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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Dr. Hunter

Research spotlight with Dr. Hunter: Identifying Disadvantaged Groups for Cochlear Implantation: Demographics from a Large Cochlear Implant Program

November 29, 2021

Hear from Dr. Hunter on the latest publication: Identifying Disadvantaged Groups for Cochlear Implantation: Demographics from a Large Cochlear Implant Program:

Dr. Hunter

What led your team to perform this retrospective analysis?

The initial motivation was the desire to build our adult cochlear implant database. Our former Neurotology fellow, Dr. Anthony Tolisano, who is now on staff at Walter Reed National Military Medical Center, and I, started building the database several years ago, with great assistance from one of our medical students at the time, Natalie Schauwecker, who is now a PGY-2 Otolaryngology resident at Vanderbilt University. The impetus that led us to explore and ultimately publish our data was that most patients in the database were White, highlighting to us that our practice probably does not represent the entire community we desire to serve.

What insights from this study were the most compelling to you and your team?  Were there any insights that surprised you?

The two most significant insights were that patients who racially self-identified as non-White were more likely to qualify for a cochlear implant, but were less likely to pursue surgery, as compared to White patients. We interpreted this to mean that non-White patients were referred for a cochlear implant evaluation further along in their hearing loss journey since their hearing loss was more substantial.

Further, as a group, while we routinely leave it up to the patient and their family to decide whether to pursue implantation if they qualify, there clearly are variables at play that lead non-White patients not to pursue surgery, arguably in a population who have a greater need for implantation in relation to the comparison group. We cannot exactly control our referrals, but recognizing differences are present in those that pursue implantation, the greater surprise was that we as a cochlear implant center were not addressing those differences. Granted, we did not recognize that those differences existed before we conducted the analysis, but as a health care practitioner, and a cochlear implant center, we wish we didn’t have those differences.

Based on these findings, how do patient demographics play a role in the referral process?

In reference to the specific referral process, patient demographics do not play a role. If a patient needs a cochlear implant evaluation, we are happy to provide that to the patient and referring provider, recognizing before we meet the patient, and potentially even after, we cannot speak to the exact motivation of the patient, family, and referring provider for pursuing the evaluation. We are not the patient or the family. But, speaking for myself, I feel it is our job and expectation to provide as much information to the patient and their family about their hearing loss journey, making sure they understand their rehabilitative options, including cochlear implantation for some patients, which includes a discussion of the surgery, rehabilitative process, and anticipated outcomes. Patient age, gender, race, or residence does not alter my counseling, but I can appreciate that different patients’ opinions may interpret my counseling differently.

As a team at a large university hospital system, have these findings changed your adult care model? If so, how?

Currently, these findings have not directly changed the model. While some cochlear implant referrals originate in our system, most are generated externally. I believe most practitioners in our practice referring patients for cochlear implant evaluations are aware of the data, though I do not know if the findings have influenced them, and I cannot speak for community referrals. Whether our approach in counseling about surgery has changed since learning of this data, and or led to any changes, I do not know. But on the other hand, as healthcare providers, this data has enabled us to reflect internally to try to be more inclusive and open-minded, despite our impressions previously.

Your study mentions 3 areas for identifying healthcare disparities, one of which classified as indication detection.  How does your team support referring professionals to ensure timely referrals and intervention?

I think this is something we can always continue to improve upon. We do not have the resources to support a cochlear implant team coordinator currently, but rely on individual relationships between the cochlear implant surgeon and audiologist and referring providers, whether that be otolaryngologists, audiologists, or any other hearing healthcare provider. Timely referrals are contingent upon a number of factors, but we encourage anyone to contact us directly to help facilitate them.

Any key takeaways that professionals should know?

This dataset and findings only reinforced the original need to step back and look at our practice from a different perspective. I think it is a valuable experience for personal development, but also for practice development, and I would encourage others to explore whether their practice is serving their own interests, as well as their community’s.

To learn more about cochlear implants as a standard of care please visit this website.

Citation:

Tolisano AM, Schauwecker N, Baumgart B, Whitson J, Kutz JW Jr, Isaacson B, Hunter JB. Identifying Disadvantaged Groups for Cochlear Implantation: Demographics from a Large Cochlear Implant Program. Ann Otol Rhinol Laryngol. 2020 Apr;129(4):347-354. doi: 10.1177/0003489419888232. Epub 2019 Nov 18. PMID: 31735055.

About the author:

Jacob Hunter is the Dedman Scholar of Clinical Care and Associate Professor in the Department of Otolaryngology-Head and Neck Surgery at the University of Texas Southwestern Medical Center. He is board-certified in Otolaryngology, with sub-specialty certification in Neurotology, having completed his residency at Albert Einstein College of Medicine in the Bronx, New York, and fellowship at Vanderbilt University in Nashville, Tennessee. His research focuses on hearing loss, cochlear implants, and vestibular schwannomas, having been awarded funding to explore the links between hearing loss, social isolation, and cognitive decline. He has published over 80 peer-reviewed manuscripts and contributed to over 10 book chapters. He is currently an Associate Editor, Otology and Neurotology for Otolaryngology-Head and Neck Surgery, published by the American Academy of Otolaryngology-Head and Neck Surgery Foundation, while serving on the editorial board for Otology & Neurotology and Otolaryngology Case Reports.

pediatric cochlear implant

Cochlear receives FDA approval to lower the age of pediatric cochlear implantation to 9 months

March 19, 2020

Approval underscores necessity of earlier cochlear implantation for better hearing, speech and language outcomes in children born deaf

By Renee Oehlerking, Senior Public Relations Manager – Cochlear Americas

Centennial, Colo. (March 18, 2020) — Cochlear Limited (ASX: COH), the global leader in implantable hearing solutions, obtained U.S. Food and Drug Administration (FDA) approval to lower the age of cochlear implantation from 12 months to 9 months for children with bilateral, profound sensorineural hearing loss. This approval ensures children born deaf have earlier access to a cochlear implant which can provide them with the hearing capabilities to develop speech and language at a trajectory similar to their hearing peers.

Cochlear implants have been FDA approved for use in children since 1990 with CochlearTM Nucleus® Implants obtaining the first approval. Decades of research and current surgical and clinical practice underscore the efficacy of earlier implantation to achieve their personal best language and speech outcomes.1-13 The research and support in practice by trained hearing health professionals provided the foundation to approve the indication be lowered to 9 months, along with the considerable developments in technology and evolving speech coding strategies in modern day cochlear implant devices.

“Cochlear implants are one of the most revolutionary and effective modern-day implantable solutions that can restore hearing to children and adults with significant hearing loss,” said J. Thomas Roland Jr., MD, Co-Director, Cochlear Implant Center, and Chair, Department of Otolaryngology – Head and Neck Surgery, NYU Langone Health. “Through our diligent research and years of treating children with hearing loss, we know the earlier a child receives access to sound the sooner they can develop speech and language that will transform their future. It is important that children born deaf have access to cochlear implants as soon as possible to give them the tools to hear and participate in their life to the fullest extent.”

According to the American Academy of Pediatrics, an estimated three in 1,000 infants are born in the U.S. each year with moderate, severe or profound hearing loss.14 Additionally, hearing loss is the most common congenital condition in the U.S.14 Hearing loss has a major impact on a child’s life, including speech and language development, literacy, mental health, social and cognitive functioning, educational achievement, employment and socio-economic opportunity.3 Research shows that children with a severe-to-profound hearing loss who receive cochlear implants early achieve better speech recognition than children who continue to use hearing aids, underscoring the importance to not delay access to cochlear implants because doing so can have lingering developmental consequences.3,4

“Earlier implantation ultimately provides children with access to critical auditory input that has been proven to enhance their development of speech and language,” said Christine Menapace, MA, Vice President, Clinical Affairs, Cochlear Americas. “We hope this approval changes the pathway and access to care for families who desire cochlear implantation so full advantage can be taken of the critical period of language development in a young child.”

While many early intervention factors contribute to a child succeeding with a cochlear implant, cochlear implants provide improved: auditory awareness of sounds at levels within the normal range of hearing15; speech understanding, sound clarity and language skills15; hearing in noise16; quality of life16; and educational outcomes.17 Up to 80 percent of children who received cochlear implants younger than 12 months of age demonstrate receptive vocabulary knowledge within the normal range by school entry, and 81 percent of children who receive cochlear implants early attend mainstream schools.13,18

“When we got the news that our daughter failed her newborn hearing screening and was diagnosed with profound hearing loss at birth, it gutted us. We had never met a deaf person before our daughter and did not know what life would look like raising a child with hearing loss,” said Christy Keane, mother to Nucleus Cochlear Implant recipient, Charly, and social media influencer focused on motherhood and children with hearing loss. “Thankfully, we had an amazing care team who helped us understand all of the possibilities on this journey, and we decided to have Charly implanted at 10 months of age. Now, nearly 3 years old, Charly receives speech therapy every day in school and we work together at home on her listening and language skills. Thanks to all the early intervention factors we provided her, Charly is on track developmentally and we’re so excited to see what her future will bring.”

In the United States, the Cochlear Nucleus Implant System is intended for use in children 9 to 24 months of age who have bilateral profound sensorineural deafness and demonstrate limited benefit from appropriate binaural hearing aids. Children 2 years of age or older may demonstrate severe to profound hearing loss bilaterally.* This FDA approval is extended to all current Cochlear Nucleus Implant models, as well as all models developed in the future by Cochlear. Cochlear implants are typically covered for children by Medicaid and most insurance plans.** For more information on implantable hearing solutions for children with hearing loss, visit IWantYouToHear.com. For more clinical information on the longitudinal outcomes of cochlear implantation for children with hearing impairment, visit: www.outcomes.nal.gov.au/key-findings.

About Cochlear Limited (ASX: COH)

Cochlear is the global leader in implantable hearing solutions. The company has a global workforce of more than 4,000 people and invests more than AUD$180 million each year in research and development. Products include cochlear implants, bone conduction implants and acoustic implants, which healthcare professionals use to treat a range of moderate to profound types of hearing loss.

Since 1981, Cochlear has provided more than 600,000 implantable devices, helping people of all ages, in more than 180 countries, to hear.

www.cochlear.com/us

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References

  1. Waltzman SB, Roland JT Jr. Cochlear implantation in children younger than 12 months. Pediatrics. 2005; 116(4): 487-493.
  2. Cuda D, Murri A, Guerzoni L, Fabrizi E, Mariani V. Pre-school children have better spoken language when early implanted. Int J Pediatr Otorhinolaryngol. 2014; 78(8):1327-1331.
  3. Ching T, Dillon H, Marmane V, Hou S, Day J, Seeto M, Crowe K, Street L, Thomson J, Van Buynder P, Zhang V, Wong A, Burns L, Flynn C, Cupples L, Cowan R, Leigh G, Sjahalam-King J and Yeh A. Outcomes of early-and late-identified children at 3 years of age: Findings from a prospective population-based study. Ear Hear. 2013; 34(5): 535-552.
  4. Leigh J, Dettman S, Dowell R. Evidence-based guidelines for recommending cochlear implantation for young children: Audiological criteria and optimizing age at implantation. Int J Aud 2016; 55:S9-S18.
  5. Cosetti M and Roland J. Cochlear implantation in the very young child: issues unique to the under-1 population. Trends Amplif. 2010 Mar; 14(1): 46-57.
  6. Holt R and Svirsky M. An exploratory look at pediatric cochlear implantation: is earliest always best? Ear Hear. 2008 Aug; 29(4):492-511.
  7. Roland J, Cosetti M, Wang K, Immerman S, Waltzman S. Cochlear implantation in the very young child: Long-term safety and efficacy. Laryngoscope. 2009; 119(11): 2205-2210.
  8. Holman MA, Carlson ML, Driscoll CL, Grim KJ, Peterson RS, Sladen DP, Flick RP. Cochlear implantation in children 12 months of age and younger. Otol Neurotol. 2013; 34(2):251-258.
  9. Dettman SJ, Pinder D, Briggs RJ, Dowell RC, Leigh JR. Communication development in children who receive the cochlear implant younger than 12 months: Risks versus benefits. Ear Hear. 2007; 28(2 Suppl):11S-18S.
  10. Ching TY, Dillon H, Day J, Crowe K, Close L, Chisholm K, Hopkins T. Early language outcomes of children with cochlear implants: interim findings of the NAL study on longitudinal outcomes of children with hearing impairment. Cochlear Implants Int. 2009;10 Suppl 1:2832.
  11. Colletti L. Long-term follow-up of infants (4-11 months) fitted with cochlear implants. Acta Otolaryngol. 2009 Apr; 129(4):361-6.
  12. Nicholas J and Geers, A. Spoken language benefits of extending cochlear implant candidacy below 12 months of age. Otol Neurotol. 2013; 34:532-538.
  13. Dettman SJ, Dowell RC, Choo D, Arnott W, Abrahams Y, Davis A, Dornan D, Leigh J, Constantinescu G, Cowan R, Briggs RJ. Long-term communication outcomes for children receiving cochlear implants younger than 12 months: A multicenter study. Otol Neurotol. 2016 Feb; 37(2): e82-95.
  14. Program to Enhance the Health & Development of Infants and Children (PEHD​IC)​ [Internet]. American Academy of Pediatrics; c2020 [cited 10 Feb 2020]. Available from: https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/PEHDIC/Pages/Early-Hearing-Detection-and-Intervention.aspx. 
  15. Novak MA, Firszt JB, Rotz LA, et al. Cochlear implants in infants and toddlers. Ann Otol Rhino Laryngol Suppl 2000;185:46-49.
  16. Hirschfelder A, Gräbel S, Olze H. The impact of cochlear implantation on quality of life: The role of audiologic performance and variables. Otolaryngol Head Neck Surg. 2008 Mar;138(3): 357-362.
  17. Wyatt JR, Niparko JK, Rothman M, deLissovoy G. Cost Utility of the Multichannel Cochlear Implant in 258 Profoundly Deaf Individuals. Laryngoscope.1996;106:816–821.
  18. Semenov, YR, Yeh, ST, Seshamani, M, Wang, N-Y, Tobey, EA, Eisenberg, LS, Quittner, AL, Frick, KD, Niparko, JK, CDaCI

Investigative Team. Age-Dependent Cost-Utility of Pediatric Cochlear Implantation. Ear Hear. 2013;34(4):402-412.

* In the United States, the cochlear implant system is intended for use in children 9 to 24 months of age who have bilateral profound sensorineural deafness and demonstrate limited benefit from appropriate binaural hearing aids. Children 2 years of age or older may demonstrate severe to profound hearing loss bilaterally. In Canada, the cochlear implant system is intended for use in children 12 to 24 months of age who have bilateral profound sensorineural deafness and demonstrate limited benefit from appropriate binaural hearing aids. Children 2 years of age or older may demonstrate severe to profound hearing loss bilaterally.

** Payer coverage policies may not align with new indications. Exceptions for coverage should be sought through the prior authorization process. Contact your insurance company or local Hearing Implant Specialist to determine your eligibility for coverage.

Dr. Roland is an advisor for Cochlear.

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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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