Cochlear Implants
by Cochlear Guest Author

New TECH Talk: Early implantation and its impact on language development

June 11, 2020
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In March 2020 the FDA approved the first expansion of pediatric indications in 20 years. Dr. Jace Wolfe, Director of Audiology and Research at the Hearts for Hearing Foundation in Oklahoma City, analyzes the benefits of early implantation and its impact on brain development.

Wolfe highlights Jaime Leigh’s study1 that suggests the need to mitigate delay in implantation. For example, if a young child is implanted, that child can parallel one year of language progress in one calendar year without falling behind their peers.  

On the other hand, if a child with severe to profound hearing loss waits to be implanted, he or she can only make three months of progress for every calendar year without a cochlear implant.

Wolfe continues by addressing the variability in cochlear implant recipient outcomes. According to Leigh, age accounts for 67% in variability of outcomes in children with hearing loss.1 So, implanting as early as possible can be key, especially as pediatric patients reach hearing and language milestones.

Through partnership together we can reach further to give pediatric patients the progress and possibilities that come with early access to sound.

Why wait? Watch now to learn more about earlier implantation!

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

References:

  1. Leigh, J.R., Dettman, S.J., & Dowell, R.C. (2016). Evidence-based guidelines for recommending cochlear implantation for young children: audiological criteria and optimizing age at implantation. International Journal of Audiology, 55, S9-S18.  

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 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.

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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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Slim Modiolar electrode

The Perimodiolar advantage with the Cochlear CI532 Slim Modiolar Electrode

July 17, 2018

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.

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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.
Dr. Tribulski

Inclusivity in video games

July 8, 2022

By Kathryn Tribulski, AuD

Why those with hearing loss can be left behind in the video game world

Below is a timeline of world events that led to a realization that as providers, we can do so much more in terms of access for our patients:

● March 11th, 2020 the World Health Organization (WHO) declares COVID-19 a global pandemic

            ● March 13th, 2020 COVID-19 is declared a National Emergency

            ● March 19th, 2020 the first state orders a stay at home order[i]

            ● March 20th, 2020 Animal Crossing New Horizons from Nintendo has its world-wide

release[ii]

● March 24th, 2020 Kat Tribulski, AuD, tries desperately to find a Nintendo Switch™…. but there is nothing in a 100-mile radius.

In 2020, many like myself searched for the latest and greatest in escapism through video games.  But those with hearing loss, particularly cochlear implant users, seemed to be left behind. With the world locked down, many turned to technology as a social outlet in addition to a form of escapism.  It was at this point I realized how many of my patients were at yet another deficit with their devices. Hearing loss professionals are often asked to educate device users on integrating technology with phones/tablets and it’s time that we expand this to video game systems.

The psychosocial benefits of video games have been debated; however, recent studies show that video games do not cause harm in terms of psychosocial development.[iii] The unfortunate truth is that those with hearing loss are not granted the same access to this form of escapism and outlet for socialization – video games currently have rating systems including the rating “E for everyone”, which isn’t necessarily true. 

In an article from October 2020, Melanie Ashford shares, “Unlike many other gamers, I am immediately at a disadvantage,” citing footstep noise, bonus level/item noises and chat functions without captions, therefore limiting access to some with hearing loss. It seems that even with the increased technological innovation such as the Nucleus® 7 iPhone compatibility and Bluetooth® streaming capability, there is still more work to be done. 

While I don’t personally have hearing loss, I approached my own video game experience and started to specifically look to see how my cochlear implant patients could access all the auditory functions some games have to offer. In many single player games remote technology like a TV Streamer or a Mini Microphone 2+ allow for auditory access; however, that access can be dependent on the patient’s access to and understanding based on their MAPping and rehabilitation model.

As video games become even more engrained in our culture, all ages of users should have some equity in terms of ability to play. In a recent Captel blog post from December 2021, hearing loss friendly adjustments to game development were shared including touch feedback (vibratory control features), visual cues, dialogue to background noise adjustment options, subtitles and captioning as some integration options to allow access.[iv]  The industry is changing and trying to address these issues; for example in a June 2020 article to The Verge, lead game designer for The Last of Us Part II Emilia Schatz is quoted as stating, “accessibility for us is about removing barriers that are keeping players from completing a game. It’s not about dumbing down a game or making a game easy. What do our players need in order to play the game in parity with everyone else?”.[v]  This game won 43 of the 94 nominations for game awards, so the disability access did not seem to negatively impact its reception – if anything it helped.

Video games are quickly becoming engrained into our culture and research has shown that they are tools used by a variety of generations for connection and growth.[vi] As the world continues to change, those with hearing loss shouldn’t be left behind and it’s our duty as hearing loss professionals to embrace those changes and assist, advocate and educate so that they are not.

Read this Cochlear ProNews article to read more from professionals on increasing access for those with hearing loss.

[i] Staff A. A Timeline of COVID-19 Developments in 2020. AJMC. https://www.ajmc.com/view/a-timeline-of-covid19-developments-in-2020. Published 2022. Accessed May 1, 2022.

[ii] Pearce K, Yip J, Lee J et al. Families Playing Animal Crossing Together: Coping With Video Games During the COVID-19 Pandemic. Games Cult. 2021:155541202110561. doi:10.1177/15554120211056125 and Donald P. Bellisario College of Communications at Penn State. Bellisario.psu.edu. https://www.bellisario.psu.edu/medialab/research-article/animal-crossing-usage-during-the-covid-19-pandemic1. Published 2022. Accessed May 1, 2022.

[iii] Lobel A, Engels R, Stone L, Burk W, Granic I. Video Gaming and Children’s Psychosocial Wellbeing: A Longitudinal Study. J Youth Adolesc. 2017;46(4):884-897. doi:10.1007/s10964-017-0646-z

[iv] Hearing Loss Accessibility Features in Video Games. CapTel. https://www.captel.com/2021/12/hearing-loss-accessibility-features-in-video-games/#:~:text=One%20of%20the%20most%20common%20hearing%20loss%20accessibility,well%20they%20are%20subtitled%20%28among%20other%20accessibility%20questions%29. Published 2022. Accessed May 1, 2022.

[v] The Last of Us Part II isn’t just Naughty Dog’s most ambitious game — it’s the most accessible, too. The Verge. https://www.theverge.com/21274923/the-last-of-us-part-2-accessibility-features-naughty-dog-interview-ps4. Published 2022. Accessed May 1, 2022.https://www.theverge.com/21274923/the-last-of-us-part-2-accessibility-features-naughty-dog-interview-ps4

[vi] Marston H, Kowert R. What role can videogames play in the COVID-19 pandemic?. Emerald Open Research. 2020;2:34. doi:10.35241/emeraldopenres.13727.1

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For compatibility information visit www.cochlear.com/compatibility

About the author:

Dr. Kat Tribulski is the Cochlear Implant Coordinator at Nemours Children’s Health in Orlando, FL.  In addition to her role as implant coordinator she is a full-time pediatric audiologist at Nemour’s.  Prior to working at Nemour’s Dr. Tribulski was the Pediatric Cochlear Implant director and Tufts Medical Center and Tufts Children’s Hospital in Boston, MA.  She is currently a member of the ASHA and the ACIA. Dr. Tribulski earned her doctorate in Audiology at Salus University in 2016.  She completed her externship at Eastern Virginia Medical School and The Children’s Hospital of the King’s Daughter in Norfolk, VA with a focus on cochlear implants.  In her free time she enjoys video games, board games and her dog Lilly.

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