The Penny

Example is not the main thing in influencing others. It is the only thing.

[Friday, September 11, 2009]

CI Stuff

Cochlear Nucleus 5

Well, the new processor from Cochlear received FDA approval last Friday. It's a handsome device, and the coil cable looks sturdier than the one on the Freedom. That is a welcome improvement. I know that a lot of people are excited about the Nucleus 5, but I'm underwhelmed. This processor brings Cochlear closer to where their competitors are, but there are no real innovations.

Remote control with bilateral capabilities? Med-El, check.

The remote can check the processor for problems. I don't think AB has anything like this, but I'm not sure. Med-El's processor automatically detects problems and immediately shuts off the processor, which usually repairs the problem (why does turning a computer off and on solve problems?) or at least prevents one MAP's corruption from affecting the other three MAPs. Automatic troubleshooting may be better than user-initiated troubleshooting.

If Cochlear's processors were as reliable as AB's and Med-El's, this wouldn't be such a concern. Cochlear touts reliability because their internal device is slightly more reliable (we're talking tenths of a percent) depending on how you measure it, but their processors break down more often than the other brands. That means people have to get an appointment with their audiologist or possibly send the processor in for repair. Hopefully the remote troubleshooting will help.

Small processor? Med-El, check. Sorry, AB, you know your product is a behemoth.

General listening program so that you don't have to change programs all the time based on the environment (how did their users put up with that for so long)? AB and Med-El, check. And Cochlear, check, because this came out six months ago!

Music program? AB and Med-El, check. Now I'd like to know how many Cochlear listeners actually enjoy music. AB and Med-El have made this data available on their website. They have different processing strategies specifically for music, such as broadening the spectrum of frequencies delivered to the implant (usually CIs filter out lows and highs in order to provide more info in the speech frequencies). Cochlear's music program basically just increases the sensitivity of the microphone.

Water-proofing? AB and Med-El, check. Laynie dropped her Med-El processor in milk, I rinsed it off in running water, and it survived.

The internal device is thinner than the old. It's 3.9 mm thick. That's down from the Freedom implant's 4.7 mm thick portion and 6.2 thick mm portion (most of the implants have had a thicker area that housed the electronics). Med-El's Pulsar is 4 mm thick, uniformly. Med-El's Sonata is partly 3.7 mm thick and partly 5.9 mm thick. AB's Hi-Res 90k is partly 2.5 mm thick and partly 5.5 mm.

Related to size: Cochlear's website initially said that their internal device is the thinnest implant. That has been changed to thinnest titanium implant. Hmm. The Pulsar is ceramic, and it's awfully close in size. I got the 3.9 mm number from the press release style "articles" popping up all over the web, because the specs are not on Cochlear's website (vague claims rather than hard data from Cochlear? shocking). We'll see if that 3.9 mm figure sticks. I think that if they were actually the smallest device, period, they would say so.

Cochlear is claiming "best hearing performance," which they are basing on CNC word scores.
But Cochlear is known to be an untruthful, unethical company, so I do not believe anything they say without checking the data myself. The graphic on Cochlear's website makes it look like there was a study of CNC word scores with all three brands and here are the results. Not so.

The graphic combined the results of several studies, which is very different from doing a single study with consistent participant characteristics and research procedures. Still, I don't understand why Cochlear is reporting CNC accuracy as 44%, when AB's research indicates 65% CNC accuracy for AB's current processor. Maybe because that research is unpublished? But Cochlear is using their own unpublished research which apparently showed greater than 70% CNC accuracy for the new Nucleus 5, without explaining anything about the participants or research procedures. Shady. AB gave a detailed explanation of their research.

Even shadier, the Med-El data on the graphic was from a retrospective study involving people implanted from 1998-2004 with Med-El's previous device, the Combi 40+. Why would Cochlear go back to this data rather than using data from Med-El's current system, which data have been available for a couple of years now? Besides, data on the Combi 40+ showed 55% CNC words, while Cochlear reports 45% for that system. ? Keep in mind that Combi 40+ users wore the old Tempo+ processor, and the current Opus processor (with Pulsar or Sonata implant) is superior. Med-El's newer FSP strategy is miles ahead of AB and Cochlear for hearing in noise (and AB is better than Cochlear). Maybe that's why Cochlear is comparing their current system to an old Med-El system.

Moreover, who ever said that CNC word scores were representative of real world performance? They're not. They are random consonant-vowel-consonant words without context. It's like if someone walked up to you and said, "Pit." Sure, you would understand them (if you're hearing), but would that ever really happen? Cochlear clings to CNC word data in quiet because their device cannot perform well in real world conditions, meaning sentences in the presence of background noise. People with CIs do not live their lives in a soundproof booth. AB and Med-El have been gearing their sound processing strategies (and, hence, their research) toward listening in noise for several years now. Sentences are easier than words due to context cues, but even sentences-in-quiet data is more similar to real-world contexts than CNC words in quiet. Cochlear can't quote sentence data, because their users are the lowest performers. So going back to the original claim of "best hearing performance," I'd say it's misleading. Customers might assume that Cochlear would result in best hearing performance in realistic situations, which is not supported by research.

I will be curious to see how Cochlear's claim of having the smallest processor plays out. This cannot be verified, because they did not provide the actual dimensions of their device. Med-El and AB both have extensive research and technical information on their websites, but Cochlear has never done so. When the Esprit 3G processor came out, Cochlear touted it as the smallest processor, but they were censured by the FCC for false advertising. In fact, it was the same size as AB's processor, and Med-El's was much smaller. Cochlear is no stranger to legal problems, especially with the bribery debacle. They were paying physicians to sell their product and to use their product exclusively--how do you think Cochlear became the "number one choice" of surgeons and, consequently, customers? They (Cochlear and physicians) were also swindling Medicare. All of this was reported by Cochlear's very own Chief Financial Officer, who left the company in 2004, when she brought her concerns to the US FDA. Who knows what Cochlear has been up to since then? Anyway, we'll see if Cochlear has to take back their size claims again or if they're actually telling the truth this time.

Yes, I'm a nerd. My nerdiness is one of my best qualities. But anyone with access to research journals could find this same information by spending a little time and applying a few neurons. Cochlear depends on people believing their marketing claims and seeing what the deaf kid next door has on his head. And listening to a surgeon or audiologist who may have received incentives to sell Cochlear's products. I prefer independent thought.

Gee, that was more than I intended to say.

Shysters bug me, especially shysters who prey on vulnerable, scared, probably grieving parents.


Laynie | September 11, 2009 at 1:12 PM

I agreed. It's hard to watch the parents not to do their research BEFORE make a choice which brand to give to a child. I was happy that I did mine before I made a decision. And I'm happy with my decision.

Anonymous | September 12, 2009 at 6:44 PM

GREAT post. Thanks!

Annie | September 13, 2009 at 5:51 PM

Laynie, remember how the audiologist and surgeon at Hopkins were so impressed with how much research and thought you had devoted to your CI decision? And the psychologist, too. They were used to people knowing very little about it before they came in. Smarty pants!

Annie | September 13, 2009 at 5:55 PM

Thanks for the props, Heather. You're a sweetheart. How's Ethan doing? Did he have his autism eval yet?

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