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This page has been significantly updated. Please read the additional notes at the bottom of the post.

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. In the northern zone there is no choice apparently because of an exclusive supply agreement between the Northern Trust and Cochlear.

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 when they start down a cochlear implant journey for their child. This page provides a recommendation for which brand of cochlear implants to choose.

We periodically revise this recommendation when the manufacturers update their products. This week MED-EL and Cochlear made changes to their product lines. Today we are changing our recommendation to the MED-EL brand cochlear implant system. 

In this article we will explain why we have changed this recommendation. However firstly we do need to clarify two things:

  1. 2ears2hear is an entirely independently run organisation of parents. It is not affiliated with any CI programme nor government entity. We are not experts. We are parents of kids with CIs. Our only direct support has been a donation of Cochlear Koala bears for use in our advocacy work (we are very grateful for this).
  2. 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. That said we believe it is important for parents to make these choices so as to take ownership of their child’s cochlear implant journey.

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.

Implants

Both Cochlear and MED-EL have launched new implants.

The Cochlear brand has relaunched their CI500 series implant. This is the implant that was recalled a few years ago when the fail rate went very high. Cochlear have identified the issue, fixed it and have now soft launched it under the name “Profile series”. The CI500 series has some very good features. It is more impact resistant than the existing Cochlear offering (2.5Js opposed to 1J). The design has a reduced biofilm profile, meaning it is less likely to get a bacteria infection attaching to the implant. And it is very thin (3.9mm). The thinness allows surgeons to minimise the amount of skull bone that needs to be recessed. This reduces surgery time – which is import now that all new children are getting bilateral implants. Apart from these differences the CI500 series and the CI24RE are very similar.

MED-EL have launched a whole new implant this week. The Synchrony series implant comes in two forms – a pinned and unpinned form. The pinned form allows it to be attached more securely to the skull. The implant is 4.5mm at its thickest – the same as the previous Concerto series implants – and drops to 3.3mm at points. Like the Cochlear Profile implant, it needs minimal recessing because of its thinness. The big development for the Synchrony series implant is the ability to be exposed to a 3T MRI with no need to remove the magnet. In addition, the magnet is now removable as well. The Concerto series implant could only be exposed to a 1.5T MRI and the magnet was not removable.

The MED-EL Synchrony now leads the Cochlear Profile in almost all areas (the thickness being the only area where Cochlear leads), although they have very different ways of functioning.

  • 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 across all 12 pairs and use this to a small extent currently (the lowest 4 frequencies can be stimulated simultaneously on some current processing strategies). 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 out of 22 electrodes are stimulated each cycle on the Cochlear device.

The short comparison summary is that the Synchrony implant can do everything the Profile implant can do, plus a few extra things.

It should also be noted that MED-EL offer to custom make electrode arrays for patients with malformed cochleas based on MRI scans. This anecdotally appears to be an optimal approach.

Given the implant is the bit that is less easy to replace, the features of the Synchrony weigh heavily in favour of MED-EL.

Processors

en_product_nuclues6_cp910_cp920_soundprocessor_500x271

Cochlear have their N6 (CP910 and CP920) speech processors. The processors are very well designed and have  numerous exciting features. These include:

  • High water resistance (IP 57 using rechargeable batteries)
  • Small size
  • Bi-directional remote control
  • Dual microphones with SMARTSOUND iQ pre-processing
  • Data Logging

 

SYNCHRONY-system

MED-EL have launched their SONNET behind the ear sound processor this week. This processor has a number of features that effectively mean it now catches up with the Cochlear N6 processors. These include:

  • High water resistance (IP 54 using disposable batteries – rechargeables still to be released)
  • Small size
  • Dual microphones with Automatic Sound Management 2.0 pre-processing
  • Data Logging

The SONNET processor is slightly bigger than the OPUS 2 processor it has replaced. However it has added all the features needed to catch up with the Cochlear N6 series processors. It has also remedied some of the shortcomings of the OPUS 2 (weak cables).

When we compared previously the Cochlear N6 processors to the OPUS 2 the N6 led significantly in these four areas:

  • 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

MED-EL’s SONNET sound processor addresses these deficiencies. In short the SONNET processor is at least as good as the N6 series processors.

One area of particular interest to parents is that the SONNET is compatible from day one with ALL MED-EL’s past implants. Cochlear’s N6 series processors are not likely to be fully backwards compatible until 2015.

Swimming Options

One of the major advantages the Cochlear N6 series processors have had is their ability to be used for swimming. Cochlear offer two options for achieving this. The first is the Aqua Accessory. This is a bag and is currently available. It provides IP 68 protection.

Aqua1

The second option, to be released in NZ later this year, is the Aqua+ swimming shell and coil.

Cochlear

This is a very clever solution and reports are that it works really really well.

MED-EL, in their release this week, have responded by providing an option for MED-EL users to swim with their processors on.

WaterWear

The WaterWear option for their RONDO processor provides a completely swimmable option (IP 68). When combined with the MED-EL Sports Headband the WaterWear provides an excellent approach.

In New Zealand MED-EL have been providing both an OPUS 2 sound processor AND a RONDO processor for quite some time with every new implant purchase. So long as MED-EL continue to do this with the release of the new SONNET sound processor (so you get two processors – one fully swimmable and one water resistant) then MED-EL will have caught the Cochlear in the swimmability stakes. In fact, being a separate processor, in many ways this is more practical in that it can be sealed up once and used for multiple swims.

Reliability and Support

Both manufacturers provide highly reliable devices and provide excellent support. Cochlear does have staff in NZ. MED-EL support the NZ market out of Australia.

It is 2ears2hear’s current assessment that both manufacturers have very similar reliability. We hope to produce an article soon on the reliability data the manufacturers provide. We are waiting for some additional data to complete this analysis.

Conclusion

The MED-EL offering has a significantly better implant than the Cochlear offering. Both manufacturers have comparable sound processors. Both have swimming options.

Because of MED-EL’s advantage in implant design, 2ears2hear now recommends the MED-EL Synchrony cochlear implant system for children in New Zealand who have a choice in manufacturer. We would expect to see the MED-EL Synchrony system available in New Zealand very soon.

Our hope is that the competition between the cochlear implant manufacturers will spur each on to make further improvements which will benefit cochlear implant users into the future. When improvements are made we will need to review this recommendation again.

 

Recently SCIP has provided information on the availability of the SONNET. This information is here. Essentially it says that the SONNET processor is available as an option immediately (with a temporary fill in with a loaner OPUS2 until mid August). The SYNCHRONY implant is available immediately.

However the information also says that the dual deal of the OPUS 2 plus the RONDO will NOT be updated to a dual deal of the SONNET plus the RONDO. The implication of this is that parents currently have to choose either a RONDO and have swimming (but not dual mics, data logging and future wireless capability) or the SONNET and have dual mics, data logging and future wireless capability (but not swimming). With the Cochlear offering all these features are available in one purchase. 

This is a significant dent in the MED-EL offering’s feature set. MED-EL have indicated that a swimmable option for the SONNET is likely to be available within 12 months. This puts the this functionality in the same category as the future wireless capability… something worth considering but not to be fully relied upon.

Swimming is a big part of most kiwi children’s childhoods. While parents should make judgements of the relative importance of the different features, when comparing the two manufacturers offerings, this lack of function does lead us to modify our recommendation.

Until the swimming option is available for MED-EL (whether this is via the addition of the dual deal or launch of a solution for the SONNET) we are changing our recommendation to neutral. 

MED-EL have a better option for the implant with the SYNCHRONY (as outlined above). Cochlear have a better all round offering with it’s sound processor. However the difference is now very close, with the swimming option and bi-directional remote being the big advantages for Cochlear.

We would recommend against going for the RONDO only option. The feature advantages of the SONNET are significant over the RONDO. Likewise, if swimming is a critical issue and your child can’t wait for 12 months, go for the Cochlear option.

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