 Now, again, welcome to our workshop. I'm Marcus Schmidt. I have the honor to moderate this workshop. And the experts that are in the studio are Jennifer Robinson, Peter Knopp, and online with us is Johanna Boyer, actually joining us from the US. So we are talking about experts. Jen, what are you an expert in? I'm an audiologist and here at Medell, I'm a senior product manager. And so I guess the aspect of fitting cochlear implants and how they work, so to speak. And all the applications. And all the applications. So Rob's rather user-based. OK, Peter, what is your expertise? I'm an electrical engineer by education. I'm one of the directors in R&D. And my responsibilities include the audio signal processing in the Medell CI system. So this is the front end audio signal processing and coding strategies and the entire fitting system. OK, so you are basically responsible for what the cochlear implant is actually stimulating. Right, I'm basically responsible for what the cochlear implant makes out of the sound. OK, picked up by the microphone. OK, OK. And how these things are then delivered to the auditory system. OK, good. Thank you. Johanna, you are a musicologist. What does a musicologist do? Oh, I got this question many times when I was studying. So musicology is the study of music, the scholarly analysis and research-based study of music. And although I focused on historical musicology during my studies, I have now focused much more on systematic musicology in my job. So that includes music theory, music pedagogy, music, or related to physiology and psychology. So what do I do at Medell? I focus on music and cochlear implants as it relates to research, rehabilitation, education, and awareness. So I support studies. I also conduct studies. I create or try to find new resources to practice music, to train music. And sometimes I get the chance to do music workshops. Like, for example, I conducted a choir workshop last June in Austria, which was a really fun experience. OK, thank you. And now, dear participants, in this meeting, we also would like you to introduce yourselves. We have a little poll for this. And maybe we can start this. And you can tell us who you are. And the poll that should come up is asking, what's your background? Are you a hearing implant user? Are you a parent or a caretaker of an implanted child? Are you a hearing implants candidate? Are you a professional working in the hearing implant field? Or are you just nothing of the above, and you're just interested in this topic? OK. So we see that the majority is hearing implant users and parents. OK, we do have some professionals. OK, so we have a good mix, actually, of people here. Thank you. Thank you. So what people do in this workshop, actually, is not just randomly answer questions. We want to do a little intro, actually. This workshop is part of Sound Sensation, the Metal Music Festival. So it's about music and hearing implants. And so this is what we want to also do in our introduction. We want to talk about technology, specifically, actually, a technology of cochlear implants. There are other hearing implants. And then we want to see how that relates to music. So, Jen, can you give us a little introduction into how hearing works, how a cochlear implant works? Yeah, absolutely. And to do this, I have some videos that I'm going to share just to help bring the point across. So let's start with how hearing in general works. Hearing is, I'm sorry, sound is made up of vibrations. And so speech, music, it's all sound vibrations. And what happens for the outer ear, the outer ear is like the gatherer, so to speak. And it funnels or directs these sound vibrations down the ear canal. As the ear canal directs the sound, and that goes straight to the eardrum. The eardrum then starts to vibrate, and that, in turn, will make the three bones in the middle ear vibrate. That then transfers the sound to the cochlea. The cochlea will spend some time talking about today. The cochlea is the main hearing organ within the ear. Now, the cochlea is designed in a unique way in that the sound perception or the pitch is organized. And we call this tonotopic pitch, tonotopic placement, or place pitch. So at the base of the cochlea is high pitches. And as you go up the cochlea, you get to the low pitches. Now throughout the cochlea, there are hair cells. And these hair cells will move with the movement of the fluid that's in there. And this movement of the fluid makes, as I said, the hair cells move. When the hair cell moves, it sends a signal to the brain. And these hair cells are all the way up the cochlea. So if it is in the base region where the high frequencies are, the hair cell will move. And it'll signal to the brain, hey, I'm in the high pitch region. And if the hair cell is in the low pitch region, then the same thing. When it signals to the brain, it says, hey, I'm in the low pitch region. So our ears are set up, our cochlea is set up. So there is a natural place to pitch. Wherever the place in the cochlea is that's being stimulated, that's how the pitch is known. With cochlear implants, an electrode is put into the cochlea. And what happens is the audio processor processes sound and that then is delivered through impulses into the cochlea. Now, we believe with Medell having a long electrode that stimulates the whole cochlea is important because of this aspect of place and pitch. OK, well, thank you. Peter, we said that you are the experts in basically designing what the implant stimulates. What is important to know about the stimulation of a cochlea implant? Right. OK, so as Chen said, a cochlear implant really tries to exploit the tonotopical principle of the cochlea. What's producing neural activity from the base of the cochlea, the brain turns into something that sounds high-pitched to you, a high-pitched tone, and neural activity that originates from the apical region of the cochlea, the brain translates into a low-pitched tone. And this is exactly what we at Medell really use extensively and very close to how nature does it in our system. One of the core parts of our system, one of the core philosophies of our system is to really use the entire cochlea for electrical stimulation, as you can see on the left side here. Here you have a Medell electrode inserted all the way up into the low-frequency region of the cochlea. That's where the red color is. And then covering all the frequencies from the low frequencies, if you follow my mouse, to the mid frequencies, to the high frequencies in the blue region, so that low-frequency tones that are then used to stimulate the most apical electrode really sound low and high-frequency tones that are used to stimulate the most basal electrode, or one of the basal electrodes, really sound high. This is in contrast to how other systems work, like the system shown on the right, where the electrode only covers what we call here the first turn of the cochlea. Here, on the left, the electrode covers more than one turn, almost two turns of the cochlea. So here, the electrode stops in the middle, mid-frequency region of the cochlea, so that low-frequency tones that are used to stimulate the most apical electrode on the array only sound mid-pitched, but really low-pitched, whereas high-frequency tones then really, again, sound high-pitched, because the location of the most basal electrode here is more or less the same as here. So while this really translates the baseline of a piece of music into really something that sounds like bass, boom, boom, boom, boom, this turns the baseline if a piece of music that sounds like mid-pitched, like boom, boom, boom, boom, right? So if you want to hear the bass, like the bass sounds to a normal hearing person, then please use a system that provides long electrodes and really covers the entire electrode. But, Peter, there are some people that say there is a hearing zone within the cochlea that only part of the cochlea can reasonably be stimulated and other parts cannot reasonably be stimulated. What do you say about that? Now, that is a discussion that was going on for many, many years. Is there something in the apical region of the cochlea to stimulate? And there is fascinating new images from the cochlea, from research that's done collaboratively between Canada and Sweden that really show that, yes, the entire cochlea is a hearing zone. The term hearing zone is not wrong. It's just wrong to apply that term only to a part of the cochlea. And this is what we call the hearing zone. But this shows the cochlea. The thing in green is the basalum membrane. You can see that on here on the next slide better. The thing in green is the basalum membrane. That's the thing that turns a frequency of sound into something that is place specific in the cochlea. So the basalum membrane for a certain frequency peaks or most heavily rings, so to speak, so vibrance at a certain point along the cochlea. And that's what Jane called the tonal topicity of the cochlea. And those vibrations of the basalum membrane are then turned into information to the brain by the yellow structure here, which is called the spiral ganglion. And for a long time, it was really debated whether there is neural structures beyond the first turn of the cochlea. Now, these new images really show that the answer to this question is yes. The spiral ganglion, again, which is in yellow here, extends far beyond the first turn. The first turns ends about here. And as you can see, there is yellow structures far into the second turn of the cochlea. So that really, again, confirms that it really makes sense to get an electrode not only into the first turn of the cochlea, but into the first and second turn of the cochlea and really use the full potential of the cochlea for turning electrical stimulation into sound sensations. OK, thank you. So the entire cochlea can be stimulated. And to the audience, why people are so excited about this image is you have to imagine that this entire structure that you see here on the screen is only a few millimeters in size. And so this is really imaging technology, very, very sophisticated. So Peter, in natural hearing, this apical turn, so the low frequencies is handled differently in normal hearing than the rest of the cochlea. It's face locking. That's the term. Does that play a role in cochlea infants? It does. Very much so. Where's my mouse? I can't see my mouse. There you go. Yeah. OK, yes. OK, so I said it's important to have an electrode or to have electrode contacts not only in the low to mid frequency region, so in the first turn, but also have electrode contacts in the second turn, like here in the green, in the red, and orange area. Now here, the cochlea works somewhat different to how the cochlea works for the mid to high frequencies or the rest of the cochlea. In this area, there is another what we call code or another piece of information that signals to the brain information about sound frequency. Remember, the first bit of information is tonotopicity. Where is the cochlea stimulated? Also in acoustic hearing, where does the basal and membrane stimulate the cochlear in response to a certain frequency? In the low frequency region, there is a second element of information, and that's timing information. In the low frequency region, in the low frequency region, yes, in the low frequency region here, the neural structures or the cochlea sends information to the brain in synchrony with the sound signal that is with the same frequency as the sound signal that comes in. So not only by identifying where the information originates from in the cochlea for a low frequency, can the brain work out frequency and translate that into pitch, but also at what rate? At how many points in time does information arrive at the brain from that location in the low frequencies? That's another source of information for the brain to work out frequency. And that's exactly what we do in Medell to really drive those apical electrodes as close as possible to how this region of the cochlea is stimulated or driven in normal hearing. We don't stimulate these electrode contacts at some artificial high stimulation rate like we do in the mid and high frequency region and like it is done in other systems across the entire array. No, we at Medell in the low frequency region in the second turn of the cochlea that is so particular and so important for low pitch sound sensation, we drive those electrodes in synchrony again with the sound signal. So that the same mechanism that is taking place here in normal hearing is modeled in our system to drive the low frequency region and thereby substitute the low frequency hearing with our cochlear implants as closely as possible as it's done in natural hearing. OK, so we at Medell is mimicking natural behavior basically. Across the entire cochlea, really. OK, a question. You often hear that all cochlear implant systems are basically the same. How would you respond to such a comment? Do you want to say something? I think that one of those things that comes from our users out there in terms of the feedback that they give and anything to add to that, Peter? Well, I just want to mention two aspects that I just mentioned before. Let me just scroll up and then scroll back down. This is Medell on the left side here. This is other cochlear implant systems on the right side here. So no, they are not all the same. Medell is the only company that really stimulates the entire cochlea and does not leave out the low frequency region that as you will hear from Johanna later is really important to fully appreciate a piece of music. And that is the, so to speak, double play between the bass line and the music line and the higher pitches and the piece of music and the same down here. Since Medell is the only company that's got electrode contacts in the apical region that are driven or stimulated at sound following frequency, again, not all cochlear implant systems are the same. OK, so we've learned Medell, CI, stimulate the entire cochlea. They stimulate the low pitch region like nature does. And we've seen colorful pictures. Does that make a difference though in real life? It does. Just as I said a second ago, feedback from our users and comments that we hear. And I've prepared just a few slides to show everyone what Medell users are saying. For example, one user from Australia has said from changing from a competitor's device, having the Medell implant is the best thing I ever did because it sounds so much better. I recently had my left ear re-implanted with Medell and it's been a very big change. The first thing I noticed was that I can actually hear speech in my left ear. At activation, I was so excited to be able to hear the actual words that were being said. And on the train journey home, I cried in tears of joy and thankfulness for being able to hear speech in that ear for the first time in 60 years. I'm now even able to appreciate music, which is truly beautiful and out of this world. For me, getting a Medell cochlear implant was a real miracle. So as I said earlier, when you ask our all devices the same, we hear from our users, no, that's not the case. Here's another quote from a user with the old CI, however much the complexity of the music was lost and music sounded blurry and mushy. I became frustrated with the old CI and gave up listening to music entirely. As soon as I started to listen to music with the Medell CI, however, I was carried away with emotion and cried because it was the first time in several years that I could enjoy music to the same degree as before I went deaf in one ear. It was so beautiful. I could now hear specific instruments and notes. And over time, I could again appreciate the complexity and color of music. Another one, they had another device on one side. And that other device, they said that it was more robotic, tinny, echoey. They couldn't distinguish between different voices. It sounded metallic. But with the Medell side, it sounded more clear and pleasant and less fatigue. And we also ask our recipients. We surveyed over 100. And what we see again in the survey, music sounds natural to me. And I enjoy listening to music with my cochlear implant system. So it does make a difference. OK, well, thank you. That's very impressive. Now we hear about listening to speech, listening to music. Johanna, how is music different from speech? Is that basically the same or does it make a difference? OK, so how is music different, especially compared to speech? And I want us to step back for a moment and think about that. There is an important aspect that makes music so interesting and emotional to us. And this is how tension and release built throughout a musical piece. So yes, tension and release is built in music. And this is what makes us connect emotionally. So now when we compare music and speech, then we know that music has a much wider range of frequencies as well as a wider range of dynamic range. So let me give an example. Originally, when cochlear implants were developed and focused entirely on speech, the frequency range started at 250 Hertz. And when you think about a piano, an 88 key piano, then that frequency range starts actually at 27 Hertz. So there is a very wide range that was missed at that point. And as I said before, also a larger dynamic range is used in music, like think about film music or orchestral music opera, where we have so many participants that play music or have much bigger changes in loudness, but also subtleties really matter. And so these are basically the wider range of frequencies and the wider range of dynamics. We want to use that in order. These are basically the requirements to build more of tension and release in music. And we've heard a lot from Jen and Peter about that the second turn did the right place pitch. And again, for music, low frequencies are so important and where and how we present them through cochlear implant matters. So I want to share a short music sample. And Jen, I hope you help me out here. Absolutely. Thank you. And so basically what I want to show you is two different music samples comparing to situations. How does it sound when we reach the apex and how does it sound when we don't? So let's start when you're ready. How does it sound when we don't reach the apex? OK, thanks. And let's now add the low frequencies, please. Thank you, Jen. So really, the point that I want to make here is what happens when all this low frequency is missing. Basically, you're missing out half of the piano that was shown below. And I think you get an impression of what you're emotionally missing, what the music is missing in terms of the potential to create tension and release. I think that becomes really clear. And one more thing that I'd like to add here, how is music different? Music is much more complex than speech. And I think there are multiple layers. And I want to bring up one example for you to think about, which is think about a speech-related complex situation. So speech and noise when we are at a very noisy restaurant, let's say. Typically, we still try to focus on one speaker and we try to ignore the background noise. But when we listen to, let's say, a very complex music situation, maybe a symphony, then we have 50 instruments playing at different frequency ranges, different pitches, different timbres. They are not always playing the same melody, right? And it's not that we just want to focus on one instrument and ignore the rest. We want that everything comes together and we want to enjoy how this get integrates with each other. And so if speech is, let's say, what's the word? It's degraded. If speech is degraded, we might still hear the content, the words. But that's not enough when it comes to music. We want really the full range. OK, thank you, Johanna. So we've learned that music is much more complex, a much more complex sound than speech. And I think this is also important that speech is to be understood, but music is not only to be understood, but it's to be enjoyed. So there's an enjoyment part to it. By the way, all these graphics that you have seen are on the medel.com website on a page that's called What Does a CI Sound Like? And so, however, you know, stories are different. You know, some of our especially cochlear implant users are, you know, we have born deaf children. We have adults that, you know, turn deaf. We have, you know, other hearing impairments for many reasons, different durations of deafness. So there's a lot of different people out there with different experiences. And we get and we got this question actually through social media where it says, well, you know, I still don't, you know, music doesn't sound so good to me, you know, despite maybe, you know, a long electrode and all these things. Now, my question, can music be trained? Yes, it can. And I think, you know, cochlear implant users, when they are talking with their audiologists, they hear probably a lot that they need to practice when it comes to speech. And the same is true for music to get the best benefit out of your cochlear implant for speech, for music, you have to practice. So what is what is what is a good way to train music? Are there, you know, can can you give, you know, some some hints on what to do? Yeah, that's what I'm here for. So typically, when I talk with our cochlear implant users about how to practice music, I talk about three different forms of training, which is active music listening, ear training, and ideally some active form of music engagement, either if they're played an instrument before or some other music therapy participation. And, you know, when it comes to ear training, I think a lot of people are lost if they don't have a music background. Like many cochlear implant users report that they don't know resources or they don't know how to practice and they get stuck. And that's why I'm really, really excited to share that Medell has been collaborating with Melodia, which is an online music training program that will help you with music, ear training. And as part of the Medell Music Festival sound sensation, we've started a promotion on Thursday and globally launched this collaboration. And I think my colleague will share some links with you because everyone that can access my Medell has access to Melodia and Medell will offer free unlimited 12 months licenses for you. So you can start your music training today. And I'm really excited because it allows you to practice independently at home whenever you have time. It's a very, oh, by the way, I think we have a slide for this. Which I forgot about, Jen, would you mind pulling it up for me? Again, this is can be used by all our my Medell account users, no matter if you're a hearing implant user, no matter if you're a professional or a parent. Melodia is really a comprehensive tool that you can use independently for long term music training. There are over 600 exercises with over one million sound sequences. So you could be busy for the next three to five years with this. And it's accessible to all our hearing implant users. And we've tested the suitability and I believe it's possible to use this independent of your age indication, how long you've been using your cochlear implant and independent of your musical background. This is for adults as well as for children. So it's a one tool for everyone. And our goal with this is to help you further improve your music perception and, most of all, your enjoyment. That's great. And Melodia is not only for hearing implant users, but I've tried it myself and I have to say that some of the tasks are tough. I mean, so I will look further into Melodia for my musical training. Sure. Yeah. Actually, you know, any model internal can also start practicing music if you're interested. And so I recently got the question is music training for everyone. Obviously, you know, music is not a priority for everyone. So I think it's more likely that people that have a high interest in music will. Immediately started practicing with Melodia, but music training has a lot of other benefits. Research has shown that musicians are very sensitive listeners and have certain advantages like understanding speech and noisy backgrounds. So I think Melodia and this ear training can also benefit for speech improvements and speech understanding and noise. So it's not just good for music, although this is our focus and priority. OK, that's great. So thank you for your presentations. And now we come to the question part. Please put your questions into the chat. And while you're doing this, we have a little poll for you again. And we have prepared actually eight questions that we thought may be interesting to you. And so this poll should come up. And please, I mean, this is like a multiple choice. You can click several of these questions. What are the questions that you would be most interested in that we answer them right here? So we will take the two or three questions that get the most votes here. And we will address these questions. So the questions are what is more important, the implant or the audio processor? Why are 22 channels not better than 12? Is a deep electrode insertion more traumatic? How important are automatic electrodes and the preservation of hearing in general? What are future goals with regards to our to improving the speech understanding and music enjoyment? What is the best approach to successfully retrain music? And we've heard about that a bit. What do hearing implant users struggle with when practicing music? How precise is pitch perception with the CI? So please give us your your vote here. And. OK. So I think we have three questions that, well, then no. I take it back, you know, the scenery has changed. OK. Then let's look at it. OK. First question, how precise is pitch perception with the CI? This is the first question we want to answer. Then let's talk about what are the future goals with regards to improving speech and music understanding? And then at the end of. Yeah, then we have two that are the same. Well, let's go to the first to their music related. How precise is pitch perception? And, you know, what are future goals at Medell with regards to improving speech understanding and music appreciation? Johanna, do you want to answer the first question? How precise is pitch perception with the CI? Sure, I can also. You can also add to that. Yeah, it showed here and we have different perspectives on this. And so my answer to that would be kind of to use our users as as example, like, what are they able to do? And. I connected a study using Melodia, which actually showed that the majority over 80 percent of the participants are able to to differentiate a semitone. And that is something that otherwise in the literature is reported. There's, you know, a wider range of discrimination. And a lot of professionals in the field don't believe that cochlear implant users can discriminate semitones, the smallest musical interval. But we have shown it's possible. And I think. You know, the musicians I'm in contact with, obviously, they need this precision to play their instruments and they perform very well. And we see more musicians singing. And for that, you also need very precise pitch in order to have a good intonation. And I think all three of you just recently experienced the Grand Finale in Vienna and you've heard our users perform and the musicians that watch this concert really were impressed by the intonation and the pitch precision. So from a scientific point of your. Well, I think, yeah, I think the the question probably relates to the question, how close is how close is the pitch or how identical is the pitch that one hears through a CIA to the pitch that one hears for the same frequency through normal hearing? And there is recent research that was done in. In in Germany and Belgium. That shows that pitch through a CIA comes. Closest to the pitch that somebody experiences for the same frequency through normal hearing. If you stimulate and I'm getting back to what I talked about earlier before, if you stimulate the cochlear in the correct place and in the correct way and by way, I mean this piece of timing information. Then if you do that, then pitch perception through a CIA can come very, very close, at least on average, very, very close to pitch perception through normal hearing, which means then a frequency of say two hundred Hertz really sounds the same to the CIA, to a CIA recipient as to a normal hearing person. And this is exactly again the philosophy of Medell through long electrodes. We stimulate the cochlear, at least we attempt to stimulate the cochlear in the correct place. If you don't have a long electrode, if you only cover the first turn of the cochlear, you cannot stimulate the cochlear even close to the correct place for a certain frequency, especially for the low frequencies. And then on top of using a long electrode, as I've shown in that one animation for the low frequencies, we stimulate the cochlear in synchrony with the sound signal. And that again, then produces the right way of demylation in the cochlear for the low frequencies. So these two things together really then bring a CIA user in terms of pitch as close as possible to a normal hearing user. I also want to say that another element. Sorry, can I say that there's a question, actually, from the in the chat about pitch discrimination. My CI went live five weeks ago. OK, in five weeks. I mean, that's not a long experience. And I started simple ear training exercises on my on the e-piano. I reasonably hear all 88 keys and my favorite tone is a zero. So that's 27.5 Hertz. The two octaves after that are great. But from F3 to G5 pitch discrimination is mercury. After that, all the way up to C8, fine again. What happens going above F3 and then above G5? How does matter give support to improve the mid-range? So there seems to be a there seems to be a range that is fine. And then some range that is, you know, not so perfect. But what would you answer, Peter? We have we have developed something that goes beyond the three the two elements that I just showed. The the the natural pitch you experience in the low frequencies. I would think really comes from these temporal way from this from the way that we stimulate the the electrodes in the low frequency region in the correct temporal way. In the mid frequency region, we have developed something that could bring your pitch, especially even closer to normal hearing pitch. We have developed a way where your fitting can be adapted to where actually the electrode contacts are in the cochlear. And I mean each individual electrode contact. So far, the fitting experts in a clinic with the audiologists, the rehab people, they've been pretty blind or totally blind with respect to where the electrode actually is positioned in a in a in a concrete cochlear that is in a concrete user. And then and then some standard way of fitting those electrode contacts to a certain frequency range were applied. Now, we've developed a tool that's called anatomy based fitting that based on post-operative images, if that's done by your clinic, the audiologists can actually see and identify at what frequency a certain electrode contact is located in the cochlear and then can adapt the fitting according to this additional piece of information. So that might be something that's maybe helping in your case. And you would have to talk to your clinic, whether that's something they do or not. It's pretty new if they don't do it right away, if they don't know about it right away, please guide them to your local medial office and let them teach your clinic. But there is ways that all I want to say is there is ways on top of complete of what we call complete cochlear coverage as a result of long electrodes and fine structure or temporal information in the cochlear region. On top of that, to further refine the fitting to make patient music sounds better. So that's basically tailoring the frequencies right to each individual user. Right. That's even further. Individualizing cochlear implant treatment with also ways to allow the that's not really a big one in your case anymore. But we've also worked out ways to identify how long a certain cochlear, for example, is right and then pick the most suitable electrode array to really cover the entire cochlear. Unfortunately, cochlear is very quite a bit between individual humans. But I think in this case, but in this case, it's really the fitting and rehab and training. So the brain is will also be helping you. The brain is flexible. The brain can adapt to some distortions, right? So what what Johanna has really mentioned is also gen not only fitting, but also training is an important step in getting further with your CI. So it's basically a combination of design, fitting and training and training. And there's a follow up question here in the chat. And kind of just say, and don't get disappointed. Five weeks is not long. You're not far into the into the CI into the. Hearing with the CI process, so it will get better. Don't give up. Five weeks is not long. So it will get better. Don't give up. Five weeks is not long. I think that answers another question. Four weeks ago, activated four weeks, if I found sounds are getting better every week. And so, yes, there is a learning process that is not finished after four weeks. There's another follow up question. Is anatomy the anatomy fitting part of your regular software distribution? So is this anatomy based? Yes, yes, yes. It's in the regular clinical software. OK, good. I think that answers that part. Let's go and I think we got the associated questions. OK, let me what are future goals with regards to improving speech, understanding and music? I think one thing that will be that we are focusing on. And Peter just mentioned about anatomy based fitting. We will continue, I think, down this road in respect of the natural tone of topicity and place pitch, so to speak, with regards to fitting. And we've seen in research supports this that as we go down this route, the success rate or the satisfaction, so to speak, with with music and speech perception is improving. So I think that's one aspect that we will continue to go down to improve overall hearing performance. Anything to add, Peter, Johanna? Just to add really, we continue to work on individualization in different ways and make it easier. Yes, and make it easier. I have to say that what I just talked about anatomy based fitting at this point in time, it is a bit of an effort for the clinic. A postoperative CT is nothing that every clinic does. We're working on ways to derive the same bits of information that are now derived from a postoperative clinical image from other sources through the CI. So making, and that's now rather relating to the clinicians among you, making the entire fitting easier, but not less effective and not less beneficial is really a big goal. We're really, and I can say that because I'm also working on fitting algorithms, we're really, we're really struggle with making fitting easier, quicker, less effort fell for the audiologist and the user, the CI user, but not give up on quality, at least not significantly. Right? So so that is a dilemma that we need to resolve in the future. And we're working on there are ways and we're working on. But that is a dilemma that we that clinics are currently in and we need to help them. You know, you can either spend an hour to for a certain user and fit the user or you spend half an hour each on two users, right, and get them maybe less optimally fitted. But still, you've treated to use patients, so to speak, right. So that is a dilemma that we are. We need to OK, solve in the future. Thank you. There's one question. My my son, five years old, has bilateral CI. I'm wondering if the position of the processor makes a difference in sound experience. As I noticed, he wrote, say, did to a certain position to get it to flash green or is he doing it to make it more clear? He has the Rondo to. Again, it's it's difficult to say. But some of the aspect can be also with regards to fitting. And I one thing to know is it was a sequentially implanted or was he simultaneously implanted? But this aspect that Peter was bringing up earlier with regards to anatomy based fitting, we're seeing now with bilateral implants where they, as an example, may have different electrode insertion lengths that the anatomy based fitting helps bring the two sides together. And so this may be one aspect. Usually the position of the processor, as long as it's connecting well with the with the magnet internally, usually the position externally doesn't have too much of an impact. It can have some, but it's usually minimal. It's more about the fitting aspect that really brings that together. To that, I mean, the processor can be fit in a way that the microphone is more directed to the front. And then there is also a fitting that is basically picking up from from all around. Maybe the second question here comes the same participant. My son can hear from far, but has a hard time recognizing, recognizing where the sound is coming from. How can we practice learning the direction sound is coming from? Will hide and seek be a good way to practice? I mean, can can localization be be practiced? Is that like music or how is that? I mean, I would assume that again, what you mentioned is have the two implants been implanted at the same time. But what's your take on that? I think two aspects, one fitting to make sure that the two sides are equal or are balanced in terms of loudness and in terms of quality. Once that's done, then, yes, training can be used to help improve that. But I think the first step is to make sure that the fitting is correct so that the implants are really or the processors are really balanced. Yeah. Yeah. And and it's important. I don't know. It's probably it's not in the chat, but your son needs to be bilaterally implanted. Yeah. He is that it is that was the first question. If I was a bilaterally, and then I have to say spatial hearing, that's called spatial hearing. If you know where a sound is coming from in space, that's in this field called spatial hearing. Spatial hearing develops over time. Yeah. Yeah. Also in normal hearing children, right? So spatial hearing develops over time. So, yes, practice will help will help to move on in spatial hearing. Yes. Thank you. Verena just posted in the chat that if you have other questions, this is not limited to this session. Also, if we maybe missed the question or we don't have time to answer all questions, there is a link where all these questions can be answered and we can also ask questions. So let's let's address the other two questions here that were in the poll. Is a deep electrode insertion more traumatic than a shallow? I mean, there is these fine structures in the cochlear. We know Medell is very, you know, looking at structure preservation in the cochlear. Jen, what would you say? It can be, but Medell's electrodes are very soft and flexible and we design them specifically to be a traumatic. OK. Thank you. And there is enough space. That's also to say there is enough space in the in the cochlear in the upper parts of the cochlear to to fit the electrode. It's not that it would be kind of damaged anything by being too big. So, Peter, I think this is a question to you. Why are 22 channels not better than than 12? It seems like, you know, Medell, we have 12 channels. Are we at a disadvantage compared to other systems? No, we are not. I think we're rather at an advantage because if you if you increase the number, I'm getting into why is 22 not better from two sides? Yeah, the first one is electrode design. The first one is this question, how how dramatic or a traumatic is an electrode? The more contacts you have on your electrode carrier, that is your more channels you have on your electrode carrier. The more wires need to be in the electrode carrier, the stiffer the electrode carrier or the electrode will be and the more potentially dramatic the electrode is. So keeping the number of channels reasonably low improves the atraumaticity of the electrode contact. Now, the question is, do you then if you do that, do you then in turn lose pitches, right? So you might think, OK, with 22 channels, I can stimulate 22 positions along the along the cochlea, which produces 22 pitches and with 12, it's only 12 positions along the cochlea and it's only 12 pitches. Now, fortunately, that's not true. If you stimulate two adjacent electrodes either simultaneously or in rapid succession after each other, then what you hear is a pitch that's intermediate to the pitch to the pitches produced to the pitch produced by the one electrode in isolation and the other electrode in isolation. So in other words, we can create a continuum of pitches between two adjacent electrode contacts. And that's all along the cochlea. How many pitches are we talking about here? So while the the theoretical limit of pitches in our system with the 12 electrodes with the 12 channels is 250, which is by far as research shows high enough to really then allow each individual user to resolve as many as many pitches as he individually came, you know, based on the individual condition of his. That was a bit much individual of his individual. OK, OK, thank you. So technically what I want to say is our system is technically not limiting the number of pitches that you can hear through your cochlear implant. Yeah. OK, OK, thank you. Last question here, very practical. How many years can we expect our recent internal components to last? We have users that are. Twenty years and beyond. We have all of our audio processors that we design are backwards compatible. And so. Yeah. That's why the implant is so important compared to the audio processor. Is the implants going to be there for a long, long time? And the audio processor is going to change. And everything, as I said, that we come out with all new audio processors will be backwards compatible from day one. OK, yeah. So so I started with Medell about 25 years ago and quite a few users that were implanted at that time still use the first medell implant. Yeah. So my answer would be 25 years. Well, that's the proven, you know, we can't really look into the future. I mean, there is no theoretical limit to the lifetime of your implant. That's what I can say. Now, you know, how far we do accelerated lifetime testing also in house where you try to, you know, model aging of the implant and so on and so on. And that extends 20 years and 25 years and beyond. But nobody can really look into the future and then say, well, it'll be 50 years. We are not there yet. Right. And at some point, I would assume that the technology is outdated. I mean, I wouldn't want to drive a car that is 50 years old. Right. But again, as as Jen said, we've never left in any existing user behind. Yeah. All our audio processors that we brought out so far. Now up to the. Where are we? Rondo three right up to the Rondo three sonnet two. We're backwards compatible across 25 years from the first day they they came on the market. Yeah. So if you at least so far, our history is that if you decide for Medell, you're not worse off than a newly implanted user so far. Right. In terms of that, we are that we are leaving you behind in terms of innovation. Right. OK, so that's our proven record. We really do everything we can, although that's quite a burden in our endeavor. I come from so far. We do everything we can to keep up with that legacy or history. OK. Well, thank you very much. Thank you, Jen. Thank you, Peter. Thank you, Johanna. Thank you, all the participants for your interest. I just want to mention one thing and maybe you can we don't have to put up the PowerPoint. There is still coming up today, sound sensation. We have three more music, daily music doses at four local time here. We have the workshop music for your child. And at starting from from seven p.m. is the grand finale. This is really something you have to see. It's amazing what comes together when musical talented people that are implanted make music on a very high level, play and sing together with professional musicians. A real the real highlight of our sound sensation festival. So thank you very much and goodbye.