Slashdot Mirror
Choosing a Cochlear Implant?
sydsavage asks: "My mom, who is profoundly deaf, has finally qualified for a cochlear implant. She is having the procedure done at the University of Minnesota, and is scheduled for surgery in early March. The doctors have left it up to her to choose between two different implants. The differences between them are highly technical, and well above her level of comprehension. So she decided to ask her geek son to take a look at the differing technologies. Unfortunately, I'm a systems administrator, not an audio engineer or signal processing guru, and reading
up on the technologies made this fact blaringly obvious to me. About the best I can tell her is one has more accessories available, as any good geek could ascertain. While this may have an impact on her decision, at the end of the day, she just wants to be able to hear better. Are there any slashdot readers with first or second hand experience with these two devices? Any signal processing engineers that would like to weigh in on the different technologies involved?"
"The two implants that are available to her are the Clarion, manufactured by Advanced Bionics, and the Nucleus, made by the Australian firm Cochlear.
The Nucleus system is the one with more bells in whistles, such as the ability to interface to FM systems for hearing impaired that are found in museums, auditoriums and theaters. It can also plug into an audio out jack of a tv, stereo or computer. It also has a built in 'tele-coil' for use with phones that are design to work with hearing aids.
My mother and I would both like to say thank you in advance for your help in making this life changing decision."
tells the patient to look at two implants and chose based on highly technical differences? This seems irresponsible on the doctor's part. I understand you are looking for audio geek responses, but shouldn't you really find another doctor/specialist to get a truly informed opinion; it's not like you are stereo shopping, this decision will effect the remainder of her life.
Yawn.
+1 Insightful??
As for why he chose that brand over other possibilities, I don't remember what he said on the air at the time (around January 2002). Here is his site's collection of articles regarding his implant.
I don't know if you will find these articles useful or not, but hopefully it will help you with your decision-making process.
Or at the least, they have popped a couple-hundred Vicontin.
I am Deaf.
I don't pretend to be an expert on Cochlear implants, but you do have to realize that there is a lot more to "curing" deafness than simply picking the best hearing aid due to its technical specs.
As an analogy, take someone who's been doing graphics work on a Mac for years, decades and suddenly tell him that if he wants to keep his job, he has to become an OpenVMS system administrator and maintain the company's equipment without the benefit of a GUI.
Don't pick an implant on the basis of what it says it can do. Pick an implant on the basis of what your Mom wants to do, and is comfortable doing. For example, the Nucleus system boasts of being compatable with tele-coils. Most conventional hearing aids today are compatible with tele-coils, and within the next five years or so, all "new" models will be.
Furthermore, in order to use tele-coils, we usually have to flick a tiny switch on our hearing aids to switch from "conventional" sounds (that use sound waves) to induced sounds. Cochlear implants have the same switch or something very similar. For the elderly, manipulating that tiny little switch is usually a pain in the ass. Guess what the predominant preference is? An amplifier that can be plugged directly into the telephone line - or better yet, phones that come with sufficiently loud speakers built in.
Your next step should be to speak to an audiologist if you have not done so already. What you need to know is what frequencies you (or your Mom in this case) tends to listen for. Like any decent home stereo system, implants are optimized for a certain range and stutter, hiss, whistle, whatever outside of that range.
As an hypothetical example, it may be that she cannot hear high frequencies at all, but she can hear bass tones easily. If that's the case, you want one that will "magnify" those high frequences until she can hear them, and give maybe just a slight boost to the lower frequencies. Then you can select a model that will give you the most flexibility in compenstating for her deafness.
Hi,
n .h tml
I wouldn't worry too much about how they work. Lots of treatments help people every day, without the doctors even knowing how they work! I'd try to find out about any proper clinical trials done - that's the best starting point for evaluating the options. Unfortunately, I've no idea what proper research has been done in this area, but I suggest you start hunting around - I'm sure there'll be info out there on the net.
Here's one starting point:
http://www.geocities.com/cicentral/ci_compariso
The key thing is to place little credence in personal testimonies and theories. By theories I mean claims of the type 'Because our device has a foo, it will cause less irritating bar'. Assuming you know nothing about the medicine and technology involved, such claims sound perfectly reasonable, but remember they are actually as useful as claims like 'Because Intel processors run at a higher clock speed, tasks like word processing become easier', or even 'Because we use XML, our software is more intelligent'. To a non computer literate person, such claims sound reasonable.
Personal testimonies are valuable, but remember how different one human is to another. It's very tempting in a sea of uncertain research to latch on to someone saying 'My aunt Maud had a type one device for 3 years, and it caused all sorts of problems - but now she's on a type 2 device it's much better'. That's effectively a single datum, and in the larger picture it doesn't mean much. Of course once you have enough of them, then it means more...
When reading info on the net about this stuff, ALWAYS look for references (citations of journal articles etc) to back up any claims. Be suitable wary of 'expert opinion' - Medical experts as just as biased as computer experts - and think how many of those say things that you think are rubbish!
If you are really serious about this kind of research, the US Govt. provides an excellent resource:
http://www.ncbi.nlm.nih.gov/PubMed/
Good luck with your hunt!
-----
I got a grandma whos hearing has been not so good for years and now around a year ago she got a hearing aid device(not implant) and you know what? she had gotten used to that small things like reading the paper don't make any noise at all and now it's real hard to get her to keep it on(because she had gotten used to things like that walking on snow makes no sound at all). it's kind of annoying when she has the thing and you still have to yell to her.
so geeks and other people alike, when they start losing their hearing tell them to get the hearing aid in time before they get used to the silence..
as to the real question, I haven't got a clue but I'd advise to ask the doctor which one gets more complaints later. Id bet that it's kind of hard to find people who've tried both.
world was created 5 seconds before this post as it is.
I'm sure I'm not saying anything everyone else (including you) isn't thinking, but differences between success rates would drive my decision. Features, bells and whistles, etc., would be secondary considerations.
I don't see how you could get to the bottom of this without depending on a doctor's advice. Like some other people who have posted here, I'm a little puzzled that the doctor would let you make the decision without more guidance, unless it really didn't matter much in terms of success rates.
I really wish your mom the best -- it's amazing what this technology can do when it works, and I hope your mom falls into that category.
--
(I don't think I can tell you anything about this that you don't know, and amateur medical expositions can be annoying or dangerous... I almost deleted the following, but decided to leave it in for others. Please take this disclaimer seriously: I'm not a doctor, and don't know what I'm talking about.)
I think that the big problem people have with these devices is that your brain tends to "unlearn" how to hear when information from your ears stops flowing into the brain. If your hearing is down for too long of a time, it's hard to bring it back.
I think that Limbaugh's spectucular success with his cochlear implant had something to do with how rapidly his hearing loss had come upon him, and how quickly he sought treatment.
But having said that, the extent of the changes and the rate at which they occur in your brain take place varies so much from one person to another that you can't make accurate predictions about what will happen. In particular, you shouldn't be discouraged if more time has passed. You just have to try it and see if it works.
My grandmother has sigificant hearing loss, although it's not the type that people who get cochlear implants have. She tried to avoid hearing aids for as long as she could, didn't like them, and didn't wear them often. Now she really needs them, and they don't work very well. She can function, but it's always hard.
Her ENT told me that the problem is in the brain "circuitry" -- she didn't forget how to hear all together (that's not what happens), but she is much worse at differentiating sounds than she used to be.
Everyone in my family, including me, had assued that her problems were coming from the technology -- that the hearing aids weren't doing a very good job, and that better technology would solve the problem. But the doctor said the problem was with the way her brain processes sounds.
I had assumed (naively, it turns out), that it ought to be possible to substantially improve hearing aids with better signal processing. I asked the doctor if it made sense to have a wireless hearing aid, with a mic and a speaker on it, that would communicate with a real, full blown computer, which could do almost anything you'd need.
He said that it would be possible to realize some improvements, but in general they wouldn't be worth the extra hassle of the external device. The real problems were in the brain's ability to differentiate sounds.
It's easy for geeks to think of your ears as providing a "line in" to the brain, or to think that if that line gets damaged, it ought to be possible to put in a patch cord that bypasses it. That's pretty much the way I thought about it. But it's more complicated than that.
Dude, since it's your mother, you owe it to her to go to your local univeristy biomedical library and read some studies yourself. Maybe there's even a usenet group where this is discussed.
.. who works in the office of hearing services for the Dept of health here in Australia:
;)
There are two 'components' to a cochlear implant - generally characterised as 'the outside bits' and 'the inside bits'.
The outside bits are changed on a moderately regular basis as technology improves. The inside bits (which are implanted), obviously don't get changed all that much.
Her recommendation is to choose the technology that makes it easiest (and cheapest) to change the outside bits - as although there are minimal technical differences between the two options at the moment, if one is much easier to 'upgrade' than the other, you'll get much better service long term on that one.
Dunno about you.. but there's something wierd about the concept of booking your mum in for an upgrade...
My friend recommends having a look at the web site of the Australian National Acoustics Labs. They're a research arm of Australian Neuroservices, and have a fair bit of info on this sort of stuff.
Red.
I used to work with a fellow that wore a hearing aid. When we were in long, tedious business meetings he would sometimes snea his hand into his pocket and turn the thing off.
There are times when I wish I could do that.
great post
Chris Pirillo has one and he is a geek of the first order. A friendly email to him might get him to comment on the technical aspects of the one he chose.
Sera
Slashdot, where armchair scientists get shouted down and armchair theologians get modded up.
+1 Insightful??
Informative, sure. Insightful? No way.
I'm a neuroscientist by trade (well, no, actually I paid good money). I used to work for the Language Section of the National Institute on Deafness and Communications Disorders. I had to know a lot about these things technically and biologically. Also, my field of interest happens to be signal analysis, and that's at the heart of these devices. Also, I was an sign language interperator and considered myself a member of the Deaf community, a social distinction which might have bearing here. I'm not a physician, but I reckon I know enough to give my opinion mand have it considered informed.
.01 total harmonic distorion is good. One with .001 THD is better. But your average stereo speaker has about 3% THD, making the point moot. If the cost between the devices were great, I'd consider the cheaper.
/. journal for my email should you wish to email with questions.
You say she's profoundly deaf. Since when? If a long time, she may not adapt well no matter how good the device. The less sophisticated may be good enough then.
If she's been deaf a long time, does she socialize with other deaf people? If so, be aware some of them look on implants as a kind of betrayal. Those whose first language was American Sign Language consider themselves a unique culture and consider their condition and method of communication to be equally good as any other. Some very vocal (pardon the pun) types become quite irrate if someone they know steps outside their culture by getting an implant. I don't claim to understand exactly, but I've observed it.
Technically, these two devices probably perform equally well. The Clarion has superior characteristics, but the difference may be measureable in the lab but not the ear. The Clarion has more channels, that is more different frequency bands, and so would probably produce more "natural" sound. (To think of channels, consider the slider switches on an equalizer on a stereo. Each handles a specific range of frequencies. The more sliders there are, the finer the divisions across the sound spectrum.)
As mentioned elsewhere, Rush Limbaugh has a Clarion. I know he's pleased with the results, and he's a professional communicator.
The Nucleus has a removeable magnet. This could be important should your mother ever need to have an MRI. With either device, she'll need to wear a medical alert bracelet saying she has some implanted metal. An MRI uses a large, powerful moving magnet. If you expose a piece of metal to the field it can turn into a little food processor blade spinning around where it ought not. Should she ever be sent to the emergency room unconscious, they'll need to know not to do this to her. The Nucleus will give them the ability to should she need it.
If I were getting one and they cost the same, I'd get the Clarion. In a given ear, the end result will probably be better with that device. However, the differences between ears and neural systems are so much grteater that this may hardly matter. It may be better than the ear can make use of. Think of stereo systems. An amplifier with
A last thought: learning or relearning to hear will require a lot of exercise in order for neural plasticity to do its job. That means exposure. Also, if she's been reading sign language, those whove; been communicating with her should continue to use it even though she may now be able to hear. The resulting associations will help her learn/relearn faster.
Feel free to check my
"I may be synthetic, but I'm not stupid." -- Bishop 341-B
HI, he's in the bathroom -- he'll be back
Isn't it the job of the doctors to explain this? Isn't there something called "informed consent" that exists, in both a legal and ethical sense, that would stipulate that the person suggesting the operation make it clear to the patient exactly the risks and benefits of either approach?
I'd be asking them, not a bunch of people whose advice is worth less that what you paid for it. I'd ask them because that's their job.
When we were in long, tedious business meetings he would sometimes snea his hand into his pocket and turn the thing off.
Sometimes I sneak my hand into my pocket during boring business meetings. It has very little to do with hearing though.
It should be as easy as a probe inserted into the third ventricle of the brain to upload the self to a computer.
-I am an elective eunuch.
Wasn't the non-Aussie device hit with some problem report(s) & knocked off the market for a while?
Don't quote me, but I think there was some risk of infection.
To find where / when to look, check the stock values of each company... one dropped after the problems came to light & - of course - the Aussie co. became "the only game in town" soon afterwards.
There may have been some details on the (Aussie) ABC's "Health Report" (radio program); to see,
search:
abc.net.au/rn & drill down to the Health Report's section of the larger site...
That's right. They're researched and developed in Australia, partially bankrolled by the federal government: http://www.bionicear.com.au/crc/ so chose based on technical specifications and what your mum can afford. The underlying technology seems to me to be the same in each product.
"...we should just trust our president in every decision that he makes and we should just support that." B.Spears 2003
Just google with:
...but wait, there's more (from same article):
h tml
"cochlear implant" risk
eg, preferably searching for items in Australia.
"July 26 2002
Advanced Bionics Corp, one of three manufacturers
of cochlear implants, says their customers should
get vaccinations to protect them against meningitis
and other similar diseases.
Australian manufacturer Cochlear Ltd, the leading manufacturer of the inner-ear devices, has sold over 40,000 devices in the past 20 years.
The US Food and Drug Administration yesterday said 25 adults and children with cochlear implants had been diagnosed with meningitis worldwide, with nine of them dying.
It says surveys of other cochlear implant centres suggest more unreported cases exist.
Meningitis is a complication of any inner ear surgery and some deaf patients are at even greater risk due to malformations of the inner ear."
"Cochlear Ltd today said the overall incidence
of meningitis in those that use its Nucleus
cochlear implants is similar to the incidence
of meningitis in the general population."
-and-
"Cochlear said it had recently learned of concerns expressed by
-another- cochlear implant manufacturer regarding a potential increased risk
of meningitis based on experience with their recipient population."
Link to article on details on meningitis risk:
www.smh.com.au/articles/2002/07/26/1027497402823.
Other links:
FAQs:
http://www.cochlear.com/943.asp
Time-Line:
http://www.cochlearamericas.com/About/116.asp
Hearing Research Inst (Melbourne):
http://www.medoto.unimelb.edu.au/
www.medoto.unimelb.edu.au/info/implant1.htm
History:
http://www.phm.gov.au/hsc/cochlear/history.htm
US English:
http://www.cochlearamericas.com/
Graeme Clark Scholarship (for students in Aussie/NZ):
http://www.cochlear.com/796.asp
Jobs (near Sydney):
www2.recruitmanager.net/cochlear/publicjobs/
How it works, et al.:
http://www.science.org.au/nova/029/029box01.htm
http://www.science.org.au/nova/029/029key.htm
My wife has an older one (put in ca. 1988), so YMMV.
First, dumb luck has a great deal to do with how well her implant works. People who can use it 100% and for things like talking on the phone are rare. Most people still need to rely on some degree of lip reading.
Ask the doc if tech specs on either unit have a clear cut winner. I seriously doubt this is the case. The more important part is going to be after surgery support. What doctors does she like, where are they located relative to her home, and what brand do they primarily deal with? Most surgeons and audiologists are equipped to do both, but their patients will skew one way or the other. Or they may prefer working with one unit over the other.
Any more specific questions, drop me an email. Like with most things, it seems slashdotters are speaking about what they don't know.
Jesus was all right but his disciples were thick and ordinary. -John Lennon
Wait, Rush Limbaugh is deaf? And here I thought he was dumb...
I've been looking into various aspects of neuroscience. Do you work for an implant maker?
-I am an elective eunuch.
I came across a page last year that claimed to imitate the "sound" of an implant, and was very shocked at the quality of sound. Perhaps I'd be able to hear the higher frequencies(over 1500 hertz) that I can't now, but if the quality isn't there that doesn't seem to help me.
Ask the doctor FOR the tech specs on both of the units along with asking if either unit is a clear cut winner. Ask the doctor how many cochlear devices she has implanted and over how many years; how many of these were in adults and how many were in children. (The FDA approved pediatric implants in the late 1980's; adult implants were being performed earlier.) Ask the ENT doctor what the complication rate has been for HER OPERATIONS at the facility that this implant will be performed. Ask the ENT doctor what the morbidity/mortality is for this procedure. (Cochlear implants are performed, mostly, by ENT specialists, at least in the U.S.) Talk to the doctor yourself to find out what message was actually being conveyed to your mother. Or have your mother return and (since she can't hear) ask for written info for the informed consent which she can take home and review.
More channels equals more recognizability. I've read studies that children with implants have done better in picking up language and speech ability when they have more frequency channels in their implants. I have not seen any studies about adults relating to the number of channels in their cochlear implants. The House Ear Institute in L.A. has also been a site that has done experimental brain-stem auditory implants, interfacing at the cranial-nerve nucleus level rather than at the cochlear nerve.
I agree with your suggestion about the post-surgery support. Find out who the speech therapists and audiologists will be post-operatively for your mother. Talk with them before the operation or before choosing which of the implants should be used.
...for experts you can call for opinions. He should be able to tell you who would know what and some tips for finding them.
Then, get on the phone and start making calls.
I'm no medical expert, but I've been in your position many times: a non-expert needing to make an important decision based on expertise. What do you do? You find experts and you ask questions. What questions? The more experts you talk to, the better your questions will become. By the time you're talking to your 30th expert, he'll think *you're* an expert from the quality of your questions.
Once you reach the point where you're not learning anything new, you're in as good a position to make the decision as anyone.
"Those who have never entered upon scientific pursuits know not a tithe of the poetry by which they are surrounded."
cochlear implant simulator i guess this is supposed to simulate different quality implants. i.e. what the implantee hears. basically seems to break the sound into frequency bands and modulate the amplitude of filtered noise or sine waves accordingly. not too special, but nice to have a quick link to perhaps.
that the one with the higher price tag is better. :)
In a strange quirk, stock in Advanced Bionics took a fairly dramatic rise after Rush got his implant, because he was so enthused about it on the air.
;)
The Clarion implant is the only US developed cochlear implant. It was developed at UCSF in a large project in Otolaryngology/Head and Neck Surgery.
That being said, most of what is in the implant now has been developed since the project left UCSF. But still, of all the options, the Clarion is the only one US developed, and the only one Rush Limbaugh uses
1. You should meet the cochlear implant team yourself to get the most specific and up-to-date info you can get. Advanced Bionics has just had a new device FDA approved and some of the comments I've seen here refer to the older model. With the new one, the magnet can be removed for MRIs. There are also plenty of accessories you can use with it. I don't think the Nucleus has more options just different approaches to the same accessories. For instance, you can use an FM system with both. Nucleus' is just smaller and (I think) wireless. I am an audiologist and I see a lot of people with misinformation. Her own surgeon and audiologists are the ones to ask. Maybe you could find out their email addresses and simply address your questions to them.
2. The doctor is not a quack. A lot of surgeons give patients a choice with cochlear implants because neither (those two or the 3rd FDA approved device) has been shown in research to consistently outperform the other. I would guess she was told this at her appoitnment. Some people will do poorly with an implant, some will do well. Both these devices have people in all ranges of performance.
3. When you get right down to it, these devices are extremely similar. The companies have developed parallel products and borrowed ideas from eachother. I would find it hard to choose between them. Whichever product you and she chooses will be fine. You can't make a bad or wrong choice with these two.
4. In the end, I would make the choice based on which one is easier for her to use on an everyday basis. Do the controls on the external processor make sense to her? Can she easily manipulate them? Can she easily change and/or recharge the batteries? It might be beneficial for you both to speak to the cochlear implant team together, and she can take another look at the external products.
Christine E. (posting with my husband's log in)
piontkofsky@yahoo.com
I have severe hearing loss, both sensorineural and conductive. This means that I can't hear at all without my "super-power" level hearing aids, but I don't need - or want - cochlears.
While I hear well in a semi-controlled environment, I have difficulty hearing in areas with lots of people - crowds, cafeterias, etc, and I find it much easier to listen to voices I know (my family & close friends) than voices I'm unfamiliar with.
I consider my hearing loss part of who I am, but as opposed to my other disability(short stature, see LPA, which I wouldn't give up for anything, I'd love to lose my hearing loss.
I would recommend the cochlears regardless of "cultural aspects" - it will make your mom more independent, not needing a translator. In addition, I believe you can remove the external bits quite easily - say, if you're going to meet some deaf friends who would disapprove. So there's really no reason not to go with the cochlears.
To contradict some previous threads, definitely go for telecoil if it's an option - not all phones can be amplified, and it's very useful for blocking out quite a bit of external "background noise" - that's not something you want to give up, trust me. Background noise is the thing that makes the difference between just hearing, and actually understanding.
They gave you a choice? When I last worked for a surgeon, they used whichever implant the reps had most recently wined & dined them. More sustained recommendations required "research funding". The price of a 10 minute meeting with the fellow doctors was a barbeque lunch for the entire staff.
Seriously, it looks like you've gotten some good posts on this topic, but you should probably look for a paid-for second opinion (from a doctor in another city).
The Cochlear device uses Zinc Air cells which are disposable and last 55 hours typically for 3 cells. This would cost about $ 480 per year. The ABC device uses rechargeable cells. However these last only about 6 - 12 hours between charges so you have to change them during the day, maybe twice. Also the cells are special modules which only last for 320 charge/discharge cycles so you would use 2 to 3 per year. At $ 300 - 350 per cell the cost would be $ 600 - 1000 per year. The other factor to consider is the failure rate of implants. Although thisis low, the ABC has a higher failure rate than the Cochlear device. Finally the ABC is made of ceramic which is more easily broken than the Cochlear device which is made of Titanium
is deaf... She was also one of the first people to receive what began the modern form of cochlear implants.
She's had the implant since she was very young. As you can imagine, the technology in a little box almost 20 years old is a little aged. Also, we've run into frequent problems with her current system, mostly involving the durability of the devices she has to wear. And they're not cheap either... just thank god my insurance covers most of it.
About 2 years ago we began the process of getting her a new implant. My insurance company agreed that it was in everyones best interest to do so. We began research on all the different options (4). In the end, we chose the Nucleus device, if only for the fact that it came from a company with which we were greatly familiar.
Now, in doing our research we didn't really find any evidence to push us in one direction or the other... in the end it was a matter of preference for what types of features you want...
Of course, the very major downside to getting a new system installed (including the parts inside the ear and head), is that you have to completely relearn sounds. You see, it's not like what we hear... and different programs and hardware cause sounds to be different... so while I may sound fine now, like her husband... with the new system i may sound like some french speaking alien with a sore throat.
In the end, we ended up not upgrading, because of some other wonderful news... the wife was pregnant with twins.... and surgery is not an option at this point. Maybe once the kids are all grown up we'll go back down this path again...
And hopefully the technology will be far beyond where it is today.
Hard-of-hearing, yes.
Mute, hardly.
Drug-addict felon, definitely.
"You might as well get your son a ticket to hell as give him a five string banjo." -unknown minister
I have been hearing impaired since birth. Currently, I have two hearing aids, the older one is analog, and the newer one is digital. I paid $2400 for the digital, which has better sound quality than the old analog. Guess which one has to be sent in for repairs about twice-a-year? You guessed it, the digital, and it's in the shop now :-(
So as far as choosing your mom's hardware, I'd go for the one that is the most reliable and would sacrifice some sound quality for that, if I had to make a choice. It's very frustrating to be without something that is so crucial for day-to-day communiations, and for an even deeper jab, something that costs so much!
Best wishes for a successful surgery for your mom!
One of my friends from high school made this site regarding the CI. Perhaps that can provide you with some assistance. -KYB
"Would you rather be right, or happy?"