• Slightly superior sound quality and speech comprehension

• T-Mic or Telecoil on BTE

• Greatest hardware capabilities and future expandability

  • DSP chip

  • Faster stimulation rate

  • Simultaneous or non-simultaneous

  • Wider IDR

  • NRI & EFI

• Flexibility of rechargeable or disposable batteries on BTE

• Significantly longer BTE battery life

• MRI compatibility (high-powered, but with surgery)

• Telecoil on BTE (but no T-mic)

• Longest track record in the industry
  

• Significantly longer BTE battery life

• MRI compatibility (low-powered, but no surgery)

Average Speech Comprehension

No one can guarantee how well anyone will do with a cochlear implant, but there may be slight differences in the average performance and speech comprehension among people with one type of implant over another (all other things being equal).  However, there are many reasons that professionals and users may be reluctant to suggest that one implant delivers superior performance over another, so it is important to evaluate the evidence in order to understand whether the chances of hearing well can be improved by getting one type of implant over another.  Click here to learn more about evaluating performance and sound quality differences between the implants, and to understand where the conclusions on the left come from.

Type of Electrode Array

The HiFocus and Contour electrode designs are more advanced than the straight electrode array used by Med-El.  The advantages of such advanced designs are that they stimulate the ear with lower levels of electrical current and may yield better sound performance.  Med-El is working on developing an electrode array similar in design to the HiFocus or Contour, and hopes to have one widely available in the near future.

Maximum stimulation Rate
(Pulses per second)

Maximum stimulation rate is measured by pulses per second (pps) that the implant's electrode array can deliver.  Currently, there is only limited evidence to suggest that higher stimulation rates leads to greater performance, but the CII Bionic Ear has vastly expanded capabilities that are putting this theory to the test.  In addition, as new kinds of sound delivery techniques are developed, the added capability to deliver high stimulation rates may be important.

Number of Potential Channels

Despite the difference in number of channels between implants, to date there is no evidence that more than 8-10 channels provides any improvement in performance.   Click here to learn more about channels and electrodes.

Input Dynamic Range

Input Dynamic Range (IDR) defines the range of sound intensities that is captured by the implant without distortion.  Click here to learn more about Input Dynamic Range and its significance.  Cochlear has developed special speech programs, like ADRO and "whisper setting" to accentuate softer sounds and compensate for its smaller IDR.  Some implants have a fixed IDR which focuses on a defined, adjustable range, while others have an automatic one which aims to adapt to changing listening environments.

Materials

All the implants are equally reliable and it is unclear what additional protection, if any, one type of material provides above another.  According to FDA tracking of device failures, devices with titanium malfunction upon impact at similar rates to those made of ceramic zirconia.

Size of overall implant and implant well

All devices are remarkably compact. The implant well measures the amount of drilling necessary in the skull to secure the implant. All the implants now come in small sizes that require minimal drilling to be done on the surface of the skull.

Approved MRI Compatibility

The Nucleus 24 is approved for use with MRIs, provided that a small surgical procedure is done first to remove the magnet in the implant and later replace it after the MRI.  The Med-El is approved for lower powered MRIs without the complication of a removable magnet and surgical procedure.  The Clarion has not yet been approved for use with MRIs, but the CII Bionic Earis similar to the Med-El in its structural design, while the Clarion HiRes 90k implant is similar in structural design to the Nucleus, so it is possible that the FDA may someday approve the Clarion for MRI use.  Regardless, it is important to note that anecdotal evidence suggests that cochlear implant recipients almost universally receive CT scans instead of MRIs, even with the option of MRI compatibility.   Click here for more information about MRI compatibility.

Imaging Telemetry

Telemetry is used to verify the inner workings of an implant and troubleshoot any problems that may arise.  In addition, it can be used to help program the implant for very young children who are unable to provide the audiologist with meaningful feedback on what they are hearing.  However, this technology is still principally used as a research tool and has limited practical value.

Speech Strategies

Click here to learn more about the technical difference between different speech strategies. Different speech strategies may contribute to sound quality and performance. Click here to learn more about studies comparing sound quality and performance with different implants.

Other features

ADRO is a new addition to the Nucleus' speech strategy that is designed to enhance sound quality.  To date, I have not seen any clinical evaluations of its benefits, so I cannot evaluate it objectively, beyond the fact that anecdotal evidence suggests that some people like it and some don't.  ADRO is only available on the Nucleus' body-worn processor; it is not an option on its BTE.

The Med-El and Clarion BTEs employ a "modular" design, which enables them to take on several different forms.  Visit the companies' websites for more information and illustrations.

Type of Processor

A DSP chip is essentially like that of a computer, with a lot of flexibility to adapt to new software and programming changes.  Fixed circuits are more limited, with preassigned functions and limitations.  BTEs based on an fixed circuit may be more limited in functionality--for instance, Med-El's BTE is incapable of running certain speech strategies (n-of-m), and the Nucleus ESPirt 3G appears to be incapable of incorporating new enhancements such as ADRO.  However, fixed circuits are considerably more power efficient than DSPs, so there is trade off between the two.

Number of Programs

Each program allows the user to hold a customized set of instructions for how the implant should deliver sound, which is often set by the audiologist for different listening environments.  Typically, most users rely on the use of a single program for 75-100% of their needs.  The Med-El technically has 9 programs, but it is designed to be used with 3 programs, each with 3 volume settings (for a total of 9 program/volume settings).

Telecoil/T-Mic

The telecoil and t-mic are technologies designed to facilitate hearing on the phone, with FM systems, or headphones.

Only the Nucleus ESPrit 3G and Clarion Auria both include a telecoil option. In the ESPrit 3G, the telcoil is built into the BTE. On the Clarion Auria, the telecoil is designed as part of the earhook. Advantages of the telecoil are that they are very effective at blocking out background noise when using the phone and that they are ideal for use with FM systems. However, not all mobile phones are compabile with telecoils.

The T-coil is an alternative to the telecoil, and is only available on the Clarion. The t-coil is effectively a microphone that is positioned at the tip of the earhook. By holding the phone up to it, it provides a more natural way to listen on a phone or headphones, and can be used with any kind of cell phone or headphones the way a normal person would. However, they don't block background noise 100% the way a telecoil can.

Regardless, it should be noted that the ability to use the telephone varies a lot between recipients depending on how well s/he hears, and a telecoil or t-mic does not guarantee that someone will be able to use the phone.

Batteries

There are pros and cons to using rechargeable vs. disposable batteries.  Rechargeable batteries are easier to handle, more environmentally friendly, and potentially cheaper in the long-run (as new technology is developed).  However, disposable batteries are more readily available in the event of an emergency or if you forget to recharge batteries.  Click here for a personal opinion article on disposable vs. rechargeable batteries and battery life.

Average Expected Battery Life (approximate)

Approx 18 hours (?)
(extended battery)

~ 44 hours
(average)

Actual battery life varies a great deal between individuals, and is a factor of many things including listening environment, thickness of the skin underneath the headpiece, the speech strategy used, and the type of BTE.  The numbers on the left represent the range of typical hours reported by different users and field tests.  The wide range on the ESPrit 3G is largely a factor of which speech strategy is used, with the average user getting approximately 44 hours.  Click here for a personal opinion article on disposable vs. rechargeable batteries and battery life.

Battery Cost

There does not seem to be a significant difference in the annual operating battery cost between the devices.  Some people are able to get their batteries covered by health insurance. This is especially true for the rechargeable batteries, which are considered replacement parts of the implant by many insurance companies.

Colors

For some, colors and aesthetics on their BTE are an important consideration. For pictures of the BTEs, and the colors, visit the company's websites.

Other Features

The Med-El's BTE has a light on it and the Clarion Auria BTE can accomodate a "firefly" earhook which provides a light so that parents can visually confirm that the implant is operating.

The Nucleus' ESPrit 3G has a "whisper setting," which is designed to enhance listening in quiet environments.  Clinical tests appear to confirm these claims.  In essence, "whisper setting" appears to be designed to compensate for the fact that the Nucleus has a smaller Input Dynamic Range (IDR) than the other implants, which makes it difficult for it to capture soft sounds to begin with.  Overall, there is no evidence that one implant is better in quiet environments than others.

Headquarters and Manufacturing Facilities

All of the companies have field offices worldwide, but the implants themselves are manufactured in their home country.

Year First Implant was surgically implanted (in clinical trials)

Cochlear's long track record gives it the most established relationships and presence in the industry.   It was established in 1983 and was the only prominent manufacturer of cochlear implants until the mid 1990s, when Advanced Bionics and Med-El released competing products.   All three manufacturers have since released new models of their implant, which continue to get better with time.

Year First Implant was Commercially Released

Recipients Worldwide (approximately in 2001)

Because of Cochlear's longer history in the marketplace, they naturally have a larger number of total users.  Of the implants being done today in the USA,  approximately 50% are Clarion and 50% are Nucleus.  Med-El has a very small U.S. market share largely owing to the fact that it was only recently approved in the USA.  However, in much of the rest of the world, approximately 50% of the implants done today are Nucleus, 25% are Clarion and 25% are Med-El.  In many clinics, especially those outside the United States, a choice of implants is not offered, so the market share percentages do not necessarily reflect the true preferences of candidates.

Marketing Ethics and Credibility

The different manufacturers employ different levels of marketing tactics and hold themselves to different standards of marketing integrity.  When considering an implant for life, the manner in which these companies conduct themselves may yield some insight into the care they provide.   Click here to review and evaluate a list of "questionable actions" and marketing tactics undertaken by each manufacturer.

Number of U.S. Patents
(Through 2/26/2002)

The number of patents provides some proxy of the amount of technological innovation and proprietary technology developed by these companies.  This may be important to consider when thinking about future developments that the companies may have to offer their recipients.