12th International Conference on Cochlear Implants and Other Implantable Auditory Technologies

Background and aims: State-of-the-art cochlear implant programming software is essentially technical. It exposes many control parameters, such as strategy options, electrical mapping levels, audio input control,... to the CI expert audiologist. The role of the CI audiologist is to know how to set these parameters in order to optimize the hearing performance of the CI user. The FOX® fitting system, developed by the Eargroup takes a different approach: it proposes an audiological workflow with specific hearing milestones such as detection of soft sounds, phoneme discrimination and speech in quiet. The FOX agent proposes fitting recommendations based on the outcomes. Multicentric study is ongoing to evaluate this approach in new users and to evaluate its efficacy and time efficiency.Methods: Two subject groups, the control and the FOX group are being investigated from the initial switch on over a period of six months. Fitting time requirements, learning trajectory and overall performance based on speech assessment in noise at the end of the study will be compared between the two study groups.Results: FOX is in use in the Eargroup since June 2008. All implant users receive FOX based fittings. Immediate positive effects are seen on the audiogram, the speech audiogram, the phoneme discrimination task and the loudness increase test. The preliminary results of the multicentric study will be presented.Conclusion: The introduction of fully automatic and outcome driven expert software has the potential to substantially reduce the fitting time and to provide good fitting quality. It may further standardize and systematize the fitting procedure and help improving the fitting expertise. Learning Objective: Discuss how there is a large variability across centres in the way how the fitting is being performed. The time spent on device fitting varies across centres between one and two and half hours per patient over the initial six months. Email: [email protected] Friday (3:00 PM 5:00 PM) Marriott Grand Ballroom 1 5 Presentation 146 Topic: Alternative Assessment & Programming Title: Patient-Driven Programming of Cochlear Implant Device with Thre Implementation Models Author(s): Ishan Ann Tsay Presenter: Ishan Ann Tsay Abstract: OBJECTIVES:Evaluate the feasibility of implementing a patient-driven software program for setting threshold and comfort levels in a cochlear implant sound processor with three models: telemedicine, group, and parent-child.DESIGN:Fourteen subjects implanted with a Nucleus® device participated in this study. A patentpending, patient-driven software program called 'MyMAPs' was utilized in a telemedicine, group, and parentchild implementation model. MyMAPs software allows the clinician to: define the sequence and parameters for measuring current levels; authorize the software to start and turn-over control to the patient; and supervise the patient’s progress. In the telemedicine model, the clinician was located in a different room from the subject and used remote desktop technology to control and monitor the patient’s computer; no local representative was required. In the group model, two subjects and one clinician were all in the same room while the subjects used MyMAPs under the clinician’s supervision. In a third model, two pediatric subjects (age 12) used MyMAPs with a parent in the room while the clinician monitored remotely. Using a double-blind study design, twelve subjects (17-80 years) who participated in both the telemedicine and group model, were tested with the CNC Words in quiet and AzBio Sentences in noise after a take-home period with each of the two device settings from the models. These results were compared to “traditional” clinician-made device settings using commercial software.RESULTS:All three models were successful when using MyMAPs with the clinician acting in a supervisory role. No statistically significant difference in CNC Words and AzBio Sentences were found between the traditional method and telemedicine or group models. CONCLUSIONMyMAPs offers an alternative for setting threshold and comfort levels without compromising outcomes. Using MyMAPs in various implementation models is feasible and allows the clinicians to adopt the technology based on clinic and patient needs. Learning Objective: Describe what patient-driven programming is and the advantages it may offer. Email: [email protected] Friday (3:00 PM 5:00 PM) Marriott Grand Ballroom 1 5 Presentation 147 Topic: Alternative Assessment & Programming Title: FS4, FS4p, FSP – A crossover study of three fine structure coding strategies Author(s): Dominik Riss, Jafar-Sasan Hamzavi, Clemens Honeder, Michaela Blineder, Isabella Ehrenreich, Christoph Arnoldner Presenter: Dominik Riss Abstract: Background:The newest speech coding strategies are designed to improve the transmission of fine structure to cochlear implant recipients. The aim of the present study was to investigate the influence of two new coding strategies (FS4 and FS4p) on speech perception and subjective hearing impression.Material and Methods:A randomized double blind cross over trial with three conditions (FSP, FS4 and FS4p) was started. 31 Patients were included. Every patient is fitted with every strategy for 4 months in a randomized sequence. After every cycle speech perception in noise is measured using the Oldenburger sentence test. In addition, patients are asked to report on their hearing impression using VAS scales.Results:The study is still ongoing. It has been shown that it is of utmost importance to fit the new coding strategies precisely in order to guarantee a natural hearing sensation. Interestingly large differences between patients have been observed concerning the perception of these changes between speech coding strategies.Conclusion:FS4 and FS4p are promising new additions to FSP. Controlled studies are needed to evaluate their benefit for the patient. Learning Objective: Assess that FS4 and FS4p are two new fine structure coding strategies Email: [email protected] Friday (3:00 PM 5:00 PM) Marriott Grand Ballroom 1 5 Presentation 148 Topic: Alternative Assessment & Programming Title: Improving speech recognition and sound quality with DUET 2 FS4 coding strategy in electric acoustic stimulation Author(s): Andrea Kleine Punte, Ellen Cochet, Griet Mertens, Paul Van de Heyning Presenter: Andrea Kleine Punte Abstract: Aim: Electric Acoustic Stimulation (EAS) is an efficient treatment for patients with functional low frequency hearing. The aim of this study was to investigate the effect of the DUET 2 audioprocessor and Fine Structure 4 (FS4) coding strategy for EAS on speech reception in noise and sound quality.Material and methods: 8 EAS patients were upgraded from the Med-El DUET to the second generation DUET 2 audioprocessor. Subjects were subsequently upgraded from envelope based HDCIS strategy to FS4 coding stategy including temporal coding in low frequencies up to 1 kHz. Speech perception in quiet and noise and sound quality for speech and music were assessed with both devices up to 6 months after switch-over. Results: Adaptive speech testing showed a significant improvement of 4,3 dB (p=0,035) in quiet and 6.3 dB (p=0,001) in noise with the DUET 2 compared to the DUET after 6 months. Fixed level speech reception with the DUET 2 significantly improved with 23,2% (p=0,028) in quiet and 17,1% (p=0,031) in noise. Also sound quality of the DUET 2 rated significantly better than the DUET. After upgrade to FS4 coding strategy sound quality improved even further. At 6 months no effect on speech reception was measured with FS4.Conclusions: With the DUET 2 speech perception in quiet and noise improved significantly. Sound quality of music and speech improved with DUET 2 audio processor. Sound quality improved further when using the FS4 coding strategy. Learning Objective: Assess how FS4 coding strategy can improve sound quality perception in EAS users. Email: [email protected] Friday (3:00 PM 5:00 PM) Marriott Grand Ballroom 1 5 Presentation 149 Topic: Alternative Assessment & Programming Title: Red Flags: Identifying Barriers To Optimal Auditory Development By Monitoring Performance with Technology Author(s): Jane Madell, Joan Hewitt, Sylvia Rotfleisch Presenter: Jane Madell Abstract: The performance and progress of children with hearing aids and/or cochlear implants can vary greatly. By utilizing specific evaluations of audition and speech perception, audiologists can identify “red flags” indicating less than optimal performance. Red Flags can include, responses to auditory stimuli, speech and language development and other aspects of learning. Techniques audiologists can use to evaluate performance and modify programming based on those performance measures will be discussed. Case studies will be presented to illustrate common issues, the techniques used to identify them, and the performance changes observed with programming changes. Learning Objective: Identify red flags identifying concern about performance of infants and children with cochlear implants Email: [email protected] Friday (3:00 PM 5:00 PM) Marriott Grand Ballroom 1 5 Presentation 150 Topic: Alternative Assessment & Programming Title: Cochlear Implant Impedance Fluctuations: Origins and Management Author(s): J Thomas Roland, Jr., William Shapiro, Phil Segel Presenter: J Thomas Roland, Jr. Abstract: Objectives: While some degree of electrode impedance variation is common within patients, some recipients may experience clinically significant fluctuations in impedance values, such that the patient percept can be altered prompting the patient to return for clinical management. The objective of this presentation is to review the causes for management of recipients with significant impedance fluctuations.Study Design:The study design included a retrospective review of Cochlear Americas database concerning patients with fluctuating impedances. Analysis of the management options and outcomes including, reprogramming, medical management and revision surgery was made and vetted against the working hypothesis that these impedance changes are likely of biologic origin. Results:A review of Cochlear Ltd’s global complaint database was conducted revealing instances of significant impedance fluctuations in 0.11% of 91,000 devices. Various patterns of fluctuations were observed across patients and even within patientsthat is even in bilaterallyimplanted recipients fluctuations could be present in one or both ears. Management included reprogramming to keep the map in compliance. Medical control of symptoms included management of infection, the reported use of steroids or cessation of other medications (e.g. HGH). Explantation was noted in 15% of cases. Where the fluctuations were linked to other medical issues (e.g. infection) post revision impedance fluctuations did not recur. However, in cases with no other reported medical issues (7) cases, patients underwent revision surgery with impedance fluctuations recurring with the second device within a short period of time post-activationConclusion:Based upon successful reprogramming or medical management in most cases as well as the finding that in the revision cases symptoms experienced with the 1st device returned in a relatively short interval the conclusion at this time is that these fluctuations are not uncommonly associated with a biological origin rather than a device origin. Learning Objective: Identify the use of impedance measurements Email: [email protected] Friday (3:00 PM 5:00 PM) Marriott Grand Ballroom 1 5 Presentation 151 Topic: Alternative Assessment & Programming Title: Evoked Compound Action Potentials (ECAP) measures in paediatric MED-EL cochlear implantees: relationship with electrode place, age and C-levels. Author(s): Samia Labassi, Bénédicte Philibert, Nasredine Bouchair, Ali Mecibah, Abderrahmane SAIDIA Presenter: Samia Labassi Abstract: Objectives: 1) to validate ECAP recording (ART) in children; 2) to compare ART responses among three tested electrodes (n°2 apical, n°6 medium and n°10 basal); 3) to look for correlation with age at the test, age at the implantation date and cochlear implant (CI) use duration; 4) to see if ART thresholds can predict C-levels. ART responses were recorded in 71 children aged between 2 and 14 years old, age at implantation varied between 1 and 11 years old. Duration of CI use varied between 2 months and 4 years. For all 3 electrodes, maximum stimulation level, ART response amplitude measured at maximum stimulation level , ART threshold and C-level were determined. T-levels were either set to zero or to 10% of the C-levels and therefore, were not analyzed. All children were implanted in, followed by and tested in the Annaba (Algeria) CI center. Results: Three electrodes were tested in each subject. ART recording was successful in 65 children for electrode 2, in 66 children for electrode 6 and in 61 children for electrode 10. Comparison among those 3 electrodes showed that ART responses amplitudes were larger for electrode 2 than for electrodes 6 and 10; no statistically significant differences were observed for maximum stimulation levels and ART thresholds. For all 3 electrodes, statistically significant paired correlations were reported between ART responses amplitudes and age of the children at the test. The older the child the larger the ART response amplitude. No such correlations were observed with age at the implantation or with CI use duration. ART thresholds were found to statistically correlate to C-levels for electrodes 2 and 6. Conclusion: ECAP recording in a MED-EL CI paediatric population was successful in most subjects. Differences among electrode places were observed showing better responses at the apex of the cochlea. Learning Objective: Record ECAPs in Med-El CI implanted children Email: [email protected] Friday (3:00 PM 5:00 PM) Marriott Grand Ballroom 1 5 Presentation 152 Topic: Alternative Assessment & Programming Title: Customized frequency-table selections in users of bilateral cochlear implants Author(s): Matthew Fitzgerald, Elizabeth Katelyn Glassman, Chin-Tuan Tan, Ksenia Prosolovich, J. Brandon Laflen, Xiang Zhou, Mario Svirsky Presenter: Matthew Fitzgerald Abstract: Compared to monaural cochlear implants (CI), bilateral CIs provide many benefits including improved speech understanding in noise and sound localization. In current clinical practice for bilateral CIs, each CI is fit independently, with minor adjustments to ensure that loudness is balanced between ears. Such fitting procedures cannot account for between-ear mismatches in insertion depth or neural survival, which could lead to a given frequency stimulating different regions of the cochlea in each ear. Such between-ear differences can hinder sound-localization abilities and may also affect speech understanding if patients cannot adapt to the mismatched stimulation. It is possible that adjustments to the frequency table in one or both implants could, however, compensate for between-ear mismatches in site of stimulation. Unfortunately, no tool exists to allow audiologists to determine when adjustments to the frequency table may be necessary, and what adjustments would be appropriate. Thus, we have been developing a tool which allows for adjustment of the frequency table in real time. In using this tool, we assume that a patient may benefit from reprogramming of the frequency table if they select a table in one ear that differs from the standard table used in the contralateral CI, especially when listening with both CIs simultaneously. We are testing this procedure in users of bilateral CIs, and observe that some listeners select a frequency table in one ear which differs from the standard. In addition, the frequency-table selections made by these individuals to maximize intelligibility bilaterally can differ from frequency tables that elicit similar pitch percepts in each ear, suggesting that these listeners may be balancing the desire for pitch-matched percepts with the need for a frequency table that maximizes speech intelligibility. Funding for this work was provided by NIH/NIDCD. Advanced Bionics provided equipment needed to perform the research. Learning Objective: Describe that current fitting procedures for bilateral cochlear implants may not account for differences in insertion depth or neural survival. Email: [email protected] Friday (3:00 PM 5:00 PM) Marriott Grand Ballroom 1 5 Presentation 153 Topic: Alternative Assessment & Programming Title: Desktop outcome assessment and programming of cochlear implants Author(s): Paul Govaerts, Bart Vaerenberg, Haico Van Oosten, Eric Schipperen, Geert De Ceulaer Presenter: Paul Govaerts Abstract: The outcome-driven programming of cochlear implants requires the definition of targets and the iterative testing of CI-users. At present targets hardly exist while testing is time-consuming and requires resources and special facilities which are expensive and scarce.A§E is a psycho-acoustical test-suite comprising several clinical tests to assess the perception of sound in its different components, i.e. intensity, spectral content and temporal content. Normative data have been established for all tests and targets have been defined for CIusers. All tests can be run as self-tests allowing experienced patients to perform them without the need of an audiologist. In addition, a desktop test room has been developed which provides ISO-compatible acoustic The outcome-driven programming of cochlear implants requires the definition of targets and the iterative testing of CI-users. At present targets hardly exist while testing is time-consuming and requires resources and special facilities which are expensive and scarce.A§E is a psycho-acoustical test-suite comprising several clinical tests to assess the perception of sound in its different components, i.e. intensity, spectral content and temporal content. Normative data have been established for all tests and targets have been defined for CIusers. All tests can be run as self-tests allowing experienced patients to perform them without the need of an audiologist. In addition, a desktop test room has been developed which provides ISO-compatible acoustic insulation, calibrated liminal and supraliminal sound presentation and real-time monitoring of the sound delivered in the box. This test box replaces the soundproof booth and the audiometric equipment and allows easy and calibrated audiological testing in CI-users.The combination of A§E and the test box will cause a drastic change in the testing and fitting of CI-users, paving the way for extensive measuring of outcome with a substantial reduction in resources needed. It is anticipated that in combination with FOX (see other presentation), CI-performance will improve in a systematic and measurable way and evidence-based programming strategies will emerge. It is also likely that this approach will be an intermediate step towards remote fitting. Learning Objective: Perform multiple and itirative testing to improve CI-performance Email: [email protected] Friday (3:00 PM 5:00 PM) Marriott Grand Ballroom 1 5 Presentation 154 Topic: Alternative Assessment & Programming Title: Computer assisted analysis of speech production; Phonetic accuracy and phonological processes in 60 Australian children using cochlear implants. Author(s): Shani Dettman, Joanne Bardsley, Leanne Buchanan, Colleen Holt, Gabriella Constantinescu, Richard Dowell, Michelle Moran Presenter: Michelle Moran Abstract: Objectives: Systematic analysis of speech production is frequently left in the ‘too hard’ basket due to the time consuming nature of the task. The Computer Aided Speech And Language Analysis (CASALA) was used to analyze the phonetic accuracy of vowels, consonants and clusters and the prevalence of phonological process errors in 60 Australian children using cochlear implants.Methods: Children enrolled in Auditory Verbal (AV; n=12), Auditory Oral (AO; n=39), or Bilingual-Bicultural sign emphasis (BB; n=9) programs completed either the Diagnostic Evaluation of Articulation and Phonology (DEAP) or Goldman-Fristoe Test of Articulation – 2 (GFTA-2) at 5 years of age or at school entry. Results were transcribed using broad phonetic transcription and data were entered into CASALA for analysis. The relationships between child variables (age at hearing-aid fitting, age at cochlear implantation, degree of residual hearing, and mode of communication) and speech production outcomes were examined.Results: Data entry and CASALA analysis of all phonemic errors and phonological processes was completed in less than five minutes for each sample. Patterns of vowel, consonant and cluster acquisition for children using cochlear implants were similar to patterns reported in the literature for children with normal hearing. Typical developmental phonological processes such as cluster errors, stopping, fronting, devoicing, final consonant deletion and gliding were observed in all three groups. There was a significant relationship between speech accuracy and communication mode. More phonetic errors and more atypical phonological processes were observed for the BB group compared to the AV and AO groups.Conclusions: This study supported the use of AV and AO communication approaches for facilitating speech accuracy for children using cochlear implants. Using CASALA to analyze the DEAP and GF-2 was a rapid and reliable tool for clinical and research purposes. Learning Objective: Recognize use of a computer program facilitated rapid, accurate and reliable speech production analysis. CASALA data from multiple samples may be exported to other data analysis programs quickly and effectively. Email: [email protected] Friday (3:00 PM 5:00 PM) Marriott Grand Ballroom 6 10 Presentation 155 Topic: Medical II Title: Treatment disparities in cochlear implantation: Do the differences between Germany and the US influence outcomes or complication rates? Author(s): Lawrence R. Lustig, Magnus Teschner, Thomas Lenarz, Colleen Polite Presenter: Magnus Teschner Abstract: Introduction. Throughout the world there exists widespread variation in both the workup and implementation of cochlear implantation. The goals of this investigation are to analyze whether these evaluation and treatment disparities result in differences in complication rates or outcomes and what economic impact such variations engender, in 2 representative cochlear implant centers.Material and Method. Fifty cochlear implant recipients in each of two representative cochlear implant centers in the United States and Germany were compared with regard to their evaluation and management. Demographics, complication rates (major and minor), and speech language outcomes between these two centers were compared. Relative costs between the 2 centers were also compared. Results. Many evaluation and treatment disparities were identified between the two centers, reflecting regional norms for treatment. These differences included length of hospitalization and the nature of the pre-operative evaluation process. Despite these differences, only small differences were noted in resulting minor complications between the two centers, and no differences were seen in the major complications. No significant differences were seen in speech language outcome measures. The cost for cochlear implantation per patient at the German center was roughly 1⁄2 the cost of implantation at the US center. Discussion. Despite differing evaluation and management paradigms between these 2 centers, representative of their 2 countries, there were no major differences in complication rates or speech outcome measures. However, the cost of cochlear implantation in Germany was markedly less expensive per patient than similar intervention in the US. Learning Objective: Compare the differences in the evaluation of patients undergoing cochlear implantation between Germany and the United States Email: [email protected] Friday (3:00 PM 5:00 PM) Marriott Grand Ballroom 6 10 Presentation 156 Topic: Medical II Title: Complications in cochlear implant surgery according to the approach. Author(s): Mario Zernotti, Victor Slavutsky, Alejo Suarez, Fernanda Di Gregorio, Luis Nicenboim, Juan Soto Presenter: Mario Zernotti, Luis Nicenboim Abstract: Introduction: Complications are a very sensitive indicator of the usefulness of a surgical technique. There are three main approaches, the classical approach uses the facial recess (RF),the suprameatal approach (SMA) does not require mastoidectomy and uses the creation of a tunnel to reach the middle ear, and the endomeatal approach (EMA) based on the completion of a groove in the posterior wall of external auditory canal. Aim: to assess the complications according to the different approaches.Material and methods: Multicenter review of 208 patients with cochlear implant, comparing the different techniques. The complications were classified into major and minor. Results: Among the 208 implanted patients, 10.5% (22 of 208) had complications, of these 2.88% (6 of 208) were major complications, and 7.69% (16 of 208) were minor complications. Comparing the results obtained by different approaches the RF technique has the least rate of major complications (1.1%) followed by the EMA technique 2.38% and 3.75% in SMA. This group has the lowest number of minor complications 6.25%, followed by those operated by EMA to 7.14% and the group operated by the RF present 10%. The minor problems with the facial nerve, there were independent of the approach used. Conclusions: The three techniques show a very similar rate of complications. Therefore we can conclude that the three techniques are alternative and safe.