Vous êtes sur la page 1sur 9

Choosing a Cochlear Implant Manufacturer

At USAIS we offer a choice of 3 manufacturers:

Advanced Bionics (AB)

we offer a choice of 3 manufacturers: Advanced Bionics (AB) Their implants (internal components) are called:

Their implants (internal components) are called:

HiRes 90K Advantage

(internal components) are called: HiRes 90K Advantage Cochlear Nucleus CI24RE (Freedom) The Speech Processors

Cochlear

Nucleus CI24RE (Freedom)

HiRes 90K Advantage Cochlear Nucleus CI24RE (Freedom) The Speech Processors (outside parts) are called : Naida

The Speech Processors (outside parts) are called:

Naida CI

Or

Speech Processors (outside parts) are called : Naida CI Or Neptune Nucleus 6 Med-el Concerto Flex28

Neptune

Processors (outside parts) are called : Naida CI Or Neptune Nucleus 6 Med-el Concerto Flex28 Opus

Nucleus 6

(outside parts) are called : Naida CI Or Neptune Nucleus 6 Med-el Concerto Flex28 Opus 2/Rondo

Med-el

Concerto Flex28

: Naida CI Or Neptune Nucleus 6 Med-el Concerto Flex28 Opus 2/Rondo J:\ISVR\SOECIC\SOECIC Folders\Documents\Device

Opus 2/Rondo

CI Or Neptune Nucleus 6 Med-el Concerto Flex28 Opus 2/Rondo J:\ISVR\SOECIC\SOECIC Folders\Documents\Device Choice\Device

J:\ISVR\SOECIC\SOECIC Folders\Documents\Device Choice\Device Choice - 3 manufacturers Children August 2013.doc Updated November (SC)

Help! What if I can’t decide which make of implant to choose?

We recommend that you:

look at the manufacturers’ websites http://www.advancedbionics.com (for Advanced Bionics) www.cochlear.com (for Cochlear) www.medel.com (for Med-el)

read their literature

consider the following differences listed below

discuss your own requirements with the team and ask any questions.

If you are unable to decide, do not worry! Patients do well with all systems otherwise USAIS would not offer a choice.

Frequently Asked Questions

Implants and internal workings Which make has the most reliable internal part (implant)? All manufacturers strive to maintain high reliability levels and all have occasional failures.

Which implant requires the smallest amount of drilling during surgery? Cochlear’s CI24RE (Freedom) requires slightly less than the Advanced Bionic’s HiRes90K and Med-el’s Concerto Flex28 implants. The HiRes90K implant also requires a slightly larger surgical entry into the cochlea.

Which cochlear implant sounds better? This is impossible to answer. All implants sound very strange at first but the user gradually gets used to them. The implants from all 3 manufacturers are adjusted through tuning to make the sound audible and comfortable. The implant will normally sound better over time.

Which implant is better in noisy conditions? The 3 implant manufacturers use different techniques to help implant users in background noise. There is a very wide variation in people’s outcomes so it is difficult to say which is best. The latest Med-el speech processing incorporates ‘FineHearing’ which gives more fine-structure information which may give better speech understanding in noise. The Advanced Bionics processing uses a ‘current steering’ technique which creates additional ‘virtual channels’ between the electrodes. This gives a ‘crisper’ signal which may help in background noise. They also use ClearVoice and Ultra Zoom which are noise reducing techniques. Nucleus uses 2 microphones which facilitate a noise cancelling system called BEAM which enhances sounds from front. Nucleus also uses autosensitivity (ASC), a noise reducing technique, which helps to eliminate steady background noises.

J:\ISVR\SOECIC\SOECIC Folders\Documents\Device Choice\Device Choice - 3 manufacturers Children August 2013.doc Updated November (SC)

Which implant performs best with music? There are limitations with all implants with music perception as implants are generally designed to give the best speech intelligibility. Recently there has been more of a focus on music appreciation and the implant companies have come up with different ways of improving the quality of music. Med-el’s implant speech processing incorporates ‘FineHearing’ which gives more fine-structure information which may give better music appreciation. The Advanced Bionics processing uses a ‘current steering’ technique which creates additional ‘virtual channels’ between the electrodes. This has been shown to give more musical appreciation to implant users who had been changed over from a previous strategy. Cochlear have recently developed a map setting aimed at improving music appreciation.

Which manufacturer is easier to tune (programme or map) for Children? Advanced Bionics and Med-el users require fewer measurements to tune their implants as they only require measurements of the loudest comfortable sounds on individual electrodes. Cochlear’s implant requires measurements of the loudest comfortable sound and also the quietest level at which they can hear on individual electrodes.

Where are the cochlear implants made and which company has been making implants for longer? AB is an American company, Med-el is Austrian and Cochlear Corporation is Australian. Cochlear has the longest history of implant manufacturing.

Are there differences in the designs of the electrode arrays (the part that enters the cochlea)? The HiRes90K array has a slightly curved tip which is designed to go around one whole turn of the cochlea but not so closely to the inner part of the cochlea (modiolus). Its active electrode length is 17mm. The CI24 RE (CA) has a tighter curve to fit around the middle of the cochlea. Its active electrode array length is 15mm. The Concerto Flex28 has the longest array (28mm) which is designed to go deeper into the cochlea.

Can I have an MRI scan with any of the manufacturers? It is important to check with your surgeon before having an MRI scan regardless of the make you choose. An MRI scan can be performed with any of the implants in place (with the surgeon’s permission) up to a certain magnetic field strength without removing the implant or magnet. The HiRes90K and the Cochlear implants are designed so that the magnet can be removed when undergoing an MRI scan, rather than the whole implant if necessary whereas the Concerto Flex28 has a fixed magnet. With the magnet in place an MRI can be performed at up to 1.5 Tesla for the Concerto Flex28 and the CI24RE implants. With magnet removed the HiRes 90K is compatible for MRI at 0.3 and 1.5 Tesla.

J:\ISVR\SOECIC\SOECIC Folders\Documents\Device Choice\Device Choice - 3 manufacturers Children August 2013.doc Updated November (SC)

Speech Processors (outside parts) and accessories Are there different colours for each manufacturer? Yes, but we ask you to choose a “base” colour for each of the manufacturers.

Do any of the speech processors have a remote control? Yes, the Nucleus 6 has a remote assistant/remote control but nearly all the functions of the remote assistant are accessible by pushing some button on the processor. The Opus 2 comes with a Fine tuner (like a remote control) which is used to change programmes etc. The Neptune does not have a remote control. Naida CI comes with comPilot and my pilot. MyPilot is an optional extra.

Do all the manufacturers have in-built Telecoil “T” switches, for use with loop systems? The Nucleus 6 has a button on the processor or on the remote assistant/remote control; the Opus 2 has a button to press on the Fine Tuner. On the Naida CI, need to use the program changing switch to activate telecoil.

Are all speech processors waterproof? The Neptune is waterproof and the Naida CI is splash proof - it can tolerate rain, humidity and sweat. Waterproofing equipment can be bought for personal use, the cost will be in the region of £500-00. The Opus 2 has not been through IP ratings but Med-el claims that very few Opus 2 processors have been returned for repair due to moisture damage. The Nucleus 6 is splash proof to a standard of IP57 and cochlear aqua accessory a waterproofing option can be bought from Connevans.

Can you directly plug into Stereos, MP3 players etc using accessory cables with each manufacturer? With Medel and Nucleus 6 you can connect a lead to listen to battery operated equipment. Advanced Bionics and Med-el do not produce a mains operated cable but Connevans makes a compatible cable. Naida CI uses compilot to stream music into your processor/s.

Are the microphones the same?

No. The Naida CI has several different earhooks/microphones for different uses. Its T mic is an ear hook which positions the microphone in

the concha of the ear which takes advantage of the natural collection of sound. The microphone for the Neptune is on the headpiece. are 2 omni directional microphones on the Nucleus 6. The Opus 2 speech processor has one omni-directional microphone.

There

Do all systems have an alarm to alert you to the fact that the batteries are low?

Yes

J:\ISVR\SOECIC\SOECIC Folders\Documents\Device Choice\Device Choice - 3 manufacturers Children August 2013.doc Updated November (SC)

 

Advanced Bionics – HiRes 90K Advantage

Cochlear – CI24RE

Medel – Concerto Flex28

Housing of implant

Titanium case

Titanium case

Titanium case

Silicone enclosure

Silicone enclosure

Silicone enclosure

Number of channels

16 channels

22 channels

12 channels

Makes use of current steering to create virtual channels

Diagnostics

Telemetry (implant test)

Telemetry (implant test)

Telemetry (implant test)

NRI

NRT

ART

Integrity testing

Integrity testing

Integrity testing

MRI Safety

Need to check with surgeon first

Need to check with surgeon first

Need to check with surgeon first

Internal magnet is removable

Internal magnet is removable

Internal magnet not removable

With magnet removed, MRI can be performed at 0.3 and 1.5 Tesla

With magnet in place, MRI can be performed up to 1.5 Tesla

With magnet in place, MRI can be performed up to 1.5 Tesla

Tuning

Measurements of loudest comfortable levels only

Measurements of quietest levels and loudest comfortable levels

Measurements of loudest comfortable levels only

Uses current steering to create virtual channels – reports of help in background noise situations and music appreciation

Uses Zoom or BEAM – reports of reduction of background noise

Uses fine hearing – reports of help in background noise situations and music appreciation

 

Advanced Bionics – Neptune processor

Advanced Bionics – Naida CI Processor

Cochlear – CI24RE with NUCLEUS 6 processor

Medel – Rondo processor

 

Processor information

 

Number of

3

5

4

4

programs

User controls

On/off control button on processor

Off: disconnection of battery

Push button: on/off, program

On/off control button on processor

Program selector

selector, volume, sensitivity

Program selector

Volume button

Lock function

Fine tuner: program selector, volume, sensitivity

Volume wheel

Remote assistant with LCD

display with help messages

Lock function

Pocket-sized remote control, with a handy display screen

 

J:\ISVR\SOECIC\SOECIC Folders\Documents\Device Choice\Device Choice - 3 manufacturers Children August 2013.doc Updated November (SC)

     

allows you to adjust simple settings

 

Battery type

AAA batteries

2 rechargeable batteries

2 zinc air batteries or

3 zinc air batteries

(processor needs one at a time)

compact rechargeable

Optional disposable batteries

batteries

standard rechargeable batteries

Average battery life

Change batteries every day

Power cell Batteries

Zinc air: up to 2 days

Zinc air: up to 5 days

available in 3 sizes: up to 16

Compact rechargeable: 12

Battery for fine tuner: 6mths

hours

hours

1 year

Optional disposable

Standard rechargeable: 17 hours

 

batteries up to 30 hours

Remote assistant: 1-2 wks

Range of colours available***

Processor: black, white

Processor: Silver,

Processor: Carbon, Maize, Mocha & Smoke

Processor: anthracite, nordic grey, crème and ebony

Colour covers: black, sand,

Caribbean Sea, Ruby, Sand,

 

ocean blue, sky blue, tropical sea, lime green, violet, red, pink, white

Pink, Chestnut, White and Black.

Processor covers available

 

in

various colours

Various colour caps for headpiece

Wearing options

Off the ear on an armband, harness, lanyard, swim headband or swim cap

Behind the ear (BTE)

Behind the ear (BTE)

Off the ear, the processor, coil

Off the ear option using

Body worn option (two

and battery pack are integrated as one unit.

Naida Clips, Light wear option

battery racks needed if bilateral

 

CI)

 

Accessories

Telecoil via Tcom (for use with a loop system)

Splash proof processor

Splash proof processor

Built in telecoil (for use with

available

Built in telecoil (for use with

Optional cochlear aqua

a

loop system)

Microphone on headpiece

a

loop system)

accessory for waterproofing

Auxillary microphone

Cables to link up to external accessories

T-Mic: microphone that sits

Built in telecoil (for use with

Cables to link up to external accessories via mini battery pack

in

the ear

a loop system)

Built-in indicator light

Standard earhook

Standard earhook

Monitor earphone (to check microphone)

Built-in indicator light (can

Cables to link up to external

Built-in indicator light

be switched off if not required)

accessories

Signal check (to check processor)

Coloured covers for coil and processor

LED: to check coil and

Built-in indicator light (can

microphone

be switched off if not required)

Radio aid compatible with Mini battery pack

Radio aid compatible

Coloured covers for coil

Monitor earphone (to check

Radio aid compatible via

microphone)

 

comPilot

Coloured covers for

Monitor earphone (to check microphone)

processor

Radio aid compatible

J:\ISVR\SOECIC\SOECIC Folders\Documents\Device Choice\Device Choice - 3 manufacturers Children August 2013.doc Updated November (SC)

 

Medel – Opus 2 processor

Number of

4

programs

User controls

On/off control button on processor

Fine tuner: program selector, volume, sensitivity

Lock function

Battery type

3 zinc air batteries or

3 rechargeable batteries (processor needs one at a time)

Average battery life

Zinc air: up to 5 days

Rechargeable battery: 16 hours

Battery for fine tuner: 6mths

1 year

Range of colours available***

Processor: Anthracite, Bordeaux red, Pacific blue, Nordic grey, Beige, Sienna brown, Crème, Baby pink and Baby blue

Wearing options

Behind the ear (BTE)

Off the ear option (active wear)

Accessories

Built in telecoil (for use with

available

a

loop system)

Standard earhook

Auxillary microphone

Cables to link up to external accessories

Built-in indicator light

Signal check (to check coil)

Monitor earphone (to check microphone)

Radio aid compatible

J:\ISVR\SOECIC\SOECIC Folders\Documents\Device Choice\Device Choice - 3 manufacturers Children August 2013.doc Updated November (SC)

Reliability data for cochlear implants

All the companies have experienced some problems with their implants at some time. The table below lists the reliability data as defined and published by the companies for their most recent implants (the ones which are being used at the moment).

Company

Implant

Date information issued by company

Company reliability data for the implants (this includes data for implants that have failed and those that needed to be explanted due to accident related issues)

USAIS reliability data for the implants

Advanced Bionics

HiRes 90K

Still awaiting data **

   

Advantage

Cochlear

CI24RE

February 2012

98.8% survival rate at 7 years

99.2% survival rate at 6 years*

MED-EL

Concerto

July 2013

99.07% survival rate at 3 years

MED-EL

* This data showed 99.2% survival rate at 6 years. Besides total failures, we have also experienced some partial failures for this implant at USAIS. This means that the implant is still being used by the patient but we needed to make changes to their settings. 9% of our patients using the CI24REhave a partial failure and we are monitoring these patients closely.

** Since this implant has only been in use for less than 1 year, we are also giving you the data published by the company for the previous implant they used – the Hi Res 90K implant – this is not the implant that you would be getting should you choose the AB

device. This data showed 98.08% survival rate at 6 years.

*** These are the only colours AIS offer; there might be other colours the manufacturers offer.

J:\ISVR\SOECIC\SOECIC Folders\Documents\Device Choice\Device Choice - 3 manufacturers Children August 2013.doc Updated November (SC)

J:\ISVR\SOECIC\SOECIC Folders\Documents\Device Choice\Device Choice - 3 manufacturers Children August 2013.doc Updated November (SC)