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Differences in Cochlear Implants


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On Medel.com I read that there are many cochlear Implant systems. One is Concert Cochlear Implant , SYNCHRONY and SYNCHRONY EAS.

 

I didn't understand the difference between these . Is one more advanced that the other ? Do it give more clarify of speech ? 

 

Who decided which one we should be implanted with ?

 

What about the Soundbridge Implant? Is it as effective the cochlear Implant ? 

 

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I read on medel.com and it seems that  SYNCHRONY EAS  is the best option for me since I still have some hearing in the low frequencies, but this only work with a BTE processor. I can't use Rondo with it. 

I wonder why .

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A Sonnet EAS has a hearing aid earmold attached to its hook.  It functions like a hearing aid for low frequency sounds and a CI for the rest.  

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14 minutes ago, Mary Beth said:

A Sonnet EAS has a hearing aid earmold attached to its hook.  It functions like a hearing aid for low frequency sounds and a CI for the rest.  

I am would like to know if I should have that implant. Is the Implant the same and the processor if different of the  SYNCHRONY  EAS is a different Implant .

My most recent Audio-gram is somehting like this :

0250.Hz L-040 R-040
0500.Hz L-050 R-050
1000.Hz L-090 R-085
2000.Hz L-095 R-095
3000.Hz L-110 R-120
4000.Hz L-105 R-120
6000.Hz L-n/r R-n/r
8000.Hz L-n/r R-n/r

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I am sorry but we are a group of Med El users.  That is something your CI team can discuss with you. Sorry I can’t help.

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Med El has a picture of audiograms that shows who are eligible for the Sonnet EAS processor.

In the US, Med El recipients are most often receiving the Synchrony internal implant.  There are many different electrode arrays for the surgeon to choose from.  People with residual hearing can use the Sonnet EAS.  Others can use the Sonnet or Rondo.  The internal Synchrony implant works with all of the external processors.

 

Sometimes Med El uses the same term for more than one thing.  For example, Maestro is a term Med El uses for a collection of internal implants/external processors BUT it is also the term Med El uses for the MAPping software used on all implants (Maestro 6 and soon Maestro 7).  Synchrony appears to be a term Med El is using in more than one way too.

 

The actual Synchrony internal implant is the same whether it is matched with a Sonnet EAS, Sonnet CI or Rondo.  Various electrode arrays can attach to it.  The most appropriate electrode array is something my surgeons selected to match my cochleas.

 

 

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Hello @stream2525

These are all good questions about EAS. The SYNCHRONY EAS system is our latest EAS system. It combines the SONNET EAS audio processor and the SYNCHRONY cochlear implant.

The MED-EL CONCERT is a previous generation cochlear implant. The SOUNDBRIDGE is a middle ear implant.

The best next step would be to contact your local MED-EL team and discuss which solution would be the best fit for your hearing. Please let me know if you need any contact details.

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On 10/27/2017 at 10:56 AM, leighf said:

Hello @stream2525

These are all good questions about EAS. The SYNCHRONY EAS system is our latest EAS system. It combines the SONNET EAS audio processor and the SYNCHRONY cochlear implant.

The MED-EL CONCERT is a previous generation cochlear implant. The SOUNDBRIDGE is a middle ear implant.

The best next step would be to contact your local MED-EL team and discuss which solution would be the best fit for your hearing. Please let me know if you need any contact details.

Thanks @leighf for your answer.

I want to know that are the differences between SYNCHRONY and SYNCHRONY EAS Implants during surgery . Is the surgery done in a different way ? 

If that is the case, then what is I decide to go for EAS surgery but later my residual hearing deteriorated ? Can I have a follow up surgery to get things fixed? 

What if I don't want to use the processor with the molds for the EAS and want to use a one piece processor ( Rondo)? 

I wonder what have been reported by SYNCHRONY EAS that is encouraging Med El to improve this in the future . I don't have much hearing left in the low frequencies, but would like to keep the hearing cells without being forced to use a processor with molds. 

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@stream2525

Great questions. The SYNCHRONY implant is used for both regular cochlear implants and for EAS. The difference with EAS is in the length of electrode array. Our shorter electrode arrays are generally used for EAS. Your surgeon and implant team will help determine the best electrode length for your cochlea and residual hearing. All of our flexible electrodes are designed to protect the delicate structures in your cochlea.

Also, it is possible to switch from an EAS processor to a different processor, like RONDO. No surgery is needed, you just need the new processor fitted by your audiologist. The SONNET EAS audio processor can also be used without the ear mold; it can be mapped to function as a normal cochlear implant audio processor.. 

 

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What if I lose more hearing after I get the short electrode ? 

Is using the long electrode damages the hearing cells of the low frequencies??

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as I know, people with a shorter electrode, that some surgeons use with EAS implant (like Flex 24), hear all range of the sounds without any compromising in speech comprehension and even music appreciation. It is rather about the individual brain plasticity than the length of electrode array.

I was implanted with the Flex 28 which can be considered as a Standard length electrode. Despite this I have a surprising amount of residual hearing preserved. I was told that MedEL atraumatic electrode array along with hearing preservation technique used during surgery play a bigger role in hearing preservation and that there is no strong data that proofs that shorter electrodes provide better preservation for residual hearing after surgery.

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5 hours ago, Cara Mia said:

as I know, people with a shorter electrode, that some surgeons use with EAS implant (like Flex 24), hear all range of the sounds without any compromising in speech comprehension and even music appreciation. It is rather about the individual brain plasticity than the length of electrode array.

I was implanted with the Flex 28 which can be considered as a Standard length electrode. Despite this I have a surprising amount of residual hearing preserved. I was told that MedEL atraumatic electrode array along with hearing preservation technique used during surgery play a bigger role in hearing preservation and that there is no strong data that proofs that shorter electrodes provide better preservation for residual hearing after surgery.

I don't quite understand you. Do you mean that I better get the longer electrode though I still have some hearing in the low frequencies?

Won't this damage the hearing cells in the inner part of the cochlea that transmits the low tones? 

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Dear stream, I cannot say what is better for you as it depends on many factors that I am not aware of and not in a position to have a professional opinion :).

But when I discussed with my surgeon which electrode is better for my second ear that retained some low frequency hearing, he was absolutely sure that I need to go with the longer Flex 28 as the scientific data he relies on show no statistically significance in hearing preservation between MedEL Flex 28 and Flex 24. The same was supported by his personal statistics for MedEL brand.

I don't know about other brands as we didn't discuss them.

Believe me, I was very concerned with keeping my residual hearing at least for sound awareness when I am without CIs. And keeping the residual hearing was important for me regardless if I get EAS or will use just a regular CI (I got EAS in 6 month after activation after it was approved by FDA). 

So, one more time, my surgeon was adamant, that Flex 28 gives me the same opportunity in hearing preservation as the shorter version. He stressed out that with the standard anatomy of my cochlea, the MedEL atraumatic design for electrodes, along with hearing preservation technique during surgery, and administration of steroids during and after surgery (which he considered optional) are more crucial factors than the length of electrode just itself.

With Flex 28 I have enough residual hearing not only for low environmental sounds awareness, but I even can understand some words/ short phrases without help of my implant.

 

Stream, I understand you very well. Making that decisions as a leap of faith because nobody can guarantee 100% success. I also feel uneasy understanding that even if 90% happy with their results, I am still have a chance to be within 10% with mixed experience.... I am glad that you get as much info as possible before deciding. Good luck.

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Daniel the Stranger

I suggest you to speak to your doctor about the type of implant. It is good to ask questions so you can have an idea, but there are some questions that you should make to your doctor or audiologist before posting them here. After your appointment you can come and share with us your experience and everyone of us will help you from there.

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Absolutely agree with Stranger, it is between your CI team to discuss what is better for you, why, how, and when. We just can share our own experience that can be absolutely irrelevant in your case. And Also we can give an emotional support and encouragement, but not a medical advises or base for decision. Even my CI team left decision solely on my shoulder after they presented all fact and answered all my questions. 

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@stream2525 There are no guarantees that any residual hearing after surgery will remain unchanged. Mine was preserved at 4% after the first implant 2 years ago, and was no longer present during my 18 month evaluation.

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Definitely surgeon skill in preserving residual hearing can not be stressed enough.  More than the electrode array, surgeon skill is a huge factor in preserving residual hearing in my opinion.  There is never any guarantee, even with the best surgical skill, that residual hearing will be preserved and stay preserved over time.

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Daniel the Stranger

Stream, you also has to take into consideration that even if you want the longer electrode array, sometimes this is not possible due to the size of the cochlea. That is why you need to see a doctor to determine your options.

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Mmmm... Very interesting discussion - even for professional circles.    

To properly set this puzzle many questions have been raised as well as answers were given, but … There are some missing parts so let’s start from the elementary: first question which should be regarded as a dynamic of Stream’s losing his hearing; and second is were there any stable periods and how long did they last.

If Stream’s hearing loss is even a bit stable, EAS system should be considered because preserving a natural sense of lower frequencies are still worthwhile because processing of the electrical stimulation and natural hearing does not go the same way as well as the acoustic amplification.

The situation of fast deterioration of hearing is absolutely and without any doubt, the case for recommending a cochlear implant with a standard length of electrode no matter the situation of having useable lower frequencies. Having more than one operation in a short period of time is – not effective for anyone.

If we consider the situation where hearing loss progresses in a far lighter version, EAS is recommendable because this type of system uses both ways of hearing stimulation.

 

To answer Stream: with EAS only using Sonnet gives you the opportunity to amplify lower frequencies by natural way – acoustically, and that way goes through the ear mold. That’s why using Rondo is nor effective (because it can not set in motion the acoustic part in any way nor it is a logical solution. I do understand that you would like to get rid of hassling with an ear-hooked outer part but this goes contrary your gain.

I hope you do understand that cochlear implant is not – a hearing aid and that rehabilitative part is nor easy nor 100% promising solution of getting a perfect result.

Having in mind these keys for a serious discussion which will have serious repercussions on your life, any definitive answers you should seek with your ENT surgeon. If you need, talk with more than one, but keep always in mind a thought that part of the decision is in your surgeon’s hands – otherwise all professional discussions would not have any sense.

I remember the EAS discussion on this world ENT Congress – it was a very dynamic talk between “giants” in our profession. Each one of them had part of uncertainty in this matter in a way that each patient should be discussed individually.

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Hi @stream2525,

EAS systems initially used shorter Electrode arrays. The MED-EL EAS electrode array was 24mm. 

EAS studies using the longer FLEX 28 electrode array found no significance differences in hearing preservation and speech understanding from using the EAS 24mm electrode array.

The EAS electrode array has been renamed the FLEX 24 electrode array.

With the FLEX 28 you also get complete cochlear coverage if the EAS system is on longer useful to you.

 

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I have a flex 28 as well. After the first month the residual hearing reappeared. It’s not enough for EAS but it’s there. I guess as the swelling and healing occurred it came back. My Audi was actually surprised. I did have a traumatic surgery so it goes to show that Med el makes good electrodes!! 

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Just to throw this out there, I was approved for a Sonnet EAS and was implanted with the synchrony flex soft which is longer than the 28. Unfortunately I didn’t retain my residual hearing ( pretty much my greatest fear, if any, going into surgery) and I can truthfully say it upset me for 15 seconds when I found out I had lost the residual hearing. What I gained is almost indescribable to what I lost that I actually feel I wasted those 15 seconds lamenting...?

(truthfully my fears going into surgery was it would be another failed hearing aid experiment that would do nothing to regain any word recognition along with losing the residual hearing but I was to the point where the gamble made sense).

So woe is me. I lost my residual hearing, I’m 10 months along, can’t talk on the telephone yet, still need cc on the tv, music still sounds weird, oh woe is me...

nothing could be further from the truth... even the first day in the booth when I realized I had lost the residual hearing and it was early days with the “casino in my head” effect still going on I realized I was light years ahead of where I started.

I’ve gone from zero word recognition on tv, radio, phone (for years) to about i’d say 70-80%, music sounds better than ever (I was missing soooo much) and even better, every time I think I’ve reached the plateau, something happens to prove I’m still improving. 

But that’s the nitty gritty small stuff. So still can’t talk on the phone, can’t watch tv without cc...

Overall, it’s simply life changing. I talk to people in lineups, actually heard far better than my spouse in a noisy restaurant the other night, talk all night with my friends without asking them to repeat themselves once! Simply life changing.

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11 hours ago, hadron said:

Hi @stream2525,

EAS systems initially used shorter Electrode arrays. The MED-EL EAS electrode array was 24mm. 

EAS studies using the longer FLEX 28 electrode array found no significance differences in hearing preservation and speech understanding from using the EAS 24mm electrode array.

The EAS electrode array has been renamed the FLEX 24 electrode array.

With the FLEX 28 you also get complete cochlear coverage if the EAS system is on longer useful to you.

 

I am a little confused. If FLEX 24 and FLEX 28 will lead to same results, r why would have the EAS? 

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