Electric Acoustic Stimulation

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EASElectric Acoustic Stimulation

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The human cochlea is shaped like a spiral staircase. Winding upward, the spirals become narrower and narrower as they reach the top of the snail shell shaped structure. This delicate structure is lined with nerve cells, each responsible for processing sound information for many different frequencies, from high to low.

If you were to travel within this spiral, from the bottom to the top, you would first pass the nerve fibres responsible for processing high frequency tones and as you near the top, the nerve fibres responsible for processing the low frequency tones.

For individuals with partial deafness, nerve cells that process the high frequencies in the lower portion of the cochlea are not functioning correctly. But because some of the delicate nerve cells located toward the top of the spiral may be impaired or only partially impaired, these individuals often have residual hearing in the low frequencies.

EAS, the world’s first solution to treat partial deafness, is now available to adults and children of all ages. The EAS hearing implant system takes a two part approach to improving hearing in the damaged and undamaged portion of the cochlea. First, a cochlear implant with an atraumatic and flexible electrode electrically stimulates the nerve cells responsible for processing the high frequencies. Second, acoustic amplification is used to stimulate nerve cells responsible for processing low frequency tones.

EAS Hearing Implant System

Welcome

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A Company Defined by Excellence . . . . . . . . . . . . . . . . 3

From Research to Development . . . . . . . . . . . . . . . . . 4

About Partial Deafness . . . . . . . . . . . . . . . . . . . . . . . . 7

Combination of Two Technologies . . . . . . . . . . . . . . . . 9

EAS — The 2nd Generation . . . . . . . . . . . . . . . . . . . . 12

DUET 2 Audio Processor . . . . . . . . . . . . . . . . . . . . . . 12

The Science Behind ASM . . . . . . . . . . . . . . . . . . . . . . 17

CONCERTO Cochlear Implant . . . . . . . . . . . . . . . . . . . 18

FLEX24 Electrode Array . . . . . . . . . . . . . . . . . . . . . . . . 19

Every Step of the Way . . . . . . . . . . . . . . . . . . . . . . . . 20

A Visionary Company . . . . . . . . . . . . . . . . . . . . . . . . . 22

Innovation & Development . . . . . . . . . . . . . . . . . . . . 24

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MED-EL

A Company Defined By Excellence

If you or someone you care about is affected by partial deafness, MED-EL welcomes you to learn more about Electric Acoustic Stimulation and the difference it can make in the lives of individuals affected by this condition.

MED-EL is a company of people unwilling to settle for less than the best. We define “best” according to four major criteria: industry leading technology, fast, courteous and consistent customer service response, state-of-the-art research and development, and worldwide leadership in educational and rehabilitation materials.

When the scientists and engineers who founded MED-EL began researching cochlear implant technology in the 1970s, they made a commitment to reinvest a substantial percentage of the company’s revenue in research and development. We’ve kept that promise for more than 20 years.

Past and present research has led to innovations such as bilateral cochlear implantation and the Vibrant Soundbridge Middle Ear Implant System. Research efforts contribute not only to advances in technology, but also to expanding candidacy criteria and improvements in medical reimbursement.

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10 Years of EAS

From Research to Development

The concept of combined Electric Acoustic Stimulation in the same ear was first realised in 1999 by Prof. Christoph von Ilberg who was able to successfully preserve a high degree of residual hearing during cochlear implant surgery. Von Ilberg published the first article about this approach in the same year. A hearing aid was used in addition to a MED-EL cochlear implant. Because the low frequency residual hearing was preserved during surgery, the user benefited from both acoustic and electric stimulation.

The hearing aid amplified the low frequency sounds while the CI provided electric stimulation in the high frequencies. The combination of both electric and acoustic stimulation had a synergistic effect allowing the recipient to experience excellent sound and speech perception, particularly in noise.

The results of this breakthrough combining acoustic and electric stimulation led to the creation of the world’s first integrated EAS system in 2005.

Electric and Acoustic, Making Beautiful Music Together The first incarnation of acoustic and electric stimulation used two separate devices, one to perform acoustic amplification and the other to perform electric stimulation. In 2005, MED-EL introduced the DUET processor, combing electric and acoustic stimulation in one device for the very first time.

Today, the 2nd generation EAS Hearing Implant System, now featuring the DUET 2, represents an additional milestone in the development of EAS. Signal processing is still strictly separated, preserving the synergistic effect between electric and acoustic stimuli.

Sounds are received by a single microphone in order to avoid directional interference. High and low frequencies are processed independently from one another with a dedicated processor for acoustic and electric stimulation. This allows for outstanding sound perception, even in the most difficult listening situations.

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About

Partial Deafness

Partial Deafness is defined as a mild to moderate low frequency sensorineural hearing loss sloping to a profound hearing loss in the higher frequencies. People with partial deafness are unable to hear high frequency sounds such as the singing of a bird, the ringing of a doorbell or the letters f, s, or k. They are, however, to varying degrees, able to hear low frequency sounds such as the whirring of a car motor or the beating of a drum.

People with partial deafness are not classic candidates for cochlear implantation. Many of these individuals use acoustic amplification provided by hearing aids, but with unsatisfactory results as they are still unable to hear the high frequency sounds. By electrically stimulating the high frequency region of the cochlea in combination with acoustic amplification for the low frequencies, the EAS Hearing Implant System can offer individuals with partial deafness a rich, detailed and satisfying hearing experience that includes the range of frequencies from low to high.

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Flex24 Electrode Array

Cochlea

DUET 2 Audio Processor

Microphone

Ear Hook with Output of Acoustic Amplification

Ear Mould

Coil

Auditory Nerve

Implant

EAS

Combination of Two Technologies

EAS is the combination of two technologies, each responsible for a specific frequency range. Here is how it works:

Cochlear Implant A cochlear implant converts everyday sounds into coded electrical pulses. These pulses stimulate the auditory nerve. The brain interprets these signals as sound.

1 High frequency sounds are picked up by the microphone of the DUET 2 Audio Processor and converted into a special code.

2 This code is sent to the coil and is transmitted across the skin.

3 The implant interprets the code and sends electrical pulses to the electrodes in the cochlea.

4 The auditory nerve relays this signal to the brain.

Acoustic Amplification Acoustic amplification turns up the volume on the sounds that the cochlea is still able to hear. For EAS, only the low frequencies are amplified.

1 Low frequency sounds are picked up by the microphone and are digitally processed.

2 Sounds are amplified by the loudspeaker located in the ear hook and relayed via the ear mould to the ear canal.

3 Sounds reach the undamaged areas of the cochlea responsible for processing low frequency sound.

4 The auditory nerve relays the signals to the brain.

Ossicles

Ear Drum

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“The difference from DUET to DUET 2 is like first enjoying a good boombox to listen to music. But then you take it to a really expensive HI-FI Stereo and play the same music. The quality just goes up.”

Maja C. | DUET 2 user

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EAS

The 2nd Generation

MED-EL is proud to offer the 2nd generation of the unique EAS Hearing Implant System for combined electric and acoustic stimulation. The system consists of both an internal and an external component.

The internal component, the new CONCERTO titanium cochlear implant, is implanted underneath the skin. CONCERTO supports MED-EL’s I100 processing technology and is available with MED-EL’s unique FLEX24 electrode array, designed especially for the preservation of residual hearing.

The external component, the DUET 2 Audio Processor, represents the 2nd generation of EAS hearing implant processors and is based on the proven design of the OPUS processors.

The processing of electric and acoustic stimulation are strictly separate for an enhanced hearing experience.

The DUET 2 Audio Processor comes with a FineTuner remote control unit giving you continuous and uninterrupted hearing. Equipped with an integrated telecoil, DUET 2 allows users further access to the world of sound.

Atraumatic FLEX24 Electrode Array

Energy Effificient D Coil

CONCERTO Cochlear Implant

FineTuner Remote Control


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The Difference is in the Details


Comfort and Reliability

Hear Your Best The DUET 2 Audio Processor has a number of features that allow users to comfortably count on their audio processor week after week and year after year.Features like SoundGuard continuously self-monitor all programmed data against possible inconsistencies, e.g., static electricity. If a problem is detected, SoundGuard stops stimulation automatically.

Convenience at Your Fingertips As setting changes are made with the FineTuner remote control, the DUET 2 provides corresponding acoustic signals. These signals confirm that setting changes have been made.

Battery Life Indicators For users concerned with facing a sudden loss of battery power, the Private Alert function provides an acoustic warning signal to alert the user to change batteries.

In addition to audio signals, the DUET 2 also provides visual indications in the form of a Status Light. Like the acoustic signals, the status light blinks to indicate low battery life and when setting changes have been made.

These features are designed not only to keep the processor working correctly, but also to reassure users that their DUET 2 is working reliably to provide daily access to the world of sound.

On-the-go adjustment with FineTuner

Up to 7 days of battery life from a single set of batteries

Strict separation of electric and acoustic stimulation processing

Telecoil and audio input connectability

Compact, ergonomic,

and lightweight design

Fastest, most effective

sound coding strategies

Powerful future-ready

electronics

Setting changes are made

without removing the

processor from the ear

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Experience High Performance

More PowerThe proven OPUS 2 control unit is the heart of the DUET 2 Audio Processor. Sophisticated I100 electronics support high-definition CIS signal processing to provide the user with a clearer, more detailed hearing experience in all listening situations.

The DUET 2 processor utilises dedicated parallel processing for both acoustic and electric signals. Dedicated processing allows each signal to be optimised for maximum efficiency.

Improved Acoustic PerformanceAcoustic amplification has been raised to over 43 dB and the acoustic frequency range has been optimised to 125–1700 Hz. This translates into a combined overall hearing range of 125–8500 Hz.

Power EfficiencyMED-EL’s patented power-efficient technology provides an exceptionally long battery life. Users enjoy up to 7 days of use with a single set of batteries.

Upgrade Today By upgrading to the new D Coil, MED-EL’s newest and thinnest coil design, all current users of the DUET 2 Audio Processor can boost their energy-efficiency up to 7 days of use! More energy efficiency means fewer batteries purchased, leading to less waste, less hassle and significantly lower cost.

On-the-Go AdjustmentThe DUET 2 is now available with an elegant switch free design. All audio processor setting changes are made with the FineTuner remote control unit. This unique, credit card sized remote control unit allows users to make adjustments to an audio processor’s volume and sensitivity without removing it from the ear. This means that hearing is continuous and uninterrupted.

Other processors use an on-the-processor switch adjustment system that requires the user to first remove the processor from the ear and to make fine adjustments to volume or sensitivity using small switches or knobs. The FineTuner alternative allows users to make adjustments easily and precisely, particularly advantageous for people who have difficulties seeing or using small controls.

For bilaterally implanted users, a single FineTuner remote control unit can be used to adjust both processors independently.

Custom-Made Ear MouldThe DUET 2 features an ear mould that is similar to that of conventional hearing aids. It is customised and sits snugly in your ear. Because it contains no electronic parts, the ear mould can easily be exchanged and new ones can be easily created. A customer’s existing ear mould from a previous DUET model or from hearing aids can be used for the DUET 2 Audio Processor.

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EAS

Connect with the World of Sound

Daily access to a world of sound may sometimes require connecting to external assistive listening devices or portable music systems. Whether the user wishes to connect with someone else over the telephone or privately listen to music on a train, the DUET 2 Audio Processor offers the flexibility to connect anywhere.

Sometimes, the user may want to listen to his or her personal soundtrack on an iPod or privately experience a broadcast of a favourite singer. Because DUET 2 features an audio input jack, listening to a favourite news programme on the radio or a favourite song on an MP3 player is easier than ever before.

With the DUET 2 Audio Processor, connecting to external listening devices has never been more convenient. Featuring an integrated telecoil, or miniature receiver, the DUET 2 can easily be used with a variety of telephones, public sound systems and loop systems. Users can connect to direct-link assistive listening devices (ALD) supporting FM or Bluetooth transmission for unsurpassed wireless connectivity.

For a complete list of compatible devices, please visit www.medel.com.

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The Science Behind

Automatic Sound Management

For cochlear implant sound processing to be effective, it is critical to compress the large (120 dB) acoustical dynamic range of normal hearing into an acceptable range for electrical stimulation (30 dB). To overcome this challenge, all MED-EL audio processors make use of the front-end processing strategy known as Automatic Sound Management (ASM). ASM consists of a wide Input Dynamic Range (IDR) and a dual stage Automatic Gain Control (AGC).

Input Dynamic Range Input Dynamic Range is one of the most important features in audio processor technology. Studies show that only a wide IDR allows for adequate speech perception in noise. 1,2 All MED-EL behind-the-ear processors feature an Input Dynamic Range of 75 dB. Therefore, all signals within the range of 25 dB and 100 dB SPL are processed. The Automatically Adaptive Sound Window further divides the entire Input Dynamic Range and automatically detects the range of 55 dB (where most incoming sounds occur) within the entire Input Dynamic Range. This allows for fine and detailed processing (i.e. compression) of an initially wide range.

Dual Stage Automatic Gain ControlMED-EL audio processors also feature a dual stage Automatic Gain Control. 3 This technology allows users to hear a very loud sound, such as an airplane, or even a very quiet sound, such as a whisper, at a comfortable volume level. Dual stage also ensures that a sudden increase in loudness does not result in a uncomfortable change in volume for the user. Similarly, dual stage also prevents a sudden soft sound following an initial loud signal. Therefore, sounds that users hear are always amplified to maximise speech comprehension.

Other processors require users to frequently remove the processor from the ear in order to make adjustments based on the environment and level of background noise. Users of processors featuring Automatic Sound Management can rest assured these changes are being made automatically. This is particularly important for infants or small children who may not be able to recognise changes in their surroundings. Parents would be required to make setting changes to their child’s processor in order to receive the best possible benefit.

With Automatic Sound Management featuring a wide Input Dynamic Range and a dual stage AGC, users can experience the optimal hearing experience whether in an airport, a concert hall, a business meeting, a restaurant or simply at home.

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1 Spahr, Dorman, Loiselle (2007): Performance of Patients Using Different Cochlear Implant Systems: Effects of Input Dynamic Range.

2 Haumann et. al., 8th International Conference of the Eurepean Society of Paediatric Otorhinolaryngology, Budapest, 8-11 June 2008: Influence of the Front End Processing on Speech Perception with Cochlear Implants of Various Manufacturers.

3 Stöbich, Zierhofer, Hochmair (1999): Influence of Automatic Gain Control Parameter Settings on Speech Understanding of Cochlear Implant Users Employing the Continuous Interleaved Sampling Strategy.

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Designed for minimally

invasive surgeries

Featuring an especially

strong electrode lead and

titanium housing

Optimised to communicate

with the DUET 2 Audio

Processor

The World’s Smallest Titanium CI

CONCERTO Cochlear Implant

Also available with pins for faster surgical fixation

Soft, flexible and atraumatic electrode array for the preservation of residual hearing

The smallest titanium cochlear implant available

4.5 mm

25% thinner than the previous implant generation

25%

Performance You Can Depend On

Tough, impact resistant and robust enough to respond to the needs of daily use, CONCERTO is reliable and powerful, relaying information to the electrode contacts in the cochlea at high speed and with great accuracy. Engineered according to the strictest safety standards and built for longevity, CONCERTO is the world’s smallest and lightest titanium cochlear implant.

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FLEX24 Electrode Array

The structure of the cochlea must be handled with care during surgery. Though the cochlea is highly specialised, trauma to any part of the cochlea can result in a loss of residual hearing. For this reason, MED-EL has designed the especially soft FLEX24 electrode featuring an atraumatic front end with increased mechanical flexibility. This special design in combination with unique wave-shaped wires increases the softness and flexibility of the electrode, key factors in the preservation of residual hearing vital to individuals with partial deafness.

Both cochlear implant choices are available with the FLEX24 electrode which is designed to be inserted no deeper than the basal cochlear turn.

Routine, Minimally Invasive SurgeryMED-EL Hearing Solutions have been implanted in individuals for over 30 years. Today, cochlear implantation has become a routine surgery. It is estimated that over one hundred thousand people have been implanted worldwide. MED-EL produces the most compact cochlear implant housing in the industry which requires a minimally invasive surgical procedure.

Featuring MED-EL’s Unique Atraumatic Tip and Wave-shaped Wires for the Preservation of Residual Hearing

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Education, Rehabilitation, Support

Every Step of the Way

Your quality of life is the foundation of our success. If you or someone you care about is considering an implantable hearing solution, it is important to consider the entire process. At MED-EL, we understand that providing the best possible hearing implant solution is only one essential element in restoring hearing. Learning to use a cochlear implant requires readiness, motivation and realistic expectations. MED-EL experts are there to guide you long after the operation offering a wide variety of materials to support you along your hearing journey.

BRIDGE to better communication, MED-EL’s comprehensive support programme, offers more support materials than any other hearing implant company. Developed with leading educational and hearing specialists from around the world, this programme consists of a wide variety of information and materials to meet the needs of adults, teens and children as well as their parents, audiologists, speech therapists and teachers.

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“What I have noticed since my wife received the new DUET 2, is that we can have conversations when we are not in the same room. Many years back I had to get her attention and tap her on the shoulder. We are getting to the stage where talking between rooms is really possible. Little differences really add up to something much better.”

Marek W. | Husband of Katarzyna

“The most difficult thing for me has always been hearing with background noise. But even on the first day after being fitted with the new DUET 2 processor, my hearing in speech and noise improved so noticeably that I thought, this is a big improvement.”

Katarzyna W. | DUET 2 user

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Since MED-EL’s founders developed one of the world’s first cochlear implants in 1975, a strong research tradition has continued to fuel the development of technologically advanced hearing solutions. MED-EL offers implantable solutions to treat different degrees of hearing loss, including cochlear and middle ear implants, combined Electric Acoustic Stimulation and Auditory Brainstem Implants (ABI).

Cochlear implant development started by MED-EL founders Ingeborg and Erwin Hochmair.

Implantation of the world‘s first hybrid multi-channel cochlear implant in Vienna.

Introduction of the COMFORT cochlear implant.

MED-EL hires its first employees. MED-EL launches the world’s first BTE (behind-the-ear) speech processor.

Introduction of the COMBI 40, the world’s first multi-channel high-rate cochlear implant.

Introduction of the CIS LINK system.

MED-EL

A Visionary Company

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Introduction of the COMBI 40+, the thinnest cochlear implant available.

Launch of the TEMPO+ behind-the-ear (BTE) speech processor.

Acquisition of the Vibrant Soundbridge®, the first implantable middle ear hearing device for mild-to-severe sensorineural hearing loss.

MED-EL launches the PULSAR cochlear implant, providing future-ready electronics in a ceramic housing.

Introduction of the MED-EL DUET EAS™ Speech Processor in Europe, the first hearing implant system worldwide to integrate cochlear implant audio processing and acoustic amplification in one compact device.

MED-EL launches the OPUS family of speech processors. The SONATA cochlear implant, with new small titanium housing, and the FLEX electrode arrays for all implant types are introduced.

Approval of EAS, the ideal solution for partial deafness, and the Vibrant Soundbridge® for conductive and mixed hearing losses in Europe. Launch of the DaCapo rechargeable battery system.

EAS in the 2nd generation. European launch of the DUET 2 Audio Processor. Amadé, the new audioprocessor of the Vibrant Soundbridge is introduced in Europe.

New MAESTRO™ system introduced in Europe including the CONCERTO Cochlear Implant and MAESTRO System Software 4.0 featuring the new FS4 and FS4-p coding strategies.

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MED-EL

Innovation & Development

MED-EL offers the broadest product range in the cochlear implant industry to treat the various degrees and causes of hearing loss.

Today, our research efforts offer great promise for the future of bilateral implantation, completely implantable devices and drug delivery methods for regeneration of nerve cells. MED-EL is currently sponsoring a great number of on-going research studies to improve the lives of individuals with hearing loss.

EAS™

Hearing Implant System Combined stimulation through acoustic amplification and a cochlear implant in the same ear is intended for individuals with residual hearing in the low frequencies and is designed to provide improved performance over a hearing aid or cochlear implant in isolation.

MAESTRO™ Cochlear Implant SystemInnovative, modular design to address individual user’s needs. The MAESTRO CI System consists of a cochlear implant, flexible electrodes, audio processor and software for an accurate fitting and natural hearing experience.

Vibrant Soundbridge®

Middle Ear Implant System The Vibrant Soundbridge (VSB) is designed to treat individuals with mild to severe sensorineural hearing loss as well as conductive and mixed hearing losses.

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Electric Acoustic Stimulation