How upgrade technology can lead to better hearing


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

*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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