Cochlear Implants
by Cochlear Guest Author

New research shows benefits of using advanced technology

January 27, 2022
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Give your patients access to significantly better sound

Hearing in a noisy world remains one of the biggest challenges for cochlear implant recipients. Speech recognition nearly always involves listening in background noise, often with dynamic sources and different presentation levels.1

In a new real-world study, recipients found speech to be significantly clearer in everyday listening environments when they upgraded their current Cochlear™ SPrint™, ESPrit™, Freedom®, Nucleus® 5 or Nucleus 6 Sound Processor to the Nucleus 7 Sound Processor.2

Superior speech recognition benefits

In real-world acoustic environments, where competing dynamic noise originates from the sides and behind the listener, the Nucleus 7 Sound Processor with ForwardFocus† enabled, provided on average a 7.54 dB superior speech recognition benefit^ compared to the participants’ current sound processor, when used with their preferred program for listening in noise every day.2

Significant self-perceived benefits

The Speech, Spatial and Qualities of Hearing Scale3-5 (SSQ-12*) questionnaire self-perceived results showed that the Nucleus 7 Sound Processor provided significant benefit compared with the participants’ existing sound processors in their daily listening environments.2

Our most advanced sound processing technology

The Nucleus 7 Sound Processor features:

  • SmartSound® iQ with SCAN using dual microphone technology, designed to help your patients automatically hear better in a range of challenging environments. ∞
  • ForwardFocus is designed to reduce distracting noise from behind, making it easier for your patients to focus on face-to-face conversation. †

By accessing a next generation Nucleus 7 Sound Processor, your patients can benefit from advances in technology that help them enjoy clearer conversation, even in challenging and noisy listening environments.

To find out more about the patient benefits of upgrading to the Nucleus 7 Sound Processor, visit our website.

1 Hey M, Hocke T, Böhnke B, Mauger SJ. ForwardFocus with cochlear implant recipients in spatially separated and fluctuating competing signals – introduction of a reference metric. Int J Audiol. 2019;58(12):869-878.

2 Zhang J, Morgan C, Deng XC, Wang Y, Lee M.  Hearing Performance Outcomes in Cochlear Implant Users after Nucleus® 7 Sound Processor Fitting. ACI Alliance Conference Poster. April 2021.

3 Gatehouse S, Noble W. The Speech, Spatial and Qualities of Hearing Scale (SSQ). Int J Audiol. 2004;43(2):85–99.
4 Noble W, Jen-sen NS, Naylor G, Bhullar N, Akeroyd MA. A short form of the Speech, Spatial and Qualities of Hearing scale suitable for clinical use: the SSQ12. Int J Audiol. 2013 Jun; 52(6): 409–412.
5 Liu J, Zhang J, Wang N, Li H, Fu X, Guo X, Fu L. Validation of the Chinese Translation of Speech, Spatial and Other Qualities of Hearing Scale for Parents. CN J. Otol. 2021; April In press. DOI: 10.3969 / j. issn. 1672-2922.2018

* Adults used Adult SSQ-12 and Children used P-SSQ-12. References 3-5.

^ Measured as a group mean SRT improvement.

† 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.

In this study, Mandarin-speaking Chinese recipients were assessed using their current sound processor (ESPrit™, Sprint™, Freedom®, Nucleus 5 and Nucleus 6) then again after up to one-month use with the Nucleus 7 Sound Processor.

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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Science Spotlight

Science Spotlight: Speech Understanding and Quality-of-Life Outcomes After Cochlear Implantation

November 16, 2020

Assessment of Speech Understanding After Cochlear Implantation in Adult Hearing Aid Users

A Nonrandomized Controlled Trial

Buchman CA, Herzog JA, McJunkin JL, et al.

Hearing and Quality-of-Life Outcomes After Cochlear Implantation in Adult Hearing Aid Users 65 Years or Older

A Secondary Analysis of a Nonrandomized Clinical Trial

Wick CC, Kallogjeri D, McJunkin JL, et al.

Purpose

To measure speech understanding in quiet, speech understanding in noise, and health utility using a cochlear implant and hearing aid (bimodal hearing) in 96 subjects versus their pre-operative condition of two hearing aids (HAs).

Key messages

Significant improvement was seen at six months post-surgery in the areas of speech perception in quiet, speech perception in noise, perceived health utility and subjective assessment of disability in subjects with and without mild cognitive impairment. Of interest, the clinically meaningful audiometric and quality of life (QoL) benefits demonstrated by older adults suggest that cochlear implantation may facilitate healthy aging.

Methods

  • Non-randomized controlled trial, multicenter, prospective, repeated measures design
  • 13 clinical sites
  • 100 subjects age 18 years and older with postlinguistic onset of bilateral moderate sloping to profound sensorineural hearing loss with an aided CNC word score of ≤40% in the ear to be implanted and ≤50% in the contralateral ear

Subjects were experienced HA users and completed objective speech perception testing and subjective QoL surveys prior to implantation. All enrolled subjects were implanted with a CI532 electrode, and used a Nucleus® 7 Sound Processor on the implanted ear and a new ReSound hearing aid on the contralateral ear. Subjects were seen by their clinicians at 1m, 3m, 6m and 12m post-activation, with endpoint measurements collected at the 6m visit. Subjects also completed a post-operative high-resolution CT scan to confirm electrode placement.

Results

Ninety-six subjects completed the six-month endpoint visit. Three serious adverse events requiring revision surgery occurred and all resolved without sequelae. By six months after activation, the average pre-operative CNC word score of 14.6% more than quadrupled to 60.9% in the implanted ear (change of 46.3 percentage points), and AzBio sentence scores at +10 SNR improved from 14.8% to 42.7% (change of 27.9 percentage points). In the binaural condition (N=94) CNC word scores increased from 28.8% with HAs to 69.2% using the bimodal solution of the Nucleus 7 and Resound hearing aid together (change of 40.5 percentage points), and the average AzBio sentences +10 SNR score of 31.8% rose to 55.9% (change of 24.1 percentage points) as shown in Figure 1. 

Statistically significant and clinically important improvements in the Health Utility Index 3 (HUI3) and the Speech, Spatial and Qualities of Sound survey (SSQ49) were evident at six months. The HUI3, which evaluates a variety of health attributes, saw the largest average score increase in the Hearing domain (.30) which directly contributed to a boost in the overall health-related QoL score from .46 to .64. (change of .18 points). Improvements were seen on the SSQ49 in all three subcategories, with the total score shifting from 3.2 using HAs to 5.7 using the bimodal solution (change of 2.5 points).

Eighty-one subjects were evaluated with the Montreal Cognitive Assessment (MoCA), and 48 of those subjects demonstrated mild cognitive impairment prior to implantation; however, as a group, the speech perception improvements of this cohort trended similarly to that of the entire study sample (Figure 2and Figure 3). Likewise, the subjects age 65+ (N=70) showed a substantial increase in performance with a score gain of 44.1 and 24.5 percentage points on CNC words and AzBio sentences +10 respectively in the implanted ear, and 37.2 and 21.6 percentage points in the bimodal condition (Figure 4). It is important to note that there were no major adverse events reported in this group, indicating a similar and acceptable risk profile to that of younger subjects.   

Conclusions

Cochlear implantation surgery is safe and can greatly improve a person’s ability to understand speech in quiet and noise, thus improving QoL. These advantages were evident across the larger study group, as well as within the subgroups of those with mild cognitive impairment and those over the age of 65. The significant differences shown in performance and satisfaction scores when using a cochlear implant emphasize that individuals with moderate sloping to profound or worse sensorineural hearing loss should be offered a cochlear implant evaluation when their HAs are not providing enough benefit.

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Citation:

  1. Buchman CA, Herzog JA, McJunkin JL, et al. Assessment of Speech Understanding After Cochlear Implantation in Adult Hearing Aid Users: A Nonrandomized Controlled Trial. JAMA Otolaryngol Head Neck Surg. Published online August 27, 2020. doi:10.1001/jamaoto.2020.1584
  2. Wick CC, Kallogjeri D, McJunkin JL, et al. Hearing and Quality-of-Life Outcomes After Cochlear Implantation in Adult Hearing Aid Users 65 Years or Older: A Secondary Analysis of a Nonrandomized Clinical Trial. JAMA Otolaryngol Head Neck Surg. Published online August 27, 2020. doi:10.1001/jamaoto.2020.1585

Authors & Affiliations:

Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri

Craig A. Buchman, MD (1,2)

Jacques A. Herzog, MD (1,2)

Jonathan L. McJunkin, MD (1,2)

Cameron C. Wick, MD (1,2)

Nedim Durakovic, MD (1,2)

Jill B. Firszt, PhD (1,2)

Laura K. Holden, AuD (2)

Dorina Kallogjeri, MD, MPH (1,2)

Statistics Editor, JAMA Otolaryngology–Head & Neck Surgery

Dorina Kallogjeri, MD, MPH (1,2)

This article is intended to serve as a resource for clinicians to help keep up to date with current clinical literature and is intended for professionals only. Clinical literature is based on research, which may include the experimental use of new or currently available products and technologies. Therefore, literature presented on this blog may represent use of Cochlear products that does not align with the intended use or indications approved by regulatory bodies, also known as off-label use. Cochlear does not condone any off-label use of its products, and it is not Cochlear’s intent to promote off-label use by providing this blog as a resource to clinicians.

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.

All figures are our own.

For compatibility information and devices visit www.Cochlear.com/compatibility and resound.com/compatibility. For a list of compatible ReSound hearing aids visit www.Cochlear.com/nucleus/compatibility

cochlear next

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

October 14, 2019

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.
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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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