Cochlear Implant - Med-El

MKT1020E r.2.0
COMBI 40+
Cochlear Implant
Leading Technology, Leading Performance

THE MED-EL COMBI 40+ IMPLANT
With a research heritage spanning over 25 years, MED-EL is pioneering cochlear implant technology
and research worldwide. This expertise has led to the development of the COMBI 40+ family of
cochlear implants, specially designed to be atraumatic and minimally invasive while providing users
unparalleled performance.
GENTLE TECHNOLOGY
Soft electrode
The biocompatible silicone array
features recessed electrode contacts
to avoid injury to the delicate
cochlear structures.
Specially designed flexible electrode
The tip and oval cross-section of
the electrode array gently follow
the curvature of the cochlea during
insertion.
Thinnest implant package available
At approx. 4mm thick, the
COMBI 40+ is ideal for use with
even very small children.
Small volume electrode
The electrode array is designed
such that it does not fill or obstruct
the cochlea.
Small cochleostomy required
The small diameter, thin singlebranch
electrode array requires
the smallest cochleostomy of all
implants available. The conical
shape of the electrode shaft and
the marker ring facilitate a tight
cochleostomy seal.
Output capacitors, telemetry,
self-check integrity, and other
features ensure the highest level
of safety.
Engineered for Excellence
A decisive factor in cochlear implantation is to minimise
trauma to the delicate structures of the cochlea. Due to
its unique design features, we believe that the MED-EL
COMBI 40+ represents the current Gold Standard.
Safety features
T. Balkany, Miami
DESIGNED FOR PERFORMANCE
The COMBI 40+ is uniquely designed for deep electrode
insertion (approx. 31mm) for stimulation of the complete
frequency range.
w. Gstöttner
Optimised electrode spacing
for distinct pitch perception
Electrode contact spacing reduces
neural interaction and provides
enhanced speech cues and
more natural sound.
Deep electrode insertion
Deep insertion targets the apical
area of the cochlea where there is
often better neuronal survival.
Representation of low pitch information
at the correct place in the
cochlea may enhance important
speech cues such as intonation,
vowel discrimination and some
binaural cues.
Ceramic housing,
the modern material of choice
The compact, robust ceramic
case is similar in hardness to the
surrounding bone and allows the
transmission of a large amount of
information with low energy requirements.
All components including
the receiver coil are
located in and protected by the
housing.
Optimised stimulation rate
for best performance
The COMBI 40+ features an infinitely
variable stimulation rate
that can be adjusted according to
individual needs.

READY FOR THE FUTURE
Outstanding Results
Technology means nothing without outcomes. MED-EL COMBI 40+ patients demonstrate
outstanding results which range from mean monosyllable scores of 70% 1 to telephone
use 2 and even music enjoyment. 3,4 Additionally, MED-EL COMBI 40+ users
reach high performance levels quickly, reaching mean scores of 84% sentence understanding
as early as 6 months. 1
Given today’s rapid advances in technology, MED-EL is committed to ensuring that cochlear implant recipients are able to
take advantage of future developments and upgrades. MED-EL demonstrates this commitment with the TEMPO+ BTE Speech
processor, the only BTE speech processor which can be used by recipients of both the MED-EL COMBI 40+ and the previous
generation implant, the COMBI 40.
Compatible with future technologies
The flexible design platform and ability to stimulate at high rates allow the COMBI 40+ to be compatible
with future technological upgrades.
MRI safe, no additional surgery necessary
The COMBI 40+ is the only implant available that is MRI safe (0.2, 1.0 and 1.5 Tesla) 5,6,7 without
the need for surgical removal of the magnet, and thus no additional period of deafness
MED-EL's Focus on Electrode Development
Cochlear implantation is not only performed on one of the body's smallest
structures, but also on one of the most delicate. For this reason, it is both a
surgical and technical challenge.
Since the foundation of MED-EL, the company's philosophy has been to develop
atraumatic electrodes designed for highest performance and maximum
protection of the cochlea. This is of critical importance because trauma to
the cochlea may increase the potential for post-operative problems and restrict
access to future technological upgrades.
Important considerations include minimisation of mechanical forces applied
to the delicate structures of the cochlea, as well as promotion of a tight
cochleostomy seal to prevent post-operative infection.
MED-EL is committed to focusing research efforts to achieve further improvements
in this area to ensure that our electrodes are not only high performing,
but structure and function preserving.
C. Gary Wright, Ph.D.
University of Texas Southwestern Medical Center,
Dallas, Texas

COMBI 40+ Standard Electrode Array
Meeting Individual Needs
Unique to MED-EL, the COMBI 40+ is available in a range of electrode options to meet individual
needs, such as electrodes for cases of cochlear ossification or malformation.
24 contacts arranged as connected pairs for 12-channel high-rate stimulation
The COMBI 40+ Standard Electrode Array is designed for deep electrode insertion (approx. 31mm)
for stimulation of the complete frequency range. This provides access to more low pitch information
containing important speech cues such as intonation, vowel discrimination and some binaural cues.
COMBI 40+ Compressed Electrode Array (C40+ S)
Specially designed for partial ossification or malformation of the cochlea
The COMBI 40+ Compressed Electrode Array features 12 pairs of electrode contacts equally spaced
over a length of only 12.1 mm. This makes it possible to insert more channels in a partially or
completely ossified cochlea than with a standard electrode.
COMBI 40+ Split Electrode Array (C40+ GB)
Specially designed for complete ossification of the cochlea
The COMBI 40+ Split Electrode Array consists of two separate electrode branches, one with 5 and
one with 7 pairs of electrode contacts. Electrode contacts are spaced at the same distance as in
the Compressed Electrode Array. These active arrays are designed for insertion into two
cochleostomies to maximize the number of inserted electrode contacts and optimize performance.
SPECIAL IMPLANTS FOR SPECIAL CASES
In addition to the electrode arrays discussed above, MED-EL is committed to working with cochlear implant professionals
to provide implant solutions for special anatomical situations. Please contact your nearest MED-EL office for
more information on special implant designs.
1) D'Haese P et al., The investigation of the binaural effect in bilateral cochlear implant users, presented at the XXVI International Congress of Audiology, Melbourne,
March 2002, The Australian and New Zealand Journal of Audiology, Volume 23, Number 2, 2002 Addendum.
2) Sorri et al, Cochlear Implants and GSM phones, Scandinavian Audiology 2001, 30: Suppl 52:54-6.
3) Helms J et al., Comparison of the TEMPO+ Ear-level Speech Processor and the CIS PRO+ Body-Worn Processor in Adult MED-EL Cochlear Implant Users,
ORL 2001; 63:31-40.
4) Stöbich et al., Presented at the 2nd Congress of Asia Pacific Symposium on Cochlear Implant and Related Sciences, Comparison of performance of the MED-
EL body worn speech processor CIS-PRO+ with the new MED-EL BTE-speech processor TEMPO+ in adults, April 1999.
5) Teissl, et al. Magnetic Resonance Imaging and Cochlear Implants: Compatibility and Safety Aspects, Journal of Magnetic Resonance Imaging 9:26-38 (1999)
6) Teissl, et al. Cochlear Implants: In Vitro Investigation of Electromagnetic Interference at MR Imaging-Compatibility and Safety Aspects, Radiology, September
1998.
7) Youssefzadeh, et al. MR Compatibility of MED-EL Cochlear Implants: Clinical Testing at 1.0 T, J. Comput. Assist. Tomogr 22(3:346-50) 1998.
MED-EL Worldwide Headquarters
Fürstenweg 77a, A-6020 Innsbruck, Austria
Tel: +43-512 28 88 89, Fax:+43-512-29 33 81