Advanced Bionics Connectivity and Linked Two-Ear Solutions

Introduction

In an increasingly connected world, the ability to hear clearly and engage fully in every aspect of life is paramount. For individuals with hearing loss, advancements in audiological technology offer transformative possibilities. Advanced Bionics (AB) and Phonak, through their unique partnership, are at the forefront of this revolution, providing comprehensive two-ear hearing solutions and unparalleled connectivity options. This article, drawing insights from a recent webinar featuring leading audiologists Dr. Kelley Dwyer and Dr. Carrie Spangler, alongside personal testimonials from recipients, explores the depth and breadth of AB's Marvel CI and Link M technologies, highlighting their clinical advantages and real-world impact.

Figure 1. Two-ear solutions.

The Gold Standard: Bilateral Cochlear Implants and Integrated Solutions

The journey to optimal hearing often involves complex considerations, but for many, bilateral cochlear implants (CIs) represent the gold standard. Dr. Kelley Dwyer, Chief of Audiology at Emory Healthcare, emphasizes that AB's system offers a host of bilateral benefits, designed to connect recipients with the moments they cherish. These benefits include Binaural Voice Stream Technology (BVST), bilateral streaming from Bluetooth, Roger mics, and Airstream devices, all controllable through a single application and fitting software.

The Marvel CI platform, encompassing Naída CI M and Sky CI M, along with Link M (Naída Link M or Sky Link M), is engineered to seamlessly integrate into a patient's life. Their features are a testament to modern audiological innovation: cosmetically appealing designs, waterproof solutions, integrated Bluetooth and Roger Direct capabilities, streamlined accessory options, an automatic operating system, and a user-friendly fitting platform. The ability to control both devices from one app and program them simultaneously through a single software significantly enhances the user experience and simplifies the fitting process for audiologists.

Dr. Dwyer's clinical experience with bilateral AB sound processors underscores the excitement patients feel when technology genuinely connects them to their world. The capacity to stream music, news, podcasts, and audiobooks bilaterally not only enriches their quality of life but also enhances their aural rehabilitation. The ease of connecting to both devices without cumbersome manual switching, coupled with the improved access to family conversations in challenging situations via Roger microphones, makes the bilateral solution profoundly beneficial. As Dr. Dwyer notes, "Everything being in stereo has just been very beneficial for my patients and they've also just really loved it."

Addressing Unilateral Challenges: The CROS Device

While bilateral CIs are ideal, a significant majority of CI recipients globally are unilaterally implanted. This can be due to various factors such as limited reimbursement, affordability concerns, fear of a second surgery, medical issues precluding further implantation, aidable hearing in the non-implanted ear, or even the desire to preserve an ear for future treatments like stem cell regeneration.

However, unilateral hearing presents distinct challenges: difficulty understanding conversations in noise, the need to constantly reposition the "better" ear, reduced sound awareness, increased listening effort, and overall fatigue, often leading to reduced participation in group conversations.

For patients who are unilaterally implanted and cannot benefit from a hearing aid in the contralateral ear, the CROS (Contralateral Routing of Signal) device offers a remarkable solution. Compatible with Naída CI and Sky CI, the CROS device functions like a traditional CROS or BiCROS system, wirelessly transmitting sound from the non-implanted ear to the CI. This allows unilateral recipients to manage noisy environments more effectively without needing to physically reposition themselves. The CROS balance can be adjusted during fitting, and transmission intelligently pauses during Bluetooth streaming, resuming automatically when streaming ends.

Figure 2. CROS candidacy.

Studies, such as one published in 2025, have demonstrated significant improvements with the CROS device. Seven unilateral CI users, after approximately one year of CROS use, showed a 32% improvement in speech understanding when speech was directed toward the non-CI ear, compared to CI-only use. Participants reported significant median improvements in their general quality of life, and their communication partners observed a significant reduction in concerns when the CROS device was in use. This highlights the device's ability to improve speech understanding in noise, localization, and overall ease of listening.

The Power of Synergy: Bimodal Hearing Solutions

The landscape of hearing solutions has seen a notable rise in bimodal use over the last two decades, driven by expanding candidacy criteria that now include patients with considerable residual hearing. The AB and Phonak bimodal system offers a compelling answer, providing consistent sound quality and excellent speech understanding—a stark contrast to the often-disparate performance of a non-integrated hearing aid and cochlear implant combination.

The benefits of bimodal hearing are extensive: improved speech understanding in quiet and noise, reduced listening effort and fatigue, enhanced music appreciation due to better access to low frequencies, and improved sound awareness. Patients with severe to profound hearing loss, aidable hearing, or those who are CI candidates with bilateral severe to profound hearing loss, whether adults or children, can be fit with Phonak Link hearing aids as part of this bimodal system.

Naída Link M and Sky Link M, compatible with Naída CI M and Sky CI M, are designed for aligned signal processing. They feature the Adaptive Phonak Digital Bimodal Fitting formula and enable bimodal streaming from Bluetooth, Roger mics, and Airstream devices. These Link M devices are battery-efficient, offering extended power without streaming, and crucially, appear together in the app and programming software for seamless adjustments. The importance of matching the platform (Naída CI M with Naída Link M, and Sky CI M with Sky Link M) for optimal performance is also emphasized.

Figure 3. Bimodal solutions.

While patients are not strictly required to use a Link hearing aid with their AB sound processor, the advantages of doing so are substantial. Any hearing aid provides bilateral hearing, but a Phonak device adds AutoSense technology, bimodally shared accessories, and remote programming capabilities. The Link hearing aid, however, truly elevates the bimodal experience, working in tandem with the CI as a cohesive system for superior hearing across diverse listening environments. Recipients enjoy the convenience of streaming to both ears via Bluetooth or accessories and controlling both devices from a single app. For professionals, the ability to program both devices simultaneously in Target CI, whether in person or remotely, is a significant time-saver, often reducing activation appointment times by up to 30 minutes or more.

This integrated solution leverages the Adaptive Phonak Digital Bimodal Fitting formula, ensuring the hearing aid complements, rather than competes with, the cochlear implant. This is achieved by:

• Shifting frequency response to the lower range.
• Matching compression ratio and kneepoint to the sound processor.
• Utilizing the same slow-acting dual-loop automatic gain control (AGC) as the CI.

Conventional hearing aid formulas fail to align acoustic and electrical signal processing, leading to suboptimal outcomes. The bimodal fitting formula intelligently identifies cochlear dead regions, providing more gain below 1000 Hz for typical CI patient hearing loss profiles and cutting off amplification to high-frequency regions where the CI provides input. Research confirms the efficacy of this approach, showing superior speech understanding in noise with the bimodal fitting formula compared to conventional formulas, even eliminating the need for additional testing to identify dead regions. Studies from Italy further validate these findings, demonstrating significantly better speech intelligibility with the Naída Link hearing aid using the APDB fitting formula compared to other setups.

Aligning the AGC between the hearing aid and the cochlear implant also yields substantial improvements. A study in the Netherlands found that patients performed better and subjectively preferred the sound quality with slower AGC, improving speech understanding in noise by up to 2dB over standard Phonak AGC, equating to a 30% improvement in speech understanding.

Dr. Dwyer highlights that the true advantage of the bimodal solution lies in how the hearing aid and implant are "truly married to each other." This synergy creates a harmonious listening experience where the implant provides clarity and the hearing aid offers confidence-boosting power. Patients thrive with both devices on, enjoying seamless streaming of music, news, and conversations, leading to happier households as TV volumes can be reduced.

The Acoustic Earhook: Integrating Acoustic and Electrical Sound Processing

For recipients with aidable low-frequency hearing, the Acoustic Earhook solution offers a unique integration of acoustic and electrical sound processing within a single device. This modular attachment provides up to 55dB of gain, amplifying up to 10,000Hz. Available in five receiver sizes for both ears, it also grants access to Binaural Voice Stream Technologies and bilateral streaming via Bluetooth, Roger Mics, and Airstream devices. Importantly, the acoustic component utilizes the bimodal fitting formula, accentuating low frequencies while maintaining acoustic and electric alignment. Should a recipient's hearing loss progress, the Naída CI can be quickly reconfigured for electric-only use by simply removing the ear hook and adding a T-mic.

Figure 4. Acoustic earhook solution.

Seamless Connectivity: Beyond Hearing Restoration

Beyond restoring hearing, AB's Marvel CI and Link M systems excel in seamless wireless connectivity, a critical aspect of modern life. Dr. Carrie Spangler, Lead Audiologist at Summit County Educational Service Center in Ohio and a Marvel CI recipient herself, passionately shares how AB and Phonak devices connect to a multitude of devices simultaneously. As a bimodal recipient, Dr. Spangler uses her Marvel device on her left ear CI and a Link hearing aid on her right, augmented by Roger technology.

The Marvel CI and Link M are compatible with various wireless signals, including Bluetooth Low Energy, Bluetooth Classic, Roger, and Airstream.

Bluetooth Connectivity: Effortless Wireless Streaming

Bluetooth connectivity with AB and Phonak devices offers ultimate ease of use, allowing direct wireless streaming to any device without requiring additional streamers or connections. Bluetooth Low Energy is designed for low energy consumption, ideal for connections to AB apps and Noah Link Wireless, while Bluetooth Classic enables continuous two-way communication for phone calls or video streaming. When one device is connected, if two are present (bilateral CIs or bimodal), they automatically pair to both, ensuring binaural hearing.

Dr. Spangler credits Bluetooth connectivity as the most appreciated upgrade she experienced with her Marvel devices and Link hearing aid. The seamless, hands-free experience for phone calls, virtual meetings, and even personal computer use has transformed her daily life. "It is a two-way transfer. I can speak and the microphone is being picked up as well as hear exactly what you are saying," she explains.

Another recipient, Julie, echoes this sentiment, finding Marvel "marvelous." She praises the Bluetooth streaming and the automatic music program that optimizes sound quality, making instruments clear and lyrics easily understood. Phone calls are equally effortless, requiring just a button press on the processor. Jim, another satisfied recipient, emphasizes the "absolutely amazing" sound quality when streaming music, recalling a richness and clarity he hadn't experienced in decades. For his work, which involves frequent phone and video calls (Zoom, Microsoft Teams), the direct Bluetooth streaming to both ears from his laptop has made a "huge difference in the quality of my work life and my ability to hear music again."

Roger Technology: Overcoming Noise and Distance

While hearing aids and CIs are powerful, the reality of a noisy world often presents challenges. Roger technology serves as a vital solution for overcoming background noise and distance. AB processors are directly compatible with Roger Direct, meaning no external equipment is needed. This groundbreaking integration makes Roger the first ear-level cochlear implant receiver, directly activating the processor.

Various Roger microphones, such as the Roger On, allow for direct audio transmission from the speaker to the listener's devices. Dr. Spangler, an educational audiologist, extensively uses Roger in schools, ensuring children receive the teacher's voice directly, reducing listening effort and providing clear signals throughout the day. She also personally uses Roger at home, in the car, and for TV listening. Roger is also compatible with AB's waterproof battery, extending its utility to beach trips, sports, or any activity involving sweat or water.

Dr. Wilder Roberts, an audiologist at the University of South Alabama, highlights that Roger eliminates the need for patients to choose between FM and Bluetooth connectivity and prevents lost parts. The seamless integration means patients can talk hands-free, just like their hearing peers. The advantages of Roger for children are particularly significant: integrated receivers for home and school, simultaneous use with waterproof batteries, and a fully integrated connectivity solution without external receivers.

Airstream Technology: Enhanced Audio Streaming

Airstream Technology, a proprietary Phonak/Sonova protocol, delivers high-quality stereo audio signals, primarily for connecting to the TV Connector and Partner Mic. The TV Connector is a simple plug-and-play device that interfaces with TVs or other audio devices, allowing an unlimited number of compatible Sonova devices to connect simultaneously—a boon for families with multiple hearing aid or CI users.

The Phonak Partner Mic, while similar to Roger, is designed for shorter distances and moderately noisy situations, perfect for one-on-one conversations in a car or a moderately noisy environment. Its ease of use makes it a valuable addition to a patient's toolbox.

Binaural Voice Stream Technology (BVST): Synchronized Hearing

BVST facilitates audio streaming between hearing instruments, allowing bilateral CI or bimodal recipients to receive signals to both devices simultaneously. Crucially, when a program or volume is adjusted on one device, it automatically changes on the other, ensuring synchronized hearing. This is particularly beneficial for phone calls, where the conversation is heard in both ears, and in noisy situations, where it aids in focusing on conversations. Dr. Spangler attests to BVST's benefit, noting the ease of answering phone calls with a button press and knowing the audio will go to both sides.

Digital Solutions: Control and Empowerment

Advanced Bionics and Sonova offer a suite of digital solutions that empower patients with greater control over their hearing experience. The AB app allows users to adjust volume, programs, and other settings directly from their smartphone. Remote Programming capabilities, also via an app, enable audiologists and patients to conduct programming appointments comfortably from home, streamlining the process. Additionally, a dedicated listening app helps patients actively participate in their hearing journey, tracking progress and engaging in auditory "brain activities" to build listening skills from quiet to noisy environments.

A key feature within the app is the balance slider, allowing users to control the relative strength of surrounding environmental sounds versus streamed audio from a TV or Roger microphone. Dr. Spangler personally uses this feature while watching TV, adjusting the balance based on whether she's alone or with others, ensuring she can both hear the TV and engage in conversations.

The overarching theme of these connectivity solutions is hands-free, optimal listening. Patients can stream from any Bluetooth device (iOS, Android, laptops, computers) to both ears simultaneously. The Binaural VoiceStream technology ensures seamless control across devices, and the ability to use the devices as both a microphone and a speaker liberates users from holding phones to their ears.

The Audiologist's Role: Counseling for Connectivity

The webinar concluded with a profound reflection on the audiologist's crucial role in patient counseling. Research from Vanderbilt highlights that audiologist recommendations are a primary factor influencing a patient's CI device choice. The technology built within the processor is another key driver. Enhanced patient education can significantly improve decision-making confidence and device retention.

This underscores the imperative for audiologists to comprehensively counsel patients on the myriad connectivity options available. Understanding a patient's lifestyle—whether they are a retiree, a working professional, a school-aged child, or a parent—allows audiologists to tailor recommendations that best suit their unique needs and maximize the benefits of AB's advanced solutions.

Conclusion

The advancements in AB's Marvel CI and Link M, coupled with their extensive connectivity features, represent a paradigm shift in hearing rehabilitation. From the gold standard of bilateral CIs and the innovative CROS device to the synergistic bimodal solutions and the versatile Acoustic Earhook, AB offers a comprehensive array of options designed to meet diverse audiological needs. The seamless integration of Bluetooth, Roger, and Airstream technologies, alongside intuitive digital control applications, empowers recipients to engage effortlessly with their world. As demonstrated by the powerful testimonials of Dr. Kelley Dwyer, Dr. Carrie Spangler, Julie, and Jim, these technologies are not just about restoring hearing; they are about unlocking richer, more connected, and fulfilling lives. The future of hearing is clear, integrated, and profoundly personal.

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