The Cochlear™ Nucleus® 7 is available for Nucleus 24 implant recipients!

Guest author: Wade Colburn

Cochlear^TM CI532 Slim Modiolar electrode is the latest offering from Cochlear. The CI532 electrode is the only sheath-based electrode on the market, which was designed to allow for a smooth, atraumatic insertion with consistent scala tympani placement ^{2, 3}. The presence of the sheath requires a two-handed technique that ensures the best possible insertion. In order to successfully insert the device, there are a few quick tips that should be considered:

1. The cochleostomy sizing tool should be used to ensure the opening to the cochlea is appropriately sized. The recommendation is to have the opening be between 0.8 mm and 1.0 mm. ¹ An appropriately sized opening ensures the best possible insertion.
2. Use the white sheath handle as a guide for correct orientation. The handle should be oriented towards the modiolus and follow the plane of the scala tympani.
3. Ensure the sheath stopper is flush to the opening of the cochlea. This will allow the electrode to hug the modiolus and navigate around the basal turn. Your natural tendency may be to pull back on the sheath, but it should be kept steady as the electrode is advanced.
4. Insert the electrode until the white alignment marker on the sheath and the white alignment marker on the electrode are aligned.¹ Remove the sheath and visually verify that the three white insertion depth markers are at the opening of the cochlea to allow the electrode to hug the modiolus. Over inserting the electrode can push the electrode towards the lateral wall.

These are just some of the key tips when inserting a CI532 electrode. Please refer to the CI532 Physician’s Guide ¹ for the complete list of insertion steps. Further, for a Quick Reference Guide of the steps for inserting CI532, see here. Feel free to reach out today to your Cochlear representative with any questions about CI532 or our electrode portfolio.

About our guest author:

Wade is the Product Manager for Cochlear Implant product portfolio within Cochlear Americas.  Wade’s responsibilities include product positioning and messaging, life-cycle management, new product launches and surgical support and training. Wade has recently joined Cochlear, but comes from an engineering background with the medical device field, including previous otology experience.

References:

1. Document 414154:Cochlear ^TM Nucleus ® CI532 cochlear implant with Slim Modiolar electrode Physician’s Guide

2. Aschendorff et al. Clinical investigation of the Nucleus Slim Modiolar Electrode. Audiology & Neurotology. 2017; 22:169-179.

3. Data on File: 473386 – EA32 Electrode Insertion Safety and Performance Study Report

Providing peace of mind and additional confirmation during cochlear implant surgery with the Nucleus CR220 Intraoperative Remote Assistant.

For a new Cochlear™ recipient and their family, knowing that the cochlear implant is functioning as their surgeon and audiologist expected, and that the auditory nerve is responding to stimulation, can be reassuring. For the audiologist and surgeon, knowing that electrode impedances are appropriate, and that AutoNRT^® thresholds were measured provides confidence that the surgical procedure was successful. In the past, a laptop with Custom Sound^®, a programming pod, and associated cables were required to obtain this information – and it was typically in the purview of the audiologist to take time out of his or her schedule to complete the testing. To address these challenges, Cochlear partnered with surgeons and clinicians to expand the capabilities of the industry-first bidirectional remote assistant to provide this valuable information more quickly, and by anyone in the operating room. Using the CR220 Intraoperative Remote Assistant means obtaining confidence that all electrodes are functioning, and that the auditory nerve is responding to stimulation, has never been easier, faster or more efficient!

 Below is some helpful information to know when working with the CR220 Intraoperative Remote Assistant:

1. Before using the CR220 in the operating room for the first time, you can learn how it works via the onboard Practice Mode. Simply press and hold the OK button, press the down arrow to highlight Practice Mode, and press OK. Be sure to explore the screens accessed by pressing the right side arrow before, during and after testing. You may wish to turn off the Beeps on Remote under Settings before starting your practice session.
2. The operating range between the CR220 Remote Assistant and the CP810 processor is up to 6 feet.
3. For simplicity, the CR220 uses the same intraoperative AutoNRT^® parameters as Custom Sound^®
   1. Stimulation rate of 250Hz
   2. Measurement starts at 170 current level (CL), after a conditioning stimulus of 230 CL for each electrode.
   3. All 22 intracochlear electrodes are measured starting with Electrode 22, followed by Electrode 1, 11, 6, 16 and so on.

Note: AutoNRT has a high success rate of obtaining threshold NRT (T-NRT) on 93 percent of electrodes, which is better than any other cochlear implant objective measure.¹

4. The CR220 Intraoperative Remote Assistant has clear, simple messages to inform you of any actions you may need to take during testing. Below are just two examples.

          a. If the connection to the internal device is lost, the following will be shown on the CR220’s display screen:

• A prompt to ‘Reconnect coil to Implant.’ You will have five minutes to reconnect, otherwise the test session will conclude.  If this occurs, you can initiate a new session to collect your data.

          b. After pressing the OK button to pause AutoNRT while it is running you will see:

• Resume AutoNRT: the device will simply continue testing from where it was paused.
• View Results: use the arrow keys to see the acquired NRT profile or individual NRT traces.
• Either Cancel AutoNRT or Finish AutoNRT If you cancel AutoNRT before three electrode measurements are completed, the Auto NRT Cancelled screen will display. Press the OK button to return to the NRT: Electrodes screen to re-start. If you stop AutoNRT after three or more electrode measurements are completed, you will have the option to Finish AutoNRT.

We hope that using the CR220 Intraoperative Remote Assistant enhances your confidence in surgery, reduces your clinical load and complexity, and enhances your clinic efficiency.

If you would like to learn more about the CR220, please visit our one-hour (CEU available) Audiology Online course using the following link:

*van Dijk, B., Botros, A., Battmer, R., Begall, K., Dillier, N., Hey, M., Lai, W., Lenarz, T., Laszig, R., Morsnowski, A., Muller-Deile, J., Psarros, C., Shallop, J., Weber, B., Wesarg, T., Zarowski, A. & Offeciers, E. (2007) . Clinical results of AutoNRT: A completely automatic ECAP recording system for cochlear implants. Ear and Hearing. 28:4, 558-570

©Cochlear Limited 2017. 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.