Cochlear Implants
by Cochlear Guest Author

Clinical Quick Tips: See how the Cochlear™ Mini Microphone 2+ can help your patients in the classroom

August 9, 2018
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Clinical Quick Tips

Flexibility in the Classroom: the Cochlear™ Mini Microphone 2+

By guest author: Janet Clarke, Au.D.

Janet Clarke

The Cochlear™ Nucleus® 6 (CP910, CP920), Kanso®(CP950), and Nucleus 7 (CP1000) Sound Processors, the Cochlear Baha® 5 series Sound Processors, ReSound hearing technology, and the Cochlear Mini Microphone 2+ (MM2+) are all great friends in the classroom! Direct streaming from the MM2+ to the processor(s), or processor and hearing instrument, offers a discreet option for enhanced listening to classroom instruction. No additional hardware is attached to the sound processor and/or hearing instrument. The MM2+ can be either worn by the teacher, used as a tabletop conference microphone, used to receive audio from a room loop via the Telecoil setting, or used with another audio input via the Line-in Direct Audio Input.

Cochlear™ Baha® with Mini Microphone 2+ (MM2+) and school

By guest author: Amy Donaldson, Au.D.

Children in schools today often find themselves in dynamic learning environments, especially where listening is concerned. The “typical” classroom, where the teacher stands in the front of the room to lecture while the student spends all day listening, is truly becoming a relic of the past. Today’s students may find themselves working on projects in pairs or small groups, participating in large group discussions or listening to videos or computer-based training or assessments.

With the shift in learning methods, more and more flexibility is required in remote microphone technology. Anyone who has spent time in a classroom where small group work is taking place will know that the need for an improved signal-to-noise ratio is still real. The MM2+ offers a flexible and affordable remote microphone solution for recipients of Baha® users. Consider the following classroom uses for the

MM2+: 

  • Traditional: Give the MM2+ to the teacher for an effortless and direct connection between the teacher’s voice and the student’s Cochlear™ Baha 5 Sound Processor.
  • Conference mode: Switch the MM2+ into conference mode by laying it horizontally on the table during small group activities.
    Direct audio input: Plug the MM2+ into any external audio source (i.e., smart board, computer or tablet) for a direct connection to classroom technology.
  • Telecoil: Switch the MM2+ into T-coil mode to easily pick up room loops during field trips or assemblies.
  • Europin connection: Attach a universal remote microphone receiver to connect the student to any FM or DM system that is utilized in the classroom.

The best thing about the MM2+ is the ease of use – students can switch modes easily using the button on the back of the device and 2.4 GHz wireless technology means the MM2+ connects directly to the processor without the need for external neck loops or dongles.

Share these videos with your patients to help them connect to the MM2+ on their own:

Visit our website for more information on the Mini Microphone and Mini Microphone 2+.

About our guest authors:

Dr. Clarke is a Professional Education Manager for Cochlear Americas.  She joined Cochlear in 1998 and has been in various Clinical or Learning roles throughout her career at Cochlear. She has been an audiologist since 1992, working with cochlear implants since 1993 and Baha since Cochlear’s acquisition of Entific in 2005. Prior to joining Cochlear, Janet worked at the University of Illinois at Chicago. Janet has her AuD from the University of Florida, and did her undergraduate & graduate degrees at Purdue University.

Amy Donaldson is an Audiologist and Professional Education Manager for Cochlear Americas.  She received her Master’s Degree in Audiology from the State University of New York at Buffalo and her AuD from the University of Florida.  She was privileged to begin her career as a pediatric audiologist and gain extensive clinical experience in implantable hearing devices at the University of Michigan in Ann Arbor and at the Manchester Cochlear Implant Programme in the United Kingdom.  After working for several years as an Educational Audiologist and Technical Support Audiologist in the hearing aid industry, she returned to hearing implants and Cochlear in 2011.

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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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Clinical Programming Series: Electric-Acoustic Stimulation

November 18, 2024
  • ‌Approximately 5 minutes to read
  • Learning objectives:
    • Understand the benefits of EAS
    • Understand EAS candidacy
    • Understand current EAS programming parameters

What is Electric-Acoustic Stimulation (EAS)?

Electric-acoustic stimulation (EAS) is a system that utilizes viable postoperative low-frequency hearing thresholds in combination with electrical stimulation for cochlear implant patients. EAS systems are underutilized and have the potential to provide not only better outcomes, but a better patient experience. Manipulation of additional parameters when fitting EAS can provide an even better experience for our patients overall and should be more often applied. 

A brief history of EAS

‌In 2013 the Cochlear™ Nucleus® Hybrid L24 CI system was the first of its kind to receive FDA approval. The Nucleus 6 Sound Processor was capable of providing EAS, giving patients with residual low-frequency hearing the ability to utilize a combined listening experience. As further advancements in both surgery and technology continue to progress, so does the ability to preserve low frequency hearing. Utilizing the EAS system, when appropriate, provides additional benefits compared to traditional electric stimulation.1 Benefits of EAS are improved speech understanding, improved music recognition, improved localization, decreased listening effort, access to binaural low-frequency cues, and providing a more naturalistic sound quality.1,2,3,4,5

Who could be a candidate for EAS?

EAS should be considered for patients who have preoperative thresholds of less than or equal to 60 dB HL through 500Hz. “Functionally aidable” is a term commonly used to describe hearing loss that may receive benefit when fit with an appropriate hearing aid. The recommendation for fitting EAS is for those with low frequency thresholds less than or equal to 70 dB HL postoperatively. 

How do I program a sound processor with an acoustic component?

‌ The utilization of earmolds can be beneficial when fitting a patient with EAS. Clinicians have options when fitting the acoustic component, including domes, however, in the cases where the patient utilized a custom-fit earmold, utilization of this mold with the EAS system can provide better retention, additional comfort, proper venting, increased low frequency sound quality, and address feedback concerns. Should the patient not have a custom earmold, one can be ordered from an outside manufacturer, or the patient can be fit using an appropriate dome. 

The default boundaries for the acoustic component should be set less than or equal to 866 Hz, while the cochlear implant frequency boundaries should be set less than or equal to 438 Hz. This reallocation of lower frequency boundaries may provide additional performance or sound quality benefits, especially in noise2,3 and may also provide the patient with a more natural and preferable listening experience.4 Further manipulation of these boundaries may provide additional benefit. 

‌A study conducted by Gifford et. al, revealed significant speech recognition and subject listening difficulty benefit in those who utilize EAS3. This study showed the less overlap in cutoff frequencies between acoustic and electric stimulation, resulted in better outcomes, with the highest outcomes achieved when the low frequency cutoffs were set closest to the audiometric thresholds. Overall, significant benefits were observed in speech recognition and subjective listening ease for individuals using bimodal and optimally aided EAS conditions, as opposed to those with only a CI. Furthermore, individuals benefited from a low-frequency cutoff program, showing significant improvement in speech recognition and subjective listening difficulty vs the default program.²

For additional information on programming using an acoustic component, check out our Electric-acoustic stimulation (EAS) fitting flow guide.

FUN1979 ISS2 JUN23 EAS Programming GuidelinesDownload
  1. Dunn, C. C., Perreau, A., Gantz, B., & Tyler, R. S. (2010). Benefits of localization and speech perception with multiple noise sources in listeners with a shortelectrode cochlear implant. Journal of the American Academy of Audiology, 21(01), 044-051. 
  2. Gifford, R. H., & Stecker, G. C. (2020). Binaural cue sensitivity in cochlear implant recipients with acoustic hearing preservation. Hearing Research, 390, 107929.
  3. Gifford, R. H., Sunderhaus, L. W., Dawant, B. M., Labadie, R. F., & Noble, J. H. (2022). Cochlear implant spectral bandwidth for optimizing electric and acoustic stimulation (EAS). Hearing Research, 108584.
  4. Parkinson, A. J., Rubinstein, J. T., Drennan, W. R., Dodson, C., & Nie, K. (2019). Hybrid music perception outcomes: implications for melody and timbre recognition in cochlear implant recipients. Otology & Neurotology: Official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology, 40(3), e283. 
  5. Shim, H., Kim, S., Hong, J., Na, Y., Woo, J., Hansen, M., & Choi, I. (2022). Differences in neural encoding of speech in noise between cochlear implant users with and without preserved acoustic hearing. Hearing Research, 108649

cochlear next

Cochlear NEXT CI532 Clinical Study Insights – Is Hearing Preservation Possible with CI532?

October 14, 2019

In the spring of this year, sixty-five otology and audiology professionals came together for Cochlear NEXT – a program focused on learning and discussing Cochlear’s CI532 Clinical Study and the respective implications of this emerging and impactful data.

The following information reviews the primary talking points and output from the day’s third and final topic of hearing preservation. You can also find available video recordings of Cochlear NEXT sessions on our YouTube channel.

Is Hearing Preservation Possible with CI532?

Presenters:
• Ryan Lopez, Group Product Leader, Nucleus® Cochlear™ Implants, Cochlear Americas
• Brian Kaplan, MD, Surgeon and Global Head of Clinical Innovation, Cochlear Americas
• David Kelsall, MD, Surgeon and CI532 Investigator, Rocky Mountain Ear Center

While not designed as a hearing preservation study, CI532 study data offers insights regarding the ability to preserve hearing using the CI532 Slim Modiolar electrode. But how is hearing preservation defined, and what other characteristics beyond electrode design play a role in patient outcomes in this regard?

During this session, NEXT participants were exposed to new, intriguing data that supports the use of CI532 in hearing preservation cases, while anecdotal discussion allowed surgeons to share their own experience preserving measurable hearing with this electrode.

Recent perspectives on hearing preservation vary in terms of how hearing preservation is defined – does hearing preservation refer to measurable hearing, or to functional hearing? Something aid-able? During a live poll, the audience overwhelmingly responded that ‘Preserving functional hearing to improve outcomes’ is the most appropriate description. Likewise, on pre and post-event surveys, the group overall agreed that functional hearing preservation should only be considered when a patient’s pre-operative low-frequency pure tone average (PTA) is better than 65dB.

Building on the consensus of defining hearing preservation, the discussion moved into which electrode design factors impact preservation, and how the CI532 Slim Modiolar array compares versus previous generation perimodiolar and lateral wall arrays – dispelling a common misconception that the CI532 will not preserve residual hearing.

Electrode Design Factors for Preservation1

The ability of CI532 to preserve functional hearing (defined for this presentation as PTA ≤ 80dB at 250 Hz and 500 Hz) was illustrated by examining the published literature, the CI532 multi-center clinical study, and the experience at Rocky Mountain Ear Center (RMEC). Overall the three data sets produced highly consistent results across 215 patients total, with 34-40% maintaining PTA ≤ 80dB at initial activation2,3,4. Looking specifically at CI532 subjects and patients of RMEC, more than 70% of patients maintained measurable thresholds at initial activation 1,4 – this despite patients not being ‘traditional’ hearing preservation candidates.

Additional discussion centered around the divergent factors affecting hearing preservation and performance – whether biological, technological, or environmental. Leading into the discussion, participants had agreed (as measured on pre-event survey) that hearing preservation is NOT the factor that has the greatest impact on hearing performance. This perspective remained largely the same following the discussion and presentation.

Conclusion

Cochlear NEXT presented a unique opportunity to bring together diverse thought and experience to address common questions regarding hearing performance – what is the impact of placement on performance, are we implementing the correct clinical measures pre- and post-implantation, and is hearing preservation possible with the CI532 Slim Modiolar electrode?

Learnings from Cochlear NEXT demonstrate that across the variability of patients we serve, biological factors are as important and impactful, if not more so, than the technology alone. Further, data collected prior to, during and after the program indicates that while there is some movement toward consensus on these issues, there will continue to be different perspectives among professionals across the continuum of care. However, that also provides opportunity for emerging insights, renewed debate, and evolving solutions to maximize patient outcomes and ensure access to a lifetime of hearing.

Check out our new YouTube playlist featuring video highlights of session topics including CI532 Study Surgical and Clinical Outcomes.


References

  1. Sweeney A, Hunter J, Carlson M, Rivas A, Bennett M, Gifford R, Noble J, Haynes D, Labadie R, Wanna G. Durability of Hearing Preservation after Cochlear Implantation with Conventional-Length Electrodes and Scala Tympani Insertion. Otolaryngol Head Neck Surg. 2016 May;154(5):907-13. doi: 10.1177/0194599816630545. Epub 2016 Feb 23
  2. Preliminary Data on File: US Multicenter CI532 Study. 2018.
  3. Friedmann et al. Surgical Experience and Early Outcomes With a Slim Perimodiolar Electrode. NYU Cochlear Implant Center. Otology & Neurotology 2019
  4. Data on file: Rocky Mountain Ear Center, 2019.
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