Inside OTOPLAN: MED-EL’s Innovative Tool for Optimizing Cochlear Implant Results

All right, well, good afternoon and welcome to another edition of This Week in Hearing. I’m really excited about the conversation that we’re about to have here. The proliferation in advances in hearing care continue. And MED-EL is no stranger to that. I’m joined today by Katelyn Glassman. She’s an audiologist and senior project manager at MED-EL So I appreciate you spending some time with us this afternoon. And before we get going on OTOPLAN, which I’m excited to talk with you about today, tell us a little bit about yourself and your role at MED-EL, please. Yeah so thank you so much for having me today. So I have been at MED-EL about a decade, which is crazy to me. I currently serve as senior manager of site initiated research. And so my primary role is working with clinicians and researchers across the U.S. that are interested in doing studies with MED-EL products. Over the past year and a half I also have been heavily involved in trainings for both surgeons and audiologists on OTOPLAN and anatomy based fitting. And so that’s the reason that I’m here today. Very, very cool. So as we dive into this, we mentioned OTOPLAN. What is it? Yeah, so OTOPLAN is a software. So it’s for otological planning for surgeons and audiologists. And so it allows US to create 3D reconstructions of a patient’s cochlea using standard clinical scans. So using CT scans and MRI scans that means preoperatively we can use those images to select optimal electrode arrays based on a patient’s individual anatomy. And postoperatively we can visualize where the electrode array is sitting within a patient’s cochlea. So then we can take that information and an audiologist can utilize that information for programming of frequency information. We know that most MED-EL patients enjoy improved outcomes using their cochlear implants. But as a company, we want to continue to seek new innovations to further improve outcomes for our patients. Very cool. And so how did this OTOPLAN come about? Yeah, so OTOPLAN is a collaborative effort between MED-EL and Cascination. Cascination is a Swiss company that develops surgical navigation software as well as robotic tools. So we first introduced OTOPLAN in our European market back in 2018 and then here in the U.S. we obtained FDA clearance for OTOPLAN back in 2022 and started promoting it back then. Very cool. And I would assume that you’ve rolled this out and it’s being utilized in centers and in hospitals. Yeah, so OTOPLAN really most centers are accessing that through our OTOPLAN on demand service. And so that’s a service where centers are sending scans directly to MED-EL So there’s a process where essentially the center lets us know that they have a patient where they’re interested in obtaining this information. We send them a link where they can upload the patient’s images directly to MED-EL So that’s through a HIPAA compliant file sharing service. And then once our team has received a patient’s images, we have a group of experts that are using OTOPLAN software to analyze that patient’s individual anatomy to provide back a detailed report to the clinics within two business days. Oh, that’s interesting. I’m going to go a little bit off script here, but the question is you know Maryland just passed for audiologists a bill that allows them to request imaging. Who’s asking for the images at this point in time? Is it the physician or is it the audiologist? And I know we’re going to talk about how this plays into the the actual service delivery here, but while you’re mentioning that, I thought that might be a good place to insert this. Yeah. So we’ve really seen a mix across our centers. So sometimes this is really surgeon driven. Sometimes it’s coming from the audiology team. You know I think we have many centers that obtaining images post operatively as part of their standard of care. And so this tool provides them an opportunity to utilize that information in a different way. But it really is, seems to be center dependent as to who’s, who’s obtaining this information. Yeah. And that’s good to know. So we have these images that get uploaded, they get reviewed, there’s a report that comes back that helps the clinician in helping them service the patient through mapping and some other things. And I’m assuming that there’s a cost in a contract or how does that work? Yeah, so there is kind of the process of getting centers up and running to get this into their workflow preoperatively. Really most centers are already getting scans as part of their CI candidacy evaluation. So it’s really about getting those logistics in place. So we are utilizing Box as our file sharing service. So there are instances where our team can work with your center. I know we have some centers that run into firewall issues and other problems. So we have a lot of experience in that and can work with it to kind of work through that process. So really it comes down to what your center or what each center has approval for in terms of what they’re able to utilize. But we’ve certainly jumped through a lot of those hoops. You know, I think the other piece of that is working with the radiology team to try to try to get access to the scans. Many centers are using PAC systems, so our team is able to work with radiologist group to help provide them the right outlet so the clinician can get those scans and get them uploaded to Meadow. Very interesting. And that was one of my questions is how are you accessing this? And you answer that. So thank you. How many centers would you say are currently using the OTOPLAN? Yeah, so we just hit our two year anniversary for OTOPLAN on demand. So we have had over 225 centers that have been uploading scans to us. Weve analyzed over 3200 scans at this point. So certainly I’ve had a huge uptake in the clinical community which is really exciting to see. Well, that’s really encouraging to hear. I didn’t realize that it was that large, but that’s cool. So within the cochlear implant workflow, and I know you mentioned preoperative and postoperative, where does the OTOPLAN actually fit? Yeah, so preoperatively really the surgeon or the audiologist, depending on the center is getting that information prior to selecting the electrode array for that patient. So sometimes patients have not already chosen which device that they’re going to get. So we have a lot of centers that want this information so they can make an educated decision using that objective anatomical information. Post operatively. Its really variable if the center is already getting scans. So centers are having to determine when they’re going to have that scanning process which is really we’ve seen success with centers getting that on the day of surgery in terms of obtaining those images. Some are doing it at the surgical follow up visit. Some are doing it on the day of activation and some after that point. So it’s really about what works best in their clinical workflow. But I think that that’s kind of the biggest hurdle is that once we get through those first pieces of those logistics, then most centers are using OTOPLAN on demand services and are continuing to use those services for their patients. Yeah, and I’m assuming that once they get this information, it’s allowing them to better fit the patient or map to the patient. If I go back to my school days of understanding cochlear implants, there are times when you can’t put the complete array in, and so you have to shorten it or whatever the case may be. And so I’m assuming that when you’re talking about having the opportunity to understand what’s in the ear and what’s available, it maximizes the opportunity for the patient to be successful. I think I remember from my training as an audiologist that really thinking the cochlea is a black box and we don’t know anything about it. And I think that’s not the truth anymore. And having access to these tools really allows us to feel more confident. So allowing surgeons to feel more confident in the electrodes they’re choosing feel that they’re able to achieve optimal coverage of the cochlea and then certainly on the audiology side, having this information. So you can objectively make changes to how you’re programming patients. Yeah. No, that’s great. And as a patient, you know, you mentioned this a little bit. What, what other benefits would I see? Yeah. So I think a lot of that comes down to how much mismatch we’re creating and the frequency information between what’s provided naturally in the cochlea and what’s being provided through the implant. And so when those things are not matched, patients report that the sound quality is shifted higher in pitch. So things might sound. People speaking to you to you might sound cartoonish or like Mickey Mouse or the chipmunks. So getting that match is really important in terms of sound quality. We can also talk about some of the other benefits that are out there. We’re starting to see more and more publications on use of OTOPLAN and anatomy based settings where we’re seeing reduced variability in patient outcomes when we’re kind of looking across patients. But also on the individual level we’re seeing significant benefits for speech and noise and different listening situations. So for example we can look at different patient groups and how this information has been really helpful. So for our traditional users, we’re seeing the sound quality impacts. There’s a recent publication by Louise La Saletta and colleagues focused on that traditional group where they allow patients to listen both to their default frequency settings which is using the same frequency setting for every patient. And then this anatomy based individualized approach and 88% of patients preferred the anatomy based approach. We can look at studies by Anya Kurz and colleagues focused on our bilateral population. So two cochlear implants or patients that are using acoustic information in one ear in conjunction with the cochlear implant when we’re providing that similar frequency information across ears, we see those improvements for speech in noise, especially when we’re looking at spatially separated situations when noise and the targets speaker are in different locations or in the same location. And then we can also look at our patients that are using both electric and acoustic hearing in the same ear. So our EAS population having this tool allows us to align that information between electric and acoustic stimulation better. And so there’s a recent publication from Margaret Dillon that shows that when we’re able to align that information and that can be using anatomical information for array selection preoperatively or using it to further fine tune the frequency settings for the patient postoperatively so after they have the implant, knowing where that array is sitting and using that information for programming patients have better performance the first six months and we also continue to see that reduced variability in outcomes. So we’re really excited about how this is affecting patient care and we’re continuing to see more and more publications come out and I’m sure we will over the next few years. Yeah, and I just absolutely love the fact that you shared the research piece of this because I think that’s an important component for surgeons. I mean I can only imagine how much of a benefit this tool is for them. Yeah, I think it really comes back to that confidence piece. Knowing that you’re selecting the right array for the patient, knowing that you’re providing them with the optimal level of cochlear coverage. Historically we’ve had many surgeons, as you said, that are concerned about achieving that full insertion. So they’ve used physical tools in the OR to try and test that out. We’re finding with OTOPLAN that many surgeons are no longer ordering those devices. So that’s been really exciting to try to provide them with this information before they even even approach the surgery. And we’ve also found that some centers that we’re seeing less extracochlear contacts. So that’s certainly, you know, potential benefit for the patient that we’re having more active channels that we’re able to program. Yeah. And lastly in this, in this patient journey is the audiologist And I would just again assume that those individuals are really loving the OTOPLAN because it makes their lives a little bit easier when it comes to fitting, as you pointed out between the acoustic and the electrical of you know, making the match a little bit better between those two signals. Yeah, no, I mean, I think when we’re thinking about the audiologist, I think audiologists tend to gravitate towards that objective information. And so I think having this as a tool where you’re not guessing on how you’re setting frequency, which is not something historically that we fit in cochlear implants much, we generally don’t play around with that. And so now we’re looking at a whole different dimension of sound. Were able to take that information, we’re able to utilize it for programming. And if we have that optimal array, if we get that array in the, the right place, we have a lot of flexibility in what we can do with frequency programming for our patient. If the patient does not have that array in the optimal place, then we’re a bit more limited. So we can make some of these adjustments programming wise to try and fine tune to improve sound quality. But doing so we may need to cut out some of that low frequency information. And so really all of these pieces are kind of, they all come together, they’re really integral for providing the patient with the best care we can. Yeah, that’s really, really cool. I wish they had something like this for hearing aids. It would make hearing aid fitting so much better. But that’s another conversation. So is there anything else out on the market that is similar to the OTOPLAN? Yeah. So OTOPLAN is the first otological planning software available globally. And we currently remain the only one available clinically. So that’s something we’re really proud of as a company. And then I would assume that because of that, that the cochlear implants outside of MED-EL are not able to use the OTOPLAN. Or am I wrong? Yeah. So OTOPLAN is designed exclusively for Med El products. Now certainly, again, as I spoke about earlier a lot of surgeons are utilizing this and audiologists are utilizing this prior to device selection. So certainly if you have a patient that has a larger cochlea, we know that we really need to pursue those longer array types that only MED-EL offers. So making sure that we’re achieving that optimal level of cochlear coverage post operatively OTOPLAN is really providing accurate information for metal products, and so that’s integrated into the software. Yeah. And then the last thing that I have for you is if someone is more interested in learning about your products, your services we’ll put a link down here at the bottom. But is there anywhere else that they can go in order to get that information? Yeah. So certainly we have a lot of resources on our website. I would encourage them to reach out to MED-EL We can actually set up opportunities for them to talk with people at MED-EL about these products. So we can kind of dig into whether somebody’s a candidate, whether they already have a device. Right now, OTOPLAN On Demand services are focused on our clinicians. So certainly, if you’re a patient and you’re interested in pursuing this for yourself I encourage you to reach out to your audiology team and they can certainly connect you with MED EL and we can try to get this information for your programming. Wonderful. Well, Katelyn I really appreciate your time and the conversation we’ve had here. It’s really, really fascinating from someone who’s not heavily involved with cochlear implants. And you’ve certainly shed light on several things and some things that I didn’t know, so. So thank you for that, and we look forward to having you guys back on down the road here as you generate more and more scans and hopefully you know, you’ll develop something new, and that will then take the fitting to a whole nother level. Well, thank you so much for having us. This has been a great chat Thank you.