by Michi Diller, AuD

Quick Tips: Bimodal Fitting Flow

October 26, 2023

Welcome to Cochlear™ Quick Tips. The purpose behind Quick Tips is to give you “bite-sized” information that you can use when working with our products.

Have you had a question in the middle of an appointment about fitting a bimodal patient? We have great news!

The Bimodal Fitting Flow and Bimodal Troubleshooting Guide are available in Custom Sound® Pro under the “Help” tab.

Visit our webpage for additional information regarding bimodal solutions for your patients or cochlear.com/compatibility for all your compatibility questions.

Upgrade benefits and advancements in cochlear implant sound processor technology

August 28, 2020

By Camille C Dunn, PhD, CCC-A, Director of Cochlear Implants in the Department of Otolaryngology-Head and Neck Surgery at the University of Iowa

Interested in talking with your patients about the benefits of upgrading their sound processor? Check out this article by Camille Dunn and share with your patients to start the conversation!

Advancements in cochlear implant sound processor technology have significantly contributed to improving the quality of life for cochlear implant recipients. Three important improvements in technology include wear-ability, streaming/connectivity and sound processing.

Wear-ability

Commonly, improvements in technology often result in smaller, lower profile devices that sit more comfortably on the head. Smaller devices might not necessarily improve hearing outcomes directly, but they can lead to improved wear time, which is a vital factor. Additionally, upgraded devices might offer longer battery time or different battery charging capabilities.

Some of the newer processors do not even sit on the back of the ear or have cables to manipulate. They are all-in-one processors that sit directly on the implant magnet site where the headpiece attaches to the internal device. Like the behind-the-ear processors, these devices come in multiple colors to blend with hair and skin color. It’s important to note that the all-in-one processors do not allow for combined processing for all Cochlear products. That is, the recipient will only receive electrical stimulation from their processor and not combined electrical and acoustic processing in the same ear.

Did someone say swimming? The newest sound processors also have an impressive water resistance rating which translates into sweat-proof and splash-proof capabilities especially useful in high humidity areas. For those who enjoy water activities, accessories are available that protect the sound processor while swimming, snorkeling, surfing or fishing.*

Streaming and connectivity

People love to be connected, which is why they might want to upgrade their sound processor. Newer technology offers direct streaming capabilities with compatible Apple® or Android™ smartphones. Recipients can stream phone calls, music, movies and other media directly from a compatible smartphone to their sound processor(s) without the need for an intermediate device, such as a phone clip.

Recipients are especially enthusiastic about the technology that allows streaming to both ears – bimodal use with a compatible ReSound hearing aid and bilateral cochlear implant. This is huge! Benefits for listening with two ears can include improved ease of listening and better speech understanding.

Recipients often appreciate the versatile wireless accessories. For example, the Mini Microphone 2+ provides improved speech understanding in noisy situations or where distance from the speaker is a factor. This technology can help cochlear implant users feel less socially isolated while dining at a restaurant, riding in a car, listening to a presenter at a meeting, classroom or place of worship. Speech is streamed to the recipient via their sound processor after clipping the Mini Mic 2+ to the collar of the talker or even placed on the table. Further, the TV Streamer sends stereo sound from the television directly to the sound processor. This provides the recipient with improved understanding of what is being said without compromising the sound level to other companions who might be watching the same television program.

Sound processing

Cochlear implant recipients benefit from advanced sound processing technology that evaluates the sound environment and automatically adjusts settings on the processor for optimal hearing. For a newly upgraded recipient, speech and sound may initially be perceived as “different.” Patience, persistence and listening practice are key as the brain adjusts to new sound processing, which in the long run, will provide better access to sound and improved speech understanding in noisy situations. As people go about their day in different listening environments, automatic adjustments optimize the user hearing experience by reducing background noise and wind noise, improving speech clarity and enhancing music.

Staying connected with loved ones and friends, relaxing to music and movies, working and homeschooling from home, while remaining informed by listening to news on a smartphone, TV and computer are more important than ever these days as we navigate social distancing and survive the many personal and economic challenges due to COVID-19. The value of upgrading to new technology and staying current with the versatile accessories can improve quality of life for cochlear implant recipients.

For more information, visit our website and subscribe to Cochlear ProNews.

This article expresses the experience and opinions of Camille Dunn.

Apple, the Apple logo, FaceTime, 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 and Google Play are registered trademarks of Google Inc.

The Android robot is reproduced or modified from work created and shared by Google and used according to terms described in the Creative Commons 3.0 Attribution License.

The Cochlear Nucleus Smart App is available on App Store and Google Play. For complete smartphone compatibility information, please visit www.cochlear.com/compatibility.

*The Nucleus 7 Sound Processor with Aqua+ is water resistant to level IP68 of the International Standard IEC60529. This water protection means that the sound processor with the Aqua+ can be continuously submerged under water to a depth of 3 meters (9 ft and 9 in) for up to 2 hours. This water protection only applies when you use a Cochlear Standard Rechargeable Battery Module or Cochlear Compact Rechargeable Battery Module. The Kanso Sound Processor is water resistant to level IP54 of the International Standard IEC60529. The Kanso Sound Processor with the Aqua+ is water resistant to level IP68 of the International Standard when used with LR44 alkaline or nickel metal hydride disposable batteries.

Science Spotlight: Considerations for a revised adult cochlear implant candidacy evaluation protocol

July 26, 2021

Considerations for a revised adult cochlear implant candidacy evaluation protocol

*A. Biever, *^C. Amurao, ^M. Mears

*Rocky Mountain Ear Center, 601 E. Hampden Ave #430, Englewood, CO 80113, United States of America, ^Cochlear Americas, 10350 Park Meadows, Lone Tree, CO 80124, United States of America

Purpose

To compare two commonly utilized tests in cochlear implant candidacy evaluations, the Consonant- Nucleus-Consonant (CNC) test in quiet and the AzBio Sentences test in noise, for uniformity and appropriateness.

To recommend an updated streamlined test battery that relies on a monosyllabic word test and a self-report subjective measure of hearing capabilities.

Key messages

The CNC word test is efficient and effective in determining cochlear implant candidacy and can be used to monitor hearing performance over time.

The Speech, Spatial and Qualities of Hearing Scale (SSQ) or SSQ-12 furnishes subjective, real-world insight into an individual’s hearing difficulties and offers complementary information to objective speech understanding measures.

Methods

Prospective, non-randomized, multicenter controlled trial at 13 clinical sites
100 experienced hearing aid users > 18 years old with postlinguistic onset of bilateral, moderate sloping to profound sensorineural hearing loss
Aided CNC word score < 40% in the ear to be implanted and < 50% in the contralateral ear

Preoperative speech recognition was evaluated in the sound field for unilateral (HA) and bilateral (2HA) conditions and at 6-months postoperatively for unilateral (CI) and bimodal (CI+HA) conditions. CNC words in quiet at 60 dBA and AzBio sentences at 65 dBA in background noise at +10 and +5 dB SNR (speech and noise at 0° azimuth) were presented. In addition, participants completed the subjective Speech, Spatial and Qualities of Hearing Scale (SSQ), pre-(2HA) and 6-months postoperatively (CI+HA). All assessment results are based on matched pair data.

Results

In total, 100 subjects were implanted in this study, ranging from 23 to 91 years of age with a mean age of 67 years at the time of implantation. The duration of hearing loss in the ear to be implanted ranged from 1 to 66 years with an average duration of 27 years, and all subjects were experienced hearing aid users.

Of the 100 subjects who were enrolled in the study, 96 completed the speech testing at the 6-month endpoint. In the implanted ear, subjects demonstrated an average improvement of 46 percentage points on CNC words at 6 months postoperatively, and 28 percentage points and 11 percentage points for AzBio sentences at +10 dB SNR and +5 dB SNR respectively. The improvement on each of the three tests was statistically significant at the 6-month endpoint, and Figure 1 shows the distribution of individual scores. All results represent matched pair data.

More variation in individual outcomes for speech recognition scores for sentences in noise was observed compared to CNC words in quiet in both unilateral and bimodal listening conditions at each test interval. Competing background noise presents the potential for additional cognitive load for hearing-impaired individuals. The scores obtained on a complex sentence test in noise can sometimes reflect the central processing function of the patient, more so than capture their peripheral listening ability. Administration of a monosyllabic word test in quiet can more reasonably assure that the clinician is evaluating peripheral performance, without the contribution of additional central processes.

Figure 1: The distribution of individual speech scores preoperatively versus at the at the 6-month endpoint. Group mean score for CNC words significantly increased by 46 percentage points ( p<0.001). Group mean score for AzBio sentences scores at +10 dB SNR significantly increased by 28 percentage points (p<0.001). Group mean score AzBio sentences scores at +5 dB SNR significantly increased by 11 percentage points (p<0.001). Note the increased variability in scores on the AzBio sentences, as well as the floor effect seen most prominently in the +5 dB SNR condition. CNC indicates Consonant-Nucleus-Consonant; SNR, signal-to-noise ratio.

As shown in Figure 2, the overall total score on the SSQ at the 6-month endpoint (N=95) showed a clinically significant improvement from 3.2 to 5.7 (a 2.5 point increase) with 77% of subjects reporting an overall improvement. Results from the SSQ scenarios can be classified into pragmatic subscales that reflect self-reported difficulties associated with acoustically dynamic listening situations where binaural hearing is especially important. The mean pre-to-post speech in noise subscale change was 2.6 and the mean pre-to-post speech in quiet subscale change was 2.9 with 86% of subjects showing a significant increase.

Figure 2: Mean scores on the SSQ (49 questions) preoperatively with hearing aids and at 6-months postoperatively with a cochlear implant & hearing aid. Significant postoperative changes were demonstrated in each subscale as well as the total score (p<0.001).

Conclusions

Results from this multi-center study suggest that clinicians adopt CNC words as the primary candidacy evaluation instrument rather than AzBio Sentences in noise. A subjective tool, such as the SSQ-12 or SSQ, can provide important complementary information regarding how the individual feels about everyday hearing abilities.

To read more Science Spotlights visit Cochlear ProNews.

Citation: Biever A, Amurao C, Mears M. Considerations for a revised adult cochlear implant candidacy evaluation protocol, Otol Neurotol. 2021 Jan; 42; (1),159-164 doi: 10.1097/MAO.0000000000002966

This article is intended to serve as a resource for clinicians to help keep up to date with current clinical literature and is intended for professionals only. Clinical literature is based on research, which may include the experimental use of new or currently available products and technologies. Therefore, literature presented on this blog may represent use of Cochlear products that does not align with the intended use or indications approved by regulatory bodies, also known as off-label use. Cochlear does not condone any off-label use of its products, and it is not Cochlear’s intent to promote off-label use by providing this blog as a resource to clinicians.

This article summary is for education and information sharing amongst professionals and partners. Any representations made in relation to medical devices or therapeutic goods are not advertisements. The representations and views expressed in this summary are those of the authors and do not reflect the views of Cochlear. Cochlear does not endorse any particular treatment or research protocol nor off-label use.”