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What Is A Cochlear Implant?
Cochlear Implantation: • Very different from a hearing aid
Bilateral, Bimodal, Asymmetric, Hybrid – Whereas a hearing aid simply amplifies sound, a
cochlear implant bypasses the outer hair cells of
the cochlea and directly stimulates the auditory
Presenter: Sarah King, Au.D., CCC-A nerve
Midwest Ear Institute
4200 Pennsylvania Ave.
Kansas City, MO 64111
816/932-1660
www.mei-kc.org
Cochlear Implant Devices Cochlear Implant Devices
Currently Available in the U.S. Currently Available in the U.S.
Advanced Bionics Corp. HiRes/90K Med-El Corp. Sonata
“Bionic Ear” - Opus 2 modular speech processor
- Harmony “ear level” or Platinum “body - Rechargeable and disposable batteries
worn” speech processor - Remote control
- Rechargeable batteries
Cochlear Implant Devices Current Candidacy Guidelines -
Currently Available in the U.S. Adults
Cochlear Americas Nucleus 5 • Moderate to profound SNHL
- N5 “ear level” or “lite wear” speech
processor • <50% sentence scores in ear to be
- Rechargeable and disposable batteries implanted
- Remote control
• <60% sentence scores in opposite ear
• Lack of benefit from hearing aids
Current Candidacy Guidelines -
Children Candidacy Changes
• Sentence test changes
• >12 months of age
– HINT sentences vs. AZ Bio sentences
• <30% speech scores
• Monosyllabic Word Test
• Lack of auditory progress
Other Candidacy Considerations Predicting Performance
• CT-scan or MRI showing no
contraindications to electrode placement • Age at onset
in the cochlea – Pre-lingual
– Post-lingual
• Medical exam showing no
• Duration of deafness
contraindications to surgery • Hearing Aid Use
• Appropriate expectations and high • Age at Implantation
motivation
Outcomes Outcomes in Children
• Open Set Sentences - HINTQ >80% • Different expectations based on
speech/language development
• Open Set Words - CNC >50%
• Age at implantation makes a difference
• Ability to use telephone
• Auditory rehabilitation/education critical
• Enhanced lip reading
What about bilateral candidacy? Binaural Advantages
• Hearing with 2 ears is better than with 1
• Handicap of unilateral hearing loss well • Summation
documented • Head Shadow
• Sound Localization
• Extensive support in hearing aid literature
• Hearing in Noise
• Now unequivocal evidence of advantage in
cochlear implant recipients
Summation Head Shadow Effect
• Most robust
• Benefit of signal presentation to both bilateral effect
ears as opposed to either ear alone • Reduction is
• Effect of central processing almost
• Perceived sound is louder than same immediately
signal perceived in one ear noted after
• 3dB gain
bilateral CI
Sound Localization Hearing in Noise
• Up to 30 degree
improvement in
sound localization • Marked improvement with bilateral CI
• Best users can • 22% advantage when listening to
localize to speech in noise
<5degrees
• 3 dB SNR improvement
• Normal hearing -
<2degrees
Cost Effectiveness Current Clinical Trials for Non-
Traditional Cochlear Implant
• Quality Adjusted Life Year [QALY] Candidates
– Dialysis = $61,294/QALY • Cochlear Implants in Adults with
– Knee replacement = $59,000/QALY Asymmetric Hearing Loss
• Unilateral implant = $9,000- • Nucleus Hybrid L24 (electro-acoustic
11,000/QALY stimulation)
• Bilateral implants = $24,859/QALY
Cochlear Implants in Adults with Candidacy Criteria for Asymmetric
Asymmetric Hearing Loss Study
• Designed for patients with asymmetric
hearing loss who are effectively functioning • 18 years of age or older
with one ear, but may be missing benefits of • Poorer ear (implant ear): severe to profound
binaural hearing (localization, hearing in sensorineural hearing loss, meets current CI
noise, quality) candidacy criteria
• Does crossover from the “good” ear help • Better ear: sensorineural hearing loss with 4-
frequency PTA >= 40 dB HL, but not reaching
keep the poorer ear functioning for an severe to profound range
implant?
– Does not meet current CI candidacy criteria
• Subjects are a traditional implant candidate
– Documented stable hearing thresholds for at
in one ear, but not in the “good” ear (i.e.
speech recognition better than 60%) least one year
– Uses appropriately fit hearing aid
Asymmetric Study Requirements Patient Example
• 77 year old male
• Study evaluation testing (~4 hours each
• Aided speech understanding left: CNC words 0%,
visit) at pre-op, initial activation, 1 HINT sentences 0% with masking
month, 3 month, 6 month, 9 month, and
12 months
• Questionnaires at each study visit
• Travel to Washington University in St.
Louis for 1 test session
Patient Example Hybrid Cochlear Implants
• Surgery – Complication
• Post Op
– After only 2 weeks, patient reported he
could localize sound source
– At 1 month, 85% on HINTs with CI only
– Bimodal improvements on all tests
• 3 months post
Hybrid Cochlear Implantation The best of both?
• Help hearing aid
• Acoustic Hearing in Low Frequencies patients who are
not quite cochlear
– Music, melody, tone
implant
• Cochlear Implant in High Frequencies candidates
– Speech discrimination • Expand the
criteria of current
implant
HEARING AID CI
Principles of Hybrid CI Cochlear Hybrid L24
• Current FDA Study
• Hearing preservation
• 16mm electrode
• Reduce surgical trauma
• 22 contacts
• Stimulation with combined modalities
• Same surgical approach
• Electrode Design
– Thinner, shorter, flexible
Nucleus Hybrid L24 Hybrid™ Candidacy
• Candidates typically present with stable
• Expansion of ongoing study beginning in 2003 mild to moderate hearing loss in the low
frequencies (up to 500 Hz) threshold < 60
• Designed for ski-slope hearing losses, where dB and severe to profound hearing loss in
the mid and/or high frequencies (above
traditional hearing aids provide no benefit to 1500 Hz).
speech understanding
• Audiometric thresholds for the ear to be
• Electrode only partially inserted for high implanted should fall within the shaded
area indicated.
frequencies, patient hears lower pitches
acoustically • Aided monosyllabic word scores between
• First Hybrid devices were 10 mm, 6 10% and 60% in ear to be implanted
electrodes, now 15 mm, 22 electrodes • Aided word scores equal to or better than
ear to be implanted, but no more than
80%
*NOT FDA APPROVED, CLINICAL TRIALS
ONGOING
Exclusion Criteria for Hybrid CI Hybrid L24 Study Requirements
• Duration of severe-to-profound hearing • Study evaluation testing (4-6 hours each
loss greater than 30 years visit) at pre-op, initial activation, 3
• Congenital hearing loss months, 6 months, and 12 months
• Conductive hearing loss • Questionnaires at each study visit
• Auditory neuropathy
• Ossification or any other cochlear
anomaly that might prevent electrode
insertion.
Patient Example Patient Example
• 69 y/o male, stable • 3 months post
hearing loss – CNC’s:
• Fit with Widex • Ipsilateral Acoustic: 46%
Audibility Extender • Implant Alone: 80%
• CNC: 52% aided • Hybrid Mode: 92%
right, 44% aided left • Combined Mode: 94%
• AzBio +5 SNR – AZ Bio +5 SNR:
• Combined: 75%
• 6 months post
Cochlear Implant Summary
Thank you!
• Cochlear Implants provide safe, effective
auditory (re)habilitation to adult and
pediatric patients with severe-profound Questions?
SNHL Comments?
• Bilateral Implantation provides greater
benefit than unilateral implantation Sarah King, Au.D., CCC-A
• Indications have increased along with
performance
