Cochlear Implants
by Cochlear Guest Author

Upgrade benefits and advancements in cochlear implant sound processor technology

August 28, 2020
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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.

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*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.

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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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Yellow ear

What is Normal Hearing? Why a simple and consistent answer is needed

October 29, 2020

By Patti Trautwein, MA, AuD, Vice President, Product Management & Marketing, Cochlear Americas

Less than 25% of people get their hearing screened annually and more than 37 million (15%) Americans have hearing loss.1-2  Less than 30% of people who can benefit from hearing aids1, 2 and approximately 8% from cochlear implants have them.3 

As an audiologist, this data can be frustrating. There have been tremendous advancements in technology in the last few decades, including more treatment options with devices that are smaller, smarter and deliver better outcomes. Despite these advances, why haven’t the growing number of people with hearing loss accessed treatment?  Recent clinical and market investigations have identified awareness, acceptance, cost and stigma as primary obstacles to adopting hearing devices.4

A recent article by Christopher Spankovich reviewed the history of defining hearing loss using the audiogram versus other measures such as speech or objective measures, explaining how the past five decades encapsulated the rationale for 15- 25 dB HL as the limit for normal hearing.5 Importantly, the author noted strong correlation between pure tone average and perceived hearing difficulty. Most interesting, Spankovich reported that when asking audiologists what normal hearing is, “not surprisingly, you get a variety of responses.” 

How does the variability across clinicians transcend to the general population’s understanding of normal hearing? 

For example, Cochlear’s industry research highlights how people described hearing and noted the variability. Some used words such as mild, moderately severe, significant or deaf, while others used percentages of loss or percentages of hearing remaining.

So, do people know what is normal hearing? The team decided to go out on the street to find out:

Raising awareness of a simple metric, such as 20 dB PTA, for normal hearing may help the general population understand hearing health. Further, it may provide guidance on when to seek clinical evaluation, treatment and even what type of treatments to consider. This becomes increasingly important as the options expand to include over-the-counter devices in addition to hearing aids or hearing implants, making it more important for consumers to get the support of an audiologist or ENT. A simple and consistent metric streamlines to the process for consumers and allied health providers to monitor and act on hearing health, as they are likely to do with other health considerations such as vision or cholesterol.  

Is this a call to action for hearing health care providers to align on the simple answer that the general public can understand?  Please share the video with your colleagues and start the conversation so we can work together to improve access to appropriate hearing healthcare.

To learn more, subscribe to Cochlear ProNews.

About the author: Patricia’s 25 years in the hearing healthcare industry includes roles in research and clinical studies, product management, education and training, sales and marketing. As Cochlear America’s VP of Marketing, Patricia is responsible for the marketing strategy, communications and public relations, brand ambassador program and product management. Her organization is responsible for positioning Cochlear Americas growth strategy, cultivating opportunities in new and existing customer markets and growing demand for Cochlear’s hearing solutions in the region.

References:

1. Abrahms, H and Kihm, J (2015) MT9 reveals renewed encouragement as well as obstacles for consumers with hearing loss. Hearing Review https://www.hearingreview.com/practice-building/marketing/introduction-marketrak-ix-new-baseline-hearing-aid-market (accessed on Sept 14, 2020)  

2. Quick Statistics About Hearing. (2020, October 2). NIDCD. https://www.nidcd.nih.gov/health/statistics/quick-statisticshearing#:~:text=One%20in%20eight%20people%20in,based%20on%20standard%20hearing%20examinations.&text=About%202%20percent%20of%20adults,54%20have%20disabling%20hearing%20loss.

3. Holder, J., Reynolds, S., Sunderhaus, L., Gifford, R. (2018) Current Profile of Adults Presenting for Preoperative Cochlear Implant Evaluation Trends in Hearing Jan-Dec.

4. Kochin, S. (2007) MarkeTrak VII: Obstacles to adult non-user adoption of hearing aids, he Hearing Journal: April 2007 – Volume 60 – Issue 4 – p 24-51

5. Spankovich, C. (2020) Some observations on normal hearing and hearing loss.  Audiology Today Sep/Oct 2020 pgs. 32-41.

baby with cochlear implant

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.




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