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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.
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.
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.
.. 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.
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.
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
In resposne to the last part of your posting, one cannot select a cochlear implant to compensate for ranges in which one has trouble hearing. A cochlear implant destroys all remaining hearing that a person has, making them entirely reliant on the implant.
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
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
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