Choosing a Cochlear Implant? 69
sydsavage asks: "My mom, who is profoundly deaf, has finally qualified for a cochlear implant. She is having the procedure done at the University of Minnesota, and is scheduled for surgery in early March. The doctors have left it up to her to choose between two different implants. The differences between them are highly technical, and well above her level of comprehension. So she decided to ask her geek son to take a look at the differing technologies. Unfortunately, I'm a systems administrator, not an audio engineer or signal processing guru, and reading
up on the technologies made this fact blaringly obvious to me. About the best I can tell her is one has more accessories available, as any good geek could ascertain. While this may have an impact on her decision, at the end of the day, she just wants to be able to hear better. Are there any slashdot readers with first or second hand experience with these two devices? Any signal processing engineers that would like to weigh in on the different technologies involved?"
"The two implants that are available to her are the Clarion, manufactured by Advanced Bionics, and the Nucleus, made by the Australian firm Cochlear.
The Nucleus system is the one with more bells in whistles, such as the ability to interface to FM systems for hearing impaired that are found in museums, auditoriums and theaters. It can also plug into an audio out jack of a tv, stereo or computer. It also has a built in 'tele-coil' for use with phones that are design to work with hearing aids.
My mother and I would both like to say thank you in advance for your help in making this life changing decision."
What joke of a doctor... (Score:3, Informative)
Re:What joke of a doctor... (Score:5, Insightful)
> and chose based on highly technical differences
It is quite possible that the doctor did not do this. My advice: visit the doctor with your mom to hear for yourself what he is asking your mom to do. There probably is a good reason that he gives her a choice, for instance:
- the two devices differ in cost (to your mom)
- one will cost here more learning effort, but will eventually give here better hearing (AFAIK, cochlear implants never 'just work'; your mom will require training to use one)
- neither of them is better than the other in all environments
- one of them allows/requires her to adjust some parameters for optimum playback, the other lacks those fine controls, making it easier to use at the cost of some sound quality
ask the doctor... (Score:2)
Then, get on the phone and start making calls.
I'm no medical expert, but I've been in your position many times: a non-expert needing to make an important decision based on expertise. What do you do? You find experts and you ask questions. What questions? The more experts you talk to, the better your questions will become. By the time you're talking to your 30th expert, he'll think *yo
Re:What joke of a doctor... (Score:1)
It's just that this part of the equation is pretty well beyond our comprehension, and I figured that someone on slashdot is likely to have a better understanding of the technical differences between the two technologies, and possibly translate this into non-geek. It sounds to me like both available technologies work amazingly well for the vast majority of their recipients. But being a layman
Rush's implant (Score:4, Informative)
As for why he chose that brand over other possibilities, I don't remember what he said on the air at the time (around January 2002). Here [rushlimbaugh.com] is his site's collection of articles regarding his implant.
I don't know if you will find these articles useful or not, but hopefully it will help you with your decision-making process.
Re:Rush's implant (Score:4, Funny)
Re:Rush's implant (Score:1)
Don't buy based on technical specs... (Score:5, Insightful)
I don't pretend to be an expert on Cochlear implants, but you do have to realize that there is a lot more to "curing" deafness than simply picking the best hearing aid due to its technical specs.
As an analogy, take someone who's been doing graphics work on a Mac for years, decades and suddenly tell him that if he wants to keep his job, he has to become an OpenVMS system administrator and maintain the company's equipment without the benefit of a GUI.
Don't pick an implant on the basis of what it says it can do. Pick an implant on the basis of what your Mom wants to do, and is comfortable doing. For example, the Nucleus system boasts of being compatable with tele-coils. Most conventional hearing aids today are compatible with tele-coils, and within the next five years or so, all "new" models will be.
Furthermore, in order to use tele-coils, we usually have to flick a tiny switch on our hearing aids to switch from "conventional" sounds (that use sound waves) to induced sounds. Cochlear implants have the same switch or something very similar. For the elderly, manipulating that tiny little switch is usually a pain in the ass. Guess what the predominant preference is? An amplifier that can be plugged directly into the telephone line - or better yet, phones that come with sufficiently loud speakers built in.
Your next step should be to speak to an audiologist if you have not done so already. What you need to know is what frequencies you (or your Mom in this case) tends to listen for. Like any decent home stereo system, implants are optimized for a certain range and stutter, hiss, whistle, whatever outside of that range.
As an hypothetical example, it may be that she cannot hear high frequencies at all, but she can hear bass tones easily. If that's the case, you want one that will "magnify" those high frequences until she can hear them, and give maybe just a slight boost to the lower frequencies. Then you can select a model that will give you the most flexibility in compenstating for her deafness.
Mod parent up... excellent post (Score:1)
Re:Don't buy based on technical specs... (Score:2, Informative)
Re:Don't buy based on technical specs... (Score:2)
Re:Don't buy based on technical specs... (Score:1)
Yep, all the hearing aids my mom has had in the last 10 years also had telecoil support. That's why I was surprised that the Clarion implant doesn't, at least not in the info I've seen.
I'm also wondering if the telecoil support is built into the external components, or the implant itself? Obviously, the former
Re:Don't buy based on technical specs... (Score:2)
there's a hell of a lot of signal processing to be done to generate a workable signal.
Clinical Evidence (Score:5, Interesting)
I wouldn't worry too much about how they work. Lots of treatments help people every day, without the doctors even knowing how they work! I'd try to find out about any proper clinical trials done - that's the best starting point for evaluating the options. Unfortunately, I've no idea what proper research has been done in this area, but I suggest you start hunting around - I'm sure there'll be info out there on the net.
Here's one starting point:
http://www.geocities.com/cicentral/ci_compariso
The key thing is to place little credence in personal testimonies and theories. By theories I mean claims of the type 'Because our device has a foo, it will cause less irritating bar'. Assuming you know nothing about the medicine and technology involved, such claims sound perfectly reasonable, but remember they are actually as useful as claims like 'Because Intel processors run at a higher clock speed, tasks like word processing become easier', or even 'Because we use XML, our software is more intelligent'. To a non computer literate person, such claims sound reasonable.
Personal testimonies are valuable, but remember how different one human is to another. It's very tempting in a sea of uncertain research to latch on to someone saying 'My aunt Maud had a type one device for 3 years, and it caused all sorts of problems - but now she's on a type 2 device it's much better'. That's effectively a single datum, and in the larger picture it doesn't mean much. Of course once you have enough of them, then it means more...
When reading info on the net about this stuff, ALWAYS look for references (citations of journal articles etc) to back up any claims. Be suitable wary of 'expert opinion' - Medical experts as just as biased as computer experts - and think how many of those say things that you think are rubbish!
If you are really serious about this kind of research, the US Govt. provides an excellent resource:
http://www.ncbi.nlm.nih.gov/PubMed/
Good luck with your hunt!
should have gotten it way much earlier.. (Score:4, Interesting)
so geeks and other people alike, when they start losing their hearing tell them to get the hearing aid in time before they get used to the silence..
as to the real question, I haven't got a clue but I'd advise to ask the doctor which one gets more complaints later. Id bet that it's kind of hard to find people who've tried both.
Re:should have gotten it way much earlier.. (Score:1)
Re:should have gotten it way much earlier.. (Score:2)
Anyway, if I were you, I'd look into whether the problem actually is the hearing aid rather than your grandma.
Re:should have gotten it way much earlier.. (Score:2)
consider living in a world where hard drive makes no sounds at all and then one day somebody gives you a device(it's a very comfortable customised one) that makes you able to hear the hard drive again, wouldn't that be a bit annoying to use the thing? if you had heard the hd all the time it wouldn't matter
Re:should have gotten it way much earlier.. (Score:2)
Re:should have gotten it way much earlier.. (Score:2)
Just think of your grandma as a usenet reader who auto-plonks all aol.com posts.
Or, think of your grandma as a Slashdot reader who browses at +4.
Maybe she sees her deafness as something like finally being
Are there differences in the success rates? (Score:4, Informative)
I don't see how you could get to the bottom of this without depending on a doctor's advice. Like some other people who have posted here, I'm a little puzzled that the doctor would let you make the decision without more guidance, unless it really didn't matter much in terms of success rates.
I really wish your mom the best -- it's amazing what this technology can do when it works, and I hope your mom falls into that category.
--
(I don't think I can tell you anything about this that you don't know, and amateur medical expositions can be annoying or dangerous... I almost deleted the following, but decided to leave it in for others. Please take this disclaimer seriously: I'm not a doctor, and don't know what I'm talking about.)
I think that the big problem people have with these devices is that your brain tends to "unlearn" how to hear when information from your ears stops flowing into the brain. If your hearing is down for too long of a time, it's hard to bring it back.
I think that Limbaugh's spectucular success with his cochlear implant had something to do with how rapidly his hearing loss had come upon him, and how quickly he sought treatment.
But having said that, the extent of the changes and the rate at which they occur in your brain take place varies so much from one person to another that you can't make accurate predictions about what will happen. In particular, you shouldn't be discouraged if more time has passed. You just have to try it and see if it works.
My grandmother has sigificant hearing loss, although it's not the type that people who get cochlear implants have. She tried to avoid hearing aids for as long as she could, didn't like them, and didn't wear them often. Now she really needs them, and they don't work very well. She can function, but it's always hard.
Her ENT told me that the problem is in the brain "circuitry" -- she didn't forget how to hear all together (that's not what happens), but she is much worse at differentiating sounds than she used to be.
Everyone in my family, including me, had assued that her problems were coming from the technology -- that the hearing aids weren't doing a very good job, and that better technology would solve the problem. But the doctor said the problem was with the way her brain processes sounds.
I had assumed (naively, it turns out), that it ought to be possible to substantially improve hearing aids with better signal processing. I asked the doctor if it made sense to have a wireless hearing aid, with a mic and a speaker on it, that would communicate with a real, full blown computer, which could do almost anything you'd need.
He said that it would be possible to realize some improvements, but in general they wouldn't be worth the extra hassle of the external device. The real problems were in the brain's ability to differentiate sounds.
It's easy for geeks to think of your ears as providing a "line in" to the brain, or to think that if that line gets damaged, it ought to be possible to put in a patch cord that bypasses it. That's pretty much the way I thought about it. But it's more complicated than that.
library (Score:2)
Recommendations from a friend.. (Score:5, Informative)
There are two 'components' to a cochlear implant - generally characterised as 'the outside bits' and 'the inside bits'.
The outside bits are changed on a moderately regular basis as technology improves. The inside bits (which are implanted), obviously don't get changed all that much.
Her recommendation is to choose the technology that makes it easiest (and cheapest) to change the outside bits - as although there are minimal technical differences between the two options at the moment, if one is much easier to 'upgrade' than the other, you'll get much better service long term on that one.
Dunno about you.. but there's something wierd about the concept of booking your mum in for an upgrade...
My friend recommends having a look at the web site of the Australian National Acoustics Labs. They're a research arm of Australian Neuroservices, and have a fair bit of info on this sort of stuff.
Red.
Hearing Optional (Score:2)
There are times when I wish I could do that.
Ask Chris (Score:2, Informative)
Sera
Differences? Not a lot. (Score:5, Informative)
You say she's profoundly deaf. Since when? If a long time, she may not adapt well no matter how good the device. The less sophisticated may be good enough then.
If she's been deaf a long time, does she socialize with other deaf people? If so, be aware some of them look on implants as a kind of betrayal. Those whose first language was American Sign Language consider themselves a unique culture and consider their condition and method of communication to be equally good as any other. Some very vocal (pardon the pun) types become quite irrate if someone they know steps outside their culture by getting an implant. I don't claim to understand exactly, but I've observed it.
Technically, these two devices probably perform equally well. The Clarion has superior characteristics, but the difference may be measureable in the lab but not the ear. The Clarion has more channels, that is more different frequency bands, and so would probably produce more "natural" sound. (To think of channels, consider the slider switches on an equalizer on a stereo. Each handles a specific range of frequencies. The more sliders there are, the finer the divisions across the sound spectrum.)
As mentioned elsewhere, Rush Limbaugh has a Clarion. I know he's pleased with the results, and he's a professional communicator.
The Nucleus has a removeable magnet. This could be important should your mother ever need to have an MRI. With either device, she'll need to wear a medical alert bracelet saying she has some implanted metal. An MRI uses a large, powerful moving magnet. If you expose a piece of metal to the field it can turn into a little food processor blade spinning around where it ought not. Should she ever be sent to the emergency room unconscious, they'll need to know not to do this to her. The Nucleus will give them the ability to should she need it.
If I were getting one and they cost the same, I'd get the Clarion. In a given ear, the end result will probably be better with that device. However, the differences between ears and neural systems are so much grteater that this may hardly matter. It may be better than the ear can make use of. Think of stereo systems. An amplifier with
A last thought: learning or relearning to hear will require a lot of exercise in order for neural plasticity to do its job. That means exposure. Also, if she's been reading sign language, those whove; been communicating with her should continue to use it even though she may now be able to hear. The resulting associations will help her learn/relearn faster.
Feel free to check my
Re: Rush Limbaugh (Score:1, Troll)
Re: Rush Limbaugh (Score:2)
Mute, hardly.
Drug-addict felon, definitely.
Neuroscience? (Score:1)
Re:Neuroscience? (Score:2)
No, I work for dept. of psychiatry at Yale Medical School, and don't have anything to do with implants here. I used to work with research related to implants and language in general at NIH. Details in my journal.
Re:Differences? Not a lot. (Score:2)
My mom has been a teacher for the deaf for longer than I've been alive (although she does not have any hearing loss). Because of her I always take an interest in deafness-related stories, and have heard arguments from both sides of the debate on how cochlear implants and similar devices are a threat to deaf culture.
Re:Differences? Not a lot. (Score:3, Insightful)
I'm not deaf (small d, as in hearing loss), but I was a "terp", and before that hung out with Deaf (capital D, as in the culture) poeple and did ASL enough that they and I considered me to be Deaf.
"My understanding is that deaf culture revolves around the idea of deafness n
Re:Differences? Not a lot. (Score:1)
Thanks again. And I'll definatly ask her about "Egg train is a short name." =)
-Trillian
Re:Differences? Not a lot. (Score:1)
It would be wonderful if schools offered ASL just like a foreign language - sign would have been much more interesting and useful to me than the French I failed back in 8th grade... :-)
Re:Differences? Not a lot. (Score:2)
Some do. Last I knew (about 20 years ago) 14 US colleges allowed ASL to satisfy their foreign language requirement. At the time we were trying to get Purdue to do so. The hold up seemed to be that we didn't have a "native" ASL person to teach the second year. The head of the program was born to de
Re:Differences? Not a lot. (Score:2)
I usually call that "fucking off". Our cousins on the other side of the pond call it "trainspotting". I suppose my Grandmother would call it "wool-gathering", if pressed.
Re:Differences? Not a lot. (Score:1)
Let me fill in some details. She has been suffering from noticeable hearing loss for about twenty years. It has progressed to a 'profound' deafness in the last five or so years. She's used all manner of hearing aids, but they have never worked as well as her own methods of coping, such as lip reading, and filling in the blanks by context. She's become quite adept at this. Her comprehens
Informed Consent (Score:1)
I'd be asking them, not a bunch of people whose advice is worth less that what you paid for it. I'd ask them because that's their job.
Wait for the singularity? (Score:1)
Rumours on non-Australian devices...? (Score:2)
Don't quote me, but I think there was some risk of infection.
To find where / when to look, check the stock values of each company... one dropped after the problems came to light & - of course - the Aussie co. became "the only game in town" soon afterwards.
There may have been some details on the (Aussie) ABC's "Health Report" (radio program); to see,
search:
abc.net.au/rn & drill down to the Heal
Some makers' gear may incr. risk of Meningitis? (Score:2)
"cochlear implant" risk
eg, preferably searching for items in Australia.
"July 26 2002
Advanced Bionics Corp, one of three manufacturers
of cochlear implants, says their customers should
get vaccinations to protect them against meningitis
and other similar diseases.
Australian manufacturer Cochlear Ltd, the leading manufacturer of the inner-ear devices, has sold over 40,000 devices in the past 20 years.
The US Food and Drug Administration yesterday said 25 adults and children with cochlea
They're pretty much the same company (Score:1)
My wife has an older one (Score:2, Informative)
First, dumb luck has a great deal to do with how well her implant works. People who can use it 100% and for things like talking on the phone are rare. Most people still need to rely on some degree of lip reading.
Ask the doc if tech specs on either unit have a clear cut winner. I seriously doubt this is the case. The more important part is going to be after surgery support. What doctors does she like, where are they located relative to her home, and what
what to ask the doctor (Score:2)
Sound quality matters as much as hearing a sound (Score:2)
cochlear implant simulator (Score:1)
Duh it's obvious (Score:2)
Not a big difference. Pick what's easier to use. (Score:3, Informative)
2. The doctor is not a quack. A lot of surgeons give patients a choice with cochlear implants because neither (those two or the 3rd FDA approved device) has been shown in research to consistently outperform the other. I would guess she was told this at her appoitnment. Some people will do poorly with an implant, some will do well. Both these devices have people in all ranges of performance.
3. When you get right down to it, these devices are extremely similar. The companies have developed parallel products and borrowed ideas from eachother. I would find it hard to choose between them. Whichever product you and she chooses will be fine. You can't make a bad or wrong choice with these two.
4. In the end, I would make the choice based on which one is easier for her to use on an everyday basis. Do the controls on the external processor make sense to her? Can she easily manipulate them? Can she easily change and/or recharge the batteries? It might be beneficial for you both to speak to the cochlear implant team together, and she can take another look at the external products.
Christine E. (posting with my husband's log in)
piontkofsky@yahoo.com
Other considerations. battery life and cost (Score:2, Informative)
My wife... (Score:1)
She's had the implant since she was very young. As you can imagine, the technology in a little box almost 20 years old is a little aged. Also, we've run into frequent problems with her current system, mostly involving the durability of the devices she has to wear. And they're not cheap either... just thank god my insurance covers most of it.
About 2 years ago we began the process of getting her
Get the best info on a CI from someone who has one (Score:1)