Cochlear Implants
by Rebecca Steinke

Cochlear NEXT CI532 Clinical Study Insights – Is Hearing Preservation Possible with CI532?

October 14, 2019
Share

In the spring of this year, sixty-five otology and audiology professionals came together for Cochlear NEXT – a program focused on learning and discussing Cochlear’s CI532 Clinical Study and the respective implications of this emerging and impactful data.

The following information reviews the primary talking points and output from the day’s third and final topic of hearing preservation. You can also find available video recordings of Cochlear NEXT sessions on our YouTube channel.

Is Hearing Preservation Possible with CI532?

Presenters:
• Ryan Lopez, Group Product Leader, Nucleus® Cochlear™ Implants, Cochlear Americas
• Brian Kaplan, MD, Surgeon and Global Head of Clinical Innovation, Cochlear Americas
• David Kelsall, MD, Surgeon and CI532 Investigator, Rocky Mountain Ear Center

While not designed as a hearing preservation study, CI532 study data offers insights regarding the ability to preserve hearing using the CI532 Slim Modiolar electrode. But how is hearing preservation defined, and what other characteristics beyond electrode design play a role in patient outcomes in this regard?

During this session, NEXT participants were exposed to new, intriguing data that supports the use of CI532 in hearing preservation cases, while anecdotal discussion allowed surgeons to share their own experience preserving measurable hearing with this electrode.

Recent perspectives on hearing preservation vary in terms of how hearing preservation is defined – does hearing preservation refer to measurable hearing, or to functional hearing? Something aid-able? During a live poll, the audience overwhelmingly responded that ‘Preserving functional hearing to improve outcomes’ is the most appropriate description. Likewise, on pre and post-event surveys, the group overall agreed that functional hearing preservation should only be considered when a patient’s pre-operative low-frequency pure tone average (PTA) is better than 65dB.

Building on the consensus of defining hearing preservation, the discussion moved into which electrode design factors impact preservation, and how the CI532 Slim Modiolar array compares versus previous generation perimodiolar and lateral wall arrays – dispelling a common misconception that the CI532 will not preserve residual hearing.

Electrode Design Factors for Preservation1

The ability of CI532 to preserve functional hearing (defined for this presentation as PTA ≤ 80dB at 250 Hz and 500 Hz) was illustrated by examining the published literature, the CI532 multi-center clinical study, and the experience at Rocky Mountain Ear Center (RMEC). Overall the three data sets produced highly consistent results across 215 patients total, with 34-40% maintaining PTA ≤ 80dB at initial activation2,3,4. Looking specifically at CI532 subjects and patients of RMEC, more than 70% of patients maintained measurable thresholds at initial activation 1,4 – this despite patients not being ‘traditional’ hearing preservation candidates.

Additional discussion centered around the divergent factors affecting hearing preservation and performance – whether biological, technological, or environmental. Leading into the discussion, participants had agreed (as measured on pre-event survey) that hearing preservation is NOT the factor that has the greatest impact on hearing performance. This perspective remained largely the same following the discussion and presentation.

Conclusion

Cochlear NEXT presented a unique opportunity to bring together diverse thought and experience to address common questions regarding hearing performance – what is the impact of placement on performance, are we implementing the correct clinical measures pre- and post-implantation, and is hearing preservation possible with the CI532 Slim Modiolar electrode?

Learnings from Cochlear NEXT demonstrate that across the variability of patients we serve, biological factors are as important and impactful, if not more so, than the technology alone. Further, data collected prior to, during and after the program indicates that while there is some movement toward consensus on these issues, there will continue to be different perspectives among professionals across the continuum of care. However, that also provides opportunity for emerging insights, renewed debate, and evolving solutions to maximize patient outcomes and ensure access to a lifetime of hearing.

Check out our new YouTube playlist featuring video highlights of session topics including CI532 Study Surgical and Clinical Outcomes.


References

  1. Sweeney A, Hunter J, Carlson M, Rivas A, Bennett M, Gifford R, Noble J, Haynes D, Labadie R, Wanna G. Durability of Hearing Preservation after Cochlear Implantation with Conventional-Length Electrodes and Scala Tympani Insertion. Otolaryngol Head Neck Surg. 2016 May;154(5):907-13. doi: 10.1177/0194599816630545. Epub 2016 Feb 23
  2. Preliminary Data on File: US Multicenter CI532 Study. 2018.
  3. Friedmann et al. Surgical Experience and Early Outcomes With a Slim Perimodiolar Electrode. NYU Cochlear Implant Center. Otology & Neurotology 2019
  4. Data on file: Rocky Mountain Ear Center, 2019.
Related Posts
Boy with ice cream

3 articles on new sound processor technology and why it can matter to your patients

March 23, 2021

Cochlear sound processor technology has significantly evolved over the years, improving  hearing performance and quality of life for cochlear implant recipients. Here are three research articles to support starting the conversation with your eligible patients:

1. Benefits in noise from sound processor upgrade in thirty-three cochlear implant users for more than 20 years

Mosnier et al., 2020

Authors explore how upgrading cochlear implant recipients who were implanted more than 20 years ago with recent compatible and new technological sound processors provide benefit in speech recognition in noise.

2. Association of Speech Processor Technology and Speech Recognition Outcomes in Adult Cochlear Implant Users

Dixon et al., 2019

This article highlights how newer speech processors are associated with improved CNC scores independent of the year of device implantation and expanding candidacy criteria.

3. Controlled comparative clinical trial of hearing benefit outcomes for users of the Cochlear™ Nucleus ® 7 Sound Processor with mobile connectivity

Warren et al., 2019

Authors conclude that the incremental refinements provided by the Nucleus 7 Sound Processor provide real-world benefits in key areas such as upgraded wireless connectivity.

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

Wilder Roberts, AuD

Including AuD students in MAPping appointments

March 9, 2022

By Wilder Roberts, Au.D., CCC-A

Wilder Roberts, AuD

Background

Emerging clinicians need experience MAPping cochlear implants as much as they need experience programming and fitting hearing aids.This includes candidacy evaluations, pre-implant counseling, activations, MAPping appointments, counseling, rehabilitation and device pairing/accessory. 

The average age of today’s audiologist is 42 years, which means these audiologists did have cochlear implant classes in graduate school and have seen the evolution of cochlear implant technology. These audiologists might have been trained by the manufacturers at the manufacturer’s facility or in regional training. Today’s students are more savvy to technology and their courses in graduate school are more in depth.

The textbooks for teaching are also improved and the course objectives directly address ASHA Standards II-A (Foundations of Practice), II-B (Prevention & Screening), II-C (Audiologic Evaluation), II-D (Counseling), II-E (Audiologic Rehabilitation Across the Lifespan) and II-F (Pediatric Audiologic (Re)habilitation). Topics specifically addressing cochlear implants range from candidacy and outcomes, to coding strategies and programming.  As with all AuD programs, course content provides the foundation and clinical opportunities provide the ability to apply course content and truly learn the software and live programming.

What opportunities are students seeking?

Students are requesting hands-on opportunities – they want to watch and observe initially and ask questions if needed. Students have a strong desire to learn, serve patients well and feel confident in services they are providing.

How can you involve students?

If you’re not currently supervising any AuD doctoral students, I urge you to consider this!  You have much to offer our budding colleagues. Obviously, the level of involvement will depend on the clinical experience your student has had. Feel free to ask them what they’ve seen, protocols with which they are familiar (they usually have copies of them) and their comfort level with cochlear implants in general.

Sample ways to include students:

  1. Students are able to prepare equipment, check it in and get your supplies ready for an appointment.
  2. Students are able to connect sound processors to cables or Wireless Programming Pods, open patient files in Custom Sound® Pro and follow a general MAPping flow. If the student is working in the software, you’re able to counsel and guide both the patient and the student seamlessly. If there’s time, allow them to practice in ‘Training Mode’.
  3. Students are great scribes, so if you’re making MAPping changes, allow them to note this for you for easy reference and documentation.
  4. Students can spend the time showing patients how to use their battery chargers, connect sound processors to smartphones, and how to connect to the Cochlear apps.

Resources

These tasks seem simple, but if we don’t give students the opportunity to practice these skills, we can’t expect them to be able to do this independently. Feel free to assign them tutorial videos prior to attempting these skills.

To assist with this, on the myCochlear website, under “CPN resources,” there is a CPN Initial activation Checklist and the student can review this. You can  choose which part the student can cover – start slow and then add to it.

If you do not use Cochlear Link, show students how to download MAPs or upload MAPs. Allow them to work with your clinic stock or better yet, have them organize and inventory your clinic stock to familiarize themselves with your system and identify parts of the sound processors.

The Bottom Line

University clinics offer background knowledge and some clinical experience. Off-campus preceptors are invaluable to the future of our profession in helping create colleagues who you are comfortable working with and referring patients. We have to pass the baton at some point, and we all want competent professionals serving our patients. Students can be an asset in your clinic and are eager to learn from your expertise.

To read more from peers, subscribe to Cochlear ProNews.

About the author: Dr. Wilder Roberts is an Assistant Professor and Cochlear Implant Program Director at the University of South Alabama in Mobile, AL.  She received her undergraduate in Deaf Education at the University of Montevallo, her Master of Science in Audiology at the University of Montevallo and her doctorate in Audiology from the University of Florida.  She has been working with cochlear implants for over 20 years in both pediatric and adult populations.  She has training in Auditory-Verbal Techniques and is a state champion for Alabama in the American Cochlear Implant Alliance (ACIA).  She has also completed Advanced Cochlear Implant Training through the Institute for Cochlear Implant Training.   Dr. Roberts is passionate about cochlear implants and increasing candidacy awareness.  Dr. Roberts is from Mobile, AL, is married and has two sons. 

For compatibility information visit www.cochlear.com/compatibility

Cochlear logo - white

©Cochlear Limited 2024. All rights reserved. ACE, Advance Off-Stylet, AOS, Ardium, AutoNRT, Autosensitivity, Baha, Baha SoftWear, BCDrive, Beam, Bring Back the Beat, Button, Carina, Cochlear, 科利耳, コクレア, 코클리어, Cochlear SoftWear, Contour, コントゥア, Contour Advance, Custom Sound, DermaLock, Freedom, Hear now. And always, Hugfit, Human Design, Hybrid, Invisible Hearing, Kanso, LowPro, MET, MP3000, myCochlear, mySmartSound, NRT, Nucleus, Osia, Outcome Focused Fitting, Off-Stylet, Piezo Power, Profile, Slimline, SmartSound, Softip, SoundArc, True Wireless, the elliptical logo, Vistafix, Whisper, WindShield and Xidium are either trademarks or registered trademarks of the Cochlear group of companies. The names of actual companies and products mentioned herein may be the trademarks of their respective owners.

 

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.

 

Cochlear ProNews is monitored Monday through Friday, excluding some holidays. Questions and inquiries submitted over the weekends or holidays may see a delay in response. For immediate assistance please contact us directly. You are solely responsible for your interactions with other members of our Websites. Cochlear reserves the right, but has no obligation, to monitor disputes or communications between you and other members of our Websites. For a full list of Cochlear’s terms of use, click here.