Cochlear Implants
by Cochlear Guest Author

How upgrade technology can lead to better hearing

January 12, 2021
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By Jolie Fainberg, AuD, Cochlear Implant Program Director at Atlanta Institute for ENT

With 34 years of cochlear implant experience, Dr. Fainberg discusses upgrading patients to the latest Nucleus® Sound Processors.

What is your current role and what do you love about it?

I am an audiologist at a busy private ENT clinic in Atlanta, Georgia. We have a pediatric ENT, four adult ENTs and we just hired a neurotologist. I love my job because in the 29 years I have worked in Atlanta, I have watched hundreds of cochlear implant (CI) kids grow up. I get to follow them through their journey to develop hearing, speech and language – I become part of their family! Cochlear implants are the most exciting technology. There have been so many changes in this industry and it only gets better.

What do you consider the biggest changes in sound processor technology affecting your Cochlear™ Nucleus upgrade patients and why?

The addition of Bluetooth® streaming technology has had the biggest impact. Everyone loves to stream their music and have the convenience of using the phone directly to their CI. Nucleus Smart App is also a great addition. Patients have more control over their sound processor overall. They can make their own adjustments as needed and change programs more easily. Next, the Hearing Tracker and Find My Processor features have been lifesavers for many patients, particularly parents of young children.  Parents have found their kid’s CI in some pretty amusing places!

How has counseling your upgrade patients evolved with today’s sound processors?

I counsel my patients to really evaluate the benefits of a new sound processor prior to upgrading, as insurance companies have specific guidelines about approving upgrade. Insurance companies can be stricter about approving upgrades. Many require that the current sound processor is not functioning before they will approve the upgrade. This is challenging as I don’t want my patients to be without sound while we wait for approval.

The technology continues to improve in leaps and bounds. Although an upgrade to new sound processor can provide a smaller device, new technology options, etc., the real benefit is the improvement in hearing. I could be the best MAPping audiologist in the world, but there are limitations to technology that cannot be changed with MAPping. When new devices are released, the better sound quality and offer of better hearing transcends any MAPping changes I can make on old technology. I wish the insurance companies understood the hearing benefit our patients get when they upgrade. They might make it easier for patients to get new technology.

What features of the new sound processors do you feel improve hearing outcomes?

Here are a few features:

  • SCAN* (the industry’s first automatic scene classifier) has been beneficial to many of my CI users. For long term recipients, it takes a week or two for them to get used to it. After a period of adjustment, SCAN helps with changes in the hearing environment without having to adjust their CI.
  • Many of my patients have liked ForwardFocus** for restaurants and one-on-one conversations. 
  • I recommend the Mini Microphone 2+ for all my patients. It helps in so many situations such as the car, restaurants and college classes.
  • The Aqua+ wear options~ have been fun for many of my patients who have never been able to hear while swimming or playing in the water.

What are the biggest differences you’ve seen in your patients after an upgrade?

First and foremost: better hearing! I have dozens of stories where patients have heard things with their new sound processors that they never heard before. One patient told me that after she got her upgraded device and was walking with her dad to their car, she asked him: “What’s that sound?” He said, “I don’t hear anything.” They continued walking and then she realized, the sound was her footsteps. She had never heard them before. Another time, a young man received an upgrade after more than eight years and tearful at how clear the sound of the new sound processor was! The newer technology offers hearing that cannot be realized no matter what we do to an older device. That’s why we upgrade our phones and computers!

Would you highlight a success story about one of your earliest implanted Cochlear Nucleus 22 patient (adult and/or child)?

One of my N22 patients who was implanted at two years of age in 1992 just graduated from nursing school and works as a nurse. Because of the COVID precautions, she wears a mask all day at work. In addition, she is a unilateral CI user, as many of our early CI kids were only implanted on one side. She successfully navigates this difficult listening situation. I have a large number of N22 patients still using their original internal device successfully. These patients are all adults now and having a CI has not stopped them from doing whatever they wanted.

How do you counsel your patients on which Nucleus Sound Processor is right for them?

I show both options to my patients and review the highlights of each device. The decision between Nucleus 7 and Kanso® 2 is highly polarizing! Patients either want one or the other. Many of my patients who received their CIs very young do not want the drastic change from behind-the-ear to single unit sound processor. Other patients are really excited about getting a single unit CI and get the sound processor off their ear!

What have your patients been most excited about with the Kanso 2 Sound Processor?

They love the convenience of no cables or other parts to worry about. They like that the sound processor is off their ear. Many male recipients find it more aesthetically pleasing and less noticeable.

What innovations do you think will drive the CI industry forward?

In a post-COVID world, I think the capability to offer remote care like more complex remote programming will be in our future. The added benefit to this is the ability to offer better hearing healthcare services to patients living far away from a CI center.

Read more about upgrade technology here and watch this AudiologyOnline course!

About the author:

Jolie Fainberg is an audiologist with 36 years of experience. Her primary interests are pediatric audiology and cochlear implants for children and adults. She received her BA in Speech and Hearing Science at the University of California, Santa Barbara, her MA in Audiology at the University of Tennessee, Knoxville and her AuD from AT Still University. She participated on the original FDA clinical trials for all three cochlear implant companies. Her research has focused on pediatric audiology, pediatric cochlear implants, cochlear implants in special populations, diagnostic techniques for difficult to test infants and children, and brain plasticity in children. In 1992, she developed and established the pediatric audiology and cochlear implant program for Egleston Children’s Hospital at Emory University (now Children’s Healthcare of Atlanta).  She is a Clinical Instructor in the Department of Otolaryngology at the Emory School of Medicine and an Adjunct Professor at A. T. Still University Post Professional Doctor of Audiology program. Currently, she works at an ENT practice doing pediatric diagnostic testing and cochlear implants in adults and children.

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.

The Cochlear Nucleus Smart App is available on App Store and Google Play. For compatibility information visit www.cochlear.com/compatibility

*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.

**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.

~The Nucleus 7 Sound Processor with Aqua+ is water resistant to level IP68 of the International Standard IEC60529. This water protection only applies when you use a Cochlear Standard Rechargeable Battery Module or Cochlear Compact Rechargeable Battery Module. The Kanso 2 Sound Processor is dust and water resistant to level of IP68 of the International Standard IEC60529. The Kanso 2 Sound Processor with Aqua+ is dust and water resistant to level of IP68 of the International Standard IEC60529. This water protection rating means that the sound processor with the Aqua+ can be continuously submerged under water to a depth of up to 3 meters (9 feet and 9 inches) for up to 2 hours. The Aqua+ accessory should be used when participating in prolonged water activities.

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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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Related Posts

Upgrade benefits and advancements in cochlear implant sound processor technology

August 28, 2020

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 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.

Cedric Pritchett

Research spotlight with Dr. Pritchett: Racial and Insurance Inequalities in Access to Early Pediatric Cochlear Implantation

October 18, 2021

Hear from Dr. Pritchett on the recent publication of Racial and Insurance Inequalities in Access to Early Pediatric Cochlear Implantation:

What inspired you to research this topic?

In the state of Florida we have a rich depth of diversity in culture, ethnicity and language. Nearly 40% of the children with hearing loss in our program have parents whose primary language is Spanish. We were desirous of understanding whether in this diversity, disparities existed.

What surprised you the most? What insights from this study were the most compelling to you and your team?

I was most surprised to learn heritage from African descent was the most predictive factor in delay to early implantation. Black children were less likely than White or Hispanic children to be implanted by two years of age (and even less so for one year of age). Demonstrating in the state of Florida, it is not unexpected for implantation of children with public insurance to occur later than children with commercial insurance; however, I did not expect to find racial background was more important than insurance status. In our study we discovered a Black child with commercial insurance was less likely to be implanted early than a White child of any insurance status—commercial, public, or self-pay, or a Hispanic child of commercial status; and with nearly the same likelihood as a Hispanic child with public insurance. In other words, the only children who were less likely to be implanted later than a Black child with commercial insurance were Black children with public insurance.

Have the findings from this study changed your team’s approach to managing children with severe to profound hearing loss? If so, how?

Realizing the existence of unequal odds for early implantation in our patient population has informed, but not changed our practice. Our team remains dedicated and intentional in our approach to provide timely access to sound in general, and cochlear implantation in particular for our children with hearing loss.

Your study references the importance of a multidisciplinary team. Can you tell us a little bit about how your team is structured? What has made your team successful?

Recently we reviewed our program’s outcomes measuring time to implantation based on several factors including race, insurance status and preferred spoken language of our patients’ caregivers. We were pleased to see such times were similar comparing the different categories within these variables. Our team has included a neurotologist, pediatric otolaryngologist, two implant audiologists, two speech pathologists/auditory verbal therapist, a pediatric nurse practitioner, a registered nurse, a licensed clinical social worker, an implant coordinator and clinical assistant. We have been very fortunate to have the presence of a dedicated social worker and several members of our team who are fluently bilingual (Spanish), including one implant audiologist and at one point both speech pathologists. These assets in our program have provided crucial insight into our families’ needs and perspectives, and then supported our program’s band width to address them.

Any key takeaways that professionals should know?

We recognize our children are the future, but this is especially worth emphasizing in the context of children with hearing loss disabilities/disadvantages. We understand children are typically dependent participants in the care they receive. Pediatric care is best delivered in a multidisciplinary team. A team involving clinicians and therapists, but also educators and family members. Our teams should be prepared to investigate at the least, and ideally mitigate the underlying challenges to optimal care our children-patients encounter.

Read more on this topic here!

Citation:

Liu X, Rosa-Lugo LI, Cosby JL, Pritchett CV. Racial and Insurance Inequalities in Access to Early Pediatric Cochlear Implantation. Otolaryngol Head Neck Surg. 2021 Mar;164(3):667-674. doi: 10.1177/0194599820953381. Epub 2020 Sep 15. PMID: 32930656.

About the author:

Dr. Pritchett is a Pediatric Otolaryngologist- Head & Neck Surgeon with Nemours Children’s Health System at the Nemours Children’s Hospital in Orlando, FL.  His scope of practice includes a range of pediatric otolaryngology conditions with particular interest in pediatric otology and hearing loss. He is a cochlear implant surgeon, presently serves as Medical Director of both the Nemours Children’s Hospital’s Cochlear Implant Program and Section of Audiology, and is an affiliated Associate Professor in Otolaryngology at the University of Central Florida’s College of Medicine. Dr Pritchett received his Medical Degree and Master’s in Public Health from The Ohio State University in Columbus, OH. Residency in Otolaryngology-Head & Neck Surgery was completed at the University of Michigan, in Ann Arbor, MI, and fellowship in Pediatric Otolaryngology at Northwestern University’s Ann & Robert Lurie Children’s Hospital of Chicago. Dr. Pritchett is a member several professional societies including the Academy of Otolaryngology – Head and Neck Surgery, and is a fellow of the American Society of Pediatric Otolaryngology, and the American Academy of Pediatrics. He has served as a reviewer for several journals, including the Laryngoscope, Otolaryngology-Head and Neck Surgery, and International Journal of Pediatric Otorhinolaryngology. He is the author of a number of articles and enjoys sharing his knowledge with training healthcare professionals from all backgrounds. He has been married for over 20 years, and has two wonderful daughters. He enjoys traveling, reading, is attempting to become a photographer, and looking to become more involved in mission work.

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