PROGRAMME & ABSTRACTS

Cochlear™ Nordic Symposium 2019 Malmö, 23-24 January

Leading ChangeTogether

WEDNESDAY, 23 JANUARY……………………………………………………………………………………

Programme Plenary Session 09.30-16.15

Professional Networking Meetings / CI Patient Organization Meetings 16.30-18.30

Welcome toast & dinner at the hotel 19.15-

THURSDAY, 24 JANUARY……………………………………………………………………………………

Morning run / power walk 06.45-07.30

Hotel Check Out 09.00

Programme Plenary Session 08.30-11.30

Breakout Sessions 12.45-16.00

KEY INFORMATION

Cochlear™ Nordic Symposium 2019Quality Hotel View,

Hyllie stationsväg 29, 215 32 Malmö

WelcomeDear Colleagues,

It is with great pleasure that we welcome you to Quality Hotel View in Malmö for our 4th Cochlear Nordic Symposium: Leading Change Together.

We are all aware of the increasing pressures that face our healthcare systems today, and the growing need to support more and more people whose lives are affected by hearing loss. The objectives of this Symposium are to share the latest research and ideas, discuss the key topics that are most critical now and for the future, and to explore the different aspects that we can influence within:

• Research & Innovation

• Evolution in Clinical Care and Hearing Rehabilitation

• Healthcare Challenges and Sustainable Care Models

In addition to this, there will be CI clinical/technical and Baha breakout sessions.Cochlear's mission is to help people hear and be heard. In partnership together, we help to empower people to connect with others and live a full life by transforming the way people understand and treat hearing loss. We innovate and bring to market a range of implantable hearing solutions that deliver a lifetime of hearing outcomes. This meeting is our joint opportunity to come together, challenge and debate in order to drive the future vision of implantable hearing solutions within the Nordics; we look forward to a stimulating, collaborative and productive event which we hope you will enjoy greatly and come away energised.

Let’s make a difference together, to help people hear and be heard for years to come.

Lotta VedholmGeneral ManagerCochlear Nordic

SESSION 1

Wednesday, 23 January

09.30-09.40 Welcome: Ms Lotta Vedholm, General Manager, Cochlear Nordics

Research and Innovation – Driving PerformanceA session aimed for all professionals, discussing the latest research and innovations

in IHS. Surgery, hearing performance, real life benefits.

Chair and Opening Remarks:

Dr Henrik SmedsKarolinska University Hospital, Sweden

09.40-10.05 1.1 Global perspective and insights in Cochlear´s long term strategy Mr Richard Brook, Cochlear EMEA & Latin America

10.05-10.35 1.2 Can functional near infrared spectroscopy help predict and monitor cochlear implant outcome?Prof. Douglas Hartley, Nottingham University Hospitals NHS Trust, UK

10.35-11.00 COFFEE BREAK

11.00-11.30 1.3 Changes and challenges in indications, combined with assessments of complications in bone conduction systems Dr Myrthe Hol, Radboud University Medical Centre, Netherlands

11.30-11.55 1.4 Clinical experience with the CI532 – Surgical aspects, hearing pre-servation, ECAPs and speech recognitionDr Filip Asp, Karolinska University Hospital, Sweden

11.55-12.15 1.5 Hearing preservation with a new slim modiolar electrode Dr Aarno Dietz, Kuopio University Hospital, Finland

12.15-12.30 Questions and discussions, wrap up by Chair and Close

12.30-13.30 LUNCH

SESSION 2

Wednesday, 23 January

Evolution in Hearing RehabilitationA session aimed for all, discussing different aspects of progression in clinical care.

Implantation in elderly, dementia, early intervention in paedeatrics, rehabilitation of isolated adults, rehabilitation models etc may be some topics of interest.

Chair andOpening Remarks:

Prof. Elina Mäki-TorkkoÖrebro University, Sweden

13.30-14.30 2.1 Aging, Hearing, and Public Health – Translating Epidemiologic Insights to Clinical Trials and Public Policy in the United StatesProf. Frank Lin, Johns Hopkins University, Baltimore, USA

14.30-15.00 2.2 Prevention of Deafness and Hearing Loss Prof. Andrew Smith, London School of hygiene and Tropical Medicine, UK

15.00-15.15 COFFEE BREAK

15.15-15.45 2.3 Severe-to-profound hearing impairment: demographic data, gender differences and benefits of audiological rehabilitation Ms Satu Turunen-Taheri, Karolinska University Hospital/Karolinska Institute, Sweden

15.45-16.15 2.4 Is cochlear implantation the new treatment for dementia? Dr Charlie Huins, University Hospitals Birmingham NHS Founda-tion Trust, UK

16.15-16.20 Wrap up by Chair and Close

16.30-18.30 Professional Networking Meetings

16.30-18.30 CI Patient Organization Meetings (Children/Adults)

19.15-19.30 Welcome drink

19.30- Dinner at the hotelSpecial guest and entertainer: Henrik Widegren, ENT Doctor

SESSION 3

Thursday, 24 January

06.30-08.30 BREAKFAST

06.45-07.30 Morning run

06.45-07.30 Morning powerwalk

Healthcare challenges and building sustainable care modelsA session aimed for all, discussing the challenges we face in the current care models and how we can make it sustainable, cochlear care, remote

care may be some of the topics.

Chair and Opening Remarks:

Dr Charlie HuinsUniversity Hospitals Birmingham NHS Foundation Trust, UK

08.30-09.00 3.1 Inspirational Speaker - The story of an ear-wittnessDr Lennart Arlinger, Sweden

09.00-09.30 3.2 How connectivity can enable new care models; insights into the future of implant careMr Luke Crowe, Cochlear Ltd, Australia

09.30-10.00 3.3 Prepared for the future - A sustainable service model Ms Tracey Twomey, Head of Service Nottingham Auditory Implant Programme, UK

10.00-10.20 COFFEE BREAK

10.20-10.50 3.4 Patient Privacy and Clinic Compliance in a GDPR World Mr Stephen Bolinger, Cochlear Ltd, Australia

10.50-11.20 3.5 Tele audiology - new ways of patient engagement Dr Miguel Angel Aranda de Toro, GN Hearing, Denmark

11.20-11.30 Wrap up by Chair and Close

11.30-12.45 LUNCH

SESSION 4a (Breakout)

Thursday, 24 January

CI Clinical & Technical A session aimed at audiologists, technicians, and other professionals who

work with CI, a successor to the Nordic technical meeting.

Chair and Opening Remarks:

Dr Ville SivonenHelsinki University Central Hospital, Finland

12.45-13.25 4a.1 Listening to music through a CI: It is not so bad after all!Prof. Jeremy Marozeau, Technical University of Denmark

13.25-13.55 4a.2 Assessing the benefits of bilateral cochlear implants in complex listening environments Dr Ville Sivonen, Helsinki University Central Hospital, Finland

13.55-14.25 4a.3 First results with the virtual reality spatial discrimination tool in sequentially implanted children Dr Cristina Simoes-Franklin, National Hearing Implant and Research Centre, Beaumont Hospital, Dublin, Ireland

14.25-14.45 COFFEE BREAK

14.45-15.15 4a.4 Evidence-based Bimodal Fitting Ms Tracey Adams, Cochlear Europe Ltd, UK

15.15-15.40 4a.5 Trauma detection during CI surgery using objective measures and imaging Dr Ralf Greisiger, Oslo University Hospital, Norway

15.40-16.00 4a.6 Changes ahead in reliability reportingDr Barry Nevison, Cochlear Europe Ltd, UK

16.00-16.15 Wrap up by Chair and Close

SESSION 4b (Breakout)

Thursday, 24 January

New adventures in Baha A session aimed at updating you on the latest news from the thought leaders in bone

conduction.

Chair and Opening Remarks:

Mr Fredrik BreitholtzCochlear Bone Anchored Solutions, Sweden

12.45-13.05 4b.1 A better fit starts inside Ms Tracey Adams, Cochlear Europe Ltd, UK

13.05-13.25 4b.2 Baha SoundArc - hearing and speech understanding with an alternative to the softbandProf. Martin Kompis, Inselspital Bern, Switzeland

13.25-14.05 4b.3 Binaural hearing with bone conduction stimulation Prof. Stefan Stenfelt, Linköpings University, Sweden

14.05-14.30 4b.4 Single center experience of 100 implantations of transcutaneous bone conduction Prof. Jaydip Ray, Sheffield Teaching Hospitals, UK

14.30-15.00 COFFEE BREAK

15.00-15.30 4b.5 National BCD guideline - is there a need to improve quality? Dr Myrthe Hol, Radboud University Medical Centre Nijmegen, Netherlands

15.30-16.00 4b.6 Challenges with bone conduction Ms Theres Björk, Cochlear Bone Anchored Solutions, Sweden

16.00-16.15 Wrap up by Chair and Close

Presentation Abstracts

1.1 Global perspectives and insights in Cochlear’s long term strategyMr Richard BrookPresident, Cochlear EMEA & Latin America, Switzerland

This presentation intends to provide an update on Cochlear’s longer term growth strategy, highlighting some of the key clinical, technological and market challenges that lay ahead of Cochlear and its partners. Building on the background of Cochlear’s pioneering work in implantable hearing, this session aims to stimulate the audience to reflect on the opportu-nities to help many more candidates benefit from implantable hearing solutions.

1.2 Functional near infrared spectroscopy can help predict and monitor clear cochlear implant outcome Prof. Douglas HartleyConsultant ENT Surgeon, Nottingham University Hospitals NHS Trust, UK

Many patients receiving cochlear implants unexpectedly fail to reach, or unexpectedly exceed predicted performance. Individual differences in brain reorganisation following deafness and cochlear implantation may help explain these variable outcomes. Our research at the Hearing Biomedical Research Centre in Nottingham aims to improve our understanding of the changes that occur in the brain following deafness and subsequent restoration of auditory input by a cochlear implant.

We use a novel functional neuroimaging method called functional near infrared spectros-copy (fNIRS) that provides a highly valuable avenue of investigation because it is comple-tely safe for use in an implanted population and, unlike other neuroimaging methods, is unaffected by electrical and magnetic artefacts associated with the implant. fNIRS allows investigation of brain reorganisation after cochlear implantation, and we have used it to develop a neuroimaging marker that correlates with clinical cochlear implant outcome in adults.

In ongoing studies in our laboratory we are evaluating whether this prognostic tool can predict cochlear implant outcomes in children. Our long-term goal is to use this tool to improve post-operative rehabilitation based on the predicted needs of an individual, and provide recipients with realistic expectations of performance following implantation.

1.3 Changes and challenges in indications, combined withassessments of complications in bone conduction systemsDr Myrthe HolRadboud University Medical Centre, The Netherlands

Myrthe Hol is an ear surgeon at Radboudumc, Nijmegen, the Netherlands, with parti-cular attention to titanium temporal bone implants (BI) and auricular reconstructions/prosthesis. She combines her clinical duties with research on most of the bone conduction hearing devices on today´s market. Next she has been working on the Dutch Guideline BCD over the past years and she will share some highlights with us. In order to address thecurrent challenges in indications she will inform us about the assessment of complications and how to guide patients and professionals in the decision making process.

1.4 Clinical experience with the CI532 – Surgical aspects, hearing preser-vation, ECAPs and speech recognition Dr Filip Asp Clinical Engineer, Karolinska University Hospital, Sweden

The properties of the electrode array of a cochlear implant may affect ease of insertion, scala tympani placement and residual hearing preservation, all of major importance for hearing outcome. While cochlear implantation is a successful treatment of severe sens-orineural hearing loss, auditory outcomes varies substantially. Evaluating a new electrode array design is therefore essential. The perimodiolar CI532 electrode from Cochlear Ltd has been used at Karolinska University Hospital since November 2015. The first part of thisretrospective study of CI532 cases was to evaluate surgical experiences, complications, and pre- and postoperative (1 year) speech recognition and pure-tone hearing thresholds. On PTA 68% had a preoperative score of 0% at 65 dB SPL in a “best-aided” condition (i.e. hearing aids when applicable). One year after surgery, the mean score was 46% (SD: 6%). No correlation was found between pre- and postoperative scores or between postoperati-ve score and deaf length. Low frequency pure tone hearing thresholds demonstrate a wide range of hearing preservation (poor to good) without correlation to preoperative demo-graphics. Early results from the CI532 hearing preservation protocol cases indicate good residual hearing preservation.

A second aim of this clinical study was to study the relation between automatically recor-ded intraoperative electrically evoked compound action potential (ECAP) and monosyl-labic speech recognition in patients implanted with two different perimodiolar electrode designs. A retrospective analysis of data from patients subjected to implantation with CI512 or CI532 at the Karolinska University Hospital, Sweden was performed. ECAPs were

obtained using the intraoperative ECAP threshold generated by the automated neural response telemetry of the CIs. The speech recognition of the implanted ear was measured with phonemically balanced monosyllabic Swedish words. The median speech recognition score one year post implantation was 58 % in the CI512 (n=38) and 52 % in the CI532 (n=25) groups. The mean intraoperative ECAP threshold (across ≥ 8 electrodes) was 190 CL (SD=17 CL) in the CI512 (n=32) and 185 CL (SD=13 CL) in the CI532 (n=22) groups.

No statistically significant differences between the groups existed. Bivariate correlation demonstrated a significant relationship between the speech recognition score and mean ECAP threshold in the CI512 group (Spearman’s rho: -0.623; p=0.0001), whereas no as-sociation was found in the CI532 group. The results suggest that the mean intraoperative ECAP thresholds automatically recorded at individual electrodes along the intracochlear array may be used as a prognostic factor for cochlear implant outcome in perimodiolarelectrode designs.

1.5 Hearing preservation with a new slim modiolar electrodeDr Aarno Dietz MD, Head of Department, Section Otology & Cochlear Implants

Matti Iso-Mustajärvi, Sini Sipari, Heikki Löppönen, Aarno DietzKuopio University Hospital, Finland

IntroductionThe preservation of residual hearing in cochlear implantation (CI) can be more likely achieved with flexible lateral wall electrodes than with perimodiolar arrays. Recently, a new slim modiolar electrode (SME) has been designed for atraumatic CI. In a preclinical study, the SME has shown mostly atraumatic insertion results in temporal bones. In the present study, we report of the first hearing preservation results in our patients implanted with the SME.

Materials and Methods16 patients with reliably measurable preoperative thresholds were included in this study. Thresholds were measured preoperatively and at 1, 3, 6 and 12 months postoperatively. The insertion results, insertion depth and scala localization were evaluated with postope-rative cone-beam computed tomography.

Results16 patients (17 ears) were included to our study. All patients were operated by a single sur-geon. There was one insertion failure in which the electrode came out of the metal sheath during the insertion attempt. The device had to be discarded and was replaced by one with a lateral wall electrode. This case was excluded from the analysis. 15 patients /16

ears were successfully inserted. The mean follow-up was 317 days (range 121-608 days). The mean insertion angle was 396 degrees (313-434) and scala translocations were not detected. A total hearing loss did not develop during follow-up in any patient. The mean threshold loss was 11,0 dB (HL) (PTA(0.125-1kHz)) and 11,2 dB (HL) (PTA0.125-0.5kHz)). Using the HEARRING classification (Skarzynski et al. 2013), the mean hearing preservation rate was 72.8 %.

ConclusionComparable hearing preservation results can be achieved with the SME as with shorter lateral wall arrays but with the additional benefit of providing a full insertion for optimal electric stimulation. The facial recess, however, has to be sufficiently large to allow for a reliable insertion. Longer follow-up is needed for evaluating the long-term hearing preser-vation results.

2.1 Aging, Hearing, and Public Health – Translating Epidemiologic Insights to Clinical Trials and Public Policy in the United StatesProf. Frank R. LinDirector, Cochlear Center for Hearing & Public Health, Johns Hopkins University

Medicine and public health have evolved through three eras over the past century. Begin-ning in the first half of the 20th century, infectious diseases were controlled for the first time in human history through vaccinations, antibiotics, and other strategies. Subsequent-ly, throughout the 20th century, chronic diseases of middle and later life (e.g., cardiovas-cular disease, cancers) became the leading causes of mortality but have also increasingly been better controlled. These successes of public health have led to a rapidly increasing population of older adults living longer than even before. In this third era of public health and medicine, we are now confronting the challenges of aging and how to best optimize the health and functioning of a growing population of older adults. In this era, hearing and our ability to engage effectively with the environment around us are critically important but not yet priorities in the spheres of public health and public policy.

He will discuss research over the past several years that has demonstrated the broad implications of hearing loss for the health and functioning of older adults, particularly with respect to cognitive functioning, brain aging, and dementia. He will then discuss how this epidemiologic research has directly informed and led to current national initiatives in the U.S. focused on hearing loss and public health. These initiatives include the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) randomized controlled trial and recent passage of the bipartisan Over-the-Counter Hearing Aid Act in 2017. This federal law overturns over 40 years of regulatory precedent around hearing aids in the U.S. in order to directly improve the accessibility and affordability of hearing care for older adults.

2.2 Prevention of Deafness and Hearing Loss Prof. Andrew SmithLondon School of hygiene and Tropical Medicine, UK

The global burden of hearing loss is large and rising rapidly. The public health approach to hearing loss is needed to reduce this burden, especially in low and middle income countri-es where almost 90% of the people with hear-ing loss live.

Prevention is one of the key components in the public health approach to deafness and hearing loss. This has been recently highlighted by the 2017 World Health Assembly (WHA) Resolution on Prevention of Deafness and Hear-ing Loss. This presentation will address prevention of hearing loss In the light of this new WHA resolution. It will describethe different methods of prevention recommended by the World Health Organisation (primordial, primary, secondary, and tertiary prevention) and the challenges and benefits of including these methods in national health programmes.

2.3 Severe-to-profound hearing impairment: Gender differences and bene-fits of audiological rehabilitationMs Satu Turunen-TaheriPhD Student, Audiologist, Karolinska University Hospital, Sweden

Turunen-Taheri S1,2 , Carlsson P-I3,4 , Johnson A5 and Hellström S1,2

1 Karolinska Institutet, Dept of CLINTEC, Division of Ear, Nose and Throat Diseases, Stock-holm, Sweden2 Karolinska University Hospital, Dept of Audiology and Neurotology, Stockholm, Sweden3 Örebro University Hospital, Audiological Research Center, Örebro, Sweden4 Central Hospital, Dept of Otorhinolaryngology, Karlstad, Sweden5 Karolinska Institutet, Dept of CLINTEC, Division of Audiology, Stockholm, Sweden Introduction: Based on the Swedish quality register, an estimation of 20,000 adult patients suffer from severe-to-profound hearing loss. The overall aim of the present study was to identify patients with severe-to-profound hearing loss who participated in audiolo-gical rehabilitation. The study also investigated in detail which kind of rehabilitation thispatient group had received, and particularly, the benefits of hearing health care. The study examined gender equality in the hearing health care for this patient group.

Methods: Data on 4286 patients with severe-to-profound hearing impairments registered in the Swedish Quality Register of Otorhinolaryngology (2006-2015) were studied. The

classification for extended audiological rehabilitation is fulfilled if the patient has partici-pated in group rehabilitation, or rehabilitated from at least three different professions in hearing health care. The study analysed demographic data, gender differences, and evalua-ted the audiological rehabilitation efforts.

Results: The study shows that group rehabilitation and visit to a hearing rehabilitation educator provided significantly most benefits in audiological rehabilitation. Only 40.5% of patients with severe-to-profound hearing loss received extended audiological rehabili-tation, with significantly more women (54.5%). A total of 9.5% participated in group re-habilitation, of which significantly more women (59.5%). Women also visited technicians, welfare officers, hearing rehabilitation educators, psychologists, and physicians andreceived communication rehabilitation in a group, and being fit with a CI significantly more often than men. Female patients appeared to have a significantly greater negative impact of hearing impairment on their daily life.

Conclusion: The study emphasizes the importance of participate in group rehabilitation and meet a hearing rehabilitation educator to experience greater benefits of hearing rehabilitation for patients with severe-to-profound hearing loss. There is a need to offer equal hearing health care with extended audiological rehabilitation to this patients group, especially in terms of gender differences.

2.4 Is cochlear implantation the new treatment for dementia?Dr Charlie Huins Consultant ENT Surgeon, Midlands Hearing Implant Programme (Adult service)Queen Elizabeth Hospital Birmingham NHS Foundation Trust, Birmingham, UK

Introduction: Hearing loss is estimated to affect up to 30% of the adult population in developed countries and has been independently associated with accelerated cognitive decline. Globally, 0.9% of the elderly have profound hearing loss and, in the UK, it is esti-mated that there are currently 855,500 severe to profoundly deaf adults.We reviewed the current literature and performed a retrospective analysis of outcomes together with a subjective assessment of outcomes of 100 patients.

Method: A review of the literature was performed using search terms ‘hearing loss’, ‘cog-nition’, ‘dementia’, ‘quality of life’, ‘elderly’ and ‘mental health’. Papers were identified andselected for relevant content. A meta-analysis was not possible due to the heterogeneity of the results. Outcome data of two groups was compared - over 65 years and under 65 years - via a retrospective review of 100 newly implanted adults’ notes. Analysis of age at implantation and outcomes was performed together with a survey completed by patients to evaluate self-reported benefits, including aspects unrelated to hearing.

Results: Collectively, the literature has identified hearing loss as a risk factor for incident dementia and cognitive decline in the elderly. Patients over the age of 70 have lower baseline cognitive scores and a 41% greater rate of annual cognitive decline compared to those with normal hearing. Cochlear implants (CI) have been shown to reduce depression and improve cognitive function, concentration and executive function. Analysis of speech perception outcomes shows that all post-lingually deaf patients achieve significant impro-vements in the first year at each test interval. Moreover, there was no statistical difference in group performance of the over 65s and under 65s at any test interval.

The survey indicated that all patients reported greatest subjective benefits since they wereimplanted in the following areas: hearing, confidence, listening and overall quality of life. Moderate improvements were reported in social life, concentration and general health. There were no significant differences in subjective ratings relative to age at implantation in any aspect.

Conclusion: CIs for severe to profoundly deaf patients are known to improve hearing and speech perception, irrespective of age. However, hearing loss may be causally related to dementia, possibly through exhaustion of cognitive reserve, social isolation, environ-mental deafferentation, or a combination of these pathways. Therefore, the benefits of CI to elderly patients appear to go far beyond hearing and speech understanding alone. Our data suggests elderly CI recipients adapt well to CI and report a higher quality of life, better general health and less depression. Moreover, the improvements in hearing result, together with reduced listening effort, in this patient group has a beneficial effect on cog-nitive function. Both age groups gain equivalent measurable benefits in speech perception and subjective benefits are reported in many other aspects of daily life, including areas unrelated to hearing, which is irrespective of age at implantation.

3.1 The story of an ear-wittness Dr Lennart Arlinger Inspirational speaker, CI-user, Sweden

After a work life in a major international biotech supply industry – as a researcher, R&D Director, Business unit director, VP - my early retirement period was divided between consultancy and volunteering activities. That was the time period – some 13 years - when my hearing deteriorated until I had very little use of my left ear, relying on the less rapidly but still declining right ear, all the time assisted by several hearing aids. I began to serious-ly contemplate leaving my board positions and other engagements since I had difficulties following discussions and noticed an unavoidable evolving social shyness. This situation was even more troublesome in my private sphere, which includes five grandchildren. The older kids could take notion of my special demand for clear talk, but that is impossible with smaller children. And in any case the contact with kids is severely impaired by poor hearing, a spontaneous chat turns into a dutiful conversation.

The private clinic I had attended for my hearing aids advised me that the county´s offers were not sufficient to cope with my problems and instead buy expensive hearing aids, but fortunately my private network advised me about the CI opportunity. After anesthet-ics during an operation clearly kicked my hearing ability below what qualified me for an implant. I have now one year’s experience as a CI user of an N7, lately in combination with a matching GN ReSound LiNX 3D. This background has told me a number of things, some of which I will share with the audience – not the least about what it takes to be a patient in the healthcare organizational maze.

3.2 How connectivity can enable new care models; insights into the future of CI care Mr Luke Crowe Global Manager Innovation, Product Management & Commercialisation, Cochlear Ltd, Australia

With the availability of the Cochlear™ Nucleus® 7 Sound Processor, connectivity to a mobile phone, combined with cloud technology, provides the opportunity to create newtools for CI clinicians and their patients which can transform CI aftercare in ways that deliver benefits for clinics and people living with a cochlear implant. An overview and demonstration of a solution that can enable a remote care model will be provided.

3.3 How Cochlear Care can transform long term patient care cost effectively Ms Tracey Twomey Consultant Clinical Scientist, Head of Service Nottingham Auditory Implant Programme, UK

In 2014, NAIP introduced Cochlear Care, the company-based support programme throughwhich Cochlear provides direct spares, repairs and trouble-shooting services to patients. This has proven to be clinically and cost-effective for our service and has been extremely well received by patients and clinicians alike. The rationale for this decision, the methodo-logy employed to develop the case of need, how this was achieved, its impact and ourexperience using the service to date will be discussed.

3.4 Patient Privacy and Clinic Compliance in a GDPR World Mr Stephen BolingerChief Privacy Officer, Cochlear Ltd, Australia

On 25th May 2018, the EU’s General Data Protection Regulation ushered in a new era of privacy protection for European residents. It brought with it a host of new obligations for organisations collecting and using personal data, and potentially massive fines for non-compliance. Personal data is an increasingly important input to health services that utilise mobile apps, cloud computing, and machine learning. Join Cochlear’s Chief Privacy Officer for a discussion of how Cochlear is addressing GDPR compliance through a patient centred approach to privacy.

3.5 Teleaudiology: New Ways for Patient Engagement Dr Miguel Angel Aranda de Toro Director of External Relations, Medical Affairs, GN Hearing

Tele-audiology is the use of telecommunications to provide audiological services remo-tely and may include the full scope of audiological practice. With the fast development of telecommunications –and especially since the introduction of “smartphones” –tele-audio-logy is currently one of the “hot topics” within the hearing aid industry. On the one hand, patients seem to be attracted to the many benefits of tele-audiology, as it can save time, reduce travel costs and facilitate communication with their hearing care professional (HCP). On the other hand, many HCPs are still hesitant to incorporate tele-audiology ser-vices into their daily practice, probably because they are not yet fully aware of the multiple options currently available and the methodology behind them.

In this presentation we will discuss how tele-audiology can be an important tool to enhance patient engagement and we will focus on three aspects: 1) how tele-audiology is currently used to provide audiological services; 2) which options developed by hearing-aid manufacturers are currently available and what the benefits are for the end-user; and 3) the importance of tele-audiology during the patient journey and how it can influence hearing aid satisfaction.

4a.1 Listening to music through a CI: It is not so bad after all!Prof. Jeremy Marozeau Associate Professor, Technical University of Denmark

Many studies have shown that most of the cochlear implant (CI) users have great difficul-ties perceiving pitch differences or recognising simple melodies without words or rhyth-mical cues. Consequently, CI users report finding music less pleasant compared to their pre-deafness period. Despite this, many of those users do not entirely reject music, and it is not uncommon to see young CI users listening to music all day, or even playing an instrument.

Listening to music is an experience that arises from more than the sum of the sensations induced by the basic elements of music: pitch, timbre, rhythm. Listening to music is a pleasant experience because it prompts high-level cognitive aspects such as emotional reactions, needs to dance, or the feeling of musical tension. Therefore, CI users still enga-ged in musical activities might experience some of these high-level features.

During this presentation, I will talk about two different studies that showed that CI liste-ners could perceive the emotion and the tension induced by the music. Overall these studies suggest that although most CI users have difficulties with perceiving pitch, addi-tional music cues such as tempo and dynamic range might contribute positively to their enjoyment of music.

4a.2 Assessing the benefits of bilateral cochlear implants in complex listening environmentsDr Ville SivonenClinical Engineer (Audiology), Helsinki University Central Hospital, Finland

Bilateral cochlear implantation (CI) is becoming a standard of care in the treatment of bi-lateral severe-to-profound hearing loss both in children and in adults, although indications worldwide still vary considerably. The audiological benefits of bilateral CI are well establis-hed in the literature, including improved speech recognition in noisy conditions and more accurate sound localization over unilateral CI. These improvements in objective hear-ing tests have also been corroborated by subjective questionnaire data. However, attempts to predict outcomes of bilateral CI from etiological factors have been somewhat unrewarding and sizeable individual variation remains unaccounted for.

The recent adoption of the Finnish version of the Oldenburg matrix sentence-in-noise test has greatly improved the accuracy of hearing diagnostics and the quality control of hearing rehabilitation in the CI clinics in Finland. When assessing spatial release from masking with this test by measuring speech recognition thresholds (SRTs) of co-located and spatially separated speech and noise signals, bilateral CI recipients still exhibit large inter-individual variation. In sequentially implanted adults, we have noted significant SRT improvements also in the first-implanted ear, which may be due to more generic learning in repeated speech audiometric tests, thus hinder-ing to gain an understanding of the true bilateral benefit.

The use of virtual acoustics may help shedding light on binaural hearing acuity via bilateral cochlear implants. In this talk, recent developments and clinical data on sound localiza-tion of panned virtual sources, the effect of add-ing reverberation on SRT in noise and the potential use of realistic virtual sound scenes in hearing assessment will be presented.

4a.3 First results with the virtual reality spatial discrimination tool in sequentially implanted childrenDr Cristina Simoes-FranklinMedical Physicist / Neuroscientist, National Hearing Implant and Research Centre, Beau-mont Hospital, Dublin, Ireland

It is well established that sequential bilateral implantation offers functional benefits to children with bilateral hearing loss, mainly in spatial and speech in noise discriminations. Despite these functional advantages, getting long term unilateral users to adapt to a se-cond implant can be challenging and requires considerable effort from patients and clinical teams, especially in older users with long inter implant delays (IID).

The objective of this study was to look at the different factors that can affect functional outcomes of sequential implantation, in particular inter implant map differences and its effects on binaural CI usage. Sequentially implanted children who had at least 1 year experience with CI2 were included in this study. Programming parameters, device usage and functional outcomes were analysed after one year of CI2 use. Spatial discrimination ability was assessed using a novel portable virtual reality tool and head related transfer functions that replicate 3D sounds delivered to the users via direct connect. Overall, older sequential implanted children show some functional benefits with the second implant, but this functional advantage is appears to be highly dependent on inter-implant delay and asymmetries between the two implant settings.

4a.4 Evidence-Based Bimodal Fitting Ms Tracey AdamsClinical Technical Support Department EMEA, Cochlear Europe Ltd, UK

Cochlear has been partnering with GN Resound to form the Smart Hearing Alliance. The Smart Hearing Alliance (SHA) aims to deliver state-of-the-art bimodal hearing for the growing group of CI users that have usable residual hearing in the contralateral ear. In this presentation he will review the elaborate research program that SHA has run to come to the current SHA bimodal fitting recommendation. He will discuss the clinical consequen-ces of the findings, also in light of other research that is out in the field.

The talk will explain that the data supports the SHA message that there is no magic to bimodal fitting and it’s best to fit both devices optimally without the need for complicatedmatching of signal processing and fitting parameters. This view is also expressed in more detail in the Cochlear/SHA white paper on bimodal fitting. In the last part of the presenta-tion he will discuss some exciting new research on bimodal hearing that was done with the research partners at KU Leuven in Belgium.

4a.5 Trauma detection during CI surgery using objective measures and imaging Dr Ralf Greisiger Senior Engineer, Oslo University Hospital, Norway

Ralf Greisiger1, Torquil Sørensen1, Hilde Korslund2, Marie Bunne1, Greg Eigner Jablonski1,3

1Department of Otolaryngology, Oslo University Hospital, Norway2Intervention Centre, Oslo University Hospital, Norway3University of Oslo, Institute of Clinical Medicine, Norway

BackgroundDuring the last years, indications for cochlear implantation are expanding, including pa-tients with residual hearing. Several factors have been identified, that reduce the residual hearing after CI surgery. This study investigated trauma during insertion of the electrode array, reflected by hearing loss. We used implant-based electrocochleog-raphy (ECochG) for monitoring the cochlear responses during electrode array insertion while performing per-operative fluoroscopy at the same time to observe the movement of the array inside the cochlea. In addition, video recording of the surgeon’s microscope view was done to capture the surgeon’s actions.

ObjectiveObjectives of this study are to identify trauma or mechanical obstruction during electrode array insertion, and better understand the different types of ECochG responses. This could improve ECochG interpretation during surgeries without visual electrode array movement feedback. We compared the movements and different ECochG characteristics with the maneuver done by the surgeon. Ideally, the gained understanding of what happens during the electrode array placement will lead to better preservation of residual hearing.

MethodsFor 12 adult patients the Electrocochleography (ECochG) responses were measured during insertion of the elec-trode array of a Cochlear™ Nucleus® Profile with Slim Modiolar Electrode (CI532). At the same time fluoroscopy was performed to analyze the movement of the array and to synchronize the movement with the measurements. As third observa-tion microscope video was recorded to track the surgeon’s insertion technique and surgical proce-dure. Finally, a postop CT scan was performed to analyze the electrode array place-ment in the cochlea. For all patients pre- and post-op audiograms were taken up to one year after CI surgery to record the loss of residual hearing.

ResultsWe have successfully monitored the electrode array insertion for 12 patients and were

able to identify some causes of cochlear trauma. There seems to be a strong correlation between loss of ECochG response and loss of residual hearing. In some cases, the loss happened during electrode insertion. In other cases, the loss may have happened already before insertion, while not measuring a response during insertion and loosing residual hearing. In addition, every movement of the electrode array even after insertion has been identified to be critical. For some cases the loss of ECochG response happened after full insertion just before or while packing the electrode array at the round window. Even coil-ing of the electrode array after sealing of the round window with the muscle has an effect on ECochG response amplitude.

ConclusionsThe combination of per-operative ECochG measurements, microscope video, fluoroscopy and post-operative CT scan gives us a valuable information about which steps during the electrode array placement may cause a reduc-tion of residual hearing. These findings will be used to improve the surgical procedure in future. Nevertheless, further investigations are necessary to increase the success rate of preserved hearing.

4a.6 Changes ahead in reliability reporting Dr Barry NevisonClinical & Technical Support Manager, Cochlear Europe Ltd, UK

Cochlear have a proud history of seeking to champion standards, adopt consensus and live the principles of open and honest communications about implant reliability. But despite standards and consensus, there remains divergence in how reliability is presented, both to the clinic and to the potential candidate; there may even still be differences in what’s included in the figures you see from one company to the other.

So is all this about to change? In 2019 it is expected that companies will need to adopt the new AAMI/CI86 standard developed in America and to report this alongside ISO5841-2:2014. So what’s this new standard all about? How will it affect the industry? And will there finally be a level playing field allowing truly objective comparison of data between companies?

4b.1 A better fit starts inside Ms Tracey Adams Clinical Technical Support Department EMEA, Cochlear Europe Ltd, UK

Creating the best fitting for your patient is easier when you understand how the technolo-gy has been developed to support better hearing outcomes. This talk presents an overview of how the BC Drive™ transducer technology in the Baha® 5 System transforms the

way patients with hearing loss can experience the latest generation of bone conduction hearing solutions.

We will discuss the performance of this technology in terms of power, sound quality and patient preference over the traditional transducer design, and demonstrate how it provides clinicians more options to fit patients with percutaneous and magnetic bone conduction systems.

4b.2 Baha SoundArc – hearing and speech understanding with an alterna-tive to the softbandProf. Martin KompisInselspital Bern, Switzerland

Kompis M 1, Gawliczek T 2, Caversaccio M 1,2, Wimmer W 1,2

1) Department of ENT, Head and Neck Surgery, Inselspital, University of Bern, Switzerland2) Hearing Research Laboratory, ARTORG Center for Biomedical Engineering Research,University of Bern, Switzerland

Objectives: To compare the performance of a bone conduction device (Baha 5, Cochle-ar Inc.) attached to either (i) a Softband and (ii) to a novel non-invasive wearing device (SoundArc) in adults with normal conductive hearing losses and normal inner ear func-tions.

Materials and Methods: Fifteen normal hearing subjects participated in this study. Both ears were occluded to simulate a bilateral conductive hearing loss, resulting in an unaided hearing loss of 49 dB (pure tone average 500 to 4000 Hz). The following tests were per-formed in unaided conditions, and with unilateral and bilateral bone conduction devices: sound field thresholds, speech reception thresholds in quiet and in a diffuse noise field (German Freiburg tests and German matrix test), and sound localization.

Results: All outcome measures were significantly better in the aided conditions with either the Softband or the SoundArc than in the unaided condition. Sound field thresholds improved by 24 dB (p <.001), speech reception thresholds in quiet by 20 dB (p <.001) and in noise by 4 dB (p <.001). Sound localization and speech understanding in noise was improved significantly (by +4 dB and by +28°), but only when the bone conduction devi-ces were used bilaterally. Differences between the Softband and the SoundArc wearing options were not statistically significant in any of the test conditions.

Conclusions: Both non-implantable wearing options bone conduction systems showed significant improvements in speech understanding in quiet and in noise, when compa-

red to the unaided condition. No significant difference between the 2 wearing options Softband or SoundArc was found. Using 2 devices bilaterally instead of just one improved speech understanding in noise and sound localization.

4b.3 Binaural hearing with bone conduction stimulationProf. Stefan StenfeltLinköping University, Sweden

Binaural hearing is often defined as the hearing benefit obtained using two ears compared with only listening with one ear. When the stimulation is by bone conduction (BC), both ears are excited by the BC stimulation from one position. Consequently, the binaural hea-ring ability is affected by the cross hearing in the skull. This has often led to the misinter-pretation that binaural hearing is not possible with BC stimulation.In a systematic approach to determine the benefit of bilateral application of BC sound, the speech perception in noise (spatial release from masking and binaural intelligibility level difference) and the ability to fuse the sounds from the two sides as one percept from a spatial position (precedence effect) was investigated in relation to (1) position of the BC transducer on the skull, (2) the hearing ability (sensorineural hearing loss), and (3) the symmetry of the hearing loss.

In all types of situations, there was a significant binaural benefit with bilateral BC applica-tion compared with monaural BC application of the sound. However, the binaural benefit with BC applied sound is less than with sound through air conduction (AC). The closer tothe cochlea the sound is applied, the better the interaural sepa-ration (less cross head transmission) and the better the binaural benefit. A sensorineural hearing loss affects the binaural benefit negatively independent of stimulation modality. In addition, the more asymmetric the hearing loss is the worse the binaural benefit. Binaural hearing is present when stimulation is applied bilaterally by BC for most types of hearing configurations. This implies that most people with bilateral need of BC hearing aids benefit from a bilateral fitting.

4b.4 Single center experience of 100 implantations of transcutaneous bone conduction

Prof. Jaydip RayConsultant ENT Surgeon, Sheffield Teaching Hospital, Professor, University of Sheffield

Jaydip Ray, Panagiotis A. Dimitriadis, Daniel Hind, Kay Wright, Vicki Proctor, Larissa Gre-enwood and Suzanne Carrick

Department of Otolaryngology, Sheffield Teaching Hospitals; Department of Otolaryngo-logy, Sheffield Children’s Hospital; Clinical Trials Research Unit, School of Health and Rela-ted Research, University of Sheffield; Department of Hearing Services, Royal Hallamshire Hospital; and Department of Audiology, Sheffield Children’s Hospital, Sheffield, UK

Objective: To assess outcomes with a novel passive transcutaneous bone conduction device (t-BCD). Study Design: Prospective data collection and patient review. Setting: Tertiary referral center. Patients: Patients who underwent implantation with the t-BCD between November 2013 and September 2016.Intervention: Implantation of BAHA Attract.Main Outcome Measures: Surgical outcome, patient reported outcomes including the ‘‘Glasgow Benefit Invento-ry’’ and the ‘‘Client Oriented Scale of Improvement’’ for adults and the ‘‘Speech, Spatial and Qualities of Hearing scale’’ (SSQ-12) for children.

Results: One hundred five patients were implanted. Numbness superior to the incision was commonly noticed. Four patients (3.8%) developed skin tenderness and redness that settled with conservative measures. Among those patients who had a conversion from a percutaneous Bone Conduction Hearing Device (BCHD) to the t-BCD (n¼15), 1 (0.9%) developed seroma and 2 (1.9%) developed skin dehiscence at the edge of the implant magnet. Significant improvement in Client Oriented Scale of Improvement and Glasgow Benefit Inventory scores with a global satisfaction of 84% and 77.4% was observed for those previously aided and unaided respectively, with use of the device. A 22% improve-ment in SSQ-12 mean score was observed in the pediatric population.

Conclusion: This is the largest single-center series reported on this t-BCD. The compli-cation rate is small but caution is required in patients of conversion from a percutaneous BCHD. The patients’ satisfaction is high and the need for aftercare is minimal. Cost-effecti-veness evaluation of these devices, development of core outcome sets and well-designed, prospective trials to compare the different BCHDs should be the focus of future research.

Key Words: BAHA—Conductive— Hearing loss—Sensorineural—Transcutaneous. Otol Neurotol 38:xxx–xxx, 2017.

4b.5 National BCD guideline - is there a need to improve quality? Dr Myrthe HolRadboud University Medical Centre, Netherlands

Myrthe Hol is an ear surgeon at Radboudumc, Nijmegen, the Netherlands, with particular attention to titanium temporal bone implants (BI) and auricular reconstructions/prost-

hesis. She combines her clinical duties with re-search on most of the bone conduction hearing devices on today´s market. Next she has been working on the Dutch Guideline BCD over the past years and she will share some highlights with us. In order to address the current challenges in indications she will inform us about the assessment of complications and how to guide patients and professionals in the decision making process.

4b.6 Challenges with bone conduction Theres BjörkClinical Research Audiologist, Cochlear Bone Anchored Solutions, Sweden

Understanding bone conduction from a practical point of view could in many cases make the fitting procedure easier. During these 30 minutes, Theres would like to share her “aha-s” within the area and how she use the information to rapidly find the right settings for her patients.

As the global leader in implantable hearing solutions, Cochlear is dedicated to bringing the gift of sound to people with moderate to profound hearing loss.

Together, we have helped over 450,000 people of all ages live full and active lives by reconnecting them with family, friends and community.

We aim to give our recipients the best lifelong hearing experience and access to innovative future technologies. For our professional partners, we offer the industry’s largest clinical, research and support networks.

Thank you for your continued partnership with Cochlear and we look forward to making a difference together to help more people hear and be heard.

Cochlear, Hear now. And always, NRT, Nucleus, and the elliptical logo are either trademarks or registered trademarks of Cochlear Limited. DEC18.

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