Cochlear Implants
by Cochlear Guest Author

New evidence supports the performance benefits of ForwardFocus

September 19, 2019
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Nucleus 7

By Amy Donaldson, Professional Education Manager

Your patients now have the freedom to focus on what matters – connecting with others.

Incorporated as a standard feature on the Nucleus® 7, ForwardFocus* is a revolutionary setting that goes beyond the state-of-the art scene analysis and adaptive directional microphones of SmartSound iQ® and allows users to enable maximum focus on what matters most to them. It is specially designed for the most challenging listening environments, such as listening to speech in a busy restaurant. 

ForwardFocus is intelligently designed to attenuate distracting noise from behind the listener, making it easier to enjoy face-to-face conversation and maximizing understanding of speech from the front.¹  It differs from the automated directionality in SmartSoundiQ by providing a more focused listening experience.  In an internal study using roving background noise, an average improvement of 2.9 dB was seen for speech recognition thresholds in noise over the default SCAN** program.1 In that same study, 88% of Nucleus 7 recipients recommended ForwardFocus for use in cafes and restaurants.

Evidence supporting the use of ForwardFocus in challenging listening environments is emerging beyond Cochlear’s internal studies.  A recent study from Germany compared ForwardFocus to BEAM (the directional microphone utilized within SmartSound iQ).2  A significant improvement of 5.8 dB was seen using the ForwardFocus program in 3-talker babble (noise presented from fixed positions of 90°, 180° and 270°), bringing performance closer to normal than with BEAM. 

Using ForwardFocus, recipients demonstrated statistically significant improvement in both conditions of spatially separated noise.1  This can result in an improved and controlled listening experience as rear-facing noise is reduced.

ForwardFocus must be enabled in Custom Sound fitting software before it can be used by the recipient.  This is because in certain situations (for example, if the recipient needs to hear sound from behind), ForwardFocus is not the best option.  Recipients must be instructed on the use of ForwardFocus and should be able to manually enable and disable this feature, something made even easier with the introduction of the Nucleus Smart App for Apple Watch®. This new feature allows for convenience control at their fingertips with a discreet tap. Patients can change programs, see battery status, adjust volume and select audio source, making it easier to use than ever before!

For more information about using ForwardFocus with your patients, please consult the ForwardFocus Clinician Quick Guide.

Encourage your patients to download the Nucleus Smart App now from Apple® App Store or on Google Play!

About the 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. Cochlear Limited. D1376556.CLTD5709 Acceptance and Performance with the Nucleus 7 Cochlear Implant System with Adult Recipients. 2018 Jan; data on file.
  2. Hey M, Hocke T, Böhnke B, Mauger SJ (2019) ForwardFocus with cochlear implant recipients in spatially separated and fluctuating competing signals – Introduction of a reference metric. Int J Audiol, 57(2).

*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.

**SNR-NR, WNR and SCAN are approved for use with any recipient ages 6 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.

The Cochlear Nucleus Smart App is available on App Store and Google Play. For compatibility information visit www.cochlear.com/compatibility
The Cochlear Nucleus 7 Sound Processor is compatible with iPhone, iPad and iPod touch. 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 is a trademark of Google LLC. 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.

Google Play and the Google Play logo are trademarks of Google LLC.

Author

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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Related Posts

Counseling new indications and the importance of early access to sound

December 1, 2020

By Ryan Lopez, Director, Nucleus® Product Management & Marketing at Cochlear Americas

For 20 years, cochlear implants have been indicated in children no younger than 12 months of age. Earlier this year, Cochlear received FDA approval to lower the age of cochlear implantation from 12 months to 9 months for children with bilateral profound sensorineural hearing loss.* This important approval ensures that children who are born deaf have earlier access to a cochlear implant which can provide them with the hearing capabilities to develop speech and language at a trajectory similar to their hearing peers.1-3­

As clinicians, counseling parents and caregivers though the decision-making process to implant their child can be an emotional journey. Confidence in understanding why early implantation in children is so important can help to reinforce the vitality of the counseling process.

Age at intervention has been shown to be highly correlated with longitudinal outcomes. Receiving a cochlear implant early in a child’s life provides a greater chance of realizing personal best speech, social and language skills.1 Early access to sound can allow a child’s speech and language development to be on par with normal-hearing peers, enabling a life of possibilities.2-3

In addition to other imperative information surrounding cochlear implantation in children, the Pediatric Evidence Summary for Cochlear Implants take a retrospective approach to clinical data focused on the importance of early access to sound.

Read the Pediatric Evidence Summary now!

References:

  1. Ching TYC and Dillon H. Major Findings of the LOCHI study on children at 3 years of age and implications for audiological management. Int J Audiol. (2013 Dec); 52 Suppl 2:S65-8. doi: 10.3109/14992027.2013.866339
  2. Dettman SJ, Dowell RC, Choo D, Arnott W, Abrahams Y, Davis A, Dornan D, Leigh J, Constantinescu G, Cowan R, Briggs RJ. Long-term communication outcomes for children receiving cochlear implants younger than 12 months: A multicenter study. Otol Neurotol. (2016 Feb); 37(2):e82–e95. doi: 10.1097/MAO.0000000000000915. Copyright 2016 Wolters Kluwer Health, Inc.
  3. Geers AE and Nicholas JG. Enduring advantages of earlier cochlear implantation for spoken language development. J Speech Lang Hear Res. (2013 Apr); 56(2):643-55. doi:10.1044/1092-4388(2012/11-0347).

*In Canada (for CI500 and CI600 series implants) and the United States, 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.

Camille Dunn, AuD

SSD/UHL treatment considerations: Q&A with Camille Dunn, AuD

April 19, 2022

By Camille C. Dunn, PhD, CCC-A, Assistant Research Professor, Director, University of Iowa Cochlear Implant Program Department of Otolaryngology—Head and Neck Surgery

Camille Dunn, AuD

Recently, we met with a diverse group of thought leaders to explore best practices for single-sided deafness (SSD)/unilateral hearing loss (UHL). Hear from Dr. Dunn on her experience treating these patients:

What clinical considerations are in your treatment pathway for SSD/UHL Patients?

We consider an array of treatment options such as osseointegrated solutions, CROS hearing technology and a cochlear implant. We have a document that we go over with patients so that they can have an understanding of what each type of technology can and cannot provide for the patient. We do an extensive interview with the patient to understand their hearing history (i.e. duration of loss, etiology), lifestyle, demographic and other medical factors and goals for seeking treatment for their SSD.  Based upon this interview, we discuss with the patient which of the treatments would be best or most realistic to help them accomplish their listening goals.

Do you think that the counseling process should include discussion on bone conduction and cochlear implant hearing solutions?

It absolutely should include all of the patient options. If the patient is choosing a cochlear implant, they need to understand that hearing with a CI is a lifelong commitment. Different than someone with bilateral severe-to-profound SNHL, the CI will not ever be their “good ear.” The CI will serve to supplement the normal hearing ear to accomplish spatial hearing abilities. They will have to commit to utilizing the CI effectively by doing listening exercises and wearing the CI all waking hours.  As with any type of exercise, consistency is key.

Why is the ability to treat patients with UHL/SSD with cochlear implants important to audiologists, surgeons and patients?

As a medical professional, we are trained to want to provide treatments to our patients. This situation is no different.  Patients coming to our clinic who have had gradual progressive hearing loss (maybe even in both ears) for several years have had a chance to accommodate situations with their gradually changing hearing loss.  For patients with sudden SSD, they often come to our clinics feeling very debilitated and scared. They suddenly cannot localize sound (or understand speech in adverse listening situations). Imagine hearing your child cry for help and you have no idea where to look for your child to provide them help because you cannot localize where the sound is coming from? Imagine working in a warehouse and all of a sudden you have no idea which direction the beeping is coming from warning you that there is a forklift nearby? All of these situations are life-altering for individuals with SSD.  When you let that patient know that there is an option to restore hearing to the deafened ear, you can immediately see a level of calm come over these patients.  

What would you tell a provider that is hesitant to explore CI as a treatment option for UHL/SSD?

I would tell them that there is good reason to be hesitant. When we first started implanting patients with SSD I thought that we were crazy!  I thought that there was no way that a person with normal hearing would want to listen to the sound from a CI in their deafened ear. I was wrong. I would also tell them that counseling these patients and preparing them for a CI is a bit different than what we used to call our traditional CI patients (because what is traditional these days?). Testing these patients for progression and benefit from their CI is a bit different than listeners with standard bilateral SNHL.  I would recommend reaching out their cochlear implant representatives to ask them to guide them through the initial processes of providing care and counseling to these patients so that their patients can have successful outcomes.   

Tell us about your experience at the SSD Thought Leader Meeting and what that means for the industry?

The SSD Thought Leader Meeting provided a dynamic avenue for professionals to come together and discuss their experience working with individuals with SSD who get a CI. I believe that together we accomplished a lot. We all came together to develop a consensus on the best way to, not only better understand the benefits of CI for SSD, but treat, counsel and better understand the needs of these patients. They are different than other listeners who have traditionally gotten a CI and because of that, they need to have their own platform of care.

Hear more from another Thought Leader Meeting attendee, Andrea Overton, AuD, and check out our recent FDA approval for CI for SSD.

Camille Dunn, PhD, joined the Department of Otolaryngology—Head and Neck Surgery at the University of Iowa in 2003 where she is an Associate Professor and the Director of the Cochlear Implant Program.  She received her Master of Science degree in 1998 and Doctor of Philosophy Degree in 2003 both from the University of Nebraska-Lincoln. Dr. Dunn holds her Audiology license from the State of Iowa. She maintains her Certificate of Clinical Competence in Audiology (CCC-A) and is a member of the American Speech-Language-Hearing Association (ASHA) and a Board member on the American Cochlear Implant Alliance (ACIA). She is a Principal Investigator on a NIH-funded grant to determine the impact of intervention on user’s hearing-related functions and disability in their natural environments.

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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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