11Manufacturer systems compared

FWhy terminology matters

A clinician who learned objective measures on one device, or who reads a paper from a centre using another, constantly meets the same biological signal under different names and different units. Confusing the brand-specific labels is a real source of error — in level setting, in interpreting reports, and in comparing studies. The underlying measures (ECAP, ESRT, eABR, impedance) are the same across every manufacturer; only the packaging differs.[2013]

Cochlear, MED-EL and Advanced Bionics dominate the global literature, but they are not the whole field. Oticon Medical(the Neuro system, successor to Neurelec's Digisonic) and the Chinese manufacturers Nurotron (Venus) and Listent serve large populations — and the Chinese devices in particular widen access in price-sensitive markets where the big three are often out of reach. A genuinely useful atlas has to read across all of them; this module deliberately does, while being explicit about where published objective-measure detail thins out for the newer entrants.

TECAP system names

All three record the same N1–P2 neural response; each brands the feature and the threshold differently.

Cochlear's AutoNRT is the most familiar fully-automated threshold-seeking implementation, built on forward-masking subtraction and an automated detection algorithm.[2007, 1999] The other systems offer their own automated and manual modes. The artifact-rejection defaults differ (see Module 3), which is one reason absolute threshold values are not directly interchangeable between brands.

The “array design” row of that comparison hides real geometric variety. MED-EL, for example, ships one electronics platform with several array lengths — all 12 channels, but spanning the cochlea very differently. Drawn to scale, the trade-off is plain: deeper, longer arrays reach the apical low-frequency regions, while shorter arrays suit small, ossified, or residual-hearing cochleae.[2013]

TCThe wider field — beyond the big three

Oticon Medical brought the Neurosystem (Neuro Zti implant, Genie Medical CI software) — the modern successor to Neurelec's Digisonic SP. Its arrays are straight, lateral-wall designs (CLASSIC and the hearing-preservation EVO), and it documents the full objective-measure suite: ECAP, impedance, the electrical stapedius reflex, and an electrically-evoked ABR (“Integrity EABR”), with intraoperative ECochG studied on the platform. Note the corporate change: Cochlear acquired Oticon Medical's cochlear-implant business in 2024, so the Neuro line is now discontinued for new implantation while existing recipients are supported — clinicians will still meet Neuro and Digisonic devices in follow-up for years.

Two Chinese manufacturers matter for global, equitable access. Nurotron's Venus implant uses a straight, 24-contact array and brands its ECAP system NRM (Neural Response Management). Listent (Shanghai) uses a precurved perimodiolar array (LCI-20PI) and brands its ECAP system NRD (Neural Response Detection). Both are NMPA-approved and positioned as lower-cost options for China and other developing markets.[2018] The published, peer-reviewed detail for these devices centres on ECAP and impedance; broader objective-measure support (stapedius reflex, eABR, intraoperative ECochG) is not clearly documented, so it should not be assumed — a gap to verify against current manufacturer documentation rather than infer.

TLevel terminology

The upper comfortable level — the same clinical concept — carries different names and is measured in different current units across systems, so never port a numeric level from one device to another. The table below shows the big three (whose level conventions are best documented); Oticon Medical uses MCL for the comfortable level, while the Chinese systems' level terminology is not consistently published.

TCParameters & defaults compared

Beyond the names, the three best-documented systems ship different defaults — level units and ranges, coding strategy, stimulation rate, pulse width, input dynamic range, and AGC. They are typical starting points (not hard limits), and the units genuinely do not transfer between makers. Switch category to compare them side by side.[2014]

TCStimulation rate — a shared trade-off

Stimulation rate (pulses per second per channel) is one parameter every manufacturer exposes differently — Cochlear defaults to 900 pps, Advanced Bionics to roughly 1500–2000 pps, MED-EL maximises it within voltage compliance — yet the underlying trade-off is the same. Higher rates raise loudness and pitch and sharpen temporal sampling, but the speech-recognition benefit plateaus for most recipients around 900–1200 pps, and very high rates can sound harsh and drain the battery. Explore the curve and how it shifts for different recipients.[2005, 2007, 2000]

The clinical lesson is that the optimal rate is individual: trial several rates, judge by sound quality and speech recognition, and lean to slower rates for recipients with auditory-nerve dysfunction, advanced age, or long-duration deafness.[2014]

TClinical software & automation

Each manufacturer ships its own fitting software, within which the objective measures live:

• Cochlear — Custom Sound, with AutoNRT integrated for automated ECAP thresholds.
• MED-EL — MAESTRO, with ART for ECAP recording.
• Advanced Bionics — historically SoundWave and successor software, with NRI.
• Oticon Medical — Genie Medical CI, with ECAP, ESRT and eABR support.
• Nurotron — the NRM platform/software (ECAP via NRM).
• Listent — Listent MAP software (ECAP via NRD).

All provide impedance telemetry and integrity checks; the depth of automated ECAP analysis, the availability of advanced measures (recovery, spread of excitation, transimpedance matrix) and their presentation differ between platforms and software versions.

CPractical cross-brand notes

• Read the brand, then the value. Always note which system produced a report before interpreting a threshold or level.
• Compare like with like in the literature. Studies using different artifact-rejection defaults can report systematically different ECAP thresholds; this is a confounder when pooling data.
• The clinical logic is portable; the numbers are not. Use tNRT/tART/tNRI for profile shape and as an in-range anchor, and the ESRT for the ceiling — the same strategy (Module 9) on every brand, with brand-specific values.