In New Zealand’s southern zone we have the choice of two of the cochlear implant manufacturers: MED-EL and Cochlear. Both provide very good products, service and most importantly outcomes.
The 2ears2hear website provides a page called “First Steps for Parents” which is designed to help parents struggling with the torrent of decisions that need to be made. We have, since its creation, been recommending the MED-EL brand cochlear implant. Today we are shifting that recommendation to the Cochlear brand cochlear implants.
In this article we will explain why we have changed this recommendation. However firstly we do need to clarify two things:
- 2ears2hear is an entirely independently run organisation of parents. It has not been supported in any way by either brand in the past and nor will it be in the future. It is not affiliated with any CI programme nor government entity. We are not experts. We are parents of kids with CIs.
- We are not saying parents who have chosen either brand have made a wrong decision. Each family makes this decision based on their own circumstances and values at a particular time. The brands have different strengths and weaknesses and parents rightly match these up to what is important to them. And these strengths and weaknesses change over time.
Either brand will produce great outcomes. The 2ears2hear recommendation is really for parents of newly diagnosed children who need some guidance. Parents who have been through this stage will know that sometimes the number of decisions that need to be made can be overwhelming.
With all that said, we will now outline the different factors that have feed into this change of recommendation. We break this into a number of different sections.
The two brands have completely different approaches to their implants.
- Cochlear have chosen to have more electrodes (22 compared to MED-EL’s 12 pairs).
- MED-EL has chosen to have the ability to provide simultaneous stimulation and use this to a small extent currently. Cochlear stimulates sequentially only and can only do this (the implant only has one power source).
- All 12 of the MED-EL device’s electrode pairs are stimulated each cycle. Only 8 are stimulated each cycle on the Cochlear device.
- Cochlear has the ability to remove the magnet to allow high strength MRIs (3T verses 1.5T). MED-ELs is fixed and not removable.
- MED-EL have a stronger implant (2.5J verses 1J). Cochlear’s CI500 series implants which were as strong as the MED-EL implant were recalled.
- Both have an array of different electrode options however MED-EL offer to custom make an electrode array based on an MRI. This is particularly useful for abnormally formed cochleas.
Overall the MED-EL implants seem better. Strength is important for children. And the ability to do simultaneous stimulation offers something extra. Essentially the MED-EL implant can do what the Cochlear brand implant can do and more. Given this is the bit that is less easy to replace, this has weighed heavily in favour of MED-EL.
Cochlear have announced their new N6 (CP910 and CP920) speech processors. While they are not yet available in New Zealand, if you purchase a current system (N5) today you will be automatically upgraded to the new N6 processor. It is this change that has precipitated the change in recommendation.
MED-EL currently offer a deal where you get their OPUS 2 processor AND their new RONDO processor. The OPUS 2 is a very light behind the ear processor. The RONDO is an all in one unit that sits on the head. This is a very good package as it gives you a spare processor (the form factor you chose not to use).
The new N6 processors however have caught up in some key areas and added some new features to their existing excellent feature set. Cochlear speech processors have traditionally been robust. The new N6 processors are now comparable to the OPUS 2 in weight and size (there is nothing in it). The advantages the N6 processors now has are:
- The N5 has had a superior water resistance rating. MED-EL processors are unrated. The N6 continues to offer the superior rating of the N5
- The ability to connect directly to audio streaming devices. This will replace the need for an external FM systems (FM boots and neck loops)
- Data logging into their bi-directional remote
- The ability to do some quite sophisticated sound processing via the dual microphones and a new internal computer
Cochlear’s speech processors offerings seem better. For children the superior water resistance, robust design and direct audio streaming (no add on FM systems) are important. The direct audio stream is very important for children receiving just one implant. The past disadvantage of weight and size has been addressed.
There are two accessories that Cochlear currently have that make a big difference.
The first is the Aqua Accessory (or Aqua bag). This is a shaped bag that can be put over the processor, sealed and then the user can swim with their cochlear implants. For New Zealand children, swimming is a big thing. To be able to communicate fully in the swimming pool makes a huge difference. The use of this accessory does not compromise your warranty or insurance. MED-EL do not offer an equivalent currently.
The second is the bidirectional remote control. This device allows two functions that the MED-EL one-directional remote does not. The first is data logging of what is going on with the processor. This will be very useful for error finding and for assessing the language opportunities a child gets exposed to. The second is the ability to monitor whether the processors are working/connected. This is very useful for young children until they learn to put the coil back on when they fall off.
The bidirectional remote also offers some exciting opportunities for development in the future like locating of lost processors, remote diagnosis of issues and maybe even remote programming of the processors.
Cochlear are also scheduled to bring out some other accessories like their audio streaming devices which they have developed with GN Resound.
While there is little in it when comparing the two offerings, we do now feel the Cochlear offering is marginally better for New Zealand children.
One complicating factor is the RONDO. This is an all in one processor that sits on the head (not behind the ear). It is a completely different approach. You could compare it to a laptop verses a desktop computer. Both are computers but the form is completely different. Fifteen years ago you wouldn’t buy a laptop for home because they were not very good. Now you won’t buy a desktop. We are unsure whether the RONDO with its completely different form is going to be like the laptop of cochlear implants.
That aside, we do think that now the weight/size of the processors are comparable, the direct audio streaming is built in and the data logging is added, that factors like the Aqua Accessory weigh in favour for New Zealand children. Obviously we hope that MED-EL respond by launching their own Aqua Accessory and other new features so that MED-EL users can enjoy these benefits. When that happens we will need to review this recommendation again.