Cochlear SPrint Sound Processor Informazioni Techniche

Cochlear™ Clinical Guidance Document

SECTION ONE | CLINICAL GUIDANCE81. Stop the stimulation and sweep all of the channels at 80% and then at C-level to confirm that sounds are comforta

CLINICAL GUIDANCE | SECTION ONE94. The default streamlined programming channels 22, 16, 11, 6, and 1 are highlighted. In the Method box, click the

SECTION ONE | CLINICAL GUIDANCE101.1.3 NRT/Objective Preset MethodThe NRT/objective preset method offsets the T- and C-level profiles from the objec

CLINICAL GUIDANCE | SECTION ONE11where T-NRT fell in relation to the behavioural dynamic range. As a result of the large variability between recipie

SECTION ONE | CLINICAL GUIDANCE121.2 ADJUSTMENTS TO CHANNEL GAINSIn addition to the user-controlled microphone sensitivity that determines the overa

CLINICAL GUIDANCE | SECTION ONE13• Automatic Gain Control (AGC) – front-end amplifier that reduces the gain of high amplitude inputs to avoid distor

SECTION ONE | CLINICAL GUIDANCE141.3.2 Supported Combinations of Implant System ComponentsThe supported combinations of implant system components an

CLINICAL GUIDANCE | SECTION ONE151.4 ELECTRICAL STIMULATION AND MAP PARAMETERS• Stimulation Mode – describes the location of the indifferent electr

SECTION ONE | CLINICAL GUIDANCE16• IIDR (Instantaneous Input Dynamic Range) – is the selected range of input signal at any instant in time that wil

CLINICAL GUIDANCE | SECTION ONE171.5 STIMULATION MODESElectrical stimulation produces current flow between an active (stimulated) and indifferent (re

SECTION ONE | CLINICAL GUIDANCE181.5.2 Bipolar (BP) StimulationIn BP stimulation, both the active and indifferent electrodes are inside the cochlea.

CLINICAL GUIDANCE | SECTION ONE191.5.3 Variable and Pseudomonopolar (PSMP) StimulationVariable and pseudomonopolar stimulation modes combine differe

SECTION ONE | CLINICAL GUIDANCE20Selecting the stimulation modeThe clinician sets the stimulation mode in the Custom Sound software on the “Open or

CLINICAL GUIDANCE | SECTION ONE21• Out of Compliance – the condition where the maximum voltage available from the implant is not sufficient to gener

SECTION ONE | CLINICAL GUIDANCE22Increasing the pulse width may result in the number of maxima being reduced automatically. The 3500 Hz per channel

CLINICAL GUIDANCE | SECTION ONE23required programming changes. Note: Nucleus 24 system implant recipients may upgrade to the CP810 or Freedom proces

SECTION ONE | CLINICAL GUIDANCE24The power level required is dependent on the type of MAP, its various parameters, and the individual recipient. Pow

CLINICAL GUIDANCE | SECTION ONE25If the coil is not on the implant when power optimization occurs, the power level is set to the previously saved le

SECTION ONE | CLINICAL GUIDANCE26Before sending the recipient home, it is recommended that you determine the batteries that are best to use with the

CLINICAL GUIDANCE | SECTION ONE27The recipient does not hear this stimulation. For MAPs that are personalized for different listening environments,

1CLINICAL GUIDANCE | TABLE OF CONTENTSSECTION 1 : PROGRAMMING PRINCIPLES1.1 STREAMLINED PROGRAMMING METHODS 61.1.1 Behavioural Procedures 71.1.2

SECTION ONE | CLINICAL GUIDANCE28Table 1: The differences between SPEAK, CIS/CIS (RE) and ACE/ACE (RE)StrategyNo. of stimulation sitesStimulation ra

CLINICAL GUIDANCE | SECTION ONE291.9.2 SPEAKSPEAK (Spectral Peak) focuses on the spectral (frequency) properties of sound. It takes advantage of the

SECTION ONE | CLINICAL GUIDANCE30The selected channels receive sequential stimulation in tonotopic order from high to low frequency. SPEAK uses a st

CLINICAL GUIDANCE | SECTION ONE311.9.3 CIS/CIS (RE)CIS (Continuous Interleaved Sampling) focuses on the temporal (timing) properties of sound. It us

SECTION ONE | CLINICAL GUIDANCE32Figure 8 illustrates the electrical stimulation pattern of the English word ‘choice’ using a 6-channel CIS strategy

CLINICAL GUIDANCE | SECTION ONE33When programming a Nucleus® 24 implant and the SPrint processor with 20 active channels, the default is Table 8 (18

SECTION ONE | CLINICAL GUIDANCE341.11 MICROPHONE SENSITIVITY AND VOLUME SETTING1.11.1 Microphone SensitivityThe setting of the microphone sensitivit

CLINICAL GUIDANCE | SECTION ONE35softer speech sounds. In both cases, C-levels should be re-assessed.The Sensitivity Mode may be set to ‘Manual’ or

SECTION ONE | CLINICAL GUIDANCE36With the CP810 Sound processor, the clinician can lock out the ability to change both sensitivity and volume via th

CLINICAL GUIDANCE | SECTION ONE37The channel gains adapt so as to optimize the loudness of the signal into the recipient’s dynamic range. For low in

2SECTION ONE | CLINICAL GUIDANCEThe primary aim of programming a sound processor is to customize the device so that the cochlear implant provides co

SECTION ONE | CLINICAL GUIDANCE38Whisper may not provide significant benefit to all recipients in all environments. Past studies2,3 with Whisper have

CLINICAL GUIDANCE | SECTION ONE39Whisper is used alone and in combination for the SmartSound Everyday environment and also in combination for the Sm

SECTION ONE | CLINICAL GUIDANCE40Focus with the Freedom Sound ProcessorThe Freedom sound processor implements the beam algorithm using one dual port

CLINICAL GUIDANCE | SECTION ONE41The polar plots in Figure 14 compare the directional sensitivity of Beam (light blue line) and a fixed directional m

SECTION ONE | CLINICAL GUIDANCE42The effects of Beam were evaluated in a double-blind trial with five adult Nucleus® CI users4. Subjects were tested

CLINICAL GUIDANCE | SECTION ONE43Group mean results for CUNY sentences at 65dB SPL are shown in Figure 16, and indicate a statistically significant m

SECTION ONE | CLINICAL GUIDANCE44equally, so a null position is selected to give the best overall result. With zoom, this null direction is fixed (Fi

CLINICAL GUIDANCE | SECTION ONE45References1. CP810/CR110 Validation, Cochlear internal data Aug 2009.1.12.5 Autosensitivity™ (ASC)The function of t

SECTION ONE | CLINICAL GUIDANCE46Recommendations for changing Autosensitivity (ASC) breakpointIncreasing the Autosensitivity breakpoint will make it

CLINICAL GUIDANCE | SECTION ONE47Environment OptionsEVERYDAYThis environment is used in typical listening situations. A clinician will typically pro

3CLINICAL GUIDANCE | SECTION ONESECTION 1 : PROGRAMMING PRINCIPLESGetting startedAt the initial activation, the clinician uses Custom Sound™ to prog

SECTION ONE | CLINICAL GUIDANCE48FOCUSThis environment is used when there is significant background noise, but the focus is on hearing what one perso

CLINICAL GUIDANCE | SECTION ONE49When you convert a Freedom MAP to a Nucleus 24 MAP, input processing options that are not supported on Nucleus 24 s

SECTION ONE | CLINICAL GUIDANCE50• Alternating stimulus polarity will effectively reduce the stimulus artefact. However, there may be a disadvantag

CLINICAL GUIDANCE | SECTION ONE51Absence of ESRT does not mean the implant is not working or the recipient is not hearing. There can be other causes

SECTION ONE | CLINICAL GUIDANCE52Accessory Adaptor. The Freedom Accessory Adaptor is needed to connect the processor end of the ESPrit FM cable into

CLINICAL GUIDANCE | SECTION ONE53Parameter Recommendation RationaleAuto Telecoil Off. (Note: for neckloop receivers, please activate the telecoil)Co

SECTION ONE | CLINICAL GUIDANCE54Many factors impact the battery life of a sound processor including the use of some accessories. It is important to

CLINICAL GUIDANCE | SECTION TWO55SECTION TWO | CLINICAL GUIDANCESECTION 2: PROGRAMMING RECOMMENDATIONS FOR SPECIALTY DEVICES2.1 SPECIALTY DEVICES

SECTION TWO | CLINICAL GUIDANCE562.1.1.1 Setting Up the ABI EquipmentBefore switch-on• Since tuning the Nucleus 24 ABI is time-consuming, consider

CLINICAL GUIDANCE | SECTION TWO57ECG monitoring equipmentCaution: During stimulation the recipient must be connected to ECG monitoring equipment wit

SECTION ONE | CLINICAL GUIDANCE4• Current Level (CL) – the amount of electrical current delivered to the implant recipient expressed in clinical pr

SECTION TWO | CLINICAL GUIDANCE587. Position the transmitter coil so it is just below the retainer disk. The transmitter coil will then be located d

CLINICAL GUIDANCE | SECTION TWO59Performing PsychophysicsNote: It is important that you perform psychophysics on an electrode-by-electrode basis. In

SECTION TWO | CLINICAL GUIDANCE60Scenario OneIn the best case scenario, all channels would have both T-levels and C-levels below any side-effect thr

CLINICAL GUIDANCE | SECTION TWO61Scenario ThreeIn a typical case, there is usually a group of channels which has only side effects, another which ha

SECTION TWO | CLINICAL GUIDANCE62Table 1: Loudness/sensation strength scaleAuditory Sensation Scale Side EffectStop 10 Stop Too loud 9 Uncomfortable

CLINICAL GUIDANCE | SECTION TWO63What to do if you reach the safe limit levelThe levels listed in the table below are considered to be conservative

SECTION TWO | CLINICAL GUIDANCE64Table 3: Maximum safe current and corresponding current levels for various stimulus pulse widths for the Nucleus AB

CLINICAL GUIDANCE | SECTION TWO65For supplementary programming guidelines for the Nucleus Freedom Processor for Nucleus 24 ABI (ABI24M) using Custom

SECTION TWO | CLINICAL GUIDANCE662.1.1.4 Fine Tuning the ABIBalancing/sweepingBefore carrying out any pitch perception test, it is important to bala

CLINICAL GUIDANCE | SECTION TWO67Give clear instructions to the recipient before conducting the pitch-ranking procedure to ensure they understand th

CLINICAL GUIDANCE | SECTION ONE5The remaining T-levels are automatically interpolated. If you wish to measure other channels, simply double-click on

SECTION TWO | CLINICAL GUIDANCE6811.It is strongly advised that after every few channels have been added to the ordered list, to sweep all the order

CLINICAL GUIDANCE | SECTION TWO69a better subjective impression between MAPs. Once you select a favourable MAP, encourage the recipient to use the p

SECTION TWO | CLINICAL GUIDANCE702.1.1.7 ABI WorksheetsFigure 10 : Nucleus® 24 ABI MAPping worksheetFigure 11 : MAPping an ABI 24 recipient

CLINICAL GUIDANCE | SECTION TWO71Note: It is recommended to maximize perceptual abilities wherever possible. This is because ABI performance is gene

SECTION TWO | CLINICAL GUIDANCE722.1.2 THE NUCLEUS® 24 DOUBLE ARRAYThe Nucleus® 24 Double Array (CI 11+11+2M) cochlear implant is based on the Nucle

CLINICAL GUIDANCE | SECTION TWO73Prior to programming, check with the surgery report to confirm which electrode array is in which turn of the cochlea

SECTION TWO | CLINICAL GUIDANCE74To ascertain electrode location (base or apex):1. Select one active electrode mid-way along each array (e.g. 6 and

CLINICAL GUIDANCE | NOTES75

As the global leader in hearing solutions, Cochlear is dedicated to bringing the gift of sound to people all over the world. With our hearing solution

SECTION ONE | CLINICAL GUIDANCE61.1 STREAMLINED PROGRAMMING METHODSCustom Sound includes three streamlined programming methods that make programming

CLINICAL GUIDANCE | SECTION ONE71.1.1 Behavioural Procedures1. Measure impedances by performing an implant test.2. In the Open or Create MAP scre