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Jan Janssen – The Future of Cochlear Implants

 In Podcast
Jan Janssen

Jan Janssen is the Chief Technology Officer at Cochlear, a leader in implantable hearing solutions. Working with Cochlear for over 20 years, Jan is an expert in the business and technology side of audiology. 

Jan got his start at Philips in Belgium, initially as a Project Manager and later as an R&D Manager. He earned his master’s degree in electronic engineering from Katholieke Universiteit Leuven.

Here’s a glimpse of what you’ll learn: 

  • Jan Janssen shares his journey to the implantable solution industry and working in Australia
  • The most challenging parts of designing a cochlear implant
  • Why the exterior design is so important for long term use
  • What does the distant future of cochlear implants look like?
  • Explaining the overlooked role of the brain in hearing
  • Clinical trials and how they need to be improved to keep up with changes
  • Jan explains the psychosocial aspects of hearing

In this episode…

Designing the perfect cochlear implant is difficult. The technology is relatively new compared to many medical devices and advancements are coming quicker than ever. There’s also the vast amount of precision required in making a durable, comfortable, and effective piece of equipment. Considering the lifespan of a cochlear implant, it’s crucial to get all three correct.

At Cochlear, they have made their mark by creating top-of-the-line implants for a range of needs. Leading the charge are their technology specialists, who have studied and researched to create the best implants on the market. Jan Janssen has been playing an integral role in this innovation for over 20 years, and now he’s here to explain where he sees the technology heading.

On this episode of the ListenUp! Podcast, Dr. Mark Syms hosts Jan Janssen, the Chief Technology Officer at Cochlear, to discuss the future of cochlear implants. They go into detail on recent improvements to the technology, how clinical trials need to keep up, and the psychosocial components of hearing. They also discuss the design aspects of their cochlear implants. Check out the episode to hear it all for yourself!

Resources mentioned in this episode

Sponsor for this episode…

This episode is brought to you by the Arizona Hearing Center.

The Arizona Hearing Center is a cutting-edge hearing care facility providing comprehensive, family-focused care. Approximately 36 million Americans suffer from some sort of hearing loss, more than half of whom are younger than the age of 65. That’s why the team at the Arizona Hearing Center is focused on providing the highest-quality care using innovative technologies and inclusive treatment plans. 

As the Founder of the Arizona Hearing Center, Dr. Mark Syms is passionate about helping patients effectively treat their hearing loss so that they can stay connected with their family and friends and remain independent. He knows first-hand how hearing loss can impact social connection and effective communication. By relying on three core values—empathy, education, and excellence—Dr. Syms and his team of hearing loss experts are transforming the lives of patients. 

So what are you waiting for? Stop missing out on the conversation and start improving your quality of life today!  

To learn more about the Arizona Hearing Center, visit https://www.azhear.com/ or call us at 602-307-9919. We don’t sell hearing aids—we treat your hearing loss.

Episode Transcript

Intro  0:04  

Welcome to the ListenUp! Podcast where we explore hearing loss communication, connections and health.

Dr. Mark Syms  0:14  

Dr. Mark Syms here I’m the host of the ListenUp! Podcast where I feature top leaders in healthcare. It’s great to have you. This episode is brought to you by Listen Up Hearing Centers, I help patients to treat their hearing loss to remain independent, socially connected, and have a more vibrant life. The reason I am so passionate about hearing loss is because I lost my brother Robbie twice, I lost the first to hearing loss and then to complications from radiation to his brain tumor, and I saw how it profoundly affected his life and because of those changes he suffered, I’m incredibly passionate about hearing loss. I am an otologist, which is the EMT, I take care of people with surgical medical problems with their ear. I’ve treated 10s of 1000s of patients surgically and 1000s of patients with hearing loss of a nerve Arjun. I’m excited to bring you this episode. If you want to learn anything more about me you can go to www listen up hearing. com I’ve also written a book of the same title. It’s listen up hearing a physicians guide to effectively treating your hearing loss. Today I have Jan Janssen. He is  the Chief Technology Officer of Cochlear Corporation. He was born in Belgium. It’s amazing. He’s highly educated. He has a engineering master’s degree. He was just telling me about chip design and telecommunications. He started working at Philips electronics in hearing and then was brought to cochlear because of his expertise. He was initially the head of a Cochlear Technology Center in Belgium and then transferred and move to down under to Australia to work at the main headquarters. He is now being promoted to the Chief Technology Officer where he is responsible for business development and strategy. And I’m really excited to have him here. I know him personally. I’ve met him many times. And he’s going to be a great guest today on welcome.

Jan Janssen  2:02  

Thank you, Mark. And it’s a pleasure to participate in the podcast.

Dr. Mark Syms  2:05  

Oh, thank you so much. So I’m just excited. You have a great, wonderful background that is just for everybody. It’s springtime in Sydney, which is a fall in the northern hemisphere and it’s beautiful there. It looks like a beautiful day or morning I suspect

Jan Janssen  2:19  

Correct. Morning. 

Dr. Mark Syms  2:21  

Yes. So, so yeah. Tell me about your, your journey to Cochlear. So you you know, obviously you graduated from school in Belgium. And you ended up going into the hearing space? How did you end up there? And then how did you end up being the Chief Technology Officer like what’s your, your origin into all of this?

Jan Janssen  2:39  

Yeah, so yeah, so when I graduated, actually, when I was studying as a, an electrical electronics engineer, I wasn’t all that interested in medical electronics, by the way. Okay. And I so I started actually my career. At Philips, we actually did my master’s thesis in Belgium, typically your master’s thesis actually, with with any industry. And I worked on, on what was called Digital Audio Broadcasting, which is actually the digital replacement of FM radio. Okay. And I started quite early my career, working on microchips, blind digital signal processing, for consumer electronic applications. And I did that for a number of years and very, very fulfilling job, started as an engineer, became system engineer, project manager, and actually had nothing to do for the first kind of seven years of my career with with hearing loss, a lot of hearing because older, the project I work on, were audio related. And one of the chips we worked on was the first chips that would carry audio over USB. And in fact, then Bill Gates for the first time, at one of the Microsoft conferences, demonstrated audio could run over USB. It was developed in the lab in which I, which I worked with, in the mid in the mid 90s. Actually, Philips was still also hearing aid manufacturer at the time, they were approached by a Belgian startup called Emperor bionic systems that had the optical Greenland. And so they were looking for a bigger strategic partner and Philips thought, Okay, we are in hearing aids, implants might be complementary to that. And they became a majority shareholder, of that of that startup. And they were then looking for a head of r&d. So it was a small company at the time. 25 people or so, and I put up my hand for that role. And I that’s how I actually ended up being cochlear implants is a bit of a serendipity. And then after a few years, Philips decided that hearing actually was not a strategic field for them. And they decided to divest that. And cochlear was interested to take over the cochlear implant part of the of that of their business. And that’s how I became part of poker in poker in 2000 and then moved to Sydney a few years after that on a tear assignment. Going out to be at the right time, perhaps from a career perspective, because during that period, we got a new CEO, CEOs, new CEOs often like to make change. So Chris Roberts was an NCO offered me to then become the SVP for r&d in 2005. So it depends the rest of the family to stay a bit longer now, and that became a lot longer. And what’s changed since then is that are also available. And those are accountable not only for r&d, but also for quality regulatory affairs and for business development strategic ventures. So that’s what I’m, that’s what I’m doing today.

Dr. Mark Syms  5:34  

There’s a lot of different stuff, isn’t it?

Jan Janssen  5:37  

It is, but I think it’s all connected. And and, of course, a lot of what we do, it’s in research development does need to find its way to the market needs to get market approval by the Food and Drug Administration in the US, for example of I don’t know, the other regulators around the world, so and I have a vested interest to make sure that what’s been developed is also does have the right evidence to gain regulatory approval.

Dr. Mark Syms  6:01  

So that ultimately go to market, right?

Jan Janssen  6:04  

Yes, and, and of course, quality is very, it’s very much ingrained in what what’s happening during the development process, as well, of course, is happening, what happens later through to manufacturing the device and supplying it. So that’s perhaps the most different part of what I do. But it’s very much also enjoying that part of my role. And then the final part is the strategic ventures, which is also very, very interesting. And venturing allows us to venture I’d also be outside, though, nice if you want a problem.

Dr. Mark Syms  6:35  

Yeah, so you know, I mean, you know, the, the application in my practice is, you know, I have parents who say, Well, you know, I’m going to have a cochlear implant for my child, how long will this last? Right, and I say, it’s designed to last for a lifetime. And so I’m glad there’s people like you, making sure there’s high quality, so it can meet that, you know, expectation of the parents to laughs for them for the rest of their life. Right. And so, you know, one of the things I’ve been interested in, and you can tell me, like, you know, when you design like, what are the most challenging things, in terms of designing the inside part, like, you know, the part that goes into your body, into your ear and under your scalp like? So from an engineering point of view? What are those things? And why I’m really fascinated about this side of

Jan Janssen  7:19  

things. Yeah, it’s a great question mark. And as I moved from, as I spent the first seven years of my career more than consumer electronics, applications, and then move to medical devices, or implantable medical devices. I’ve thought initially, how hard can it be right to put the same take a certain French and put it inside someone’s body? I thought perhaps it’s twice as hard. And that’s probably 10 times as hard. And, and which is good that people think that right? Yes. Yeah. And it’s, it’s not that it’s rocket science, either. But it just requires a lot more diligence and foresight. And in particular, as you try as you put things inside the human body, human body is a very hostile environment. It’s like It’s like seawater, right, it’s full of basically saltwater environment. So want to make sure we Yes, and so we need to make sure that we protect the electronics from from the body, we do that by putting the electronics in hermetic enclosure, but then we of course, need to get the, the signal from that or the stimulation, our case, from that hermetic body rigid electronics is we need to bring it out so we can, we can stimulate the nerve. And so that’s done through what’s called the feature, that’s always very tricky technology to make that to make sure that aromaticity is guaranteed for a very long time. Then you insulate these, these feedthroughs so that the body fluids actually don’t make electrical contact with those. And then of course, the depending where the device is in the body, it also might be subject to external influences such as a blow to the head or a tennis ball or things like that. So it’s better multicity than protecting the if you want the wiring that goes to the device both from the environment as the saltwater if you want as well as for mechanical impact. And the difficulty markets I would say it’s not to do that once but it’s how do you do it consistently over the life of the author or through the manufacturing process? I think that’s that’s where the challenges.

Dr. Mark Syms  9:27  

Right like so we all know that almost you know, a car will wear out or you know, a lot of things that we use are almost going to wear out and yours is the exact opposite. It can’t wear out it’s got to stay from not wearing out right so it’s a different philosophical approach to the durability

Jan Janssen  9:45  

Yes of course anything that has moving parts will be more likely to wear out but also like the silicone for example, that protects the say the the implant or the wiring on the outside of the of the medic can will be subjected to a kind of aging mechanism. And so we do a lot of experimentation acceleration in the testing to, to mimic that.

Dr. Mark Syms  10:09  

We like to move it right? You put it through simulations, right?

Jan Janssen  10:13  

Yeah. So that’s what the mechanical movements, but also probably chemical aging, we test our plants at higher temperatures during the verification for every 10 degree Celsius increase that you have, that’s typically doubling of the lifetime. So if you test the device at 95 degrees instead of 35 degrees, that’s like 60 degrees higher. So that gives you a fantastic acceleration factor of 32, if I’m not mistaken, are 16. So the sorry 54, excuse me. So. So that’s one method that we can apply to try to predict the long term behavior of polymers in particular, or like, like silicone in, in that environment.

Dr. Mark Syms  10:55  

So you’re trying to measure its ability to age in a shorter period of time, so you can test the outcome?

Jan Janssen  11:01  

Exactly. And, of course, implants are now. So the oldest implants that are still active have been in people’s bodies for more than 30 years. And still, more than 90% of these implants are still in use. So it shows that the the, that it can work for a long time. But of course, perhaps it will change after 4050 years. And our modeling that we did perhaps falls apart at some point. But I think we have a reasonable amount of confidence that our implants will really last four decades, how long? Exactly they will last? I think we will, we will find out. But at least we can say 30 years 90% survival, we already demonstrated it.

Dr. Mark Syms  11:41  

Well, that’s great. And I appreciate the work that people have done to get that from a clinical point of view. That’s right. And then so the the interesting thing for people who don’t know much about cochlear implants, that’s only the inside part. And then you’re responsible. And you have to design the outside part too, right?

Jan Janssen  11:56  

Yes, and to some extent, that’s actually equally hard. Because unlike saying many of the consumer electronics device that we use in our in our lives, and we don’t tend to use them like 16 hours a day, and we honestly want to use them in environments that are more hostile to these to these products. I think very few people will tell their children to them in the in the surf on the beach with their mobile phone in their hand, for example, although I’m sure it’s happening. But the fact that people use it day in day out 1214 16 hours a day means that yes, we have to think about It’s also fairly hostile, external environment, there’s their sweat, there’s all kinds of other things that get on the devices. And so also there we’ve we’ve come a long way in in developing test methods that also subject our external devices to very harsh environments while we’re developing the devices to to do to really extend that useful life of the external component as much as possible. 

Dr. Mark Syms  12:58  

Yeah, I remember one of your engineers sharing with me that hot sauce made sweat very hostile. Yes, yes. Which is kind of you never really think about that.

Jan Janssen  13:08  

Yeah, and is a common effect of sweat and UV light of sunlight that can be very, very abrasive to again to gather, used to get.

Dr. Mark Syms  13:16  

So sunlight plus sweat. Yeah, well, and guess what, when you’re out in the sun, guess what you do? You sweat. Alright. So that’s pretty cool. And so you know, in terms of that, what what are the most challenging things to do to design those durability, obviously, what else are some of the design challenges you have to face?

Jan Janssen  13:31  

So the other element, of course, with the implant is that it’s a bit like with a satellite, like once it’s launched, once implanted, you can’t get to it anymore, right? So you really have to think ahead, and in terms of the flexibility that you that you want. And if in the future, our implants will have software in them, and today’s implants, basically pure hardware, but if you think of in the future, if I said like totally implantable devices, for example, but have software in them. So it’s always thinking ahead, how can we upgrade that, that software in a way that’s, that’s robust and reliable, cybersecurity becomes more and more of an issue. Also, regulators are starting to ask more about about that. And, of course, our products had a lot more connected. So 20 years ago, he had an implant, he had an external device. It was connected, say, during a programming session or fitting session in the hospital to a computer. And that was it. Today, our external devices are connected with mobile phones, multiple devices, through data connectivity software that’s connected to the cloud. So there’s a lot more connectivity, which is great from a functionality perspective, and really make a better user experience. Make the follow up easier, but it also creates a number of risks that we need to think of, and that we need to manage in terms of cybersecurity, privacy, etc.

Dr. Mark Syms  14:56  

Yeah, no, yeah, it’s uh, you know, that’ll be interesting. You’ll update your cochlear implant app inside of your cochlear implant, right? That’s essentially what you’re talking about.

Jan Janssen  15:06  

Yes. And even today’s like the nucleus seven or latest that sound processor or the cancer to date communicate with Apple devices, we google devices, we find it we were the first company to work with these companies to get that connectivity going. But for them, it’s also not that straightforward. They’d miss when they do a software upgrade. They don’t necessarily think of, oh, it’s been useful to calculate plan, anything we’ve overlooked. So we need to make sure that we test their Beta version, things like that. And occasionally we’ll we’ll find a glitch that we then need to, of course, work with them to fix them as soon as

Dr. Mark Syms  15:39  

possible. Oh, yeah, I didn’t think about that. So they do an update, they’re not thinking, how’s this gonna impact Cochlear? And so you guys have to-

Jan Janssen  15:47  

Yeah, they do have our they do have devices. So they have this, this beta test library, they do test these things. But they don’t necessarily think of all the use cases, also with the bimodal user, so people have a cochlear implant the one year, hearing it in your ear, we partnered with a thing called resound. And that’s another set of use cases that that need to be taken into account during the testing. And that’s not always brought to mind, which is understandable. 

Dr. Mark Syms  16:12  

It’s not. Now, I mean, you guys are the experts. So you know, you, you you check it to make sure that all of your users are, you know, entering some of it might be found after a rollout. Right. And that’s just kind of the nature of the situation. So that’s why so yeah, you know, I mean, you’re, you know, kind of developing, and this is what you’re dealing with right now. Well, I assume some of your work is, you know, what’s the future? What does it look like? And so, you know, from your perspective, what do you see, you know, happening in the next five years, you know, what, how will the cochlear implant experience or what happens or what we do change in the next five minutes or?

Jan Janssen  16:50  

So and So first of all, I think, the question mark, I want to mention that it’s it’s a very significant part of what we do. And I think particular for people that play leadership roles like for myself, my leadership team, it is very, it’s it’s, it’s not a topic we discuss once a year, it’s a topic, we have an ongoing conversation on. And I would say of the, say about 500 people that we have working in research and development and cochlear, there will be about a third that will be working on things that are probably at least at least five years away. So it’s a significant part of our of our investment is that medium. And long term. I do think that there’s a lot that will change in the coming 10 years in SPECT, Aleksey, sometimes I think that more might change in the coming 10 years and what we’ve seen in the last 20. And I think that’s in a number, because in a number of areas, I think we are at the point where a lot of learning that’s happened over the last 2030 years, plus advancing technology actually will allow us to, to make significant change in how we do. Surveys, go through the different aspects of, say hearing outcomes. If your ease of use of the device, and then perhaps the clinical connected pairs, we call it talk about. So in terms of I think hearing outcomes, a few things are changing, I think we’ll change in the future. For the last 2530 years, we’ve basically stimulated hearing nerve electrically, the same way, we’ve made some, some changes there, we’ve we’ve introduced more atraumatic electrodes that also closer to the hearing of what we had. But so far, it hasn’t really changed significantly, I would say, the way that we use the the hearing nerve that still there when it receives a cochlear implant industry by cochlear implant. We’ve worked now for almost two decades on novel ways of stimulating the nerve, where we can be a lot more precise if you want to stimulate the nerve. And I think that in the coming five to 10 years, I think we’ll be able to take that early research, hopefully into a more broad clinical application combined with a deeper understanding about the health of that nerve. So at the moment we we don’t really have a good understanding which part of the of the cochlea is, is you’re better suited for electro stimulation than other parts. It’s we kind of assumed as kind of uniform, what we call neuro survival. I think in the future, we’ll be able to have a much better picture of where the, of how the neural survival looks like how homogeneous it is, are there gaps in there, that we can then use to stimulate the nerve in in in a more precise and smarter way?

Dr. Mark Syms  19:46  

So the cochlear implant be able to map that?

Jan Janssen  19:49  

Yes, yes, that’s what we expect will be possible. There are so many tests today that can be used to to kind of make a map of neural survival, but they find it very tedious to do that. within a future, we expect that that will be that will be possible. And if you take that, together with no more, if you want differentiated way of potentially stimulating the cochlea, then I think we will be able to, to enhance hearing outcomes in noise with music appreciation. And in fact, we have some early work that we’ve done actually in our Denver lab in the US that that indicates that that should be possible.

Dr. Mark Syms  20:27  

So it’s, if, if I, you know, for simple guy like me, so it’s basically a higher resolution hearing is what you’re kind of talking about.

Jan Janssen  20:34  

Yes, yes. So and, and so we have 22 channels today in our implants, I think we, we, with novel stimulation matters, I think you’ll be able to make more of those 22 channels, but that then also might be then the springboard to get to a higher number of channels. But it requires us to make sure we, we can use every channel more than in a different way than what we’re doing today. Because today, the channels probably wouldn’t make a difference. So you

Dr. Mark Syms  21:05  

know, the thing I’ve always had problems understanding on is, you know, it’s electrical current. So it’s a field. Right? That makes sense. And so how to get more resolution?

Jan Janssen  21:16  

Yeah. So it really comes down to how can we constrain the view on the width of that field? That’s been our philosophy behind what we call pyramid it electrodes, electrodes that sit closer to the hearing, they do constrain the field already,

Dr. Mark Syms  21:32  

because of the distance. In other words, because the distance is shorter, you can get a better resolution. Okay, that makes sense. Right?

Jan Janssen  21:38  

So that’s one step. But then I think getting that electrode placement more consistent in the future, I think they’re also with better imaging, and not necessarily imaging that is done through an x ray or a CT beam. But electrically, we can we have methods that will probably help to guide or inform a physician, how well that electrode is placed. So you name

Dr. Mark Syms  22:03  

your map the location based on the electrical performance, is that what I’m gonna say, this is in two millimeters further than this other one, because the electrical map that we’re seeing are something.

Jan Janssen  22:15  

That’s, yeah, that’s the ambition. That’s definitely the ambition that we have. And I think there’s some indication that that will be possible. And then if so we can get that field mechanical proximity optimized. And then if we combine that with different ways of electrically using, or constraining the width of that field, that appears when we stimulate the nerve, that will then open up new ways of thinking. And so I think that will become a reality in the coming five to 10 years. But of course, this is still research, scientific research that will take some time, also, because we know what happens in the cochlea. But how that then is perceived by the brain and how the brain can use have some more precise electrical stimulation. That’s also the part that’s a lot harder to predict.

Dr. Mark Syms  23:11  

Yeah, I, I tell you in my career, I’ve gone from having very little discussions about the brain and the role of the brain and hearing, did it becoming a predominant part of my discussion. And so I always tell people, if there was a cochlear implant gonna work, and I say, well, it’ll definitely fire and stimulate your nerve. And then we have to figure out whether or not your brain and what it can do with that signal. And that’s a much harder thing to predict. Oh,

Jan Janssen  23:41  

yeah. And that’s where we also see when we run these experiments that really change. The way we stimulate the nerve is that sometimes it’s an immediate effect. But often, it actually almost takes people to unlearn a bit. The Electro stimulation patterns that were used to do novel patterns, but obviously the benefit. And that, of course, means it takes time. And so while I’m optimistic that we will see significant improvements in hearing outcomes over the coming decade, I’m also caution have been been 20 years in this field, to to realize that it doesn’t always go as quickly as we would like.

Dr. Mark Syms  24:18  

Wow, the fact that it takes time it happens is awesome, because it shows you how plastic the brain is and how much the brain can learn and unlearn or the year, however, you want to talk about it, right? The whole hearing mechanism. That’s pretty amazing. 

Jan Janssen  24:31  

Absolutely. And because cochlear implants, of course, or kind of, to some extent a miracle product or solution, but it’s only a miracle product because of the brain and the brain scribes the real miracle, because the the sound has been provided is fairly brutal. The information provided to the brain is fairly crude. You could say, well, the normal ear gets in 3000 channels we do in 22. And And yet, people get fantastic outcomes with implant. So sort of brain I think we absolutely deserves a lot of credit. It’s our role, of course to mimic the input that the brain can get as close as possible normal hearing, because it will improve outcomes. And also it will shorten that adaptation time ramps our goals that you’re hearing in day one. That’s our ambition. So that you don’t have to go through that learning process that you have today. That’s gonna take time.

Dr. Mark Syms  25:22  

Yeah, I think you’ll you’ll, you’ll crunch it, I don’t think you’ll eliminate it.

Jan Janssen  25:25  

I agree.

Dr. Mark Syms  25:27  

I agree. That’s kind of my hunch. But you know, I mean, and you know, sometimes some of the things that are worth getting take time to learn and take time, right? You can’t not everything is instant, but I know you’re competing.

Jan Janssen  25:38  

Yeah, and if it’s won’t be one month, say, to get for people to get to meet you 90% of what their outcome will be instead of six months, it will be already significant. You get it to one day, I think it’s probably gonna be very hard to envision. So that’s, yes. Yeah. So that’s I think it does a hearing items marked the progress. I think in terms of lifestyle in the coming after five years with 10 years, I do think that what we call totally implantable devices. So where we have more elements of the system implanted, so including the battery, including the processing, including the microphone, we are now well into our second generation research, totally implantable device, he started that study few years ago, and has given us invaluable insights in terms of the benefits that it provides. As well as in the feasibility silhouette to go before we get to commercial product. But it’s a rather talk about 10 and a five year timeframe. But I think that’s going to be very significant. Step forward, because it really it’s almost going from crutches to a hip implant. And it’s now part of you, you don’t have to necessarily think about it to put your external device on, it’s just going to you have hearing from from the minute you wake up, till the minute you go to sleep, and you can decide even on by asleep or not, or the other parts of the day. But I think that will enable a solution that blends Pepe more into into people’s life. And then what we have today, nevertheless, of course, means we’ve seen fantastic progress in usability, the external components. So I think the fact that there is an external component should not deter anyone from getting a cochlear implant. But I think it will really help once we get to totally implantable solutions to get adoption. 

Dr. Mark Syms  27:29  

Yeah, it’s, it’s, it’s fascinating to me, because you know, the things that just run through my head is like, Well, how do you charge it? Where’s the microphone? And I know, they’re all different takes on all of this. And so we’ll see what were there are a lot of, let’s say, horses in the race, and we’ll see where they all end up. But I know people are working at it furiously to make it totally implantable. I think it’ll be fascinating. I, you know, I think the external part to some extent, you know, compared to the hearing, you know, maybe I underestimate because I don’t have one, you know, it seems totally worth it. But it will be interesting.

Jan Janssen  28:06  

Absolutely. Yeah. Isn’t it’s also when we talk about a future, we’re always on emphasize hearing loss. It’s a big, big impact to the lives of your profession here. And it’s a big impact on people’s lives. Yes, there’s always future technology coming but don’t wait for them. I’ll because every year you’re going to wait your brain is deprived from from that auditory. And so, so that’s as much as I’m fascinated and excited thinking about novel technology. First message that we have these conversations with potential candidates, for example, that are interested. And don’t don’t wait, is it’s like what everything does all this will be better suited in the future. 

Dr. Mark Syms  28:41  

But yeah, I mean, it’s like if you, you know, why would you go without a smartphone just because there’s another version coming out, because there’s always another version coming out, right? And so, and the thing is, the version might be better, but going from zero to none is or from nine to one is huge. It’s a huge, huge issue. That’s great stuff. And then what’s the last year we’re talking about?

Jan Janssen  29:02  

Clinical or the last thing you’re thinking? Yeah, in the in the clinical care that happens, particularly after surgery. So today, that’s still a fairly evolve process, where people depending on the clinic that they that they work with, they might go back to the clinic, four times a year, six times a year, some clinics 12 times a year, some clinics keep you there for a week after surgery. And we think there’s a lot of opportunity there to simplify and streamline that. It’s it’s also the current practice is often based on on what was done before rather than on good evidence and tradition. Yes. And I think that there are more and more. I think we see the nations actually questioning the way that things are done today and looking for more streamlined methods to do that. But that’s also where technology we expected plays a big role as we can listen to the, to the ear to the hearing nerve device in the future. be able to listen to the brain through a device. And that thing combined in combination with artificial intelligence will probably give clinicians a tool to really simplify and streamline that, and perform that, that care remotely if needed. So we visited our clinic, just a few sessions, perhaps in the first year, and after that, you perhaps just you cleaning nation where there’s an issue, not necessarily every six months, how about

Dr. Mark Syms  30:26  

prognostication? And so what I mean by that is, you know, prognosticating, an outcome for a patient and us being able to work on expectations. So, you know, for my experience, the people who are consumptive in an aftercare point of view, are the people whose expectations haven’t been met by their preoperative expectation, right. And so when we were talking about the brain being such a big part of it, you know, it is very difficult to predict outcome and then to give language that is meaningful to a hearing impaired person, that they can actually intellectualize what you mean by that outcome becomes a challenge as well. 

Jan Janssen  31:02  

Yeah, that’s a great question mark. And it’s, it is an area that is has gotten into getting significant attention in our in our research team. Recently, I think it was recently published, and the collaboration that we had with IBM, where they used all their artificial intelligence tools on a data set with a few 1000 patients that we work with a number of clinics to, to, to collect that anonymized, obviously. And this bony part of that is that that exercise, only explained about 20% of variability. So what this suggests is that the data that was available to the exercise was probably not the right data. Right. And so what you’re-

Dr. Mark Syms  32:06

Measuring wasn’t the right thing to measure is what you’re saying, right? 

Jan Janssen  32:10

Yes, yes. So if we were just so what that data would typically have with the audiogram. So what are good people hearing, and so many other medical history? And so it’s, it’s become ah, and another factor seems some some cognitive assessment as well. But it was clear that we’re not feeding these algorithms, I think with the right data yet, then. And we know building on that we’ve improved since then. So we making some some improvements. We might be in shape to say 25%, perhaps, predictive value. But we also looking at other measures, good, good. Could have perhaps, bigger predictive value. And one of the measures that we think has a significant value, but not easy to measure before is that health of that of the hearing nerve, how good is that nerve. That’s there, one of the tests that actually does seem to be quite useful, but not used routinely, is what’s called the PB Max, this is where you try to get the maximum possible hearing understanding with with headphones. And that does seem to be that might be a proxy of how good the hearing nerve is, but it’s not the-

Dr. Mark Syms  33:01  

Maximum measure of residual capacity. Correct.

Jan Janssen  33:05  

But it is not a measure that’s done typically when a hearing test is done. So So because we very much could see the benefit. As you allude to mark if if you as a as a physician, or as a clinician could manage their expectation based on on the individual, that will be very, very valuable.

Dr. Mark Syms  33:25  

Personality tests, have you done anything with personality tests, because it seems to me some of its psychosocial.

Jan Janssen  33:32  

And we don’t have that widely available at the moment. But I compare with your, I guess, intuition, that the way that people think about the device, and the motivation that they have to, to use it, and also plays a significant role. And even simple things as how many hours a day people are using the device or getting good quality speech input into their input device in the first six months, is probably an important report to measure, not only the data logging, we are now collecting a lot of that information. And we actually have at the moment, significant project that looks at the variability in outcomes and looking really at what are the contributing factors? And so I think we will also there may be significant progress in the coming by.

Dr. Mark Syms  34:20  

Yeah, it’s interesting. I mean, one of the my clinical experiences with AI, it’s, you know, the term I call it as magical thinking, right? And so I have patients, I mean, you’ll sit down and you will tell them exactly what you think are reasonable expectations. And I as percentage of these patients and what they think they go, I know you’re telling me that but I’m going to be the guy that does way better, right. And it’s almost like you can’t stop them from having that thinking. And it’s interesting, if you had a a test that I could test for magical thinking would be very helpful. I don’t know if it exists, but it seems like that’s more of a psychologist I but we all know that it’s psycho acoustics, right? So we do know that there’s an emotional, psychological component to that. perception of communication or ability to communicate, right?

Jan Janssen  35:04  

Yes, yes. And I think also the so I think we will be able to come up with with a reasonably predictive models in, say in the coming five, five or 10 years. The other thing also often hear is that the objective hearing outcomes that people achieve after a cochlear implant, don’t necessarily correlate with the happiness, agreed 1,000%. Because,

Dr. Mark Syms  35:29  

yeah, I have a patient that comes to mind she, she was probably handicap. And she was incredibly difficult to manage educationally. She was on, you know, multiple medicines to curb her behavior. And then she got a cochlear implant, she has no open set, she has speech perception, she’s off of all medicines. And she needs she went from having four care providers to one. Now from a hearing outcome point of view. It’s a It’s terrible, right, but from a satisfaction outcome, or mother will tell me every year it’s the best thing she has ever done to improve her daughter’s quality of life. Right. And so that’s an extreme example, but I agree with you 100%. And so the hearing tests, you know, I mean, because we’ve all had these people, we say, you are an amazing performer and they go, I don’t like it at all, I don’t think I’m doing well, or people who don’t do well. And they’re like, this is all you know, this is this is great. Right? And so we both see that. It’s an interesting thing. And I think obviously, once you have a bigger and more robust data set, you’ll be able to start a fight out on these more softer things to measure if that makes sense. 

Jan Janssen  36:38  

Yeah, so our mind is a bit of background noise here.

Dr. Mark Syms  36:42  

Yeah, it’s fine. So so that is really great stuff. Yeah. And I really appreciate it. And so, you know, let’s, let’s talk about like, so. Okay, so that’s, what about 25 years, let’s get real pie in the sky.

Jan Janssen  36:58  

So one of the things that also happening, of course, is there’s a lot of research happening towards pharmacological solutions for hearing loss. And so we do see that probably, that’s not, that’s not even gonna be 25 years away. But where we see the combination device or combination therapies, between that combine drugs with devices, we actually announced last year that we start the pivotal trial with the first drug eluting electrodes. So a cochlear implant with a drug eluting electrode that has a steroid, that’s there to help manage the foreign body reaction after implantation. But that’s really only just to start, we expect. So there’s a research that was published in Nature, for example, a few years ago in which we were part of where, as part of the implantation procedure, this was, this was in preclinical research on animal research in animals, where neural growth factors were applied in the cochlea, just before the cochlear implantation. And that’s in an animal model, it was demonstrated that that actually helped the Reese crowd’s connections from the from the hearing nerve out into the cochlea. So on one hand, we tried to bring the electrodes close to the nerve. This is bring the nerve close to the, to the electrode. And, and so we have now been a part of a human study, that’s in which that’s been been tried out here in Australia, that study is still ongoing. So it’s too early to talk about the outcomes. But if what we see in the animal model, true, then, as part of our payment procedure, we might not only He can provide a lack of stimulation to the nerve, but also enhance the nerve. And I think it’s, it’s quite likely that those type of therapies will become a reality. If not, in five years, probably not in five years, but in 1020 years, I think that we might be able to augment if you want those to biology, as part of Yeah, that’s what I love about this field,

Dr. Mark Syms  38:58  

because I think there’s from other fields that will become applicable. So I always say to patients, you know, thank God for cell phones they go, why so because all of this connectivity and the smaller batteries and all of this stuff that you have in your cochlear implant is a lot of it is technology developed for bigger fields that then gets moved over to cochlear implants. And so, you know, the other work in nerve regeneration might be cochlear nerve regeneration, but other nerve regeneration will hopefully there’ll be you know, further breakthroughs that you’ll be able to roll out very quickly in the hearing world and be able to get a huge impact. That’s great.

Jan Janssen  39:32  

The thing is the brain there’s there’s drugs being developed to help people to augment their brain function. And one application of those could be indeed for for devices like cochlear implants, which might really need that could benefit from that boost, particularly in the first month after receiving so, it will be fascinating to see what will happen how a couple implants will look like.

Dr. Mark Syms  39:53  

So it sounds like there’s plenty of stuff for you to work on in terms of expansion in the field.

Jan Janssen  39:59  

The challenge for this is not the lack of ideas, how to improve it, it’s more how do we select between all the things we could do? How do we select the things that we think will have likely the biggest impact?

Dr. Mark Syms  40:11  

Yeah, so a little bit of a gamble, but hopefully an educated gamble.

Jan Janssen  40:17  

That’s, I guess, my role and others in the company is

Dr. Mark Syms  40:20  

about, no, it’s great. I mean, when we need leadership in this row to figure out where the resources go, and how to where the the field goes. And I know there’s a lot of stuff and a lot of great ideas. But this is great stuff. So, you know, one of the questions I always like to ask Jan is, you know, in terms of your mentors, who do you think in terms of the people who helped you get here today, like, so who do you think I mean, it’s always nice to know, who are the people that get you to where you are today?

Jan Janssen  40:46  

So, great question Mark, to the people that come to mind, first of all, is that Professor Stefan Peters, he was my mentor, when I moved into cochlear implants in Philips. So when I moved in that small startup at Philips had acquired, and he had been, is one of the founders of that company. And he told me a lot, because I didn’t know anything about. And so he taught me a lot. And still, a lot of my thinking today actually goes back to some of the philosophy, for example, in that selectivity of stimulation is a big, big focus of him at the time. So I learned a lot from him. I learned a lot and as part of cochlear of people like Jan Patrick, who was caught was first head of r&d and led r&d For many years, John Parker, who was my predecessor in my role, talking a lot about reliability, about the things that how we can use things like New York telemetry, for example, response telemetry, and how that would improve the devices in on the business side. Also, the CEOs that I’ve worked with, Chris Roberts was president CEO for more than a decade, and was a good mentor. In very wise men in terms of how we approach things, Chris Smith, who was then the successor, very dynamic and challenging left, right and center, but really good for people to push you out of your comfort zone. And I think how it was 30 years I’ve worked for, so those are the two people that are that I learned off from, but also from a lot of positions that we work with, like like yourself, and I always enjoy having conversations with physicians. And the way that they think, is you’re very close to the patient. And the way that you question often what we do, but also emphasize what’s really important for patients.

Dr. Mark Syms  42:58  

So without trying to get great outcomes, you know, it’s wonderful. So, one question, I love to ask people, Jan, is, what’s your favorite sound? I mean, you’re in the sound business. So what’s your favorite?

Jan Janssen  43:12

Yeah, so I had a question. It’s probably more Academy than a single time. But I would say it’s, it’s music. So I love music, I play in a corporate band. So we have a band playing that. So? Yeah, music is, is something that fascinated me, which is also why when I was started as an engineer, and starting at Philips, working audio was something that I very much enjoyed, and was probably also be one of the reasons why me to step into, into purple implants. Now I know that people with purple implants have a bit of a love hate relationship with music, some people really enjoyed or say so different. And so every one of my ambitions is to make sure that we can make musicals as enjoyable as possible for for corporate events. 

Dr. Mark Syms  43:40

Well, I’m not going to at some point, maybe I’ll try to figure out my own head, who are the members of the Cochlear band, I don’t, I don’t want to know, but I could put some in the band. And it would be funny to make up the composition of the band. But I’ll leave it at that or that. So yeah, thank you so much. For the time, this has been great. If people want to get a hold of you, where do they find you on the website? Or where do they find?

Jan Janssen  44:03  

Yeah, so people are free to contact me through my email, LinkedIn, and my happy to share my email mark, as part of the podcast, Jason. Lead. Yeah. always very happy to talk to anyone about cochlear implants, what the future brings, and any or any questions.

Dr. Mark Syms  44:25  

Well, that’s this has been great. I really appreciate the conversation. We’ve had Jan Janssen. He’s the Chief Technology Officer of cochlear Corporation. And I appreciate him and it’s amazing that I can talk to you from the opposite side of the world, and we can have a face to face conversation. Technology is just absolutely amazing. Thank you for coming on.

Jan Janssen  44:44  

It’s been a pleasure Mark and looking forward to see you in in in real life. Hopefully next year.

Dr. Mark Syms  44:48  

Hopefully. Thanks Jan!

Outro  57:18  

Thanks for tuning in to the ListenUp! Podcast. We’ll see you again next time and be sure to click subscribe to get updates on future episodes.

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