In New Zealand we have two cochlear implant programmes – the Northern Cochlear Implant Programme (NCIP) and the Southern Cochlear Implant Programme (SCIP). NCIP have only ever offered Cochlear brand implants. They provide support for Cochlear, MED-EL and Advanced Bionics implants. When SCIP was formed they offered only Cochlear brand implants. In 2006 they started offering MED-EL brand as well as Cochlear brand implants. The MED-EL brand became very popular. Like NCIP, they provide support for Cochlear, MED-EL and Advanced Bionics implants.
Earlier this year the Ministry of Health announced that all future children who needed cochlear implants would have access to getting two implants. The existing funding of 46 implants at approximately $50,000 was retained. This funds the first implant. The funding for the second implant however is only $20,000 (plus separate funding for support). $20,000 is less than what both implant companies were charging for implant systems, let alone covering the additional surgical costs.
In response SCIP went out to both MED-EL and Cochlear for pricing for the next 18 months. Because of the pricing offered, SCIP now only offer Cochlear brand implants.
The loss of choice has saddened many existing users and their families. While it is understandable that the implant programmes need to try to live within the incredibly (impossibly?) tight funding constraints the Ministry of Health has imposed, the loss of choice does have some negative consequences.
- Cochlear now have an effective supply monopoly. As such there is less pressure on them to provide the excellent level of support services that they currently provide.
- Parents and candidates no longer need to do the level of research that was required when they faced having a choice. Doing this research lead to more educated and informed users.
- The implant programmes now bare all the responsibility – financially, technically and morally – if there is a systemic failure or fault in the devices prescribed.
We believe it is much wiser for both implant programmes to offer choice between brands that meet the functional standards. However we do accept the financial constraints faced by the programmes.
A small group of prospective users do have a choice. Private patients have a choice at both programmes. In addition there are a small number of patients who have medical reasons why a MED-EL device may be a better choice. For this reason we will outline the main differences in the offerings from Cochlear and MED-EL.
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 previous 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 important now that all new children are getting bilateral implants. Apart from these differences the CI500 series and the CI24RE are very similar technically with the same electrode arrays and chipset..
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 and Cochlear’s CI500 series implant can only be exposed to a 1.5T MRI with the magnet in place. The Concerto series could not have its magnet removed. The Cochlear CI500 can have its magnet removed via surgery. The Synchrony and Concerto series have the same impact resistance as the CI500 series.
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 and SCIP surgeons will likely still use MED-EL devices for these patients.
Given the implant is the bit that is less easy to replace, the features of the Synchrony weigh heavily in favour of MED-EL.
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
MED-EL have launched their SONNET behind the ear sound processor. 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.
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.
The second option, currently available, is the Aqua+ swimming shell and coil.
This is a very clever solution and reports are that it works really really well.
MED-EL have responded by providing an option for MED-EL users to swim with their processors on.
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.
Currently there is no option for the SONNET processor. This is being talked about as being released “soon”.
The Waterwear option is quite expensive per swim. The Aqua+ option is very expensive upfront but can be reused a large number of times. Cochlear have a definite lead in this area of development.
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 have produced an article about the various implant brands’ reliability. From the data we would recommend the use of pins for MED-EL implants.
The majority of candidates starting their journey to hearing with cochlear implants now no longer have a choice as to which brand of implant system they receive in New Zealand. We are saddened by this change but understand the reasons for it. As such we no longer provide a recommendation as to which brand to choose as it is pointless. We do point those small number of candidates who do have a choice to the key areas outlined above and suggest you weigh these up in relation to your priorities. If you are offered a MED-EL implant system because of medical reasons, you should follow the advice of your surgeon.