Cochlear Implants
by Cochlear Guest Author

New TECH Talk: Age of implantation and critical development window

May 11, 2020
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Dr. Jace Wolfe, clinical audiologist and Director of Audiology and Research at the Hearts for Hearing Foundation in Oklahoma City, uses his 22 years of cochlear implant experience to examine results from the Longitudinal Outcomes of Children with Hearing Impairment (LOCHI) Study based out of Australia to understand the long-term impact of age at implantation. The March 2020 FDA approval to expand pediatric indications to nine months further reinforces the urgency to give pediatric patients early access to sound, especially as they reach hearing and language milestones.

Moreover, the LOCHI study observed children from the age of hearing loss identification until early adulthood to explore speech, language, literacy, auditory, educational, vocational, social and pragmatic outcomes. Wolfe further recaps the factors that may influence hearing outcomes such as age of implantation.

Key finding of the LOCHI Study:

  • For every 6-month delay in implantation there’s a ½ standard deviation (about seven points from the mean score for a standardized measure of language ability) reduction in their language outcomes.1,2

This suggests the presence of a critical window for language development and auditory stimulation. Through partnership, together we can reach further to give pediatric patients early access to sound.

“Every moment within that critical period counts,” Wolfe concludes.

To learn more about early implantation visit our TECH Talks page or website.

References:

  1. Ching, T.Y., Dillon, H., Leigh, G., & Cupples, L. (2018). Learning from the longitudinal outcomes of children with hearing impairment (LOCHI) study: summary of 5-year findings and implications. International Journal of Audiology, 57(2), S105-S111.
  2. Ching, T.Y., Dillon, H., Button, L., Seeto, M., Buynder, P.V., Marnane, V., Cupples, L., & Leigh, G. (2017). Age at Intervention for Permanent Hearing Loss and 5-Year Language Outcomes. Pediatrics, 140 3.

In the US, 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 two years of age or older may demonstrate severe to profound hearing loss bilaterally. In the 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 two years of age or older may demonstrate severe to profound hearing loss bilaterally.

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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Wilder Roberts, AuD

Including AuD students in MAPping appointments

March 9, 2022

By Wilder Roberts, Au.D., CCC-A

Wilder Roberts, AuD

Background

Emerging clinicians need experience MAPping cochlear implants as much as they need experience programming and fitting hearing aids.This includes candidacy evaluations, pre-implant counseling, activations, MAPping appointments, counseling, rehabilitation and device pairing/accessory. 

The average age of today’s audiologist is 42 years, which means these audiologists did have cochlear implant classes in graduate school and have seen the evolution of cochlear implant technology. These audiologists might have been trained by the manufacturers at the manufacturer’s facility or in regional training. Today’s students are more savvy to technology and their courses in graduate school are more in depth.

The textbooks for teaching are also improved and the course objectives directly address ASHA Standards II-A (Foundations of Practice), II-B (Prevention & Screening), II-C (Audiologic Evaluation), II-D (Counseling), II-E (Audiologic Rehabilitation Across the Lifespan) and II-F (Pediatric Audiologic (Re)habilitation). Topics specifically addressing cochlear implants range from candidacy and outcomes, to coding strategies and programming.  As with all AuD programs, course content provides the foundation and clinical opportunities provide the ability to apply course content and truly learn the software and live programming.

What opportunities are students seeking?

Students are requesting hands-on opportunities – they want to watch and observe initially and ask questions if needed. Students have a strong desire to learn, serve patients well and feel confident in services they are providing.

How can you involve students?

If you’re not currently supervising any AuD doctoral students, I urge you to consider this!  You have much to offer our budding colleagues. Obviously, the level of involvement will depend on the clinical experience your student has had. Feel free to ask them what they’ve seen, protocols with which they are familiar (they usually have copies of them) and their comfort level with cochlear implants in general.

Sample ways to include students:

  1. Students are able to prepare equipment, check it in and get your supplies ready for an appointment.
  2. Students are able to connect sound processors to cables or Wireless Programming Pods, open patient files in Custom Sound® Pro and follow a general MAPping flow. If the student is working in the software, you’re able to counsel and guide both the patient and the student seamlessly. If there’s time, allow them to practice in ‘Training Mode’.
  3. Students are great scribes, so if you’re making MAPping changes, allow them to note this for you for easy reference and documentation.
  4. Students can spend the time showing patients how to use their battery chargers, connect sound processors to smartphones, and how to connect to the Cochlear apps.

Resources

These tasks seem simple, but if we don’t give students the opportunity to practice these skills, we can’t expect them to be able to do this independently. Feel free to assign them tutorial videos prior to attempting these skills.

To assist with this, on the myCochlear website, under “CPN resources,” there is a CPN Initial activation Checklist and the student can review this. You can  choose which part the student can cover – start slow and then add to it.

If you do not use Cochlear Link, show students how to download MAPs or upload MAPs. Allow them to work with your clinic stock or better yet, have them organize and inventory your clinic stock to familiarize themselves with your system and identify parts of the sound processors.

The Bottom Line

University clinics offer background knowledge and some clinical experience. Off-campus preceptors are invaluable to the future of our profession in helping create colleagues who you are comfortable working with and referring patients. We have to pass the baton at some point, and we all want competent professionals serving our patients. Students can be an asset in your clinic and are eager to learn from your expertise.

To read more from peers, subscribe to Cochlear ProNews.

About the author: Dr. Wilder Roberts is an Assistant Professor and Cochlear Implant Program Director at the University of South Alabama in Mobile, AL.  She received her undergraduate in Deaf Education at the University of Montevallo, her Master of Science in Audiology at the University of Montevallo and her doctorate in Audiology from the University of Florida.  She has been working with cochlear implants for over 20 years in both pediatric and adult populations.  She has training in Auditory-Verbal Techniques and is a state champion for Alabama in the American Cochlear Implant Alliance (ACIA).  She has also completed Advanced Cochlear Implant Training through the Institute for Cochlear Implant Training.   Dr. Roberts is passionate about cochlear implants and increasing candidacy awareness.  Dr. Roberts is from Mobile, AL, is married and has two sons. 

For compatibility information visit www.cochlear.com/compatibility

ForwardFocus graphic

New evidence supports the performance benefits of ForwardFocus

September 19, 2019
Nucleus 7

By Amy Donaldson, Professional Education Manager

Your patients now have the freedom to focus on what matters – connecting with others.

Incorporated as a standard feature on the Nucleus® 7, ForwardFocus* is a revolutionary setting that goes beyond the state-of-the art scene analysis and adaptive directional microphones of SmartSound iQ® and allows users to enable maximum focus on what matters most to them. It is specially designed for the most challenging listening environments, such as listening to speech in a busy restaurant. 

ForwardFocus is intelligently designed to attenuate distracting noise from behind the listener, making it easier to enjoy face-to-face conversation and maximizing understanding of speech from the front.¹  It differs from the automated directionality in SmartSoundiQ by providing a more focused listening experience.  In an internal study using roving background noise, an average improvement of 2.9 dB was seen for speech recognition thresholds in noise over the default SCAN** program.1 In that same study, 88% of Nucleus 7 recipients recommended ForwardFocus for use in cafes and restaurants.

Evidence supporting the use of ForwardFocus in challenging listening environments is emerging beyond Cochlear’s internal studies.  A recent study from Germany compared ForwardFocus to BEAM (the directional microphone utilized within SmartSound iQ).2  A significant improvement of 5.8 dB was seen using the ForwardFocus program in 3-talker babble (noise presented from fixed positions of 90°, 180° and 270°), bringing performance closer to normal than with BEAM. 

Using ForwardFocus, recipients demonstrated statistically significant improvement in both conditions of spatially separated noise.1  This can result in an improved and controlled listening experience as rear-facing noise is reduced.

ForwardFocus must be enabled in Custom Sound fitting software before it can be used by the recipient.  This is because in certain situations (for example, if the recipient needs to hear sound from behind), ForwardFocus is not the best option.  Recipients must be instructed on the use of ForwardFocus and should be able to manually enable and disable this feature, something made even easier with the introduction of the Nucleus Smart App for Apple Watch®. This new feature allows for convenience control at their fingertips with a discreet tap. Patients can change programs, see battery status, adjust volume and select audio source, making it easier to use than ever before!

For more information about using ForwardFocus with your patients, please consult the ForwardFocus Clinician Quick Guide.

Encourage your patients to download the Nucleus Smart App now from Apple® App Store or on Google Play!

About the 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. Cochlear Limited. D1376556.CLTD5709 Acceptance and Performance with the Nucleus 7 Cochlear Implant System with Adult Recipients. 2018 Jan; data on file.
  2. Hey M, Hocke T, Böhnke B, Mauger SJ (2019) ForwardFocus with cochlear implant recipients in spatially separated and fluctuating competing signals – Introduction of a reference metric. Int J Audiol, 57(2).

*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.

**SNR-NR, WNR and SCAN 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 2) report a preference for different program settings.

The Cochlear Nucleus Smart App is available on App Store and Google Play. For compatibility information visit www.cochlear.com/compatibility
The Cochlear Nucleus 7 Sound Processor is compatible with iPhone, iPad and iPod touch. 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.

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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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