Hearing Technology Definions: Where do we draw the lines? Meredith A. Holcomb, AuD, CCC-A Medical University of South Carolina Clinical Director, Cochlear Implant Program Clinical Assistant Professor, Dept of OTO-HNS Agenda • Hearing review • Funcon of a hearing aid • Funcon of a cochlear implant • Difference/Similaries • Changes over me • Melding the two devices • Future for technology How do we hear?

Types of Hearing Loss

• Conducve Hearing Loss • Sensorineural Hearing Loss • Mixed Hearing Loss Conducve Hearing Loss

• Examples: • Fluid in the middle ear from colds and/or allergies • Ear infecon (os media) • Poor eustachian tube funcon • Perforated eardrum • Benign tumors • Impacted earwax (cerumen) • Swimmer's Ear (os externa) • Foreign body • Absence or malformaon of the outer ear, ear canal, or middle ear • Treatment: • Surgery • Hearing aids • Osseointegrated Device Sensorineural Hearing Loss

• Examples of SNHL: • Illnesses, Syndromes • Ototoxic drugs • Genec or hereditary hearing loss • Aging • Head trauma • Malformaon of the inner ear • Exposure to loud noise • Treatment: • Hearing aids • Cochlear Implant Mixed Hearing Loss • Conducve hearing loss occurs in combinaon with a sensorineural hearing loss. • Possible damage in the outer or middle ear and in the inner ear(cochlea) or auditory nerve. • Examples: • Permanent hearing loss and ear infecon • Permanent hearing loss with impacted cerumen • Treatment: • Surgery • Hearing aids • Osseointegrated Device • Cochlear implant Funcon of a Hearing Aid

• Three parts: 1. Microphone Picks up sound Sounds are analyzed / processed and sent to the amplifier 2. Amplifier Increases volume of sounds and send to loudspeaker 3. Speaker Sends sounds into the ear Photo courtesy of Starkey.com What is a Cochlear Implant?

Cochlear implants are designed to bypass damaged parts of the ear to stimulate the auditory nerve directly through the application of external electrical current

Image courtesy of MED-EL How a Cochlear Implant Works 1) The speech processor microphone picks up sound from the environment. 2) The processor turns sound into electricity.

Image courtesy of MED-EL How a Cochlear Implant Works

3) This electricity is transmitted across the skin, and the internal implant generates electrical pulses at the electrodes.

Image courtesy of MED-EL

How a Cochlear Implant Works

4) Each electrode fires thousands of times each second to represent sounds in the environment.

Image courtesy of MED-EL

High Mid Low Hearing Aid vs Cochlear Implant

• Amplifies sound and delivers it acouscally • Amplifies sound and delivers it electrically • No surgery • Surgery • Covered by few health insurance policies • Covered by most insurance policies • Smaller in size • Larger in size • 10-14 days with disposable baeries • 3-4 days with disposable baeries • For paents who struggle with speech • For paents who struggle with speech understanding without amplificaon understanding with appropriately fit HAs • Does not fix hearing loss • Does not fix hearing loss • Improves quality of life • Improves quality of life Advanced Bionics Corporaon NEW PROCESSORS OLD PROCESSORS Naida Q70 Naida Q90

Neptune

Courtesy of AB Cochlear Americas New Processors Old Processors

Courtesy of Cochlear Med EL Corporaon NEW PROCESSORS EAS OLD PROCESSORS Sonnet

Opus 2 Tempo Tempo

Rondo

Courtesy of MedEl Internal CI Devices Bimodal vs Bilateral Bilateral CI Bimodal HA+CI

• All bilateral users(CI + CI) and bimodal users (CI + HA) perform beer than unilateral CI users • Firszt et al 2008; van Schoonhoven et al 2013;Dunn et al 2010 • Bimodal users with beer HA aided PTA (< 55) are more likely to benefit from amplificaon • Yoon et al 2012 Technology Similaries / Differences

Hearing Aid vs Cochlear Implant

• Accessories are addional purchase • Accessories included with surgery • Direconal mics • Direconal mics • Noise suppression • Noise suppression • Wind reducon • Wind reducon • Front end signal processing • Front end signal processing • Telecoil • Telcoil • Phone signal to both ears for most companies • Phone signal to both ears for landline (one company) • Cannot smulate all frequency range parcularly when there are “dead regions” • Able to smulate all frequency range CI and HA in ONE device

Hybrid (Cochlear) EAS (MED-EL)

Tradional CI EAS / Hybrid for Adults

Audiometric requirements have changed greatly for adults When to consider referral for CI eval: Factors Affecting Success with CIs and HAs • Degree of HL • Participation in aural rehab program • Family support • Resources • Accessibility to services • Noise • Medical history (syndrome, cognition, other developmental delays) • Inner ear anatomy • Wear time Future Direcons for CI

• Unilateral hearing loss • Expanded candidacy criteria • Improved programming methods • Beer technology • Completely Internal • Waterproof on ear device • Baery life • Lower manufacturing costs • Beer connecvity Conclusions: A Cochlear Implant Is ONLY A DEVICE! Hearing DOES NOT Equal Speech Understanding!