Cochlear Implants
by Cochlear Guest Author

Supporting recipients’ success in today’s hybrid classroom and work environments

October 6, 2020
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As adults and families navigate the landscape of today’s diverse classroom and work environments, recipients with hearing implants may still struggle to hear and understand speech in noisy situations and different learning environments. Be confident that Cochlear is committed to helping our recipients hear their best, no matter the listening environment or public health intervention requirement. With our direct connectivity to compatible Apple® or Android™ devices*  and True Wireless™ technology, recipients are provided consistent and audible sound, essential to helping them achieve success.

Even as listening environments change throughout the day, from quiet conversations to a noisy classroom or workplace, Nucleus® Sound Processors help recipients focus on what matters with the ability to automatically adapt to the environment to provide an optimal listening experience.

Direct-to-device streaming technology

Students and adults in the virtual classroom and workplace may be engaging with teachers and peers through online platforms using a tablet or watching educational and training videos using a smartphone. With direct to device streaming technology,  recipients with a Cochlear™ Nucleus 7 or Kanso® 2 Sound Processor can stream directly from a compatible Apple or Android device.* Direct-to-device streaming allows recipients to hear clearer audio without struggling to hear speech.1

Nucleus Smart App

The Nucleus Smart App allows recipients to manage the settings for their Cochlear Nucleus 7 or Kanso 2 Sound Processor directly from a compatible Apple or Android device.* They can quickly and easily

control how they stream audio from Cochlear True Wireless accessories. In addition, the Nucleus Smart App offers recipients and parents the ability to quickly adjust a device, view personalized use information with Hearing Tracker, turn on ForwardFocus***, and even locate a missing sound processor. A unique feature for Kanso 2 Sound Processors is the ability for loved ones, parents and teachers to monitor the sound input from the microphones with Sound Check.

The Nucleus Smart App can be downloaded for free from the Apple App Store or Google Play Store.

Open the App Store or Google Play Store on a compatible device and search for ‘Nucleus Smart App’.

Bimodal Streaming

Hearing with two ears can give someone better understanding in noise, speech recognition and sound localization.3 Cochlear and ReSound have partnered to offer smart bimodal hearing for Nucleus 7 and Kanso 2 Sound Processor recipients. With a compatible ReSound hearing aid and the Nucleus 7 or Kanso 2 Sound Processor, a recipient can experience the benefits of wirelessly streaming sound directly to both ears at the same time with a True Wireless accessory.+

Focus on what matters

When students or adults are working in small groups or enjoying conversations with peers in a noisy environment, hearing and understanding speech may be difficult. With SCAN¥, the industry’s first automatic scene classifier, a Nucleus Sound Processor continuously analyzes the acoustic signal and classifies the listening environment into one of six scenes.  Once classified, the selected scene automatically adapts microphone directionality and applies input signal processing to increase audibility, especially in noisy environments, without the need for recipients to make manual adjustments.

In addition to the automatic features of SCAN, the Nucleus 7 and Kanso 2 Sound Processors offer ForwardFocus** which may help adults and older children hear conversations better in a particularly challenging listening environment. Once enabled by the clinician, a recipient can simply switch on ForwardFocus through the Nucleus Smart App to significantly decrease noise coming from behind, making it easier for them focus on face-to-face conversations.5

Battery life

Providing consistent hearing is essential to help recipients achieve success in the classroom and workplace. The Nucleus 7 Sound Processor offers a choice of compact and standard rechargeable batteries (lasting up to 30 hours) and disposable battery (lasting up to 3 days) options^, so  recipients and parents have the flexibility to power sound processor use all day based on needs. The Kanso 2 Sound Processor features a powerful, integrated rechargeable battery that recipients and parents and can rely on for all-day hearing.^^ 3

True Wireless™ accessories

True Wireless technology helps Nucleus Sound Processor recipients hear more clearly in challenging situations by streaming sound directly to their sound processor.2  Cochlear’s True Wireless accessories utilize the same 2.4 GHz wireless protocol that Bluetooth® and Wi-Fi devices depend on.

Mini Microphone 2+

With an extended range and portability, the Mini Microphone 2+ has the flexibility to provide recipients better hearing in one-on-one situations, in the classroom or at the workplace. The Mini Microphone 2+ also has a line-in direct audio input that allows recipients to stream wirelessly from portable technology with a 3.5 mm audio port to a Nucleus Sound Processor.

Tips for use in different listening environments:

• One-on One: Keep the Mini Microphone 2+ six inches or less from the speaker’s mouth in an upright position. The upright position ensures the Mini Microphone 2+ is in a directional setting, which helps reduce background noise.

• Small group: Place the Mini Microphone 2+ horizontally on the table or desk. This puts the Mini Microphone 2+ into an omnidirectional microphone setting.

• Portable technology: From the 3.5 mm audio port on the bottom of the Mini Microphone 2+ connect to an external audio source.

Download the quick guide now.

Visit the School Resource Center for additional information on wireless technology in the classroom.

1. Cochlear Limited. D1182081. CLTD 5620 Clinical Evaluation of Nucleus 7 Cochlear Implant System. 2017, Mar; Data on file.

2. Wolfe J, Morais Duke M, Schafer E. Improving hearing performance in Cochlear Nucleus 6 users with True Wireless Accessories. Denver: Cochlear Americas; 2015.

3. Potts LG, Skinner MW, Litovsky RA, Strube MJ, Kuk F. Recognition and localization of speech by adult cochlear implant recipients wearing a digital hearing aid in the nonimplanted ear (bimodal hearing). Journal of the American Academy of Audiology. 2009 Jun 1;20(6):353-73.

4. Cochlear Ltd. D1710313 CP1150 Battery Life Coverage Technical Report. 2020; Mar. Data on file.

5. Cochlear Limited D1376556 Acceptance and Performance with the Nucleus 7 Cochlear Implant System with Adult Recipients. June 2018, Data on file.

* Direct streaming available for the Cochlear Nucleus 7 and Kanso 2 Sound Processor from a compatible Apple® or Android™ device. For compatibility information, visit www.Cochlear.com/compatibility.

** ForwardFocus can only be enabled by a Hearing Implant Specialist. It should only be activated for users 12 years and older who are able to reliably provide  Feedback on sound quality and understand how to use the feature when moving to different or changing environments. It may be possible to have decreased speech understanding when using ForwardFocus in a quiet environment.

^ Battery life may vary by individual. Battery life is dependent on several factors including streaming and accessory usage.

^^All day hearing is defined as 16 hours, expected battery life is up to 18 hours.  Battery life may vary by individual.

¥ SNR-NR, WNR and SCAN are approved for use with any recipient ages six years and older, who is able to 1) complete objective speech perception testing in quiet  and in noise in order to determine and document  performance 2) report a preference for different program settings.

+ Compatible ReSound hearing aids can be found at www.Cochlear.com/US/Nucleus7Compatibility.

+++For True Wireless™ accessories where applicable, this may include the charging cables and charging adaptors.

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

Android and Google Play are registered trademarks of Google Inc.

©2020. 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.

The Bluetooth® word mark and logos are registered trademarks owned by Bluetooth SIG, Inc. and any use of such marks by Cochlear is under license.

ReSound is a trademark of GN Hearing A/S.

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.

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Journal Club: Pediatric cochlear implant wear time and early language development

December 16, 2019

By Amy Donaldson, Professional Education Manager, Cochlear Americas

Gagnon, Erika B., Eskridge, Hannah, Brown, Kevin D.

Pediatric cochlear implant wear time and early language development

Sep 29, 2019:1-6

Cochlear Implants Journal

In today’s busy clinical environment, clinicians who value research-based practice often struggle to keep up with current literature.  To help, we’re excited to offer a new ProNews Blog monthly feature – Journal Club!  Each month, rotating guest authors will present a current journal article summary.

This month’s Journal Club explores a recent study by the team at the University of North Carolina published in September 2019, Pediatric Cochlear Implant Wear Time and Early Language Development. This article may be especially useful for those clinics working with pediatric recipients as a resource for counseling on device use.

What did the study investigate?

This study was designed to examine the relationship between device wear time in pediatric recipients and their language development. 

For children with hearing loss, consistent access to auditory information with either hearing aids or cochlear implants is associated with better speech and language development.1,2,3,4 Unfortunately, clinicians can’t always rely on parental report of device use – some studies have shown that they overestimate device use by an average of 2.6 hours per day.5 

Modern cochlear implant systems now have datalogging available to help clinicians objectively track device use, but it can be unclear how these results should be interpreted or what is the impact of differences in wearing time.  If a one-year-old uses their device seven hours per day, is that enough to provide access to spoken language?  What about the same use per day for a five-year-old?  This study attempted to answer these questions.

How did they do it?

The authors utilized datalogging in the Nucleus® sound processor and applied a measurement called “Hearing Hour Percentage” or HHP to track the amount of device use: 

HHP = total wear time/median awake time * 100

This measurement provides more information than just hours per day since it considers the waking hours of each day for children of different ages.  For example, according to the American Academy of Sleep Medicine6 the average median awake time for a one-year-old is 11.5 hours; for a five-year-old, it’s 12.5 hours.  That makes sense – younger children sleep more.  So seven hours of device use for the one-year-old is 61% of their awake day; but for the five-year-old, it is only 56%.  See table below:

Here are the key features of the study:

  • 37 children implanted prior to age 5
  • Average age of implantation: 1.97 years
  • Followed for the first year of device use
  • All using Nucleus 6 technology or later
  • Language tests: The Preschool Language Scale: Fifth Edition (PLS-5) or Oral and Written Language Scales: Second Edition (OWLS-II)

Results

The study found HHP of the 37 children ranged from 18% to 117% with an average of 63%.  More than half of the group achieved an HHP of over 60% by the end of their first year of device use.  This is interesting since many professionals would recommend device use during “all waking hours” but this study demonstrated that average usage of cochlear implants in children may only be about 60% of waking hours. 

The study found a positive correlation between HHP and receptive language abilities – the more recipients used their device, the better their receptive language – although the correlation was not significant for expressive language abilities.  This may have been because they only followed the children for one year after device use and expressive language development lags behind receptive language development.  Device use accounted for 40% of the variability in receptive language for the children confirming that while device use is important, it is still only one variable in outcomes for children.

Discussion

The results of this study support the importance of consistent device use for language development in children and highlight device datalogging as a critical tool in measuring progress.  The findings may also encourage professionals to consider how they counsel parents of young children who are using cochlear implants.  Combining datalogging with information about average awake time allows clinicians to determine the HHP for an individual child.  Counseling a parent to have their child use the device “all waking hours” may be helpful, but it might be even more useful to encourage use for a percentage of the child’s awake time and measure their progress by increasing that percentage. 

Pediatric clinicians encourage families to achieve “full time” device use.  This study helps define what that number should look like for children of different ages and gives parents and caregivers specific goals.  While datalogging can help clinicians track progress during clinic visits, Hearing Tracker is now available for parents to use between visits.  Hearing Tracker is available for the Nucleus 7 sound processor in the Nucleus Smart App, and is available in both iOS and Android™ devices. 

With Hearing Tracker, datalogging and device use information is not just available to clinicians but can be seen real-time by parents and caregivers, supporting device use and helping to support language development in children who use cochlear implants. 

Learn  more about this exciting clinical strategy by accessing the publication here and stay tuned for next month’s edition of Journal Club!

About our guest author:

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. 

References:

  1. Weisman KB, Warner-Czyz AD (2018) Inconsistent device use in pediatric cochlear implant users; Prevalence and risk factors. Cochlear Implants International, 19, 131-141.
  2. Toblin, JB, Harrison, M, Ambrose, S, Walker EA, Oleson, JJ, Moeller MP. (2015) Language outcomes in young children with mild to severe hearing loss. Ear and Hearing, 36(Suppl 1):76S-91S.
  3. Easwar V, Sanfilippo J, Papsin, B, Gordon, K. (2018) Impact of consistency in daily device use on speech perception abilities in children with cochlear implants: datalogging evidence. Journal of the American Academy of Audiology, 29:835-846.
  4. Guerzoni L, Cuda D (2017) Speech processor datalogging helps in predicting early linguistic outcomes in implanted children. International Journal of Pediatric Otorhinolaryngology, 101:81-86.
  5. Walker EA, Spratford M, Moeller MP, Oleson J, Hua O, Roush P, Jacobs S. (2013) Predictors of hearing aid use time in children with mild-to-severe hearing loss. Language, Speech & Hearing Services in the Schools, 44(1):73-88.
  6. Paruthi S, Brooks LJ, D’Ambrosio C, Hall WA, Kotagal S, Lloyd RM, Malow BA et al (2016) Recommended amount of sleep for pediatric populations: A consensus statement of the American Academy of Sleep Medicine. Journal of Clinical Sleep Medicine, 12(6):785-786.

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.




Boy drawing

Interview with Melissa Tumblin: Advocating for Ally’s Act

March 5, 2020

Introducing Ally’s Act, H.R. 5485

Interview with Melissa Tumblin, Founder and Executive Director of the Ear Community Organization

Cochlear: Who is Ally? 
Melissa Tumblin: My daughter, Ally Tumblin, is a 10 year-old girl from Broomfield, CO who was born with microtia and aural atresia of her right ear. Ally wears a bone anchored hearing device to help restore her significant conductive hearing loss. She is now an advocate for the deaf/hard-of-hearing (D/HOH) community, especially for the microtia and atresia community.

Wanting to advocate during Better Hearing and Speech Month in May 2019, she wrote to Congressman Joe Neguse (D-CO) asking for help and he responded! As a result, Congressman Neguse introduced Ally’s Act, H.R.5485 honoring Ally and her advocacy to help others obtain hearing device insurance coverage for hearing implants through private insurers.

Cochlear: What is Ally’s Act?
Melissa Tumblin: Ally’s Act, H.R. 5485 is a bipartisan national bill that would ensure that private insurance companies provide coverage for hearing devices including osseointegrated hearing devices (OIDs) like bone anchored hearing aids and cochlear implants as well. Ally’s Act is not a state-level bill, which means the legislation would help children and adults by ensuring that these hearing devices have coverage in every state, unlike the current situation where hearing device coverage varies from state to state. In fact, only half of our states have legislation in place to cover hearing aids. Even with this coverage in place, bone conduction hearing aids and cochlear implants are not always included in these coverage plans.

Once passed, Ally’s Act may allow or enhance access to these important devices by covering:


1. A bone conduction hearing aid or cochlear implant
2. An upgrade replacement of these hearing devices every five years
3. Accessories including Soft Band headband, hard headband and adhesives
4. Repairs for these devices
5. One comprehensive hearing assessment per year
6. One preoperative assessment per year
7. Implantation surgery
8. Postoperative medical appointments for purposes of ensuring appropriate recovery from surgery
9. Postoperative audiological appointments for activation, fitting and programming
10. Aural rehabilitation services related to the use of this device

Congressman Neguse, who introduced H.R. 5485, states, “This bill would ensure that insurance coverage for hearing devices such as [hearing implants] be consistent and fair, to ensure every child can thrive and obtain the hearing healthcare they deserve.” Ally’s Act, H.R. 5485 would help these individuals obtain consistent hearing device coverage in every state through private insurers identified in the Affordable Care Act.

Cochlear: How do you wish to partner with professionals and how can they support Ally’s Act?
Melissa Tumblin: Many medical professionals have encountered patients who have had claims denied by private insurance providers when trying to obtain hearing implants. These professionals now have the chance to take action – hearing health professionals such as ENTs/otolaryngologists, audiologists, speech and language pathologists, teachers of the D/HOH, school district educators and interpreters have the opportunity to write and call their local representatives about Ally’s Act.

They can also reach out to their professional organizations to support this important piece of legislation. Lastly, these medical professionals and supporting organizations who have endorsed Ally’s Act can also schedule appointments and speak with their local representatives in person to support passage of the legislation.

Cochlear: How could Ally’s act impact the hearing industry as a whole?
Melissa Tumblin: Ally’s Act helps raise awareness of implantable solutions and advocates for the insurance coverage needed to increase access to these devices. This impacts the accessibility of hearing implants in general.

Moreover, Ally’s Act educates law makers about what is needed to improve hearing health care by hearing directly from medical professionals, the impacted families and adults who wear hearing implants. In fact, this could also educate the involved insurance companies. Ally’s Act may even pave the way for better hearing health care bills down the road!

Cochlear: What do you need from the public to help get Ally’s Act approved?
Melissa Tumblin: After introduction, this piece of legislation must pass through the House and the Senate and be signed by the President of the United States before becoming law. To aid this process, we must rely on the community to support this bill. I encourage anyone with a vested interest in healthcare to write to and call their local representatives, asking them to co-sponsor Ally’s Act.

In addition, community members can write to the House Committee for Energy and Commerce and call the members who sit on this committee. If there is not a House member who sits on this committee representing your state, they can then write to and call Chairman Frank Pallone. Even though the act may need 290 co-sponsors, this number is not always the deciding factor that could help move this bill out of the House Committee. The quality of letters and calls, along with following up with the offices of the representatives that have been contacted make a difference.

To stay updated on the status of Ally’s Act, H.R. 5485 please visit the Congressional website.

About Melissa Tumblin:

Melissa founded Ear Community ten years ago after her youngest daughter, Ally, was born. Ear Community is the first parent-driven nonprofit organization that directly helps children and adults who are born with microtia and aural atresia. It cultivates a community focused on education, awareness and support. Ear Community donates bone anchored hearing devices to individuals who have been denied coverage for these devices and awards college scholarships.

In the United States and Canada, the placement of a bone-anchored implant is contraindicated in children below the age of 5

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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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