Monday, June 01, 2009

Why Did I Choose Advanced Bionics?

I decided to do a little spring cleaning to my inbox and I noticed that my sent folder was overflowing with emails answering why I picked Advanced Bionics for my cochlear implant. It seems that after a 100 or so emails, I have unknowingly created this wonderful base for this blog. :)

There are several reasons I chose AB. I wanted to be able to hear better in noise. I wanted to be able to use the phone like a normal person. I wanted to be able to listen to music with ear buds that otherwise proved completely useless to me when I had a hearing aid – the ear was already full enough :) I wanted to be able to transition through different sound environments without fiddling around with the program. I wanted rechargeable batteries because they are safer for the environment and economically friendlier. I wanted the support that was needed that goes along with learning how to hear with a cochlear implant and because of Hearing Journey, I got answers the second I post a question. I wanted to be able to access the latest MRI technology with minimal surgery. I wanted promises of future technology designed to emulate better hearing without further surgery. I wanted total reliability. I wanted the implant to withstand sweating when I work out since I was forever killing my hearing aids. I wanted to push the envelope of hearing. When it came down to it – AB was the only company that could give me that.

1. T-Mic Microphone

The T-Mic ear hook is only available with Advanced Bionics cochlear implant system. This is not to be confused with the T-Coil, an option that can be turned on by your audiologist on your Harmony Processor. It uses the natural shape of the ear to emulate natural hearing. It helps to provide clarity that is needed for speech and is absolutely fantastic in noise because you can rotate your ears to what you want to focus on like a normal hearing person. It comes in two sizes, standard for big ears like mine and pediatric size for itty bitty ears.

Being a long term hearing aid wearer, I was familiar how directional microphones (catches the sound in front of you) and omni-directional microphones (catches the background sound) works but this design intrigued me. With the T-Mic earhook, I can just put the telephone up to my ear without fiddling with anything and the background noise immediately fades away making the your voice or the person on the other end of the phone the dominant sound . When you or the person stops talking, the background noise will become noticeable. It is the same phenomena when I wear a Bluetooth headset and stick IPOD ear buds in my ear. These are things I never thought would be possible with a hearing aid.

2. Auto Sound

The phenomenon that I was just talking about is called Auto Sound which automatically adjusts for the environment that you are in. I shall spare you the technicalities of it all. It allows you to hear whispers to shouts without flipping a switch. You don't have to fiddle around with programs. This is a cut and paste from a bilateral AB user that lives with a bilateral Freedom user that explains how useful it is to have valuable Auto Sound is.

My resident (bilateral) Freedom user having to switch for the phones, having to switch for restaurants, having to switch back for normal conversations. When we listen to music, he switches and switches programs trying to find something that sounds ok. He gets frustrated with it. If he forgets to switch back, he can spend the morning not hearing well in normal situations, with his voice louder than necessary. That is my tip off that he forgot to switch back...so I will have him check and sure enough, he forgot to switch back from whatever program he was using, back to his "everyday" program.

I would be highly agitated if I had to keep flipping programs to go from my house, to my car, to work. With Auto Sound, I hardly ever have to switch.

3. Familiarity of Hearing Aid Style

Advanced Bionics has the options of three program slots and it mimicked the style of what I was used to with my HA. Right after you get activated, you tend to play a lot with different programs options that AB has to see what suits you best but now I settled down with just one program from everything: But just for sake of having options, I have a normal everyday program, a noise/telephone program that I hardly ever use unless I am in a noisy environment and music. I find it redundant to have more than three program options because like myself, most of the CI users after they learn how to hear with the CI, you might find yourself just sticking to one. If you go to a CI clinic that gives you two processors, a primary and a back up, you can utilize both of them to play around with different settings until your brain figures out which one it likes best.

4. Widest Window of Sound (IDR)

Since a normal person ear cannot process any sound louder than 120dB and it will hurt a hearing person to hear anything louder than 120dB which results them sticking their fingers in their ears to dampen the noise. AB has its own ceiling as well. It is called IDR which stands for Input Dynamic Range that can be adjusted up to 80dB. Other companies are at 45dB. It just means that ceiling on the CI or window of sound can process up to 80dB and then Auto Sound kicks in and automatically dampens the sound to make it comfortable for us to tolerate the loud noise.

If you can picture a window shut, which means very little sound is coming through because the window absorbs most of the sound. If you open the window a little bit, you will begin to hear some noise such as leaves blowing around, cars passing or a faint impression of someone hammering. I call this a low IDR. If you open the window up halfway, you are inviting even more noise. You might get the leaves blowing, cars passing and a more distinct impression of the person hammering but you might hear the birds singing as well. If you open it up all the way, you might as well be standing outside. I like to it call it adjustable noise control. :) With a wide IDR, I can go to a concert and hear the concert as it was meant to be heard. With a narrow IDR, it gets rid of unimportant noise or what I call "white noise" and brings a sense of perceptible clarity.

5. Rechargeable Batteries

I am extremely environmentally friendly. I recycle. I drive a hybrid which resembles a hardboiled egg but you just can't beat it the 55 mpg that I get. So, rechargeable batteries are an easy "green" option. Advanced Bionics has two sizes of rechargeable batteries, extended and slim. Extended is what I have which I get an average of 24 hours out of, you figure every two days I'm slipping a new one in. I got four batteries with my processor when I was activated and I lost one (blushing) but three batteries last me the whole week. It is not only environmentally friendly, it is economically friendly as well. There are no trips to the store to buy batteries which means more money in your pocket. You might want to buy a new set of batteries every 2-3 years but if you have a durable medical rider on your insurance policy, that means very little out of pocket. AB provides a little wallet that you can attach to your key ring to carry your batteries with you.


6. HiResolution Fidelity 120 Sound Processing Option

The latest software development is the HiRes speech strategy option with Fidelity 120 options. This is an option that can help you in noisy conditions, appreciate music and on the telephone. The only way I can describe it is if I compare it to a camera. A hearing aid is a Polaroid and HiRes with Fidelity 120, it is a 4MP Camera. I can hear in noise much more easily than I could ever hear with a hearing aid. Since it was designed with music in mind, it has been a joy to actually enjoy music especially now that I am bilateral.

It uses current steering technology to increase spectral resolution from as few as 12 to 22 spectral bands to as many as 120 spectral bands. Advanced Bionics is the only company that can achieve this type of current steering technology because it has a power source each electrode. Other companies that have only one power source for all of their electrodes claim that they can steer electrodes but they have no speech strategy devised for it which makes it totally useless, doesn't it?

7. Independently Controlled Currents or Electrodes

Since I have a technical background, I have always been interested in how components function and it played a large part of my research. All the components may look similar in programming, chip size and material but the old saying, never judge a book by its cover. The HiRes 90k implant has the 16 independent computer controlled current sources where other companies have one power source. It is like if you set up X number of speakers and plug them into one outlet, you will not get the same performance if you plug in each one of those speakers to its own power supply. With independently controlled current sources, the ability for tons of future software development since it can control each electrode.

8. Internal Chip Memory

The fact that the internal chip memory is only operating at 25% capacity means that there are tons of room for development.

9. Total Reliability of Internal and External Report

Advanced Bionics has been able to issue a total reliability report. For the implant, it is at 99.5 on June 2008 and for the Harmony processor, the return rate is less than 1%. I do want to point out that you want to be worried about the reliability of both the implant and the processor because if one stops functioning, you can't hear - point blank. The other companies do not offer a reliability report on their processors because it is absolutely deplorable. I always hearing about parts breaking down and being replaced. I absolutely hated it when I was left in the dark when my hearing aid broke down and believe me, I have done my fair share of killing them. I felt so disconnected from the world as I knew it. I have yet to have my processor replaced (knock on wood) but if I ever did, I would have it within 48 hours with the Processor Direct Program.

In 2004, Advanced Bionics was under another company called Boston Scientific when they had agreements with two Vendors to supply a part for the internal component. They noticed that the rate with Vendor B component was prone to moisture issues was 1% lower than the Vendor A component. AB issued a recall on their own accord recalling the devices due to the potential presence of moisture in the internal circuitry, which can cause the device to stop functioning. Not all of the Vendor B implants had this problem. Advanced Bionics has since resolved this issue by only using parts supplied by Vendor A. As a result, their total reliability has gone way up.

10. Processor Direct Program

Processor Direct Program minimizes the time waiting if you should ever need your sound processor replaced. Just call your audiologist and they will contact AB via our secure, automated website and upload your sound processor’s unique program file. AB technicians will load your program into a replacement sound processor and ship it directly to you. Because you receive a fully functional processor preloaded with your customized program, there’s no need to schedule a programming visit. That means more time for yourself and more money in your pocket.

Processor Direct is completely safe, so there’s no risk of hearing with the wrong program. AB’s secure website makes it impossible for your audiologist to upload the wrong program file, and for additional security, AB’s patented IntelliLink™ feature will not allow a processor loaded with the wrong program to work with your implant. You enjoy peace of mind knowing you have the correct programs—developed specifically for you. An office visit to program a replacement sound processor might not be covered by insurance companies, which mean you may have to pay the cost. With Processor Direct, no programming office visit is required and that means no unexpected costs.

11. Support

Advanced Bionics has the largest online community forum – Hearing Journey with over 4,500 users. It consists of CI candidates, recipients and parents of children recently diagnosed with hearing loss, parents of children that have cochlear implant and audiologists. It is a huge wealth of information as everyone rallies around for support, offers advice, shares tips and tricks about surgery or learning how to hear with a cochlear implant. There is a CI chat held every Thursday night from 8pm EST til the cows come home, that you can come and talk to other cochlear implant recipients, candidates, parents and audiologists. Just log in to Hearing Journey and click on the chat options and you are in!

Advanced Bionic has taken it one step further to provide one-on-one support. They have just launched a new site for cochlear recipients and candidates from across the country through its new "Connect to Mentor" Web site. The new site, part of the BEA (Bionic Ear Association) Mentor Program, that I and several other bloggers are a part of, allows cochlear implant candidates to contact volunteer "mentors" and communicate directly with hearing professionals. You see my smiling face on this site as well. :)

Candidates can use the Connect to Mentor website to search for mentors who include parents of implanted children, relatives of cochlear recipients and adult recipients. Each mentor has a profile complete with a personal photo and facts such as favorite sound, interests (i.e., cell phone user, traveler, musician), hometown, age they were implanted, severity of hearing loss and how they can help cochlear implant candidates. Then, candidates can choose to "start a conversation" with the mentor directly from their profile.

22 comments:

Anonymous said...

Abbie...are you using a phone "like a normal person?"

Lucky

Abbie said...

Yes, I use a regular telephone, a cell phone and a bluetooth headset like a normal person. I just pick it up and start yacking away.

Anonymous said...

Looks to me like AB should Hire you. Excellent descriptions!

Adam

Sam said...

Well said! Thanks for such valuable insight.

Anonymous said...

Abbie,
Awesome. Obviously you're one of the "Lucky" ones!

Thanks for sharing.

Lucky

Laurie said...

A wonderful and informative post, Abbie! I learned alot! You are a great mentor and advocate for AB! See you soon at the Convention!

melissa said...

Abbie, I really admire you, you're an inspiration to me and are fantastic! I love reading your blog, it's so informative and interesting!! Keep it up

x

Dan Schwartz said...

Hi Abbie!

Very nice article that laid to rest one of my quiet concerns: That of how well the Bad Effects of sweat & moisture on the external BTE processor has been engineered out.

As an old RCA-Camden Engineer who co-op'd in the Reliability & Maintainability group in the Small Terminals (mobile satellite communications camper-backs & trailers) program, your reason #8 jumped off the page at me.

Do you know what the bad component was on the implanted side that was getting hosed; & who mfr. A & B are?

It wouldn't happen to be a tantalum "capaci-tater" in question, would it?

Thanks… And keep up the great writing, too!~

BLOG ENTRY POSTED TO MY FACEBOOK WALL.

Dan Schwartz said...

Reason #9 is... ?!

Abbie said...

The internal component is called a feedthru which supplied electrical signals to the electrode. It was supposed to be waterproof but it has some moisture problems. The Vendor B component was supplied by Astro Seal who AB no longer does business with.

Tom Hannon said...

Abbie: I have read no better user explanation about life with the Advanced Bionics Cochlear Implant System; only wish that I had during my candidacy process, but of course you hadn’t yet written this back then! So when I am asked “What are the differences between the three cochlear implant manufacturers?” that person will be directed here! How bout ya give us “Chapter 2” detailing the rhyme & reasons of mapping strategies starting with our CI’s first NRT breathe in the operating theater? Thank you for a concise well written explanation into what makes Advanced Bionics stand heads taller than the others!

~Tom Hannon : Deaf 2006 : CI-Borg 2007 : Luminoid 2008-9

william said...
This comment has been removed by a blog administrator.
Brakeshoe said...

Reason number seven is no longer true: During my visit to MedEl's U.S. HQ with a fellow Engineer Wednesday, he confirmed that all of their electrode assemblies now come with separate current sources for each electrode.

This matched what I was told by an audiologist in the MedEl booth at HLAA.

--------------------------------

FWIW, it's still a close call for me between AB & MedEl; but I still need to interrogate the guys over at Penn why they are an almost-exclusive CCA shop before I commit.

Also, I want to walk through AB's Soundwave mapping software, as I did through MedEl's Maestro programming software.

Since I'm paying the bill out of my pocket, I get to pick what is wedged into my skull, the surgeon who does it, and the Engineer (or audiologist) who programs & maps it.

Abbie said...

Actually #7 is stays true. Med-El claims to have 24 electrodes but in actuality there are 12 electrodes that are being counted twice to account for the bi-polar presentation - 12 negative and 12 positive. If AB were to count this way then we would indeed have 32. The architectural limitations of their design prevents them from being able to alter the phase of the current source; making the number of current sources irrelevant as they can not be stimulated at the same time with bipolar stimulation (positive and negative phase necessary for cochlear implant strategies). And since they lack a simultaneous stimulation means no current steering.

Discpad said...

No, MedEl does not claim to have 24 electrodes in any of the American (FDA approved) literature; nor had I seen or heard that claim at the show or by their EE in Durham on Wednesday.

Also, indeed they do have bipolar stimulation; but each electrode is fired first with a positive charge and then an equal negative charge.

Notice I used the word charge instead of current: Absolute charge is in Coulombs, while current is Coulombs per unit time (with an an ampere defined as 1 Coulomb/sec).

The difference is subtle, but important: The cochlear fluid bathing the electrode assembly is hardly ideal, being a "leaky" dielectric, with the charge behaving in a complex manner, depending on the E-field vector (and not just scalar) values. Because the medium is non-isotropic (let alone non-homogeneous), with varying values of rho (resistance), one is able to steer the charge pattern in many different ways.

In some cases, the MedEl stimulation techniques actually fire as many as 4 electrodes for a given input, depending on the status of the ganglia nerve at that point.

In fact, what Bob stressed to me repeatedly is that the charge patterns do not follow the patterns of the tonotopic map for acoustic stimulation at all.

Without much more than AB's marketing materials, plus one research paper by AB's Leonid ("Larry") Litvak, I don't have too much to go on, especially in the inside half of AB's hardware.

Also, while MedEl was happy to show me their US (FDA) version of their Maestro software, and give me a roadmap as to things already in their CE version headed here.

FWIW, I also put in a request Friday afternoon with CCA to have a teleconference with one of their EE's to get my arms around what they are doing w/r/t both processor signal manipulation and stimulation strategies; of course offering to sign an NDA with them, as I have offered Advanced Bionics.

----------------------------------

Since I was rather taken aback with MedEl's stimulation strategies, I wasn't planning on addressing this in a public forum just yet.

In any case, what was supposed to be a rather quick confirmation ratifying my decision to go with AB implant hardware has now been completely upended; with good people (like you!) honestly believing that each one they design, build &/or use is the best... And each makes their own points as to why.

As I said at HLAA, unlike hearing aids, there's no such thing as a 30 day money-back guarantee. Gotta nail this 3-point jumper on the first shot.

Dan Schwartz said...

I have a couple of sets of eyes & ears inside the biennial Cochlear Implant Scientific Conference at Lake Tahoe this weekend. [This used to be held at Asilomar; the one where the engineers sit around all night.]

What comes out of that conference will heavily steer my decision.

Also, Cochlear America is giving me direct access to a VP of Engineering, a person who has been published on CI signal processing all the way back in 1986.

At this point, I'm leaning about 2/3's towards AB; with the remainder split evenly between MedEl & CCA.

In any case, your blog post above is very helpful to anyone considering a CI for themselves.

Dan Schwartz
Cherry Hill, NJ

Karen Mayes said...

Oh...

I just read your blog. Hmmm...

My 12-year-old son (who's late deafened) is a CI candidate and we discussed two CIs (AB and Cochlear's Nucleus Freedom) and we decided on Cochlear. Now I read your blog and I went like hmmmm... but it's too late, since the audiologist already ordered for Cochlear's Nucleus Freedom.

Oh well.

Abbie said...

Karen,

Oh honey, it doesn't have to be an "oh well" situation. You have options, you can contact the Audiologist and tell them you changed your mind. The cochlear implant is a life partnership with your son.

Dan Schwartz said...

Karen, I just saw your post; and I'm in total agreement with Abbie: You have the right to change your mind up until the surgeon opens the sealed surgical kit in the OR.

Although I didn't mention it here, I chose AB as well for myself. Of the three CI manufacturers, AB's 1J electrode indeed has the best onboard electronics inside the electrode assembly; with MedEl having some limits (Abbie: We're both right - I'm busy, but will `splain later); and importantly, Cochlear having an older, slower design that is already pushed to the limits of the processor & stimulation technology.

Hope you get this message before the surgery date. If it were me, I would postpone if necessary to get the AB hardware.

Hope this helps!
Dan Schwartz
Dan@Snip.Net

uplyme said...

I have a nucleus N22 in my right ear and an AB Harmony in my left.
I have found that the N22 is superior to the Harmony in every respect. Most important of course is that I can hear a lot better with it. Also the N22 processor is much more robust than the Harmony and has both types of battery. No on/off switch to the Harmony is awful

Dan Schwartz said...

Tina Lannin in London has a superb, well-researched blog article on why she chose Advanced Bionics; and to readers of this blog, it goes into never-before-posted details.~

thelisteningtree said...

Hi Abbie,

While your descriptions are very useful, it should be noted that Cochlear Ltd implants use an 'instantaneous input dynamic range', which is different to those of other manufacturers and not comparable. This IIDR compresses the range of sounds within a listeners' limited electrical dynamic range to ensure that the signal of interest can be heard. Effectively this means that in noisy environments, medium and loud sounds are given priority, and low-level background noise is not presented to the listener. However in quiet environments, a wider range of sounds may be coded.

Also, recent research using a cross-section of implant models and manufacturers indicates that an IDR of >55dB does not provide any appreciable improvements in word or sentence recognition in quiet or noise.

It should also be noted, that the average cochlear implant user (all brands/devices and strategies) is unable to effectively utilise input from more than 8-10 channels at any one point in time for speech recognition. Commercially available implants use electrodes that are implanted in the perilymph-filled scala tympani. Electrical currents generated at the surface of electrodes travel further than desired, resulting in overlap between currents generated at adjacent and distant electrodes. This reduces the saliance of the percept provided to the user. In lamen's terms, it's like overbrushing too many different paint colours at once. You end up with a whole lot of brown.

This is the central limitation of current implant design, and is the reason why most manufacturers use processing strategies that limit the number of simultaneous inputs well below the maximum number of implanted electrodes.

The next great leap in CI-technology is likely to involve light-based heating of spiral ganglion afferents (cochlear neurons) which should allow for more accurate targeting of stimulation.

I am uncomfortable with your analogy "A hearing aid is a Polaroid and HiRes with Fidelity 120, it is a 4MP Camera." Given that the average implant user has speech recognition abilities equivalent to an equivalent hearing aid user with a flat hearing loss of between 76 and 80dBHL (severe loss), it is evident that this is not a fair comparison. I agree that hearing aids have many limitations, but cochlear implants also have different limitations.

You might also consider that other manufacturers also have very low cumulative failure rates. Yes, this is a blog about your own personal choices, but other manufacturers also make their reliability reports available to the general public. Here are some quick-links below:

http://professionals.cochlearamericas.com/cochlear-products/nucleus-cochlear-implants/reliability

http://www.medel.com/english/30_Products/Reliability/Reliability.php

Indeed, the cochlear site is reporting a wide range of independent studies which indicate that their devices are between 3.5 and 5.8 times less likely to fail other manufacturers devices. However these are likely to include all previous device generations in their samples. Med-El and AB used ceramic housings for their implants in previous generations which were more prone to cracking than Nucleus systems. It is important to do your research in regards to all manufactures before making technical-based claims.