Cochlear Implants
by Rebecca Steinke

Introducing the NEW Cochlear™ Nucleus® Profile™ Plus Series Cochlear Implant

June 17, 2019
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We are excited to announce that Cochlear has received U.S. Food and Drug Administration (FDA) approval of the new Cochlear™ Nucleus® Profile™ Plus Series Cochlear Implant and an expansion of the Nucleus 7 Sound Processor’s built-in connectivity featuring direct streaming with compatible Android™ smartphones.*

Nucleus Profile Plus Implant: 3T MRI without magnet removal or head wrap  

With the Nucleus Profile Plus Implant, cochlear implant recipients have access to 3.0 and 1.5 Tesla (T) MRI scans without the need for internal magnet removal or use of a head wrap.1 The new implant is built upon Cochlear’s Nucleus Profile Series Implant, which features an accessible magnet if removal is ever required.  In the event of future changes in MRI technology or if image artifact reduction is needed, the easy-to-remove magnet is designed for lifetime access to MRI according to a recipient’s healthcare needs.

Continuing our proven track record of reliability, the Nucleus Profile Plus Implant will maintain the unrivaled cochlear implant reliability record of the Profile Implant and of the Cochlear Nucleus implant portfolio2-4. The Nucleus Profile Plus Implant also features a thin receiver design5, providing cochlear implant recipients the potential for improved comfort and cosmetic outcomes. To ensure your preference of devices goes uninterrupted, the Profile Plus series platform will include the Slim Modiolar (CI632), Slim Straight (CI622) and Contour Advance (CI612) electrode arrays.

Live webinars are available

For a more in-depth review of Profile Plus features as well as surgical and clinical considerations, join us for a live webinar, ‘Introduction to the new Nucleus Profile Plus: Surgical and Audiological Consideration’.

Register here for any of the following options:

Monday, June 24 @ 12pm EDT

Monday, June 24 @ 5pm EDT

Tuesday, June 25 @ 8am EDT

When to expect availability of the new implant

The Nucleus Profile Plus Series Cochlear Implant is expected to be commercially available later this month. For surgeries that are currently scheduled in July and beyond, Cochlear is now taking orders for new systems with the Profile Plus, with an anticipated shipment date near the end of June.

Programming a patient with Profile Plus in Custom Sound

In order to program patients with the Nucleus Profile Plus implant, you will need to input the Authorization Key enabling access to this new implant in Custom Sound 5.1. To obtain the Key please reach out to your local Cochlear Americas representative or access instructions in the “Software Support” resource section of myCochlear Clinic.

Nucleus 7:  Connect without Compromise

Cochlear is the first cochlear implant manufacturer to enable access of direct audio streaming from Android devices to Nucleus 7 sound processors without any intermediary devices or attachments. This feature will allow Nucleus 7 recipients the ability to connect to compatible Apple® and Android devices without compromising on size, weight6 or battery life7 of the sound processor.**

When to expect availability of expanded connectivity features

The Nucleus 7 Sound Processor expanded connectivity features will be commercially available this fall across the U.S. and Canada through a simple firmware update.

Accessing expanded connectivity with Custom Sound

Cochlear recipients with the Nucleus 7 Sound Processor and a compatible Android™ device will be able stream audio directly to their Nucleus processor without the need for the Cochlear Phone Clip. A firmware update to the processor is required (done via Custom Sound 5.2 later this fall) along with a future update to the Nucleus® Smart App and the Android™ 10.0 (Q) operating system on compatible Android™ devices.**

We are excited to deliver these updates to our customers in the coming weeks and months, and to further strengthen our portfolio of reliable and innovative products designed to ensure access to a lifetime of hearing for our recipients.

For more information on the new Nucleus Profile Plus Implant, please check out our press release and register for one of the live webinars scheduled for next week!

References

  1. MRI Guidelines D774756.
  2. Cochlear Nucleus Implant Reliability Report. Volume 17 | December 2018. D1593476. Cochlear Ltd; 2019.
  3. Hearing Implant Reliability Reporting | MED-EL [Internet]. Medel.com. 2018 [cited 06May2019]. Available from: https://www.medel.com/hearing-solutions/cochlear-implants/reliability
  4. 2018 Global Implant Reliability Report. 027-N025-02. Advanced Bionics AG and affiliates. 2019.
  5. Data on File: Internal Specifications
  6. Cochlear Limited. D1190805. CP1000 Processor Size Comparison. 2019, Apr; Data on file.
  7. Cochlear Limited. D1140877. Battery Life and Power Consumption Comparison between CP1000, CP900 Series and CP810 Sound Processors. 2017, Sept; Data on file.

 * Access to direct Android streaming between the Nucleus 7 Sound Processor and a compatible Android phone is dependent upon Android phone manufacturers implementing Google’s Audio Streaming for Hearing Aids (ASHA) protocol into future operating system updates for their handsets.

** The Cochlear Nucleus Smart App is available on App Store and Google Play. For complete smartphone and app compatibility information, please visit www.cochlear.com/compatibility as it becomes available. For more detailed information on the portfolio of Cochlear Nucleus Implants’ MRI compatibility, visit www.cochlear.com/US/MRI.
© Cochlear Limited 2019. All rights reserved. Hear now. And always and other trademarks and registered trademarks are the property of Cochlear Limited or Cochlear Bone Anchored Solutions AB. The names of actual companies and products mentioned herein may be the trademarks of their respective owners. Apple, the Apple logo, 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 is a trademark of Google LLC. Google Play and the Google Play logo are trademarks of Google LLC.
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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Face masks inhibit communication for 95 percent of people with hearing loss, new survey finds

January 26, 2021
  • Hearing Loss Association of America and Cochlear survey highlights COVID-19’s impact on the community of people with hearing loss in the U.S., includes hearing and mental health-related implications
  • Nearly half of those with hearing loss noticed impacts to other aspects of their health during the pandemic including increased anxiety, isolation and loneliness
  • Seventy percent are more aware of their hearing loss due to the pandemic; nearly half are more eager to explore hearing loss treatment options

Rockville, MD/Lone Tree, Colo. (January 26, 2021) — Ninety-five percent of people living with hearing loss in the United States say masks and facial coverings impact their ability to communicate during the COVID-19 pandemic, which has also heightened levels of anxiety, social isolation and other mental health-related effects among nearly half of the nation’s hearing loss community.1

This is according to a new survey conducted by the Hearing Loss Association of America (HLAA), the nation’s leading organization representing consumers with hearing loss, in partnership with Cochlear Limited, the global leader in implantable hearing solutions. Hearing loss is an invisible disease that affects almost 50 million Americans.2 The online survey of 1,399 participants sought to find out the pandemic’s impact on those in the hearing loss community, including individuals with hearing loss, their loved ones and their hearing health care professionals. Key findings include:

Hearing Loss and the Pandemic

  • 70 percent of those with hearing loss say they are more aware of their hearing loss due to the pandemic, and 47 percent say they are more eager to explore hearing loss solutions due to the pandemic.
  • 46 percent notice their hearing loss influencing other aspects of their mental health since the pandemic began, with:
    • 67 percent having feelings of anxiety
    • 63 percent having feelings of isolation
    • 47 percent having feelings of loneliness
    • 22 percent having feelings of confusion
    • 21 percent having feelings of forgetfulness
  • 52 percent say they feel less connected to friends and family as a result of their hearing loss during the pandemic.

Hearing Loss and Accessibility

  • 95 percent of the hearing loss community say face masks/coverings have created communication barriers since the pandemic began.
  • 89 percent report experiencing accessibility issues since the pandemic began (including but not limited to the ability to lipread due to face masks, physical distancing making conversations harder and not having access to captioning across all technology platforms).
  • 35 percent say they have experienced a lack of empathy from others for their hearing loss during the pandemic.

“Hearing and understanding are two different things. With masks, I can hear you, but I don’t always understand you,” said Lori A. Mertes, NBCT, MEd, MAT, special education teacher and bimodal hearing recipient (a cochlear implant in one ear, and a hearing aid in the other). “Given we all may be challenged to hear with masks right now, I hope others will understand the challenges many of us in the hearing loss community face on a regular basis and now have amplified because of masks and distancing. Please slow down, speak clearly, be patient with us, and if we ask to you to repeat, please don’t say, ‘never mind.’ It’s very frustrating to be dismissed.”

Hearing Loss and Technology 

  • 68 percent of those with hearing loss have increased their use of technology during the pandemic to communicate with others.
  • 68 percent say pandemic-related increased use of technology has caused them to become more aware of their hearing loss.
  • 55 percent say their hearing loss creates challenges while using technology to communicate, while 45 percent use assistive hearing devices that make it easier to communicate.

“With the prolonged pandemic, I did not realize the mental stress and fatigue culminated over time would add to the challenges to understand with masks,” said Tim Browning, digital communication and web specialist, HLAA, and bilateral hearing aid user (a hearing aid in each ear). “I am missing the day-to-day practice of listening and talking to people in face-to-face situations. Online communications and captioning are wonderful, but to effectively hear requires continual practice hearing in all situations. When we get out of practice, it becomes harder and harder to understand with masks, so we then have to advocate for ourselves all that much more.”

“Research has long shown untreated hearing loss can negatively impact a person’s quality of life – and with masks and distancing, the impact the pandemic has had on people with hearing loss is enormous,” said Barbara Kelley, Executive Director, HLAA. “The survey results reinforce the overwhelming challenge with masks for the hearing loss community, and many requested that the larger population invest in safe, clear face masks. Additionally, the hearing loss community would like to see universal captioning provided across all technology platforms. I hope coming out of this pandemic we will see people continue to take their hearing loss seriously and treat it appropriately, as well as continue to see greater standards on accessibility to help those with hearing loss.”

Hearing Loss and Hearing Health Care

  • 87 percent of hearing health care providerssay they have seen increased signs of loneliness or isolation in their patients since the pandemic began.*
  • 84 percent of hearing health care providerssay they have noticed an increase in their patients’ awareness of their hearing loss during the pandemic, and 52 percent say they have seen an increase in their patients’ desire to explore new hearing loss solutions due to the pandemic.*
  • 51 percent of those with hearing loss report their hearing health care provider offers remote care options, and 36 percent say they have used, or have thought of using, remote care options during the pandemic.

“Many individuals with hearing loss and their loved ones are now realizing how important hearing and connection is to our overall quality of life. While the pandemic has challenged our ability to hear and connect, this realization is empowering consumers to act and seek treatment for their hearing loss,” said Patricia Trautwein, MA, AuD, Vice President, Product Management & Marketing, Cochlear Americas. “We hope given the results of this survey, individuals, health care professionals and payors will focus on prioritizing hearing health and begin setting standards around protecting our hearing, monitoring hearing loss and ensuring individuals have access to and can obtain appropriate treatment for their hearing loss.”

Survey Demographics

  • 85 percent of respondents are age 55 and up.
  • Respondents’ gender skews female at 69 percent.
  • Respondents represent 49 of 50 states, plus Puerto Rico.
  • 52 percent of those with hearing loss have been diagnosed with hearing loss for over 30 years; 77 percent have hearing aids, and 32 percent have (a) cochlear implant(s).
  • Of the respondents, 1,298 (93 percent) identify as individuals with hearing loss or individuals acting as a representative for someone with hearing loss, and 57 (4 percent) identify as “other,” which includes individuals who are both of the hearing loss community and a hearing health care professional, those who work as advocates for individuals with hearing loss, and other professionals whose work revolves around the hearing loss community.*

In the United States, one out of three people over the age of 65 and half of people over 75 are affected by disabling hearing loss, 3 but appropriate hearing treatment and technology continues to be widely underutilized.4  Research continues to show aging adults with untreated hearing loss can be substantially affected by social isolation and loneliness with impacts to brain health and quality of life.5

If you or a loved one notice a change in hearing or suspect a hearing loss, see these resources for help:

About the Hearing Loss Association of America

The Hearing Loss Association of America (HLAA) is the nation’s foremost organization representing consumers with hearing loss. The mission of HLAA is to open the world of communication to people with hearing loss through information, education, support and advocacy. HLAA holds annual conventions, produces Walk4Hearing events in cities across the country, publishes Hearing Life magazine, online learning and support webinars, advocates for the rights of people with hearing loss, and has a network of chapters and state organizations across the country. hearingloss.org

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. COVID-19 & its Impact on the HLAA Community survey. Survey of 1,399 conducted by Survey Monkey, October 10-31, 2020. Data on file.
  2. Hearing Loss Basics [Internet]. Hearing Loss Association of America; c2020 [cited 15 Dec 2020]. Available from: https://www.hearingloss.org/hearing-help/hearing-loss-basics/.
  3. Hearing Loss and Older Adults [Internet]. National Institute on Deafness and Other Communication Disorders; c2018 [cited 26 Nov 2020]. Available from: https://www.nidcd.nih.gov/health/hearing-loss-older-adults.
  4. Market penetration. This figure is a global estimate based on Cochlear sourced data.
  5. Brody, J. E. (2018, December 31). Hearing Loss Threatens Mind, Life and Limb. Available from: https://www.nytimes.com/2018/12/31/well/live/hearing-loss-threatens-mind-life-and-limb.html.

* Not statistically significant given 44 respondents (3 percent) identified as a hearing health care professional.

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.

© Cochlear Limited 2021. All rights reserved.

The Hearing Loss Association of America provides information on all treatment of hearing loss. HLAA neither endorses any one product or treatment for hearing loss, nor does exclusion of a treatment suggest disapproval. People should seek consultation with their hearing health care providers for individualized, person-centered care.

Clinical Programming Series: Impedances

August 7, 2024
  • Approximately 5 minutes to read
  • Learning objectives:
    • Understand why and how impedances provide valuable clinical information
    • Understand what factors impact impedances
    • Understand how the clinician can use impedance measurements to determine the need for programming changes

Why are we talking about impedances?

As cochlear implant audiologists, the concept of impedances is integral to our clinical lexicon. Due to the growing interest in a more in-depth understanding of impedances, our clinical team has compiled a summary that delves into the science of impedances in cochlear implant care and outlines the essential information for programming cochlear implants.

What are impedances?

When electrical current flows in a conductor (in this case, the cochlea) there is a force that opposes the flow of the electrical current through the cochlea to the spiral ganglion cells.  This is known as resistance. All materials naturally contain some resistance to the flow of an electrical current. Electrode impedances measures this resistance to the flow of electrical current from the cochlear implant electrode to the spiral ganglion cells.

Electrical impedance is calculated as the ratio of the applied voltage (driving force) to the resulting current that flows through the material or solution.

How does Cochlear calculate impedances?

Cochlear calculates the total impedance which includes the Polarization Impedance and the Access Impedance. Polarization Impedance looks at the electrode-electrolyte interface. Polarization impedances are caused by electrochemical effects at the electrode’s electrode-fluid interface. Access Impedance looks at the bulk material around the electrode. High access impedances are caused by the presence of fibrous tissue or new bone growth around the electrode array. To have an accurate understanding of the surface quality change of the electrodes, it’s necessary to assess both Access and Polarization Impedances. Total impedance offers the most complete picture of impedance and its effect on compliance, power requirements, and MAP parameters.

Impedance in a tissue-stimulating system is more complex than a simple material or solution due to the dynamic behavior of the electrode-tissue interface.  Biological processes at a cellular level can change the electrode-tissue interface and therefore also affect the impedance of the system over time frames ranging from seconds to minutes to much longer periods.

Impedance measurements are included in Cochlear™ Nucleus® implants to perform three functions:

  • To confirm the integrity of the electrode contacts through detection of open and short circuits.
  • To ensure the map is set to maintain electrodes in compliance.
  • To provide some insight into the characteristics of the local environment around the electrode to assist with clinical management.

What factors can impact impedances?

Conditions unrelated to a patient’s hearing have been associated with changes in hearing outcomes or impedance.  In these cases, it may take an extended time for clinicians to find out that a recipient is on contributing drug therapy since the recipient may not associate other health conditions with challenges in their hearing. Papers have associated impedance rises to Meniere’s disease and tinnitus1, labyrinthitis2, otitis media3, 4, delayed hearing loss5, and episodes of vertigo2, 6. In these instances, the impedance change is an indicator of some process that is happening in the inner ear. 

There are reports involving bilateral recipients where impedances are seen to rise in a single ear1, and others where the process involves both ears2 suggesting a more systemic involvement. Interestingly one bilateral case with different model implants experienced increased impedance in both implants at the same time2.

A number of papers report on the potential for pharmaceuticals to reduce electrode impedance. In one case treatment with cortisone, antibiotics and widening pulse widths resulted in impedances falling over 25 kohm to under 14 kohm within 24 hours2. 

Why is it important to monitor impedances?

Alterations in impedance can lead to reduced performance in patients. By managing these changes through medical intervention or by adjusting the pulse width, these issues can be addressed, resulting in optimization of the recipient’s programming.

How do we use this information clinically?

Regular measurement of electrode impedances is considered good clinical practice, typically performed at each programming session. For adults and children capable of providing feedback on their cochlear implant’s sound quality, routine monitoring of the impedance profile, alongside speech perception measures and other case information, constitutes a best management approach. This practice establishes a historical record of impedance measurements, facilitating correlation with additional recipient data collected over time. Should any electrodes fall out of compliance, it is common practice to increase the pulse width across the array to return these channels to compliance, rather than deactivating.

Additionally, electrode impedance measurements detect circumstances under which certain electrodes should not be used, such as open or short circuits. Since each electrode interacts with its local environment, impedances can vary from electrode to electrode across the array.  An unexpected impedance pattern calls for a detailed review of the electrode impedance data in context with the recipient’s imaging, programming, medical history, and auditory performance.

Please reach out to your local Cochlear representative to learn more about what impedance measurements can tell you about your patient’s cochlear implant.

1 McNeill, A., & Eykamp, K. (2016). Cochlear Implant Impedance Fluctuation in Meniere’s Disease: A Case Study. Otology & Neurotology, 37(7), 873-877.

2 Neuburger, J., Lenarz, T., Lesinski-Schiedat, A., &  Büchner, A. (2009). Spontaneous increases in impedance following cochlear implantation: Suspected causes and management. International Journal of Audiology, 48(5), 233-239.

3 Vargas, J.L., Sainz, M., Roldan, C., Alvarez, I., & Torre, A. (2012) Long-tern evolution of the electrical stimulation levels for cochlear implant patients. Clinical and Experimental Otorhinolaryngology, 5(4), 194-200.

4 Dixon, J.F., Shinn, J.B., Adkins, M., Hardin, B.D., & Bush, M.L. (2015). Middle Ear Disease and Cochlear Implant Function: A Case Study. Hearing Balance and Communication, 12, 155-158.

5 Scheperle, R.A., Tejani, V.D., Omtvedt, J.K., Brown, C.J., Abbas, P.J., Hansen, M.R., Gantz, B.J, Oleson, J.J, & Ozanne, M.V. (2017). Delayed changes in auditory status in cochlear implant users with preserved acoustic hearing. Hearing Research, 350, 45-57.

6 Plontke, S.K., Götze, G., Rahne, T., & Liebau, A. (2017). Intracochlear drug delivery in combination with cochlear implants. HNO, 65, 19-28.

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©Cochlear Limited 2024. All rights reserved. ACE, Advance Off-Stylet, AOS, Ardium, AutoNRT, Autosensitivity, Baha, Baha SoftWear, BCDrive, Beam, Bring Back the Beat, Button, Carina, Cochlear, 科利耳, コクレア, 코클리어, Cochlear SoftWear, Contour, コントゥア, Contour Advance, Custom Sound, DermaLock, Freedom, Hear now. And always, Hugfit, Human Design, Hybrid, Invisible Hearing, Kanso, LowPro, MET, MP3000, myCochlear, mySmartSound, NRT, Nucleus, Osia, Outcome Focused Fitting, Off-Stylet, Piezo Power, Profile, Slimline, SmartSound, Softip, SoundArc, True Wireless, the elliptical logo, Vistafix, Whisper, WindShield and Xidium are either trademarks or registered trademarks of the Cochlear group of companies. The names of actual companies and products mentioned herein may be the trademarks of their respective owners.

 

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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