New here and looking for info on speech in noise and residual preservation

[Enigmachick]

Hello,

I am in the process of making a final decision about what implant to get and am choosing between  a Med-el flex 24, flex 28 or AB Slim J array. I'm really interested in hearing about people's experiences with hearing in noise as EAS bimodal recipients but really anyone who has only one implant.

Also, I still have pretty decent low frequency hearing which I'd like to preserve but am concerned about what happens if I lose it all. My doctor suggested the Flex 24 for preservation but I guess I'm concerned that if I lose it all, I will have gypped myself by not getting the longer array.

Any thoughts/ideas/experiences would be really helpful.

Thank you in advance.

Vicky/enigmachick

[Jewel]

Welcome @Enigmachick

[Mary Beth]

Hi @Enigmachick.  Welcome Vicky.

We do have at least two members here who are happily using EAS Sonnets.

@Cara Mia

@Sherri

From reading posts from people with residual hearing, in addition to a flexible array, surgeon skill in preserving residual hearing is a HUGE factor.  I suggest you gather info about your surgeon’s track record of preserving residual hearing with each array if possible.  

 

Wishing you the best on your journey.

[Enigmachick]

Hi @Mary Beth.  Thanks for your reply.

My surgeon suggested the flex 24 as he has about 76% near pre-op preservation with that one. He thinks it's about 10% less with the Flex 28. He said when discussing "any usable" preserved hearing he's at about 90% with the Flex 24. I have a lot of confidence in him.

I would really love to get input about speech in noise.. from anyone really

[Mary Beth]

Hi Vicky @Enigmachick

 

I can tell you my experience with a medium electrode array (which is 24 mm but not flex) on my right and a flex 28 on my left. You can look here to see how the medium and flex 24 share some similarities as to active length etc ...   http://www.medel.com/data/pdf/21617.pdf

 

I needed the medium due to my right cochlea complications.  I am not suggesting the medium over the flex 24, just sharing that my right side has the same length as a flex 24.

 

I hear great with both my right and left sides.  In fact, they test out almost exactly the same and more importantly they function the same in my real life.  I do not notice anything lacking in my right side even though it has the shorter array.  I was not a candidate for EAS as my right ear had zero hearing and my left ear was too advanced and still losing hearing.  I do not miss the little hearing I lost in my left side.  We were not attempting to save it.  If I had useable stable hearing in that ear, we would’ve tried to save it.  

 

So for me, the medium 24 works just as great in my right ear as the flex 28 works in my left ear.  I love music and have returned to playing the piano.  Right now we are jamming to the Hamilton Broadway soundtrack as I type.  It’s so wonderful to be surrounded by music again.

 

I am glad you have found a great CI surgeon.  That makes a huge difference.  An awesome CI audiologist is just as important on this journey.  I have been very fortunate.  I hope you are as well.

 

Noise.......

understanding speech in noise varies for everyone, like everything else.  Smile.

I do very well in noise.  I can stay in omni mic setting and do fine or move into adaptive mic setting on the Sonnet and it is amazing in noise.  Really quite spectacular in noise......Sonnets in adaptive mic setting.

Which CI center are you using?  Will you get the Plus Rondo 2 promotion?  I fell under the Plus Rondo promotion in 2015 and absolutely love my Rondos in waterwear covers in the ocean!  So much fun!

 

I hope you stick around.  Ask as many questions as you wish.  We are a friendly bunch.

 

 

[Enigmachick]

Hey again @Mary Beth 

Thanks for the detailed reply. It's really helpful. I'm sure it varies for everyone but since I'm debating not only electrode length but also brands, it's good to hear positive info about hearing in noise. AB spends a lot of time talking about how great their hearing in noise tech is so much better than everyone else's so I needed some perspective.

As for my doctor (not sure if it's ok to mention his name here or not), I think he's great... I certainly hope he's great. He's the head of the CI unit at Weil Cornell and took over (at Mt Sinai) Dr. Simon Parisier's (who did my mom 20 or so years ago) practice. I've heard good things about him from others and he's very kind and thoughtful which is a huge plus for me. I never feel rushed when I talk to him and he called me himself to let me know there was a weird issue with insurance so again, a huge plus. I guess the surgery itself takes place at NY Presbyterian. He recommended the Flex 24 for preservation but said he'd go with whatever I decide and we would make it work. Because the AB electrode is so new he hasn't done any live implants with it so... a good reason for caution there.

Music - Extremely important to me and because I still have residual lows, it still sounds pretty good even with HAs. It sounds better with earbuds. I'll only do one ear until I feel I have absolutely no other choice because I really do believe that having as much natural hearing as possible is important. I'm happy to hear that you are enjoying music. I watched my mom lose that ability and she too was a pianist. She never got it back with her CI unfortunately but times have changed dramatically.

I have to decide next week and I keep changing my mind. I love the externals for AB (buttons on Processor, T-mic, RIC EAS instead of mold) but wonder if/when Med-el will come up with something comparable. I hate the idea of not having volume and program buttons on my processor. I tend to lose remotes and hate carrying them around. I feel a lot more confident about the internals for Med-el which I suspect in the long-run is really the important part. I'm that person who buys used/older model cars because I know what to expect so clearly you can see the direction I'm heading in

It's good to know that both sides work well for you and I assume, from what you said, the sound quality is the same as well.

Thanks again and I'll definitely be around if I go with Med-el. It seems like a very nice group here.

 

[Mary Beth]

Hi Vicky @Enigmachick

 

We have mentioned surgeons on here without problems.  Dr Alexiades performed my right side surgery at NYEE and is now at Cornell.  He did an amazing job.  Dr. Ana Kim performed my left side surgery at NYEE and is now at Columbia.  She did an amazing job as well.

 

Here is the thing about the remote.  I don’t carry it around.  I stay in the same program with the same volume and sensitivity settings all the time.  If I am going to be in an especially loud place for a long time, sometimes I put the thin remote in my pocket so I can switch to adaptive and sometimes I don’t and just stay in omni.

 

All of the CI brands promote their brands differently.  In the end, there are happy CI users with every brand.  Pick what appeals to you.  I chose Med-El for the electrode array options.  Since then I have learned a few things that make me thankful I chose Med-El .  Namely....

-Med-El makes new processors backward compatible with older internals.  So my friends with Med-El who have been implanted a long time are able to use the new Med-El Sonnet.  That is not true with all brands.  Check into that a bit if you are interested,  I have a friend with a different brand who can not use that brand’s newest processor with her older internal unit.  I never knew that happened until after I was implanted.

 

-Med-El in the US has a 5 year warranty even on upgrade processors we get through our insurance later on.  Neither of the other brands offer that in the US at this time.  I didn’t realize that until this year when trying to get a replacement part through a different brand for one of my students.  The student’s warranty ended at 3 years since it is an upgrade processor (her brand is not Med-El).

 

But in the end, the only thing that matters is that you are happy with the brand you chose and that your CI team is experienced in inserting the electrode array and subsequent MAPpings.

 

The externals change all of the time.  In my 3 years, I have used Opus2, Rondo and Sonnet processors and soon Rondo 2 will be released.  As far as streaming tech, there are many options.  I listen to audiobooks and music everyday and look forward to the AudioLink, which is Med-El’s intermediary device for 2.4 wireless to the Sonnets.  Tech is changing so fast and we will be on the receiving end of those advancements.  

 

Whether you choose Med-El or a different brand, feel free to stick around.  We have a lot of great info on aural rehab and tech which applies to any CI user.

 

Wishing you the best!  (Deciding on brand was a difficult decision for me too.)

[Enigmachick]

@Mary Beth, 

It's so nice to know of someone who had Dr. Alexiades and even nicer to know he did an amazing job. One person told me that their audi said "oh, he has golden hands" which made me smile. I talked to three other docs, all with good reps but I just like him so much and feel like he's always totally straight with me. It's hard not to go with  his first suggestion but I'm a difficult child   It's an awful decision to make. Do I plan for total loss and go for longer array or do I hope for the best and go with shorter and possibly preserve more structure making future therapies more viable for me? My brain is scrambled and I'm almost at the flipping a coin stage.

AB says they only use about 25% of their internal chip making it more future ready than any other...etc etc. I'm still waiting on numbers from MedEl regarding chip capacity. I do know that they have focused on making their processors backward compatible which is reassuring. One of the Drs I met said he thinks ABs tech is better especially for hearing in noise but again, not sure where that comes from. I can only assume it's from his observation or some studies that I can't find.

You're so right about externals changing all the time and the speed with which that happens is only getting faster so, maybe in time I could end up with exactly what I want.. RIC for acoustic, no external additional "stuff", bluetooth compatibility with... everything. Yeah.. I do want everything but who doesn't?

Lots of folks say they don't change programs. My experience with HAs has been that, even with adaptive/auto programs I still end up wanting to change stuff. having the ability to do that directly on the HA is great and further changes (equalize, noise reduction, focused mic)  from my phone (I have ReSound) is pretty great too. I suspect that the programming for CIs is exponentially more complicated and more effective in those regards. 

I didn't know about the warrantee thing. My understanding is that you can't upgrade via insurance in less than 5 years. Does the warrantee for MedEl renew or just continue if they happen to come out with a new processor in 3 years (that I pay for out of pocket?).  I read they all had 10 year warrantees but maybe that only refers to the internal parts. Did I mention that I really really have fought against doing this for as long as possible? I applied for the gene therapy trial at Columbia but my hearing was too good so I have no more excuses. I'm looking forward to meeting the MedEl rep next week. We had a long FaceTime chat last week and that was helpful. I also felt like she much less of a "salesman" kind of vibe which I appreciate.

I'll try to connect with the two EAS folks you mentioned above. I've been looking at their posts. I've looked at so much technical stuff that, at this point, I mostly want human reactions and opinions. 

I imagine the decision is difficult for many of us and, in a way, envy those who say their doctor will only do one kind... but only a little. I'm glad to hear you're happy with your choice and appreciate the reasons why.

Thanks for all the kind words, suggestions and support. I'll definitely keep hooked in no matter what I decide.

[Mary Beth]

 

@Enigmachick

So much info...it’s like being on overload isn’t it?  I waited as long as possible before exploring a CI too but in hindsight, my life would’ve been much easier if I had done it sooner.  Smile.  I woke up singing happy birthday to my left ear on its surgery day.  I was sooo excited.

 

Here is the warranty info as I know it.  Check it out for yourself though too. 

In the US, all three brands have 10 year warranty on internal component.

In the US, all three brands have 5 year warranty on processors received connected to CI surgeries.

In the US, Med-El has 5 year warranty on processors received later via insurance upgrades.  (The other brands have 3 year warranties with upgrade processors. )

 

As far as timing of insurance approval for upgrade processors, rule of thumb seems to be 5 years in the US but some insurance plans require certain other parameters to be met which may make it longer than 5 years. 

 

For both of my surgeries, I let the CI surgeons choose the most appropriate electrode array.  It worked well for me.

 

Ask your CI audiologist which companies have long standing users who can not use their brand’s current processor.  She will know how that has worked out for all brands.  I honestly never even considered that it would happen to anyone.  Maybe that was lack of foresight on my part.  I was relieved to learn Med-El is backward compatible.

 

I have been implanted for three years so I have not gone through the insurance upgrade process yet.  I received extra processors through Med-El promotions so that is why I have Sonnets, Rondos and Opus 2.  I hope to not have to self-pay for any processor, but time will tell.  My understanding is each processor (self-pay or insurance) comes with a 5 year warranty from Med-El.  

 

Maybe you can meet some CI users face to face?  If I lived close to NYC, I would offer to meet for coffee but I travel 5 hours each way to NYC to get to NYEE.

 

Trust your instincts.  Choose whichever brand you think will be best for you.  Then enjoy your CI journey.  It is amazing!

[Enigmachick]

@Mary Beth

I actually don't live in NY. I'm coming up from Florida. I'm originally from the northeast CT, MA, NY but moved here to get out of the cold and to get better insurance so I could see my doctor in NY. As crazy as that sounds, it happen to be true. Thanks for the almost offer for coffee

I'm terrified that the insurance company is going to mess with me. They told the Dr.s office that the procedure didn't require pre-authorization and had voided all the pre-authorization forms. They wouldn't give anything in writing... so far. I'm trying to figure out who to harass about that since I really want it in writing.. not just a verbal confirmation.

The MedEl rep I'm meeting with next week is also a recipient. Sadly I don't really have the opportunity to meet any other recipients before May 8th (eek). I have chatted with a lot of folks on Facebook however and that has been pretty helpful. The horror stories... not so much .. but at least people are honest about their experiences for the most part.

Anyway, I can't imagine an implant/processor not being backward compatible. That's nuts but I guess it happens. I'm not worried about that with MedEl or AB so that's one thing not to worry about. 

You asked earlier what processor I'd go with. Given that I'm hoping for EAS, the Rondo2 seems moot. I may try it out anyway just to confirm but I'll probably get 2 Sonnets if I do MedEl... the direction I'm leaning in.

Sadly I often second guess myself and analyze till I'm just confused. I'm trying to stop doing quite so much research and just focusing on feelings and human interaction.

Oh.. one question... how do you feel about the customer service with MedEl? Responsive? Quick? Efficient? etc?

 

[Mary Beth]

Hi Vicky @Enigmachick

 

Maybe you are meeting Virgi?

My insurance does not require preauthorization either but they will give a preauthorization in writing if requested.  There is a name for that but I can’t remember what it is called. (Maybe predetermination?)

 

I am going to send you an email note through HPs.  Look at the top near the envelope symbol in a few moments.

 

Excellent customer service from Med-El.  Each region has a Customer Service Representative (CSR).  Mine is fabulous.  I email if I have a question or need something and he responds right away.  Excellent.  Three years and excellent customer service.  

 

Two processor centers in the US, let you receive two processors connected to a surgery.  (That will not happen with insurance upgrades later though.). Right now Med-El has a Plus Rondo 2 promo so ask your CI audiologist about that.  You should be able to choose 2 Sonnet EAS processors if Cornell is a two processor center and also receive the Plus Rondo 2 voucher from Med-El.  

 

Keep asking questions.  Others will jump in I hope.  It is actually snowing here so I am a captive audience today.  Smile.

[Enigmachick]

@Mary Beth,

Yes, I'm meeting with Virgi. She's been fantastic. 

Great to hear about customer service!

RE: voucher for Rondo 2 - If I start with 2 Sonnets and wanted to get the Rondo2, do I need to give back one of the Sonnets? That's kind of what I assumed would happen. I definitely can get two processors. I already checked that out. The audi did say "well, if you are going with EAS the Rondo doesn't make sense" so that might require further discussion. 

One thing at a time

Sorry about the snow or hope that you like it.... a lot. 

[Mary Beth]

 

@Enigmachick

NYEE is a two processor center.  I chose 2 Sonnets for my left side.  Med-El had a Plus Rondo promotion at that time so I also received a Rondo.  2 Sonnets under the two processor CI center via my insurance and 1 Rondo under Med-El’s Plus Rondo promo.

 

So talk it over with your CI audiologist again.  Ask if you select 2 Sonnet EAS processors (as long as Cornell is a two processor center), will you still receive the Plus Rondo 2 promotion voucher from Med-El.  (Also discuss it with Virgi and she will explain it to you.)

 

I LOVE snow but I am ready for Spring so 8-13 inches of snow this weekend is not making anyone here happy.  Smile.

[Mary Beth]