Cochlear Implants
by Cochlear Guest Author

The Perimodiolar advantage with the Cochlear CI532 Slim Modiolar Electrode

July 17, 2018
Share

By guest author: Wade Colburn

Wade Colburn

The Cochlear™ Nucleus® CI532 Slim Modiolar electrode is the latest offering within the Cochlear™ Nucleus® implant portfolio.  The CI532 Slim Modiolar electrode is a thin atraumatic electrode that can be successfully placed within scala tympani in a perimodiolar position to maximize performance outcomes.  In fact, in a large independent multicenter study, 100% of the Slim Modiolar electrodes were successfully placed in the scala tympani.1  Another institution that assessed electrode placement with the Slim Modiolar also found results that show highly consistent scala tympani location.2

Research describes the rationale on why perimodiolar placement within the scala tympani provides advantages over other electrode placements:

Increased Number of Electrode Contacts in Scala Tympani:

Berg et al3 looked at the performance of cochlear implant recipients in relation to the number of electrodes in the cochlea and found that the greater the number of electrodes in scala tympani, the better the performance. When testing in words in quite (CNC), and sentences in quiet and +5dB noise (AzBio), they found that 22 electrode contacts were significantly better than recipients with only 4, 6, 8, 10, and 12 electrodes.

Proximity to the Modiolus:

Perimodiolar position

The CI532 electrode was designed to reduce the distance to the modiolus, which has shown to improve performance5,6 and allow for more focused stimulation7,8. In a study conducted at Washington University by Holden et al4, they showed a correlation between the position of the electrode with respect to the modiolus (often referred to as the “Wrapping Factor”) and CNC word score. The group showed that those electrodes with perimodiolar placement had a lower wrapping factor and improved performance.

The CI532 electrode delivers on the three principles of the Cochlear™ Nucleus® electrode portfolio: preservation, performance and preference. The Slim Modiolar Electrode is designed with 22 electrode contacts, reduces the likelihood of translocation from the scala tympani, reduces the proximity to the modiolus, and minimizes insertion forces through a consistent sheath-based insertion.  These advantages translate into improved speech performance 1,2,4, structural preservation 9, more focused stimulation 7,8 and lower electrical stimulation thresholds 10,11.

Visit our website to learn more about the benefits of the CI532 Electrode or by reaching out to your local Cochlear representative.

Download the CI532 X-Ray Brochure.

CI532 X-ray brochure

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.

Cochlear logo

References:
  1. Aschendorff et al. Clinical investigation of the Nucleus Slim Modiolar Electrode. Audiology & Neurotology. 2017; 22:169-179.
  2. McJunkin, J. L, et al. Early Outcomes With a Slim, Modiolar Cochlear Implant Electrode Array. Otology & Neurotology. 2018; 39(1):e28-e33.
  3. Berg et al. Number of electrode needed for optimal speech and auditory perception. Poster Presentation at American Auditory Society (AAS). 2017.
  4. Holden LK, Finley CC, Firszt JB, Holden TA, Brenner C, Potts LG, et al. Factors affecting open-set word recognition in adults with cochlear implants. Ear Hear. 2013; 34(3):342-60
  5. Lazard D. S, et al. Pre-, per- and postoperative factors affecting performance of postlinguistically deaf adults using cochlear implants: a new conceptual model over time. PloS one. 2012; 7:e48739
  6. Blamey P, et al. Factors affecting auditory performance of postlinguistically deaf adults using cochlear implants: An update with 2251 patients. Audiology & neuro-otology. 2013; 18:36-47.
  7. Hughes, ML, Abbas, PJ. Electrophysiological channel interaction, electrode pitch ranking, and behavioral threshold in straight versus perimodiolar cochlear implant electrode arrays. J Acoustic Soc Am. 2006; 119(3):1538-47.
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.

View all posts

Related Posts
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

###

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.

CI Task Force

Global Task Force calls for consistent standard of care guidelines for treating adults with cochlear implants

March 1, 2022

The formation of a new global Task Force was recently announced, marking the next step in the creation of ‘Living Guidelines’ to set the standard of care for adult cochlear implantation (CI).                  

The Task Force aims to create a consistent global standard of care for adults with severe to profound hearing loss, to access referral pathways and treatment with cochlear implants. Currently only 5% of those who may benefit from a cochlear implant receive one, often due to lack of clear guidelines amongst medical professionals.1

This independent Task Force consists of cochlear implant users and key hearing experts from surgical and audiology backgrounds, representing more than 22 countries. The Task Force will engage with the Cochlear Implant International Community of Action (CIICA), representing cochlear implant users, other consumer organizations and professional societies to ensure the perspectives of adults with hearing loss are included in the process.

The project goal is to create global living practice guidelines and guidance that can be adapted and adopted in country, to optimize the standard of care for adults eligible for CI. As ‘living’ guidelines, they can be updated continuously as new evidence becomes available, as a real-time repository of guidelines under the governance of the Task Force.

In 2021 The WHO World Report on Hearing called for an overall 20% increase in the effective coverage of adults with hearing loss that use hearing aids and cochlear implants.2 These living guidelines, and the work of the Task Force, will build on existing evidence including the systematic literature search conducted for the International Consensus Paper1 on the use of cochlear implants as the minimum standard of care for adults with bilateral severe, profound, or moderate sloping to profound hearing loss, published in JAMA Otolaryngology–Head & Neck Surgery in 2020. 

Leo De Raeve, Task Force Co-Chair, commented:

‘This initiative to create living practice guidelines for CI is significant because it involves key stakeholders from subject matter experts to CI Users across the globe. They will contribute to and support the effective development and dissemination of a set of accurate, consistent guidelines. These practice guidelines can be adapted and adopted in any country, to optimize the care for adults eligible for CI.’

The process is supported by Health Technology Analysts, an independent healthcare consultancy, who will coordinate the Task Force and provide technical expertise to facilitate the development of the guidance and guidelines.

To view more information on the Living Guidelines Project, including methodology and objectives, click here.

About the Task Force and CIICA

Cochlear Implant International Community of Action (CIICA) is an exciting new global community of cochlear implant user and family advocacy groups and individuals who support a shared vision of closing the global access gap in cochlear implant provision and ensuring lifelong support for all who could benefit. The community of organizations and individuals value the opportunity for a new way of working for cochlear implant advocacy groups and the opportunity to make a difference. Working together, the aim is to make CIICA a shared and trusted space for collaboration to strengthen users, including children and young people, in advocacy work.  CIICA currently has 75 organizations and over 336 individuals from 47 countries. https://ciicanet.org/ 

The Task Force is guided by three Co-Chairs:

Meredith A. Holcomb, AuD, CCC-A

Director, Hearing Implant Program, Associate Professor Department of Otolaryngology, University of Miami, Miller School of Medicine, Ear Institute.

Leo De Raeve, PhD

Acting Chair of CIICA (Cochlear Implant International Community of Action).

Ángel Ramos Macías, MD

Professor, University of Las Palmas. School of Medicine, Department of Otolaryngology – Head and Neck Surgery and Maxillofacial

The Chairs are supported by Task Force Members comprised of an additional 47 experts in the field of cochlear implant use, including audiologists and ear, nose and throat specialists from 22 countries.

The Chairs are supported by Task Force Members comprised of an additional 47 experts in the field of cochlear implant use, including audiologists and ear, nose and throat specialists from 22 countries.

Shakeel Saeed1, Timo Stöver2, Åsa Skagerstrand3, Domenico Cuda4, Bernard Fraysse5, Michal Luntz6, Laura Turton7, Ulrich Hoppe8, Darja Pajk9, Stefano Berrettini10, Lise Hamlin11, Natalie Morog12, Oliver Adunka13, Sarah Sydlowski14, Matthew Carlson15, Regina Presley16, Craig Buchman17, Maura Cossetti18, Paul Mick19, Alicia Spoor20, Richard Gurgel21, Erin Miller22, Alejandra Ullauri23, Jennifer Maw24, Esther Ximena Vivas25, Alejandro Rivas Campo26, Tatsuya Yamasoba27, Hao-WU28, Catherine McMahon29, Holly Teagle30, Cathy Birman31, Claire Iseli32, Katie Neal33, Peter Wolnizer34, Hen Wai Yuen35, Seung Ha OH36, Bamini Gopinath37, Nina Quinn38, Jenny Loo39, Neelam Vaid40, Mohan Kameswaran41, Pádraig Kitterick42, Frederico Alberto Di Lella43, Ricardo Bento44.

1Professor of Otology/Neuro-otology, Consultant ENT and Skullbase Surgeon at University College London, U.K. 2 CI ENT, Director ENT Department, Frankfurt University Hospital, Frankfurt, Germany. 3 PhD, Audiologist and Researcher, Audiological Research Centre, Örebro University Hospital, Sweden.4 Director of ENT Department and CI Program, Piacenza and President of the Italian Society of Otolaryngology, Italy,5 President of the World ENT Society(IFOS), France, 6Professor of Otology, Director of Ear and Hearing Center, Tel Aviv, Israel, 7Adult Audiology Rehabilitation Team Leader at NHS, Tayside, U.K. 8 Professorof Audiology, Department of Otorhinolaryngology, University Hospital Erlangen, Germany, 9Occupational Therapist, VDC Toncka Hocevar, Slovenia,10Head of  ENT, Audiology and Phoniatrics unit of the University Hospital of Pisa, Italy,11Director of Public Policy at Hearing Loss Association of America (HLAA), 12Department of Surgery University of Saskatchewan Saskatoon SK Canada, 13Director Otology, Neurotology and Cranial Base Surgery Department of Otolaryngology – Head and Neck Surgery, Professor at Ohio State University, Nationwide Children’s Hospital, USA, 14Associate Chief Improvement Officer at the Cleveland clinic, Director of the Hearing Implant Program at the  Cleveland Clinic, 15Mayo Clinic Consultant, Department of Otorhinolaryngology, Mayo Clinic, Rochester, USA,16Senior Cochlear Implant Audiologist at Greater Baltimore Medical Center, USA, 17Head, Department of Otolaryngology at Washington University, St. Louis, USA, 18Director, CI Program, New York Eye and Ear at Mount Sinai Health System, Assistant Professor at LSU Health Sciences Center Shreveport, USA, 19Assistant Professor Pediatric Otolaryngology, Surgical Director for the Neurotology and CI Programs, Saskatchewan Health Authority, Canada, 20Designer Audiology, ADA, Maryland Academy of Audiology, USA, 21Associate Professor, Neurotology – Skull Base Surgery, University of Utah Health, USA, 22Chair, Professional Development Council. American Academy of Audiology, Professor of Instruction & NOAC Coordinator, The University of Akron, USA, 23Director Chicago Hearing Care, USA, 24Otolaryngology-Head and Neck Surgery, Ear Associates and Rehabilitation Services (EARS) Inc, San Jose, USA, 25Associate Professor, Neurotology, Otolaryngology, Otology, Emory University School of Medicine, Atlanta, USA, 26Director of the CI. Division Chief of Otology and Neurotology at Cleveland OH, University Hospitals. USA, 27Professor and Chairman, Department of Otolaryngology and Head and Neck Surgery at University of Tokyo, Japan, 28Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, China, 29Professor of Audiology, Head of Department, Department of Linguistics, Macquarie University, Sydney, Australia, 30Associate Professor, University of Auckland, Clinical Director, The Hearing House, New Zealand, 31Associate Professor, Medical Director of the Sydney Cochlear Implant Centre, Australia, 32Department Otolaryngology, Royal Children’s Hospital, Royal Victorian Eye & Ear Hospital, Melbourne, Australia, 33Principal, Research and Audiology Learning and Development, The Shepherd Centre, Sydney, Australia, 34Former Dean of Economics and Business at Sydney University, Australia, 35Senior Consultant, Changi General Hospital, Singapore, 36Professor Otolaryngology, Seoul National University, Sth. Korea, 37Cochlear Chair in Hearing and Health and Professor at Macquarie University, Sydney, Australia, 38CEO Neurosensory, Australia, 39Audiologist, National University Hospital, Singapore, 40Head of the Cochlear Implant Programme and BIG EARS, the Audiology and Speech Pathology Department at KEM, India, 41Hospital Managing Director & Senior Consultant, Madras ENT Research Foundation Ltd, India, 42Head of Audiological Science, National Acoustic Laboratories, Sydney, Australia, 43Department of Otorhinolaryngology, Hospital of Buenos Aires, Argentina, 44Professor and Chairman, Otolaryngologic Department of Otorhinolaryngology at the Faculty of Medicine, University of São Paulo, Brazil.

References

  1. Buchman et al. Unilateral Cochlear Implants for Bilateral Severe, Profound, or Moderate Sloping to Profound Sensorineural Hearing Loss: A Systematic Review and Consensus. JAMA Otolaryngology 2020; www.adulthearing.com
  2. WHO World Report on Hearing (WRH) www.who.int/publications/i/item/world-report-on-hearing
Cochlear logo - white

©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.

 

Cochlear ProNews is monitored Monday through Friday, excluding some holidays. Questions and inquiries submitted over the weekends or holidays may see a delay in response. For immediate assistance please contact us directly. You are solely responsible for your interactions with other members of our Websites. Cochlear reserves the right, but has no obligation, to monitor disputes or communications between you and other members of our Websites. For a full list of Cochlear’s terms of use, click here.