Cochlear Ltd. Implants for Moderate to Profound Hearing Loss

Cochlear Ltd. is the world leader in hearing implants. Founded in Australia in 1981, it was among the pioneers who commercialized cochlear implants to restore hearing for people with severe-to-profound sensorineural hearing loss. Cochlear is also a leader in bone-anchored hearing implants for people with single-sided deafness or conductive hearing loss:

• For people with sensorineural hearing loss – caused by damage to the hearing cells in the inner ear – the company’s cochlear implants process external sound, bypass the damaged cells, and deliver it to the auditory nerve and brain.
• For people with conductive hearing loss – when the hearing cells are healthy but organs in the outer or middle ear are not working properly – Cochlear’s bone conduction implants transmit sound waves through the skull directly to healthy hearing cells in the inner ear.

Cochlear’s products include the Nucleus and Kanso cochlear implant systems, Nucleus Hybrid electro-acoustic cochlear implants, and the Baha and Osia 2 bone conduction implants.

In 2023, Oticon Medical sought to sell its Ponto bone conduction implant and Neuro Zti cochlear implant to Cochlear Ltd. But the sale of the Ponto system was objected to by the anticompetitive authorities in several countries and blocked by the UK; it's now expected that Cochlear will take on the Neuro Zti cochlear implant sometime in the first half of 2024.

Cochlear Ltd. product milestones

• Nov 2022 - Nucleus 8 Cochlear Implant
• July 2021 - Baha 6 Max Bone Conduction Implant
• July 2020 - Kanso 2 Sound Processor
• Dec 2019 - Osia 2 Bone Conduction Implant
• July 2017 – Nucleus 7 Cochlear Implant System
• Sept 2016 – Kanso Off-Ear Cochlear Implant Processor
• April 2015 – Baha 5 Bone Conduction Implant
• Sept 2014 – Nucleus 6 Cochlear Implant System
• March 2014 – Nucleus Hybrid Cochlear Implant

Implant and sound processing technologies

Implant systems integrate a complex combination of technologies. Cochlear implants have external sound processors and internal implantable electrodes that deliver sound to the auditory nerve and brain. Bone-conduction implants, sometimes known as bone-anchored hearing aids, collect sound waves from the air and transmit them through vibrations in the skull that reach the hearing nerves in the inner ear.

Sound processing technology

Cochlear’s sound processing technology works with both its cochlear implants and its bone-conduction implants. The external sound processors for the cochlear implants look a lot like large hearing aids. But instead of amplifying sound, they convert it into digital signals that travel through an electrode to the inner ear. A powerful chipset drives advanced sound processing software that’s tuned to help users understand speech.

Cochlear has improved its sound processing technologies in lockstep with advances made by high-end hearing aid manufacturers. Its latest improvements for the Nucleus 8 (N8) are designed to provide easier management of program settings, better understanding of speech in challenging listening environments, and feature a reduction in size and weight with a new ergonomic design:

• SmartSound iQ 2 enables dual microphones to capture speech and work together to filter out background noise.
• SCAN 2 analyzes your surroundings with greater accuracy (compared to the original SCAN) and identifies the listening environment; this enables SmartSound IQ 2 to automatically optimize the sound and adjust the program setting for that scene.
• ForwardFocus, which has also been improved in the N8, activates directional hearing with your Cochlear smartphone app when you want to decrease noise coming from behind you and focus on the face-to-face conversation in front of you. With the N8, you can have the option for this to be an automatic function.
• Beam technology can further reduce noise from various directions in real time.
• IP68 is the "gold standard" for hearing devices against moisture and dust, and the N8 with rechargeable battery achieves this ingress protection rating.

Cochlear also offers a smartphone app that makes it easy to change programs, adjust volume, bass and treble, and check battery life of the external sound processor without carrying a separate remote control.

Implantable electrode technology

Cochlear has stayed at the cutting edge of electrode implant technologies since its inception. It has constantly improved its electrodes in significant ways:

• It has made the electrodes thinner and easier to insert into the cochlea to minimize damage to the delicate internal structures of the inner ear.
• It has constantly improved surgeons’ ability to place the electrode precisely where nerve stimulation will be most effective to provide access to a full range of sound.
• And in 2014 it introduced the first hybrid electrode, providing electronic stimulation only at high frequencies while enabling patients to continue using their natural hearing at low frequencies.

Cochlear’s implanted electrodes are highly reliable and are designed to be used for life. And Cochlear makes sure new generations of external sound processors are compatible with them, so patients get the benefit of new digital technologies as they become available.

At only 3.9 mm in thickness, Cochlear’s Profile series of implantable electrodes fit snugly under the scalp on the skull. And Cochlear’s Profile Plus electrodes address the problem of magnets in their implants making it difficult for patients to undergo MRI tests, enabling access to MRI’s at 1.5 Tesla and 3.0 Tesla. The magnet can also be removed and replace in outpatient surgery if necessary.

Wireless connectivity

For its cochlear implants and bone-conduction implants, Cochlear provides advanced connectivity with both hearing aids and smartphones.

• It was the first implant maker to provide wireless Made-for-iPhone audio streaming directly to cochlear implant and bone-conduction processors, without the need for an intermediate streaming accessory.
• In late 2022, the N8 processor now incorporates Bluetooth (BT) Classic and the newer Bluetooth Low Energy (LE) protocols, making it ready for future Auracast broadcasting streaming.
• In 2019, through a technology-sharing alliance with top-five hearing aid maker GN ReSound, Cochlear implemented the ASHA protocol (Audio Streaming for Hearing Aids utilizing Bluetooth Low Energy technology) to enable direct audio streaming from Android smartphones.
• The ReSound alliance also enables Cochlear to offer bimodal solutions, with sound processing balanced between a Cochlear sound processor on one ear and a ReSound hearing aid on the other ear.
• And since 2014, it has been offering 2.4 GHz wireless audio connectivity through streaming accessories, including remote Mini Microphones, a TV Streamer, and a Phone Clip.

Bimodal hearing technology

Through its alliance with GN ReSound, one of the world’s top-five hearing aid manufacturers, Cochlear also offers bimodal solutions — coordinating sound processing between a hearing aid in one ear and a cochlear implant in the other. Your ReSound hearing aid can work simultaneously with the same wireless accessories used with your cochlear implant.

Nucleus cochlear implants

Cochlear integrates all the components required for cochlear implant systems. Its Nucleus cochlear implants include an internal electrode array and an external sound processor.

• The internal electrode array is implanted on the skull under the scalp, with a filament that extends through the skull into the cochlea in the inner ear. The electrode generates the same kinds of electrical signals that the dead hearing cells previously transmitted to the auditory nerve and brain.
• The external sound processor has multiple microphones and is connected to a headpiece with a magnet that couples with the electrode array under the scalp. It looks similar to a large, behind-the-ear hearing aid, but instead of amplifying sound waves, it converts them into electrical pulses that the implant sends to the auditory nerve.

The Cochlear Nucleus 8 system, introduced in November 2022, is the successor of the Cochlear Nucleus 7, which was the first Made-for-iPhone cochlear implant. Like its predecessor, it provides wireless audio streaming directly from Android phones that support the ASHA (audio streaming for hearing aids) protocol and Apple iOS 15 or later. Nucleus 8 benefits include:

• Superior sound processing, with automatic adjustments to various listening environments via Cochlear’s SmartSound IQ 2 with SCAN 2.
• Hands-free audio streaming, with Cochlear’s 2.4 GHz True Wireless streaming accessories.
• Smartphone connectivity, including wireless streaming of phone calls and music from Apple iPhones and compatible Android phones, without the need for an intermediary streaming accessory, and has added Bluetooth LE Audio making it ready for Auracast, when available.

Cochlear says the improved ergonomic design of the N8 Behind-the-Ear (BTE) sound processor, makes it smaller and lighter, while changing how the device sits on the ear. The company boasts the N8 sound processor is over 30% smaller (measured with a medium earhook and a compact battery) and 34% lighter than the N6—although the N7 is the previous generation of processors, not the N6. However, when comparing the length, width, and depth measurements of the N7 to the N8, the overall size reduction is approximately 5.5%, and the weight reduction is about 13%, making the N8 one of the smallest—if not the smallest—BTE sound processors on the market.

This video, produced by Cochlear Ltd., explains some of the key improvements in the Cochlear Nucleus 8 sound processor, including its smaller and more ergonomic design, better connectivity, and increased hearing performance. Closed captions are available on this video. If you are using a mobile phone, please enable captions clicking on the gear icon.

Kanso 2 cochlear implant sound processor

For patients who don’t want a sound processor sitting on their ear with a wire extending to a headpiece linked to the implant, Cochlear puts all the sound processing in a standalone Kanso 2 cochlear implant headpiece. Cochlear says Kanso is the smallest and lightest off-the-ear sound processor available with two microphones.

The Kanso 2 Sound Processor, which comes in a range of eight hair-matching colors, has an all-in-one design, with no cables and nothing on the ear to worry about. It magnetically attaches to the implant sitting under the scalp, collecting and transmitting the digitally encoded sound to the implant electrode through magnetic induction.

Kanso 2 offers many of the same benefits as Cochlear's behind-the-ear Nucleus 7 Sound Processor, including direct streaming from compatible Apple or Android™ devices, dual microphones, wireless accessory compatibility, water and dust protection, and signature Cochlear features like SmartSound® iQ (with SCAN) and ForwardFocus, for improved hearing in noisy situations.

Nucleus Hybrid implant system

The Nucleus Hybrid System amplifies the low-pitched hearing a person still has while restoring access to high-pitched hearing that’s been lost. It combines acoustic amplification of low frequencies with the electrical stimulation of high frequencies in one device.

Cochlear’s hybrid hearing system combines two technologies. The first is the same kind of acoustic amplification found in a hearing aid. An acoustic component attached to the end of the Nucleus 7 Sound Processor amplifies the low-frequency natural hearing you may retain after cochlear implant surgery. At the same time, the hybrid sound processor delivers high-frequency digitally encoded sound waves through a special electrode designed to preserve low-frequency hearing.

Baha bone-conduction hearing systems

Cochlear’s Baha Bone Conduction Implant System is a solution for conductive hearing loss, which occurs when sound waves fail to reach the healthy hearing cells in the cochlea. When organs in the outer or middle ear are damaged or deformed, they sometimes fail to transmit sound waves from the air to the inner ear. A bone-anchored implant can bypass the outer and middle ear organs by transmitting sound waves through the skull directly to the cochlea in the inner ear.

The Baha system is also for people with single-sided deafness (SSD). By placing the implant on the side of the head with no hearing and having it transmit sound through the skull to the ear with healthy hearing cells, it enables the 360-degree perception of sound.

How does Baha work? Your skull bone is a very efficient conductor of sound waves to the hearing cells in the cochlea. A bone-conduction hearing system collects sound with an external processor and converts the sound waves into vibrations that travel through the skull to the cochlea in the inner ear. When the hearing cells in the cochlea are working well, they convert the vibrations into the electrical pulses carried by the auditory nerve to the brain, which recognizes the pulses as sound.

This video, produced by Cochlear, provides an overview of the Baha 6 sound processor. Closed captions are available on this video. If you are using a mobile phone, please enable captions clicking on the gear icon.

The Baha^® 6 Max Sound Processor, released in 2021, is the newest bone anchored hearing solutions speech processor from Cochlear and will fit up to a 55 dB HL (Hearing Level as shown on your audiogram) sensorineural hearing loss (SNHL). It replaces the Baha 5, introduced in 2015, and Baha 5 Power. Cochlear continues to offer the Baha 5 SuperPower Sound Processor which, although an older generation, can accommodate up to a 65 dB HL and may be a better option for those with more significant hearing loss.

Baha 6 offers several upgrades over its predecessor, including the new Xidium chip platform that gives it faster processing speeds, increased frequency range, and the ability to stream both Apple and Android devices. It also has an IP68 rating, which is the industry standard for moisture and debris resistance. The LowPro™ coupling system—the connection point between the processor and the abutment or magnet—also lessens the implant projection and allows it to sit closer to the head, thus improving its cosmetics.

Osia 2 bone conduction implant system

Like Baha, the Osia^® 2 bone conduction implant system is also designed for people with conductive or mixed hearing loss or those with single-sided deafness (SSD), as well where a traditional air-conduction hearing aid won't work well (e.g., chronic ear infections, malformation, etc.). However, the active implant component of the Osia 2 sits entirely underneath the skin; in other words, no abutment protrudes from the head, and the processing unit affixes to the implanted unit via a magnet.

Osia 2 also features a smaller, lightweight sound processor. Unlike the Baha system which uses an electromagnetic mechanical system to drive the vibrations (much like a speaker system in a stereo), Osia 2 utilizes a piezoelectric transducer to vibrate the implant. The system is designed to provide more stability and make it less prone to acoustic feedback (squeal). Being smaller, it also can be located closer and more in line with the ear opening, providing better cosmetics.

Osia 2 is Apple MFi compatible, but you need an accessory to connect to most Android devices and it does not provide hands-free calling. It has a dust and moisture rating of IP57 which is less than Baha 6, but the Aqua+ accessory bumps it up to IP68.

Implant accessories

Cochlear’s True Wireless accessories connect to cochlear implant and Baha sound processors using Bluetooth technology. They are compatible with the Nucleus 7 and Nucleus 6 sound processors, the Kanso 2 sound processor, and the Baha 5 sound processors.

Remote wireless mics

The Cochlear Mini Microphone 2 and 2+ extend the hearing range of Cochlear’s sound processors and improve comprehension of speech in challenging listening situations. By optimizing signal-to-noise ratio in public settings or for one-on-one conversations, the wireless clip-on microphones transmit speech and sound directly to the sound processor.

• Mini Microphone 2 has a range of up to 80 feet with a clear line of site. Cochlear says it’s the smallest wireless microphone option for an implant sound processor. It has a directional microphone that helps you understand speech in noise, and its rechargeable battery operates up to 10 hours before recharging.
• Mini Microphone 2+ is slightly larger and more powerful but still fits snugly in your pocket or clips to your collar; it has an omnidirectional microphone for use in groups or on a conference table, and its rechargeable battery delivers 11 hours of service between charges.

TV streamer

The Cochlear Wireless TV Streamer sends stereo sound from a TV or other audio device directly to one or both sound processors. 2.4 GHz wireless technology also lets you connect it to multiple computers, music players and other audio devices.

Phone Clip

The Cochlear Phone Clip enables wireless streaming of phone calls and music from your smartphone to your implant processor. It’s small enough to clip to your clothing or keep in your handbag or pocket.

Smartphone app

The Nucleus Smart App works with the Cochlear Wireless Phone Clip to adjust the sound processor settings across a range of different environments directly from an iPhone or iPod touch, or from compatible Android devices. You can raise or lower volume, view battery life, adjust the mix between wireless audio from the phone and environmental sound, and perform other monitoring and control functions. It also has a “find-my-sound-processor” function that locates your implant processor if you don’t know where it is.