Cochlear Implants for Hearing Loss

(ACE Trial)

Not currently recruiting at 9 trial locations

Overseen By Lavin Entwisle

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Cochlear

Disqualifiers: Pregnancy, Cochlear implant, Ear infection, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 2 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 8

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests the safety and effectiveness of cochlear implants for adults with bilateral sensorineural hearing loss. The researchers aim to determine if individuals who do not meet the usual qualifications for cochlear implants could still benefit from them. Participants will receive a Cochlear™ Nucleus® implant and undergo speech perception tests at several visits. Suitable candidates have significant hearing loss in both ears but do not qualify for traditional cochlear implants.

As an unphased trial, this study offers a unique opportunity for patients to explore new possibilities for hearing improvement.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinator or your doctor.

What prior data suggests that cochlear implantation is safe for adults with bilateral sensorineural hearing loss?

Research has shown that cochlear implants, including the Cochlear™ Nucleus® System, are generally safe. In one study involving children with these implants, 60 issues occurred in 227 ears, with 14 classified as major. This indicates that about 26% experienced some problems, though serious issues were less frequent. The Cochlear Nucleus system is FDA-approved for specific types of hearing loss, indicating it has been tested and found safe for those cases. These findings suggest that cochlear implants are usually well-tolerated, although, like any medical procedure, some risks exist. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Unlike other treatments for hearing loss, which often rely on hearing aids to amplify sound, the Cochlear™ Nucleus® System directly stimulates the auditory nerve. This approach bypasses damaged parts of the ear entirely, offering a unique solution for individuals with severe to profound hearing loss who don't benefit from hearing aids. Researchers are excited because this system can provide a more natural hearing experience, potentially improving speech understanding and quality of life for users.

What evidence suggests that cochlear implantation is effective for hearing loss?

Research shows that cochlear implants, such as the Cochlear™ Nucleus® System, work well for individuals with moderate to severe hearing loss. Studies have found that patients understand speech much better after receiving the implant. On average, within three months, users notice significant improvement in recognizing speech compared to before the implant. These benefits persist over time, making the cochlear implant a dependable option. The implant is also considered safe, with studies confirming its successful use across various age groups. ^{1 6 7 8 9}

Are You a Good Fit for This Trial?

This trial is for adults with bilateral sensorineural hearing loss who don't currently qualify for cochlear implants under FDA guidelines. Participants will be assessed over seven visits after receiving the implant.

Inclusion Criteria

Meets audiometric criteria for the non-implanted contralateral ear: clinically established SNHL with a four frequency PTA at 500, 1000, 2000, & 4000 Hz of >30 dB HL

I have severe hearing loss and struggle to understand words even with a hearing aid.

Candidate is a fluent speaker in the language used to assess speech perception performance as determined by the investigator

Exclusion Criteria

Pregnant or breastfeeding women

Meets current indications on audiometric thresholds for traditional adult CI candidates

I do not have a cochlear nerve or my cochlea is undeveloped.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Cochlear Implantation

Participants will be implanted with a commercially approved Cochlear™ Nucleus® implant

1 day

1 visit (in-person)

Post-implantation Assessment

Participants complete speech perception assessments and questionnaires over the course of seven visits

6 months

7 visits (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment

36 months

What Are the Treatments Tested in This Trial?

Interventions

• Cochlear Implantation

Trial Overview The study is testing the Cochlear™ Nucleus® System to see if it's safe and works well in improving hearing for those who have significant hearing loss but aren't eligible for current treatments.

How Is the Trial Designed?

Group I: Cochlear™ Nucleus® System Experimental Treatment 1 Intervention

Participants will be implanted with a commercially approved Cochlear™ Nucleus® implant.

Cochlear Implantation is already approved in United States, European Union for the following indications:

Approved in United States as Cochlear Implant for:

• Severe to profound sensorineural hearing loss in both ears
• Moderate to profound sensorineural hearing loss in both ears with limited benefit from amplification
• Single-sided deafness/unilateral hearing loss (SSD/UHL)

Approved in European Union as Cochlear Implant for:

• Severe to profound sensorineural hearing loss in both ears
• Moderate to profound sensorineural hearing loss in both ears with limited benefit from amplification

Who Is Running the Clinical Trial?

Cochlear

Lead Sponsor

Trials

96

Recruited

6,300+

Headquarters

Sydney, Australia

Dig Howitt

Cochlear

Chief Executive Officer since 2018

BE (Hons), MBA

Michael del Prado

Cochlear

Chief Medical Officer since 2022

MD, MSc, FRACP, FAAHMS, FAICD

Althea Anagnostopoulos Harrington

Collaborator

Trials

2

Recruited

110+

MV Clinical Research, LLC

Collaborator

Trials

2

Recruited

110+

LWB Consulting

Collaborator

Trials

2

Recruited

110+

NAMSA

Collaborator

Trials

55

Recruited

21,500+

Published Research Related to This Trial

In a study of 52 patients with recalled Advanced Bionics cochlear implants, significant hearing performance degradation was observed, particularly linked to issues with the basal-most electrodes of the device.

After revision surgery, patients showed a rapid recovery in hearing performance, reaching peak levels much faster than after their initial implantation, indicating effective outcomes from reimplantation procedures.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Voluntary Field Recall of Advanced Bionics HiRes Cochlear Implants: A Single-Institution Experience. McHugh, CI., Swedenborg, BK., Chen, JX., et al.[2023]

A study analyzing adverse event reports for cochlear implants found that most incidents involved patient injury (16,736 cases) and device malfunction (10,760 cases), highlighting areas for potential safety improvements.

Using machine learning algorithms, researchers achieved high prediction accuracy (up to 88.6%) in identifying the cochlear implant manufacturer and type of adverse event based on the descriptions, suggesting that data analysis can enhance understanding of device performance and safety.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Machine learning for pattern detection in cochlear implant FDA adverse event reports. Crowson, MG., Hamour, A., Lin, V., et al.[2021]

A study of 3,417 cochlear implant recipients over 23 years revealed that the cumulative survival rates (CSRs) for cochlear implants vary significantly between different models and brands, particularly at the 6-year mark.

Common causes of device failure include impact, electronic dysfunction, and leakage, but explant-reimplant procedures are considered safe and effective for addressing these failures.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A review of device failure in more than 23 years of clinical experience of a cochlear implant program with more than 3,400 implantees. Battmer, RD., Linz, B., Lenarz, T.[2022]

Cochlear implants are advanced devices that electrically stimulate the hearing nerve, making them suitable for individuals with severe to profound hearing loss who do not benefit from hearing aids.

These implants replace the function of damaged hair cells in the cochlea, leading to improved hearing and communication abilities for users.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Cochlear implants]. Demanez, L., Renglet, T., Bernard, C., et al.[2015]

Cochlear implants are effective electronic devices that help restore hearing in individuals who have lost their hair cells by directly stimulating the spiral ganglion cells of the cochlear nerve.

The article provides essential information for head and neck surgeons regarding the necessary imaging protocols and potential anatomical anomalies to consider before performing cochlear implantation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cochlear implant assessment: imaging issues. Marsot-Dupuch, K., Meyer, B.[2019]

Cochlear implants and auditory brainstem implants provide patients with profound hearing loss the ability to perceive sound through electrical stimulation of the auditory pathway, which is crucial for communication.

Cochlear implants are effective for those with inner ear disorders and a functioning hearing nerve, while auditory brainstem implants are designed for patients with hearing nerve defects, highlighting the importance of thorough preoperative evaluations to determine the appropriate device.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cochlear implants and electrical brainstem stimulation in sensorineural hearing loss. Laszig, R., Aschendorff, A.[2019]

In a study of 9 children with auditory brainstem implants (ABIs) at Shaare-Zedek Medical Center, 6 had previously unsuccessful cochlear implants due to deficient auditory nerves, highlighting ABI as a crucial option for those who cannot benefit from traditional cochlear implants.

While the functional auditory outcomes for ABI recipients were generally lower than those for cochlear implant users, some children achieved significant benefits, including one child who attained open-set speech perception, indicating that ABIs can provide auditory awareness in cases where cochlear implants are not viable.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[AUDITORY BRAINSTEM IMPLANTS (ABI) IN CHILDREN: CASE SERIES IN SHAARE ZEDEK MEDICAL CENTER]. Perez, R., Sichel, JY., Salem, R., et al.[2023]

Cochlear implants, which send electrical impulses directly to the cochlear nerve, are a significant advancement for patients with severe hearing loss who cannot benefit from traditional hearing aids, and they are now being used in pediatric patients as well.

A multidisciplinary team approach is crucial for the successful implantation and follow-up care of cochlear implants, with 29 patients having received implants using a preferred multi-channel intracochlear system, demonstrating a positive impact on their quality of life.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Cochlear implants in children]. Garabedian, EN., Moatti, L., Roger, G., et al.[2006]

Cochlear implants have advanced significantly, but some patients still struggle with speech recognition, especially in noisy environments, and music appreciation remains a challenge.

Targeted auditory training can significantly enhance speech recognition for both poorly performing and high-performing cochlear implant users, suggesting that additional rehabilitation is essential to fully benefit from cochlear implants.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Maximizing cochlear implant patients' performance with advanced speech training procedures. Fu, QJ., Galvin, JJ.[2021]

Cochlear implants significantly improve hearing in profoundly hearing-impaired patients, with performance in a study of 63 patients showing a wide range of outcomes, including up to 62% correct word recognition and 98% enhancement in lipreading.

Prelingually deaf children benefit from cochlear implants but take longer to show improvements compared to postlingually deaf individuals, highlighting the need for tailored rehabilitation approaches.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

What can we learn about hearing aids from cochlear implants? Tyler, RS.[2019]

In a study of 113 patients with Advanced Bionics Ultra cochlear implants, 17.7% experienced device failure, primarily in children, highlighting the need for ongoing monitoring of at-risk devices.

After revision surgeries, patients generally maintained stable auditory performance, indicating that revision procedures are effective and safe, with most patients opting to stay with the same manufacturer for their new devices.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

HiRes ultra series cochlear implant field recall: failure rates and early outcomes. Winchester, A., Kay-Rivest, E., Friedmann, DR., et al.[2023]

Cochlear implants are effective electronic devices that significantly improve hearing quality for individuals with severe to profound deafness, including both children and adults.

Advancements in surgical techniques and device technology have broadened the criteria for who can receive cochlear implants, allowing more people to benefit from this intervention.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cochlear implants in children. Balkany, TJ., Hodges, A., Miyamoto, RT., et al.[2022]

The SONATATI(100) cochlear implant has been shown to be safe and effective in a study involving 50 patients, with no unexpected adverse events reported during medium-term use.

The implantation of the SONATATI(100) cochlear implant is less traumatic due to smaller incisions and less drilling required, making it a suitable option for both adults and children.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The MED-EL SONATATI 100 cochlear implant: an evaluation of its safety in adults and children. Mueller, J., Baumgartner, WD., Godey, B., et al.[2013]

Cochlear implants significantly improve auditory performance and speech production compared to hearing aids, as shown in a study of 84 patients, highlighting their effectiveness in enhancing quality of life for children with severe to profound hearing loss.

Younger implantation age is associated with better health-related quality of life outcomes, but even older children can achieve good results with proper selection and training, indicating that cochlear implants can be beneficial across different age groups.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Health-related quality of life in cochlear implanted patients in Romania. Necula, V., Cosgarea, M., Necula, SE.[2015]

Cochlear implants (CIs) provide significantly better hearing improvement for patients with severe to profound hearing loss compared to conventional hearing aids, making them a more effective treatment option.

The MED-EL multichannel CI system has shown high reliability, with no technical failures reported over a 5-year observation period, highlighting the advancements in implant technology and design.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Device profile of the MED-EL cochlear implant system for hearing loss: overview of its safety and efficacy. Baumann, U., Stöver, T., Weißgerber, T.[2022]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC6792393/

Long-Term Outcomes of Cochlear Implantation in Patients ... Results demonstrate long-term success of patients with high-frequency hearing loss following Hybrid L24 (Cochlear) cochlear implantation.

2. cochlear.com cochlear.com/us/en/professionals/products-and-candidacy/nucleus

Cochlear™ Nucleus® systems Nucleus cochlear implant is an effective & long term solution for people with moderate to profound hearing loss. No one match our record for implant ...

3. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11185016/

Safety and Early Outcomes of Cochlear Implantation ... Improved hearing with cochlear implant use was shown in all outcome measures. Findings reveal that the procedure is safe for infants and that ...

4. pronews.cochlear.com pronews.cochlear.com/science-spotlight-longitudinal-outcomes/

Science Spotlight- Longitudinal outcomes of ... On average, by 3-months postimplant participants exhibited significant increases in speech recognition in the implanted ear compared to their preimplant ...

5. mdpi.com mdpi.com/2077-0383/14/11/3765

Evaluating the Clinical- and Cost-Effectiveness of Cochlear ... Hearing loss onset occurred on average at 30 years (SD 21.0), with 12 years (SD 6.2) of CI use. The outcomes show significant improvements in speech ...

6. accessdata.fda.gov accessdata.fda.gov/cdrh_docs/pdf/P970051S205B.pdf

Summary of Safety and Effectiveness Data (SSED) The Cochlear Nucleus 24 Cochlear Implant System is indicated for individuals with unilateral hearing loss who meet the following criteria:.

7. cochlear.com cochlear.com/us/en/professionals/products-and-candidacy/nucleus/nucleus-reliability

Cochlear™ Nucleus® Reliability Reports Cochlear reliability reporting provides reliability data for the internal (cochlear implant) and external (sound processor) components of our Nucleus Implant ...

8. aetna.com aetna.com/cpb/medical/data/1_99/0013.html

Cochlear Implants and Auditory Brainstem Implants According to FDA criteria, children from 24 months of age with severe-to-profound hearing loss who score less than 30% on open-set speech recognition tests and ...

9. sciencedirect.com sciencedirect.com/science/article/pii/S0196070925000973

Cochlear implantation in cochlear nerve deficiency The cochlear implant has long proven to be a safe and effective device for facilitating communication in children with congenital SNHL. Although the absence of ...