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All cochlear implants are not the same

Posted Jul 30 2011 1:57pm

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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!


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