Examples using take-home / device-based platforms
Remote Cochlear Implant Programming Protocol – Western Washington University
Version 1.1 February 23rd, 2021. Prepared by D.P. Sladen
Remote cochlear implant (CI) programming was approved by the Food and Drug Administration (FDA) in November 2017 for the Cochlear Nucleus device, and June 2019 for the MED EL device.
Remote CI programming requires a download and upload speed of 1 Mbps. Internet speed may be checked using an online tool such as www.speedtest.net
Remote Access Software
Various software programs are available for remote connection. The following have been recommended by Cochlear/MED EL.
- GoToMeeting version 18.104.22.1682 or later
- TeamViewer version 10.0.47484 (used by Western)
The FDA indications for remote programming include:
- Patient 12 years of age or older. Adult supervision for patients under 18 years of age
- At least 6 months of implant experience
- Patient should have the ability to conduct video-based connections
- Family members are encouraged to attend to provide additional support
Western’s remote CI programming services adhere to the FDA guidelines with the exception of length of implant use. Specifically, Western’s CI remote programming services have included initial activations in addition to re-programming.
Hardware and Software
A Dell Latitude 5580 laptop computer is delivered to the patient’s home. Delivery is done by mail or drop off. The laptop is configured with a sign in specific to cochlear implant patients.
Prior to delivery the implant laptop case is stocked with the appropriate interface and cables as well as backup cables, and a loudness scale. The equipment is wiped down with disinfectant wipes.
The laptop is configured with TeamViewer and each of the three FDA approved cochlear implant software programs (Custom Sound 5.2, MAESTRO, and SoundWave). Each software program is password protected to prevent sign in from an unauthorized user.
Instructions are emailed to the patient. A hard copy is also placed inside the laptop, along with a loudness scaling chart.
The instructions include how to connect the CI laptop to the patient’s home internet, and how to connect the cable to their sound processor. The patient is instructed to connect the laptop to their local internet 30 minutes prior to the scheduled meeting. Once connected to the internet, the patient is instructed to open the TeamViewer software on the CI laptop. A graduate clinician is available to assist them with questions or troubleshooting. The patient is instructed to attach the cable to their sound processor.
Once TeamViewer is opened, the CI audiologist connects to the CI laptop from their office computer, and opens the video camera and microphone on both ends. The patient is oriented to a chat screen in case we need to communicate while they are “off the air”.
The patient’s spouse or family member is asked to move their finger through the patient’s hair above the implant site. They are instructed to look for irritation or deep indentations and report to the CI audiologist.
Programming is conducted according to recommended procedures that are specific to each manufacturer. The programming tasks include electrode impedance testing, measurement of thresholds (if needed) and loudness, and live voice fine tuning. The programs are downloaded to the patient’s primary and secondary processors. Instructions and coaching on device use is conducted by the CI audiologist.
The patient is instructed on packing up the computer and pick up/mailing of the system is arranged. The patient is disconnected from the computer and the session is ended.