Choosing a brand

NEWSFLASH: A new site is available at www.cochlearimplantHELP.com with everything you ever wanted to know about cochlear implants!

Choose a brand that is the best one for YOU.

What is a cochlear implant? Imagine you’ve bought yourself a new computer. The computer hardware is the implanted part of the cochlear implant (AB’s HiRes 90k, MedEl’s Pulsar & Sonata, Cochlear’s Freedom), the computer processor is the external speech processor (AB’s Harmony, MedEl’s Opus or Cochlear’s Nucleus 5 / Freedom), and the software is the programme which is adjusted through a series of mappings with the audiologist (AB’s HiRes Fidelity 120, MedEl’s FineHearing, Cochlear’s SmartSound). The cochlear implant companies bring out upgrades  in the form of additional software to improve hearing functionality – such as AB’s ClearVoice which reduces background noise to provide greater speech clarity and ease of listening in noisy environments.

In the UK, you will usually be offered 3 cochlear implant brands to choose from;
MedEl (established 1989)
Advanced Bionics (AB) (established 1993)
Cochlear (established 1981)

You might be offered a fourth, Digisonic, by Neurelec from France, which has been available since 2004 (available in UK since 2011). The latest model is Viaphonix. The first person to receive a Digisonic implant tells her story here (it’s unfortunate that the article incorrectly refers to the CI as a hearing aid).

(Useful site : US clinic finder for all CI brands) – to be updated with a working link when it becomes available

Which one is the best? My cochlear implant team told me they were all the same. But are they? Remember, they are audiologists and surgeons, not electrical engineers. Plus, they’re not deaf, so they don’t have a personal interest in ensuring you are fitted with the best cochlear implant for you. Each brand has positives and negatives, in the implant electronics (which is the ultimate limiting factor in the stimulation that can be applied), the electrode array itself, the processor hardware, and the Digital Signal Processing software.

Useful post: Bilateral mixed-brand cochlear implant recipients talk about their experiences

The electronics in the implanted part are what you own; and any ability for processor hardware and software improvements on the outside for a better stim hinge on what the internal circuits can accurately yet quickly decode. Basically, it boils down to this: the processor is something replaced/upgraded every 3-5 years, and you do indeed need to live with it until the next upgrade comes out. The implanted electronics is something you’ll be living with for the next 20 years (or longer). Whatever level of technology in the stim you get when it’s switched on is what you’ll have to live with.

By a good margin, AB and MedEl have the best implant electronics with separate current sources for each electrode button. AB’s can fire 90k pulses per second on its 16 buttons simultaneously with both + .AND. – charges; MedEl can fire about 56k pulses (but simultaneously either – .OR. +) per second on its 12 electrodes; while Cochlear’s can only fire 30k pulses per second, and only one pulse at a time. This means AB has 128 virtual electrodes, MedEl has somewhere around 90 (but they don’t claim a number due to their triangular waveform)… while Cochlear only has 22, with an unapproved  (in US) capacity of 43 with current shorting. There is an article from Operative Techniques in Otolaryngology on cochlear implant electrode insertion which describes insertion techniques and the currently available electrodes.

The physical electrode array itself is where the action is, especially if residual hearing is desired to be preserved. Here, MedEl is on top, while Cochlear is also rather good. That being said:

Preservation of residual hearing also greatly depends on the skill of the surgeon, with an overall average of about 65-70%. The best cochlear implant surgeon in the world is Rick Case at Washington University in St Louis (WUSTL) who has a 98% success rate, and John Niparko at Johns Hopkins University in Baltimore (JHU) is right with him.

Preservation of residual hearing is also subject to a third variable, besides manufacturer and surgeon: whether the electrode is placed perimodionally or floating. Perimodional (wrapped in a tight spiral around the core) placement puts the buttons closer to the nerves for a better stim with lower power and tighter focus (especially if current steering is enabled), and it also enables a deeper placement for a given length (tighter radius); but it also entails a higher risk to to residual hearing.

The processor hardware is important, as it entails both the number-crunching capacity of the chips needed for speech processing and digital noise reduction, and also the physical container:

On the processor capacity itself, all three are adequate for the stimulations that the implant electronics can deliver at present. That being said, the implant electronics for Cochlear is already stretched to capacity; while it is estimated by some that MedEl still has 5-7 years to go and AB at least a decade.

The physical packaging for the new Freedom 5 is rather good, with waterproofing technology borrowed from RION’s HB-54 series hearing aids; and being shrunk almost as small as the MedEl Opus2. With 50% of cochlear implants going into children (at least in the USA), Advanced Bionics’ relatively clumsy processor has turned off many parents and cochlear implant centres for infants and small children.

The DSP (Digital Signal Processing) software running in the processor is also important, as there are two main parts to it: the manipulation of the incoming sound across the frequency spectrum for noise reduction -­ or lack thereof for music ­- and the conversion of the processed sound into one of the various stimulation strategies (CIS, n-of-m (ACE), Hi-Res Parallel, Hi-Res Sequential, etc)… which is ultimately limited by the amount of memory and processing power of the electronics in the implant itself.

Audiologist Jo-Ann has programmed Advanced Bionics and Cochlear patients. The biggest thing she wishes recipients to know is that everyone’s brain is different. You cannot predict how you will do, so having a choice of processing or coding strategies is key. Just like with hearing aids, some people prefer the sound of Phonak some Oticon, etc. With AB, they have MPS, CIS, HiRes-S, HiRes-P, HiRes-P with 120, and HiRes-S with 120.

Audiologist Joanna has mostly dealt with Medel, 30% with Cochlear and 1 with AB. She says the implant itself is only part of the solution. Most of your work starts when the processor goes on and most of it is positive mental attitude coupled with lots of listening practice. The more you practice the better the discimination becomes. For some, clarity happens straight away – for others it takes time, so there is no easy answer.

Some people’s brains prefer the sound of HiRes-S vs HiRes-P because they stimulate differently. With Cochlear you really only have one choice. Cochlear patients cannot try out other strategies because there is only one power source. This is also what gives the audiologist flexibility in making a good program for you. Even if Cochlear has new software coming out; with one power source you are limited. Jo-Ann compares it to building a house with 22 rooms. If you only have one light switch you can turn all the lights on or all of the lights off. You need multiple power sources to turn off/on on each “room” individually. This is also why Cochlear rates are slower and they can get away with disposable batteries.

It’s always a great idea to contact each company and speak with one of their audiologists – ask as many questions as possible especially about the research and about the internal capabilities. It’s also great to find a centre that has done equal amounts of each company so they have a less biased opinion. The company audiologists are the ones that will be supporting your programming audiologist and helping your centre after you are implanted. Surgeons really only see you once a year and don’t know about the programming. Also they won’t know about the external returns or breakdowns. Another test for companies is to call their customer service line and see how fast you get hooked up to a real person. (Courtesy Jo-Ann, audiologist)

Technical comparison of cochlear implants – dated March 2007.  Note, only the cosmetics have changed on Cochlear’s Nucleus 5. The N5 processor is currently under recall, but the Freedom processor is backwards compatible with the older internal processor.

ADVANCED BIONICS

Check out AB Harmony v Nucleus 5

AB’s is by far the leader in the implant electronics, with full current steering for 120 virtual electrodes from their 16 electrode buttons and HiRes speed delivering up to 90 thousand updates per second for the best stims, especially for music & for speech intelligibility in noise.

The downside to AB is in about 5% of implant surgeries because they only make two electrode arrays — The “antenna” that goes into your cochlea. Both the Helix, for perimodiolar placement, and 1J semi-curved, for lateral placement, work well… But not for everyone.

One of AB’s implantees, Mike Marzalek, is writing stimulation software to achieve better music enjoyment with his cochlear implant.  It only runs on his special hand built speech processor.  If successful, this will open the door to more people getting cochlear implants as you won’t have to be quite as deaf to get real benefit, ­ not to mention faster & better aural rehab, which is often overlooked. Dan says,

While you’re on Mike’s site, be sure to view his biography page. Read the 6th paragraph; and if it doesn’t sink in, rinse and repeat until it does.

There are two other “CI Insiders” who are also guiding me; but what Mike has up his sleeve writing his own stim and testing it on himself as he goes along is the reason why I’ve chosen an Advanced Bionics implant.

This is in addition to AB’s ClearVoice noise reduction technology, now released in the UK (March 2010) and Canada (February 2010); but still awaiting FDA approval for release in the United States. That, coupled with Phonak’s buying of AB in September 2009 means that their 50 years of “front end” audio processing will be migrating to the next generation of BTE processors to be married up with the “back end,” the actual encoding of the signal for electrical hearing.

AB’s offerings are quite good; but they lack in one critical area: the electrode arrays. When it comes to preserving residual hearing, their older 1J semi-curved electrode in a lateral (hugging the outside wall) placement was designed to be used with the positioner (which stopped being included after they resumed shipping c.2002). AB’s Helix array was designed for a perimodional placement (hugging the inside perimeter, close to the spiral ganglion). There is no evidence that the helix array does any more or less damage to the cochlea than any other array.  Some doctors or centres like to have a backup device with a 1J array when they are implanting a helix.  The helix array is slightly thicker than the 1J, so if the cochlea is narrower than expected, they can switch to the 1J, but that doesn’t happen very often.

Worse for AB is that AB’s chief electrode engineer, Janusz Kusma, was fired by CEO Jeff Greiner, putting them years behind MedEl and even Cochlear when it comes to low insertion trauma. AB has no other offerings, such as compressed electrode arrays for partially-formed or ossified cochleas: you either get a 1J or a Helix array.

AB’s processor is the largest of the three — about the size of the MedEl Opus 1.

MEDEL

MedEl is about 7 years behind AB on the electrode itself, with about 55,000 updates/second; but they only have partial current steering with their FineHearing; and an estimated 90 virtual electrodes with their triangular waveform. With the MedEl Sonata implant you’ll have 5-10 years of new stims still coming. Looking at size, the MedEl Opus 2 processor is much smaller than the N5.

The upside to MedEl over AB is their selection of electrodes for almost every type of cochlea imaginable; complete cochlear coverage and custom built electrodes that nobody else can do.

There is quite a bit of antipathy about MedEl. The issue is in the surgical placement of the electrode into the cochlea itself; and although there are similarities, there are also wide differences, especially when attempting a perimodional (vs lateral) electrode placement when threading it into place. What you want, especially for the tricky perimodional placement while trying to preserve residual hearing, is a surgeon with a lot of experience with that cochlear implant brand. MedEl’s processor and implant electronics are almost as good as AB’s; and their variety of electrode arrays is as good as, maybe even better than, Cochlear’s.

COCHLEAR

Bringing up the rear (from the implant electronics technology, working outwards) is Cochlear. They are hopelessly buried by competitor AB and MedEl patents. Because of this, even though they have a slick new N5 BTE with a remote control, they are still limited to the same 30,000 updates per second as they were over a decade ago. And, even though they have 22 electrode buttons, the best they can do is 43 virtual electrodes with current shorting — and they still haven’t released it yet!

The N5 is about the same as MedEl’s CI from 2006. Cochlear has almost nothing new. They have a huge marketing budget though so beware, not all that glitters is gold….

There is one area where the N5 is worth a very long, careful look: children. Even though the implant electronics are obsolete, the implant itself is quite robust, and with infants and small kids they can’t tell you if it’s not working properly. The Freedom 3G processor has a fingernail-sized LCD status display on it; while the N5 has a dual purpose (and bidirectional) remote control that also is a status indicator, duplicating the processor’s LED status lights. This is handy because a parent or teacher can simply walk up to the child with the remote, push a button, and get instant feedback from the processors and implants. This can be helpful when the parents themselves aren’t diligent in watching their children’s hardware.

SUMMARY

Best hearing performance – Only recently have independent comparative studies been published, and AB came out on top in all of them.

Best reliability – All manufacturers claim +99% reliability for the implant, but only AB includes the external processor in the calculation. AB doesn’t make a big deal about water resistance, but their warranty does cover water damage. Cochlear makes claims about water resistance, but their warranty does not cover water damage.

Best upgradeability – AB’s HiRes 90k uses about 25% of its capabilities. Cochlear’s implant is pretty much tapped out, while Med-El’s is somewhere in the middle. The implant is the part you plan to keep for a very long time. You can check out the US Patent and Trademark Office search engine and fill in the search box for a company name. Make sure to select ‘Assignee Name’ for the field. The results (Dec 2011);

Advanced Bionics, with 311 patents
Cochlear Limited, with 167 patents
Med-El, with 58 patents
Neurelec, with 0 patents

The numbers are even more skewed than they may appear at first glance. Cochlear is a larger company and has been around for a longer time than AB, so if you count patents per engineer, or patents per year, or patents per engineer-year, AB just dominates.

The T-mic – MedEl and Cochlear have their mics on top of the ear, like BTE hearing aids. But AB has the mic at the tip of the ear hook, which is right at the entrance to the ear canal. This means your ear shapes the sound normally. Most users find this works much better than the BTE mic (which is also included, and is selectable in software). And you can use phones and headphones just like a hearing person. It’s patented, so the other manufacturers can’t put the mic there.

Miniaturization of processors – AB was purchased by Sonovus, the holding company of Phonak, in January 2010. This means that AB is the only company with access to the super miniaturization technology and years of experience of a hearing aid company. And Phonak is among the best. While AB’s processor isn’t currently the smallest, look for excellent features down the road.

INDEPENDENT STUDIES

Spahr et al EH 2007 compares performance of  cochlear implants from Advanced Bionics, Med-El and Cochlear. (extract)

Audiology Online: “Preliminary Comparison of Performance between Patients Fit with the CII Bionic Ear and Patients Fit with the Nucleus 3G.” M. Dorman (Arizona State University), A. Spahr (Arizona State University) and K. Kirk (Indiana University School of Medicine), June 2003

In an independent study supported by NIDCD grant and contributions from all cochlear implant manufacturers, researchers compare performance between adults who use HiResolution sound and those who use the Nucleus 3 System. Results from the study’s first reported findings indicate that there “are differences in performance between patients using the two implant systems.” “Significant differences in performance (p < 0.05) were found between subjects in four test conditions.”

Cochlear: Performance comparison study – comparison of speech recognition for recipients with CI technology from AB and Cochlear Jace Wolf Ph.D., Hearts for Hearing, Oklahoma City, OK, USA.

With thanks to surgeons Professor Saeed and Dr Jeremy Lavy, speech therapist Liz Stott, audiologist Eilene Dyason; Howard Samuels, BEA Mentor and software engineer; numerous other individuals who have been very helpful; Advanced Bionics, Med-El, Cochlear.

212 responses

3 03 2010
Jackie Lewis

Tina,
I am in awe of your research posted!I am also impressed with the amount of time you dedicated to this project but also to the caliber of information that is here. I will bookmark this site to share with others I may come across on their journey for a CI.
Thank you!!!!
Jackie Lewis

15 08 2011
Donna

Wow! How blatantly obvious is the bias towards AB on this site?!?! Given about 7/10 people choose a Cochlear device and given that Cochlear is a financially stable company who haven’t had an implant recall ever (unlike AB and Med El), I am really glad I chose Cochlear for my implant! I notice this information isn’t shared for this very important question. I think its also important to think about who is going to be around to support you with your implant for your lifetime. Given AB keeps being sold off to the highest bidder, I feel very comforted that I have a Cochlear device and would never consider AB! Just read the FDA website on AB’s products if you are not sure which brand to go with! You won’t pick AB!! Go with Cochlear or Med El – at least they have been around for a long time and likely to be around for a long time. AB are firing staff and hearing aid people are taking over – its not a good situation!

15 09 2011
Admin

Actually Donna, I am not biased towards AB when presenting facts. I wear an AB device so my personal story is about learning to hear with an AB device. 7/10 people choose Cochlear because Cochlear has been around for longer, and they did have a recall around 2004, and have now called another recall. It’s interesting to note that you tell other people what brand to go for. I’m sure they are able to consider all the facts and make up their own minds, so why don’t you allow them to do that? As a Business major, my evaluation is that AB will be around for a long time, they have a diversified product base and a good strategy. Restructuring is a natural and beneficial result of a takeover.

It’s always better to take a rational, considered and objective view of a medical device rather than an emotional one.

18 02 2014
Sam Spritzer

Donna…Just because Tina wears AB doesn’t necessarily mean she is biased towards it. She is also a co-author and contributor to the website cochlearimplanthelp.com. This site has received accolades for being one of most unbiased and accuracy.
Have you seen recent news about Cochlear? Here is one…

http://www.brw.com.au/p/tech-gadgets/cochlear_banks_on_spending_to_recover_E7qCNJxuDb4Vb9H19TlzRM

and here is another

http://www.4-traders.com/COCHLEAR-LIMITED-6491483/news/Cochlear-Limited–COH-Jury-Trial-Verdict-on-USA-Patent-Infringement-Case-17838653/

Both are very recent….
Sam

11 07 2014
sandy

7/10 people might chose cochlear because of the fact that AB does not have any warrantee to speak of right Donna? This is the hardest decision I have had to make and I think I will go with cochlear they have an excellent warranty and this site is very biased I am mad that I read all this and took it as fact! The crap about upgrades is pure fabrication as far as I can see and what I have heard from the people in the medical field. Thanks Donna!

11 07 2014
Tina

Hello Sandy

Sandy, thank you for your comments.

All the information on this site is correct and has been checked with manufacturers and audiologists. There is another site that is more up to date though, which includes warranty information. Do check it out.

https://dl.dropboxusercontent.com/u/84378947/CochlearImplantShoppingGuide.pdf

19 01 2013
Scott Rinehart

I am an employee of Cochlear and bilaterally implanted myself. While I commend your enthusiasm to do research and convey information to those with hearing loss, I must say that many of your assumptions about Cochlear’s device are incorrect. For instance, you are correct in the specific pulse rates for the three companies, but did you realize that the the speed limitation is not with the technology but with the hearing nerve itself. Once the nerve fires there is a recovery period before that area of the nerve can fire again, so even if you stimulate a million times a second, the nerve won’t send information to the brain at that rate. Cochlear has done extensive research to maximize the correlation of electrode pulse to the nerves ability to send information. If you like fast cars, a good analogy would be having a super fast Ferrari in a stand still traffic jam. The other cars limit the speed of how fast your Ferrari can go. If fact, a bicycle will actually get you where you need to go faster and more efficiently than the Ferrari. You are right that technology is important, but remember if that technology doesn’t accurately match the need then it isn’t going to be as helpful. In Cochlear implants the need is hearing performance and Cochlear has proven that people will have equal or better hearing performance as every other company…not only that, they can do so using significantly less power. Meaning you hear well and your batteries last much longer.

19 03 2010
Julie Robbins

I did add your blog to my post…I apologize for taking if off your w/o permission. I love all the information you put together. Great job! Love your blog.

15 07 2010
Joel Saren

As someone who will be new to CI (November 2010), I can’t tell you all how much I appreciate your candid remarks and information. I will be having the surgery at MEEI, Boston and feel much better about having someone drill a hole in my skull, since I’ve read everything that everyone has sent to me.

I am leaning to AB for the device.

Joel

15 10 2011
Karen

Joel,

How is it going with your CI. I am in Dallas and getting all the test run to proceed with a CI soon. I am excited seeing all the positive blogs about CI. I know it is an adjustment, but praying it will all go smoothly.

I am leaning towards AB as well. I have never done great with BTE hearing aids and always ended up turning them in after 3 months trial. I think a lot of my last experience had to do with my audiologist. After I received the aids, she did not think she need to spend any time adjusting. I am not using that audiologist anymore.

Anyways, hope you are adjusting well,
Karen

13 12 2012
Hanna Webster

Hello Karen,
~ I am also in Dallas, and would so much appreciate getting first hand info about an implant. My hearing has taken a dramatic downward spiral and it seems I am now a candidate for the surgery. But the info out there is overwhelming and it would be nice to speak with someone who has a bit more time in … Thanks !!!

27 07 2010
Elaine

Fantastic Stuff! Can I add this to my blog?

27 07 2010
Funnyoldlife

Hello Elaine, feel free to add a link on your blog. Thanks for the nice feedback!

11 08 2010
stuart

Just thought i would pop on and ask how you are doing ?

Take care

CJ

15 08 2010
Suma

Thank you very much for such an informative blog, full of facts, I am so gald to have reda this, but need to go over again as it is quite complicated!!

17 08 2010
David Lawson

Wow. That’s really useful info.

Thank you for spending the time to put that together.

18 08 2010
Catherine Mellor

Tina, you have done wonders with this website, especially this report and I could feel my awareness of CI’s expand from reading this. Do you have some kind of electronic training or did you very patiently take apart the tech-speak and present it in layman language? Either way it was a good crunchy read. When I was reading the promotional material for AB and Cochlear, I chose AB simply because they could use two electrodes at a time, whereas Cochlear could only use one. In math 16 choose 2 is 120, and that sold me. And from reading this report that you compiled, I can walk away patting myself on the back! Thanks. I have bookmarked this page.

19 08 2010
Dan Schwartz, Editor, The Hearing Blog

Catherine, you chose wisely, as you’ll have many years of software and processor improvements that are already in development. As you may know, Phonak (OK, technically Phonak’s holding company Sonovus) bought Advanced Bionics in January; so over the next 3-5 years watch for Phonak technology to be integrated into the AB processors.

Key to this technology is that AB can fire as many as all 16 electrodes at once, which allows for things like current steering. With current steering, you get the intermediate pitches, allowing all 88 keys on a piano to be heard. With Cochlear, it can only fire one electrode at a time, so all you get to hear for the rest of your life is 22 piano keys. Period.

15 10 2010
Andy Paterson

As with everything in life, this is a very polarised viewpoint.
All the report you quote is biased towards AB – and its from an american.
I don’t totally trust politicians and I’m afraid without any democratic multiple opinions – I advise taking all the AB bias with a large pinch of salt.
Oh yes – why did AB need buying out anyway?

18 01 2011
Leah

Dan, this is completely inaccurate. Yes, Cochlear has the 22 real electrode array design, the most electrodes available from any manufacturer and the right length for maximum protection of the
delicate structures within the cochlea. AB only has 16 electrodes, and MED-EL has 12. For the Nucleus 5, the Average pitch perceptions demonstrated by research is 161. AB reports 120. MED-EL does not have any reported data.

The source of the research findings is published in two places:

Cochlear update March 2006. Pitch steering with sequential stimulation of intracochlear electrodes. Cochlear white paper 2006

Kwon J et al. Dual-electrode pitch discrimination with sequential interleaved stimulation by cochlear implant users. J Acoust Soc Am 2006 Jul;120(1):EL1-6

18 01 2011
Leah

I located the White Paper PDF for you to read: http://professionals.cochlearamericas.com/cochlear-products/nucleus-cochlear-implants/software-and-programming/custom-sound/pitch-steering-seq

Dan, you can read the data and interpret it for me in layman terms with your analytical engineering skills, but please don’t make any exaggerations or inaccurate interpretations.

Two electrodes ARE activated at a time. With my over 18 years of experience with being mapped, I’ve found that the less pitches I hear (say 161 vs. 127), I discriminate speech much better at a slightly lower number.

I asked my speech therapist yesterday what she thought of Advanced Bionics. She said that her kids do really well with it. Most of her kids wear Cochlear because they’ve been around longer, but both are really good products. 120 (AB) and 127 (Cochlear) discriminable pitches are darn good.

16 10 2010
Howard Samuels

Hi Catherine,

That’s right – 16 choose 2 is 120. If the HiRes90k were able to turn on any pair of electrodes at a time, that would be the maximum number of combinations available. In fact, each electrode has its own power source, for a total of 16. And in Fidelity 120, only four electrodes are used at at time – two pair, in a round-robin manner. So the potential for many more virtual electrodes is built into the implant; the scientists need to figure out how to use that potential.

One of the challenges is that when a nerve is stimulated, it takes a certain amount of time to recover and prepare for the next stimulation. By including much more ability in the implant than the scientists know how to use today, AB made sure that current recipients will be able to take advantage of advances for decades to come.

Cochlear’s single power source is shared among all of its electrodes, and it is more than sufficient for good speech recognition. I do hope that Cochlear develops an implant with independently-controlled power sources for each electrode so they will be able to provide excellent hearing for their future recipients.

27 12 2010
Melissa

Hi everyone , I have just been told by my Implant center in the U.K. that I am to go through for surgery in Feb 2011. I wanted the AB system but as we all know this has been withdrawn at present.

My second choice was the Nucleus 5 system. I have read that AB do not have an electrode array for mal formed cochlea. I have been diagnosed with Pendreds syndrome and have 1- 1/2 to two turns at best. ( According to my Audiologist)

My Question is should I wait for AB to come back on line ? Also funding for the surgery could be affected If I wait after March 2011 as the local Health Authority will be finding it?

HELP?

27 12 2010
Dan Schwartz

Hi Melissa!

Tina asked me for help on this one, so here goes. Please take the time to explore all of the carefully selected links I provide, as they will give you valuable information. The links are bolded, to make them easier to spot.

With that in mind, here goes…

A partially formed cochlea is actually Mondini’s SyndromeKatie-louise “Bionic Bailey” has this, hers caused by the Brachio-Oto-Renal (B-O-R) genetic defect. The CI surgeon really needs to look closely at the hi-res CT scan (64-slice or better) to determine exactly what he’s getting into, as “…and have 1- 1/2 to two turns at best” will make quite a difference as to electrode placement. Cases like this where the surgeon placing the electrode earns his pay, so you want the best one you can find.

Pendred’s Syndrome is a different beast, manifesting itself with symptoms like EVAS (LVAS) but also involving the thyroid. It is important to note that Mondini’s cochlear malformations can occur alongside Pendred’s, which may be what you have.

Cases like this are the reason no CI center can be strictly AB: They only make two 25.4mm electrodes — Lateral (floating placement 1j semi-curved, and Helix (perimodiolar; i.e. hugging the inside perimeter wall) — for normal 2-3/4 turn cochleas, which is about 95% of CI’s. If you need any other electrode, such as a shorter one for Mondini’s or a hybrid hearing aid-CI (electroacoustic stimulation) or even a split one for badly ossified cochleas (after meningitis or when otosclerosis spreads into the cochlea), a CI center must also carry and support MedEl &/or Cochlear, as they will make a custom electrode array for a patient, as well as them having a library of designs & fixtures.

Irrespective of the funding deadline vs AB’s return to production, you’ll still need to go with MedEl or Cochlear anyway, to get the right electrode for the job. Yes, the surgeon can try to thread (force) a 25.4mm (1.0 inch) AB or Nucleus electrode all the way in; but there is a big risk he will pierce the basilar membrane, as the scala tympani narrows down to a point as it spirals inwards. When the basilar membrane is pierced, the perilymph and endolymph fluids mix together, destroying all residual hearing. To see the electrodes MedEl builds, go to:

http://www.medel.at/english/30_Products/01_MAESTRO/Cochlear_Implants/08_Advanced_Electrode_Design.php

The MedEl EAS and FlexEAS are 18mm long, with the 12 electrode button pairs more closely spaced together than their standard and FlexSoft 31.6mm arrays. They also make their “compressed” array as a stock item, which is — I believe 11mm (but I could be wrong).

I’ve been told by another Electrical Engineer (who has performed more advanced electrctromagnetic calculations than I have!) that the 1.5mm (0.060 inch) electrode button spacing AB uses is just about optimum. MedEl’s standard spacing is about 2.5mm, so their 18mm EAS array is right about the optimum 1.5mm spacing.

In addition, AB’s SoundWave 2.0 programming software has what I consider a serious shortcoming: The MAPs it creates cannot be shifted in frequency placement without shutting off electrodes. If the surgeon hits his marks and verifies electrode placement before closing with a CT scan or even an X-ray, then all will be reasonably close. When the electrode buttons are properly placed, voices will sound about like a robot when switched on, and this will lead to faster auditory rehab, especially for those who are postlingually deafened and/or try to use a hearing aid on the other ear (so-called “bimodal” use; not to be confused with hybrid EAS on the same ear): This is called a “tonotopic match” and can be seen on the Greenwood chart at the bottom of this page:
MedEl also has an excellent Greenwood diagram of a normal cochlea at the bottom of this page:

http://www.medel.at/english/40_Professionals/Complete_Cochlear_Coverage/Prospective_Benefits.php

If the electrode is not inserted deep enough, then speech will sound like the speaker had just inhaled helium (“Donald Duck” sound), or worse, be extremely high pitched and more difficult for the brain to comprehend — It will eventually adapt, but it will take longer and take more extensive auditory therapy. AB’s Soundwave 2.0 can .NOT. compensate for tonotopic mismatches… MedEl’s Maestro 3.0 software (released in Summer 2009, right as I visited their US HQ on the way home from HLAA) can… That is, if the CI audie has sense enough to adjust these advanced controls, which sadly many in the US are totally clueless to even knowing they are there. [In fact, the MedEl Maestro 4.0 software I saw at MedEl in beta goes even further, allowing the center frequency and now the filter cutoff frequencies (bandpass filter skirts) to be adjusted, for the Really Heavy Duty CI Geeks; but I digress].

Now, you’re probably wondering what this has to do with your Mondini’s causing you to have 1-1/2 to 2 turns, instead of the normal 2-3/4 turns… And the answer is everything.

If you go back to the Greenwood (tonotopic pitch-placement) chart at the bottom of this page:

http://www.medel.at/english/40_Professionals/Complete_Cochlear_Coverage/Prospective_Benefits.php

you’ll see that the normal CI software from AB, MedEl and Cochlear is pretty much optimized for a normally formed cochlea, and in fact AB’s SoundWave 2.0 can’t really be adjusted for tonotopic mismatches… MedEl’s Maestro 3.0 & up (and Cochlear’s Soundscape) can be adjusted.

The real crapshoot for malformed cochleas is that there really are no Greenwood charts, as we really don’t know in these cochleas where you perceive each pitch relative to the location: This will make adjustment even more difficult unless there’s some trial-and-error during the fitting process, where what you hear electrically needs to be compared to your residual hearing (if any) in your other ear, and manually match them.

So there you have it: With Mondini’s, you’re better off with MedEl or even Cochlear due to their various electrode designs and better, more flexible MAP software.

Cochlear also makes a shorter array for EAS, but like all Nucleus implants it does NOT have the capacity for current steering (which is a major limitation as you don’t get virtual electrodes); and in addition their EAS arrays only have 8 or 12 electrode buttons giving only 8 or 12 channels… Not Very Good. AB calls their current steering Fidelity 120, for the 120 virtual channels it delivers over the 16 electrodes… but only when turned on by the CI audie. MedEl also has a more basic form of current steering, but it also provides for 90 virtual channels. Cochlear’s implant electronics deliver 22 real channels, with no capacity for virtual channels… Sorry.

Lastly, there is an issue of production lead time for a custom electrode, if one of the off-the-shelf arrays can’t fit the bill: For the USA this is about 7 months, as first the design must be submitted to the Food & Drug Administration (FDA; “Foot Dragging Authority” bureaucracy) for design waiver approval which takes four months, and then it’s released to production in Innsbruck, which takes about 11 weeks, partially due to pressure testing and burn-in. [And, we all know what happens to a CI when an improper burn-in schedule is used: Infant Mortality Failures leading to recalls.

For the UK, which uses the worldwide CE marque instead of the more stringent FDA regulations (though CE is tightening them down to almost-FDA levels now), I do .NOT know what the specific regulatory requirements are for custom implant arrays, and hence the delay to UK Red Tape — It might be nothing but a rubber-stamp (if at all); or it could be months. That is why, with cutbacks looming large in March, you get your CI as quickly as possibleb>, else the door slam shut, leaving you deaf like you would be in New Zealand.

Most likely the MedEl Maestro CI system with the SonataTI-100 implant package & 18mm EAS or FlexSoft EAS electrode array will turn the trick. You’ll also like their Opus2 speech processor, as it’s atually a bit smaller than the Nucleus 5 processor; and much smaller than AB’s Harmony processor.

27 12 2010
Melissa

Dan,

Thankyou and again thankyou for your response even on Boxing day!!!

You have helped me with regard to which implant. Due to the reasons of tonotopic matching I will rule out the AB system. Interestingly, my sister was fitted with the AB system and she was not able to tell the difference between male and female voices for well over 1 1/2 yrs. Your comments have helped me to understand why this was the case.

You have suggested the Med-el over the Cochlea system is this due to the fact that the implanted electrode array is faster and able to provide a greater degree of fine structure as opposed to the Nucleus 5 ?

Both manufacturers offer various arrays for mal formed cochleas, But I am getting the feeling that Med-el would be able to offer more prgramming flexability for the Audi, to help with tonotopic issues. Also that the Med-el would have the potential to offer more auditory definition compaired to the Cochlea array. Im I correct in my thinking?

Regards

Melissa.

27 01 2011
Robyn Carter

[edited]You can get so caught up in the technical details, that you forget that all 3 brands work extremely well, with no brand performing better over another in any test. So you can’t say one brand is better than another.

They simply all work differently.

27 01 2011
Funnyoldlife

Robyn, there’s no need to be rude.

All 3 brands do work very well for speech, and they do work differently, and people are different too. It is very difficult to compare them on an equal basis. In studies, AB has in fact been proved to outperform other brands.

27 01 2011
Robyn Carter

[Edited]
Like Andy Paterson said above, this whole chart is very obviously polarised and biased, and people should be very careful to do their own research than to take this as being correct.

Cheers
Robyn

27 01 2011
Howard Samuels

Hi Robin,

Tina put this together as she was researching which implant to get for herself. She is a very intelligent woman, and did a great job distilling all sorts of different inputs. Everybody has their own specific needs and desires, and chooses their brand accordingly. Clearly Tina felt that AB was best for her, and she took the additional effort to post her comparisons for others to read. She does point out advantages and disadvantages of each implant. Wouldn’t it be odd for her to choose a brand that she didn’t think was best for her?

Just as we don’t all buy the same car, we don’t all choose the same implant. And I’m sure we all have reasons why we chose a particular car over other cars. So I don’t think this section is biased; it reflects the thought process of somebody who did their research and settled on one particular brand.

27 01 2011
Robyn Carter

Hi Samuel,

I applaud Tina for reaching a decision for the brand she chose. I have no problem with the AB brand. Any implant is better than no implant. All three brands work and have great results. I am not into brand wars.

The problem I have is when information is available on the internet which has misinformation in there, which is why I hope this comparison chart is not taken as gospel, and that people do their own research.

However, I got this from a a professional and it should be posted here to correct the information in the actual blog itself…

The single power source in the Nucleus implant is intentionally designed this way to enable Nucleus users to take advantage of BOTH high quality hearing AND optimal battery life. No other brand compares with the great battery life Nucleus recipients enjoy. Nucleus processors can be programmed to use simultaneous strategies like the fixed rate ones used by AB and MedEl, stimulating 4, 8, 16 channels at a time. These programs are power hungry. Cochlear had designed the roving strategies (Mpeak, Speak and Ace/Hi Ace) to essentially bring about the same effect that stimulating all electrodes at once does. With Cochlear’s strategy, electrodes are stimulated one-at-a-time in milliseconds, so fast that it’s comparable to them being stimulated all at once. An illustration of this is the TV screen – It has 21 lines across it that are projected so rapidly (‘milliseconds) that it gives the appearance of being displayed all at once. What Cochlear has been able to accomplish using this type of stimulation is to reduce background noise considerably by selecting ‘maximas’, a group of electrodes programmed to be stimulated according to the most dominant sounds in the environment. This group of electrodes is constantly being analyzed for selection by the Nucleus roving strategy that sweeps the array (in those ‘milliseconds) and chooses the optimal electrodes to stimulate to provide the best sound quality while discarding stimulation of unnecessary/undesired sounds. This is how Cochlear is able to develop those wonderful listening strategies that help us in background noise and otherwise optimize our listening experiences with other unique program options. The Nucleus array is patented and no other manufacturer can duplicate it. Fixed rate strategies like AB and MedEl use are public domain, developed by researchers using government funding so available to all (‘CIS’ – remember, Cochlear can run a CIS (fixed rate) strategy, too but few people want this as the ACE strategy is very effective and capable of so many variations in listening program options).

Cochlear recipients enjoy and continue to benefit from the smallest speech processors (N5) and accessories like the two-way remote control that the other manufacturers haven’t come close to designing – this is possible because of the internal array not having the heavy power requirements the other devices need to function. We don’t need a power hungry electrode design to enable us to hear as well or sometimes better than people who have competitive devices – and of course, all these improved speech processor advances (and new listening strategies such as sensitivity and ADRO) are backwards compatible for all Nucleus recipients.

.

1 04 2011
Dan Schwartz

Miss Robyn Carter wrote,

The single power source in the Nucleus implant is intentionally designed this way to enable Nucleus users to take advantage of BOTH high quality hearing AND optimal battery life.

This is a classic Microsoft Windows excuse:
It’s not a Flaw, It’s a Feature!

Unfortunately, Miss Carter leaves out two critical facts in the “opinion” cited above:

1) Both the MedEl and Advanced Bionics implants can be programmed to slow down to the 30,000 update/second rate and also fire one electrode at a time, which will yield the same power consumption applied to the stim. In other words, Yes, the MedEl and (especially) AB implant circuits are going to draw more power, because they are firing multiple electrodes to provide current steering… Because they are doing much more because they have the capacity to do it for better hearing.

2) Cochlear cannot use current sources for each electrode even if they chose to do so: They are locked out by AB’s & MedEl’s worldwide patents (intellectual property). And, as I stated above, even with separate current sources, the stimulations used by Cochlear would draw the same amount of power regardless of their being one or 22 current sources, as only one would be in use at any given time.

Lastly, there seems to be a question of the optimum number of electrode buttons on an implant: If they are too close together, channel interaction will occur, causing tones to get mixed up as the electrode stimulates the wrong nerves (see below). On the other hand, three of the five CI manufacturers — Advanced Bionics, Neurelec, and Viaphonix all use a 25.4mm (1.0 inch) electrode with 16 contacts, as this provides for the optimum spacing.

Now, on to channel interaction caused by the CI512′s electrode contacts being too close together…

Daniela Andrews of Melbourne, Australia is a musician and music teacher who lost her hearing four years ago; and 12 months ago received simultaneous bilateral Nucleus 5 CI’s. [Her long story is here.]

Because of her musical background, Daniela became involved with the groundbreaking Bionic Ear Institute “Interior Design” concert.

With that background, from section 3: Playing Music of Listening to music with a hearing loss, I quote Daniela:

“At first, the piano sounded terrible. Like somebody had broken into it while I was in surgery and mixed up all the notes for fun. Playing scales barely resembled an up and down pattern at all. There were random low tones in between higher ones, and vice versa. Being simultaneously implanted brought another challenge – each processor rendered two different tones for the same note. Familiar songs sounded alien-like with all these extra wrong notes thrown in. How was my brain ever going to make sense of that mess? But I brought it back to basics, bit by bit, day by day: chromatic scales starting from the first note on the piano and moving up towards the end of the piano, semitone by semitone. Every time a note did not sound like it should, I’d stop and play the two notes either side over and over again until my brain rendered the pattern properly. Then I’d continue with the scale. Eventually I could make it all the way up the piano without stopping. Each processor was playing back one tone, the same tone, when I pressed a key. The piano sounded melodic again. More importantly, it was fun again.”

[The entire article is quite good, so you may want to read it in its’ entirety.]

You probably noticed I bolded three passages:

At first, the piano sounded terrible. Like somebody had broken into it while I was in surgery and mixed up all the notes for fun. Playing scales barely resembled an up and down pattern at all. There were random low tones in between higher ones, and vice versa.

These two passages perfectly illustrate inter-channel crossover, caused by the electrodes being spaced too closely together, stimulating the wrong nerve endings…

Being simultaneously implanted brought another challenge – each processor rendered two different tones for the same note. Familiar songs sounded alien-like with all these extra wrong notes thrown in.

Here, Daniela accurately described binaural diplacusis from her simultaneous implanting, which is exacerbated by the inter-channel crossover from the Nucleus 5 interelectrode spacing.

Dan Schwartz,
Editor, The Hearing Blog

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3 04 2011
Anonymous

Dan,

You misread the article about the woman playing the piano. She said, “At first…” the piano did sound terrible. She no longer has the issue of hearing the piano as if it sounds terrible. Music sounds normal again as she stated, “Every time a note did not sound like it should, I’d stop and play the two notes either side over and over again until my brain rendered the pattern properly. Then I’d continue with the scale. Eventually I could make it all the way up the piano without stopping. Each processor was playing back one tone, the same tone, when I pressed a key. The piano sounded melodic again. More importantly, it was fun again.”

This has nothing to do with whether it’s because of Cochlear or not. EVERY recipient, regardless of what brand they choose, who had normal hearing and then become deaf later in life have this same experience. They go through this experience simply because their brain had to be rewired to learn to hear with a bionic device rather than normal hearing.

As for this quote, “…each processor rendered two different tones for the same note. Familiar songs sounded alien-like with all these extra wrong notes thrown in.”

This woman was hearing differently in each processor not because of how Cochlear’s electrodes are designed. It’s simply because the placement of electrodes in her cochleas are different, hence why mappings are totally different in each ear.

3 04 2011
Anonymous

I should add that while surgeons try their best to place the electrodes in the exact same position for both ears, it’s almost impossible because the array are so thin. Also, I’ve heard that people who have an internal implant failure and are reimplanted with the exact same internal implant including the exact same generation, even have to relearn how to hear with their reimplanted device due to the electrode array being place differently in the cochlea. So, what I’m saying is that the design of the internal is not the only thing that impacts how the brain hears, but also the placement of the electrode array in the cochlea can impact the way the brain hears too.

25 04 2011
Michele

Is this information from a Cochlear America technical rep? I too am researching which CI brand is better for me and it is overwhelming. One day I think I am closer to a decision then I read something new and am not so sure. I did read that Cochlear was behind AB and Med-El in research/updates so at this ooint not sure what is the most important thing to look at.

26 04 2011
Tina

Hello Michele,
Robyn has taken her information from a CI rep (Cochlear) however I much prefer to do my own research and look at the products from the inside out, which I explained on this page. Your choice of brand really depends on what you are looking for, what is important to you, what your values are. For me, it was current technological ability, ability to hear music, and future possibilities for technological developments and a smaller size, so I chose AB as it has only used 50% of its operating capacity, it is great for music, and it has merged with Phonak who specialise in making hearing aids smaller. Med-El is great if you require specialised arrays.

All CIs are good and all will give you the ability to understand speech, but I would advise you to think long term as you will have your CI for life (hopefully). Why not join Hearing Journey, introduce yourself and your hearing, and ask away. You’ll be inundated with answers. http://www.hearingjourney.com/

26 04 2011
Anonymous

Michele,

While Tina suggested you to visit http://www.hearingjourney.com which is part of Advanced Bionics, I thought you would also like to know about Cochlear Community at http://www.cochlearcommunity.com which is part of Cochlear and Medel also has their own support group called HearPeers and they’re coming out with revamped site soon – http://hearpeers.com/ . With both of these support groups, you will be able to meet several recipients and they will be able to share their experiences with Cochlear or Med-el cochlear implants.

Also, another website has a comparison chart that might be helpful – http://cochlearimplantonline.com/site/?page_id=2359

28 04 2011
Tina

Anonymous, I recommended HJ as it is universally acknowledged as the best resouce for advice – an enquirer will get the quickest response and the widest variety of responses. HJ is sponsored by Advanced Bionics but is open to (and populated by) users of other brands, who interact with the discussion board on a daily basis, unlike other discussion boards.

The comparison chart you mention has some errors.

4 10 2012
Jerry

I applaud you Robyn. I have never seen so much mis information. All three have their unique qualities. Ashame one would go to this much effort and the information is false. By no means make your decision from this blog alone. There are many better sites with open and “Honest” information. Best to you.

4 10 2012
Tina

Jerry
You are right in saying they are all different. But why would anyone go to all this effort to post false information? All anyone has to do is to either show this information to their audiologist or do their own due diligence, and they will see that this is an unbiased collation of facts. My audiologist is a well respected professional in her field and she says this is a good blog. I have actually asked her to correct me if any of the information here is incorrect.

If there is any misinformation here, I’d be very glad to correct it. Would you care to enlighten me as to the ‘mis information’ you refer to and to the better sites with ‘honest’ information? I’d be very interested to know!

28 01 2011
Howard Samuels

Hi Robyn (please call me Howard),

I agree, everything you read on the Internet has to be taken with a grain of salt!

The professional who sent you that information sounds like an employee of Cochlear. I’m sure that each manufacturer would like to portray its products in the best light possible. We’re fortunate that multiple companies are competing to make better implants for us all.

10 03 2011
Catherine Mellor

Reinstating my subscription to your blog.

3 04 2011
Robyn Carter

Dan,

First off, I may of written that, but I quoted from a professional, so much as I would like it to be, you’ve quoted me wrongly.

Secondly. I too am a pianist. At first the piano sounded awful to me too. But we have to remember that the implant has been designed for speech, not music, which is much more complicated. After playing a tune, or a piece of music over and over again, (or a scale), the music eventually over a short period of time, began to sound normal to me again. This has nothing to do with the channels, but of the brain relearning the sound through the implant.

With my second implant after my failure, I had to relearn everything again because the electrode placement wasn’t in the same spot, but because my brain had done it once, it was a much quicker process.

Any problems can be discussed with a professional cochlear implant audiologist, and can usually be mapped out at the next mapping.

I enjoy the piano again, and it sounds wonderfully normal – like it used to when I was growing up before my hearing loss got profound.

The same can be said for learning to use a phone again, to learning what sounds are out there (lawn mower). At first you don’t recognise the sound, but after asking, then recognising, the next time you hear it, the brain puts it in it’s correct context.

The brain has a lot to do with the cochlear implant success. Personally, I think you’re focusing too much on the technical issues, they may play a very minute part, but it’s the brain and how your brain works that will give you the ultimate result.

I will stand by my comment, that it doesn’t matter which brand you have, the results are much the same, and no implant stands out better than another one. They simply work differently.

Cheers
Robyn

15 10 2011
Dan Schwartz, Editor, The Hearing Blog

Robyn Carter: The issue of channel crossover has ZERO to do with the speech processor, or anything to do with the stim used. Instead, it is a function of the electrode contact spacing on the electrode array, and is something that is physiological.

Yes, through neural plasticity — and through much tedious auditory therapy (as Daniela Andrews describes) — Nucleus users can remap theor brain through “brute force to perceive music again… But this is a problem AB, Med-El and Neurelec users do not have to deal with, as their electrodes are spaced wide enough apart so that the electrical charges stimulate the targeted portion of the spiral ganglion from the pitch map, as seen on this tonotopic chart.

Dan Schwartz,
Editor, The Hearing Blog
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18 09 2011
Tom Taber

Hi. I’m new and I appreciate the information provided here. I have to say though that I did read the brochures from all of the manufacturers and the only thing that was consistent was the statement to the affect of: CI’s cannot restore ‘normal’ hearing-you will hear things differently as it is because of electrical stimulation, instead of the normal human hearing process. If someone is hearing “just like they did before the loss”, then I have to wonder what makes them different from everyone else. I’d like to have that ability too.

Tom

18 09 2011
Admin

I do agree with you there Tom. It is a very different sound and it was about 8 months before I was happy with it. I think when someone says they can hear like they did before, they mean they can hear as well as they did before, not that they are hearing in the same way.

23 09 2011
Manoj MP

good discussion ! But as a cochlear implant surgeon who has done around 500 implants in the last 9 years, I have to admit there is very little to choose when it comes to the big three- Nucleus, AB and Medel. We favor MedEL as the processor is small, has a chargeable battery, parents love it, it is cheaper than the other two and the processor has a tiny foot print. plus the dealer is good and all repairs are attended to immediately.
Manoj MP
mpmanoj@drmanojsent.com

23 09 2011
Tina

Hello, I always like to see a professional opinion! Thank you for commenting.

15 10 2011
Karen

I will be have a CI in the near future, and will later receive a second one. I am encourage by everyone blogging positive experiences. So I am concerned about wind noise.. My son plays the piano, and I sit down with him a lot and am concerned about Music. (loved the information about the lady working with the piano to tell the difference in keys)

I have been wearing huge in-the-ear hearing aids for years, so I am not really worried about how it looks, but I am concerned about comfort and future use.

Questions on different implants.

MedEl is the smallest internal implant, but it makes me nervous that you cannot change programs on the BTE external processor. I am guessing, I will loose or not carry the remote at all times. Do CI patients use different programs after 1/2 a year? The magnet in this implant does not come out. If you have a MRI, they need to remove the processor?

AB has the speaker in the ear. This sounds great to me, because I have never done well with BTE hearing aids. I picked up sounds behind me as loud as in front. Also, I had problems with dead space in front lower area where my children usually are. These issues could have been due to incorrect programing. AB is the largest external processor, and wonder if it will be comfortable. I am sure AB will come out with a smaller unit in the future. User can change programs and volume on external unit. I am leaning towards AB.

Cochlear has the smallest and nicest looking BTE external processor. User can also change channels and volume in external unit.

CI make me nervous in that there is no trial period, or switching manufacturers. As with hearing aids, each manufacturer publishes charts that says their product is the best in certain areas, a lot of those areas overlap. It does seem that everyone on your blog likes their choice, which is encouraging.

Thank you for this website! It is very encouraging and has a ton of information and links. My understanding has grown in the procedure, what to expect, and how to help make my implant the most positive experience.

15 10 2011
Howard Samuels

Hi Karen,

Congratulations on deciding to get an implant! It sounds like you have a pretty good idea what to expect, and also understand the options with a good amount of detail.

Wind noise can be a problem with any hearing aid or implant. AB’s T-mic has two interesting features regarding wind noise. First, your ear blocks wind from some directions (behind you) so it may cut down on the noise sometimes. Second, you can get a windscreen for a small lavalier mike from your local electronics store and slip it over the T-mic. It’s probably not something you would wear every day, but if you know that you will be spending some time outdoors on a windy day, it is worth considering.

You can switch programs using the program switch on the Harmony processor. But most people let AutoSound take care of adapting to the listening situation. With AB, it is automatic, and you don’t have to make adjustments manually during the day.

You are also correct about a new processor! AB is developing a smaller processor in conjunction with its new sister company Phonak. We are also excited to see how much of Phonak’s signal processing expertise gets into this new processor. Also, please check elsewhere on this blog about the Neptune waterproof processor from AB.

It’s an excellent point about not having a trial period with a cochlear implant – I never thought about that!

15 10 2011
Dan Schwartz, Editor, The Hearing Blog

Karen writes,

My son plays the piano, and I sit down with him a lot and am concerned about Music. (loved the information about the lady working with the piano to tell the difference in keys)

The issue of channel crossover has ZERO to do with the speech processor, or anything to do with the stim used. Instead, it is a function of the electrode contact spacing on the electrode array, and is something that is physiological. That you enjoy the piano is reason in and by itself to disqualify the Nucleus 5 system from your choices; and this is in addition to the lack of hardware support in the implant itself for current steering, which gives you about 90 channels for Med-El and 120 channels for AB.

The process of charge beam forming (which AB & Med-El less accurately describe as “current steering”) focuses the charge by simultaneously firing multiple electrodes to focus the beam on a small area of the nerve endings, which gives a purer tone — Think of a tightly-focused spotlight vs a wide angle floodlight — and less of a “spitting,” distorted sound.

Again — And I cannot stress this point enough — Even the new Cochlear CI512 implant (which has been recalled due to moisture problems) CANNOT perform charge beam forming due to the hardware limitations of the implant circuitry itself; — while AB and Med-El can

Yes, through neural plasticity — and through much tedious auditory therapy (as Daniela Andrews describes) — Nucleus 5 users can remap their brain through “brute force to perceive music again… But this is a problem AB, Med-El (and even Neurelec) users do not have to deal with, as their electrodes are spaced wide enough apart so that the electrical charges stimulate the targeted portion of the spiral ganglion from the pitch map, as seen on this tonotopic chart.

As for your choice between Med-El and AB, many surgeons are rightfully gun-shy about implanting the HiRes 90k, as they have been repeatedly burned, and lied to, by AB, claiming for the third time since 2004 that they have fixed the moisture impingement problem from poor quality control of the ceramic feedthroughs, along with other quality control problems they have refused to address, which I document in detail inThe Hearing Blog.

What is more, due to a 2006 US Supreme Court decision affecting medical device makers, they are now immune from product liability lawsuits as the Court has held that since the device is approved by the FDA, it is deemed “safe and effective.” The only way I would recommend an AB implant is if you can get in writing from AB an agreement that they waive their rights under this decision. [I forget the name of the decision off the top of my head;but it was explained to me by a CI litigation specialist who has represented over 100 patients with failed AB implants -- I'll have a blog article on it shortly.]

Dan Schwartz,
Editor, The Hearing Blog
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10 02 2012
Joanna

I have Medel’s leaflet in front of me. It states that the the Concerto titanium implant supports 250 spectral bands, Not 90 as you say, whereas AB has up to 120 bands(according to AB’s leaflet which is also in front of me). Cochlear also supports 180 spectral bands but I am not sure on that(I was told that by a Medel representative who made a comparison between Medel v Cochlear).
Also, Medel has 24 electrode contacts, being placed right and left, making 12 pairs, and giving 12 stimulation channels.
AB has got 16 electrodes straight line, giving 16 stimulation channels.
Cochlear has got 22 electrodes (and two more spare) straight line, giving 22 stimulation channels.
So why is AB the best??? Unless of course if Medel and Cochlear give false statements and write lies. And only AB tells the truth about technical features.
In Europe, Cochlear is more expensive, then Medel, followed by AB. But I don’t think that price has anything to do with quality. I really believe that all three are good, so stop giving incorrect information. It seems that you are biased.

11 02 2012
Howard Samuels

Hi Joanna,

You are doing the right thing to research the difference between the available options, since the implant will be with you (or a family member) for a long time. Shopping for an ear is really much more important than shopping for, say, a car.

It is very frustrating that we have to rely on marketing material from the vendors. It would be much easier if there were disinterested third parties who you could turn to. You’ve found Tina’s blog, which chronicles her research from when she was choosing her own implants. Maybe it isn’t 100% accurate, but it is quite an impressive achievement, since the information that was available to her is pretty much the same as what you have.

Regarding spectral bands, there are several points along the signal chain where they can be defined. I’m afraid that each manufacturer chooses a definition that puts them in the best light possible.

Medel has 12 current sources which drive the 24 electrodes. Each current source drives two electrodes. The audiologist can choose the spectral band, or center frequency, of the electrode that provides the lowest frequency information. Likewise, the center frequency of the electrode that provides the highest frequency information can also be selected. And there are several ways to distribute the intermediate frequencies among the remaining 10 electrode pairs. All told, there are 250 spectral bands available. That is the number you see in the brochure. Of those 250, the audiologist effectively chooses which 12 bands will be used for a particular program. So your program will only have 12 spectral bands, even though there are 250 to choose from. Each band does overlap the others, and most users perceive more than 12 pitches. But the implant is only presenting 12 bands to the user. The hardware appears to be capable of creating virtual pitches between the physical electrodes, but an algorithm that takes advantage of this capability is not currently available.

AB has 16 electrodes, and each one has its own current source. It is tempting to say that the implant creates 16 spectral bands. But the current software assigns pitches that fall in between two electrodes partly to one electrode, and partly to the other. The perceived pitch is closer to the electrode with the stronger signal. Current software uses only 3 bits per electrode pair, making 8 possible pitches per pair. 16 electrodes have 15 pairs, so 15*8 = 120. That doesn’t mean that every user will perceive 120 pitches. In a study of 57 ears, the range was 8 to 466 pitches, and the average was 93. Based on that study, AB developed Fidelity 120. My experience when being upgraded to Fidelity 120 in 2007 was that music, which was formerly mush, unless predominantly rhythm, became instantly more enjoyable and recognizable. I went from guessing perhaps one song per week to being able to ‘name that tune’ in just a few beats. While AB doesn’t advertise it, the hardware has 8 bits of amplitude information per channel, so those 8 frequencies per pair can be as high as 256. The maximum number of virtual electrodes is 15*256 = 3840. I’m not saying that we will all hear 3840 distinct tones, but that is likely more than people with normal hearing can discern. AB has not developed an algorithm that takes advantage of that number of spectral bands. But if they do, it will only be a software upgrade for people who have the current or previous generation of implant.

Cochlear has 22 electrodes, but only one current source. The additional two electrodes you mention are ground electrodes. They are the most important ones in the system. Without them, the implant will not work. All implants have ground electrodes. As a side note, one of the two electrodes (the MP2 electrode) fails on some of the implants. Sometimes it fails even before the surgeon implanted the device. The implant will work with only one ground electrode, but there is no backup for it. Cochlear sent a letter to surgeons and audiologists basically leaving it up to the doctor’s discretion whether to leave a faulty implant in the patient, or to swap it out for a good one, even while the patient was on the operating table. This problem has nothing to do with the recall of the CI512, the implant part of the Nucleus 5 system. I sincerely hope that the company takes the opportunity of the recall to fix not only the hermeticity problem, but also the ground electrode problem. Ask your doctor about the MP2 electrode issue.

The single current source fires one electrode after another, but it cannot fire more than one at a time. Cochlear did a study on just 12 ears to determine whether stimulating one electrode followed by another in rapid succession can create additional pitch percepts. This is like the perception of a moving picture created by a succession of still images. The study concluded that an average of 161 percepts can be achieved. However, the company has not released an algorithm that utilizes this effect. In fact, the test was done using one pair of electrodes at a time, as did the AB study. But unlike the AB study, the hardware is not capable of the processing speeds required to run a real time algorithm that creates these additional pitch percepts.

So for MedEl, spectral bands means the number of center frequencies from which 12 can be chosen for a particular program. For AB, spectral bands means the number of virtual electrodes created with the current version of software. And for Cochlear, the definition seems to be the 161 pitch percepts in the demonstration program that used only two electrodes at a time, but is not available or possible with the current hardware.

21 10 2011
Robert MacPherson

“many surgeons are rightfully gun-shy about implanting the HiRes 90k, as they have been repeatedly burned, and lied to, by AB, claiming for the third time since 2004 that they have fixed the moisture impingement problem from poor quality control of the ceramic feedthroughs”

The above is absolutely incorrect information. There has been only a single instance of feedthru failure, that of those manufactured by Astro Seal, Inc., leading to the recall of 2006.

One, not three.

21 10 2011
Dan Schwartz

No, Robert:

Advanced Bionics has had three recalls, in 2004, 2006 and 2010 over moisture impingement; and all three times it was due to faulty ceramic feedthroughs. Yes, there were “Vendor B” (Astro-Seal) failures that caused a 40% failure rate for the batches of implants that were built up through the first two recalls; however Advanced Bionics has refused to release the failure rate data for the implants built with “Vendor A” parts, in an attempt to obscure the failed seal issue.

The simple, stubborn fact remains that Advanced Bionics has had FIVE recalls of their implants in the last decade, with the 2004, 2006 and 2010 recalls due to moisture-induced failures…And reputable surgeons will take this into account before risking their reputations on a product with a proven track record of poor reliability.

Dan Schwartz,
Editor, The Hearing Blog
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21 10 2011
Robert MacPherson

WRONG, Dan.
2004, moisure trapped at time of manufacture. Feddthru failure: no.
2006, moisture intrusion secondary to feedthru failure.
2010, insufficient thickness of dielectric layer in substrate – unrelated to moisture.

22 10 2011
Deb

Dan,

As usual, you are misinformed. Bob is correct.

You are trying to make a name for yourself in hearing loss and CI circles as a “professional”. I believe you are trying hard in a lot of ways, but your reputation is suffering an awful lot from so much incorrect information and how you interpret, and then “report” things. Not quite sure why you are picking on AB, but it’s pretty obvious.

AB has a very high reliability data with a 99.8% one-year CSR, which is why surgeons can be confident implanting the HiRes 90K. I am sure you understand what it means to have a 99.8% reliability rating. I really don’t think AB needs to prove anything else, the numbers speak for themselves.

The CI industry, by and large, has found AB to have been very open and honest, and transparent. This was further proven by the 2010 recall when AB pulled product after only two (2) reports of a particular issue.

The company took a big hit based on only two reports because it was the right thing to do. They didn’t wait for a spike in failure reports. They didn’t build up reserves in an older device before they reported it. It only took two cases and because the number was so small doctors around the world questioned why AB was recalling at all.

AB didn’t know it would just be two devices when they did the recall. They decided to put patients first. It cost them a lot of money, but long story short, they continue to keep their reputation as an honest CI company. The surgeons and clinics are starting to finally understand how important that is.

The clinics were overjoyed to have AB back in business! Maybe not in Dan’s world, but in the real world!

Deb

9 12 2011
Mike

My story, simple and not technical. I am from Montreal Quebec Canada.
Our Medicare system pays for the unit, operation and follow-ups. This happens only if you meet requiremnts established by the system. They offer 4 companies now in service and the patient does not have a choice. This is established by the Cochlear Implant committee. I was implanted with the Neurelec Saphyr system from France. All I can say is (Incredible) I am not saying they are the best, because I was also told by surgeon and audiologists depending on the individual, they all perform the same way. I hear so clear it is unbelieveable. Hear and distinguish conversation without seeing the person. Speak on the phone and cell with no problem. Listen to the radio in the car. Before I received the implant it was at least 5-6 years could not use phone. Watch TV without close caption. Noises that I haven’t heard in many years a bit of learning and questioning. Music, a little more difficult. As I write this, it has improved considerably. I was implanted April 2011.
What hearing I had left before the implant: right ear gone completely about 20 years ago. Left ear had 12% left and 0 speech recognition.
All I can say is that is was a success for me and made very happy. What a difference. Sit and chat with family and friends. (WOW)

7 04 2012
Sammarcko

Yes Mike I am reading good things about Neurelec saphyr. They are just hard to find outside Francophone countries.
Enjoy.

30 04 2012
Mike

Baltimore Maryland May 2nd-5th.
12 Annual Convention for Cochlear Implants.
Neurelec will be there. They are starting to expand.

11 02 2013
agnes

Hello Mike.

My nephew has been implanted with a Neurelec CI about a year ago.
We made a lot of research about Neurelec CI’s tuning and it seems that for some reason, french technicians are not willing to get the most out of Neurelec CIs possibilities in terms of performance.
We are thinking about going abroad to have the CI fine tuned the best way possible.
Could you tell me more about your experience ?

We can exchange emails if you want

Thank you a lot!

5 03 2013
Mike

Hello Agnes, I am doing very well with my implant. It’s hard to believe from before and now. It will be 2 years mid April with the implant. This month the audiologist is going to set me up with a small microphone on my right ear. It will be attached by single wire on the outside back of my head to processor.
I am very anxious to try this. Two months ago I had another audio test and it was 80% + effective. I still question noises. I guess with so many years of not hearing my brain forgot them. I could go on and on. One thing I can say is I do not know how much more they can do to better it. At this point in time it’s great to be part of life sound, hearing and speech wise. The only thing I will say is that not all music sound the same that I remember.
I met with a lady that had same implant, did not do so well. Had to re-operate and put another system in. In the end it was not the system, it was her condition. I would be very happy to help in any way I can. Let me know.
PS: not sure where you got your info regarding CI fine tuning. Mine is excellent. For me, it is very very clear.

Kind regards
Mike

29 12 2011
Alli

Might you have any information on how to follow-up on an unsatisfactory CI experience? My 84-year old father had a Med-El CI in March 2011 and is terribly dissatisfied with the results – in his words, “I hate it!” After numerous trips to the audiologist for hours of numerous adjustments, his hearing has worsened as a result. Presently he is considering having an Esteem device put in his other ear as he is desperate for improvement. The concern those of us in his family have is, might he lose the little hearing that he has remaining? He and I have good conversations by phone regularly with no hearing device used – so he can hear when there is directed sound and little or no background noise (with my raising the volume of my voice and enunciating carefully).

Is there a follow-up procedure for CI patients with poor results that he ought to follow before giving up on the CI? He has seen the ENT and audiologist at the hospital where his surgery took place for 9 months off and on with no improvement. Is there someone who might do an independent evaluation to determine if it might be a device failure? Any suggestions are appreciated.

29 12 2011
Tina

Hi Alli,

I’m wondering if your father has done much rehabilitation work after getting his CI? I had to practice daily and it took some time to see the benefits. It’s about re-training the brain to understand what it is hearing. There are rehab resources on the CI websites, on my blog, and your father can ask for suggestions from his audiologist – mine said the best way is to use audio books and the accompanying tapes/CD to train the brain. Hearing Journey has The Listening Room. The audiologist’s adjustments are only half of the story. Your father’s brain and it’s ability to respond to and interpret signals from the CI are the other half, along with motivation, determination and patience. Has he joined the Hearing Journey forum? He will get lots of support there, and answers within 24 hours – just ask him to introduce himself and he’ll get a ton of replies!

I wasn’t happy with my performance so I pushed the envelope further by trying Auditory Verbal Therapy. That might be something worth investigating, depending upon your father’s situation.

31 12 2011
deaflinguist

Hello Alli,

Tina has given you some great answers and she is right about motivation, patience and perseverance.

Two things jump out at me from your post: first, the vehemence of your father’s response, and second, the fact that you say you have good phone conversations with no hearing device used. Do you mean without loudspeakers, telecoil, etc. rather than without the CI, as it must, I suppose, be difficult without the CI? I wonder if the two things are connected?

It may be that if you are having good phone conversations with him the CI is possibly working well, but what he may be disliking is the *quality* of the sound. It takes a while to be confident using the phone with a CI, but it sounds as if your father is doing well on that score – you know how to talk to him, which is helping.

I am wondering whether your father is objecting to the kind of sound that he is perceiving, as robotic, Darth Vader, chipmunks, Daleks or what you will? That is normal across all brands and the brain learns over time to assimilate those to more “normal” sounding sounds. What CIs do not do is give you back hearing as you knew it – it is a different kind of hearing.

As Tina suggests, Auditory Verbal Therapy is likely to be beneficial, but in any case hearing therapists can also give counselling as well as practical therapy sessions. Does the hospital have their own therapist, or can they refer your father to one?

I hope this helps in your quest for answers.

26 02 2012
Nancy Ross

From Nancy in PA

Just wondering if it is possible to have a different implant brand in each ear?? I have a Cochlear brand in one ear that is eight years old. The implantable technology was not as good as it apparently is now. I need another implant in the other ear.
Any thoughts out there on this??

27 02 2012
Tina

Hi Nancy
Yes of course it is possible. There are a few people who wear 2 brands. Hopefully they will post here on their experiences. It’s just a bit of a pain for the audiologist to have to get out two sets of mapping software but it’s not a problem. You may find the sound is different, though.

27 03 2012
Heather

WOW, thank for this article. My husband and I are getting ready to choose am implant for our daughter. This has been quite helpful.

30 03 2012
Taka

Hmm, confusing confusing is all I can really say. I really want AB, but checking the pamphlet I received from my audiologist, the surgery seems different between AB and cochlear. (at least according to the picture) My doctor is a well known surgeon who you actually posted the video but considering most of the audiologist patients are cochlear, it makes me wonder if my doctor has done a lot of AB surgeries.

One of the huge advantage I see of the AB is the telecoil. I want to hold the phone normally and talk normally. Do I need to use blutooth or something for Cochlear? Ive read so many threads but there are so many things that just make my decision confusing. (I should get the implant after my ct scan in a few weeks) I want to choose AB, but past recalls make me slightly worried. They have telecoil and I hope clearvoice would be good. cochlear is fairly reliable excluding the one recall and my sister also has cochlear. She says it is very good so it just forces me to think even more on choosing which one.

30 03 2012
discpad

Dear Taka,

All three implant brands are “installed” pretty much the same way, with slight differences in the tools used to thread the inch-long electrode into the pea-sized hearing organ.

Most important is a high resolution 64-slice (or better) 0.5 mm collimation (or less) CT scan of the temporal bones with images that are reformatted to include cuts in the plane of (Poschel) and perpendicular (Stenver) to the superior canals, in addition to the typical coronal scan. This will give the surgeon a roadmap as to where s/he will place the cochleostomy and as to how far to place the gun or stylet into the cochlea.

The trick is to place the tip of the gun or stylet deep enough against the inside radius (modiolus) after it curves inward; but not so far as to rest against the lateral wall, which will result in rubbing the basilar membrane, damaging the delicate structures and wrecking residual hearing, and possibly kinking the electrode.

In any case, your surgeon has been trained by each CI manufacturer, with him practicing on threading the electrode into cochleas from cadavers and animals (cats & chinchillas).

Dan Schwartz,
Editor, The Hearing Blog
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7 04 2012
Sammarcko

In my experience that is not true that AB has trained all their surgeons on inserting their electrodes. As you know AB have the Helix and the 1J electrode and AB doesn’t explain the difference (and most AB fans don’t even know the difference between them) and most international distributors so not stock the helix. It has to be special ordered and the procedure is if the surgeon cannot thread the helix the 1J is always on the table as a back up. In my recent experience AB were going to permit a surgeon with less than 5 AB implants under his belt to do a simultaneous bilateral with a Cochlear America/Australia experience surgeon on me. Naturally I refused. Then before that the surgeon with Cochlear/America/Australia experience was told over the telephone that he could go ahead and implant his first AB Bilateral device ON HIS OWN while the AB training surgeon (who never trained him but only met him at conferences) flew home from his holiday.
I forgot to mention I got slapped with a $1200-00 bill just for ordering the helix as it was not a stock item as a Fed-ex fee. Nah. I am no longer a fan of AB International services!!

30 03 2012
Robyn Carter

Taka, I have the Cochlear brand and am very happy with it. It has a telecoil and I just hold the phone up to my ear naturally whenever I want to make a phone call.

My surgeon tells me that brand comparison charts should not be taken too seriously…. they can give quite a good overview, but some of the alleged benefits of one device over another are taken from manufacturer’s marketing data. Manufacturer’s typically quote papers which support their case and ignore others which do not. One good example is all the alleged benefits of so-called “Fine Structure Processing” and its effects on speech and music appreciation with the MedEl. We heard a number of comparison papers last year at the Politzer Society meeting which found no advantage to FSP over, for example, ACE. Studies to see whether the patients have any increased pitch perception accuracy with the Med-El have not been able to demonstrate any, despite what the marketers say. There is still little to choose between the devices in real life – some patients do better than others with each device, and the best and worst with each are pretty-much equivalent.

So don’t beat yourself up too much over brands – which ever you get, you will do well.

Cheers
Robyn

1 05 2012
Mike

Agree with all you say. I am a Cochlear Implant receipient now 1 year and doing extremely well and an implant you probably never heard of Neurelec. Could not ask for better at my age 65.
Love my unit and easy to use. I did a 2 week tuning and a 4 week follow-up after receipt of my processor. Met many people with different brands at my 4 week sessions and all had different outcomes. I also on occasion meet with Cochear implant receipients and discuss different situations. I can say with the experience I have had in the past year depending on the person, duration of deafness, ear cochlea condition, proper surgery and good follow-up a recipient could still have problems.
All I can say is good luck to all that receive one and hope they will enjoy as much as I do.

1 05 2012
Tina

I would love to hear more about your CI … :)

25 06 2012
Mike

Hi Tina, I posted two comments on site I look so I can hear. I would gladly leave more comments. What would you like to hear about my implant?

25 06 2012
Tina

Hi Mike, yes I am interested to hear about yours! I understand you have Cochlear and Neurelec, is that right? I’ll email you.

30 06 2012
Mike

Hi Tina, I have one unit the Neurelec Saphyr. Another comment that may come in handy for others. Before my Implant I had a top hearing aid by Siemens with a remote. Used the remote once. Never had any use for it. Something else to carry around and forget. I had controls on the unit itself. Made it more simple and quick. Remote controlled volume and channels. Had to take remote out and look at the buttons to control it. Made it more tedious for me. So if someone is looking at an implant and are sold for remote optons, I feel it is not something people should look at. Hope this helps.

30 06 2012
discpad

Mike, your own experience with remote controls is typical of about HALF of the hearing aid users: In my 20+ years of dispensing remote controls along with hearing aids, I’ve found attitudes are about evenly split between “Love It!” and “Shove It!”

Dan Schwartz
Editor, The Hearing Blog

http://www.TheHearingBlog.com

30 03 2012
Howard Samuels

Hi Taka,

All current BTE processors have a telecoil. That’s the part that senses the field from the coil in the telephone speaker. You can either switch to it manually for a phone call, or use Auto-telecoil with the Cochlear Nucleus 5.

I think you are talking about AB’s T-mic, which is a regular microphone at the entrance to the ear canal. You don’t need telecoil mode – you just hold the phone up to the T-mic.

Of course, you can always rig up various ALDs like neck loops for telecoil, Bluetooth used either with telecoil or direct audio input works too. But it’s probably a good idea to try and use your implant without any ALDs, and only add them if you find it easier. ALDs can certainly help, but they come at a cost of convenience.

I agree with Robyn – most of those studies are done with only a few participants, and almost invariably conclude that more participants are needed, and that the latest hardware and software should be used. The studies take long enough that the setups are usually out of date by the time they are published.

Even the studies that Robyn cited which discredit other studies should be taken with a grain of salt!

30 03 2012
Taka

Do excuse me, I am talking about the t-mic, not telecoil. This was the feature that makes me very interested in the AB brand. The only question is how clear is the sound compared to telecoil. (Although im sure it depends on the person)

At this point though, what years have the product been upgraded/produced, etc? Im curious on which one is the “latest” product. I know AB just recently reentered the US market last year, but was there product changed in order to reenter the US market? For the cochlear, the Nucleus 5 is the latest compared to freedom? Is there any advantage of taking the nucleus 5 instead of the size/remote difference? I am asking if there is any difference in the hardware or software for the sound.

Thanks for the answers, it really does help.

7 04 2012
Shelia Williams

I’m in the process of getting a implant. I’m really pulling with Me El I think because the coil is longer and I will benefit more from it. I don’t want a device that I have to depend on that adjusts it self I don’t want to be dependent on that. I like being in control so with the remote I can control what I hear or not hear. All this information has really been interesting I was going with AB at first but then decided Me El is the one for me. I’m excited but a little scared at the same time. I’m just wondering how my brain is gonna react !!!

Thanks So much.

7 04 2012
Sammarcko

I have read somewhere that the Med-El have the longest coils and reach deeper into the cochlea where the lower frequencies are clustered which is what one wants if one likes the low frequencies. The reason we get more and mostly the Higher Frequencies in our implants are because the majority of electrodes in the various arrays stim the outside regions of the cochlear where the high frequencies “live” I hope I am making sense.
However all things being equal all the technology that is used TODAY is pretty much equal across the product range. The next generation of electron arrays and the processors to power them will be a whole new ball game.

11 04 2012
Ruth Kaldor

I just found this blog after coming home from my consultation. My surgery will be May 10th and I have to decide between Med-El and Cochlear. The Med-El does reach longer into the cochlear I was told and at first Med-El users will distinguish male vs female voices better at first. Cochlear users would take a bit longer to make that distinction. My decision is based more on the fact that the Med-El doesn’t have any buttons on the device so all settings need to be made using the remoter while Cochlear’s settings can be made either way. Also, Cochlear has the water shield and since I like to fish that might be a consideration. I have never researched all this technical information written on this blog though.
I do like the design of Med-El a bit more from the artistic perspective. Does anyone out there have a Med-El?

15 04 2012
Mathew

I’m in the process of getting an implantat. And i aggree with the rest, that it is very difficult to choose the “best” brand. Actually a prefer AB but there is something that makes me worried. Consider they would implant the HRes90 to me that works along with the HRes Harmony processor (BTE). My question concerns the compatibility of future developments of BTE processors of AB. Is it possible to use a completly a new BTE processor generation with the currently implanted HRes90? Or do i have to change the implant everytime there is a new BTE-processor (no software upgrades, but completly new processors)? My audiologist told me that story. With Cochlear and MedEl it is always possible to use the newest BTE-processor generation along with the current implant, he said. Is that correct?

16 04 2012
Howard Samuels

Hi Mathew

When I was implanted in 2005, I received the Auria processor to use with the HiRes 90k. In 2007 when Fidelity 120 came out, I upgraded to the Harmony to be able to use it. No surgery required. I chose the HiRes90k because it seemed to have the most upgrade capability for the internal part, among other reasons.

Some day any implant will run out of gas, and you may not be able to take advantage of the latest and greatest software. But I don’t see that as a reason not to get implanted now, as you would otherwise be missing out on life.

16 04 2012
Howard Samuels

…and the new waterproof Neptune processor also works with the HiRes 90k.

18 04 2012
Mathew

@Howard, txh for your answer, that is what i expected:)

I have 2 more questions:
1.) What about the recalls of the three big players? We talked here about AB in 2004, 2006, 2010. What about the last two years. Does anyone now, if there were any recalls in within the last two years with any implant or processor of AB? We talked also about the recall of N5 of Cocllear, but what about MedEl? Does anyone know someting about it?

2.)Some people talked about reimplantation here, and about the fact, that you must relearn how to hear under certain cercumstances. What is if you do not change the implant but only the BTE processor or the software (umgrade, coding). Do you have to relearn how to hear too?

22 04 2012
Howard Samuels

Hi Mathew,

There haven’t been any recalls recently besides AB 2010 and Cochlear 2011. Remember that while the numbers are small, more failures are reported to the FDA that don’t result in a recall. While the FDA receives over 100 incident reports a month, the 2010 AB recall was a prompted by 2 failures. If you are interested in reliability, you are going to have to mine the MAUDE database. And even then, the instructions are clear – you aren’t supposed to use it to compare reliability between manufacturers. I *think* that is because the FDA has no jurisdiction over a failure that occurs outside of the US and is reported to a manufacturer located outside of the US.

When you get a new external processor, of course you can keep the same program that you had before – no learning required. When I upgraded to the Harmony, the purpose was to allow me to use Fidelity 120 for improved music enjoyment. And it certainly did that! But I didn’t experience a step backwards for speech or anything else.

23 04 2012
Joel Saren

Tina,
It’s hard to believe people you don’t know. It’s ok. It’s good to be cynical. I can only say that the support AB people get from Katie, Howard, and Barbara is amazing. The other devices are also good, but I have not found them to have Katie, Howard, or Barbara.

29 04 2012
Abi

My brain seriously hurts. I’m getting really overwhelmed. I simply want to be able to understand speech more clearly both in quiet and noisy situations but don’t want music to sound rubbish. How are we meant to choose!?

29 04 2012
Tina

Hi Abi. You could dig a bit deeper and look at what’s inside the implants, look at the technology. What else is important to you? Type of battery, whether you want a remote control? Have you seen the information on http://www.cochlearimplanthelp.com ?

11 05 2012
Howard Samuels

Here’s a page about the incidents as reported to the FDA. Notice how little the reliability over time has to do with the recalls any company has had.

http://cochlearimplanthelp.com/journey/choosing-a-cochlear-implant/cochlear-implant-problems/maude/

21 06 2012
Noel Holston

I have a Cochlear Americas Nucleus 5 and it has not been nearly as helpful as my surgeon and other professionals in the filed predicted. The company is now recommending revision surgery. I’d love to hear from someone who’s had this experience. And, on a broader topic, I’d love to hear from anyone who believes objective information about implangs is much harder to come by than it should be. It often seems to me the CI world is awash in publicity and propaganda. Am I just not looking in the right places?

21 06 2012
Tina

Hi Noel. I agree, it’s really hard to find objective impartial information. There is a new website which *does* give that, at http://www.cochlearimplantHELP.com

22 06 2012
Dan Schwartz, Editor, The Hearing Blog

…And in a pleasant surprise, fellow Electrical Engineer Howard Samuels just handed me an hour ago his business card with that http://www.cochlearimplantHELP.com website on it, at the HLAA Convention here in Providence!

24 06 2012
Geoff Turner

@Noel, I’m sorry to hear about the issue with your implant.

I myself had revision surgery in September 2011 to replace a failed internal device after 11+ years of faithful service. While it was upsetting and put me in a difficult position socially and professionally because it left me totally deaf for two months, it was a true blessing in the long run. The revision surgery provided me a great opportunity to get the latest implant technology AND have my other ear implanted for the first time. I’m now a proud owner of bilateral HiRes90K implants from Advanced Bionics. The upgrade from the old AB C1 on my right side was significant – in fact, it doesn’t even compare. Speech discrimination improved dramatically, even in noisy situations, and listening to music took on a whole different level.

The surgeon said replacing the old device was a piece of cake; in fact, the simultaneous bilateral surgery took just 3 hours, in the morning, home by late afternoon. Recovery was a breeze – I was back to work in a week.

While you are considering revision surgery, are you going to consider other brands to replace the current implant? If so, then the link that Tina to cochlearimplantHELP.com is an excellent starting point to begin your research on other options in earnest.

i wish you the best of luck and please do keep us posted on your progress.

10 08 2012
SHammond

Just to add my 2 cents, I just passed 100 days since second ear implanted with MedEl Opus 2 / Pulsar combo. I am very pleased with the great professional service I receive from MedEl and my wonderful cardiologist.( I fired the first audiologist when I got my first MedEl years ago ) I do enjoy my nifty remote that allow me to control both Opus 2 processors on my ears.

Email me if you want to know more about my wonderful experience with MedEl.

Stevehammond1@June.com

11 08 2012
Shelia Williams

@Steve I tried to email you wouldnt send what Here is my email happychic0361@yahoo.com please email me so I can ask you some questoins. thanks, Shelia

11 08 2012
Tina

Try gmail.com :)

17 09 2012
Grigoris

Hello to everybody….My name is gregory an i have a 9 months boy who borned deaf…..Have anyone had the same expirience who had surgied so young???? I have decided to proceed with AB NEPTUNE….

15 11 2012
Tina

Gregory – you can find other parents with babies implanted with AB Neptune on the AB forum “Hearing Journey” http://www.hearingjourney.com/

3 10 2012
Stormy Culliver

Love your blog!

4 10 2012
Teofila Rajala

Hi there, i just needed to drop you a line to say that i thoroughly enjoyed this detailed post of yours, I have subscribed to your RSS feeds and have skimmed a few of your posts before but this one really stood out for me. I know that I am just a stranger to you but I figured you might appreciate the admiration Take care and keep blogging.

15 11 2012
A Concerned Father

Hi all,

Below is the reply i’ve from a Choclear America follower when asked the comparison between the N5 and the Neptune:

First point I’d like to make is that this chart is produced by Advanced Bionics. They are very good at Marketing things to make it sound like it would be ridiculous to choose anything other than an Advanced Bionics device. They do tend to leave out a lot of details assuming that the customer isn’t going to dig past the surface. For now I’ll just go down the chart and speak to each item. If you have further questions on anything just let me know.

1) Temporal Resolution (Stimulation Rate) – The Advanced Bionics stimulation rate is by far the fastest. What is failed to be mentioned is that most people prefer SLOWER rates for hearing. While their device can produce super high pulse speeds most people don’t use those high rates. When I received my Nucleus Freedom implant 7 years ago high speed was all the rage. I was programmed with my implant cranked up to the max speed. It was a bit overwhelming and the biggest thing I noticed was not improved hearing performance, but how poor my battery life was. Since then I’ve gone to a much slower rate 7200pps. Not only do I hear very well, but my battery life lasts twice as long. Cochlear did a study when they started seeing its patients gravitate to these slower speeds and found that most people actually preferred slower speeds so they changed their recommendations for audiologist to start there rather than at the fastest rate. It makes sense because the Spiral Ganglion cells (nerve endings) that the electrodes are stimulating can’t fire at those speeds. Every time one fires to send a message to the brain there is a recovery time necessary before it can refire to send another message. If we are stimulating the same electrode before the sprial ganglion cell can fire again we are just wasting energy. In the world of America today, Bigger, FASTER, stronger is better, but the reality is that it isn’t always the case. In this case, faster actually can have significant drawbacks.

2) Spectral bands – This topic gets kind of complicated, but basically Advanced Bionics is not comparing Apples to Apples in this case. They say they have 120 spectral bands and Cochlear only has 22. If we wanted to compare electrodes Cochlear has 22 and Advanced Bionics has 16. 120 is referring to the number of pitches that can be assigned to those 16 electrodes and 22 is referring to the number of physical electrodes Cochlear has inside the cochlea. Further down the chart mentions number of power sources. Advanced bionics programming allows them to fire two electrodes with varying degrees of power to create a band in-between electrodes. Cochlear has shown that they can create the same thing by using a single power source and changing the speed that they stimulate one electrode then the next. Keep in mind that 120 is a just the number of divisions that is made in the programming between electrode 1 and electrode 16. 120 has no indication as to what the recipient will actually hear at each one of those divisions. The more physical electrode contacts (22 vs 16) you have the better coverage of the nerve you are getting.

3) Pitch percepts – Measuring pitch percepts is a subjective test that varies widely between recipients. You may come across anywhere between 8 and 500 as numbers that have been demonstrated. When Advanced Bionics first came out they touted 120 pitch percepts (Hence the speech coding strategy High Res 120). When Cochlear tested a small number of patients to see where they stood they averaged 161 pitches. As mentioned above 120 is a theoretical number and the actual average for AB’s study was 93 across their tests subjects with a range from 8 to 466. (Not very good data when your range varies so much) When Cochlear showed 161 Advnaced Bionics started to show their highest performing numbers rather than the average which is where the 460 comes from. Again these tests were not Apples to Apples kind of tests because the fundamental ways each implant works are completely different. I will be the first to say that none of these studies (Advanced Bionics or Cochlear) hold much weight in the science world. They were purely conducted from marketing purposes. Personally, since the data is so weak and highly variable I wouldn’t focus on this area as a decision making area. The important thing to note is that even though the implants work differently they both produce a very good possibility of hearing many different pitches. If you have more questions about it I am happy to go into more details though.

4) Input Dynamic Range – This is another case of not comparing apples to apples. Cochlear’s Implants work on the concept of Instantaneous Input Dynamic Range rather than a static Input Dynamic Range like Advanced Bionics. Essentially both devices cover a wide range but go about how they do that differently. Cochlear purposely reduces the range from 80 to 45dB, but that 45dB roves up and down creating a complete Input Dynamic Range. AB’s is static and doesn’t rove. Both are necessary to make each individual implant work but is not an indication that one is better than the other. Again this is AB’s Marketing pairing two numbers together with very little information to show that one is bigger than the other.

5) Independent Current Sources – Advanced Bioincs has multiple current sources allow the implant to stimulate multiple electrodes at the same time. Cochlear has purposely designed its implants not to have this. They have spent millions of dollars on research and found that having multiple current sources has shown no benefits to hearing performance. Cochlear has proven that with a single current source they can achieve the same if not better result. On top of that a single current source uses much less power. I believe this is why Advanced Bioincs processors are still huge compared to Cochlear’s. They physically cannot make them smaller because they need such a large battery to power the device. This is something to consider going forward with future technology. Having independent current sources could be very limiting when it comes to trying to make smaller more comfortable processors. I am guessing this is one of the reasons why they are trying so hard to make the body worn style Neptune processor sound so appealing. A body worn processor can be bigger and allow them to easily fit the power necessary to run their implant. cochlear implants started as body worn devices 30 years ago and with extra long cables were very frustrating for people. In my mind, processors are supposed to get smaller not bigger so it is a step backwards.

6) Stimulation Phase Inversion – Sounds like a mouth full, and to be honest I’ve never heard of it. I will do some research to see if I can figure out what it is.

7) Sound Coding Strategies – Advanced Bionics has a ton of variations of the exact same strategy, CIS. All of the HighRes strategies listed are slight variations and work in essentially the same way as the original CIS strategy. Clearvoice is not a coding strategy. It is a processing algorithm that manipulates the incoming signal to try and provide a cleaner signal to the implant. This is not new and Cochlear has had this for years. In fact we have several different processing algorithms (BEAM, Zoom, AutoSensitivity, Whisper and ADRO) that make up our SmartSound environments (NOISE, FOCUS, MUSIC, and EVERYDAY). None of these are listed of course :-) The Cochlear device can perform CIS as well as SPEAK. These are completely different coding strategies that utilize different aspects of sound information (Pitch cues vs Spectral cues). Cochlear has developed ACE to incorporate both Pitch and Spectral Cues into the strategy making it the most similar to how natural hearing works.

8) Natural Microphone Placement – This is an interesting one because the Neptune places the main microphone up on the coil/magnet the furthest away from the natural placement. They do have an added accessory that allows one to wear a microphone down in the ear, but from what I’ve heard from people the only benefit they see is that they don’t have to constantly move the phone from up on there head to down to their mouth to speak. Cochlear’s Micorphones are placed on the ear all the time. An interesting fact, one of the developers for Advanced Bionics T-Mic has sinced come to work for Cochlear over 8 years ago. Cochlear could have made a T-mic of their own if they saw a significant benefit. One thing to caution from experience, the more physical connections and pieces that you have to snap together and take apart the higher the likelihood that something will break.

9) Case Impact Resistance – Cochlear tested their implant to pass the necessary impact testing for Pace Makers which is 2.5 joules. So it is at least impact resistant to the pace maker standard. There is not a specific standard for Cochlear implants and the industry has followed Pace maker standards for a long time so why Advanced bionics chose to go above that I don’t know. The number of failures due to impact is very low. This implant is significantly more reliable than any other implant from any company and it has the history to prove it. Which implant would you have more confidence in one that has 99% reliability at 7 years or one that has 99% reliability at 1 year. I would take the 99% at 7 years any day because it has proven that it has maintained its reliability over a longer period of time. The companies are very good at manipulating the numbers and putting the time frames in very small print to try and show that their implant is the same or better. Don’t be fooled.

10) Swimmable Technology – The Neptune is swimmable, but guess what so is the Nucleus 5. It may not have quite the same degree of water resistance of the neptune, but Cochlear fully backs the Nucleus5 processor by including complete coverage of water damage in its warranty policy. Cochlear has created a covering that will soon be available in the US (pending FDA approval) It is currently available in Canada. I actually was in Toronto last weekend playing with it :-) It is a simple $2 option that will keep an ear level processor safe from water or any other liquid for that matter. Keep in mind that the Neptune is $8000 and it is highly dependent on being put together properly and seals staying pristine and water tight over time. The Aqua Accessory is very simple to use.

15 11 2012
Tina

“Concerned Father” – a reply is forthcoming! Exactly which chart are you referring to?

15 11 2012
David Ryan

Hello Concerned Father,

I am sorry you have been approached by this type of poorly informed individual who gets their information from marketing. They do not help when you are trying to make an informed decision. Their first point regarding the CIHelp Chart being produced by Advanced Bionics is incorrect. AB has no association with the chart. The chart was done by people who use AB, but they also happen to be people who value facts and understand the need for people to know what they are getting away from the marketing. The information you find in the chart can be verified by researching independently and if any information is incorrect, the chart is willingly and happily rectified. There is no marketing agenda behind the chart.

As for the points made:

1) Temporal Resolution (Stimulation Rate) – The speed capability of the AB implant allows for more advanced processing strategies, both now and in the future. It is not as simple as providing a fast rate. As with the independent current sources in the internal implant, you need the capability to produce a strategy such as Fidelity 120 to put out 120 channels.

2) Spectral Bands – You have electrodes and then you have channels. The electrodes are where the current is emanated from. The channels are where the current ultimately stimulates the cochlea. When you have independent current sources you can direct where the current goes. So rather than 22 fixed points of stimulation, as with the Nucleus device, you have 120 points of stimulation in the cochlea. To be fair, it has not been shown that there is improvement in speech discrimination as a result of more channels. 8 channels are all you need for speech discrimination. Additional channels make a difference in terms of sound quality. AB users overwhelmingly prefer Fidelity 120 for this reason, particularly recently deafened and implanted post-lingual adults.

3) Pitch Percepts – It would be easier to advise you that this point needs to be ignored since too much of it is just plain wrong. When AB first came out, Fidelity 120 did not exist. The Clarion implant was released in 1996 and ran older strategies. In 2001, the Clarion II was released, which was the first internal implant with the capability to run strategies like Fidelity 120. Fidelity 120 was not released commercially until 2007. The 161 pitches claim from Cochlear comes from the clinical testing of a device that is not commercially available. Their implant lacks the capability to run a strategy to make that possible both now and in the future. Unfortunately, it was used as a marketing statement without that clarification, leading users to believe they were running a program that gave them 161 pitches.

4) Input Dynamic Range – Cochlear’s IDR does not rove. The channels do. The strategy roves 8 channels up and down the the electrode array depending on the sound being reproduced. That is a completely different topic altogether. The person may be trying to refer to the fact that IDR moves up and down depending on the loudest sound. That is why IDR is referred to as a “sound window.” If you have a 45 IDR, the sound window will move up.. ignoring the quieter sounds that may be heard below that window. If you have an 80 IDR, the window will also move up, but capture quieter sounds within that window that a 45 IDR would otherwise ignore. Whether or not this is good for the individual depends on the individual. It does play a major role with music as you will probably surmise.

5) Independent Current Sources – Cochlear’s lack of this ability has nothing to do with extensive research. They have kept their electrode array essentially the same since it’s inception. As for requiring “such large batteries” or the idea that Neptune is marketed to hide “that fact”….. it is true that you need more power if you are going to run a strategy that provides you with 120 channels of stimulation vs 22. It is not true that a device such as the Neptune is marketed to hide that fact. The original body worn processor from AB was the Platinum Series Processor. This was a larger and heavier body worn processor with the bulk of that weight coming from the large proprietary rechargeable battery. Today.. the Neptune runs on a single AAA battery, is easily concealed and very light. This gives the user the flexibility to get their batteries from almost any store rather than depend on proprietary batteries. It is designed to give you wearing flexibility while keeping the processor secured to you when participating in physical activity or swimming. It is also very nice to not have anything on the ear. It’s a great device to have as a choice in conjunction with a BTE. The Harmony BTE gives you a choice of two battery sizes and will be replaced by a new BTE due to arrive next year that will not only be smaller, but gives you two smaller rechargeable battery choices as well as the choice to use hearing aid batteries.

6) No correcting needs to be done here.

7) Sound Coding Strategies – It is incorrect that AB’s strategies are all just variations of CIS. By that logic, every CI strategy is a variation of CIS. All 3 of the major manufacturers started with CIS. As someone who has used every strategy available from AB, with the exception of CIS (I used MPS, a variation of CIS used paired stimulation which gave a fuller sound), I can tell you they are all quite different and easily distinguishable. ClearVoice is a processing strategy and Cochlear does not have anything like it nor do they have the ability to have anything like it. ClearVoice is done at the strategy level while Cochlear’s hearing-in-noise programs are done at the microphone level.

8) T-Mic – Cochlear could not produce a T-mic of their own. It is patented by AB. The T-mic is preferred largely due to the fact that sound is naturally collected by the ear and directed to the canal where the T-mic is placed. This is a very noticeable difference between using a T-mic or using a BTE Mic located at the top of the ear. AB users have both choices available to them. When using the Neptune with just the headpiece microphone, the sound is certainly different… but not bad. It is just less direction. It may be preferable depending on the environment.

9) Case Resistance – I find it silly that there is any need to try to downplay having additional joules. It is what it is. As for the reliability claims… at this point I think it should be understood that no manufacturer has a foothold on that, especially considering Cochlear’s N5 internal implant failures. It’s a man-made device. Devices fail. All of the companies work at keeping that to a minimum. It’s common sense both business-wise and ethically.

10) Swimmable Technology – The fact is that only one implant is capable of being used for swimming without putting a plastic bag over it. The Neptune is sealed to begin with and is not at risk of having it breakdown over time as well as being warrantied should it fail to do what it was designed to do. The water-proof form factor boils down to swapping out the headpiece and removing the Connect Module. It’s not a complicated procedure and can be worn 24/7 in water-proof form factor if you wish.

15 11 2012
bleedingpurist

I would like to clarify that I was confused as to which chart was being referred to. The chart that the email writer was referenced was indeed authored by Advanced Bionics. That does not change any of the facts.

15 11 2012
Sam Spritzer

Concerned father…I just want to throw in my 2 cents in plain simple terms. I am one of the contributors to this website. i have AB. i am also a mentor, helping others in their journeys with CIs.
Clearly, the response you got is simply twisted marketing hype. In fact, the terms being used are so technical that even I have a hard time understanding it.
There is one point however that says it all…#10 – if the Nucleus 5 is swimmable, why do they need the aqua accessory to begin with? Why are they wasting R&D efforts on a temporary fix? Its interesting to note that this accessory came out shortly after AB received approval from the FDA and not before when they were available in other countries. Instead, they give you some marketing hogwash that doesn’t come close to trumping AB. With that, the other points can be considered in the same light.

15 11 2012
Robyn

Sam – Again – when you reply about Cochlears Aqua Accessory, you reply with misinformation. Cochlear’s Aqua Accessory was in development prior to the summer of 2011 and long before the Nepture came out.

15 11 2012
Robyn

David Ryan wrote: 7) Sound Coding Strategies – It is incorrect that AB’s strategies are all just variations of CIS. By that logic, every CI strategy is a variation of CIS. All 3 of the major manufacturers started with CIS.

David, Cochlear didn’t start with CIS – but with SPEAK. I’ve used both SPEAK and CIS and got 100% open set with both.

15 11 2012
Howard Samuels

Hello concerned father,

First, congratulations on moving forward with getting a cochlear implant for your child! Finding out that your child is deaf has to be a very traumatic experience. The promise of a cochlear implant starts out being a dim hope, but as you learn more about them, and talk to people who have them, you begin to realize that your child will lead a life much closer to your original dreams than you could have dared to hope.

Certainly all manufacturers of any product like to portray their own product in the best light possible. I’m sorry that this discussion started on a very technical level. I’m happy to be as technical as you like, but unless you specifically request otherwise, let’s speak in plain English!

1. Stim rate – of course AB’s stim rate doesn’t have to be the maximum. That is the capability of the implant, and the audiologist can choose to use it or not. Why would you intentionally choose an implant with less capability?

2. Spectral Bands – This is a fascinating topic to me. Imagine that the electrodes in a cochlear implant are like keys on a piano. 12, 16, or 22 is not a lot of keys. I was activated before Fidelity 120 was available. I was lucky in that speech was great right out of the box – I was even able to understand a foreign language in the activation room!

Music was just OK. I spent a lot of time listening to the radio in the car. Every once in awhile, I would recognize the rhythm of a familiar song, and it felt like a template fell into place. From that point until the end of the song, it seemed that I was doing a pretty good job understanding it. But as soon as the next song started, I had to guess the song all over again. Having grown up with normal hearing, I taught music theory in college, and have a deep music collection, much of which was acquired for a disc jockey business I did for fun. I used to win all the ‘name that tune’ contests. So you can imagine how frustrated I was when I could only get one or two songs per week, on radio stations where I should have been able to get nearly all of them in just a few beats. I sold my treasured Klipsch speakers to a theater in Maine, which was looking for a sister pair to the ones that they already had. Interesting trivia – Stephen King frequents that theater, so he has been enjoying my speakers!

I received the Fidelity 120 software upgrade at about the same time that I got my second implant. Wow, did that make a difference! Suddenly, I went from trying to guess what song was playing by the rhythm content to actually enjoying the music! I never thought that I would start spending my money on audio gear again, but I bought an iPod, then I upgraded the stereo in my car. And when I bought a car recently, the most expensive option was the upgraded sound system!

The point of this story was to convey my personal experience of the difference between exciting a single electrode at a time to Fidelity 120. And while pairs of electrodes work together, Fidelity 120 actually fires 2 pair, or four electrodes simultaneously. The other 12 electrodes are waiting for the scientists to figure out how to take advantage of them.

The paper where Cochlear describes 161 pitches was written as a response when Fidelity 120 became available. Here it is for your viewing pleasure:

http://cochlearimplanthelp.files.wordpress.com/2012/03/pitch-steering-white-paper1.pdf

Notice the asterisk at the end of the abstract on the first page. Look for the corresponding footnote, I’ll wait. Okay, I’ll give you a hint. It’s at the bottom of page 7. If you read the paper carefully, you will notice that a special algorithm that only uses 2 electrodes, one after the other, was developed for the test. The hardware is not capable of firing pairs of electrodes in sequence fast enough, which is why the algorithm is not available, and cannot run on a full program.

Fidelity 120 fires the adjacent electrodes at the same time. It’s like shining a blue light and a yellow light, and seeing green. Compare that to switching back and forth between blue and yellow. This is what Cochlear did in that paper. Do it fast enough, and you can see green.

As for variability among subjects, all cochlear implant users are different. In fact, figure 4 of the Cochlear paper shows that the highest performing subject was able to discern about 10 times as many pitches as the lowest performing subject. That’s wider than the range quoted for the AB test subjects!

4. Input Dynamic Range – Mine is set at 70dB. It can go up to 80dB, but that was a bit much for me. And it can go as low as the maximum offered by Cochlear, or even lower. Most AB users I know end up between 60dB and 80dB after some experimentation.

5. Independent current sources – again, the capability to power all of the electrodes simultaneously is there. But it isn’t required to use all of them! It seems like the person helping you continues to make an argument against extra capability.

I volunteer as a test subject at my clinic. Researchers from a couple of very famous universities study cochlear implants, and have been doing pure research for decades. Currently they are trying out different methods of stimulating the electrodes to see how it affects my ability to discriminate sounds. The results of the research will be available for anybody to use. For this set of tests, they wanted to use subject with all the available cochlear implants. They bypass the external processor, and connect their computer to my implant. Only the AB implant has the capability and flexibility to try out the different methods of stimulation, so they were not able to include subject with implants from Cochlear in the study.

I plan to keep my implants for a very long time, so I appreciate the extra unused capacity.

AB’s Harmony processor is currently the largest ear-level device of the three available in the US. Next year a much smaller processor is coming out. The title of smallest processor is always a horse race, with the latest and greatest being in the lead. It sounds like somebody is trying to scare you into thinking you need a car battery to power the device. As for the Neptune, the flexible wearing options have taken the industry by storm. It is a big part of why AB is rapidly gaining market share for kids. And adults are also choosing it in large numbers.

7. ClearVoice runs alongside all of the other goodies that AB has, such as Fidelity 120. In quiet, it does nothing. In noisy situations, it improves the signal to noise ratio. You don’t have to switch programs for different situations – it is always active, and automatically adjusts for the different listening environments.

Cochlear has several features for dealing with noise. BEAM helps when the speaker is right in front of you. It requires a program change for those situations. SmartSound is a global sensitivity adjustment, that does not improve signal to noise ratio. ADRO works on the whole signal, not on the different parts that may have more or less noise.

With all those options, you can see why Cochlear provides a remote. I once polled a bunch of Cochlear users online. About a third use the remote all the time, a third don’t use it, and a third use it sometimes. I’d rather let AB’s signal processing take care of things for me. AB doesn’t have a remote now, but I expect to see one soon, if for no other reason than to assuage potential candidates who think that they may need one. Do you think a teacher will always be able to choose the right program for your child in different situations? And remember to switch back when they get back to the classroom?

8. Natural microphone placement – this is HUGE! I love holding the phone up to my ear, using small on-ear headphones, letting the shape of my ears reduce noise from behind, etc. It’s the way we are supposed to hear. It’s not nice to fool Mother Nature!

Neptune has the mike in the headpiece specifically because it is a completely off-ear solution. Some people prefer it for the best comfort, others like how it doesn’t interfere with glasses. And of course, you can have the best of both worlds with Neptune and the T-Comm, which adds the natural mike placement capability.

AB has a bunch of patents on the T-mic natural placement, and that is the real reason that Cochlear cannot offer that. That’s also why Cochlear cannot offer a mike in the headpiece!

9. Case impact resistance. Are they seriously trying to say that lower impact resistance is better? That’s quite an argument. Cochlear increased the impact resistance to 2.5J on the latest generation implant. I attended a talk where the,engineers described all the effort that was put into that. But the latest implant is not currently available, so the best they can offer is 1J impact resistance.

All implant manufacturers claim best reliability, and all have data to back it up. I don’t know what to believe. However, I’ve been analyzing the data of incidents reported to the FDA. You can read about that here:

http://cochlearimplanthelp.com/journey/choosing-a-cochlear-implant/cochlear-implant-problems/maude/

10. Swimmable – this is one of the reasons Neptune is taking over the market! Parents want to communicate with their children in the bath, kids want to take swim lessons and hear the instructor, lifeguards want to be able to get children’s attention when they are in the water.

I’m thrilled that Cochlear has come out with a means to allow users to swim with the implants. I’m not sure I follow the point about the processor being waterproof and warrantied for any water damage. Why is the Aqua Accessory even necessary? In any case, if you want to learn about the Aqua Accessory, please read this review and also have a look at this video demonstration.

http://cochlearimplanthelp.com/2012/10/10/cochlear-aqua-accessory-review/

http://cochlearimplanthelp.com/2012/10/18/cochlear-aqua-accessory-demo/

Neptune users shouldn’t get to have all the fun!

As you can see, people can be passionate about their choice of implant!

16 11 2012
Dan Schwartz, Editor, The Hearing Blog

Before buying into Cochlear’s design, more physical electrodes are not always better: Theirs are spaced too close together, spraying charges onto the wrong spiral ganglion cells, making hash of music.

Don’t believe me: Read Melbourne piano teacher Daniela Andrews accidently describe it in Cochlear Implant Channel Crossover: First Person Report:

3. Playing music

There is not a large amount of research investigating whether playing music can help with re-training the brain after a hearing loss. However there are some personal stories we can share. Daniela Andrews lost her hearing around 4 years ago, and for the last 10 months [implanted April 2010: DLS] has bilateral cochlear implants:

“At first, the piano sounded terrible. Like somebody had broken into it while I was in surgery and mixed up all the notes for fun. Playing scales barely resembled an up and down pattern at all. [This is channel crossover, caused by the electrodes being spaced too close together, stimulating the wrong nerve endings in the spiral ganglion: DLS] There were random low tones in between higher ones, and vice versa. Being simultaneously implanted brought another challenge – each processor rendered two different tones for the same note. [This is diplacusis — the same tone sounding different in each ear — which is exacerbated by the randomness caused by the channel crossover: DLS] Familiar songs sounded alien-like with all these extra wrong notes thrown in. How was my brain ever going to make sense of that mess?”

Balance of article including a further explanation in Cochlear Implant Channel Crossover: First Person Report

Dan Schwartz,
Editor, The Hearing Blog
All incoming Facebook friend requests are welcome

16 11 2012
Sam Spritzer

Robyn…when was the aqua accessory introduced to the public? That is what matters. It could very well have been in development in response to the Neptune. That would be much a much easier and quicker “waterproof” option than a processor. Bottom line…N5 is NOT swimmable and sitting poolside or standing in the water with head above hardly qualifies as swimming.

16 11 2012
Debra

Hi Concerned Father,

Thank you for posting this. It’s always interesting to see how marketing works to create answers! I am glad you are doing your research!

I do happen to have AB device and I spent nine months doing a huge amount of researching. I have never been one of these people to take things lightly. I was first told that my insurance would pay for Cochlear’s product, my research took me to AB. I had to appeal, in writing, telling them why I wanted AB instead. Once I did this, and my health insurance understood the upgrade capability of AB compared to the other company, I was approved to go out of network for an AB device. It was all about the future for me.

I do happen to be a person who does have/need high speed processing. I am grateful that I had the options to have what I needed to hear my best. I have been tested with the slower programs, I am sure there are people who do better with slow, it’s quite nice to have the options and know my internal device can handle both.

I think you already have your point by point comparisons between the devices, so I won’t repeat that. I will add that I have been participating in CI clinical trials for a long time. In Los Angeles, at the world famous House Institute, they do a lot of CI research. Some of the very in-depth, futuristic research could only be done with Advanced Bionics subjects . For the longest time only AB users could participate because we were the only ones that had internal devices powerful enough for the testing. I have been told that they have since added Med El patients for some of the testing. Cochlear’s internal device is not advanced enough to do these things.

You will be able to hear with any Cochlear implant. My first CI in 1985 had only 4 channels, but it was enough to give speech. I started out with a program earlier than Cochlear’s SPEAK. I have also used CIS as my first program with Advanced Bionics. CIS is a fine program, it’s older technology, but for speech it’s perfectly satisfactory. It was not so hot for music.

I am happy to say I have had three major software upgrades though AB. I have also been upgraded with hardware. All the companies come out with new external devices from time to time, but so far, only AB has come out with major software advancements for us. It’s because they can.

It really boils down to the future. I went with AB based on the hope of things to come in the future, and that was 10 years ago. The technology is advancing like crazy these days, I am able to take advantage of the new software technology as it’s developed. I already know my internal device is only using approximately 25% of it’s capability. Ten years ago it was only using 10% of the capability, that was a huge deciding factor for me.

Not everyone has a choice in which device to get. Those that do have a choice would be doing themselves a favor to compare the specs and capabilities of the internal devices. That’s really the driving factor in a cochlear implant.

Good luck to you on your quest for better hearing! We all deserve the best we can have.

Deb

18 11 2012
A Concerned Father

Hi again everyone!

I’m rather overwhelmed by everyone’s wishes, in-depth replies, expertise and self-experience feedback!! :-) Many many thanks!!!!

I overlooked to mention that my son is close to his 5th bday. So you can only imagine my concern… Unfortunately for him and I, my wife is set on the N5. He currently uses hearing aids and the way she sees it is that with a CI he’ll hear better regardless. Me on the other hand feel that if he’s getting this surgery at 5, which I’m already eerie about, he might as well get the very best available and with the most capabilities with the future in mind.

The 10 point I originally included on my post is the from an N5 user and obvious hard core supporter and someone who is also part of the audiologist team overseeing my son, unfortunately.I.T. is my passion so I understand technical specs when i see some, given the technical spec between the 2 systems his points/argument was rather bologna in my eyes so all of your replies have been VERY valuable to my son’s future as well as to me.

Yet in my quest to continue adding hard cold facts to my research, in order to open my wife’s eyes, it would be great to hear some feedback possibly from any former N5 users who have no switched to AB or maybe any current N5 user following this thread that would like to chime in?? Also, aside from not being able to get the AB’s due to circumstances such as insurance, or hospital not offering the AB’s etc… possibly even own believe, why does Cochlear’s systems seems to be more popular? Our son’s audiologist is inclined towards Cochlear (again, unfortunately) and in fact when I personally asked for the difference between AB and Cochlear this is what I was told:

> wrote:
>
> > I’ll be honest with you, most of what either processor does is more of an attraction for adults than with kids.
> >
> > With adults, they have had normal hearing and can remember what sound was like before becoming severely or profoundly hearing impaired. The software in both devices can be adjusted with enhancements such as ClearVoice, or Autosensitivity or ADRO to potentially enhance the hearing.
> >
> > With children, we build those features into their programs. However a child has no basis for comparison and most miss can’t really tell the difference between a program with or without ClearVoice in the early phase. For kids who didn’t have the option to try it until later, some like it and some don’t.

Again, this isnt a satisfactory nor the technical answer i was after. I like technical feedback, this answer i dont find too technical. Once again, your feedback would be once again GREATLY appreciated.

p.s. you guys ROCK!!! independently of the feedback its comforting to hear from everyone :-)

Best regards.

18 11 2012
Tina

Hi

I know of someone who wears AB and Cochlear – I will ask him to contact you.

Where you are and which hospital you are attending can affect availability of implant, as well as insurance issues and availability of funding. At the end of the day, you should be the ones able to choose, not your CI team, as your son will be the person living with the implant for many years.

I am not happy with your professional response to the child/adult aspect of choice. As your son grows, I am sure he will appreciate being able to make use of any extra functionality of the implant. What he is implanted with will be what he will have to live with, for at least 20 years. So of course, it makes sense to give him the best implant he can get. The processor can always be upgraded, but the implanted stim will limit his ability to hear to the ability of that implant.

Personally, my hearing is like that of a child, as I was born profoundly deaf and being able to hear is totally new to me. I most certainly do appreciate the difference Clearvoice and High Fidelity 120F make, in fact I use Clearvoice 24/7 and wouldn’t be without it – it makes the noisy world softer and it is much easier to hear voices against background noise. So I’m sorry, but I feel the advice you’ve been given on not being able to appreciate enhancements is just bunkum.

You can check out an unbiased comparison of cochlear implants at http://www.cochlearimplantHELP.com which is checked by audiologists and manufacturers.

18 11 2012
discpad

Notice how the audiologist is talking about the external processor, which is a field-replaceable part; and not about the implant circuit, which will be wired into your son’s head for the next 20 years:

I’ll be honest with you, most of what either processor does is more of an attraction for adults than with kids.

If you’re here in the US, insurance covers all three brands equally, as all three have full FDA approval, with identical package labelling mandated by the FDA. You need to ask the audiologist and surgeon a pointed question: Were they ever a participant in Cochlear’s “Partners Program?” This was a “Frequent Flier” kickback scheme; and Cochlear Americas was fined almost a million dollars by the DOJ after their former CFO Brenda March was given whistleblower status:

http://fraudblawg.com/2010/06/09/allegations-of-illegal-kickbacks-prompt-cochlear-americas-to-settle-whistleblower-suit/

Official announcement from the DOJ in June 2010:

http://www.justice.gov/opa/pr/2010/June/10-civ-673.html

Now ask yourself this question: Do you want to trust your son’s future to a company that has to pay surgeons to implant their devices?

Dan Schwartz,
Editor, The Hearing Blog
All incoming Facebook friend requests are welcome

18 11 2012
Robyn

Concerned Father:

I have the Cochlear Brand and have had since 1993. I was implanted with old technology back then, yet heard 100% open set sentence for many many years. I enjoyed music and had great background noise discrimination despite the fact I was a unilateral user. In fact, no one could really tell that I had a hearing loss unless they saw the implant on my head. The sound was and still is: extremely ‘natural’.

During this time I was able to enjoy upgrades of newer software on a regular basis, I started with the old MSP processor, then Spectra, then 3G technology. Each time I was upgraded, I got improved quality of sound, although I couldn’t improve on the 100%, sound got better and better.

I have since been reimplanted in 2009 in the same ear, and after an initial relearning that took several months, I once again hear 100% open set, still enjoy music (I play piano), have no problem on the phone and still sounds very natural. I know that anything that Cochlear upgrade to, will be brought to me as they are committed to providing all recipients of all internal cochlear implant generations with new technologies every few years.

I don’t think you need to worry about ‘future’ capabilities between brands at all.

Cheers
Robyn
20 years of Cochlear Implant use.

18 11 2012
Kara

I wear the N5 and was implanted in July 2011. At the time of my surgery I only had a choice between Med-el and Cochlear. AB was under complete and total shutdown by the FDA and had been for some time. Prior to getting that knowledge I had been looking at all three companies and was leaning towards Cochlear. AB has had many recalls and failures over the years. Med-el is the newest of the three and so there was less data on its reliability. I felt most comfortable with the N5 and that is what I went with. Cochlear did have a recall of the internal part from when I was implanted but mine hasn’t failed. And unlike AB which was totally shut down Cochlear was not, they just didn’t use that internal hardware anymore. I love my N5. Because I have a high amount of residual hearing it has taken me longer to adjust to it but that would have been true for any brand. I didn’t lose all my residual hearing in the implanted ear.I had the implant as an adult but know there are some aspects on the N5 designed for parents of kids with it to make sure it is on and working. I would love a completely swimmable processor but would have still gone with the N5. The choice would have been more difficult but would have stayed the same. Cochlear has a record of being much more reliable. I believe it is only a matter of time before they come out with something more advanced, possibly in 2013.

It’s a hard decision. I am happy with the one I made. Good luck making yours.

18 11 2012
Geoff Turner

Kara, it was a voluntary recall AB imposed on itself immediately after just two incidents of implant failure was reported, not a recall ordered by the FDA. This is two out of 28,000. Cochlear, on the other hand, apparently waited nine months after the first N5 implant failure was reported. By the time of the recall, there were a few hundred failures already reported to Cochlear.

18 11 2012
Sam Spritzer

Robyn…congratulations on your achieving 100% open set sentence. Not many people can achieve those results. I am sure a lot of it has to do with your commitment and dedication to achieve those results. You know, I am not sure if you are aware of this but I am a very competitive triathlete. I really wished I could find a pair of sneakers that could get me as fast as the best. Unfortunately, I can only go as fast as my body will let me no matter how hard I try.

Kara…while the older implant is reliable, it is as reliable as the other 2 brands. The difference between all three brands is less than 1%. Unfortunately, Cochlear’s newest internal was not and it had to be recalled. Here is the letter from the CEO… http://products.cochlearamericas.com/suspension Were you aware of this?

Unconcerned father…like you, I am also into I.T. I call myself a byte miner but in reality I am a programmer that specializes in mining data. Other people call them report writers. So I am sure you and I are deep in the theory of logic and common sense. That approach has helped when I am having a discussion. I won’t tell you what to say to your wife, here, but feel free to email me privately and I’ll help you win the battle of the sexes. :D

18 11 2012
Geoff Turner

I’m in the unique position of having an old AB implant that was similar to what Cochlear offers today in terms of listening strategies. For over 11 years I had the old implant using CIS as my listening strategy. When it failed, it was replaced by the HiRes90K. When I was activated for the first time, I noticed immediately the difference. Much richer, clearer, and robust. Resolution is fuller. Speech comprehension is significantly improved, especially over the phone, and I was born deaf. Music, in particular, sounds incredible compared to the old implant. I have met several people with Cochlear and they unanimously said music is all mush or terrible. I can so relate to what they’re saying because with the old implant it was mush and bleh to me too.

18 11 2012
Tina

How interesting that you were born deaf too, I hadn’t realised. I love music and listened to it from day one after activation. It sounded awful at first and it took 3 months to sound beautiful and perfect. I have Fidelity 120, music sounds so crisp and clear. I feel so lucky and blessed.

19 11 2012
Geoff Turner

Tina,

The ironic thing about music was that I thought it sounded pretty good with the C1 implant, much better than a HA for sure. So I related very well with Cochlear users who told me that music sounds good if not perfect.

But with HiRes90K, it just blows me away how I can hear music is such crisper, cleaner and more 3D detail. I mean, hands down, Fidelity 120 is superior in every way to any variation of CIS or SAS and I suspect to any sound processing strategy Cochlear can offer.

It made me realize how the brain adapts and attempts to fill the missing pieces because of a CI’s technological and software limitations. And that over time people think music sounds pretty good in spite of those limitations.

18 11 2012
Geoff Turner

I forgot to mention I have Fidelity 120 instead of CIS. The claim by the Cochlear user that Fidelity 120 is a variation of CIS couldn’t be more wrong. It’s nothing like the CIS. Fidelity 120 blows it away and then some. I’m hearing more pitches than I ever could with CIS.

19 11 2012
Robyn

Dear Sam,

I’m sorry you haven’t been able to achieve 100% open set with your Advanced Bionics implant, this despite you having a competitive nature.

My reason for pointing that out, is that it is achievable, despite Advanced Bionics implantees trying to always make out that the cochlear brand is inferior when it isn’t. I will also point out that I only have 16 of the 22 electrodes switched on, so the number of electrodes inserted doesn’t actually have anything to do with the ability to be able to hear well.

(I only have 16 of the 22 electrodes inserted because of bone growth inside the cochlea).

My wanting to achieve those results has nothing to do with the actual result, but probably more to do with the skill of the surgeon, the brilliance of my audiologists, and my brain plasticity, and also most likely the length of time I’ve had a Cochlear Implant. It will be 20 years this coming March.

I’ll also point out that because Dan pointed out Cochlear was sued for kickbacks, one must also remember that Advanced Bionics was fined $2.2 million dollars by the FDA for not approving the vendor B plant appropriately. I point this out because it seems that most companies in the US of A seem to fall down somewhere along the line. You can read all about it here: http://www.reuters.com/article/2008/03/28/us-advanced-bionics-fda-idUSN2834058620080328?feedType=RSS&feedName=domesticNews

While Cochlear’s newest N5 was recalled, it was a voluntary recall and compared to ABs record of 5 recalls in total, Cochlear is much more reliable. That is just fact.

Cheers
Robyn

19 11 2012
sharoncrouch

All brands have a unique quality. When all of my research was said and done my decision was made for Cochlear and believe me I am not sorry. My friend has Med El she wishes she had some of the choices our cochlear gives us. I can do so with the remote that is not available to the other companies. I think that cinched it up for me knowing I would have some control as any time needed. When going to CI support groups I find the Cochlear implantees to be very happy. It is a personal choice you have to make after looking at all sides I wish you the best in making your decision.

19 11 2012
Sam Spritzer

Robyn….I am not going to get into a back and forth with you but the lawsuit was settled for $1.1 million. Please do a better job researching before commenting.

19 11 2012
Joel

this is not aimed at any specific brand though I wear two Harmony AB devices. Before I got my first, I played my clarinet daily and enjoyed it via the hearing aid. Then I got my first CI (Harmony) and the sweet clarinet music continued. After I got my second CI (Harmony) my clarinet sounds terrible and I have stopped playing it. That makes me want to cry. I have started to play a tenor Sax. This is a much bigger sound, but not as sweet as the clarinet.
So when anyone talks about music, I hope they are not talking about playing music, but listening.

Joel

19 11 2012
David Ryan

Joel, why wouldn’t you continue to enjoy playing music with at least the first implant? Yes, some of us are talking about playing music as well as listening. I am one of them.

19 11 2012
Sam Spritzer

Joel…is it possible to describe what or why the clarinet doesn’t sound the way it should?

19 11 2012
Joel

CI are designed for speech, not music. I can now hear at 82%, but lost the sweet soft sound of the clarinet. I’m told to keep my options open. Keep training my brain

19 11 2012
Howard Samuels

I’d like to thank Tina for not having a heavy hand on the censor button, and for allowing a discussion like this to take place.

It’s always disheartening to hear comments attempting to equate voluntary recalls with reliability. A company that halts production before too many people are affected earns high points in my book. All companies claim top reliability, and they all have data to back it up. When somebody posts a comment like ‘Cochlear is much more reliable. That is just fact’ it would certainly be helpful to back that up with data.

The only independent source I am aware of is the FDA database. It certainly has its limitations, but it is the best source we have for now. The key to interpreting the charts is in looking for a sudden rise in reported incidents. I interpret that as indicating a large number of defective devices that were implanted before a company chooses to institute a recall.

Please refer to the charts in this link:

http://cochlearimplanthelp.com/journey/choosing-a-cochlear-implant/cochlear-implant-problems/maude/

You can see a bump in AB’s reported incident rate in 2006, about the time of what was arguably the company’s largest recall – the hermeticity failure. Since that time, the number of reported incidents has held steady or even decreased, while the number of implants has grown both due to the expanding market and also to Advanced Bionic’s increasing market share.

Compare that chart to the one for Cochlear. The dramatic rise in reported incidents in 2011, and the sustained higher rate of incidents since then, indicates that a large number of defective devices were implanted before Cochlear chose to institute a recall.

Cochlear was severely criticized for this recall because the root cause – hermeticity failure, was well known in the industry due to Advanced Bionics’ recall. And after 14 months of recall, the company has not determined why it is failing, let alone come up with a proposed solution.

So sound bites like ‘Cochlear is much more reliable. That is just fact’ may be persuasive, but they don’t reflect reality. If I were choosing an implant today, and trying to assess reliability, I would try to assess whether a company would implement a recall before too many defective devices are implanted.

19 11 2012
Robyn

Geoff,

Seeing you have never had a Cochlear device, how can you compare that it might be better than AB? You simply can’t.

ACE and Hi-ACE are strategies that are unique to Cochlear that no brand can ever have because they are patented. How are you able to make statement that HiRes90k provide better music appreciation than Nucleus CI24RE with Hi-ACE strategy when you have not had experience in hearing with any of Cochlear’s devices? Or – Provide a source that AB recipients who hear with HiRes90k have better music appreciation than those with CI24RE.

Robyn

20 11 2012
Tina

I like to see cold hard facts and their source when undertaking due diligence. It’s very important to research carefully as you’re stuck with an implant for a very long time.

Open and frank discussions are important as they help to clarify issues – but please keep your comments polite and professional. There are opinions, and there are facts. Let’s not muddy the line between the two.

20 11 2012
Robert MacPherson

Cool, Tina – cuz this sure is smelling bad so far – smells like the brand wars of oldto me…

20 11 2012
Sam Spritzer

And now a word from our sponsor…..*Twilight Zone theme music*……

20 11 2012
Vernice Meade

I am a bilateral Cochlear Americas recipient. I had my first implant in 2004 and at that time chose the CI brand because of the MRI problem. I had the second implant in 2007. Before getting the second implant, I could not enjoy music at all. The second implant changed all of that and now I listen to music on my iPod and to CD’s and to the car radio. Since I was in my 50′s when I got my first implant probably much of my success (I have 100% speech discrimination) has to do with auditory memory as well as how hard I worked to fill out my hearing journey. I think that most everybody that is successful with the particular choice of CI has no regret about choosing it. I know I am not. I don’t swim so that particular problem is moot for me but I can see where it would be important to others. I hear so well that I consider myself with “normal hearing” and can’t remember what normal hearing was like since I started losing my hearing in my early 20′s and I am now in my 60′s. I think a lot of the success rate for any of those brands depends on the brain’s ability. And I also think age plays a part, the older that you are the harder you have to work because older brains are slower.
My question or comment relates to the array. I attended a meeting where a very well known audiologist was giving a talk about cochlear implants. New research is showing that having a shorter array protects the hair cells that are deeper into the cochlear thus making it possible to retain some of your residual hearing and that if every there was a breakthrough in hair cell regeneration this could help those who have profound hearing loss to regain some of their hearing. Those that have the older arrays could not avail themselves of this technology because the array causes irreputable damage. I think that Cochlear is the only one who has this technology right now – the Hybrid is an example- but since I am not an engineer or someone who understands a lot of the technical “speak”, how does this research play in the market with the AB and the Med El? I would think even with more technology available in the AB, this could change the way that people decide.

20 11 2012
Tina

Vernice

I totally agree with you on the ability of the brain to make sense of sound and the affecting factors. Personally, I think there are larger differences between individual people’s brains than between cochlear implants.

I have always listened to music and lipread instead of listening to speech, so my brain is ‘primed’ for music enjoyment and it sounds fabulous, but I don’t do so well with understanding speech (even though I can pull off a great audiogram in the testing booth, showing normal hearing at -20db). That’s the fallout of being a music junkie plus I’ve been almost stone deaf for all of my life *shrugs*

You ask a good question about the array. I’ll leave it to my more technical readers to respond to this ….

20 11 2012
Howard Samuels

Hi Vernice,

If hair cell regeneration ever becomes a reality, it may be possible that undamaged parts of the cochlea are more likely to benefit. I’m not a medical professional at all, but it is probably quite premature for anybody to speculate on that.

Here is a comparison of electrode arrays by MED-EL, comparing to AB and Cochlear:

http://cochlearimplanthelp.files.wordpress.com/2012/11/med-el_12mkt_22767r3_electrode-comparison-brochure.pdf

My feeling about using an intentionally short array is that you would miss more low-frequency sounds with the implant. Since we know how well cochlear implants work today, and have no guarantee on the timing of hair cell regeneration (if ever), or whether having an electrode in the meantime would make a difference, I’d opt for the performance now.

26 11 2012
morgan

I chose cochlear americas for its simplicity. I’m a set it and go type person, and cochlear had the best option to fit my lifestyle. With ab there were so many interchangable parts, it turned me off. In the end, its like a stock portfolio, you go with what you’re comfortable with.

14 12 2012
Vernice Meade

I have been a cochlear implant recipient since 2004, (the right ear) and the second in 2007, I had started losing my hearing in my early 20′s and after wearing hearing aids for 30 years, finally had to admit that my hearing was gone. I did my research as well. I got Cochlear Americas in both ears. The first was an N24 and the second a Freedom. I love my life now. I woul.d not go back for anything. I volunteer (a lot), write a monthly newsletter, and try to spend as much time as possible with my grandchildren as I can. If you want to email me to get more info my email address is: vmeade1@cox.net. I live in Oklahoma City. There are several CI recipients in the Dallas/Ft Worth area. You can also go online and join any one of the CI communities and talk to lots of recipients. Think about it. I don’t know enough about AB or Med-el to talk about those particular products but you can go online to cochlearcommunity.com and ask all the questions you need to know about CI’s and have lots of experienced people answering them.

28 12 2012
Iftikhar

I am planning CI for my son. He has good speech is 19 years old.Advise me on selection of brand, also cost in Pakistan is very high , do advise on cost reduction. Thankyou

28 12 2012
Tina

Hello

Check out the following pages

http://funnyoldlife.wordpress.com/cochlear-implants/choosing-a-brand/

http://cochlearimplanthelp.com/journey/choosing-a-cochlear-implant/

I can’t advise on cost reductions, sorry. Your surgeon and cochlear implant centre may only implant one or two brands, so you will need to check with them too. Good luck!

28 12 2012
discpad

You’ll want to go to New Delhi as it’s become a center for inexpensive, top notch “medical tourism” surgery for Americans who lack insurance.

Also, Anadolu Medical Center near Istanbul is a Johns Hopkins affiliate:

http://www.hopkinsmedicine.org/international/international_affiliations/europe/anadolu_medical_center.html

3 01 2013
Tina

I spotted this news today;

FREE Cochlear Implants in Pakistan – a medical university is offering some free cochlear implants in Karachi. This news is published in today’s Jang (Urdu), they also said they are going to the UK to talk to CI companies to obtain subsidiary equipment. Let’s hope many will benefit. To date, they have operated on two children.

3 01 2013
Howard Samuels

More information on free cochlear implants for children in Pakistan:

http://cochlearimplanthelp.com/2013/01/03/50-free-cochlear-implants-in-pakistan-this-year/

30 12 2012
Rebekah Stone

I have had three Ci’s. Two AB and one MedEl. One AB was removed shortly after implant due to complications. We then put an AB in the other ear and I used that satisfactorily. Several years later I opted for a MedEl in the “empty” ear. Using two different brands isn’t common. I immediately loved the MedEl, it was sound like I remembered (I’m late deafened). With the AB, I only used it when I needed to interact with hearing people, but with the MedEl I forget I have it on and no noises are unpleasant except those that are unpleasant to hearing people. I can use the phone, but not reliably…I have to ask the person to repeat what they said quite often. I can listen to music as well, although sometimes it is not clear. If it is live, it is fine, but through speakers it depends on the quality of the sound equipment. In restaurants and crowded situations I can usually keep up with the conversation but I have to adjust the sound using my little remote gizmo that does stuff I don’t understand, volume control and something else clever like decreasing obnoxious noises. So, for me, at least, the MedEl has trumped the AB. I have the latest model of AB, the waterproof Neptune, and a devoted and patient audiologist who has spent hours trying to adjust it so that the two CI’s work in tandem, but as it is, I am unable to wear them both since they don’t sound anything alike. It would be like wearing headphones with one ear getting a clear sound and the other getting bad, slightly delayed reception. My brain can’t adapt, even after trying for many hours. I start to feel sort of seasick, actually. So I don’t wear the AB at all. The other minor point I like about the MedEl over the AB is that it activates immediately when you turn it on or when you put the magnet on your head, whereas the AB has a delay of a second or two, which can be a bit bothersome because people start talking the second they see you attach the magnet, and you have to say, “hold on a tic, I’m not turned on yet…” by which time you are turned on. Not a big deal but a bit of a drag.

I was pleased to find your site. It’s good to see something devoted to the differences, and also something that points out how we all will react differently due to how our brains respond. I think it is far too early in the game to know how well any of these really will work. In 50 years, I imagine they will have it down pat. But for now, it’s important for potential recipients to have somewhere they can read about other’s experiences without too much bias in one direction or the other. I am most certainly biased towards MedEl, but that is what has worked best for me. One important point I should make, though, is that we had to turn off more than half the electrodes in the AB in order for me to begin to understand the sound. I was unable to utilise the latest technological upgrades because it was too painful. So, from this perspective, MedEl, with its lesser number of electrodes and whatnot, as well as it’s choice of sizes for the electrode itself, made a big difference, I think.

By the way, for what it’s worth, I was about 33-5 when I began losing my hearing. I got my first implant when I was 43 and got the MedEl just last May, a few months prior to my 50th birthday. Cause of hearing loss was genetic.

Cheers,
Rebekah Stone

30 12 2012
Shelia Williams

I just got my CI in may. I haven’t really got used to it yet. But I’m getting there. I can tell when I don’t have it on and just have my hearing on. I really like it. Hear everything just not sure what I’m hearing. Lol. I used to wear a hearing aid in my right ear but it got to where hearing aids weren’t helping. I chose Med-El because I think I will benefit better from it. The coil is longer so I think that’s a big plus. Love the remote.

30 12 2012
thehearingblog

Rebekah, you are the first person I know of who has both a Med-El and an AB CI; and your experiences are highly intriguing: I know several people with Nuke & AB; and their observations are the opposite of yours.

Please do contact Mike Marzalek at Mike at MikeMarz DotCom, starting out with a copy/paste of your text above. Tina has written about him and his home-brew CI processor; and Mike runs the CI Theory website.

Dan Schwartz,
Editor, The Hearing Blog
All incoming Facebook friend and LinkedIn colleague requests are welcome are welcome

28 01 2013
Roy Crabbe

The Freedom has an on/off switch very useful

With the Freedom I have 4 different programs and I can adjust the VOL and Sensitivity on each. The Harmony has one program and the sensitivity is not adjustable. The Harmony is TOO sensitve on many occasions

The Freedom has a choice of rechargeable or throwaway batteries.

Speech and music is clearer an the Freedom.

The wire connecting the processor to the transmitter is twice as long as it need be on the Harmony. Only one size available.

28 01 2013
Geoff

Roy, thank you for the clarification. Which implant center do you go to? I ask because the Harmony actually holds three programs, although most AB users settle on one. And while most users don’t feel the need to adjust sensitivity, the audiologist can program your processor so that the knob does control sensitivity.

It seems like your audiologist may not be very familiar with the Harmony. Have you tried visiting somebody with more experience?

Are you familiar with the Neptune processor, which has both volume and sensitivity controls on the processor itself (no need for a remote), and is completely off-ear, which may alleviate your concern about the cable length?

Have you seen the preliminary information on the new BTE processor?

http://funnyoldlife.files.wordpress.com/2013/01/ab-brochure.pdf

We don’t know much about it yet. But it will come with a remote, which features ‘one-touch changes to programs, volumes, and sensitivity settings.’ The picture shows a different headpiece and cable, and the cable is removable

28 01 2013
Sam Spritzer

Hi Roy…I think it would be unfair to try to compare the two because no two ears are alike. The Harmony has 3 program slots and of course you can adjust the volume. If you find the Harmony too sensitive, please ask your audiologist to adjust it.

As for the cosmetics, I don’t necessary consider one better than the other. As an environment sensitive individual, I do my share by limiting the disposal of batteries. As for the cable length, how much longer does it need to be? I would prefer shorter if I had my druthers!
Sam

28 01 2013
Roy Crabbe

But we need to adjust sensitivity on the run, for different situations.
The original post compared implants. My cable is twice as long as necessary and a nuisance. I was deafened by streptomycin and so, the structual ears are both healthy.

28 01 2013
Sam Spritzer

Roy…understand that everyone is different. Some of us just set our processors to one setting and never touch it again. I am one of those that has the routine everyday. I turn on my ears with the setting at 12:00 and I leave it there till I go to bed. The only time my processors de-ear is if I have to change the battery.
Sam

28 01 2013
Robert MacPherson

In the matter of Harmony headpiece cable lengths, there are 3 available for the current UHP (Universal HeadPiece) : 3.5″, 4.25″, and 5.5″.

28 01 2013
Roy Crabbe

My understanding is that the Harmony has 3 different program SETTINGS but only the CV is of any use. I think the others can include such as Loops etc. I do have RAW sound setting not CV just for music.
AB head office has said there is only one cable length.
I know nothing about Neptune. My Centre carries out about 1 inplant/week and is very experienced. Remember mine is six years old. Please could people commenting pl. say how long they have had an implnt – it would help.
I have, cummutively 24 years experience.

28 01 2013
Tina

I’ve had my 1st Harmony for 3 years and have been bilateral for just over a year. I found my newer CI to seem less ‘able’ than my older CI, but it just needs time to catch up. My older CI has had a 2 year head start. Why should the brand make a difference?

The Harmony has 3 settings and Clearvoice is an additional filter. I don’t use Clearvoice when I want to listen to music, and it is pure, beautiful, raw sound. I like to use Clearvoice when I want to reduce background noise, which I have added to another program slot.

28 01 2013
Roy Crabbe

sorry that should read cummulatively

28 01 2013
Roy Crabbe

Please, where did you get all your facts from then?

28 01 2013
Roy Crabbe

Yes, I disbelieve each any every Company’s sales literature

28 01 2013
Tina

Talking to specialists, engineers, and research. Sales is just that, sales. No one is going to lie about their products but they can market it any way they like. What exactly is your point Roy? Do you just like to argue with people?

28 01 2013
Robert MacPherson

Roy: There ideed ARE 3 BTE cable lengths for the UHP. This is fairly new – perhaps you have not researched this lately. With the UHP, the cables are replaceable without replacing the entire headpiece assemby as with the original.

28 01 2013
Tina

You do a super job of keeping up to date with all of the technology Bob – thanks!

28 01 2013
Roy Crabbe

This will be my last comment:
I have received hate mail in the past for expressing an opinion. I have both Cochlear and AB implants and 24 years implanted experience. Some AB recipients cannot accept the fact that they may have done better elsewhere.
and yes, manufactures WILL lie about their products

28 01 2013
Tina

You can certainly express an opinion on my blog – but it should be an INFORMED opinion :)

I note that you didn’t bother to answer my questions.

28 01 2013
nzcaptions

Roy – I’m very interested in your experiences with the two implants of different brands. I would be keen to hear more. Do you have a website or email address I can contact with you? Mine is robyn.carter@xtra.co.nz Like you I am a cochlear implant user coming up to 20 years. I’ve got Cochlear Brand and am very happy with it. You’ve jumped into a thread here where they absolutely bash cochlear and are full on AB, so you won’t make much headway here. Look forward to hearing from you.

28 01 2013
Geoff Turner

Robin, are you saying that some of Roy’s comments regarding AB’s processor and implant are true?

28 01 2013
Sam Spritzer

Excuse me Ms. Carter but where in this thread is Cochlear being bashed?

29 01 2013
Sam Spritzer

Well folks, Geoff and I have not gotten a reply from Ms. Carter which makes her appearance highly suspicious. It should be noted that she is an administrator of a Facebook group that is pro-Cochlear. The group is known to suppress the expression of truthful information and has liberally misused the word “brand-bashing”. The group has also been known to censor posts.
Sam

28 01 2013
discpad

@Roy: In fact, the advertising literature for CI’s is extremely tightly regulated by the United States Food & Drug Administration (FDA); and in fact it must be preapproved; and only on released products.

Cochlear got spanked by the FDA when they claimed they had 168 channels, when in fact it was “up to 168 pitch percepts.”

Dan Schwartz,
Editor, The Hearing Blog
All incoming LinkedIn colleague and Facebook friend requests are welcome~

28 01 2013
Sam Spritzer

Roy…I beg your pardon but what Tina said were her own words and very truthful of her experience with her implant which happens to be Advanced Bionics. I think you owe her an apology and I think you need to reconsider some of your words/comments if you don’t want to receive any hate mail.
Sam

28 01 2013
Howard Samuels

Roy, I’m sorry that you are not having a pleasant experience today. Kindly help me understand a few things, though. I received my first AB implant in 2005, and my second in 2007.

After listing a number of things with which you are unhappy regarding your AB implant, several people offered inputs to help you. But those inputs were ignored or refuted. Tina did approve your post, so you may safely ignore people who throw around accusations of ‘bashing.’ She even approved that post!

You thought that your Harmony only has one program slot, you learned that there are three. They are all fully programmable – choose CV or not on each slot, at any level, tele coil, volume or sensitivity adjustment, whatever. An appropriate response might have been ‘Oh, I didn’t realize that. I’ll have to bring that up with my audiologist.’

After learning that you can indeed adjust sensitivity on the Harmony, well, there was no response.

When you learned that there is a completely new processor (Neptune) that also has many of the features you desire, you just said that you hadn’t heard about it, and didn’t bother to even ask where to find information about it.

When the new headpiece with different cable lengths was brought up, which you complained about twice, you refused to believe the people who are trying to help you.

Geoff posted a link to information about a new BTE processor from AB that also addresses all of your concerns. As far as I can tell, you haven’t even clicked on the link.

So here is my question for you. If you really do have an AB implant, and are unhappy with it, why aren’t you interested in learning about all of the things the company has done to make your life better?

25 03 2013
Mason

I would like to add to this.
My son was born profoundly deaf, at 18 months he was implanted with his first CI – Cochlear, he had that till he was 8 years old, it worked just fine for a long time, he is a very active boy into all sorts of sports mainly Gymnastics.

He had an unfortunate accident during a competition which broke the implant, the fall really didn’t look that bad or even hurt him, but we found it had broken the implant.
So two weeks later he was re-implanted with the latest Cochlear CI, two weeks later was turned on, he commented that the results for him were about the same as the old implant, sadly 6 ,months down the track the same thing happened again.

This is where we decided to switch brand to Med-El at the suggestion of his Audi.
He was implanted with a Med-El Sonata 3 weeks down the track it was activated with an Opus 2, the response from him within 48 hours of activation was immediate, he was hearing things he had never heard before, in music and on TV. When we went fishing he could hear the water splashing as a fish broke the surface.
The Med-El system was a boon for him he was loving it. So eventually another accident happened only this time much worse where he landed very badly hit his head on an apparatus breaking the implant.

By this time we were left wondering what next, he was wearing his processor as well at the time, so the implant was wrecked and the processor was in 5 pieces with broken plastic all over the place.
The Med-El system lasted him till just after his 9th birthday

This brings us to AB, his Audi had never done an AB implant before but said it would be a better option having an impact resistance of 6 joules where as the Cochlear had a resistance of 1 and the Med-El 2, if I remember right.

So finally we are at the last surgery the new AB implant goes in, there were some small problem the surgeon mentioned but in the end said it would be fine but would need 6 weeks before it could be activated.
Six weeks pass, he has it activated with a Harmony within a week he says he is hearing more still than ever before.

He is 11 years old now, no more problems with the implant, he has had a few bad falls since this implant was inserted but zero problem with it, he is happier with it than the other two brands and has just had the ClearVoice update.

I have asked him if he will allow us to give him a bilateral implant as well, for the longest time he said no, but he is coming round to it seeing the benefit it will give him. He initially said no because of the amount of surgery it has already caused him..
That’s his experience, other people may well have different experiences but if you have older children I urge you to consider how well the implant will cope with any impacts.
Kids will be kids

14 06 2013
Vernice Meade

If you are on FB, join a support group called CI Hear. It is open to wearers of all brands and type of CI wearers. You can ask questions of anybody. Not everybody is happy with their CI but those that are not don’t typically join support groups. The reason is because we all have high expectations when we go into this type of surgery. I am bilateral with Cochlear Americas brand. I have had great success so don’t have a lot of negative things to say about the brand. I like that they have been in business for 35 years with only a couple of recalls.

14 06 2013
Shelia Williams

I got my Med-El last year Ivan say I am very happy with it. I hear everything and a lot of things I hear I have no clue what they are I just ask whoever I’m with what the sound is until my brain can register fully what it is. I’m really glad I had this done. I did a lot of research and I choose Med El because it goes farther into your cochlear than the other brands I felt I could benefit more from that. So good luck. I was real scared at first but have supported family that knew how frustrated I was not being able to hear. I’m 52 years old so this was a big step for me

18 06 2013
Robert MacPherson

Last I heard, MED-EL’s market share was in the mid-teens. But with the market in turmoil like perhaps never before – who knows what the numbers will be like by next year – except the strong likelihood that Cochlear’s share will decline.

18 06 2013
Debra

I have to agree with Bob, I have seen where Med El’s market share was somewhere in the teens, but that was total market share, not market share in the U.S. They have been in Europe for a long time.

We have two clinics where I live. One of them, my clinic, will do all three manufacturers. There are only a handful of Med El users compared to AB and Cochlear. The other clinic pretty much does Cochlear. This was our first clinic when we moved. They will do AB also, but if a person comes in with no preference or knowledge, they come out with a Cochlear device. They don’t work with Med El at all. The audiologist told me why, but that’s just her opinion.

If you are in an area with a strong Med El presence, like near their headquarters, then I don’t think the percentage of users in the US is going to matter. If you plan to move somewhere else, it might be a little hard to find a clinic that does Med El.

18 06 2013
roy.crabbe@yahoo.com

You should ask an opinion of one who has both an AB and Cochlear implant

18 06 2013
cem4881

No matter whose numbers you look at, it is very likely your chosen implant will be safe to wear. So I never worried about safety. If they were dangerous or unusable they just wouldn’t be around after all these years. And yet, it is still a very young industry and one that should be able to survive because it does work so very well. I can see it eventually replacing hearing aids with only a moderate hearing loss instead of the profound loss required right now. And I wasn’t at all worried about appearance. I felt the most important question was which would deliver the best sound? At this point, the sound delivered is not natural hearing, but which comes closest? I wish there were charts and graphs to show comparisons. You can’t just try one on like a dress. And really, that is the biggest question, and how is one to answer that? I am bilaterally implanted and have been extremely happy with my choice. I will leave it to you to guess which one? :)

22 06 2013
cem4881

You talking about the Vanderbilt Project, Robert? They are still waiting for more results to arrive and be included in the statistics. But so far, it’s looking fabulous.

22 06 2013
cem4881

And I would like to add that this is the longest running ummm, umm, whatjacallit, in a blog. Wondering how to categorize it. :)

22 06 2013
Robert MacPherson

I’m referring to rating the UNC-CH program as “average”.

22 06 2013
cem4881

Oh! Okay and thanks, Robert. I am going to be asking this question here and elsewhere. Is there anyway to compare what the different brands are delivering to be heard by the user? Not what is heard, that, I am pretty sure, is not possible yet, but what is delivered?

22 06 2013
Shelia Williams

U ask what is delivered. Are u talking about sounds and noise? I hear everything. I mean everything. My brain is destinguishing what the sounds are. I’m gradually hearing and understandind what my husband is saying when he is in another room. All sounds are delivered (well to me they are). It’s gonna depend in the persons brain as to how fast your brain can tell what the sound is.

25 08 2013
Matt

My son who just turned two will be getting implants soon. He has severe to profound hearing loss. We have been given the speech that all implants are similiar and to research which one would work best for us. After reading some of the comments it seems to complicate matters even more. We are new to all of this and could use any help possible.

Do any of you have opinions which one would work best for a 2 year old?

25 08 2013
Tina

Hi Matt

All recipients are told by the medical professionals that all implants work well and they are basically the same. It’s up to the individual to undertake due diligence and research carefully. There are differences between the implants and processors, the way they work, but there are bigger differences between the recipients themselves – auditory memory, hearing history, and ability/willingness to work with sound.

I would recommend you take a look at cochlearimplantHELP.com which is impartial, accurate and is updated on a daily basis. This website has been reviewed and checked by hearing professionals and cochlear implant companies. Look for the Shopping Guide on the bottom left corner of the home page. You won’t find a better overview of all cochlear implants in one place on the internet. Best of luck!

26 11 2013
becsp1224

All very interesting to see the discussion. I have been accepted for an implant. My surgeon has said both the AB and Nucleus would be suitable. My remaining ear hears 50% with a hearing aid so I will still be relying on that. My ear to be implanted is currently only 16%. Ideally I want the CI and the HA to be able to work on the same wireless system. This means that my HA will need to be a Phoank or a Resound/danalogic brand. I understand the reason that my CI should be driver as to what I choose as that is the one I am stuck with. However, having tried Phonak HA twice now, mapped separately by 2 different audiologists multiple times but I just cannot get on with them at all. Whereas the resound one was more or less perfect after one mapping. Consequently this means my CI will be the Nucleus.

2 01 2014
Andrew

Having read this I believed it was rather enlightening.
I appreciate you taking the time and effort to put this content together.
I once again find myself spending way too much time both reading and commenting.
But so what, it was still worth it!

2 01 2014
Tina

Thank you Andrew!

4 01 2014
john

I found this thread whilst awaiting my first CI Its been a whirlwind experience and I have read from top to bottom with glee ! thank you to everybody who has taken the time to add to it I have worn aids for nearly 25 years and am now 44 I can remember bird song and babbling brooks from my childhood but only recently got a referral to be tested for CI’s well surprise if well passed the stage where I need them
In the UK as an adult Im only allowed one and can chose left or right, as the left side of my brain is dominant Im left handed and Listen to what I need to hear the most with my left ear, it is, the side I would most like to improve however its not the poorest ear by any stretch It was explained to me that passed procedure was to implant the worst ear, but as this is a once in a lifetime opportunity I’m only likely to ever have one on account of the cost Im plugging for the left its a gut feeling thing!

My hearing loss is mainly the high frequencies I still have a fair degree of bass hearing and indeed this is my chosen instrument having given up the alto sax when it dawned on me Id lost the who top half of the range

Ive been offered either AB or MedEl by way of choice and When I began to read this blog I was drawn to AB in a big way, So much technical ability so darn clever. but as I read on I began to understand that the my ears being very low Tec might well be spoilt for choice you know rather like put me in an F1 car to do the weekly shop
then I heard that the MedEl was longer and would reach further into the ear closer to my beloved bass Which has been a sore point since when you put in you hearing aids to hear the world around you and it wipes out everything you are comfortable with
A remote can be hard work I have one for my hearing aids but so too can be a hearing aid that automatically supresses everything when you least want it
I try to play bass in a music group and spend a lot of time pulling either one or the other hearing aid out to try to balance the all bass or all treble effect.
Upgradability, now you talking nobody wants to be left behind right but I think AB and MedEl have good scores on this account
Time to pull out the glossy brochures again and read cover to cover
Things will be so much better which ever I end up with and thats pure joy that has me sitting here with a grin on my face !

4 01 2014
Tina

Hi John

Good luck! The NICE guidelines are just that, they are guidelines. So I would keep pushing for a 2nd CI, you might get it, it depends on how much funding is available. I know of a few people who have got a 2nd CI.

Rather than read the glossy marketing brochures, I’d recommend you check out the best non-biased and up-to-date comparison chart at http://cochlearimplanthelp.com/cochlear-implant-comparison-chart/

5 01 2014
discpad

John, first off, I wish you well in your journey.

With the monopolar stimulation used by both the AB & Med-El devices, tonotopic organization is only approximate. What’s more, the low frequencies are delivered by “pulsing” the apical electrode: This is how they were able to create several pitches with the old 3M-House single electrode CI.

Especially since you have residual hearing, you’ll do better if your surgeon tries to preserve it — The overall results are better with an atraumatic insertion. I’ve been getting good reports on AB’s new mid-scala array with this respect — Talk to your surgeon, as their skills vary widely.

Although Med-El has the 31.6mm electrode, most surgeons are using the newer 28mm array, which has about the same angular depth of insertion as the AB array, as the latter hugs the modiolus a bit tighter.

8 02 2014
Jeff

Hi everyone,

I really appreciate this site as well as the cochlearimplanthelp site. I live in Colorado in the US and in about 3 weeks time, will be getting a single side implanted (my right side). I have absolutely no residual hearing in my right ear and I wear a hearing aid for some residual hearing in my left ear. (Eventually I hope to get implanted in my left ear as well, but one at a time.)

Like everyone who has been through this process, I have found the decision of choosing a manufacturer very difficult. My audiologist and surgeon originally recommended Cochlear primarily because it has been around the longest, it has (or possibly had) the lowest overall total of recalls and because Cochlear is based here in Colorado.

So as a place to start I watched and looked through all of the marketing info from all of the companies. I then found several comparison charts online of the 3 brands (Cochlear, AB & MedEl). In this aspect the cochlearimplanthelp site was very helpful in explaining a lot of the technical specs that I didn’t understand. Finally I found this site.

At this point, I am fairly strongly leaning toward the AB product. The fact that the implant has multiple power sources to stimulate multiple electrodes simultaneously seems that it would make for better hearing in more complex situations. The fact that the implant is using 25% of its capacity, whereas the Cochlear implant is using almost all of it’s capacity, makes me hopeful that there is more ability to upgrade in the future.

But I have a few questions for others on this site: Cochlear boasts a lot about their backwards compatibility as they come out with new processors. How does AB compare in this regard of backwards compatibility? In one of these articles, written several years ago, one person mentioned that AB has numerous stimulation strategies, while Cochlear has only one. As a few years have passed, does anyone know if this is still the case? Cochlear talks about the ability to raise or lower the microphone sensetivity and the processor volume as well as the ease of ability to turn on and off the t-coil in any program. How does AB compare on these functions?

Finally, I would just like to express my profound appreciation for all the research, input and shared experiences everyone has offered on this site. It has really helped me come a long way in my decision about a manufacturer. I also thank you all in advance for your help in making this important and life changing decision.

9 02 2014
Debra

Hi Jeff, I have had my AB since 2002 and I have had every processor that’s come out since then. Anything after April of 2001 is with the CII or 90K internal family. With the C1 internal, the previous generation, they can have up to the Harmony so far. I have also had programming upgrades all this time, not just an external processor upgrade.

Just being able to have a new processor is not going to change the programs for early generation users of any brand. For instance, Cochlear N22 users can also have upgraded processors…I think they have the Freedom so far. But the thing is they still only have one program to use, it’s called SPEAK. AB C1 users are in a similar situation, they can have new processors, (it’s much harder to develop them due to the power limitations) but they will keep their programs the same. They can have CIS & MPS & SAS.

I am an AB “S” user, my programs are using that type of firing method. So, I have Fidelity 120-S and have the new Naida CI Q70 processor and use UltraZoom. If I didn’t like “S” I could have gone over to “P” or paired strategy. It’s nice to have the choice. Most people seem to like “S” better, but you will find strong “P” users because for whatever reason, that appealed to them better. I would hate to be forced into something because that’s all there was. I think our brains would adapt to anything however, even if there was better hearing out there we could have, some people might never know.

I am not aware of Cochlear having anything new. My husband is a Cochlear user and he’s using the same base program he got in 2003. They do have some extra mic programs (he’s got N5′s) but his main ACE program is “it”. He’s not expecting any surprises from Cochlear. He is using everything they offer.

My program is also “tweaked” by the audiologist to give me an effective IDR (dynamic range) that is higher than what it says on the software. I am walking around with what amounts to a 90 IDR. What this does for music is epic! I don’t recommend that for new users, but I am an old pro and can handle it! My husband wanted to try to do that for his programs, seeing if there was a trick he could use. Our audiologist called Cochlear and was told NO, they do not offer a higher IDR and also, they don’t need a higher IDR, as the one they have is “perfect” already.

You might want to check out HearingJourney.com. It’s AB’s web community. There are over 25,000 users on the site, and if you have any questions or comments, someone is there to answer you. I know quite a few AB users in Colorado that are quite active with skiing and sports. Good luck with your journey to better hearing!

Deb

9 02 2014
John Martin

Hello deb
I’ve just had my AB implant switched on and am having a bit of a wobble up until now I’ve been a hearing aid user who despite convention refuses to stop play my beloved bass and proforming with a small jazz groupe now everything is so very different I feel like I’m listing through a loudhailer my music sounds like it’s been put through a wah wah distortion peddle with added twang
I mean no disrespect to AB I’m still sure it’s the best one on the market but please please tell me it will get more normal I’m beside myself

9 02 2014
Tina

Hi John
It will definitely get better. It took 3 months of daily listening for music to become perfect for me. The key thing is to practice daily. Just wear the CI all the time, and it will get better. If it becomes unbearable, don’t switch it off, just turn it down. Hang in there!

9 02 2014
John Martin

Thank you so much that really means a lot to me, ok wobble over chin up, I’ll keep you posted x

10 02 2014
Tina

Just remember that it’s a brain thing. It will slowly turn things around as it gets used to the new input. Music will sound awful at first, I was thinking the same “What have I done?!”. Start off with something like iTunes – practice listening to the snippets and find something you like – I found that the simplest worked best – Japanese instrumental, guitar, harp. Then I moved onto music I know well. Then I tried new things. It really is a fascinating journey.

The best tool for audio rehabilitation is to get an unabridged book and matching audio recording. You can get these in your local library for free. Listen to them every day, on your commute even, and it won’t make much sense at first. Just keep listening and reading at the same time. Your brain will eventually make sense of it all. I re-read the first Harry Potter book four times, and each time I listened to it, it was different. It went from meaningless sounds with spaces, to a foreign language, to some words being understood, to being able to understand quite a lot of the spoken word. (I was sick of Harry Potter by then).

The radio is good. There are plenty of resources on the internet. The main thing is to remember you’re going to hear better every day, as long as you keep listening :)

9 02 2014
Debra

John,

Yes, Tina is correct, it will continue to improve! Music is harder than speech because it is much more complex. Since you are new and just now switched on, what are you doing for rehab? Rehab makes things move forward faster and sort of jump starts your brain to use the CI. You should also join HearingJourney.com and start talking to the other musician’s and see what they did to get their music working with the CI.

I listened to a LOT of music, and pretty much put as much time into music as I did speech. The low tones are in there, and we are very fortunate in what the future is going to bring for AB users!

For me, I was missing the music over the 30 years I had zero hearing. I could lip read quite well to get by, but losing the music was like losing a bit of my heart. Patience and patience are the key words with a new CI.

Deb

13 02 2014
Andy

First of all I want to say thank you for all that information provided here.

I have been implanted on 07th February 2014 with AB`s HiRes 90K Implant plus MidScala Elektrode and looking forward to my Activation Day on 24th February.

I don’t feel any pain and have some taste irrigations only. The healing is going well.

I will get a Naida CI Q70 in Velvet Black and for me it was the T-Mic 2 that made me choose AB.

I’m a Private Pilot and this type of microphone should be the best solution when wearing Aviation Headsets.

Greetings from Germany,

Andy

13 02 2014
Tina

Congratulations Andy! Sounds like a textbook procedure. Enjoy your new hearing journey!

13 02 2014
Debra

Congratulations Andy! I do know another pilot with AB, and he also loves the T-mic! Just for your information, the default setting on the T-mic is 50-50. Meaning 50% Tmic and 50% regular mic. Most of us like the T-mic setting on 100%. There are a lot of good reasons for that. It makes it very easy to use phones and headphones. With it on 50%, you might pick up other room noise you don’t want on a phone.

The audiologist can set up the mic settings in a variety of ways, but if you do want 100% on one slot, the audiologist will have to set that up for you. I have one program that is 100% T-mic and the next program is the same but with 100% regular mic…for in case something goes wrong with the T-mic.

It’s going to take you awhile, with rehabbing the new ear, but hopefully before too long you will be flying the friendly skies with a smile on your face!

Deb

9 05 2014
Marius Delia Berinde

Awesome blogs ! 👏…..Now ,(may be)I’m ready to choose the right CI for me! I recently have been treat for SEVERE TO PROFOUNDLY HEARING LOSS. How about Google Glass !……. Is there future combined whit CI!?
Tina ! ….thank you for all the info.👂

10 05 2014
Tina

Well, that combination wouldn’t surprise me! You can follow testing with Glass in London on http://121captions.com/blog/

11 07 2014
Dan Schwartz, Editor, The Hearing Blog

Sandy wrote,

7/10 people might chose cochlear because of the fact that AB does not have any warrantee to speak of right Donna? This is the hardest decision I have had to make and I think I will go with cochlear they have an excellent warranty

Actually, the AB HiRes 90k implant has a 10 year warranty.

Also, in fact Cochlear doesn’t spend as much as AB does in R&D, at least since they were acquired by Sonova in January 2010, especially after Cochlear laid off many of their engineering staff.

Finally, in fact Cochlear had a BIG recall in 2012 when they permanently took their new CI512 implant off the market as it had a major design flaw: The metal case was too thin, and the resulting flexing was causing many of the implants to fail. Unlike AB which only has their one implant available worldwide, Cochlear ramped up production of their older, less expensive CI400, which they continued to make to sell to the Third World.

11 07 2014
Robert MacPherson

Expanding on Dan’s comment: The Cochlear’s recall of the CI500 series implants was actually in September, 2011. At latest count – February, 2014 – 7% of implanted devices had failed, resulting in over 2,000 revision surgeries. Cochlear primarily relied on the CI24RE (4th generation, Freedom) implant for replacement – which is electrically and functionally identical to the CI500 series. Of note, the CI500 series has recently been reincarnated as the “Profile” series, manufactured in an all-new production facility.

11 07 2014
DavidR

Sandy, I would read read over the chart suggested to you. You’ll find that AB does indeed have a warranty as does every other company. As far as your contention that the upgrades are pure fabrication…. with the HiRes 90K, users started with the HiRes strategy. That strategy was upgraded to Fidelity 120, which you can research the difference users experienced going from the earlier strategy. Fidelity 120 was further expanded upon with ClearVoice, which strips out unwanted noise and leaves speech intact.. all done at the strategy level. There is now also Optima, which helps with battery life. There are other strategies in development currently.. all of which are possible due to the design of the internal device and all of which are impossible in Cochlear’s device as it lacks the ability to steer current. That is why the focus with Cochlear has been to incorporate hearing aid features on their processors. Finally, Cochlear has the market share due to being in the market the longest, not by having superiority. It is currently being out paced by AB and Med El in market gains.

28 01 2013
Tina

Hi Roy, can you clarify your comment please – how is the Cochlear Freedom better in each aspect of the implant and sound processor?

28 01 2013
Geoff

Hello Roy, as you’re answering Tina, could you please also give us the hearing history for each ear? I have one ear that has always been much stronger than the other so it’s naturally better in every respect than my other ear even though they both have the exact same implant. Thanks!

28 01 2013
Tina

Kindly show me where I have copied from AB’s sales literature. I’m most interested to know!

If I copied anything, you are saying AB’s own marketing literature is biased and inaccurate …. their OWN marketing literature?!

18 02 2014
Tina

Hi Tom

Thank you for this, I do know about that chart however this chart is more accurate and more up to date.

http://cochlearimplanthelp.com/cochlear-implant-comparison-chart/

18 02 2014
Sam Spritzer

Roy…Cochlear is not only losing market share but they have also been found guilty of patent infringement.

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