Week 5 Med-El Flashcards
1
Q
Med-el basics
A
*innsbruck, Austria
*6 generations
—ceramic in early generations
*all are monopolar and sequential
*simultaneous stimulation I100
*forward-backward compatible speech processors
*12 electrode pairs
#ed apex to base
2
Q
Combi 40+
A
- first internal device from med-el
- approved 2001 for 18 months, 2003 for 12 months
- ceramic with a magnet that could do MRI to 1.5T but was not remove able
- impedance telemetry
- electrode arrays
- –24 electrodes in pairs, 12 channels
- —-standard 31.5 mm (2.4mm)
- —-medium (1.9mm)
- —-compressed (1.1mm)
- —-split (5 4.4mm with 1.1 between 7 6.6 mm 1.1 between)
- sound processor: CIS PRO+, TEMPO+
3
Q
Pulsar CI100
A
- med-els second internal device
- approved 2005 for 12 months
- ceramic with non-removable magnet that can do MRI up to 1.5T
- impedance telemetry, ECAP, electrical field telemetry
- simultaneous stimulation, triphasic
- electrode arrays:
- –standard, medium, compressed, and split
- speech processor:compatible
4
Q
Sonata TI100
A
- med-el 3rd internal device
- approved 2007 for 12’months
- titanium with non removable magnet up to 1.5T
- impedance telemetry, ECAP, electrical field telemetry
- electrode arrays: standard, medium, and compressed
- sound processor:
- –2008 opus 1 which looked like the tempo but could use fine structure strategy and HDCIS
- –2008 opus 2 came with no controls or anything, but the edge pulls out to turn off processor
5
Q
Concerto Mi100
A
- 4th internal device from med-el
- approved in 2011 for 12 months and up
- titanium with non removable magnet for 1.5T
- 25% thinner than sonata and had 2 pins added to the casing to prevent it from moving around because surgeons ,moving away from drilling divit for device
- impedance telemetry , ECAP, electrical field telemetry
- electrode arrays: standard, medium, and compressed
- –flex array added in 2012 which is now the commonly used array
- sound processor: opus 2, rondo, sonnet, sonnet 2
6
Q
Synchrony (Mi1200)
A
- 5th internal device from med-el
- fda approved in 2015
- titanium/self aligning and removable magnet that can do 3.0T with magnet in, also has pins
- impedance telemetry, ECAP, electrical field telemetry
- electrode arrays:
- –standard, medium, and compressed
- –flex array
- sound processor
- –rondo, sonnet, sonnet 2
7
Q
Synchrony 2 (Mi1250)
A
- 6th internal device from med-el
- fda approved in June 2019
- similar to the synchrony but redesigned the electrode array to be in the middle like the other manufacturers
- titanium, with self-aligning removeable magnet (3.0T in) and pins
- impedance telemetry, ECAP, and electrical field telemetry
- electrode array:standard, medium, and compressed
- sound processor: rondo, sonnet, sonnet2 (August 2019)
8
Q
Start on
A
Slide 20
9
Q
Med-El basics about the company
A
- from Innsbruck, Austria
- 6 generations of devices
- –used ceramic in early devices to limit static discharge
- all are monopolar and synchronous
- simultaneous stimulation for I100
- forward-backward compatible speech processors
- 12 electrode pairs
- electrodes # apex to base
10
Q
COMBI 40+
A
- 1st implantable device from Med-el approved in 2001 for 18+ months and in 2003 for 12+ months
- ceramic with nonremovable magnet that could do MRI up to 1.5T
- impedance telemetry
- electrode arrays:
- –24 electrodes in pairs, 12 channels
- —–standard is 31.5mm which covers almost entire cochlea and 2.4mm between electrodes
- —–medium is 24mm which is about as long as other’s standard array and 1.9mm between electrodes
- —–Compressed is 15mm long with 1.1 mm between electrodes
- —split is 5-4.4mm with 1.1 mm between and then 7-6.6mm with 1.1 mm in between for cases of ossification
- sound processor:
- –CIS PRO+
- –TEMPO+
11
Q
Pulsar CI100
A
- 2nd internal device from med-el approved 2005 for 12+ months
- ceramic with non-removeable magnet with MRI up to 1.5T
- impedance telemetry, ECAP, and electrical field testing
- simultaneous stimulation, tri-phasic
- electrode array: standard, medium, compressed, and split
- speech processor: compatible
12
Q
SONANA TI100
A
- 3rd implantable device from med-el approved 2007 for 12 months+
- titanium with non-removeable magnet up to 1.5T MRI
- impedance telemetry, ECAP, electrical field telemetry
- electrode arrays: standard, medium, and compressed
- sound processor:
- –OPUS 1 in 2008 which looks like TEMPO but was able to use fine structure strategy and HDCIS
- OPUS 2 2008= no controls but can pull apart edge of processor to turn off
13
Q
Concerto Mi100
A
- 4th internal device from med-el approved in 2011 for ages 12 months +
- titanium with non-removeable magnet for up to 1.5T
- 25% thinner than Sonata and has added 2 pins on the end of the casing to hold the implant in place because surgeons stopped drilling place for it to sit and not move around
- impedance telemetry, ECAP, electrical field telemetry
- electrode array:
- –standard, medium, and compressed
- –flex array in 2012 whihc is now the commonly used array
- sound processor:
- –OPUS 2
- –Rhondo (2013), Sonnet (2014), and Sonnet 2 (2019)
14
Q
Synchrony (Mi1200)
A
- 5th internal device from med-el approved in 2015
- titaium with self-aligning and removable magnet to 3.0T with it in (this really changed the market because of the diametric magnet)
- also has pins
- electrode arrays: standard, medium, compressed, and flex
- sound processor: Rondo, Sonnet and Sonnet 2
15
Q
Synchrony 2 (Mi1250)
A
- 6th internal device from med-el approved June 2019
- difference from synchrony is the redesigned array location made to be in the middle of the casing now like the other manufacturer’s
- titanium with self-aligning magnet (3.0T in) and pin
- impedance telemetry, ECAP, electrical field telemetry
- electrode arrays: standard, medium, and compressed and flex
- sound processor: rondo, sonnet sonnet 2 (August 2019)
16
Q
electrode arrays from med-el
A
- wide variety
- flex are supposed to be better at protecting the cochlea
- –wavy to curve with the lateral wall easier
- –flex28 got rid of the paired electrodes 1-5 to make the array smaller
- flex soft is standard array
- FORM array is approved in Europe but not US and has a small plug at the end that can be helpful in cases of malformed cochlea where pt is at risk of CSF leak because it plugs the round window
17
Q
Opus 2
A
- processor from med-el from 2008
- omnidirectional mic
- LED
- 4 programs instead of the 3 with Opus 1
- no controls but on and off switch; has fine tuner remote control for VC, sensitivity, and programs
- there is a test device that turns red when there is communication between the internal and external device
- D-coil (2011) is thinner and less battery consumption (50%) than earlier coil
- batteries are rechargeable or zinc-air
18
Q
Rondo
A
- processor from med-el 2013
- one piece processor
- omnidirectional mic so must be sitting facing up or down, not on the side
- has on/off switch, but remote for every thing else
- sports head band, or clip to attach to clothes because problem with falling off
- batteries=zinc-air
19
Q
Sonnet
A
- processor from med-el 2014
- no controls
- IP rating of 54
- 2 mics
- built-in t-coil
- LED
- DL-coil which has an LED light to replace the test device and a lockable cable (2016)
- datalogging (1st med-el device with it)
- radiofrequency transmission (2.4GHz)
- was ready to do electroacoustical stimulation when made and the stimulation was approved in 2016, then just needed to add a receiver
- –48dB gain at 125-2000 Hz
- –OSPL90=118 dB SLP
20
Q
Rondo 2
A
- processor from med-el 2018
- features wireless charging within 4 hours
- built in rechargeable lithium-ion battery
- –lasts 18 hours, and life expectancy of 5 yrs
- –can also have a wearable minibattery pack of AAA battery to last 35 hours
- omnidirectional mic so up or down
- controls are done with fine tuner
- IP68 with casing and attachment clip
21
Q
Sonnet 2
A
- processor from med-el (2019)
- no controls
- –fine tuner
- –fine tuner echo which is more advanced or use app on iphone or android (AudioKey app)
- IP54
- 2 mics
- built-in T-coil
- LED
- DL-coil (LED and lockable)
- radiofrequency transmission (2.4GHz)
- electroacoustical stim
- datalogging
- AudioLink is wireless option to stream to implant
22
Q
Med-el programming connector
A
MAX programming interface which is a box that can connect 2 implants at 1 time
23
Q
med-el programming software
A
- MAESTRO
- –bilateral mapping
- –faster telemetry
- –EAS proramming
- –ART, eSRT
- –eABR
- –triphasic pulse which is a new capability to new software, but older implants can use this too
- —–the reason to use this would be to control if there is any other types of stimulation going on like facial
24
Q
impedance field telemetry (IFT)
A
impedance testing gives voltage distribution profile (VDP) which is also known as voltage matrix
- –this is another way to measure impedance which allows to identify other problems in the array such as short circuit
- —-would expect to see a large bar on the diagonal line and then for the rest of the bars to be less than 50% of the big one
25
Q
Med-el coding strategy
A
- HDCIS
- FSP
- FS4
- FS4-P
- –FSP up to 350 Hz which means the stimulation rate will match the frequency up until that point
- –FS4 was improved so that the stimulation rate will match the frequency up until 1000Hz
- FS4 is the default coding strategy
26
Q
volume control with med-el
A
- IBK is the mode for volume control, there is another option but it is rarely ever used
- –with IBK set minimum and maximum which is a percent of the MCL (not the dynamic range)
- —-for example 0% would be turning all the way off; 80% would be setting it at 80% of what the MCL normally is
- –recommended not to give much for VC unless device has just been turned on
- –recommended minimum at 80% and maximum at 100%
27
Q
stimulus level with med-el
A
- charge units (qu) which is amplitude*width/1000
- –range is from 0-282.2qu
- –MCL is commonly under 40 qu (10-25qu)
28
Q
thresholds with med-el
A
- audible threshold would lead to buzzing and humming
- elevated SF threshold, MCL, Maplaw, threshold
- —–can modify the map using live voice
29
Q
ESRT
A
balancing at 80% and sweep at 100%
30
Q
frequency bands with med-el
A
- 70-8500Hz
- –low end is 70-350 Hz adjusted in 10 Hz steps
- –high end is 3500-8500 Hz adjusted in 500 Hz steps
- distribution:
- –logarithmic FS *the default
- –LinLog–narrower low frequency (linear in the lows and logarithmic at the higher)
- –tonotopic approach (going with what the cochlea naturally does)
- –linear increasing–narrower high frequency
31
Q
MAPLAW
A
- acoustic into electric dynamic range
- –logarithmic MAPLAW
- –S-shaped MAPLAW-noise
- –recommended compression:
- —-500 for 10% threshold or measured threshold
- —–1000 for 0% threshold
32
Q
automatic sound management (ASM)
A
- microphone directionally:
- –omni, natural, adaptive
- AGC Default 3:1 (2:1, 2.5:1, and 3.5:1)
- sensitivity default 75%
