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.

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.

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.

*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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Cochlear Case Studies – CI632 case with Dr. Sarah Mowry

May 12, 2021

Cochlear Case Studies is a new series on Cochlear ProNews that highlights relevant clinical and surgical scenarios surrounding the latest hearing industry topics and research. We’re excited to partner with professionals to highlight their experiences surrounding specific patients. This first installment features surgeons, their cases and contributing factors for use of different electrodes.

Case Study

A 52 year old male sustained direct head trauma after falling down a flight of stairs. Immediately after the fall he reported no hearing bilaterally and the left side of his face was paralyzed. He was ultimately transferred to our medical center with a diagnosis of bilateral otic capsule violating fractures with the left side complicated by complete facial paralysis and a dural sinus thrombosis (CT images shown, MRV shown). Audiometry obtained five days after the fall demonstrated bilateral profound sensorineural   hearing loss.

On day six after the fall, the patient was taken to the operating room for a left total facial nerve decompression via a translabyrinthine approach. A complete transection of both the 7th and 8th cranial nerves was identified in the fundus of the IAC, thus precluding placement of a cochlear implant in the left ear. He was brought back to the operating room approximately two weeks later (three weeks from the injury) to attempt placement of a right cochlear implant via a transmastoid approach.

The cochlea was visualized through the facial recess. A formal cochleostomy was created anterior inferior to the round window membrane as the fracture did involve the bony niche overhang. The scala tympani did appear to have some inflammation and granulation tissue; therefore, the depth gauge was inserted into the cochlear duct without removal of the stylet. Placement in the cochlear duct was confirmed with intraoperative X-ray. Once the depth gauge was confirmed in the duct and not in either the IAC or the fracture line, the depth gauge was removed and the CI632 Slim Modiolar Electrode was introduced into the cochlea.

I chose the CI632 for its perimodiolar position, MRI compatibility and slim profile to help minimize trauma in this already traumatized cochlea.  Placement in the perimodiolar position was confirmed with X-ray intraoperatively. Electrical testing of the device was then performed (see tracings). The patient did have robust response of the cochlear nerve to NRT on several electrodes but had no response on others. Activation occurred four weeks postoperatively. He had responses in the low to mid frequencies and was able to detect sound and static with speech sounds.  The patient has had his second stimulation is reporting improved detection and a recognition of speech vs noise!

Image 1. Bilateral otic capsule violating temporal bone fractures. The left fracture transected the entire 7/8th nerve complex in the fundus of the IAC precluding implantation of the left ear. The right fracture spared the IAC and the facial nerve but resulted in pneumolabryinth and profound hearing loss.

Image 2. Air in the right cochlear duct.

Image 3. MRV demonstrating decreased flow in the left transverse and sigmoid sinuses.

Image 4. Audiogram from five days after the injury demonstrating profound bilateral SNHL.

Image 5. Depth gauge in the cochlear duct. The gauge was inserted with the stylet in.

Image 6. Intraoperative skull X-ray demonstrating appropriate coiling of a CI632 electrode into the cochlear duct.

Image 7. Screenshot of a NRT obtained on the day of activation demonstrating variable responsiveness across the electrode array. This may represent injury to the cochlear nerve from shearing forces sustained at the time of fracture.

Image 8. Example of NRT from electrode 22.

Image 9. Screenshot of his progressive map at the end of programing. His pulse width was widened to 37 from 25.

Are you a surgeon who has a case study to share? Contact mcoon@cochlear.com for a chance to be featured on Cochlear ProNews.

About the author: Dr. Mowry is an board certified otology/neurotologist who strives to provide excellent clinical care to patients while promoting the education of the next generation of leaders in the field. She treats both pediatric and adult patients who have dis orders of hearing, balance and the lateral skull base. Her interest in cochlear implants as a young medical student has translated in to a career of service to those with hearing disorders. She is also the residency program director for the University Hospitals Cleveland/Case Western Reserve University Otolaryngology department. She enjoys spending time with family, traveling, cooking and exercising.

girls listening to music laying on ground

Clinical Quick Tips: A closer look at accessory mixing in the Nucleus® 7 Sound Processor

December 26, 2017

By guest author: Dave Catlett

Dave Catlett

The Cochlear™ Nucleus® 7 (CP1000) sound processor gives recipients the ability to connect wirelessly to a wide variety of audio sources in several ways.

It is the first and only Made for iPhone (MFi) cochlear implant sound processor that lets recipients wirelessly connect to Apple® iOS devices and stream music, phone calls and more. In addition, Cochlear’s True Wireless™ technology, including the Mini Microphone 2 and 2+, the Phone Clip and the TV Streamer, allow for reliable, untethered connectivity to the sounds that recipients want to hear.

For dynamic FM use, Nucleus 7 processors are also compatible with Phonak’s Roger™ 20 integrated FM receivers. And, as always, a built in telecoil is available and can be used to interface with a variety of telephones, neck loops and looped environments, as found in some theaters, churches and meeting rooms.

All of these technologies are designed to help improve hearing performance and recipient experience in even the most challenging environments.

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The Nucleus 7 sound processor provides recipients with an unprecedented level of control over mixing ratio, which is the amount of input presented to the user from accessory/telecoil input in relation to the processor microphone input. For example, the default pediatric accessory mixing ratio is 1:1 meaning that their streaming Mini Mic 2+ and their processor microphone are presented with equivalent loudness, allowing for good awareness of environmental sounds near the recipient as well as the target input from the remote mic.  This differs from the adult default accessory mixing ratio of 2:1 which results in a 6dB attenuation of their processor mic while streaming, so the accessory signal is given more emphasis. The mixing ratio is set by the audiologist using Custom Sound® 5.0 and can be varied from ratios of 1:1 through 6:1 (with increasing processor mic attenuation) or even accessory-/telecoil-input only.

Clinical Quick Tips

In previous generation processors like the Nucleus® 5 and Nucleus® 6, recipients could change their mixing ratio using the remote assistant. The Nucleus 7 sound processor allows for much greater control of this mixing using the Nucleus® Smart App and, if sensitivity control is enabled, using the iOS Accessibility menu or ‘triple-click’ Accessibility shortcut.

Clinical quick tips

Default pediatric mixing ratio (1:1) settings as seen in (from L to R) Nucleus Smart App, iOS Accessibility menu and iOS Accessibility ‘triple-click’ shortcut

When streaming is active, users can make adjustments to the accessory/telecoil input and the sound processor mic independently and therefore create mixing ratios that can differ greatly from the programmed setting. This can be done in several ways:

  • In the Nucleus Smart App, both ‘Mini Mic Volume’ and ‘Microphone Volume’ (Nucleus 7 sound processor) can be increased or decreased from their default setting to provide the recipient with more emphasis or attenuation on either or both inputs. These are based on a scale from 0 (no sound) to 20 (+12 dB additional gain above the default sensitivity setting of 12). Mixing changes can be made using the Nucleus Smart App regardless of whether sensitivity control is enabled, or not, on the Nucleus 7 sound processor.
  • If sensitivity control is enabled by the clinician in Custom Sound® processor settings, then the iOS Accessibility menu allows users to adjust the ‘Mini Mic Volume’ and the ‘Hearing Aid Mic Volume’ on the Nucleus 7 via sliders that range from 0% to 100%. These controls can be found via Settings -> General -> Accessibility -> Hearing Devices (iOS 10) or MFi Hearing Aids (iOS 11).
  • Also if sensitivity control is enabled, a quick triple-click of the iOS device’s home button brings up additional sliders to control ‘Stream Volume’ from the accessory and ‘Mic’ volume meaning the Nucleus 7. This is the same percentage range of 0-100% as seen in the Accessibility menu.

Both the app and the MFi controls allow adjustments over a range of 21 steps from 0-20 or 0-100% respectively, and each step up or down results in an increase or decrease of 1.5 dB in gain on the input source’s signal.  So recipients can choose to emphasize or attenuate sounds from their accessories and Nucleus 7 sound processor in whatever mix they feel appropriate in their listening environment.  It is important to note that any changes made by the user to their mixing ratio will remain in effect only until the CP1000 is powered down, after which it will return to the setting programmed by the clinician in Custom Sound.  So if a recipient is consistently changing their mixing ratio to one that differs from this default, their clinician should consider adjusting the mixing ratio in Custom Sound to reflect the user’s preferred settings.

This chart shows equivalent ratios as seen in Custom Sound, the Nucleus Smart App and iOS:

Clinical quick tips

Mixing ratio controls in the Nucleus CP1000 processor is just one example of the many ways that Cochlear’s latest technologies provide both simplicity and depth of control to our Nucleus 7 recipients.

About our guest author: Dave Catlett, Au.D., CCC-A, FAAA, Regional Clinical Training Manager

Dave Catlett is a Regional Clinical Training Manager for Cochlear Americas covering the Southeast and Atlantic regions.  In this role, he provides clinical training and mentorship for Cochlear field staff as well as developing and presenting clinical trainings for Cochlear’s professional partners.  He earned his Masters in Audiology at UNC Chapel Hill and his Au.D through the University of Florida.  Prior to joining Cochlear in 2005, David spent several years as a clinical audiologist at UNC’s pediatric cochlear implant program.

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The Nucleus 7 Sound Processor is compatible with iPhone 8 Plus, iPhone 8, iPhone 7 Plus, iPhone 7, iPhone 6s Plus, iPhone 6s, iPhone 6 Plus, iPhone 6, iPhone SE, iPhone 5s, iPhone 5c, iPhone 5, iPad Pro (12.9-inch), iPad Pro (9.7-inch), iPad Air 2, iPad Air, iPad mini 4, iPad mini 3, iPad mini 2, iPad mini, iPad (4th generation) and iPod touch (6th generation) using iOS 10.0 or later.
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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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