Howard Samuels: The effects of rapid product development are already beginning to manifest themselves with the recent introduction of the Neptune processor, the T-Comm accessory, and the upcoming next-generation BTE processor. Cochlear implant candidates often wonder whether to move forward with their implant, or to wait for the Next Big Thing. Do you think candidates should wait?
Tracey Kruger: Generally speaking, no, I don’t think they should wait. However, this decision must be made in consultation with the candidate’s audiologist and surgeon since they are the ones who have the best understanding of the individual’s specific situation and expectations. In the case of young children, research has shown that early implantation has a positive benefit on outcomes. For adults, often this decision depends on the level of need of the candidate.
When a person enters the implant candidacy process they may have had a certain level of hearing that enables them to get by quite well in day-to-day life. They may be willing to wait a bit longer for new technology that is under development in order to receive a certain new feature. On the other hand, there are those who are in a situation where they are no longer able to communicate or function well at work or in their relationships. They may need an implant as quickly as possible to begin the process of restoring their hearing so that they are able to communicate with loved ones and/or resume their daily activities. It is for this type of situation in particular that I would not recommend waiting for new technology.
Cedric Navarro: This is especially true for children.
One of the nice things about the Advanced Bionics product line is that our technology platform is able to provide many new improvements merely through software or external processor upgrades. So there really is no reason to wait for a cochlear implant knowing that you are going to get the benefits of new technology and better sound processing strategies over time.
TK: Even with the new externals, we try to make the processors that we develop, as much as we can, backwards compatible. That’s proven to be much more difficult with our first generation cochlear implant mainly due to power requirements and some other technical challenges that we face. But for everything that we’ve manufactured since early 2001, we’ve maintained backward compatibility and we intend to continue to do that as much as possible. Of course, we are also continuing to work on new innovations for our first generation device as well, it is just not always possible to provide the same types of innovation in the same time frame as for recipients of our more recent generation devices.
HS: What are your intermediate-term objectives for cochlear implant product development, over the 5-year time frame?
TK: Advanced Bionics has always been really committed to patient performance. We believe people get cochlear implants to hear better and that we have a responsibility to continue our efforts to improve performance for those who have chosen our cochlear implant.
We have several projects ongoing right now that we hope will drive patient performance ahead in a variety of different ways. Of course it is likely that not all of these ideas will meet with success; however, for the ones that do, we absolutely intend to bring them to market so that recipients of our device have the opportunity to hear better in more situations. ClearVoice is a great example of this commitment.
Of course, we will also continue to try to improve power consumption since that will allow us to improve battery life and create sound processors that are smaller in size. Wireless connectivity is also becoming a very important topic for recipients of cochlear implants so we will continue to invest in projects that address this need.
Another area of great interest to AB is expanded bilateral and bimodal functionality. I think you will see that we have some very nice features in upcoming products that address both bilateral and bimodal hearing. This is just the beginning. We will continue to innovate and try to lead the market in this area.
HS: What do you think the competitive landscape will look like in the 5-10 year time frame?
TK: The great thing about the situation that we are in now, with several established and emerging competitors in the market, is that there is more pressure to do more, do it faster, and do it better.
We are obviously moving towards miniaturization and wireless connectivity, as I have already mentioned.
Of course all companies have been investigating fully-implantable technology for many years. There is a lot of work going on in a variety of areas to better understand the feasibility of some technologies required to achieve this as well as in understanding the use case involved with such products. In addition to this I think we will see more innovation in the area electrode technology and preservation of residual hearing.
Over the past few years there has been a great deal of research into expanding the service delivery model, including areas such as streamlined programming, remote fitting, and self-customization of programs. I am guessing we will see more of this in upcoming years.
HS: What do you envision for hearing restoration in the long term? We’ve been reading about hair cell regrowth for decades. Fully implantable cochlear implants seem to be a technology challenge rather than one requiring medical breakthroughs. Optical stimulation rather than electrical stimulation has been in the news occasionally.
TK: There is active research going on in all of these areas, as you know. There is promise that we will be able to regrow hair cells. The question for me is what kind of functionality we will be able to restore with this technology. Eventually, someday we will get there, but I don’t think that it will be in the next 10 or maybe even 20 years.
Regarding fully-implantable cochlear implants, the question that I have is whether we will be able to introduce this technology without any degradation to patient performance. Once you have a microphone implanted under the skin or in some alternate location in the body, how robust will it be? External microphones today can suffer problems due to moisture and debris. In the body where you have a lot of moisture and potentially other types of contaminants, how well would the microphone survive? And how long will such a microphone be able to transmit sound accurately? Another important consideration is implantable batteries. Obviously safety will need to be a primary consideration, but also batteries will need to be very small yet last a considerable amount of time in the body to minimize the need for repeated surgeries for replacement of a depleted battery. I do believe that we will get there I am just not sure how long it will take before this kind of solution becomes really mainstream.
The area of optical stimulation is a really exciting. I’m not sure how quickly we will see the research and development going on here to turn into a usable product but it is certainly very interesting. I am guessing that this will take more time than 10 years but this is certainly not my area of expertise so maybe I will be pleasantly surprised!
Next: The Human Factor.