Benefits of upgrading to the Nucleus® 6 sound processor for a wider clinical population

Objectives: To determine whether a large clinical group of cochlear implant (CI) recipients demonstrated a difference in sentence recognition in noise when using their pre-upgrade sound processor compared to when using the Nucleus 6 processor, and to examine the impact of the following factors: implant type, sound processor type, age, or onset of hearing loss.

Methods: A file review of 154 CI recipients (aged 7–92 years old) who requested an upgrade to the Nucleus 6 sound processor at the Cochlear Care Centre Melbourne was conducted. 105 recipients had complete data collected according to the protocol. A repeated measures, single subject design was used. Performance of CI recipients was compared with their pre-upgrade sound processor versus the Nucleus 6 processor using the Australian Sentence Test in Noise.

Results: Group performance of CI recipients improved by 4.7?dB with the Nucleus 6 compared with the pre-upgrade sound processor. The benefit was not affected by pre-upgrade sound processor type or implant type (including older implant types and sound processors), age or onset of hearing loss (pre-lingual versus post-lingual).

Conclusion: This study confirmed that a clinical group of CI recipients obtained a significant benefit when upgrading to the Nucleus 6 sound processor.     

Multicenter evaluation of Neurelec Digisonic® SP cochlear implant reliability

Over the past decade, the adoption of universal hearing screening in newborns has led to earlier detection of hearing problems and significant lowering of the age of first cochlear implantation. As a consequence, recipients are now expected to keep their cochlear implants (CIs) for a longer period of time. Comprehensive longitudinal information on CI reliability is essential for device choice. The aim of this study was to assess the reliability (in children and adults) of the latest generation of the Digisonic^® SP CI launched in 2006 by Neurelec. Failure rate (FR) and cumulative survival rate (CSR) for a 5-year period were calculated. This survey is a multicenter retrospective study. A questionnaire was sent to nine CI centers requesting information about patients implanted with Neurelec Digisonic^® SP CIs. FR and CSR over a 5-year period were calculated on this group. Collaborating centers collected data on 672 patients (362 children and 310 adults) implanted between March 2006 and March 2011. The overall rate of explantation was 2.23 % (15 cases): six devices were explanted due to device failure (0.89 %) and nine were explanted for medical reasons (1.34 %). Four patients were lost to follow-up. The CSR at 5 years was 98.51 % on all patients, 98.48 % for children and 98.57 % for adults. FR was 0.97 % for adults and 0.83 % for children. This first independent study that assesses FR and CSR on the current generation of Digisonic^® SP CI represents an important resource that can help clinicians and patients during their device choice.     

Benefits from upgrade to the CP810™ sound processor for Nucleus® 24 cochlear implant recipients

The objective of this study was to measure performance benefits obtained by upgrading recipients of the Cochlear? Nucleus^® CI24 cochlear implant to the new CP810? sound processor. Speech recognition in quiet and in spatially separated noise was measured in established users of the Cochlear ESPrit 3G? (n = 22) and Freedom? (n = 13) sound processors, using the “Everyday” listening program. Subjects were then upgraded to the CP810 processor and were re-assessed after a 3-month period, using both the “Everyday” program and the new “Noise” program, which incorporates several pre-processing features including a new directional microphone algorithm (“Zoom?”). Subjective perceptions were also recorded using the abbreviated profile of hearing aid benefit (APHAB) questionnaire. Mean scores for monosyllables in quiet, presented at 50 and 60 dB SPL, increased by 11 % (p < 0.0001) and 8 % (p < 0.001), respectively, after upgrade, for all subjects combined. Significant increases were also recorded for both processor groups. In noise, the mean scores were 60.0 and 67.4 % for the original and CP810 Everyday programs, respectively (difference not significant). With the CP810 Noise programs the mean score increased to 82.5 % (p < 0.01), with significant increases in both processor groups. There was evidence of slightly greater upgrade benefit in users of the ESPrit 3G processor and in relatively poor performers. The APHAB questionnaire also indicated significant reduction in perceived difficulty in the background noise and reverberation sub-scales after upgrade. The findings of the study appear to support the expectation of increased benefit from the new CP810 sound processor.     

Outcomes for a clinically representative cohort of hearing-impaired adults using the Nucleus® CI532 cochlear implant

European Archives of Oto-Rhino-Laryngology - Hearing performance data was collected from a large heterogeneous group of subjects implanted with the Cochlear™ Nucleus® CI532 with Slim...     

Novel use of the Cochlear® Hybrid CI24REH cochlear implant

Cochlear implantation is becoming more widespread. From its early days to date, huge strides have been made in the technology and surgical technique. However, one challenge remains: implanting malformed or abnormal cochleae. Even more challenging is a cochlea that appears normal at first glance, but is not. We present a case of a child with chondrodysplasia punctata, who had apparently morphologically normal inner ears, but with one major obstacle: the cochlea was smaller than normal in all dimensions. To the best of our knowledge, this is the first case described, and the solution is a novel one as well.     

Implementation and preliminary evaluation of ‘C-tone’: A novel algorithm to improve lexical tone recognition in Mandarin-speaking cochlear implant users

Objectives: Because of limited spectral resolution, Mandarin-speaking cochlear implant (CI) users have difficulty perceiving fundamental frequency (F0) cues that are important to lexical tone recognition. To improve Mandarin tone recognition in CI users, we implemented and evaluated a novel real-time algorithm (C-tone) to enhance the amplitude contour, which is strongly correlated with the F0 contour.

Methods: The C-tone algorithm was implemented in clinical processors and evaluated in eight users of the Nurotron NSP-60 CI system. Subjects were given 2 weeks of experience with C-tone. Recognition of Chinese tones, monosyllables, and disyllables in quiet was measured with and without the C-tone algorithm. Subjective quality ratings were also obtained for C-tone.

Results: After 2 weeks of experience with C-tone, there were small but significant improvements in recognition of lexical tones, monosyllables, and disyllables (P?Discussion: The real-time C-tone algorithm provided small but significant improvements for speech performance in quiet with no change in sound quality. Pre-processing algorithms to reduce noise and better real-time F0 extraction would improve the benefits of C-tone in complex listening environments.

Conclusions: Chinese CI users’ speech recognition in quiet can be significantly improved by modifying the amplitude contour to better resemble the F0 contour.     

Evaluation of the Digisonic® SP cochlear implant: patient outcomes and fixation system with titanium screws

Cochlear implants have revolutionized the way patients affected by severe hearing loss experience the world. Neurelec developed a fixation system with two titanium screws that requires no skull bone drilling.ObjectiveTo describe the outcomes and procedure-related details of a series of patients implanted with the Digisonic® SP cochlear implant.MethodThis retrospective study analyzed patients submitted to cochlear implant placement within a period of 18 months. All patients had postlingual hearing impairment. Data was collected from patient charts and standard questionnaires answered by the surgeons in charge of carrying out the procedures.ResultsThe six patients offered the Digisonic® SP cochlear implants were operated by experienced surgeons. The procedures took 95 to 203 minutes (mean = 135') to be completed, which is less time than what has been described for other fixation approaches. No complications were recorded and hearing improvement was satisfactory.ConclusionThe Digisonic® SP cochlear implant developed by Neurelec offered good audiological results for adult patients, shorter surgery time, and no surgical or postoperative complications.     

Evaluation of the ‘Fitting to Outcomes eXpert’ (FOX®) with established cochlear implant users

Abstract

Objectives

To evaluate the possible impact of ‘Fitting to Outcomes eXpert (FOX^®)’ on cochlear implant (CI) fitting in a clinic with extensive experience of fitting a range of CI systems, as a way to assess whether a software tool such as FOX is able to complement standard clinical procedures.

Methods

Ten adult post-lingually deafened and unilateral long-term users of the Advanced Bionics^TM CI system (Clarion CII or HiRes 90K^TM) underwent speech perception assessment with their current clinical program. One cycle ‘iteration’ of FOX optimization was performed and the program adjusted accordingly. After a month of using both clinical and FOX programs, a second iteration of FOX optimization was performed. Following this, the assessments were repeated without further acclimatization.

Results

FOX prescribed programming modifications in all subjects. Soundfield-aided thresholds were significantly lower for FOX than the clinical program. Group speech scores in noise were not significantly different between the two programs but three individual subjects had improved speech scores with the FOX MAP, two had worse speech scores, and five were the same.

Conclusion

FOX provided a standardized approach to fitting based on outcome measures rather than comfort alone. The results indicated that for this group of well-fitted patients, FOX improved outcomes in some individuals. There were significant changes, both better and worse, in individual speech perception scores but median scores remained unchanged. Soundfield-aided thresholds were significantly improved for the FOX group.     

Speech performance and sound localization abilities in Neurelec Digisonic® SP binaural cochlear implant users

In this prospective study the outcome of the Digisonic? SP Binaural cochlear implant (CI), a device enabling electric stimulation of both cochleae by a single receiver, was evaluated in 14 postlingually deafened adults after 12 months of use. Speech perception was tested using French disyllabic words in quiet and in speech-shaped noise at +10 dB signal-to-noise ratio. Horizontal sound localization in quiet was tested using pink noise coming from 5 loudspeakers, from -90 to +90° along the azimuth. Speech scores in quiet were 76% (±19.5 SD) in the bilateral condition, 62% (±24 SD) for the better ear alone and 43.5% (±27 SD) for the poorer ear alone. Speech scores in noise were 60% (±27.5 SD), 46% (±28 SD) and 28% (±25 SD), respectively, in the same conditions. Statistical analysis showed a significant advantage of the bilateral use in quiet and in noise (p < 0.05 compared to the better ear). Significant spatial perception benefits such as summation effect (p < 0.05), head shadow effect (p < 0.0001) and squelch effect (p < 0.0005) were noted. Sound localization accuracy improved significantly when using the device in the bilateral condition with an average root mean square of 35°. Compared with published outcomes of usual bilateral cochlear implantation, this device could be a valuable alternative to two CIs. Prospective controlled trials, comparing the Digisonic SP Binaural CI with a standard bilateral cochlear implantation are mandatory to evaluate their respective advantages and cost-effectiveness.     

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

Objectives: To assess subjective benefits and objective speech recognition performance following a take-home trial with the new Cochlear? Nucleus^® 7 Sound Processor (SP), in experienced users of compatible cochlear implants from Cochlear Limited.

Methods: A total of 37 adult participants were fitted with the Nucleus 7 SP and used the device for up to one year. Baseline speech recognition was assessed at the initial fitting session, using each participant’s own SP, and Client Oriented Scale of Improvement (COSI) goals were identified. Speech recognition was measured after 3 months of device use and outcomes of the COSI and a non-validated Processor Comparison Questionnaire (PCQ) were collected. After 11 months, a subset of subjects were tested on speech recognition delivered via direct wireless streaming from an Apple^® smartphone to the SP and compatible hearing aid on the opposite side (if worn).

Results: The COSI and PCQ instruments both indicated significant improvement in perceived subjective benefits in comparison to the participants’ previous SPs. Direct streaming via an Apple mobile phone showed improvements when compared with the acoustic alone condition. Standard speech recognition in quiet and noise was equivalent to that obtained using a previous generation SP which uses the same basic processing as the Nucleus 7 Sound Processor.

Conclusions: The incremental refinements provided by the Nucleus 7 Sound Processor provide real-world benefits in key areas such as upgraded wireless connectivity. The COSI proved to be an effective tool for individualized assessment of specific benefits that may not be addressed by more standardized instruments.     

The Great Ormond Street Hospital paediatric cochlear implant programme 1992–2004 A review of surgical complications

Abstract

The authors present a review of surgical complications following cochlear implantation at Great Ormond Street Hospital, since inception of the programme in 1992 until June 2004. Complications are defined as major (resulting in re-operation, explantation, re-implantation or which resulted in permanent serious morbidity or mortality) or minor (where the implant was not threatened). A comparison of surgical complication rates is made both with an earlier study in the same institution and also with other cochlear implantation centres worldwide. The decrease in surgical complication rates is discussed along with the difficulties inherent in cochlear implantation in the paediatric population with coexisting medical complaints. Copyright © 2007 John Wiley & Sons, Ltd.     

Swelling around the implant body: A late complication of cochlear implantation. How to deal?

Abstract

Objective

In this retrospective review, we aimed to determine the most appropriate management of the complication of late swelling around the implant body following cochlear implantation.

Methods

The medical records of 516 patients who underwent cochlear implantation between January 2008 and June 2013 were reviewed for a history of swelling around the implant body.

Results

Of the 516 patients, 16 (8 males and 8 females) had a history of swelling around the implant body following implantation. The onset of swelling was from 1 to 60 months (median 21.2 months) after implantation. Three of the 16 patients had a history of manifest trauma to the head, and the remaining 13 had experienced an upper respiratory tract infection just before the swelling arose.

Discussion

In the light of our clinical experiences, we may suggest that late swelling around the implant body seems associated with a manifest or hidden head trauma or upper respiratory tract infections.

Conclusion

After the initial assessment of swelling, surgeons should be aware of the possibility of abscess formation. As a general rule, any kind of pus collection should be drained surgically. However, in the case of pus collection without abscess formation, conservative measurements can often achieve satisfactory results.     

Evaluation of pediatric cochlear implant care throughout Europe: Is European pediatric cochlear implant care performed according to guidelines?

Objectives: International guidelines indicate that children with profound hearing loss should receive a cochlear implant (CI) soon after diagnosis in order to optimize speech and language rehabilitation. Although prompt rehabilitation is encouraged by current guidelines, delays in cochlear implantation are still present. This study investigated whether European countries establish timely pediatric CI care based on epidemiological, commercial, and clinical data.

Methods: An estimation of the number of pediatric CI candidates in European countries was performed and compared to epidemiological (Euro-CIU), commercial (Cochlear^®), and clinical (institutional) age-at-implantation data. The ages at implantation of pediatric patients in eight countries (the Netherlands, Belgium, Germany, the United Kingdom, France, Turkey, Portugal, and Italy) between 2005 and 2015 were evaluated.

Results: From 2010 onwards, over 30% of the pediatric CI candidates were implanted before 24 months of age. Northern European institutions implanted children on average around 12 months of age, whereas southern European institutions implanted children after 18 months of age. The Netherlands and Germany implanted earliest (between 6 and 11 months).

Discussion: Implemented newborn hearing screening programs and reimbursement rates of CIs vary greatly within Europe due to local, social, financial, and political differences. However, internationally accepted recommendations are applicable to this heterogeneous European CI practice. Although consensus on early pediatric cochlear implantation exists, this study identified marked delays in European care.

Conclusion: Regardless of the great heterogeneity in European practice, reasons for latency should be identified on a national level and possibilities to prevent avoidable future implantation delays should be explored to provide national recommendations.