Phonak cross system

What is the CI system I am in the UK

CI = cochlear implant.

You should have cochlear implant evaluation, referral for this is usually given by an ENT doctor (at least in my country, perhaps HIS or audiologist can do that too, but I don’t know, perhaps @kevels55 or @Zebras will chime in).

Yeah @goldsmith, it is hard to judge what might be suitable for your particular loss, in the absence of an Audiogram… If you look at mines, you wouldn’t think I would get much contextual information from my left side, but I notice big time if its unaided! But, both ears have been aided from 6 months after my initial sudden hearing loss… Posting up your Audiogram would be helpful, there are a few Audiologist/HIS on here, whom may offer you some free expert advice… Cheers Kev

Thank you for the Audiogram…That’s a fairly asymmetric loss @goldsmith, I believe they can be challenging to get a good fit? Perhaps @Neville or @Um_bongo might kindly give their expert opinions as to what they might recommend for you? Cheers Kev

Yes, working with one ear really degrades speech in noise processing, and with this kind of asymmetry it really is one ear with a supporting side character.

So, sounds like a CI is out permanently. I’ve certainly seen older people than you get implanted succesfully, but looking at your one good ear and considering your age I wouldn’t be inclined to push back against a decision not to pursue it. If your other ear were worse I might.

There is more heterogeniety in how patients with one very bad ear like to be set up, and often requires a bit of experimentation. How thorough to be with that can also depend on how much money the patient is willing to invest, because there are likely going to be some non-refundable costs (e.g. earmolds, extra services).

Once a CI has been considered and definitely rejected, the next step I would usually take would be to try to determine to what extent the bad ear was still useful at all. Some people do like to keep amplification in that ear even without any speech clarity because they like the balance, environmental awareness and maybe tinnitus support and because in some cases that ear does contribute meaningfully to speech understanding. Others find that amplification in the bad ear makes things worse for them, that it is just distortion and interference–there’s enough of an asymmetry in goldsmith’s case that an appropriately fit hearing aid on the left ear is going to send sound through the skull to the right ear, for good or for ill. There are some minor binaural speech checks one can do it in the sound booth, but nothing that is really going to trump a real-world trial. So usually my first recommendation would be to wear two hearing aids for a while and then remove the hearing aid in the bad ear and just see if you notice a difference. In this case you already have hearing aids and so can just do this, BUT I suspect that the RIC-style hearing aid is not appropriately supporting the left ear. It’s too weak. You’d need an SP/UP BTE to provide prescriptive gain and unfortunately phonak hearing aids are not compatible from one style to another (e.g. RIC on one ear and BTE on the other). You could do it with Oticon if you were interested, but Oticon won’t interface well with the Roger system which is also a consideration (more below). However, it is also regularly the case that when one ear drops out suddenly the user cannot tolerate full gain in that ear because it just sounds distorted and crappy. You may already know. If you are already wearing that hearing aid turned down, then trying a BTE may not be a valuable process.

Once it’s determined that there is no benefit to amplification in the bad ear, then I would move to a CROS and off the top of my head I would say uptake is about 75/25 for people who find it valuable versus people who do not. But it’s important to understand that a CROS will generally not help you that much in noise. Certainly the phonak CROS allows for greater beam forming in combination with the hearing aid, but in general the speech-in-noise loss of only having one ear tends to be greater than the degree of support that any hearing aid on the market can give. You need an accessory mic for noise. The CROS will give you access to your bad side and will help you to avoid craning your neck in odd and uncomfortable ways. It can give a boost in calmer situations. Some people can still wear their CROS in noise, some remove it. The Phonak CROS battery life sucks, but the Phonak interfaces better with the Roger microphones which are going to be more powerful in noisy situations–so if I have any sense that the user might use and benefit from the Roger On I’ll go with the Phonak CROS even though the battery sucks and even though swapping back and forth between manufacturers to trial different set-ups (HA+BTE versus HA+CROS) is annoying. If the user refuses to use the Roger or really finds no benefit from it, then I’m happy to move to Oticon or Signia for the better CROS battery life.

The Phonak Sphere is incompatible with the CROS unfortunately, but I’ve had a few patients ditch their CROS for the Sphere (with a custom tip) because they find that it gives them more support in noise such that they have to use their accessory mic less often. The Roger can be powerful for individuals who are good at using it, but at the end of the day most people would prefer to not have to.

So, there you go, that’s my general route when there’s one ear with limited use. tldr: HA+CI –> 2 HAs (and accessory mic) –> HA+CROS (and accessory mic) –> single hearing aid (and accessory mic)

@Neville said:

In this case you already have hearing aids and so can just do this, BUT I suspect that the RIC-style hearing aid is not appropriately supporting the left ear. It’s too weak. You’d need an SP/UP BTE to provide prescriptive gain and unfortunately phonak hearing aids are not compatible from one style to another (e.g. RIC on one ear and BTE on the other). You could do it with Oticon

This is another issue, which Phonak should improve - interoperability between different form factors. @Michael_Phonak

It’s a different system in NHS Audiology Rick, it would appear their whole aim is to prevent those in the severe/profound thresholds from ever getting CI’s, unless you try and force their arm, or an ENT consultant is pushing your case? Audiology is at the bottom end of their priorities, if you don’t have a life threatening illness, then you can wait many years for help! For instance, my wife Elspeth has had 4 different cancers, in each instance her treatment was extremely quick and exceptional, exemplary comes to mind, they are brilliant at what they do, but resources are very limited… Especially so, for HOH, whom generally don’t create much fuss, because of the nature of their disability! Cheers Kev

But perhaps it changed a bit during last several years? Guidelines and indication could change.

The Roger On might be a bit more useful in groups if its affordable/available to you.

@kevels55 said:

Some area health boards are fairly proactive, other areas have little or no budget for CI’s, unfortunately, everything was not created equal in the NHS, it is what it is…

I think we’re the same here in that some provinces and locations have better access to CIs than others. We saw pediatric CI access expanding from one ear to two when I was just starting out. At that time and for a while after adults only got one and only if both ears were very bad. Now adult ears are starting to be assessed separately, so you can maybe get one in a bad ear even if the other ear is still hearing, but not as commonly. I assume in the future we’ll progress to adults being eligible for two, but I’m not sure when. Although it does depend a bit on money here, it depends strongly on formal published evidence of benefit which may not actually be robust yet. If I were a CI user I think I’d like to be bimodal if possible, but if not I’d probably remortgage the house and fly to the States to get a second one if I were still working. If I were retired it would depend a bit more on my lifestyle I think–I’m not hugely extroverted.

Thank you for your take @Neville…Agreed, but everyone is different, personally there didn’t seem much point in going for CI’s, simply because I was retiring, when I was asked to go for assessment, the sports I am still involved in, 8 ball pool and lawn bowls, are mainly visual, so I don’t really need to hear, to be involved… Of course, it would be nice to have better hearing, but it isn’t a prerequisite of involvement. I am fairly content as I am, if I need to hear a conversation, I have plenty Roger devices to assist me… At home, my wife will sign to me if I am unaided. In my earlier years, I would have jumped at the chance of CI’s, but that was then, nowadays I am just content to plod along and go with the flow, I can stream directly into my ears, via iPad or iPhone, and in most instances catch nearly all of the conversations, my imagination usually fills in the gaps… CI’s are wonderful, but not for me… Cheers Kev

Interesting I agree it is about getting the best out of life at our age. I worked all my life in the world of art and design designing and making jewellery and other than talking to clients and could have achieved what I did even if I was totally deaf, bit like a blind musician. However I now teach a small art group which does require some hearing. I am also a member of a life drawing group and although the drawing does not require any hearing, a big part of the the fat is meeting and chatting with the other artists which can be a problem for me, particularly as this happens in the cafe coffee shop.

Good for you David in the Art teaching, I was never an artist, perhaps a slight one in wood, I used to make a fair bit of furniture, hand made furniture always sells, the buyer has something unique, someone may have a similar item, but never identical… My wife is an artist though. I have done a lot of coaching pool over the years, many of my prodigy’s went on to achieve great success, coaching loads of youngsters in busy pubs and clubs was challenging, but you always found a way to effectively communicate… You will hopefully see a big improvement with the Lumity Spheres in louder environments, from what I have read, the vast majority see a marked improvement! Good Luck, cheers Kev