Last week was my 9 month, optional, visit. When I was last at MUSC and discussing whether or not to go, it’s a 10 hour drive for me, I had decided to not go. Then I received a couple of queries from MUSC about whether I wanted to book the appointment, so I did.
Boy, am I glad I did.
Most of the time was taken up with me asking a lot of questions. I’d stay technical, trying to understand better how the ear and the implant device work. Trying to figure out where the limitations are – inherent in the design / engineering / what is humanly possible from a technological point of view.
One of the things that bothers me is the limited bass from the implant. I suspected, correctly, it’s largely because the bass frequencies are captured at the innermost point of the cochlear and it is difficult, if not impossible, to get the electrodes (probes) into that location. There are similar engineering challenges with the electrodes at the very outer edge which impacts the highest frequencies that can be “heard”. Add to that all the harmonics that are essentially missing and you have why the implant doesn’t, generally, sound “natural”, especially of there is no natural hearing left in the implanted ear. Which is my case.
Anyway, all the questions aside, we went through a re-calibration of the implant, which I don’t think changed much. There are 16 electrodes of which one, in my case number 15, is turned off because it was not providing any information to my brain. We were going to try and turn it back on, but keep the impulse lowest / off but for some reason that wasn’t possible. Apparently, even with the impulse set to minimum, it does impact some individual’s hearing to have them turned on, even if the setting on the electrode is effectively 0.
Well, we did a new program for my implant which I am now using full time although I do have my old program still installed.
This new program has added a new degree of clarity and eliminated some of the “duckishness” inherent with the implant. After the new program we went and did the sound field tests with words and sentences. My comprehension has risen to 62% from 52% in June for words and, if I remember correctly, from 67% to 72% (or 75%) for sentences – i.e. in context. Those results are just my implant results, left ear plugged.
Since coming home I have had a few conversations with people relying solely on the implant, i.e. not wearing my left hearing aid, which makes my brain depend a lot more on the implant on the right. Yesterday was a 10 minute conversation, outside, with the guy sealing my driveway. It was challenging due to his accent, primarily, but I probably managed to understand 90% without having to ask him to repeat himself. That was awesome.
I had to admit, at MUSC, that I had not spent a lot of time training, other than removing my left hearing aid when I am passive listening, or listening to things that aren’t important for me to understand (like politicians, news hosts etc.).
I have also made a renewed commitment to practice the piano for at least 30 minutes every morning. I am going to do this every single day to see if it has much impact on my hearing. I still play piano, guitar and bass, but I thought to really concentrate on scales on the piano to see what impact, if any, that has on my hearing.
I will post again when I have some news.
God bless.
6 thoughts on “Envoy Acclaim® Cochlear Implant Update”
That is a great update! Looking forward to hearing how you progress with the new programming (phone, music etc). Shot in the dark… I don’t suppose they said when trial would be ending and when this would potentially be commercially available?
Generally, from the investor information stuff, the company is expecting / hoping to complete their submission of the fourth and final module for approval in the 2nd quarter 2027. That will mean that the clinical trial is complete.
They are hopeful they will get approval for the device in the latter half of 2027 or 1st half of 2028.
At that point it will become commercially available and covered by medicare (presumably), but probably only initially available for implanting at one of the hospitals that participated in the clinical trial (for training reasons).
IF they get their final module submitted, I personally see no reason for delays. The battery technology is pretty standard, including the recharging an implanted battery. The implant itself is also pretty standard stuff from the electrodes to the processor. The only difference I see, I say “only” but it’s significant, is the transducer (mic) is embedded behind the tympanic membrane and the processor is implanted too, not external.
I don’t see any of that being a hold up. Things like pacemakers etc. have been totally implanted for decades.
I would think that approval should be complete before the end of 2027, but you know government…
Good afternoon. Modern cochlear implants (and hearing aids, for the most part, too) provide frequency perception up to 8 kHz. In the article “Activation Day,” you wrote that your audiologist tested frequencies of 15 and 16 kHz for you. Does this mean that Acclaim is designed to work with these frequencies?
Med-El’s electrode reaches the apex and covers 70–8500 Hz. It turns out that Acclaim, conversely, handles very high frequencies well. Is it possible that its electrodes are located at the very outer edge of the cochlea?
Hi. Thanks for the question.
From my discussion with my audiologist in the trial, it isn’t the ability of the implant that is the primary issue, it is locating the electrodes with the lowest frequencies being the hardest to locate. According to my audiologist, the electrodes at the edge of the cochlear are the easiest to locate, and this is so for all cochlear implants.
Implants have different numbers of electrodes too. I don’t remember the exact numbers. Sometimes the electrodes don’t have any impact because of where they end up located so they will turn them off. Other times they will leave them on, but turned down. I think, if I remember correctly, I have one electrode actually turned off (15).
Given that most speech is in the 2-4k range, that’s where implant developers focus their attention. That’s my understanding anyway.
Hearing aids are quite different in function. They are basically sophisticated frequency equalizers / processors and amplifiers and rely entirely on whatever remaining natural sensors one has in one’s cochlear while implants effectively replace the sensors in the ear (scilia) which normally convert the sound pressure waves to electrical energy to feed to the auditory nerve.
Some people retain some natural hearing when they receive a cochlear implant. Some do not. I did not. Consequently I have no remaining lower-end frequencies in my right ear, which makes me want to keep my left ear natural for as long as possible.
Thank you Robert. I am going for my 9 month optional appointment next week. I hope I see the type of improvements that you are realizing. I feel like I should based upon perceptions of improvement in following TV un aided. Also the VA just tested my hearing in my good ear and the cochlear ear and they had high praise for the improved hearing, particularly in the higher frequencies, in the cochlear ear versus their pre surgery testing for hearing aids.
One question I have is what support will the study participants have after the trial if Acclaim gets approved and if not. For example if the commercial version becomes compatible with an I phone will we be able to migrate to it. And if Acclaim for any reason does not get approved how will our existing devices be supported in the future.
If I get an answer I will share it with you here.
Hi Jim.
My sense is that after the trial you are on your own. The real question is whether or not the Acclaim will be approved by the FDA and I do not see this being an issue. I full expect it to be approved before the end of 2027. They’ve been implanting cochlears for 40 years already, have other devices with embedded batteries like pace makers etc..
Once it is approved I expect you will be able to get insurance coverage and medicare will cover it, as they do other implants.
If Envoy goes bust it will be inconvenient, but the worst case scenario is you end up having to replace the Acclaim with a traditional implant. In reality, the company has enough IP assets that I believe their assets would be purchased by a more financially stable medical company so it’s not really a concern for me.
I would be interested to hear what response you get.