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Remote Mapping: Have Cochlear Implant, Won't Have to Travel

Cullington, Helen PhD

doi: 10.1097/01.HJ.0000462429.26374.cf
Journal Club

Dr. Cullington is associate professor, research coordinator, and principal clinical scientist at the University of Southampton Auditory Implant Service.

Recently, a Sydney Morning Herald article entitled “My Week Without My iPhone” made me think of all the things I do with mine: watch television, check my pulse, shop, monitor my fitness and physical activity, instantly send pictures and videos across the world, see my family at the touch of a button, identify songs on the radio, see images of my living room from wherever I am in the world, and even turn on the heat in preparation for my return home.

Most of us have become very reliant on technology in our everyday lives and can't imagine a day without these devices, let alone a week. So, how is technology affecting healthcare?

The first article on telemedicine, which described the transmission of electrocardiogram data over telephone wires, was published more than 100 years ago (Archives Internationales de Physiologie [International Archives of Physiology] 1906;4:132-164).

However, telemedicine as we now know it—the provision of interactive healthcare using telecommunication—began to emerge in the 1970s. It has been employed in long-term conditions such as heart disease and diabetes.

In the United Kingdom, there are only around 20 cochlear implant programs to care for the whole U.K. population, which includes more than 800,000 severely to profoundly deaf people.

As a result, many cochlear implant users live several hours away from their implant center. They take time off from work to attend appointments, incur extra expenses and family disruption, and feel exhausted after spending several hours in traffic and then trying to do mapping. This situation makes cochlear implant care an ideal candidate for telemedicine.

Validation of Remote Mapping of Cochlear Implants

Eikelboom RH, Jayakody DM, Swanepoel DW, Chang S, Atlas MD

J Telemed Telecare

2014;20(4):171-177 http://jtt.sagepub.com/content/20/4/171

This study, published in the Journal of Telemedicine and Telecare, was written by a team from the University of Western Australia. The first author, Robert Eikelboom, was interviewed by The Hearing Journal in 2011 (November 2011 e-newsletter, available at bit.ly/HJ-Eikelboom http://bit.ly/HJ-Eikelboom). At that time, he spoke about the new telehealth software his team was developing. How great to see this project come to fruition, as discussed in the current article.

This is not the first article describing remote mapping of cochlear implants. However, in previous studies, the cochlear implant mapping software was located in a remote clinical setting, and the programming audiologist accessed the software using a remote connection. Supporting clinicians were with the patient at the test site.

The authors of the new study wanted to have a system where the patient or family member could connect the processor to an interface box and would not need a clinician present, hence expanding the utility of this method to many more locations. The researchers designed a PC-based remote-mapping system that uses a simple patient log-in along with voice, video, and text communication.

This project tested the concept by putting the patient and the audiologist in different rooms at the same clinic. The patient's room had an interface box connected to a computer. A family member or an assistant who had no experience with cochlear implant patients sat with the patient being mapped. Mapping was performed using both the remote method and standard programming techniques.

Speech recognition was similar for the remote and face-to-face mapping procedures, as was patient preference for the maps produced by each approach. While the remote session took approximately five minutes longer than conventional programming to perform, it affords patients a substantial savings in travel time.

All but one participant indicated that they would be willing to use remote programming in the future. The only negative aspect reported was a lack of synchronization between the audiologist's voice and video image, which made lipreading difficult. (Many of us have experienced this problem with video calling.)

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LOOKING AHEAD

This study is an exciting start. It makes me wonder how much further the technique can go. One cochlear implant company has already introduced a remote control that gives the potential for patients to do their own mapping at home or anywhere they are. Most implant systems now have the capability of wirelessly streaming to other electronic devices.

I can do everything else on my iPhone—how soon can cochlear implant users do their mapping there, too? Of course, if and when these options become clinically available, we hope that they will improve access to cochlear implant services.

At the same time, we will want to ensure good clinical effectiveness and cost-effectiveness, participant-reported outcomes, and user experiences. Neither clinicians nor patients want to compromise care for the sake of convenience.

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