Week 4 Cochlear

Question 1

IP ratings

Answer 1

Ingress protection

• a rating scale for how electric devices tolerate solids (first number) and liquid (second number)
• 68 is the highest rating

Question 2

Cochlear basics

Answer 2

• new South Wales, Australia
• 9 generations
• all devices use sequential stimulation and have titanium implants
• have 22 electrodes
• electrodes numbered 1-22 from base to apex

Question 3

Nucleus 22

Answer 3

Cochlears 1st internal device

• FDA approved in 1985 for adults, 1999 for 24 months
• nonremovable magnet
• cannot do impedance telemetry or ECAP
• electrode:
• –22 full bands spaced 0.45mm with 10 stiffening rings outside the cochlea to help surgeon insert
• –can use bipolar and common ground stimulation
• –has one extracochlear electrode on the casing for grounding
• sound processor:
• –wearable sound processor (WSP)
• –mini sound processor for children (MSP)
• –spectra 22 which is ear level processor compatable with all 22 things

Question 4

Nucleus CI24M

Answer 4

• Cochlear’s 2nd generation of internal device
• approved in 1998 for 18 months and up
• removable magnet that can do MRI up to 1.5 Tesela with it out, and a thinner case
• can do impedance telemetry and ECAP
• electrode:
• –22 full band with 0.45mm spacing and 10 stiffening rings
• –started creating 2 extracochlear electrodes (MP1 which is the lead and is a ball electrode under the temporalis muscle and MP2 which is the one on the casing)
• –extra electrode allowed for monopolar stimulation, but can also do bipolar and common ground
• –released with a double array which one can be in the bottom half of cochlear and 1 in the top in cases of ossification
• prosessor:
• –SPrint is body worn
• –ESPrint is the 1st ear level processor and is compatable with recent processors listed

Question 5

Nucleus CI24R

Answer 5

• 3rd generation of internal device from Cochlear
• approved in 2000 for 12 months and up
• removable magnet and can do MRI of 1.5T with it out
• can do impedance telemetry and ECAP
• smaller than CI24M and has 3 electrode arrays
• –CI24R(CS)= half band and is a contour stylet
• –CI24R(ST)= full-band and is a straight array
• –CI24R(CA)= half-band and is a contour advanced
• —-no more stiffening rings
• sound processor:
• –SPrint, ESPrint
• –ESPrint 3G (2002)
• –Freedom, Nucleus 5, Nucleus 6, and Kanso

Question 6

Nucleus CI24RE “Freedom”

Answer 6

• 4th generation of internal device from Cochlear
• Approved in 2005 for ages 12 months and older
• removable magnet can can do 1.5T MRI with it in and 3.0T MRI with it out
• Chip has been change to consume less power and be faster
• can do impedance telemetry and ECAP
• dual-electrode stimulation is used to create virtual channels (just 1 because no current steering)
• MP1 and MP2 electrodes
• electrode:
• –CI24RE(ST)
• –CI24RE(CA)
• sound processor:
• –Freedom
• –Nucleus 5,6,7, and Kanso

Question 7

Nucleus CI512 “Nucleus 5”

Answer 7

• 5th generation of internal device from Cochlear
• later know as “Profile Implant”
• approved in 2009 for 12 months and up
• removable magnet (1.5T in and 3.0T out MRI)
• thinner and redesigned MP1 to be more of a pin instead of a ball (compared to Freedom)
• impedance telemetry and ECAP as well as dual electrode stimulation
• electrode= CI512(CA)
• sound processor:
• –Nucleus 5,6,7 and Kanso
• withdrawn in 2011 because 7.1% fail rate as compared to 0.7% for freedom within 5 yrs
• –when it went thinner, a layer of protection from fluid and other stuff was lost and when fluid got into the device, it stopped working

Question 8

Nucleus CI422

Answer 8

• 6th generation of internal device from cochlear
• approved 2012
• is the Freedom with a modified electrode to replace the CI512
• –is the CI422(ST) which is thinner, with a shallower insertion to preserve the low frequencies
• removable magnet so 1.5T MRI with it in and 3.0T with it out
• impedance telemetry, ECAP, and dual electrode stimulation
• sound processor is the Nucleus 5,6,7 and Kanso

Question 9

Nucleus L24 Hybrid CI (CI24REH)

Answer 9

7th generation internal device from Cochlear

• approved March 2014, is a modified Freedom
• removable magnet so 1.5T with it in and 3.0T with it out
• impedance telemetry, ECAP, and dual electrode stim
• electrode is L24 and is a little shorter at 16mm with 22 half band electrodes
• –designed to be only in the basal turn and not in the apex so low freq can be stimulated with HA component
• sound processor is Nucleus 6 or 7

Question 10

Profile Series

Answer 10

8th generation internal device from Cochlear

• is CI512 (CA)released again in 2015
• –also CI522(straight) in 2016 and CI532(slim modiolar) in 2017
• —–note called profile series because these three electrodes were released (512 is contour advanced, 522 was attempt to protect cochlear structure, and 532 is pre-curved without stylet, it is in a little tube and when the surgeon pulls the tube off it curves and allows the electrode to be thinner, this is becoming the default electrode
• everything is the dame as Nucleus 5 in terms of electronic components, but different electrodes

Question 11

profile plus series

Answer 11

• 9th generation internal device from Cochlear
• CI600 series: Profile plus was released in June 2019
• –everything the same a profile
• –redesigned magnet (dimetric) meaning north and south pole are on either side of the magnet instead of top and bottom so the magnet will just rotate to align with magnetic field of MRI instead of flipping or coming out
• –can do MRI of 3.0T without removing
• idea from MED-EL
• has same electrode family (CI612 which is CA, CI622 which is straight, and CI632 which is slim modiolar

Question 12

peri-modiolar vs lateral wall electrode placement

Answer 12

peri-modiolar curves around the modiolus while lateral-wall is away from the modiolus
=straight array has a better chance or protecting the cochlear structure, peri-modiolar can be a bit more damaging
*insertion force with precurved is less because it follows the turns of the cochlea without much resistance, the straight array will get to lateral wall of the cochlea then will need to start being pushed a bit to turn and damage could occur at this point
*location of electrode will dictate how stimulation will work, the further from the neurons, the more current needed to stimulate them
—this could cause battery drain and channel interaction

Question 13

Freedom processor

Answer 13

• from Cochlear (2005)
• –compatible with all internal devices
• –2 omni-mic, t-coil, and display
• –4 options for programs, VC, and sensitivity control
• –uses 675 rechargeable or Zinc-air
• –IP44
• –electroacoustic stimulation (EAS) is an option
• –no remote
• –no wireless compatibility but FM compatibility

Question 14

Nucleus 5 processor

Answer 14

CP810 which is from 2009

• –compatible with all internal devices except nucleus because this is too small to provide enough power
• –2 omni mics and a T-coil
• –4 programs, VC and sensitivity control
• –rechargeable or zinc-air batteries
• –IP of 57 for rechargeable, 44 for zinc-air, and 68 with Aqua+
• –remote assistant CR110 (CR=cochlear remote)
• –no wireless compatibility, but FM compatible

Question 15

Nucleus 6 processor

Answer 15

CP910 and CP920 from 2013

• –compatible with all internal devices
• –CP910 has DAI which is direct audio input, but CP920 does not which makes it a little smaller
• –2 omni mics which allow for SCAN algorithm and auto-T
• –4 programs, VC, sensitivity control, and T-coil
• –batteries are rechargeable or zin-air
• –IP rechargeable is 57, Zinc-air is 44, and Aqua+ is 68
• –remote assistant CR230 and remote control CR210
• GN ReSound technology means they used their tech for electroaudio stimulation and thus have their accessories too (mini-mic 2+, phone clip+, TV streamer 2
• –FM compatable
• connects to a RIC with a dome or mold
• –special purpose average (SPA) OSPL90=117.1
• –SPA full on gain @ 50=50.6
• –reference gain at 60=41.4
• –frequency range=200-1781Hz
• –equivalent input noise level (EIN)=27.1

Question 16

Kanso processor

Answer 16

CP950 released on 2016 and was a 1 piece processor

• compatible with all internal devices except nucleus 22
• has dual mics
• IP 54 (68 with aqua+)
• uses connectivity similar to N6
• remote assistant CR230 and remote control CR210

Question 17

Nucleus 7 processor

Answer 17

CP1000 released in 2017 as the iPhone processor

• one small size with better battery life (again rechargeable or zinc-air)
• –campatible with all devices except Nucleus 22
• –new slim line coil (only with N7) was to improve connectivity and preserve power
• 2 omni mics and auto T
• EAS similar to N6 with additional options for receiver power
• –uses connectivity similar to N6
• –IP of 57 for rechargeable and 68 with Aqua+
• CR310 and Nucleus smart app on iPhone because basically remote assistant on phone so just basic remote option

Question 18

Cochlear programming software names

Answer 18

• custom sound
• –has programming pods with specialized cables (cable A for N5, N6, Kanso, and N7 and cable B for Freedom)
• custom sound EP is used during surgery, after implant is in place measurements are made to make sure the implant is working–does impedance testing and electric compound action potentials

Question 19

Cochlear default mapping strategy

Answer 19

ACE

• default rate is 900 pps
• 11 maxima and 37 microsecond pulsewidth (default is actually 25 but recommended is 37)

Question 20

cochlear anchor electrodes

Answer 20

electrodes 22, 16, 11, 6, and 1

Question 21

cochlear map y-axis

Answer 21

• current level or clinical unit (CL)
• amplitude range from 0-255 CL but normally the electric dynamic range is about 40-50 CL
• C-level is 10-20 CL below ESRT (electric stapedial reflex level)
• –T-SPL is normally about 9-50 dB and C-SPL is normally about 65-84 dB

Question 22

volume control with cochlear

Answer 22

can give the patient a certain % of the dynamic range for their volume control, 100% gives them the ability to essentially turn off their device, generally the default is 20% but give children 100%

Question 23

sensitivity control with cochlear

Answer 23

when you control the default for the patient’s bubble

• default is 12 which is a range of 25-65 dB SPL
• break-points or autosensitivity is maintaining the IIDR with sensitivity hovering to catch where the speech sensitivity is
• –taking advantage of the Lombard effect where people talk louder in noise
• –autosensitivity turns on at 57 dB when people would start talking louder than 55-60dB

Question 24

frequency allocation for cochlear

Answer 24

6 frequency bands

• cochlear gives a lot of control over what frequency range is sent to what electrode
• –probably dont need to change too much but they supply tables to show what is appropriate for what population

Question 25

voltage compliance with cochlear

Answer 25

no more than 5 electrodes within 10% of the voltage compliance - --tells the limit of the battery and processor for each electrode depending on the impedance of each electrode and is shown by a red mark on the channels of each electrode - --if above compliance, can damage tissue and electrode

Question 26

channel gain with cochlear

Answer 26

basically dont mess with it

Question 27

SmartSound IQ

Answer 27

programming features that can be applied to create other programs - --ASC (autosensitivity control) breakpoint is set here - --adaptive dynamic range optimization (ADRO) looks at when the signal coming through is low in channels and increases the gain for these channels and reduces gain from channels with a lot of noise - --Beam (adaptive directionality) and zoom (fixed directionality) - --whisper (activated in quiet to allow soft and distant sounds to be amplified in quiet environment) * programs: - --everyday= default and has ASC and ADRO - --focus= for noisy environment and has Beam and ASC and ADRO - --music=whisper and ADRO

Question 28

SCAN

Answer 28

assess the noise environment and chooses the appropriate environment program - --is better than SmartSound IQ - --approved ages 6+ - --only N6, N7, and Kanso

Question 29

signal to noise ratio--noise reduction (SNR-NR)

Answer 29

reduce gain of channels with primary noise * approved ages 6+ * only N6, N7, and Kanso

Question 30

Wind noise reduction (WNR)

Answer 30

switches to omnidirectional mic and reduces channels with wind noise * approved ages 6+ * only N6, N7, and Kanso