Inside the Cochlear Nucleus Nexa Implant System: Advancing Hearing Outcomes Through Innovation

Welcome to This Week in Hearing. I am Gael Hannan, a hearing health advocate and author of Hear & Beyond: Live Skillfully with Hearing Loss with Shari Eberts. This week, we are talking about something that is not only important, but personal to me, cochlear implants. More specifically, an exciting new development for CI recipients, both externally and internally. Our guest is Brendan Murray from Cochlear Corporation, and he’s joining us from Sydney, Australia. Brendan Murray is the vice president of Cochlear Implant Product Portfolio and Strategy, based in New South Wales, Australia, where he leads product and marketing strategy to bring Cochlear’s hearing solutions from inception to commercial release. He has more than 25 years of experience in the healthcare and medical devices industry, with global experience working in markets around the world, including Australia, the UK, Europe, South Africa, Middle East, and Africa. And I, I said, “South Africa.” I meant South Asia, the Middle East, and Africa. I do not see my own country, Canada, there. But that’s we’ll need to talk about that, Brendan. Anyway, welcome, welcome. Thank you, Gael, and thanks for having me here, and welcome to your audience as well. Yeah. Oh, it’s great. Now you may have gathered by now, Brendan, that I am not a techie, and I’m going to let you tell us about this exciting new system, the Cochlear Nucleus Nexus system. And I’m asking if you could do that in terms that are simple enough for people such as me, people with hearing loss who may be considering cochlear implants or already have one, or for whom cochlear implantation is so important, so that we can understand it. But also so that the hearing care professionals who work in, with CIs won’t be bored and will have a, a good understanding. So there’s your challenge. Yeah Great. Why don’t you start off and tell us a bit about this great new system? Sure. I think the important thing, as you’ve mentioned already, Gael, is this is a new system. So a system for us means it’s both a new cochlear implant and also new sound processors and also the new programming software, and everything goes with that whole system concept. So it’s not one. It’s actually seven different components all working together. But the real hero piece of this system is the new implant, and the implant has a completely new chip. And the chip is the brain of the implant, and that new brain allows us to do a number of novel things with this new Nexus system, which we’re calling the world’s first and only smart cochlear implant. And I’ll explain a little bit why we call it a smart cochlear implant. So in the past, I think cochlear implants have had upgrades for the sound processor only. This, this system, with this new implant, allows us to make upgrades to the implant over the lifetime of the patient. So as new technologies become available, we can download what we call firmware. So it’s got upgradable firmware capabilities just like your smartphone. So when you get new firmware updates, you get new features and enhancements. This implant allows new technologies that may help you hear better, may give greater diagnostic abilities for the audiologist or surgeon to enhance the outcome of the patient. So that’s what’s really exciting about this new system, is its upgradability and its smartness. It also has memory, so we can store information on the implant about the patient’s use of the device and also guide them on what’s the best use in different listening environments. So there are a number of different aspects to this new system that enhances potentially the outcome for every candidate and, I think, this journey that patients go on with their hearing device. So not just the first day they receive the device, but during that lifetime of their hearing journey. And whether that be a child who receives the implant at one or someone’s, who’s at a different stage in their hearing journey, there are benefits to having that upgradability and those other features around the memory that’s on the device. So that’s, that’s why we call it smart, and that’s why it’s so different to any other device that’s been launched to the market before. I should say this is the first new implant system in 20 years, really, by any of the, the Cochlear implant companies. So it, it is a significant breakthrough in that respect. It sounds very exciting. So I wanna get the bad news out of the way. When you said it’s a smart implant system, it’s not gonna make me smarter, right? That, No. No. No, the implant is smart, but it won’t make, make, make the individual smarter, no. But the other bit of bad news, I’m guessing, is that I have been implanted for eight years down. I have a Kanso. This is for new implants, right? I can’t go, “Ooh, I want me one of them in my right side.” That’s, that’s not going to happen. Is that right? It’s a great… It’s a great question, and we do… We had that question from a number of people who, like you, have already received their first cochlear implant. Now we don’t recommend that people who are doing very well, such as yourself, have their device removed and replaced. But we have seen many people opt to have their opposite ear, if it’s appropriate implanted with a Nexa device. So we do have many, many candidates using both a Nexa on one ear and the, and a different device on the other ear. So that certainly is possible, but replacing the device that’s working very well that it clearly is for you, Gael we wouldn’t recommend that. But that’s a discussion between your healthcare professional as to whether the opposite ear is. But there certainly is cases where people do need the devices removed and replaced, and that, that can happen, but we don’t recommend that unless there’s a very, very good reason to do that. But certainly, opposite ear implantation is possible. Well, tell me a little bit more about that because I am bimodal, so I’m currently using Because I use Cochlear, I use ReSound on this side. And I have been approached I don’t feel that I’m ready yet because I can… Things sound more natural to me, but, you know, that could change. So, let’s say I Yeah. … “Hey, I’d like to try the, the Nexa.” And I did. Let’s say I was implanted. So I’d still be working on two separate systems, is that right? The systems would be different, but you’d be surprised how aligned they are. So we do consider that when we design these systems, that people may have different configurations of implants, but also they may have different configurations of sound processors. So they may have a Kanso in one ear and a Nucleus 8 on the other ear, or they may have a different generation of sound processor. So that’s something we consider when we design the systems, that they work not only as a one system, but they can work as a, a bilateral system integrated together. So that is also possible, but the discussion as to whether your other ear is appropriate is one for you and your healthcare professional, your audiologist and surgeon to decide. Is that ear at a level and are you comfortable that you want to go down that path? But certainly, we have many people who’ve made that choice when it’s appropriate. Right. And I was just asking as, as, as a possibility because for some people that would very much be something that’s exciting. So let’s go back to the Nexa. So what happens is with this upgrade of, of information and, and that sort of thing, I would not have to go… Let’s, let’s say I have it. I would not have to go back to my CI audiologist and have it my processor changed. What would what happen? What does the person with who has the Nexa system, what does this mean for them and their daily lives and when, and things get changed in the system itself? Did Yes. … question make sense? Yeah, a very good question. So what we do see is, and you would know this, that over a period of time we introduce new sound processors to the market, so whether that be an on-the-ear or off-the-ear like the Kanso or the Nucleus 8, and different generations of those from the Nucleus 6 all the way to Nucleus 8. Patients go through upgrades and they happen periodically, usually on a five-year cycle. And so usually for new technology you have to wait five years, and that usually involves what we call front-end processing, so how the sound processor diagnoses background noise and then cleans up the signal and makes you hear better. But with a firmware update on the implant, you can send that to the patient through their implant. You can do it in two ways. So if there’s a new technology we want to bring to the patient and we don’t want to wait for that new technology, we can either send it to the, through the programming software that the audiologists use. So when they connect your device when you go in for your routine programming session, that will download a new version of what we call firmware, which is a new piece of information that the implant can then implement, and it may be something that improves your hearing in certain domains or gives you new diagnostic capabilities or even new efficiencies that make the battery last longer. So there’s a number of things that that could be. Another way we can potentially do it is we can send what we call wireless updates. So they can go through your app and they could speak directly through the sound processor to the implant. So that’s two potential ways we can send these upgrades to the implant, either via the clinic programming software or via the Nucleus Smart App that many, many patients use today. Well, I mean, obviously I, as a user I would prefer that just because I have to travel quite a Right. and take a ferry and go to a different city. So to have that. So it’s the same information, the same process, except your audiologist is doing it or your phone is doing it. Is that right? That’s right. But the audiologist would be notified that this firmware update is available, so they’re, they’re aware of these updates and they would agree that those things should be brought out and, and, and what we call sent to you. And that’s a really important point you mentioned about not having to go back to the clinic all the time, so that these updates are really convenient for the patient. Right now we can only do it through the programming software, but certainly in the future we’ll be able to do it through your smart app. And to your point, which is really critical, clinics are really, really busy and they get very, you know, a lot of, It’s difficult sometimes to go in and see your, your audiologist or your healthcare professional, so many patients want to self-manage their care. And so having them manage that through, through an app is much more convenient and we do, we are focused on that. There are other features in the Nexa which also enable the patient to manage themselves or make it much more easy for the clinician to manage their patients remotely rather than having to bring them back into the clinic. And that’s another aspect of the Nexa system which is very desirable, that it does reduce the burden on the clinic through features such as memory on the implant, which we call a new feature called Smart Sync where, for example, if you lost your processor unfortunately and you had to then travel all the way to the clinic and the audiologist would then have to find Gael and then find your maps and then find the right processor and either get that to you or have you wait while they did that. With this new feature on the Nexa, we could simply… Cochlear or the clinic could send you a, what we call a blank or unprogrammed sound processor directly to you, and you just put it on, back on your head and the maps will transfer back into the sound processor and you’re back on air. So you don’t … To travel to the clinic. And that’s a feature we call Smart Sync. So that’s another aspect of the smartness we have with this new system, that this ability to store the patient’s maps securely with them all the time allows this feature that they could use should they unfortunately lose or break their processor and they don’t have a backup, either Cochlear or the clinician could just send you another processor unprogrammed, and then you just place it on your head and within 20 seconds, you’re back on air. Well, I like that idea. In the past when I had I got a new a Kanso, an upgraded, or I went to Kanso 2 I’m trying to remember, but I, the processor was sent directly to me from Cochlear in Denver. But I guess that already would have, through the system, been uploaded. Okay. I’m answering my own question here. Yeah. So by that token if these processors are unprogrammed, would it be easier for people to have backup processors? And I say that in the United States, it’s my understanding, and many of my friends there who they get two processors when they are implanted. In Canada, with our health system, our laws, we, we get one, so we’re always very nervous about losing it. So would it be more likely that most people get the Nexa would have one or two extra unprogrammed processors? that’s, that’s a great point. So you’re absolutely right, that in some places in the US, patients get two devices, a backup device and the device they use. And so, they can just leave their backup device blank, and often what they’ll choose is a, a BTE, a N8, and they’ll have an OTE, a Kanso, and they may swap or they may leave that one. Now, the great thing about having memory is your latest maps are always there. So if you forgot to bring your processor into one of your mapping sessions, you, you may have a difference. But if you leave the processor blank and you just put it on, your latest maps will always be downloaded to the processor. So, that’s a, that’s another benefit of this system, that even if you, you just don’t need to worry about that backup system. You just have it there and when you need, you just put it on and then it will work should you need to do it. So that’s a, that’s a, that’s a, an important feature, so the, the second processor is always left blank until you need to use it, and then it will download those latest maps. That, yeah, that, that’s very exciting. Is there any other benefit that the user would, would notice right away? I mean, it’s said some good ones. Is there anything else yeah. So the other thing is the battery life. So the battery life on the new system is, is, is much extended. So we use a very efficient, what we call the, the way that it, the sound processor communicates to the implant, which we call the link we’ve made that much, much more efficient. And we’ve done that in a very clever way so the implant uses much less power, and it only uses power to the needs of the, each individual patient. So what that allows us to do is to shrink the externals, if you’re using a behind-the-ear processor, or and make the battery life longer. So patients can use a smaller device and get longer battery life. So that’s also an extremely desirable feature. So compared to someone who’s using a non-Nexa N8 you can get 16 to 18 hours of battery life in a processor that’s about 10% smaller and about 12% lighter. And for a Kanso user, that would, that would translate into same size, but the battery life is several hours longer by using the Nexa device. So there’s a power efficiency aspect to this as well, and a reduction in size of the externals with the behind-the-ear processor, and a longer battery life, which is also, when we talked, when we talked to people when we were designing the system, and particularly recipients, the size and the battery life was a really important and critical factor about being confident that you will get a whole day of battery life and not be caught stranded with the battery running low somewhere where you didn’t want that to happen. So that was a, that’s another critical factor that we designed into the system. That, that’s huge. Now, I, with the Kanso 2 I get up pretty early in the morning you know, around five or six o’clock, and then go to bed anywhere from, you know, mid-evening to midnight, and I’m, my battery, I, I always have lots of battery left, but I guess it depends on lifestyle. Right. I So, what Yeah. Yeah. There are individual differences in patients in characteristics, in terms of the program that you use. Also, things like you know, the, the skin flap you have it varies from children to adults, and that also affects the battery life. So there are multiple factors, not just the programming levels that affect the battery consumption, but also the, the way that we implement the what we call the link is also critical to how we can do that. So that it, multiple factors that are determined, so there’s, there is a, a range of battery performance that individuals get depending on their individual physical and physiological characteristics. So when you say skin flap, that is the, the, the skin between my processor and the, the, the thingy. Yep. The thingy underneath the skin is what I call it. Exactly. The Yep. Coil or the antenna we, you know You can call it the ‘thingy’ The thingy’s great. But you know what we mean. So the, the bigger the range that the, the link has to cover, the more energy it consumes. So, so simply, that’s translates into battery life. It’s exciting. It really is exciting, and I, I am very envious. I’m very envious. Of course, a smaller external processor is always of excitement. Especially for older people, when our hair isn’t as luscious and thick as it used to be, something a little smaller that can hide behind the few wisps of hair we have next, left. This is great. Is there anything like really super technical you would like to say to our hearing care professionals who like the, the numbers and techie stuff? Is there anything else I think during the… So we launched this new system in June, and the Food and Drug Administration just approved it in July, and I think they’ll begin to see more information about this. I think going around and presenting on this new system, what I Feedback from the professionals is certainly the thing they’re most excited about is what we call the upgradable firmware aspect, and that’s this ability to download new features into the implant, and they can be things like new coding strategies. This implant has an incredible ability to do novel stimulation strategies, so coding strategies. So we’re developing a number of new coding strategies and looking at the benefits they may bring. There are other capabilities where we can look at the nerve, the neural survival across the cochlea using some very smart diagnostic tools within the implant to look at, if you like, the topography of the neural survival and see whether that helps place stimulation in the right place to to help enhance the, the stimulus strategy of the patient individually. And I think the other thing they’re very excited about is this smart sync with the memory on the implant. So those are the three things when I talk to the professionals that they’re particularly excited about, and to your point about not having to come back to the clinic all the time to, to seek treatment when it, when it could be done in a different way, these things are also very exciting for the the busy clinic as well. That’s amazing. I know that I’m gonna have to look up neural survival when I get off this, this call. And so my question was when was it released? And you said in June at the FDA. Thats in the United States. Do you just happen to know when it might be available in Canada? So I believe we have… Im not in the, obviously the North America region, but I believe we have approval now from Health Canada and the FDA, and that was in July. So the product will begin to become available in North America, I believe, from August. So I think it’s, it’s approved in both markets, as far as I’m aware both, and I think available from August onwards as, as far as I understand. So in that time window I think is what you’re looking at. So and the first approval actually came in Europe, so each, each jurisdiction has a different regulatory environment, so Europe got it in June and then US got it in July, Canada got it at the same time. So it’s a little bit of work to get it onto the ground, so August, September is the timeline we’re looking at for launch. Yeah. Those Europeans, you know, they always like to think of themselves as farther ahead, right? So this has been absolutely fantastic. It does, does get me excited, and I, I can’t wait to talk to my audiologist who’s a a cochlear implant as well as a tinnitus… We won’t talk about tinnitus now, but then, then that’s another interview for another time. So I wanna thank you so much. You know, whenever I talk to someone who’s very, very very technical, I’m always feeling a little inferior, and I don’t feel that way here ’cause I… My contribution to hearing loss Arena, are different, but I’m absolutely in awe and grateful for people and organizations like Cochlear who made this… Have made our lives easier. I know that in the eight years since I’ve had a Cochlear implant, I hear so much better. It hasn’t been without challenges for me, but at the end of the day, I hear better. And one of the key things is right now I’m streaming with Through my mini mic and, and through my computer and hearing as clearly as I ever have in my life talking to you on literally on the other side of the world, or at least across the Pacific. So I wanna thank you for spending this time with us, Brendan. I really do. Is is there any other last thing that you thought, “Oh, I, I meant to talk about that”? Look I think the main thing is just how incredible these cochlear implant devices are and that not enough people are, are really getting them. We, we think that less than 1 in 10 who could benefit from these incredible pieces of technology do. So certainly talk to your clinician about the need to have these devices if you’re struggling with your hearing aids, but really they are transformational, not only from a hearing perspective. and I’m sure you can talk to this, Gael, from a lifestyle perspective as well. It, it changes so much for people who receive them and that’s why I love working in this industry and seeing people like you and talking to people like you. It’s been terrific. Yeah, it’s great. It’s all about connection and communication, but there was a time in my life when I, I, I realized that I needed to switch my goal from just wanting to hear better to wanting to communicate better, because it’s communication that connects us to each other as people. And technology is, it’s so much a part of that, but there’s all the other things. There’s self-advocacy and learning how to, you know all, all the interpersonal things. So anyway Brendan Murray, thank you so much, and I certainly look forward to meeting you in person one of these days. And in the meantime we’re, we’re happy to spread the, the news about this fabulous new system that Cochlear has. Great. My pleasure, and thanks for having me, Gael.