(NL-0050) CI Disaster – A very long Rant.

My honeymoon with Cochlear is over, that’s for sure.

Here’s my opinion: The N5 BTE really sucks. At least it does for me.

It’s Christmas Eve Day (is 1:26 AM daytime?) and I’ve finally (finally!) gotten around to posting here. Many apologies to the folks who have been after me for updates. Last anyone knew, I was doing just dandy. That changed some-what.

This post is long. Be warned, you will need some time to read it all.

Normally I am pretty easy going and have learned to deal with things I can’t change in life. But this time, there are so may issues with the new Nucleus 5 BTE and all the outside hardware that I’m not going to be “nice” here. I just can’t.

On December 4, I visited my Surgeon to make sure that the incision was healed up enough to activate and wear the BTE (behind the ear) unit. A few days before that, I had noticed I had a pretty bad headache every morning when I woke up. My headaches seem to have been caused by the way I sleep.

I sleep on my belly and have to have one ear or the other on the pillow. I know for a fact that I swap sides (turn my head over) every hour or so, as my wife is a light sleeper and tells me so.

Since I had the left side implanted, I have been “forcing” myself to sleep on the right ear for a full eight hours.

Aside from the fact that I never really got a good sleep (waking up every hour or so), I seem to have a very heavy brain.

I know this because many folks have told me my head is full of rocks and rusty old metal sprockets. Some of those people have even suggested the presence of lead, saying my head is indeed very dense. Lets hear it for gray matter.

At any rate, my right CI is forever trapped between my dense, heavy brain and my well packed and very dense feather pillow. The pressure I had been putting on the right CI seems to have been causing my headaches. The doctor said I could now try and alternate. I did and this had immediate positive results for me (no more throbbin’ noggin). There's a lesson in that for all you prospective bi-lateral folks.

The other issue I brought up to my doctor was that the new CI incision seemed to be healing up a lot slower than the first one. Even though the outside of the incision looked ok, I continued to “bleed out” when I was asleep. Fortunately, I have been using old pillow cases for the last month. The bleed outs stopped a few days ago, thank goodness. Healing up fine now.

On December 5, I went to have my new CI activated. More problems.

A big problem is that Cochlear did not ship the hospital a complete CI kit. I had a Nucleus 5 implant put in for the left side (my right side is an N4). The N5 is so new that Cochlear seems to be having trouble getting enough product out the door. As a confirmed Test Engineer, I know the problems that come with trying to manufacture and ship a new product, especially a medical device. It’s much more of a challenge than climbing Mount Everest. Trust me on this.

My kit shipped without a backup BTE. It shipped without rechargeable batteries or a battery charger. It shipped without an audio cable that has an isolation transformer (Cochlear calls it a “mains cable”). God knows what else it is missing. I was not and still am not a happy camper.

The backup BTE was found a couple of weeks later, apparently roaming the halls of the hospital where I had the implant put in. That BTE was finally delivered to my audiologist on December 8 (more on that later).

Also, as I discovered, the N5 system does not have rechargeable batteries, because Cochlear is waiting for FDA approval (the USA seems to be the only place that can’t get rechargeable batteries yet). I am thoroughly unhappy with this situation. It could be YEARS and YEARS before the FDA gets it’s butt in gear and makes an approval. I’m not gonna buy batteries for all that time. It’s wasteful, not environmentally friendly, and dang expensive.

And things just get better (not).

The initial activation and mapping went ok. But the N5 BTE really, really, really (did I say “really”) is not at all what I had expected or wanted.

The N5 is smaller, but the same weight of the N4. It is water resistant (a very good thing). But, in almost every other way, it fails to give me any reason to use it.

There is no longer a display to show the state of the BTE. Just idiot lights. It’s completely impossible to open the “latch” of the audio accessory socket unless you happen to be carrying a screwdriver with you (and yes, the CI kit comes with a screw driver).

I find it totally appalling that, unless I have a tool handy, I literally have to disassemble the N5 BTE just to plug in an audio cable. I use my audio cable about 20 to 30 times a day (with my PC). I also use it for my IPOD. It’s totally insane to have to carry around a tool to use a BTE. Simply insane.

The design of the BTE is such that Cochlear placed the “on/off and change program” button butt-up-next to the coil assembly wire. I don’t know about the average person, but I have large fingers. It’s very difficult to press or even find that button. I can’t imagine the effort elderly folks will have to undertake. I can’t see anyone with even mild arthritis operating an N5.

But wait.. the N5 comes with a remote and that’s what the remote is for, right? Big easy buttons? Simple interface? No problem, right?

Yeah, right.

Aside from the fact that I carry a phone and an IPOD with me at most times, I can’t see why on earth I also need to carry a remote for my BTEs. The remote does not come with a case or a belt clip (of course you can buy an over priced case from Cochlear, but you won’t get one in the CI kit (what were they thinking?).

And the user interface on the remote must have been written by several drunken monkeys.

I hold five engineering degrees. I still (after a month) cannot find the functions I want to find on the remote. The menu system is completely un-intuitive. It does not use any mainstream icons or tools that I’ve ever seen, and it doesn’t seem to hold a charge for more than a couple of days (where as my TV remote can go for a couple of years between battery changes)…. Oh and there’s no battery that you can replace. You have to use AC or plug it into your computer to charge it. I know that the internal battery is not going to last as long as the BTEs or the implant.

So what happens after 3 years and the Lithium Ion battery croaks? I guess I’ll have to shell out for a new remote.

And…. when you plug the remote into a windows PC for charging, the PC asks for a driver, which, of course Cochlear does not provide and does not mention that you would need.

Actually, I’m really surprised that the PC-to-remote charger cable connects to the USB data lines. Why on earth would it need to do that? Does Cochlear intend to allow me to upload/download data into the device? I think not. So now I have had to modify my PC to ignore the driver request. Maybe later I’ll hack into the remote and see if I can reprogram that GUI (graphical user interface). It really sucks, and that’s the nicest thing I can say about it.

And, get this, there’s a menu selection to “reset” the BTE.

--- RESET! ---

Why would I ever, ever need to, or want to, reset a BTE? Is Cochlear telling me that the BTE can lock up (think Windows on a PC)? Can a BTE scramble itself so that the firmware inside of it just gets “lost” … ????? Jeepers!

Take it from an old Engineer; anytime you see a “reset” function on a medical device (or any other device), it’s a bad, bad, bad sign. It usually means that the design is not robust. In my opinion, there’s no way to put a positive spin on that. Sorry.

Oh, and you can reset the remote too.

Funny, but my very complex TV remote does not have a reset button. I wonder why?

My right N4 maps were transferred to the new N5. It seemed to work ok. But later on, when I used the phone with my audio cable and PC, it was very apparent that the sounds I hear with the N5 are not the same as the sounds with the N4. Don’t know why. Something needs tweaking.

And….. the saga continues….

I had to go to Santa Barbara to visit with one of my clients. This was the day after the missing N5 (for the right side) was found and programmed. So off I went on my trip with two new N5s and a remote controller.

I had the left N5 activated on December 5. The right side N5 on December 8.

On December 10, at about 10 PM, while watching TV in my hotel room, my left side went completely quiet. Dead silent.

That’s not a good thing when you are 250 miles from home and you didn't bring your backup BTEs (stupid me).

The left side N5 BTE seemed ok. It would respond to the remote. It responded to all on-board BTE button commands. I could see on the remote that the microphone was picking up sound (there is a somewhat crude sound meter on the remote). However, the BTE insisted that it could not communicate with the left side implant. I was really concerned that the implant had stopped functioning. To make matters worse, I had not taken my N4 BTEs as a backup, so I had to wait until I got back home to verify that my implant was not damaged.

I tell you, it’s a hard thing on the mind to have just had an implant and then, without warning, to think that it has failed. Every thing I could test on the BTE pointed to one of two things: the BTE output to the transceiver coil was bad or the implant was bad. Not a set of choices I wanted to see.

Fortunately, it was the BTE’s driver output to the coil that was bad. After I came home I found that my implant worked just fine with my N4. But I am now very, very concerned with the reliability of this new N5 BTE. It was only seven days from turn on to failure. Seven days. That’s really disturbing.

Well, on to other issues (oh yes, there are more!)….

Today I bought a bluetooth ear piece. On it’s website, Cochlear states:

Bluetooth Friendly

For safe hands-free connectivity. The intelligent design of the auto telecoil allows it to automatically detect sound from a Bluetooth headset when it’s worn on the ear.

And if you believe that, I know of a big bridge in San Francisco that I can sell to you. Only ten bucks.

No, the BTE does not detect sound from the bluetooth headset.

Well, I take that back. It does detect the sound, but only if I remove the headset from my ear and physically hold it against the BTE (a distance of about 1/4 inch). So, yeah, it works, but it’s not hands free. You have to hold the bluetooth headset at all times.

I can get better sound by leaving the N5 in normal mode (T-coil off) and holding my phone up the BTE (but the sound still is bad).

And speaking of phones. It is well known that 3G phones don’t work well with T-coils. My phone is a SideKick. It makes a heck of a racket with a T-coil.

With the N4 BTE, I can not use the T-Coil and so I just place the phone next to the N4 BTE and it sounds great. When I do this with the N5, the phone audio sounds really tinny and garbled. So bad, in fact, that I can’t use my phone at all with the N5. Some improvement, eh?

Ok, well, there are more issues I have and I am sure I will discover many more in the next few months, but I’ll stop at this point.

Right now, I am wearing my N4 BTEs. One is beige colored, the other one is gray. My wife can’t stand the color mismatch ( heh heh!). But I can hear fine with them. They are easy to operate and easy to use. I see no reason to ever want to use the N5s.

My left N5 has been sent for repair. I refuse to use the right side N5 until I get the left one back, and even then, I can’t say that I will use the N5s at all.

I really believe the N5s were designed with children in mind. Why else would there be the following features?

• Smaller than N4 (but weighs the same)
• Can lock the battery case (so kids can open it and swallow the batteries)
• Can lock the button controls via remote (kids love to push the buttons)
• Can control the BTEs via remote (parents can control the BTEs on a child)
• Audio cable socket cannot be opened without a screwdriver

I can easily see how the N5 would be a God-Send for parents with infants and toddlers. I know I am the wrong demographic for the N5 as I'm a "way too critical Engineer."

In my opinion, anyone but small children are the wrong target demographic for the N5, and that’s sad as I know Cochlear put 2 or 3 years of R-and-D into the N5. My advice to all is to stick to the N4s for now.

In conclusion, given the time of the year, I end on this cheery note:

Bah, Humbug!

…dan…

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