What if you lose your residual hearing?

[Shirsee]

Hi, I'm scheduled to get MedEl's EAS Hybrid on August 30th for my worse ear. My situation is that I have pretty good low frequency hearing. In the ear not to be implanted, I use a hearing aid with good results and good word recognition. I still can catch a lot of sound with my bad ear but my ability to understand speech is pretty much gone. I can still appreciate a lot of music in my bad ear. I can't catch the lyrics but if I really focuse with an earbud in place, I think I could still learn a new melody with that ear. The big problem is speech comprehension which is only at 10%. I've lost most of my middle and high frequencies. I'm still very nervous about this surgery. My biggest concern is what happens if I lose a lot or most of my low residual hearing either right away or months or years from now. Will the EAS array cover those lows for me adequately? I've heard some people complain that the sound is tiny without the base. Anyone have some experience with this? Thank you. 

[Mary Beth]

Hi!

 

Thats a terrific question to discuss with both your surgeon and audiologist.

 

I have the medium array (not flex but it is 24 mm) in my right side due to the condition of my cochlea.  I have no residual hearing in that ear at all as I lost it decades ago.  I hear great sound, and wonderful music, from that side.  So, for me, the 24 length provides great results for speech and music.  Other people's experiences may vary.

 

I have the flex28 array in my left side and that works terrific as well.

 

Both sides perform well for speech and music alone.  Together they are amazing.

 

There are so many things to consider when we are getting ready for our CI surgery.  I remember well how overwhelming it all felt.  I hope your journey is fantastic!

[hadron]

Hi Shirsee,

If you get implanted with the Flex 28, which has complete cochlear coverage, and lose your residual hearing your audiologist will turn on the electrodes for the EAS frequencies. The Flex 24 does not have complete cochlear coverage.

Post surgery expect up to a 25 DB reduction in your residual hearing.



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[Mary Beth]

It's important to keep in mind that each of our cochleas are different and not all cochleas require the 28 length to get complete cochlear coverage, although many people seem to have the flex28.

[hadron]

The Flex 24 is designed to be inserted no deeper than the basal cochlear turn. Not enough for full coverage.

[Shirsee]

Hadron, as Mary Beth says, a lot depends on your individual anatomy but that said, the flex 24 is made to preserve your residual where the flex 28 is not recommended as a hybrid array and doesn't give as good a chance for keeping your residual. My residual is very precious to me so it's sort of like placing your bet on the greatest chance your residual will be saved or placing your bet that it won't, at least not in the long term. I really wish I could hear from more people who got the flex 24 and how things turned out for them but because it hasn't been approved in this country all that long, there's not a lot of stories that I can find. I only know one person personally who seems OK with the results although she did eventually lose her residual years after surgery. She was in a trial so that's why more time has passed by in her experience. 

[Shirsee]

On 8/7/2017 at 1:10 PM, Mary Beth said:

Hi!

 

Thats a terrific question to discuss with both your surgeon and audiologist.

 

I have the medium array (not flex but it is 24 mm) in my right side due to the condition of my cochlea.  I have no residual hearing in that ear at all as I lost it decades ago.  I hear great sound, and wonderful music, from that side.  So, for me, the 24 length provides great results for speech and music.  Other people's experiences may vary.

 

I have the flex28 array in my left side and that works terrific as well.

 

Both sides perform well for speech and music alone.  Together they are amazing.

 

There are so many things to consider when we are getting ready for our CI surgery.  I remember well how overwhelming it all felt.  I hope your journey is fantastic!

Hi Mary Beth, I have discussed this with both my surgeon and audiologist. My surgeon says simply that the flex 24 is what is recommended to preserve my residual and that if I lose the residual the flex 24 can be adjusted to handle the lows. His rate of preserving residual has been very good. My audiologist says that this issue is in debate even at the clinic where I will be having surgery. There are pros and cons and some strong feelings by the surgeons for both approaches. Do you know if the position or number of electrodes is different for the medium 24 array and the flex 24 array? Thank you for the good words. It's a leap of faith I'm becoming more and more ready to take and that's good because my surgery is soon. Just to make overwhelming more overwhelming, I've learned I have to have another surgery unrelated to my hearing surgery. That took me by surprise. It's surgery for a heart valve replacement. So you can imagine how anxious I feel at times. Thanks again. 

[hadron]

@Shirsee The Flex 24 used to be called the FLEX EAS and was used in the MED-EL clinical trials. So there are plenty of users that used it.

As I mentioned earlier the Flex 24 is designed to be inserted no deeper than the basal cochlea turn. If you go deeper I would be concerned about trauma.

Recent studies have shown no significant difference in preserving residual hearing between the Flex 28 and Flex 24 electrodes. So surgeons have started using the Flex 28 since it has complete cochlear coverage. 

Your surgeon seems to be doing the opposite.

[Mary Beth]

I would be anxious too.  I do not know the technical differences between flex24 and medium (which is also 24) except for the electrode differences in the flex section.

 

But there is a FaceBook group with active EAS users where you may get some answers to your questions.  Search for it, ask to join and post your questions there as well.

 

Med El Cochlear Implant Discussion Group

[Shirsee]

Maybe I should ask MedEl what they think. 

[Mary Beth]

@leighf may be able to put you in touch with your regional Med El reps.  Good luck.

[Mary Beth]

@Shirsee

 

And also talk more with your surgeon about your concerns.  The electrode array is an important factor in preserving residual hearing but surgical skills in preserving residual hearing is equally, or even more, important in my opinion.  

 

Take a look at the Sonnet EAS audiogram requirements too so that you can compare that with your present audiogram and understand how much room you have in order to remain in the EAS fitting range.

 

This is a topic that I have no personal experience with as neither side qualified for EAS prior to surgery and my hearing loss was progressive, which also eliminates the EAS.

 

Wishing you the best.

[Mary Beth]

Here is a link to the EAS audiogram requirements

 

http://www.medel.com/us/eas-hearing-implant-system

[Shirsee]

Thanks Mary Beth. I appreciate it. I certainly fit their requirements. 

[Shirsee]

20 hours ago, hadron said:

@Shirsee The Flex 24 used to be called the FLEX EAS and was used in the MED-EL clinical trials. So there are plenty of users that used it.

As I mentioned earlier the Flex 24 is designed to be inserted no deeper than the basal cochlea turn. If you go deeper I would be concerned about trauma.

Recent studies have shown no significant difference in preserving residual hearing between the Flex 28 and Flex 24 electrodes. So surgeons have started using the Flex 28 since it has complete cochlear coverage. 

Your surgeon seems to be doing the opposite.

Hi, where can I find these studies? It would be a great time for some hard facts and data. Thanks. 

[Hicksy]

Shirsee, I was perhaps a lot like you, had some residual hearing in both ears but I had long lost the ability to talk on the phone, impossible in groups, starting to shy away, realizing I just couldn't hear all the music anymore etc... I was implanted with a flex soft with all the trepidation that you have especially when it came to music but the residual hearing was lost. It wasn't evident until a few months post activation due to healing and such and by that time I seriously had regrets for about 20 seconds as the implant has been so much better than I ever expected. Hearing aids never worked for me, just made the din louder. I'm only 7 months in and have a long way to go but it is so incredibly better. Music was really strange at first but now it's starting to come into focus is the best I can describe it. The unplanted ear still picks up the bass but the implanted ear is getting closer every day. Sure it would have been nice to have the residual hearing in the implanted ear and seriously that was my biggest fear going in but I don't give it a second thought now.  Just thankful I have had no serious problems of any kind and so well on the way back to "normal" hearing. I had the robot voices, didn't even have that at first, the sheer bafflement at most of what I was hearing at activation, the fear that perhaps my hearing was too far gone to ever make sense out of anything, to yesterday having a conversation with my neighbor across porches with traffic noise and wind. Unthinkable 7 months ago! And I know I still have a long way to go and know it will get even better.

So that's my story, hope it helps.

[MED-EL Moderator]

On 8/9/2017 at 4:39 AM, Shirsee said:

Hi Mary Beth, I have discussed this with both my surgeon and audiologist. My surgeon says simply that the flex 24 is what is recommended to preserve my residual and that if I lose the residual the flex 24 can be adjusted to handle the lows. His rate of preserving residual has been very good. My audiologist says that this issue is in debate even at the clinic where I will be having surgery. There are pros and cons and some strong feelings by the surgeons for both approaches. Do you know if the position or number of electrodes is different for the medium 24 array and the flex 24 array? Thank you for the good words. It's a leap of faith I'm becoming more and more ready to take and that's good because my surgery is soon. Just to make overwhelming more overwhelming, I've learned I have to have another surgery unrelated to my hearing surgery. That took me by surprise. It's surgery for a heart valve replacement. So you can imagine how anxious I feel at times. Thanks again. 

Hi Shirsee, firstly thank you for reaching out to the HearPeers community - I can understand this is a time full of great anticipation for you! @Mary Beth @hadron and @Hicksy have all brought up some important points to consider. I'll try to offer you some helpful information, but I am unable to offer medical advice and so I cannot say which electrode array would be best for you.

The FLEX 24 has 19 platinum electrode contacts, and the Medium (from the CLASSIC series) has 24 platinum electrode contacts. This document is quite technical and is actually created for professionals, but it does go into more technical detail about our different electrode arrays if you would like to take a look at it: http://s3.medel.com/pdf/21617.pdf  

What I can recommend is to stay in close contact with your CI team including your ENT surgeon. As everyone's ear anatomy is different, they will know your case best and you can discuss with them what the best option will be for your hearing. If you would like additional support from a local MED-EL Representative, just let me know and I can put you in touch with them.

Kind regards,

Leigh 

HearPeers Support Team

[Mary Beth]

@Hicksy

 

Terrific!  Sounds like you are off to a fabulous start.,  I am so happy for you!

[Shirsee]

10 hours ago, leighf said:

Hi Shirsee, firstly thank you for reaching out to the HearPeers community - I can understand this is a time full of great anticipation for you! @Mary Beth @hadron and @Hicksy have all brought up some important points to consider. I'll try to offer you some helpful information, but I am unable to offer medical advice and so I cannot say which electrode array would be best for you.

The FLEX 24 has 19 platinum electrode contacts, and the Medium (from the CLASSIC series) has 24 platinum electrode contacts. This document is quite technical and is actually created for professionals, but it does go into more technical detail about our different electrode arrays if you would like to take a look at it: http://s3.medel.com/pdf/21617.pdf  

What I can recommend is to stay in close contact with your CI team including your ENT surgeon. As everyone's ear anatomy is different, they will know your case best and you can discuss with them what the best option will be for your hearing. If you would like additional support from a local MED-EL Representative, just let me know and I can put you in touch with them.

Kind regards,

Leigh 

HearPeers Support Team

Hi Leah,

And thank you. I do think that the best course of action is to express my concerns to my surgeon. I have done that before but it never hurts to bring up a topic you are concerned about more than once. I may already be in contact with my local representative but also, I may not have communicated with them recently. Would it be possible for you to send me their name and contact info so I know if we have talked before? Thanks so much. 

On 8/9/2017 at 1:38 AM, hadron said:

@Shirsee The Flex 24 used to be called the FLEX EAS and was used in the MED-EL clinical trials. So there are plenty of users that used it.

As I mentioned earlier the Flex 24 is designed to be inserted no deeper than the basal cochlea turn. If you go deeper I would be concerned about trauma.

Recent studies have shown no significant difference in preserving residual hearing between the Flex 28 and Flex 24 electrodes. So surgeons have started using the Flex 28 since it has complete cochlear coverage. 

Your surgeon seems to be doing the opposite.

Hi, where can I find these studies? It would be a great time for some hard facts and data. Thanks. 

[Cara Mia]

On 8/8/2017 at 10:38 PM, hadron said:

@Shirsee The Flex 24 used to be called the FLEX EAS and was used in the MED-EL clinical trials. So there are plenty of users that used it.

As I mentioned earlier the Flex 24 is designed to be inserted no deeper than the basal cochlea turn. If you go deeper I would be concerned about trauma.

Recent studies have shown no significant difference in preserving residual hearing between the Flex 28 and Flex 24 electrodes. So surgeons have started using the Flex 28 since it has complete cochlear coverage. 

Your surgeon seems to be doing the opposite.

I have WAS with Flex 28. I also was very anxious about my residual hearing before surgery and thought to go with Flex 24. But my surgeon told me the same what Haddon said that there is no significant difference in hearing preservation between Flex 24/28. He highly recommended to go with 28 which I did. AFTER SURGERY I got steroids which help to diminish any impact of surgery trauma. And now I am enjoy the full coverage provided with Flex 28 and almost unchanged residual hearing. Shirsee, my best wishes to you and hope your residual hearing will stay with you unchallenged after surgery ?

[Mary Beth]

@Rosemary