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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The Cochlear™ Nucleus® 7 sound processor is proven to optimize hearing performance

November 21, 2017

 

The Cochlear™ Nucleus® 7 sound processor is proven to optimize hearing performance. The Nucleus 7 sound processor features SmartSound® iQ with SCAN*, which is designed to replicate natural hearing by capturing sound and automatically adapting to your environment without the need to make manual adjustments.

Optimize hearing performance with the Nucleus 7 sound processor

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*SNR-WR and WNR are approved for use with any recipient ages 6 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 and 2) report a preference for different program settings. SCAN is FDA approved for use with any recipient ages 6 years and older, to be used at the discretion of the recipient/parent/caregiver.

Clinical Programming Series: ESRT

September 16, 2024
  • Approximately 5 minutes to read
  • Learning objectives:
    • Understanding what ESRT measurements are
    • Understanding ESRT clinical applications and correlations
    • Understanding how to optimize ESRT measurements

Electrical Evoked Stapedius Reflex Thresholds (ESRT) can be used as an objective measure for cochlear implant programming when clinically appropriate. Studies support the use of postoperative ESRTs for MAP verification ¹˒²˒³˒⁴˒⁵. Cochlear suggests using ESRT in conjunction with behavioral loudness scaling to ascertain upper stimulation levels.

What are ESRT measurements?

The stapedius reflex serves as a protective mechanism for the inner ear against excessively loud and potentially harmful sounds. In individuals with normal hearing, this reflex is activated by sound pressure levels (SPL) ranging from 70 to 90 dB SPL. Exposure to a loud noise causes the stapedius muscles in both ears to contract. This contraction moves the anterior stapes away from the oval window and increases the rigidity of the ossicular chain, thereby reducing the amount of vibrational energy reaching the cochlea.

ESRT is the minimal level of electrical stimulation necessary to induce a stapedius muscle contraction, which can be detected through middle ear measurements, such as acoustic admittance, or visually. It is typically measured post-operatively but can also be assessed intra-operatively.

How do we use this information clinically?

Post-operative ESRTs are estimated to be present in approximately 70% to 80% of implant users. ¹˒⁵˒⁶˒⁷ Examining research dating back to 1988 reveals several studies that demonstrate a strong correlation between C levels and ESRT.⁸ Additional research indicates a robust relationship between ESRT and upper stimulation levels ¹˒²˒⁶ and that ESRT measurements typically align with, or are slightly higher than, patients’ psychophysical assessments of upper stimulation levels. ⁶˒⁹˒¹⁰

What factors to consider to ensure optimal ESRT outcomes?

Ipsilateral ESRT measurements are possible; however, our programming guides generally advise to start with the contralateral ear due to the typical absence of responses following cochlear implant surgery, which may effect immittance of the middle ear system. Nonetheless, if there is no response in the contralateral ear, an ipsilateral measurement can be considered. Another consideration to help with the success of obtaining ESRT measurements is to consider changing the probe tone frequency or starting with a higher probe tone (226 Hz, 678 Hz, 1000 Hz).¹¹

Some tips and tricks for ESRT include:

  • Ensuring a properly fit probe tip. The probe tip must maintain a proper seal without assistance from the clinician. Adjust the probe tip size as necessary. For a proper seal, Otoferm may be used. The probe tip should keep a seal without manual assistance.
  • To address hyper-compliance, increase the probe tone. Apply positive pressure manually to stabilize the tympanic membrane, up to +50 daPa.
  • ESRT measurements are also sensitive to conditions such as middle ear disease or obstructions and necessitate a quiet and still patient. Moreover, the relationship between intraoperative ESRT, postoperative ESRT, and C-levels requires further investigation.¹²

What additional resources are available for ESRT measures?

ESRT is a valuable tool for cochlear implant audiologists, especially when combined with behavioral loudness scaling to set upper comfort levels. It can be extremely useful in situations when programming for individuals who are unable to provide reliable psychophysical loudness judgments. For guidance on conducting ESRT measures, detailed instructions are available, including the necessary equipment, protocol setup, and test procedures here:

FUN5188 ISS1 FEB24 ESRT Guide in CS ProDownload
  1. Hodges, A., Balkany, T., Ruth, R., Lambert, P., Dolan-Ash, S., & Schloff man, J. (1997). Electrical middle ear muscle refl ex: Use in cochlear implant programming. Otolaryngology—Head & Neck Surgery, 117(3 Pt 1), 255–261. 3.  3
  2.  Jerger, J., Fifer, R., Jenkins, H., & Mecklenberg, D. (1986). Stapedius refl ex to electrical stimulation in a patient with a cochlear implant. Annals of Otology, Rhinology, & Laryngology, 95, 151–157. 4. 4
  3. Messersmith, J., Entwisle, L., & Stout, A. (2002). Electrically evoked stapedial refl ex threshold: A procedure. Perspectives of the ASHA Special Interest Groups, 9(3), 4-11. 5. 6
  4. Rene Gifford, Ph.D., Maximizing Performance in Cochlear Implant Recipients: Programming Concepts NYU, December 5, 2022 2.  8
  5. Wolfe, J., & Kasulis, H. (2008). Relationships among objective measures and speech perception in adult users of the HiResolution Bionic Ear. Cochlear Implants International, 9(2), 70–81. 11
  6. Spivak, L.G., Chute, P.M., Popp, A.L. & Parisier S. C. (1994). Programming the cochlear implant based on electrical acoustic reflex thresholds: patient performance. Laryngoscope, 104(10), 1225-1230. 9
  7. Van Den Abbeele, T., Noël-Petroff, N., Akin, I., Caner, G., Olgun, L., Guiraud, J., . . . Arnold, L. (2012). Multicentre investigation on electrically evoked compound action potential and stapedius reflex: How do these objective measures relate to implant programming parameters? Cochlear Implants International, 13(1), 26–34. 10
  8. Jerger J, Oliver TA, Chmiel RA. (1988). Prediction of dynamic range from stapedius reflex in cochlear implant patients. Ear Hear, 9, 4–8. 5
  9. Han, D., Chen, X., Zhao, X., Kong, Y., Li, Y., & Liu, S. (2005). Comparisons between neural response imaging thresholds, electrically evoked auditory reflex thresholds and most comfortable loudness levels in CII Bionic Ear users with HiResolution sound processing strategies. Acta Oto-Laryngologica, 125, 732–735. 2
  10. Pitt, C., Munoz, K., Schwartz, S., & Kunz, J. (2020). The long-term stability of the electrical stapedial refl ex threshold. Otology & Neurotology, 42, 188-196. 6. Wolfe, J., & Kasulis, H. (2008) 7
  11. Wolfe, J., Gilbert, M., Schafer, E., Litvak L.M., Spahr A.J., Saoji A., Finley C. (2017). Optimizations for the Electrically-Evoked Stapedial Reflex Threshold Measurement in Cochlear Implant Recipients. Ear Hear, 38(2), 255-261.  12
  12. Caner, G., Olgun, L., Gultekin, G., & Balaban, M. (2007). Optimizing fitting in children using objective measures such as neural response imaging and electrically evoked stapedial reflex threshold. Otology & Neurotology, 28, 637–640. 1

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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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