Spy Photo – CR210 Basic Remote Control for Cochlear CP900 Processors

21 03 2013

cr2101

Thanks to Cochlear Implant HELP for the shoutout!

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A Call for Help Gets Answered

27 04 2012

FOR IMMEDIATE RELEASE

Global, April 27, 2012

A Call for Help Gets Answered

 

CochlearImplantHELP.com, a new and comprehensive website aimed at helping current and future users of cochlear implants and their families, announces the website launch today.

A need was identified to help others better navigate their journey to receiving a cochlear implant, whether for themselves or for a family member such as their child. And cochlearimplantHELP has been created to help them wherever they are on their cochlear implant journey.

Whether just starting to learn about cochlear implants or a seasoned cochlear implant user looking for ways to connect to a favorite piece of electronic equipment, cochlearimplantHELP has what you need.

Please take a few moments to peruse the site, and feel free to link to it or share it freely. CochlearImplantHELP.com can be found on the World Wide Web at http://www.cochlearimplantHELP.com

Press Release 04 27 2012





Win Cochlear implant decorations

7 10 2011

Do you customize your Nucleus® 5 or Nucleus Freedom™ Sound Processor?

Submit a photo of your blinged out sound processor for your chance to win a free package of SkinIt for your Nucleus 5 or Nucleus Freedom Sound Processor. Share your photo on Cochlear’s Facebook page today!





Should Cochlear Americas issue a recall?

11 08 2011

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Cochlear Americas have identified cochlear implants with a faulty Monopolar 2 (MP2) ground electrode presenting an open circuit, in less than 0.3% of devices registered (as of June 2011).

The following document makes recommendations for management of this situation with Nucleus 5: Cochlear Clinical Product Update July 2011

The CI512 cochlear implant from Cochlear Americas was designed with a backup ground electrode for several reasons.  Firstly, in case one fails, the other will still work – this is the redundancy built into the implant.  Secondly, it decreases noise, making NRT recordings more accurate.  Thirdly, it improves battery life.

The electrode that failed (MP2) is the one on the case of the device. That means that the only remaining ground electrode is a wire that comes out of the implant case.  It is the wire that ends in a straight piece in the photo.  If that electrode were to fail, the implant would stop working.

It is surprising that Cochlear is allowing these known defective units to be implanted.

Why isn’t Cochlear issuing a recall?

Why would the decision to implant a device that is tested to be faulty in the operating room be left up to the surgeon?

Why don’t they take them off the shelves and replace them with devices that are grounded properly?

Why allow a patient to have a less than perfect implant that can give them 10% extra impedance issues?

Would you want one of these devices for yourself or your child?

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Recall : Updated in this post.





All cochlear implants are not the same

30 07 2011

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If anyone tells you “all cochlear implants are the same”, ask them what they mean!

They are not the same, they work differently, have different technology, they are even different from day to day in how the user functions with them. They are only the same in that they all provide useful hearing. Some of the technology is much older, some of it is much more advanced.   The engineering is different, and the capability for internal upgrades is not the same.  The processing speeds are much different,  The “sound windows” are different … one has a wide dynamic range and the other doesn’t. Huge differences in stimulation rates and processing speeds. There is a lot to know about the differences.   It’s like knowing about a computer.  It IS a computer!

When you go to buy a computer you compare the specs… and you should do the same before you get a cochlear implant.   Any car will get you from point A to point B.   The difference is in the engine, and in a CI, the difference is in the internal parts and internal engineering.  The important part by far is what gets surgically implanted in your head.

Josephine talks about the differences between two brands of cochlear implant, from Cochlear Americas and Advanced Bionics.

My family has two cochlear implant users. We have different brands. We live the difference. We both notice it. Not our imagination. One of us has Advanced Bionics, and one of us has Cochlear Corporation. We both use the latest programming from our companies. We are both long term users (over 5 years). We are both post-lingual.

I am the AB user. My husband is the Cochlear user. I have my dynamic range set on 70. This is not as high as it goes, but I like 70. My husband has his dynamic range as high as it can go. He’s got it about 45. That doesn’t mean much unless you know how that might work out in daily living.   I can hear the doorbell when he can’t.    I can hear the phone ring when he can’t. He has to be closer to hear certain things. As long as he’s close enough he can hear fine.

AB’s software has a feature called “Auto Sound”. I put my processor on in the morning and don’t fiddle with it all day and all night. The software makes the changes for me as I go from situation to situation. My program is called Fidelity 120-S. This means I am using a program that offers 120 pitches, using advanced virtual technology and my electrodes fire in a sequential manner. AB’s electrodes each have an independent power source that allows for sophisticated programming.

AB also offers a alternative choice in how the electrodes fire called “PAIRED” firing. Two electrodes fire at the same time. Some people have a strong preference for one over the other. AB is the only company that offers a choice in this.  My software has all the features of my husband’s program, only they are built into the software instead of being manual. I can use all 16 of my electrodes at the same time.

My husband uses Cochlear’s main program called ACE. Most people with Cochlear have this program. It is a traditional program that has been around since the 90’s. It is not an automatic program. There are different settings for different situations. They all have names, like Beam, ADRO, Zoom etc. Depending on what we are doing, he will manually switch to the best program for that setting. Once he has manually switched, (sometimes he has to try each one to see which is best) all is well. It’s important that he remember to switch back to the “all purpose” program.   If he forgets to do that, his hearing will be wrong for the next situation. He has gone all day on the wrong program and didn’t have his best hearing.

Not everyone with Cochlear does all this switching around.   One woman I talked with said she “should” be changing programs, but she is lazy and she knows she is not utilizing her hearing as much as she could.   Cochlear’s N5 has a remote control that will help with switching programs.

In a nutshell, I don’t have to work at all to have my best hearing and my husband has to work to get his best hearing.

I think the main difference between the programs and companies is how the electrodes fire and how many electrodes are actually used at the same time. It’s not how many electrodes you have, it’s what they can do.  More can be less, and less can be more. It’s one of those things people have no clue about.

My husband’s programs use 8, 10 or 12 electrodes in a sweep. So, although he has 24 electrodes (two are for grounding purposes) he cannot use all the 22 electrodes at the same time. His maximum (called Maxima) is 12 at a time. The more electrodes his program uses during a sweep, the shorter his battery times.  People who get very good times on their disposable batteries are most likely using a smaller Maxima program.

We both talk on the phone. I use AB’s T-mic. This is a special microphone that AB designed and patented. I have this mic set on 100%.    I pick up the phone and put it to my ear and talk.   Doesn’t matter which phone. I also have the T-coil if I want to use it. I rarely use it for the phones, I don’t need it, but it’s there if I want it.

My husband uses T-coils for the phone and he also likes assistive technology such as neck loops and FM systems.  He uses his CI in a similar way he used his hearing aids. He can pick up the phone and hold it to his ear, however he needs to find the “sweet spot” which is usually above his ear. I don’t need to find the sweet spot…the T-mic is already in my ear canal and I hold the phone like a normal hearing person.   I really prefer to hear my voice when I am on the phone.  My husband had his T-coil set so he can hear his voice some, but he still shouts on the phone.

I use rechargeable batteries. I use the smaller batteries called “SlimCels”.  I get a full day on one charge. This is usually 17-18 hours. I like using rechargeable batteries. If I were to use hearing aid batteries, I was told that my programs are so powerful, three of them would only last about 10 hours.  That’s quite a few disposable batteries!    I have a larger battery also, I get approximately 30 hours on that for one charge.

Some rechargeable users of any brand of cochlear implant will need to change the battery during the day, depends on various things, but knowing you are due for a change gives you a fresh battery for the evening anyway.  I think that’s a good piece of mind knowing you are in charge of your hearing and don’t have to worry about a battery dying.

My husband uses disposable batteries and has rechargeable batteries also. He gets 2-4 days on the disposable hearing aid batteries, the more he hears during the day, the shorter his battery time.  His best hearing is with the super powerful batteries from the company.

Yes, in a pinch he can go to the store and get hearing aid batteries. But the sound quality is not as good as the Power One batteries from the company. His rechargeable battery lasts about 12 hours.

Insurance pays for our batteries, rechargeable or disposable. It’s easier to get the rechargeable batteries covered because they are considered “durable medical equipment”.

An important thing about using rechargeable batteries is that you know how long it’s going to last and can plan the day and night without worrying a battery is going to go out on you.  With the disposable hearing aid batteries, yes, they do last longer than rechargeable batteries, but you don’t necessarily know when they are going to die.   I am rarely the person changing my batteries in restaurants or wherever we are.  My husband hears some warning beeps and that’s his advance notice.  We can be anywhere, and we have to stop what we are doing for him to change.

Disposable hearing aid batteries are considered “hazardous waste” in most states in the U.S.  these days and have to be disposed of the same way you dispose of other types of batteries.  Take them to a disposal center…NOT in the trash!   We have quite the pile of batteries to dispose of.

Music, I enjoy music with 120 pitches right now and that was a huge improvement after I upgraded to F120-S software.    My husband has 22 pitches, his music enjoyment is only so-so. He doesn’t have a passion for it. But that’s not to say another person wouldn’t.  He does say music sounds weak and tinny.  I wish that was different for him.

Cochlear says they have “160 pitches” but they don’t have anything like that in a wearable processor or program. I hope that will happen. I want my husband to have more pitches to enjoy.  He’s been waiting for a new software program since 2003.

AB did the same sort of pitch testing that Cochlear did for their “future” 160 pitches and AB users in trials were recognizing up to 470 pitches. This is not a developed program either…but I sure hope it will be!

I have been upgraded with new software and hardware several times over the years.  AB focuses on both major software improvements in addition to the updated external devices.   Cochlear focuses more on improving the external device with improved microphones and things of that nature.

With a software upgrade from AB (using your own processor) there is no charge…it’s free!   Yes, you just go for a mapping, and if there is a new software upgrade out, you can have it at no charge other than your normal co-pay if you have one. The software improvements are substantial and in every instance of a major software upgrade from AB, they have delivered improved hearing for their users.

Both companies come out with improved external devices every few years.  When a new BTE or other processor comes out it’s NOT at all free.  There are usually trade in programs, but the bottom line is you pay out of pocket for these things.  They usually cost $7,000-$8,000 or more.  Most insurance won’t even consider upgrading a person for an external device until they have had it for over 5 years and the next generation device delivers a substantial improvement over the last one.  Insurance usually denies the upgrade and most people have to appeal and fight for the next generation BTE.

I think AB’s free software is a major value!  Most people have no idea that this is the case and don’t take future costs into consideration in choosing a CI. AB’s newest software upgrade is called ClearVoice. It’s a “smart” program enhancer that recognizes speech and drops out other repetitive sounds (traffic sounds for example) so we can hear speech better in noise. This will be free for me when it’s approved in the U.S.

Nope, the different CI companies are not providing the same product.  They are not all the same, don’t function the same way. It’s important you know what you are getting and it’s also important to know you should have a choice in the matter. It should be your choice, it’s your body, your hearing, and your future.

A bilateral mixed-brand cochlear implant user comments on StratMed, which is also interesting reading!





Cochlear implant mapping

4 05 2010

I’ve had 5 “mapping” sessions since activation. A mapping is a reprogramming of the cochlear implant, to readjust the electrical stimulation limits of the electrodes as each user’s brain adapts to sound and fibrous tissue grows over the internal implant. Mappings are typically carried out once a week for the first 6 weeks, then every few months, then twice annually.

At each mapping I was given increased volume and it was an opportunity to address any concerns with the audiologist. This was followed by a coffee break in the hospital cafe then a speech therapy session. I have one more mapping session this week, then my next one is in June when I have my 3 month check.

It’s been a rollercoaster ride. I’ve started with beeps and pushed so hard that I got a constant whine when I put the implant on. This set me back and I had to slowly build up my tolerance again of high frequency sounds from zero, bit by bit, and have successfully avoided a reocurrence of the whine. I have not yet reached full volume, there is still some way to go, which is kind of scary. I found last week quite difficult as everything seemed too loud and I started feeling stressed, but I hung in there and carried on wearing the cochlear implant until I got used to the increased sound levels.

Increased sound levels can be problematic for cochlear implant users because they are more sensitive to loudness changes. A normal hearing person can hear a wide range of sounds from very soft whispers to loud rock bands; this dynamic range of hearing is about 120dB (normal speech is within the 40-60dB range). However, a cochlear implant processor’s input dynamic range (IDR) or sound window is limited to an electrical current of 20dB, and 120dB of sound needs to be compressed into this. Therefore the cochlear implant user is more sensitive to changes in loudness than a hearing person.

If the IDR is small, sounds outside the IDR need to be omitted or compressed; sounds that are too quiet will be cut off, and sounds that are too loud will be compressed and will sound distorted. The 3 main brands of cochlear implants have different IDRs; Advanced Bionics has 80dB, MedEl 55dB, and Cochlear 45dB but with autoranging. I currently have my IDR set at 60dB.

What actually happens in a mapping session? I replace my processor’s battery with a direct connect input lead to the audie’s computer and put the processor back on my head. (Yeah, this freaked ME out the first time I did this).

The audie’s software will reprogramme my implant’s Harmony external processor.

My cochlear implant has 16 electrodes and when each one is stimulated, I will sense each stimulation as a beep.
The audie will set the Threshold (T) levels [to access soft speech and environmental sounds] and Comfort (M) levels [the amount of electrical current required to perceive a loud signal] for each electrode by judging the most comfortable and the highest stimulation I can tolerate – the most comfortable and loudest beeps I am happy to listen to.

I use the loudness scaling chart to indicate to the audiologist which level each stimulation correlates to, ranging from ‘Just Audible’ to ‘Too Loud’.

Then the audie ensures the M levels are similar in terms of my perception, so that the volume is the same in each electrode – I was able to tolerate very high levels of high frequency sounds this week but she brought these back down, otherwise everything would have sounded weird and unbalanced.

This mapping method is rather tedious and drawn out over several months. Clarujust is new software (currently in FDA trial) from Audigence Inc where the patient and processor are interfaced to a computer and words are played and repeated as heard, the software adjusting the map accordingly. Mapping this way reportedly takes 30 minutes. This software can be used by all hearing aid and cochlear implant companies except Advanced Bionics, however Phonak signed up with Audigence Inc this year prior to the Advanced Bionics/Sonova acquisition.

When a mapping is new, it tends to sound louder, until I get used to it. It takes 3 days to get used to a new mapping, then I find loud sounds have become softer and more tolerable, and I can hear a wider range of soft sounds. It is uncomfortable turning up the volume of life to the max every few days. I still have to brace myself for the jolt first thing in the morning, making the transition from complete silence to a full technicolour river of loud sounds pouring into my brain. Amanda’s Tip of the Day: If you wake with a hangover, take your time to put on your CI and turn down the volume. It helps. A little.

It’s an amazing learning process as I am also trying to identify sounds as well, discovering amazing new ones, and learning to discriminate between things that sound similar to me. My hearing is like a baby, it needs time to learn and grow, but it can be fun too.

Erber’s model set forth 4 levels of auditory skill development;

    Awareness of sound (presence v absence)
    Discrimination (same v different)
    Recognition (associating sound/word with meaning)
    Comprehension (using listening for understanding)

I have now reached the second level, I am hearing things but finding it difficult to discriminate between some sounds. Obviously, this means I am still lipreading. In my speech therapy session this week, I discovered I can’t distinguish between Gear v. Dear, tIme v. tAme. I can listen and fill in a word missing in a written sentence, but listening to a whole sentence and being given one written word is more difficult. With hearing aids, both tasks would have been impossible.

In addition to mapping, my progress is occasionally evaluated with an audiogram and speech perception performance with the cochlear implant in a soundproof booth. These tests assist the mapping process and indicate any further adjustments required. I expect I’ll have this done this week, and hope to have improved upon the 18% I achieved in my last speech perception test.

I was programmed with ClearVoice last week but am still adjusting to my new mapping, so I have just been ‘tasting’ this wonderful addition. I tried it on the train; the roar of the train engine and clashing sounds (brakes or pressure pads? – haven’t worked this sound out yet) dropped away significantly and I could clearly hear voices around me. It was awesome. Yesterday, I was sitting by a window and became conscious of this sound. I realised it was the rain spitting outside. In the garage, I could hear the drumming of the rain on the roof and the traffic outside. With ClearVoice on, the traffic became very quiet and the rain became a very clear high PLINK PLINK PLINK, and a lower PLONK PLONK when it came through a hole in the roof and landed on an object. Again, awesome!

Try out the ClearVoice demo for yourself. Don’t forget to say the mandatory WOW!

Shanti is waiting for her cochlear implant operation date and works as a personal trainer and complementary therapist. She gave me a super aromatherapy massage yesterday and I left feeling very relaxed. As soon as I left, I plugged into my iPod and was amazed to hear that the tinny / Donald Duck tone of vocals had gone from a lot of songs. Perhaps there is a link between relaxation and better hearing. Today, voices sound largely normal and it’s so so so NICE to have some normality again!

Photos courtesy of Byron





The unbearable loudness of hearing

25 04 2010

It has been one month since activation and my world has changed beyond recognition and exploded into a kaleidoscope of sounds. Some are old sounds which sound different, some are completely new. The world sounds different through a cochlear implant and it is starting to sound much better.

Each time I have a mapping, my bionic hearing is adjusted – at the moment we are still focusing on increasing the volume. For the last week I have been listening in awe to the (surprisingly noisy) birds, the crackle and pop of rice krispies, my office clock ticking, the ssss of my perfume atomizer, the jangle of keys and my dog’s clinking collar tag, and all the little sounds my dog makes when he wants something! I am discovering that some things, heretofore silent to me, actually do make a sound. The photocopier touchpad beeps, the door of the room next door squeaks (and now annoys me immensely), my hands rasp when I rub them together and so does moisturiser when rubbed on my skin, running my fingers up my arm makes a soft rasping sound too.

I have been utterly shocked by the cacophonous ssshh of brakes and beeps of doors on public transport, the roar of traffic, people in the street, the sharp crackle of plastic bags and paper, the clatter of crockery, the flushing toilet, the microwave nuking food, and the kill-me-now roar of aeroplanes (unfortunately, I live near Heathrow). Last Saturday was the first day in my life that I was able to hear all the birds so I sat in the garden, in the sunshine, and listened. This also happened to be the first day of the airline stoppages due to the Icelandic volcano eruption and the skies were silent. I only realised how much noise airplanes made this week when the airports re-opened for business. Over the last three days, I have become quite overwhelmed by the loudness of some sounds, now that my implant’s volume is nearing an optimum level.

I went to a social event a few days ago and although noisy, I was able to pick out peoples’ voices more easily which made lipreading easier. I heard this strange sound behind me and turned around to see a woman playing a harp. It sounded totally different from what I expected, like a soft guitar.

The strange thing is that high frequency sounds seem much louder to me than other sounds. A person with a hearing loss cannot screen or ‘filter’ out sounds in the way that hearing people do, so everything seems loud. This is why noisy places are so problematic, as hearing aids and cochlear implants amplify all sounds so that environmental sounds are as loud as voices, and the hearing impaired person is unable to filter out the background noise (the cocktail party effect). Now that the high frequency sounds are so new to my brain, these seem extra loud to me, my brain is going WOW What’s This?, sitting up and taking notice, and is only now listening to low frequency sounds again. The world is starting to sound more normal. Voices still sound tinny so it’s a struggle to understand speech.

I can now hear the dial tone on the phone. I started off by listening to phone sounds (these work on both pc and Mac) and will next try listening to a script I’ll give to a friend.

There are four levels of auditory skill development according to Erber’s model – awareness of sound (presence v absence), discrimination (same v different), recognition (associating sound/word with meaning) and finally, comprehension (using listening for understanding). As I was born deaf and have been deaf for 40 years, I’m going to struggle harder and for longer to climb up this ladder.

It is a common misconception that we hear with our ears. In fact, the auditory system, from the outer ear to the auditory nerve, merely provides the pathway for sound to travel to the brain. It is in the brain that we hear. If a person developed hearing loss after learning language (postlingual hearing loss), the brain will retain an “imprint” of the sounds of spoken language. The longer a person is deaf, the more challenging it is to recall these sounds. In the case of a person who has never heard (hearing loss at birth), or who has had very limited benefit from hearing aids, sound through a cochlear implant will be almost entirely new. That person will need to develop new auditory pathways, along with the memory skills to retain these new sounds. Whatever a person’s history, rehabilitation can be very useful in optimizing experience with a cochlear implant.

Being able to detect sound, even at quiet levels, does not mean that an individual will be able to understand words. Norman Erber developed a simple hierarchy of listening skills that begins with simple detection: being aware that a sound exists. An audiogram indicates detection thresholds. Although thresholds with a cochlear implant may indicate hearing at 20 dB to 40 dB (the range of a mild hearing loss), the ability to understand words can vary greatly. The next level of auditory skill is that of discrimination; that is, being able to determine if two sounds are the same or different. For example, one may detect the vowels oo and ee but not be able to hear a difference between the two sounds. The third level of auditory skill is identification. At this level, one is able to associate a label with the sound or word that is heard. Key words may be clear, such as cloudy or rainy, within the context of listening to a weather report. Erber’s final level of auditory skill is that of comprehension. Words and phrases provide meaningful information rather than just an auditory exercise. At the level of comprehension, a person is able to follow directions, answer questions, and engage in conversation through listening.

(Source: Advanced Bionics)

I’m still at the stage of detecting sounds and trying to move into the next stage of discriminating between sounds.  Two weeks ago, I was unable to tell the difference between PAT and BAT, TIN and DIN, FAN and VAN. With the practice I have done, I am now able to do this with almost no errors. I am now working on listening for the difference between MACE and MICE, and DEAR and GEAR – which is difficult as D and G sound so similar. I don’t know what to listen for so am hoping the brain kicks in at some point!

My speech perception is improving slowly. I have tried to make discrimination practice fun, by listening to Amanda on Skype. She will give me a colour, or a month, or a day of the week, or a number between 1-10. Maybe next I will try tube stations or football teams, whatever I think I can cope with, to keep it fun. We decide which closed set we will do – using Mac to Mac, the in-built sound (and video, for lipreading) quality is very good, aided by my use of a direct-connect lead to my processor. I am trying to work towards ‘open sets’ – unknown sentences – by asking people to put a hand over their mouth and give me a sentence. Patrice gave me my first sentence this week : “Bob and Kirby are waiting for me in the car park” and I got it correct except for the word “car”. She gave me a second sentence and I got that spot on. With practice, I will improve. We tried a discrimination exercise – I am now able to hear the roadworks behind the office – they had been working there for a year and I had missed it all (lucky me). So when they hammered, drilled, or dug with a spade, Patrice told me and I listened for the different sounds.

Music is improving too. I am finding that rock with vocals louder than music wins hands down. Opera sounds good, piano/flute/guitar sound quite good. There are musical resources specifically for CI users. Advanced Bionics offer Musical Atmospheres (free for AB users) and available online or on CD, where new music is discovered through 3 hours of recorded musical examples, each containing increasing levels of complexity in musical appreciation, helping to establish a firm foundation for musical memory. They also offer A Musical Journey, through the Rainforest and Music Time for children. Med El offer Noise Carriers, a musical composition available on CD from hearf@aol.com – see Listen,Hear! newsletter no.20 for further information. Cochlear don’t seem to have any resources but they do offer tips.

I am finding that I am feeling soooo much better than I did with hearing aids. I used to have headaches almost every day, I was always exhausted from the constant effort of lipreading, reading the palantype (CART), concentrating to make sure I didn’t miss anything, and stressed by the thought of any social event.  Now, I’m not exhausted every evening, I’ve had one headache since activation, lipreading is somehow easier as I’m getting more audio input even though people still sound like Donald Duck, and I feel much more relaxed overall, and more positive about communicating with ducks people.

I’ve finally discovered the noisy world that everyone lives in. This noisy world should get a bit quieter this week when I get ClearVoice, which will automatically reduce background sounds so I can concentrate on voices. It’s almost a magic wand for hearing loss. All I will then need is to be able to comprehend speech, and I’ll do a convincing fake of a Hearing Person.

I’ve lost the clouds but I’m gaining the sky. And the sun will shine. You’ll find me out there, in the Hearing World, shining brightly with happiness. And as the video below nicely demonstrates, I want to kick your butt!