Week 5 Med-El

Question 1

Med-el basics

Answer 1

*innsbruck, Austria
*6 generations
—ceramic in early generations
*all are monopolar and sequential
*simultaneous stimulation I100
*forward-backward compatible speech processors
*12 electrode pairs
#ed apex to base

Question 2

Combi 40+

Answer 2

• first internal device from med-el
• approved 2001 for 18 months, 2003 for 12 months
• ceramic with a magnet that could do MRI to 1.5T but was not remove able
• impedance telemetry
• electrode arrays
• –24 electrodes in pairs, 12 channels
• —-standard 31.5 mm (2.4mm)
• —-medium (1.9mm)
• —-compressed (1.1mm)
• —-split (5 4.4mm with 1.1 between 7 6.6 mm 1.1 between)
• sound processor: CIS PRO+, TEMPO+

Question 3

Pulsar CI100

Answer 3

• med-els second internal device
• approved 2005 for 12 months
• ceramic with non-removable magnet that can do MRI up to 1.5T
• impedance telemetry, ECAP, electrical field telemetry
• simultaneous stimulation, triphasic
• electrode arrays:
• –standard, medium, compressed, and split
• speech processor:compatible

Question 4

Sonata TI100

Answer 4

• med-el 3rd internal device
• approved 2007 for 12’months
• titanium with non removable magnet up to 1.5T
• impedance telemetry, ECAP, electrical field telemetry
• electrode arrays: standard, medium, and compressed
• sound processor:
• –2008 opus 1 which looked like the tempo but could use fine structure strategy and HDCIS
• –2008 opus 2 came with no controls or anything, but the edge pulls out to turn off processor

Question 5

Concerto Mi100

Answer 5

• 4th internal device from med-el
• approved in 2011 for 12 months and up
• titanium with non removable magnet for 1.5T
• 25% thinner than sonata and had 2 pins added to the casing to prevent it from moving around because surgeons ,moving away from drilling divit for device
• impedance telemetry , ECAP, electrical field telemetry
• electrode arrays: standard, medium, and compressed
• –flex array added in 2012 which is now the commonly used array
• sound processor: opus 2, rondo, sonnet, sonnet 2

Question 6

Synchrony (Mi1200)

Answer 6

• 5th internal device from med-el
• fda approved in 2015
• titanium/self aligning and removable magnet that can do 3.0T with magnet in, also has pins
• impedance telemetry, ECAP, electrical field telemetry
• electrode arrays:
• –standard, medium, and compressed
• –flex array
• sound processor
• –rondo, sonnet, sonnet 2

Question 7

Synchrony 2 (Mi1250)

Answer 7

• 6th internal device from med-el
• fda approved in June 2019
• similar to the synchrony but redesigned the electrode array to be in the middle like the other manufacturers
• titanium, with self-aligning removeable magnet (3.0T in) and pins
• impedance telemetry, ECAP, and electrical field telemetry
• electrode array:standard, medium, and compressed
• sound processor: rondo, sonnet, sonnet2 (August 2019)

Question 8

Start on

Answer 8

Slide 20

Question 9

Med-El basics about the company

Answer 9

• from Innsbruck, Austria
• 6 generations of devices
• –used ceramic in early devices to limit static discharge
• all are monopolar and synchronous
• simultaneous stimulation for I100
• forward-backward compatible speech processors
• 12 electrode pairs
• electrodes # apex to base

Question 10

COMBI 40+

Answer 10

• 1st implantable device from Med-el approved in 2001 for 18+ months and in 2003 for 12+ months
• ceramic with nonremovable magnet that could do MRI up to 1.5T
• impedance telemetry
• electrode arrays:
• –24 electrodes in pairs, 12 channels
• —–standard is 31.5mm which covers almost entire cochlea and 2.4mm between electrodes
• —–medium is 24mm which is about as long as other’s standard array and 1.9mm between electrodes
• —–Compressed is 15mm long with 1.1 mm between electrodes
• —split is 5-4.4mm with 1.1 mm between and then 7-6.6mm with 1.1 mm in between for cases of ossification
• sound processor:
• –CIS PRO+
• –TEMPO+

Question 11

Pulsar CI100

Answer 11

• 2nd internal device from med-el approved 2005 for 12+ months
• ceramic with non-removeable magnet with MRI up to 1.5T
• impedance telemetry, ECAP, and electrical field testing
• simultaneous stimulation, tri-phasic
• electrode array: standard, medium, compressed, and split
• speech processor: compatible

Question 12

SONANA TI100

Answer 12

• 3rd implantable device from med-el approved 2007 for 12 months+
• titanium with non-removeable magnet up to 1.5T MRI
• impedance telemetry, ECAP, electrical field telemetry
• electrode arrays: standard, medium, and compressed
• sound processor:
• –OPUS 1 in 2008 which looks like TEMPO but was able to use fine structure strategy and HDCIS
• OPUS 2 2008= no controls but can pull apart edge of processor to turn off

Question 13

Concerto Mi100

Answer 13

• 4th internal device from med-el approved in 2011 for ages 12 months +
• titanium with non-removeable magnet for up to 1.5T
• 25% thinner than Sonata and has added 2 pins on the end of the casing to hold the implant in place because surgeons stopped drilling place for it to sit and not move around
• impedance telemetry, ECAP, electrical field telemetry
• electrode array:
• –standard, medium, and compressed
• –flex array in 2012 whihc is now the commonly used array
• sound processor:
• –OPUS 2
• –Rhondo (2013), Sonnet (2014), and Sonnet 2 (2019)

Question 14

Synchrony (Mi1200)

Answer 14

• 5th internal device from med-el approved in 2015
• titaium with self-aligning and removable magnet to 3.0T with it in (this really changed the market because of the diametric magnet)
• also has pins
• electrode arrays: standard, medium, compressed, and flex
• sound processor: Rondo, Sonnet and Sonnet 2

Question 15

Synchrony 2 (Mi1250)

Answer 15

• 6th internal device from med-el approved June 2019
• difference from synchrony is the redesigned array location made to be in the middle of the casing now like the other manufacturer’s
• titanium with self-aligning magnet (3.0T in) and pin
• impedance telemetry, ECAP, electrical field telemetry
• electrode arrays: standard, medium, and compressed and flex
• sound processor: rondo, sonnet sonnet 2 (August 2019)

Question 16

electrode arrays from med-el

Answer 16

• wide variety
• flex are supposed to be better at protecting the cochlea
• –wavy to curve with the lateral wall easier
• –flex28 got rid of the paired electrodes 1-5 to make the array smaller
• flex soft is standard array
• FORM array is approved in Europe but not US and has a small plug at the end that can be helpful in cases of malformed cochlea where pt is at risk of CSF leak because it plugs the round window

Question 17

Opus 2

Answer 17

• processor from med-el from 2008
• omnidirectional mic
• LED
• 4 programs instead of the 3 with Opus 1
• no controls but on and off switch; has fine tuner remote control for VC, sensitivity, and programs
• there is a test device that turns red when there is communication between the internal and external device
• D-coil (2011) is thinner and less battery consumption (50%) than earlier coil
• batteries are rechargeable or zinc-air

Question 18

Rondo

Answer 18

• processor from med-el 2013
• one piece processor
• omnidirectional mic so must be sitting facing up or down, not on the side
• has on/off switch, but remote for every thing else
• sports head band, or clip to attach to clothes because problem with falling off
• batteries=zinc-air

Question 19

Sonnet

Answer 19

• processor from med-el 2014
• no controls
• IP rating of 54
• 2 mics
• built-in t-coil
• LED
• DL-coil which has an LED light to replace the test device and a lockable cable (2016)
• datalogging (1st med-el device with it)
• radiofrequency transmission (2.4GHz)
• was ready to do electroacoustical stimulation when made and the stimulation was approved in 2016, then just needed to add a receiver
• –48dB gain at 125-2000 Hz
• –OSPL90=118 dB SLP

Question 20

Rondo 2

Answer 20

• processor from med-el 2018
• features wireless charging within 4 hours
• built in rechargeable lithium-ion battery
• –lasts 18 hours, and life expectancy of 5 yrs
• –can also have a wearable minibattery pack of AAA battery to last 35 hours
• omnidirectional mic so up or down
• controls are done with fine tuner
• IP68 with casing and attachment clip

Question 21

Sonnet 2

Answer 21

• processor from med-el (2019)
• no controls
• –fine tuner
• –fine tuner echo which is more advanced or use app on iphone or android (AudioKey app)
• IP54
• 2 mics
• built-in T-coil
• LED
• DL-coil (LED and lockable)
• radiofrequency transmission (2.4GHz)
• electroacoustical stim
• datalogging
• AudioLink is wireless option to stream to implant

Question 22

Med-el programming connector

Answer 22

MAX programming interface which is a box that can connect 2 implants at 1 time

Question 23

med-el programming software

Answer 23

• MAESTRO
• –bilateral mapping
• –faster telemetry
• –EAS proramming
• –ART, eSRT
• –eABR
• –triphasic pulse which is a new capability to new software, but older implants can use this too
• —–the reason to use this would be to control if there is any other types of stimulation going on like facial

Question 24

impedance field telemetry (IFT)

Answer 24

impedance testing gives voltage distribution profile (VDP) which is also known as voltage matrix

• –this is another way to measure impedance which allows to identify other problems in the array such as short circuit
• —-would expect to see a large bar on the diagonal line and then for the rest of the bars to be less than 50% of the big one

Question 25

Med-el coding strategy

Answer 25

* HDCIS * FSP * FS4 * FS4-P - --FSP up to 350 Hz which means the stimulation rate will match the frequency up until that point - --FS4 was improved so that the stimulation rate will match the frequency up until 1000Hz * FS4 is the default coding strategy

Question 26

volume control with med-el

Answer 26

* IBK is the mode for volume control, there is another option but it is rarely ever used - --with IBK set minimum and maximum which is a percent of the MCL (not the dynamic range) - ----for example 0% would be turning all the way off; 80% would be setting it at 80% of what the MCL normally is - --recommended not to give much for VC unless device has just been turned on - --recommended minimum at 80% and maximum at 100%

Question 27

stimulus level with med-el

Answer 27

* charge units (qu) which is amplitude*width/1000 - --range is from 0-282.2qu - --MCL is commonly under 40 qu (10-25qu)

Question 28

thresholds with med-el

Answer 28

* audible threshold would lead to buzzing and humming * elevated SF threshold, MCL, Maplaw, threshold - -----can modify the map using live voice

Question 29

ESRT

Answer 29

balancing at 80% and sweep at 100%

Question 30

frequency bands with med-el

Answer 30

* 70-8500Hz - --low end is 70-350 Hz adjusted in 10 Hz steps - --high end is 3500-8500 Hz adjusted in 500 Hz steps * distribution: - --logarithmic FS *the default - --LinLog--narrower low frequency (linear in the lows and logarithmic at the higher) - --tonotopic approach (going with what the cochlea naturally does) - --linear increasing--narrower high frequency

Question 31

MAPLAW

Answer 31

* acoustic into electric dynamic range - --logarithmic MAPLAW - --S-shaped MAPLAW-noise - --recommended compression: - ----500 for 10% threshold or measured threshold - -----1000 for 0% threshold

Question 32

automatic sound management (ASM)

Answer 32

* microphone directionally: - --omni, natural, adaptive * AGC Default 3:1 (2:1, 2.5:1, and 3.5:1) * sensitivity default 75%