Cochlear Guest

Question 1

Is magnetic removal always the gold standard for MRIs?

Answer 1

Yes, because it creates a shadow of the image
Polarity is side by side in the internal magnet and it will rotate to align with the magnetic field of the MRI

Question 2

What are the electrode types?

Answer 2

Peri-modiolar electrode (curved for consistent placement within the scala tympani and in close proximity to the modiolus) and slim straight (thin and easy insertion)

Question 3

What is the code that is associated with a slim straight electrode?

Answer 3

CI622
CI = cochlear implant
6 = 6th generation
22 = electrode type

Question 4

What is cochlear link?

Answer 4

Accessible when a clinic signs up for the service
Connect a processor to the software and they have immediate access to services
Through this they can contact Cochlear and get a replacement in 24 hours (except if they report this on a Sunday)

Question 5

Does cochlear have insurance support?

Answer 5

Yes, they will deal with it for you and your patient
Fight denials up to 2x

Question 6

Did cochlear recall an implant due to decreased survival percentage?

Answer 6

Yes, and then they discovered what was wrong
Released an improved version a few years later

Question 7

What is classified as all-day use?

Answer 7

16 hours
That’s how long the battery life of the external sound processor should last
Can last longer too

Question 8

What is forwardfocus?

Answer 8

Directionality
A way to reduce noise
Can be manually controlled on/off or automatically - only manual on Kanso

Question 9

Is the Nucleus 8 sound processor the smallest and lightest behind the ear sound processor?

Answer 9

Yes
And the Kanso 2 is the smallest and lightest off-the-ear sound processor

Question 10

Is the waterproof packaging necessary for the Nucleus 8 an Kanso 2?

Answer 10

No
Waterproof or water-resistant
No need unless they will be in the water for a long time

Question 11

What is Nucleus SmartNav?

Answer 11

Helps surgeons track and monitor electrode insertion to achieve the desired placement and hearing outcomes

Question 12

Does cochlear offer remote care solutions?

Answer 12

Yes, remote check and remote assist
Remote check allows patients to complete a hearing check assigned by their clinician without visiting the clinic (asynchronous impedance check)
Remote assist is video appointments with patients, including remote sound processor adjustments (synchronous programming) - billable to Medicare

Question 13

What is the cochlear volunteer network?

Answer 13

Matching a candidate with a CI user
Able to give them advice and their personal experience

Question 14

What is current level and pulse width?

Answer 14

Current level - represent the amplitude of the biphasic pulse
Pulse width - the amount of time the pulse is on

Question 15

What kind of stimulation do they use at cochlear?

Answer 15

Monopolar stimulation
Active electrodes are coupled with an external ground electrode

Question 16

Does loudness increase with increased current (amplitude) and pulse width?

Answer 16

Yes
They are related
To make it louder, we increase charge

Question 17

What is electrode impedance?

Answer 17

Measures the resistance to flow of electrical current through a medium
Measured in ohms
Impedance = voltage/current

Question 18

Why do you check impedance twice during activation session?

Answer 18

Want to break up the bio-film through stimulation (that was sitting there for multiple weeks after surgery)
Expecting impedance to go down
This allows us to increase current level without affecting compliance

Question 19

Do hormones affect impedances?

Answer 19

They can
Can occur during both puberty and menopause

Question 20

What else can affect impedances?

Answer 20

Drugs
Steroids
Blood flow
Gender affirming care

Question 21

What coding strategy is used?

Answer 21

ACE
Frequencies are split into 22 bins (22 electrodes)
Frequencies with the largest amplitudes are chosen as maxima
Maxima are then coded to stimulate at certain current level (dependent on T and C levels)
The stimulation of the physical electrode then causes stimulation of the corresponding neural components

Question 22

What is a MAP?

Answer 22

Set of electrical parameters that tell the implant what to do
for that patient
Typically based on behavioral responses to
establish loudness and pitch
Where we set the Cs and Ts

Question 23

What is the T-level?

Answer 23

Threshold level
Lowest level of electrical stimulation which produces an audible sound for the patient
Want them to be between 20-30 dB

Question 24

What is the C-level?

Answer 24

Comfort level
The highest level of electrical stimulation which produces a
loud (but not uncomfortable) sound for the patient

Question 25

What is a program?

Answer 25

A MAP is combined with pre-processing and other parameters (eg, noise reduction, directional microphones, etc) to create a program which is then loaded in the sound processor

Question 26

What is MAP durability?

Answer 26

Stress test by manipulating T-levels Up 30% and 60%; down 30%, 60%, and 90% Results (+/- 30% T levels): No difference in CNCs at 50 and 60 dB SPL No difference in SIN at 55 and 65 dB SPL No difference in SSQ

Question 27

What is electrical dynamic range?

Answer 27

Difference between C-levels and T-levels Recommended DR is between 10-60 CL to ensure good sound quality

Question 28

What is the programming solution for cochlear?

Answer 28

Population mean Not AutoNRT or ESRT (find this value and then subtract 20 dB and that's your c-level)

Question 29

When are most patients activated?

Answer 29

About 2 weeks Different from the FDA approved activation timeline

Question 30

Do MAPs stabilize over time?

Answer 30

Yes, t-levels and c-levels become stable within 3 to 6 months of activation After this happens, they only need an appointment once a year

Question 31

What are 3 things you want to achieve on activation?

Answer 31

Make sure they have audibility (soft sounds are soft) Dynamic range is between 40-60 We want the overall sound to be loud (tell patients this, not comfortable)

Question 32

What do you want to counsel on at activation?

Answer 32

Wear time 10+ hours a day

Question 33

What are the testing goals post-op?

Answer 33

SF thresholds better than 30 dB At 3 months CNC greater than or equal to 56% or 20% improvement from pre-op

Question 34

Why should you only adjust the MAP when necessary?

Answer 34

They have to adjust to it each time a change occurs Improved satisfaction and progress reported

Question 35

What is the programming software for cochlear?

Answer 35

Custom Sound Pro

Question 36

If the impedance is too high or too low, will the system flag it?

Answer 36

Yes and turn it off automatically

Question 37

What does autoNRT stand for?

Answer 37

Automatic neural response telemetry

Question 38

What are global adjustments?

Answer 38

Overall audibility and loudness Global changes to t and c levels during love speech

Question 39

What is comfort adjustments?

Answer 39

Loudness tolerance Make sure c levels are loud and around the same loudness for all of them Sweep c-levels in groups of electrode bands Make sure they are loud

Question 40

Can you adjust individual thresholds?

Answer 40

Yes Only really do that if a patient is struggling in a certain frequency range

Question 41

What is sensitivity control?

Answer 41

Microphone sensitivity will change and how far they are picking up sounds Usually don't enable this for patients

Question 42

What is master volume control vs volume control?

Answer 42

Volume control - 10 step changes to utilize full map; will not let them mute the device Master volume - patient's changing their c-levels on their own; will not let them go to a DR less than 20 or exceed the abilities of the device *might be a solution for those with fluctuating hearing loss

Question 43

What happens when you reach compliance for some electrodes?

Answer 43

It will prompt you to adjust the pulse width instead of the amplitude This will still keep the perceived volume for the patient loud