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Cochlear Implants
by Cochlear Guest Author

Comfort and listening benefits of the Kanso™ off-the-ear sound processor in children

November 20, 2018
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Research updates

By: Birgit Philipsa, Anke Plasmansa, Prof. Dr. Ingeborg Dhoogeb

In September 2016, Cochlear introduced the Kanso™ off-the-ear (OTE) sound processor. This paper summarizes a clinical investigation of the Kanso device with existing pediatric cochlear implant users, and discusses considerations for use with this population. Clinical testing compared the performance outcomes of Kanso with a conventional behind-the-ear (BTE) sound processor, and collected subjective feedback on comfort, retentionBoy wearing Kanso, aesthetics and ease of use ratings for pediatric users. The outcomes were found to be consistent with recently published results in adult Kanso users, demonstrating equivalent speech understanding in quiet and in co-located speech and noise, and positive subjective feedback on the device.

Read the white paper in its entirety.

Cochlear Guest Author
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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 our ProNews blog as Guest Authors.

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Slim Modiolar electrode

CI532: The Perimodiolar Advantage

January 22, 2019

By guest author: Wade Colburn

Wade Colburn

 

 

Cochlear introduced our first perimodiolar electrode array in 2000. Perimodiolar arrays reduce the distance to the modiolus to improve performance1,2 and allow for more focused stimulation3,4. In a study conducted at Washington University by Holden et al5, they showed a correlation between the position of the electrode with respect to the modiolus (often referred to as the “Wrapping Factor”) and CNC word score. The group showed that those electrodes with proper perimodiolar placement had a lower wrapping factor and improved performance.

Cochlear continually innovates with the intent of making perimodiolar electrodes thinner, less traumatic and consistent in placement, and with the ultimate goal of improving patient performance. The perimodiolar advantage has been observed by many clinicians over the years, which is demonstrated by the fact that 2 out of every 3 Cochlear™ Nucleus® implants are perimodiolar6.  Cochler Slim Modiolar Electrode

Currently, two perimodiolar electrodes are available for purchase, the Contour Advance (CI512) and the new Slim Modiolar (CI532).  Contour Advance has been available since 2005 and is still used among surgeons. The new Slim Modiolar electrode improves upon a few key design elements and redefines any historical assumptions surrounding perimodiolar arrays, such as scalar translocations and limitations on surgical approach. While there are certain patients that can benefit from the stylet-based Contour Advance, the sheath-based Slim Modiolar has shown performance benefits7.

The Slim Modiolar electrode redefines the perimodiolar advantage in four major areas:

Performance:

While the performance benefits of a perimodiolar electrode is well understood 1,2,3,4,5, a recent publication by Shaul et al7, demonstrated that in a matched population (post-lingual patients with all electrodes in scala tympani) phoneme score at 12 months was significantly better with Slim Modiolar (79.5% (mean), 14% (SD)) compared to Contour Advance (69.4% (mean), 17% (SD)).

Placement in Scala Tympani:

In multiple published surgical papers on Slim Modiolar, successful scala tympani location was seen in 90 to 100% of the patients 7,8,9,10. Slim Modiolar redefines the reputation of perimodiolar electrodes and presents an opportunity to combine the benefits of being close to the hearing nerve with consistent scala tympani location.

Preservation of Structures:

The Slim Modiolar is designed with a sheath-based delivery system, which allowed for a 60% reduction in volume compared to Contour Advance, making it designed to preserve the delicate inner ear structures. The thin design and smooth insertion with a sheath delivery showed in a temporal bone study that 98% of the bones that were implanted experienced “no trauma”. The Slim Modiolar is designed to preserve the natural structure of the cochlea.

Preference of Insertion:

Another benefit of the Slim Modiolar electrode is the ability to use the preferred surgical approach, including a round window insertion. Contour Advance design was limited to cochleostomy insertion, but Slim Modiolar is designed to be implanted via round window, extended round window and cochleostomy. In Aschendorff et al8, 44% of the cases were performed with round window insertion, 22% with extended round window and 34% with cochleostomy. This study demonstrated that Slim Modiolar could be implanted with all surgical approaches, while still maintaining consistent scala tympani location.

Slim Modiolar electrode (CI532) is designed intentionally to take the great elements of the Contour Advance and improve upon them to create an ideal electrode for your patients. Closer to the hearing nerve has proven to be a benefit and CI532 has redefined the perimodiolar advantage for the better.

To learn more about CI532 and practice insertions in a simulated model, contact your Cochlear representative.

 

About our guest author:

Wade Colburn is the Product Manager for the Cochlear™ Implant product portfolio within Cochlear Americas.  Wade’s responsibilities include product positioning and messaging, life-cycle management, new product launches and surgical support and training. Wade has recently joined Cochlear and comes from an engineering background within the medical device field, including previous otology experience.

 

 

References:
  1. Lazard D. S, et al. Pre-, per- and postoperative factors affecting performance of postlinguistically deaf adults using cochlear implants: a new conceptual model over time. PloS one. 2012; 7:e48739
  2. Blamey P, et al. Factors affecting auditory performance of postlinguistically deaf adults using cochlear implants: An update with 2251 patients. Audiology & neuro-otology. 2013; 18:36-47.
  3. Hughes, ML, Abbas, PJ. Electrophysiological channel interaction, electrode pitch ranking, and behavioral threshold in straight versus perimodiolar cochlear implant electrode arrays. J Acoustic Soc Am. 2006; 119(3):1538-47.
  4. Cohen L., Richardson L., Saunders E., Cowan R. Spatial spread of neural excitation in cochlear implant recipients: comparison of improved ECAP method and psychophysical forward masking. Hearing Research. 2003; 179 (1-2):72-87.
  5. Holden LK, Finley CC, Firszt JB, Holden TA, Brenner C, Potts LG, et al. Factors affecting open-set word recognition in adults with cochlear implants. Ear Hear. 2013; 34(3):342-60
  6. Internal sales data on file.
  7. Shaul C, Dragovic AS, Stringer AK, O’Leary SJ, Briggs RJ. Scalar localization of peri-modiolar electrodes and speech perception outcomes. J Laryngol Otol 2018; 1-7. https://doi.org/10.1017/S0022215118001871
  8. Aschendorff et al. Clinical investigation of the Nucleus Slim Modiolar Electrode. Audiology & Neurotology. 2017; 22:169-179. https://www.ncbi.nlm.nih.gov/pubmed/29059669
  9. Data on File: US Multicenter CI532 Study. 2018.
  10. Cuda, D, Murri, A. Cochlear Implantation with the nucleus slim modiolar electrode (CI532): a preliminary experience. European Archives of Oto-Rhino-Laryngology. 20017; 12:4141. https://www.ncbi.nlm.nih.gov/pubmed/29032420
  11. EA32 Electrode Insertion Safety and Performance Study Report. Data on File (Document Number: 473386)

Supporting the benefits of bimodal hearing: ReSound ENZO Q™ and the Smart Hearing Alliance

July 24, 2020

By Natasha McDougald, Product Manager, Bimodal and Hybrid Hearing

Discussions around the importance of acoustic input from both ears in individuals with hearing loss started as a key discussion with Schroers and team in 1985.1  Since then, research has occurred in both the acoustic and electric (cochlear implant) arena, with recent articles discussing electric and acoustic hearing contributing to the bimodal condition. 

Dr. Jennifer Schumacher, audiologist with GN Hearing, recently authored a white paper supporting the benefits of bimodal hearing.  She highlights key benefits of patients in the bimodal condition in the everyday listening environment, and speaks to recent research showing speech understanding improvements with the addition of a hearing aid when compared to using a cochlear implant alone in both quiet and noisy environments.2-4

Real-world benefit was not just limited to speech performance outcomes, but also improvements in rated satisfaction with sound quality and spatial perception.5  These outcomes parallel the results in Cochlear’s Multicenter Study featuring the Slim Modiolar electrode, where patients experienced a 40 percentage point gain in CNC words in quiet and a 24 percentage point improvement in noise.6

Additionally, subjects in the Cochlear study demonstrated an improvement in reported satisfaction with their hearing performance. Pre-operatively, only 9% of subjects reported satisfaction using bilateral hearing aids. Post-operatively, 95% of subjects reported satisfaction in their overall listening ability while wearing a bimodal solution in a device use questionnaire.6

Speech Understanding with Cochlear Implant and Hearing Aid (N=94)

**p = < 0.001

Moreover, while some patients fit bimodally will see benefit, the amount varies from person to person, and others may be appropriately suited for bilateral cochlear implants.  Factors that may affect this outcome include a consistent practice of fitting the other ear acoustically for unilateral cochlear implant recipients, and the amount of hearing benefit gained from the acoustic input.  

Schumacher mentions that participants at the New York University School of Medicine study by  Neuman et al. in 2017 were more likely to discontinue hearing aid use when they had poorer mid-to high-frequency hearing loss in the non-implanted ear and no significant increase in speech understanding with addition of the hearing aid.  She postulates beyond the factors discussed that optimal fitting of the hearing aid may assist in success with bimodal hearing.7

The author introduces the Smart Hearing Alliance, a collaboration between Cochlear and ReSound that aims to develop hearing solutions that meet the advanced innovation needs of both patients and professionals.  Cochlear and ReSound have released an updated fitting flow with simple steps designed to maximize audibility, incorporating loudness balancing driven by conversational speech, and supports selection by the hearing healthcare provider of various fitting rationales including the ReSound proprietary Audiogram+.  Instruction is also provided to enable direct wireless streaming and assist in wireless accessory setup.

The Smart Hearing Alliance’s implementation of connectivity allows patients to take advantage of direct streaming to both ears from compatible smartphones. Further, use of wireless accessories has been confirmed by independent studies increase a bimodal patient’s speech understanding via mobile phone and to supply signal-to-noise ratio improvements, which could aid speech understanding in noisy environments. 8-9

The new ReSound ENZO Q™ behind-the-ear hearing aid for severe-to-profound hearing losses may be uniquely suited to the needs of a bimodal patients.  It offers an upgraded chip allowing direct connectivity to compatible Apple® or Android™ smartphones* and has an IP rating standard of 68 and completely nanocoated to assist in resistance to moisture and to increase durability.  To provide high quality amplification of the wide range of everyday sounds, the ReSound ENZO Q 98 model features an increased input dynamic range extending to 113 dB SPL as well as 145 SPL peak output.  Bimodal patients who want to travel less, or are served by a separate cochlear implant audiologist and HCP, can use the ReSound Smart 3DTM app on their compatible smartphones to take advantage of ReSound Assist Live for live synchronous support or remote hearing aid fine-tuning requests via the asynchronous ReSound Assist feature. These types of remote features may be especially useful for patients and their clinicians when navigating this new patient care paradigm.

To stay up to date on the latest industry topics, subscribe to Cochlear ProNews and read the article now.

About the author: Natasha has worked at Cochlear Americas for almost 9 years partnering with clinicians and surgeons at the University of Miami, UCSF, Stanford, UC Davis and UCSF Benioff Children’s Hospital of Oakland to bring cochlear implants to pediatric and adult patients.  Extremely passionate, Natasha is professionally and personally invested in the implantable hearing industry and strives to forward the cause of those affected by hearing loss. 

References:

  1. Schroers, K.K & Olsen, W.O. (1985).  Comparison of Monaural and Binaural Hearing Aid Use on a Trial Period Basis. Ear and Hearing, 6(4), 198-202
  2. Potts LG, Skinner MW, Litovsky RA, Strube MJ, Kuk F. Recognition and localization of speech by adult cochlear implant recipients wearing a digital hearing aid in the nonimplanted ear (bimodal hearing). Journal of the American Academy of Audiology. 2009;20(6):353-73.
  3. Ching TY, Incerti P, Hill M. Binaural benefits for adults who use hearing aids and cochlear implants in opposite ears. Ear and Hearing. 2004;25(1):9-21.
  4. Ching TY, Van Wanrooy E, Dillon H. Binaural-bimodal fitting or bilateral implantation for managing severe to profound deafness: A review. Trends in Amplification. 2007;11(3):161-92.
  5. Schafer EC, Amlani AM, Paiva D, Nozari L, Verret S. A meta-analysis to compare speech recognition in noise with bilateral cochlear implants and bimodal stimulation. International Journal of Audiology. 2011;50(12):871-80.
  6. Clinical Evaluation of the Cochlear Nucleus CI532 Cochlear Implants in Adults Investigator Meeting. 2019 Apr.
  7. Neuman AC, Waltzman SB, Shapiro WH, Neukam JD, Zeman AM, Svirsky MA. Self-reported usage, functional benefit, and audiologic characteristics of cochlear implant patients who use a contralateral hearing aid. Trends in Hearing. 2017;21:1-14.
  8. Wolfe J, Morais M, Schafer E. Speech recognition of bimodal cochlear implant recipients using a wireless audio streaming accessory for the telephone. Otology & Neurotology. 2016;37(2):20-5.
  9. Vroegop JL, Dingemanse JG, Homans NC, Goedegebure A. Evaluation of a wireless remote microphone in bimodal cochlear implant recipients. International Journal of Audiology. 2017;56(9):643-9.

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.

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

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.

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­©Cochlear Limited 2021. All rights reserved. Hear now. And always and other trademarks and registered trademarks are the property of Cochlear Limited or Cochlear Bone Anchored Solutions AB. The names of actual companies and products mentioned herein may be the trademarks of their respective owners. ­This content is meant for professional use. 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. Views expressed are those of the individual. Consult your health professional to determine if you are a candidate for Cochlear technology.