Whitepaper
MAESTRO 9.0 Early Market Experience
MED-EL Product Management
M00673_1.0 (Sep 2021)
Introduction
MAESTRO 9.0 is MED-ELs latest fitting software for MED-EL cochlear implants. The software builds on the guided workflow and easy handling of MAESTRO 8.0 and introduces powerful new fitting options and helpful tools. We integrated extensive feedback from audiologists and clinicians in the field to make MAESTRO 9.0 our most powerful and intuitive software ever. The main enhancements will be reviewed here.
Method
To evaluate the acceptability of the changes that were made, an online survey was devised, containing questions about the new features and highlights of the MAESTRO 9.0 fitting software. This online survey consisted of 35 questions and was sent to clinicians all over the world. Responses from 139 clinicians were collected. All clinicians had previous MAESTRO experience and work mainly as audiologists, engineers or audiometrists (Table 1).
The questions were phrased in a way that the participant would provide their rating on several aspects of the MAESTRO 9.0 fitting software. The main aim of this paper is to focus on the usability of and satisfaction with MAESTRO 9.0 in general as well as with new or improved features.
| Years | % | |||
|---|---|---|---|---|
| Mean | 11.03 | More than 40 | 10.8 | |
| Max | 32 | Between 21 and 40 | 25.2 | |
| Min | 0 | Between 10 and 20 | 32.4 | |
| Less than 10 | 28.8 | |||
| Missing | 2.9 |
Results
The results are based on specific responses, i.e., skipped or ‘N/A’ responses were not counted. Clinicians may have skipped question e.g., if they have not gathered enough experience with certain aspects of the software yet or are about to get trained on them.
Intuitive Handling
MAESTRO 9.0 was designed to be as accessible and intuitive for both new and experienced clinicians. With a guided workflow, recommended tasks are highlighted, thus the tasks can be easily identified and performed for both intra- and post-operative objective measurements and fitting sessions. The session view provides a comprehensive overview of a current fitting session, as seen in the screenshot below.
Figure 1: Session view with guided workflow in MAESTRO 9.0
Survey results showed that 76% of responding clinicians are satisfied or very satisfied with the guided workflow of the software, indicating that the highlighting of tasks helps in clinical practice (Figure 2). The clear structure of the session view is intended to streamline a fitting session and decrease the time needed for a fitting. 83% of clinicians said that they are satisfied or very satisfied with the time needed for a fitting (Figure 2).
Figure 2: Figure 2: Satisfaction on aspects of the session view
Session View enhancements that were introduced with MAESTRO 9.0 were rated useful or very useful by 83%. More than 64% agreed or strongly agreed that the configuration options for Remote Control, Coil and Datalogging are easier to find in MAESTRO 9.0 (Figure 3).
Figure 3: Effectiveness of session view enhancements
Bimodal Fitting
MED-EL cochlear implants are designed to provide a closer to natural match with any hearing aid. There are three main components that should match between the CI system and the hearing aid: pitch perception, loudness growth, and timing of a sound. By combining these three elements, MED-EL offers the best solution for bimodal listening with practically any hearing aid. And with MAESTRO 9.0, these settings can easily be optimized in the bimodal session view.
Besides the ability of performing a bimodal loudness balancing in the session view, MAESTRO 9.0 also allows for bimodal synchronization. Every hearing aid has an inherent processing delay, which is longer than the processing time of the CI audio processor. This can cause a mismatch between the CI audio processing and the acoustic hearing aid. In turn, this timing mismatch would affect accuracy of inter-aural timing differences (ITDs).
With Bimodal Synchronization, you can easily match the processing delay timing between RONDO 3 or SONNET 2 and nearly any hearing aid, without needing to refit the hearing aid. This more natural timing perception can support better sound localization. 1 2 3
You can find the detailed delay settings for more than 150 hearing aids at go.medel.pro/bimodalsync.
Figure 4: Bimodal Session View of MAESTRO 9.0
In regard to the bimodal fitting capabilities of MAESTRO 9.0, 73% of clinicians find them useful or very useful. Different aspects of bimodal fitting achieved a high percentage of satisfaction (Figure 5), like ease of use (75%), time needed for a fitting (73%) or the integration into the clinical workflow (71%). One clinician called bimodal synchronization
“An important option with great prospects for the future.”
Figure 5: Effectiveness of session view enhancements
When asked about the patient’s feedback after applying the bimodal synchronization, none of the clinicians reported an unsatisfactory or very unsatisfactory response, neither acutely, nor after a follow-up appointment.
Anatomy-Based Fitting
Our philosophy has always been to provide a closer match to natural hearing. The default FineHearing frequency allocation in the MAESTRO software is designed to follow the natural tonotopic map of the cochlea with a target angular insertion depth of approximately 630°. However, to provide a closer match for each individual patient, MAESTRO 9.0 provides new anatomy-based fitting tools, where a clinician can easily fine-tune the frequency map to be closer to the natural map based on the specific electrode placement for each individual cochlea. By combining detailed imaging data from OTOPLAN with MAESTRO 9.0 one can now quickly assign center frequencies based on the actual anatomical location of each electrode contact (Figure 6).
Figure 6: Anatomy-based fitting in the Fitting task of MAESTRO 9.0
With anatomy-based fitting, 74% of the responding clinicians responded that they find this feature useful or very useful. More than 60% expressed their satisfaction with the ease of use, the time needed and the integration into the clinical workflow of anatomy-based fitting (Figure 7).
Figure 7: Satisfaction on aspects of anatomy-based fitting
These data show that the implementation of anatomy-based fitting is well accepted amongst clinicians. When asked on how CI recipients reacted to this type of fitting, one clinician specifically mentioned that
“New patients finding it easier to adapt to sound and music sounds more pleasing.”
System Check
With the System Check in MAESTRO 9.0, a clinician can easily check how the microphones of RONDO 3 and SONNET 2 respond to sound in order to confirm that the processor is correctly receiving input. Furthermore, it displays current status information for the integrated rechargeable battery of the RONDO 3 audio processor (Figure 8).
Figure 8: New System Check tool in MAESTRO 9.0
The new System Check is rated as useful or very useful by 86% of clinicians. Furthermore, clinicians are satisfied or very satisfied with the ease of use (80%), the presented information (73%) and the time needed for performing a check (84%) (Figure 9).
Figure 9: Satisfaction on aspects of the system check
ARTFit Enhancements
ARTFit enables a clinician to quickly and easily create reliable automatic fitting maps for CI users.4 This makes ARTFit an excellent tool for fitting patients who cannot provide useful behavioral measures. Clinicians were asked how satisfied they were with enhancements that were made for the ARTFit feature. 80% of the clinicians say that they were satisfied or very satisfied with the user interface of ARTFit (Figure 11). Also, 81% were satisfied or very satisfied with the improved results display (Figure 12). Overall, 68% find the enhancements useful or very useful (Figure 10). One clinician specifically mentioned that
“ARTFit was helpful with a client who was not able to provide any behavioral responses.”
Usefulness
Figure 10: Usefulness of ARTFit
Satisfaction
Figure 11: Satisfaction with ARTFit user interface
Displayed Information
Figure 12: Satisfaction with display of ARTFit results
Powerful Tools
MAESTRO 9.0 provides an intuitive workflow for everyday fitting, but also has advanced fitting tools integrated to give a clinician more control and insight. These include triphasic pulses, integrated electrically evoked stapedius reflex threshold (eSRT) and electrically evoked auditory brainstem response (eABR) tasks, and late-latency cortical objective measures.
The unique triphasic pulse shape helps control current spread, which can be especially useful for patients with non-auditory stimulation. Reported occurrences of FNS for cochlear implant recipients ranges from ~1–10%, and can occur regardless of implant brand. Facial nerve stimulation can be difficult to manage, as it often requires reducing stimulation levels or deactivating electrodes—and hearing outcomes are often affected. In MAESTRO, the user has an effective tool at hand for minimizing facial nerve stimulation and non-auditory side effects. By changing the way stimulation is delivered, FNS has been reduced in about 90% of affected patients so far.5 6 This triphasic pulse technology is exclusively available with MED-EL cochlear implants.
Overall Rating of MAESTRO 9.0
Clinicians gave an overall average star rating of 4.2 for the MAESTRO 9.0 fitting software (Figure 13).
Figure 13: Overall star rating on MAESTRO 9.0
Conclusion
MAESTRO 9.0 was further improved from MAESTRO 8.0, based on feedback and comments that were received from clinicians. Furthermore, MAESTRO 9.0 provides additional fitting tools, such as bimodal synchronization or anatomy-based fitting, which can improve the sound quality perceived by a CI recipient. All features and changes in MAESTRO 9.0 have been well accepted by clinicians of various experience levels and areas around the world.
Clinical Considerations
As with previous versions of MAESTRO, neither new nor experienced clinicians reported an extensive acclimatization period after the upgrade to the new software. This is an indication that an upgrade of the software does not cause any disruption of the clinical routine. MAESTRO 9.0 supports clinicians in terms of usability and builds on top of a standardized workflow. The software itself and the new fitting tools try to integrate into the clinical routine seamlessly so that a clinician does not need to spend extensive time on working out additional programming settings. With these improvements, clinical fittings can be performed faster, more convenient and more precise, to the benefit of CI recipients and clinicians of any degree of experience alike.
For more information, please contact your local MED-EL representative.
Zirn, S., Arndt, S., Aschendorff, A., & Wesarg, T. (2015). Interaural stimulation timing in single sided deaf cochlear implant users. Hear Res. 328.↩︎
Zirn, S., Angermeier, J., Arndt, S., Aschendorff, A., & Wesarg, T. (2019). Reducing the device delay mismatch can improve sound localization in bimodal cochlear implant/hearing-aid users. Trends Hear. 23.↩︎
Angermeier J., Hemmert W., & Zirn S. (2021) Sound Localization Bias and Error in Bimodal Listeners Improve Instantaneously When the Device Delay Mismatch Is Reduced. Trends Hear. January 2021.↩︎
Gärtner, L., Lenarz, T., Büchner, A. (2018) ECAP basiertes Fitting von Cochlea-Implantaten. DGA 2018, Halle(Saale), Germany.↩︎
Alhabib, S.F., Abdelsamad, Y., Yousef, M. et al. (2020). Performance of cochlear implant recipients fitted with triphasic pulse patterns. Eur Arch Otorhinolaryngol 278.↩︎
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