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Half is Not Enough
Mark Doshier, Senior Manager-Cochlear
Network
Awareness
My Story
"I love bilaterals! I cannot stand to wear just one
(when I am changing the battery). Only one sounds
so wierd now! Wish I had done this a LONG time
ago!“—Teri, age 58
Today’s Topics
•
•
•
•
•
Binaural hearing—with 2 ears
Adult and pediatric study results
Programming
Reimbursement
Bilateral Recipient Feedback
Cochlear’s Philosophy
Cochlear believes everyone should
have access to the most natural
hearing possible. This means that
binaural hearing is best practice.
How Hearing Works
“Since my children received their second implants, they do
not have to work so hard to listen. I've had to give up on
getting them to take a nap. They now have more energy to
play.”
Binaural Hearing Animation
Why Bilateral Implantation?
• Provide benefits of
binaural hearing to
individuals who receive
limited benefit from
acoustic amplification
• Published studies
indicate main benefits
to be improved
understanding in noise
and sound localization
Litovsky R, Parkinson A, Arcaroli J, and Sammeth C.
Simultaneous bilateral cochlear implantation in
adults: a multi-center clinical study. Ear and
Hearing (in press).
Adult Study Conclusions
• Subjects demonstrated improvements in speech
understanding in noise
The largest benefit is from head shadow effect, listening using
ear with better SNR
• Subjects demonstrated better speech
understanding in quiet
Always capture better ear
Binaural redundancy
• Subjects report improvements in performance
with 2 cochlear implants (APHAB)
Pediatric Study Conclusions
•
Improved understanding of
speech in quiet environments
• Improved understanding of
speech in noisy environments
• Improved ability to localize
sound
Pediatric Speech Perception
MLNT Words - 3 to 5 Years
N=6
N=7
N=7
N=10
N=6
N=9
N=8*
N=13
100
100
90
90
90
80
80
80
70
60
50
40
30
Percent Correct
100
Percent Correct
Percent Correct
N=7
LNT Words - 8 to 13 Years
LNT Words - 5 to 8 Years
70
60
50
40
30
60
50
40
30
20
20
10
10
10
0
Preoperative
1st Side Only
Bilateral
2nd Side Only
3 Months
6 Months
12 Months
Test Interval
0
Preoperative
1st Side Only
Bilateral
2nd Side Only
3 Months
6 Months
12 Months
Test Interval
* One subject at 9 months
Preoperative
1st Side Only
Bilateral
2nd Side Only
6 Months
Test Interval
Word recognition for older children improves compared
with preoperatively with a hearing aid, but gap between
Gap between 1st ear
(green) and 2 ear (blue)
closes over 6 to 12 months
for younger children (3 to 5
yrs and 5 to 8 yrs
Cochlear Pediatric Sequential Study
N=12
70
20
0
N=13
1st and 2nd ear does not close as with younger children.
12 Months
Pediatric Candidacy
• Consider for children who do not benefit from
amplification in the contralateral ear
• For children with usable residual hearing in
contralateral ear, a hearing aid trial
should be conducted prior to consideration
of a 2nd implant
Moog School Survey
•
Parent survey of 20
bilateral children
Take away message:
All participants would
recommend bilaterals to
other parents
What Parents Say
Top reasons parents gave for choosing a 2nd CI:
• Improved localization
• Improved comprehension
• Child expressed desire
• For easier communication
• Hear better in noise
• Progressive loss in hearing aid ear
• Hoping for faster rate of progress
• Back-up if one implant fails
2006 Moog School Parent Survey
What Bilateral Kids Say
Feedback from children (8+)
•“Now I can hear in both ears”
•“It’s not hard to get used to or take
care of”
•“It’s easier to hear what people say
to me”
•“If you’re playing hide & seek, you
know which way to go”
•“I like that people won’t worry
what side [of me] to sit on”
2006 Moog School Survey
Nucleus® and Bilaterals
• Reliability is twice as important for bilateral patients—
Nucleus® leads industry in reliability of internal implant—
generation after generation
• Best hearing performance—Nucleus Freedom™ clinical
trial revealed a new benchmark in hearing performance
• Lifetime Commitment—only Cochlear has a track record
of providing all of our recipients the opportunity to
continually upgrade to new technology
• Programming software designed to maximize
performance for bilateral recipients
Reimbursement
Considerations
"Music sounds so much richer and fuller; I'm definitely
getting much more appreciation of music with two
implants"- Lexi, age 41
Obtaining Coverage
Points to consider:
• Combination of medical, educational,
behavioral and legal arguments
• Medical necessity
• Family and provider persistence: key to
exceptions
• Coordinated efforts among clinician and
family/patient
Obtaining Coverage
•
A preponderance of literature regarding
advantage of binaural hearing
• Always mention first implant
• Payers seem to cover children more readily
than adults
• Performance: Improved localization and
in noise
• Bilaterals not “experimental”
function
Cochlear’s Insurance Support
Since 1988, OMS Insurance Support has been
a resource for professionals and consumers
• Preauthorization services
• Verification of insurance coverage
• Assistance with appeals process if
denied coverage
• Vaccination programs
• Warranty programs
Cochlear’s OMS
OMS Insurance Support services provided free
of charge; contact us at:
1-800-633-4667
Or
http://www.omsinsurancesupport.org/
Summary
A Fast Growing Trend
• There are over 4000 Nucleus® bilateral cochlear
implant recipients worldwide
The Bilateral Difference
Having a cochlear implant on both sides can make a
difference; there is the potential to:
• Hear with greater ease in more places
• Understand better in noisy situations
• Know where sound comes from without looking
• Greater ease of overall communication
Thank you… Any questions?
How a CI Works
1.
Sound processor
captures sound &
converts to digital
signals
2.
Processor sends
signals to internal
implant
3.
Implant converts
signals into electrical
energy, sending it to
electrode array in
cochlea
4.
Electrodes stimulate
hearing nerve and
brain perceives
signals