Remote medicine comes to cochlear implant users | News

Cochlear implant users who need help with their devices have a new way to get it, even — or perhaps especially — if they’re on the road. All they need is a smartphone, tablet or iPad and the internet.

At the Center for Neurosciences at the University of Arizona, Dr. Mary Rose Goldstein, lead audiologist, now has access to a program designed to diagnose implant problems and can have consultations from afar. 

Remote medicine is not a new idea, but it is relatively new to cochlear implant users. Dr. Goldstein believes the possibility of practicing remote medicine has the potential to free her patients since adjustments and some repair work can be done through Cochlear Remote Care. Provided, of course, it’s a device from Cochlear.

“With Cochlear, their program allows us to test patients through Nucleus Smart App on their phone and get information that normally would take an hour-long visit in the office,” she said. “We can get all kinds of information from the patient and analyze that in about five minutes, so it’s been really helpful in a lot of different ways, not only for the patient but for our practice as well.”

A cochlear implant is different from a hearing aid, which works by amplifying sound. The implant is for people who are diagnosed with severe to profound hearing loss and helps with both sound and clarity. It works by bypassing the damaged inner ear (cochlea) and directly stimulating the auditory nerve, which sends signals to the brain. 

According to Dr. Goldstein, only about 10% who qualify for a cochlear implant have one. She said one reason is because there just are not a lot of audiologists who work with them. With this new capability, just about anyone with a Cochlear implant can get an appointment to be seen that much quicker, though mostly patients don’t need to be seen. It’s the device that’s the patient.

“This is one way we can troubleshoot things without them having to come in for a visit,” Dr. Goldstein said. “You can imagine a patient calls in, especially during our busy time, it might be up to six weeks out before they can get in for a visit.”

That’s especially true when the snowbirds hit town.

Here’s how the app works:

“You say you’re having (an) issue; I’m going to have our assistant send you a Remote Check,” she said. “We’ll get a lot of information on that. It will test the device, make sure it’s functioning, make sure the microphones are functioning. It will check the implant in their head as well and make sure there’s nothing wrong there. It will also do a hearing test through their cochlear implant, like ‘raise your hand when you hear the beep’ sort of test, like we would do in the office. It also does a speech recognition test with them.”

That information is then used to troubleshoot the device.

“We might get something back (to the app) that says, ‘You just need to change your microphone cover,’” Goldstein said. “Then we can message them back and then that’s going to save them six weeks of potentially not hearing well when it was a simple fix.”

In addition, Cochlear has a “Recipient Solutions Manager,” which is a fancy name for a technician, who can help recipients with the technology. 

The check is done on both the exterior and internal devices.

When patients start their implant journey the Center asks them to enroll in a series of classes and one of the classes concerns how to do telehealth, Remote Check and Remote-Care with their implant.

“It’s actually surprisingly easy to do so (patients) often just need that little bit of a confidence boost,” which they get in class, Goldstein said. 

The average age of the Center’s practice is 77. There could be some concern that they cannot manage the app.

“There’s always this kind of worry or assumption that the older adults can’t do some of the telehealth or digital things,” Goldstein said. “What we found was with a little bit of encouragement from Cochlear and a Recipient Solutions Manager most of them are successful.” 

Getting a cochlear implant is no small deal. Patients are asked to come in for six visits over the course of a year and that has been a barrier for some. Consider the cost and if the patient is elderly, the drive.

“Often they have to drive,” Goldstein said. “We have patients from Four Corners, from rural New Mexico because they can’t get the services there. They have to come into Tucson.”

The Cochlear Nucleus Smart App along with Remote Care makes it possible to meet over the internet for two of those visits.

For Goldstein, the app and the telehealth program have made it much more efficient to see patients. In fact, she sees 40% more cochlear implant patients every month by offloading these two visits and some of the troubleshooting issues through this telehealth remote check option,” she said. “It’s really enabled us to increase the access that we can provide for patients and keep that timeline down.”

She has these words of advice.

“Don’t wait to do something about your hearing,” she said. “Secondly, if you feel even after doing something about your hearing, if you’re still not doing well don’t accept that that’s all there is. There are a lot of audiologists who don’t offer cochlear implants and aren’t comfortable talking about it with their patients and so you may be missing out on years of better hearing if you just accept where you’re at versus maybe seeking out learning about a cochlear implant or seeing if you’re a candidate for one.”