperative impedance measures predict postoperative electrode function? Otol Neurotol. 2013; 34:239–44.

3. Kuphaldt, T.R. (2006). Lessons in Electric Circuits, Volume I – DC. Fifth Edition. Retrieved from: http://www-mdp.eng.cam.ac.uk/web/library/enginfo/textbooks_dvd_only/lessons_pdf/DC.pdf

4. Cafarelli Dees D, Dillier N, Lai WK, von Wallenberg E, van Dijk B, Akdas F, Aksit M, Batman C, Beynon A, Burdo S, Chanal JM, Collet L, Conway M, Coudert C, Craddock L, Cullington H, Deggouj N, Fraysse B, Grabel S, Kiefer J, Kiss JG, Lenarz T, Mair A, Maune S, Müller-Deile J, Piron JP, Razza S, Tasche C, Thai-Van H, Toth F, Truy E, Uziel A, Smoorenburg GF. Normative findings of electrically evoked compound action potential measurements using the neural response telemetry of the Nucleus CI24M cochlear implant system. Audiol Neurootol. 2005 Mar-Apr;10(2):105-16. doi: 10.1159/000083366. Epub 2005 Jan 12. PMID: 15650302.

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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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