Cochlear Nucleus 8 Cochlear Implant Sound Processor

Cochlear™ Nucleus^® 8, also called the N8 or CP 1110, is the latest sound processor from the world market leader in cochlear implants, Cochlear Ltd. N8 improves upon the company's previous cochlear implant processor (Nucleus 7 or N7) in several key areas, including wireless capabilities, overall size and weight (the N8 is said to be the smallest in the world), water and dust protection, sound quality, and listening in noise.

In this article, we take a look at the pros and cons of the N8 processor, and then we review its key features, unique technologies, and more in detail.

Who is the Nucleus 8 cochlear implant processor for?

Cochlear implant candidacy varies by age and by manufacturer and, in the United States, is guided by FDA device approval. In recent years, research into cochlear implant candidacy has expanded considerably, as has Medicare and Medicaid coverage for the devices.

For adults, you generally must have moderate to profound hearing loss and experience significant difficulty hearing even with well-fit hearing aids. Be sure to consult with your Hearing Care Provider (HCP) for more information. If you would like additional information specifically about Cochlear devices and candidacy, please visit their website. Additionally, the American Cochlear Implant (ACI) Alliance has good resources and videos for adults and parents of children about CI implant candidacy.

The new Nucleus 8 (N8) is appropriate for new cochlear implant recipients and those looking to upgrade their sound processor from an older device. For example, if you have had your sound processor for 5 years or more, you may want to consider upgrading.

In addition, your device may be retired, as is the case with the N6 sound processor introduced 10 years ago in 2013. Cochlear has notified all N6 wearers that, as of March 31, 2023, parts and accessories for that device will no longer be available, and Cochlear will no longer be able to repair them. However, extended warranties will be honored. If you are wearing an N6, it simply makes sense to upgrade to the latest device when possible.

Keep in mind that most of Cochlear’s implant systems—including the older Nucleus 24 implant (introduced in 1997)—are compatible with the new N8 sound processor. That is, you won’t need another surgery to enjoy the latest speech/sound processing technology.

In addition, for current cochlear implant recipients, remember that your healthcare insurance may pay for the new sound processor—or at least a portion of the cost. Cochlear offers recipients assistance with letters of necessity and help in obtaining insurance approval. If you think you might be ready for a processor upgrade, discuss your options with your implant audiologist and Cochlear.

Finally, Cochlear has the Kanso 2 Off-The-Ear (OTE) sound processor, and HearingTracker has published a product review of the Kanso 2 that you may find helpful. Choosing a BTE-style processor (N8) or an OTE device (Kanso 2) will depend on your lifestyle, listening needs, and other factors. Again, be sure to discuss your options with your implant audiologist and/or your implant surgeon. Cochlear also offers an online comparison chart that is useful for deciding which processor to choose.

Who makes the Nucleus 8 processor?

Cochlear is a global company headquartered in Sydney, Australia, and one of the pioneers in the field of implantable hearing solutions. Cochlear was the first company to be approved in the United States for its multi-channel cochlear implant in 1984. Today, they provide a range of implantable technology including osseointegrated (bone) implants, acoustic implants, as well as cochlear implants. Cochlear currently enjoys the dominant cochlear implant market share in the United States.

The N8 sound processor is the latest in a long line of products and is considered the 8th generation processor. Cochlear has continued to minimize the size of the device while incorporating improved speech processing strategies and modern wireless connectivity.

Key unique features of Nucleus 8

• SmartSound^® iQ 2 with SCAN 2
• New Automatic ForwardFocus using Beam^®
• Reduced size and weight
• New ergonomic design
• Improved moisture and dust protection
• Updated Bluetooth LE protocol
• Auracast™ compatibility

Improvements in sound and listening capabilities for Nucleus 8

Designed to help you hear conversations more clearly, particularly in noisy situations, the Cochlear Nucleus 8 features unique technologies that may make communicating with people easier.

SmartSound iQ 2 with SCAN 2 for better hearing in multiple listening environments

Cochlear has introduced SmartSound iQ 2 with SCAN 2 in the new N8 sound processor. This is the terminology Cochlear uses to describe their sound processing strategies. Simply put, the processor with SCAN 2 listens to the recipient’s environment and, based on the MAP (programming of the device) and the listening environment, will align sound-treating features automatically.

The intent is to provide the best possible listening for that particular environment. Once the environmental classifier determines the most likely listening environment, the sound processor will align controls such as sensitivity, noise reduction, and directional microphones to help improve listening ease.

Cochlear claims that the N8 incorporates a more precise scene classifier allowing for more accurate steering of features. Specifically, Cochlear claims an 8% improvement in classifying noise and an 11% improvement in classifying all listening environments compared to the previous generation product.

In other words, the N8 should better classify noise, speech, music, or wind than the previous N7 or N6 products. Correctly identifying the listening environment is crucial in ensuring that features like noise reduction or utilized appropriately.

ForwardFocus and Beam for directional hearing

N8 also introduces an improved ForwardFocus feature. With the N7 product, your implant audiologist could decide to allow you access to a dedicated directional microphone program. This was accessible via the push button on the sound processor or the Cochlear smartphone app, the Nucleus Smart App. ForwardFocus is designed to help recipients hear better in noisy situations, ideally when the speech of interest is in front of the listener. It works by attenuating noise from the side and to the rear of the wearer. ForwardFocus is only intended for recipients 12 years and older who can easily understand when and how the feature should be used.

With the N7 product, ForwardFocus was not automatic; the recipient had to choose the program or feature to activate it and remember to turn it off in quieter environments. However, with N8, your implant audiologist can program the device to allow for automatic ForwardFocus, although it can still also be configured to be accessed manually.

In addition, Cochlear notes that they have improved on the adaptive feature of the directional microphones via their Beam^® technology. This means the sound processor can attenuate (reduce) noise from varying directions in near real-time.

For example, if you are speaking to someone at a gathering and the noise is primarily behind you, the directional microphone will attenuate noise from directly behind you. However, if you shift and pivot to your right, for example, the directional microphones will adjust and now try to diminish the noise to your right side. This allows for better hearing in dynamic noisy situations. Adaptive directional technology has been available for quite some time in hearing aids and is now considered standard for most digital hearing aids on the market.

Some recipients may find the automated ForwardFocus annoying, as they may hear it changing more often than they may be accustomed to (e.g., for those that have upgraded from the N7 to the N8). However, keep in mind that your audiologist can program ForwardFocus to be manual or automatic.

Nucleus 8 gets a design makeover for a better look and improved durability

Cochlear has improved the ergonomic design of the N8 Behind-the-Ear (BTE) sound processor, making it smaller and lighter, while changing how the device sits on the ear. The N8 sound processor is over 30% smaller compared to the N6 sound processor (measured with a medium earhook and a compact battery). The N8 is also 34% lighter than the N6; however, this is a bit misleading, given that the N7 is the previous generation of processors, not the N6.

When comparing the length, width, and depth measurements of the N7 to the N8, the overall size reduction is approximately 5.5%, and the weight reduction is about 13%. While this is not a huge reduction, it can still make a difference in overall comfort and help improve cosmetics, especially for children. It’s important to note that this makes the N8 one of the smallest—if not the smallest—BTE sound processors on the market.

Cochlear has also reduced the distance between the earhook and the back of the sound processor, changing the curve and shape slightly of the N8. This design change is intended to improve the comfort and retention of the sound processor on the ear. For some recipients, it may also improve overall cosmetics of the device as it may be hidden slightly better behind the ear.

Improved moisture and dust protection for N8

The N7 sound processor, with a rechargeable battery, was noted to have an Ingress Protection (IP) rating of only IP57 and achieved an IP68 rating only with the Aqua+ accessory. However, the N8 now has an IP68 rating when using a rechargeable battery. This means the sound processor is very resistant to both dust and moisture. An IP68 rating indicates that the device can be submerged in water of approximately 1 meter for up to 30 minutes. This makes the N8 more durable and less likely to malfunction due to sweat, dust, dirt, etc.

It should be noted that Cochlear does not recommend swimming with the N8 sound processor without using the Aqua+ accessory, which is also available for the N7 and Kanso 2 sound processors.

Better audio streaming with an updated Bluetooth LE protocol; Auracast-ready

Cochlear notes that the N8 sound processor now incorporates Bluetooth (BT) Classic and the newer Bluetooth Low Energy protocols.

Bluetooth LE was designed initially for devices that did not require a constant connection and only needed to transmit smaller amounts of data. This made Bluetooth LE not ideal for audio streaming but did allow for much longer battery life. For example, it was perfect for connecting remote controls to hearing aids or sound processors where the remote only needed to be connected intermittently to the sound processor or hearing aid.

However, the latest Bluetooth LE Audio allows for audio streaming and still minimizes the energy required for the connection (compared to BT Classic). It also provides for standardizing the BT protocol for hearing devices—meaning the N8 sound processor can direct stream to more BT devices. For a list of compatible smartphones, hearing aids, and accessories, please see Cochlear’s compatibility page.

Cochlear also appears excited about the ability to connect the N8 sound processor to Bluetooth Auracast™ enabled devices. Auracast is a new BT capability that allows for audio connections and is being promoted as the next generation in assistive listening technology. It will allow devices to share audio, pick up audio from enabled TVs in public areas, and hear public broadcast systems in places like airports, train stations, etc. You can think of it as a kind of Wi-Fi for audio connections.

However, Auracast is brand new and the implementation of it in public spaces is only beginning; we think you probably won't see it widespread for a couple of years, at a minimum. So it's unlikely you'll find a theater or airport with Auracast enabled right now. In addition, Cochlear does not appear to have software updates available to accommodate the new technology. However, the BT group is working hard with companies to implement the technology, and the hope is that it will be quickly and widely accepted. If it is, the N8 will be capable of connecting via Auracast, assuming Cochlear implements the necessary software requirements.

In the meantime, the N8 also has a telecoil, providing access to hearing loop systems. In all likelihood, consumers will need access to both telecoils and Auracast for many years to come.

What’s it like to use the N8 sound processor?

The Cochlear N8 sound processor was approved by the FDA in November 2022, and many cochlear implant recipients are just beginning to receive the new device. As such, feedback from actual users and from implant audiologists is somewhat limited at the time of this writing. But initial feedback regarding the smaller size and lighter weight of the product has been positive.

The new BT Audio LE implementation may help improve overall connectivity options; however, there are some reports of difficulties pairing and maintaining a connection with a compatible hearing aid on the opposite ear, as is the case with bimodal fittings.

Onboard controls and remote for N8

Cochlear’s new N8 sound processor incorporates a control button on the spine of the processor and allows for up to 4 separate listening programs. Your implant audiologist configures these, and the type and number of programs enabled for you will depend on numerous factors, including what stage you are in of your aural (re)habilitation process, your listening needs, and your lifestyle.

As noted in the section regarding SmartSound iQ and SCAN 2, your first program will likely be programmed to be automatic, meaning you may not have a lot of need to change your sensitivity, volume or even programs frequently. However, should you need to, the control button can be used to move from one program to another. The button also acts as an on/off switch and allows access to an incorporated T-coil, if enabled in your programming. The control button can also let you start/stop audio streaming to connected accessories or compatible devices.

Alternatively, you can also use the free smart phone app, the Nucleus Smart App to make changes to program number, sensitivity, volume, etc. The app is available for both Apple^® and Android™ users (see below).

Finally, a remote control is additionally available, the CR310 remote. The CR310 is an optional and complimentary remote included for new recipients and is ideal for those recipients wishing for a simple way to control their processor.

Using the Nucleus Smart App

You can download the Nucleus Smart app for free from either the Google Play™ Store or the Apple App Store^®. For Apple devices, you will want to use iOS 15 or later, and the WatchOS 6 or later for Apple Watch. For Android™ products, you will want to use Android 8 or later. Again, to ensure your device is compatible with your processor, please consult Cochlear’s compatibility page.

For the new N8 sound processor, it does not appear as though there have been any significant changes in the app, and the latest version is noted to be v6.0.220600. Please keep in mind that once you have downloaded the app, you will need to set up an account with Cochlear to make use of the app.

The Nucleus Smart App allows you to change programs, volume settings and, if enabled, sensitivity settings. It also allows you to start streaming for connected devices. Practical features include the ability to see the status of your processor(s) including battery status. For caregivers, the number of “coil offs” (i.e., the number of times throughout the day the coil of the processor is disconnected from the implant) is also indicated. This can be especially helpful to ensure that your child stays “on the air” and it can let you know if new or different retention options are needed.

Another handy feature for the (re)habilitation process is logging time spent in speech and other environments. The app can even help you set goals. For example, if your goal is to listen to speech for a certain number of hours a day, the app can let you know if you are on track.

The “find processor” component of the app can also give you great benefit if you lose or misplace your processor. Using this feature, the app can indicate the last place the processor had wireless contact with the app. This is provided in a map view and can help you narrow down the location of the processor.

Finally, the Nucleus Smart app can be used for remote care. That is, if your implant center participates, you can receive some remote care from your implant audiologist. Please note that Remote Care is not used for initial mapping or follow-up mapping of your processor; rather it is used as a tool to monitor progress. For example, via a scheduled remote care appointment, your implant audiologist can conduct an aided audiogram test via the Nucleus Smart app, measure electrodes, check usage data and hardware health, and more.

Many implant recipients find this very helpful for routine checks, as it means not having to go into the clinic for a quick check of your device(s). It can also help your implant audiologist troubleshoot your device(s) and determine if more direct care is required. Please remember that not all implant centers utilize this feature and that many appointments, including cochlear implant map changes, should be done in person in the clinic.

At this writing, the Nucleus Smart app was not highly rated, with 3.3 stars (out of 5) for Android and 3.2 stars for Apple. The primary complaints, even for the new N8 sound processor, are typically related to connectivity issues. That is, reviewers have noted that the app cannot find the processor(s), will not stay connected, won’t connect with a hearing aid on the non-implanted ear, etc. It should be noted, however, that such ratings are also typical for many hearing aid smartphone apps (which usually hover between 2-3 stars), and many find the Nucleus app quite helpful.

Nucleus 8 connectivity to other handy accessories

The Nucleus 8 sound processor allows for connectivity not only to compatible Apple and Android devices but also to Cochlear’s True Wireless™ accessories, including the Mini Microphone 2+, the TV Streamer and the Phone Clip.

While up to 5 devices can be paired to your processors, keep in mind that only one device can be actively connected at one time.

The Mini Microphone 2+ provides multiple functionality features including:

• Remote microphone
• Telecoil/loop system access via an imbedded telecoil
• FM access via the built-in pin connector and an FM receiver
• Access to external analog sources via a built-in line-in connector

This one little device allows you to connect to an array of different devices and technology. Even if you only use it as a remote microphone in noisy listening environments, you’ll likely find it very useful.

Cochlear's Wireless TV Streamer can be especially useful in making TV audio more accessible. It works very similarly to how a hearing aid TV accessory works: once connected to your TV and paired to your processor, the TV audio will be streamed directly to your processor(s). This ensures a clean audio signal for the sound processor(s).

Finally, the Phone Clip can be used to pair your sound processor to non-compatible BT devices, and it can be used when hands-free calling is required. For example, when driving, you will want both hands on the wheel and not one on your phone. When attached to your lapel, the Phone Clip picks up your voice, allowing the person on the other end of the phone to hear you while also streaming their voice to your speech processor. Additionally, it can be used to stream audio from BT-enable devices such as laptops and tablets.

Making phone calls with Nucleus 8

The N8 sound processor incorporates a proprietary 2.4 GHz wireless link and is Bluetooth Audio LE enabled. This makes the N8 compatible with both Apple and Android phones allowing for direct streaming of audio from compatible devices.

If you are a bimodal patient (cochlear implant in one ear and a compatible ReSound hearing aid in the non-implanted ear), you should be able to stream audio to both ears. It should be noted that hands-free calling is not possible even with the new N8 device without the use of an accessory, the Phone Clip. This has not changed from the N7 device.

Battery life of Nucleus 8 processor

The N8 sound processor, like its predecessor the N7, has 3 different battery options:

1. A disposable zinc-air battery module
2. A compact rechargeable battery module, and
3. A standard rechargeable module has been renamed the “power extend” module.

The chargers for the N8 are now white but are otherwise unchanged, as are the expected hours of use. If you move from an N7 to the new N8, you should expect approximately the same hours from your batteries.

Maximum wearing time is dependent on the battery type and other factors. Cochlear notes that on a full charge, you can expect up to 20 hours of wear time with a power extend battery, 10 hours with a compact, and 35 hours with two standard 675 zinc air batteries.

Your actual wearing time with the different battery modules will vary according to your implant mapping, internal implant, and how you use the device, among other factors. Your implant audiologist can give you an estimate of hourly battery life based on your personal settings.

Bimodal (CI + hearing aid) users and Nucleus 8

Bimodal simply means wearing a cochlear implant on one ear and a hearing aid on the other. As it’s usually helpful to have hearing with both ears, bimodal takes advantage of useable hearing in the non-implanted ear.

With Cochlear products, compatible hearing aids are made by GN ReSound, as Cochlear and GN ReSound have an established corporate agreement called the “Smart Hearing Alliance.” This agreement, first introduced in 2015, allows for sharing of technology and products. For example, when fitted with a newer Cochlear sound processor like the N8 or Kanso 2 and a compatible GN ReSound hearing aid, you can stream audio to both devices simultaneously from compatible Apple and Android devices.

While products that are part of the Smart Hearing Alliance allow for bilateral access to sounds, including streaming audio, this doesn't necessarily mean bilateral control of the devices is seamless. That is, pressing a control button on one device or making a change in the smart app will not automatically change a program or volume on the other (i.e., the control is independent across the devices). However, some smartphones, such as Apple-compatible devices, may allow for bilateral control via the accessibility menu. Be sure to work with your implant audiologist or with Cochlear support to learn how to control your two devices.

Regarding bilateral access to sounds, consider that utilizing a GN ReSound hearing aid in the non-implanted ear is really only an option when you have viable hearing in that ear. That is, if your hearing loss is significant and your speech understanding is very poor in the non-implanted ear, a hearing aid may not provide that much additional benefit. However, some people find having access to sound—especially for environmental awareness—is very valuable.

Note that GN ReSound does not have a compatible CROS (Contralateral Routing Of Signal) hearing aid for the Cochlear sound processors. CROS systems pick up sound from one ear and transfer it to the “better hearing” ear for improved speech intelligibility. In the case of cochlear implant recipients, the sound is picked up on the non-implanted ear and sent to the processor on the implanted side. This allows access to sound from the ear that cannot benefit from traditional hearing aids. While this is an option with some implant manufacturers, it is not with Cochlear.

Finally, the Smart Hearing Alliance also carries over to their True Wireless™ accessories, such as the Mini Microphone 2+, the TV Streamer, and the Phone Clip. In fact, GN ReSound hearing aids offer the same accessories but are rebranded for Cochlear devices. If you already own a GN ReSound accessory, it may work with your Cochlear sound processor.

How does the N8 stack up against its competitors?

For those considering a cochlear implant to improve your or your child’s hearing, choosing one device over the other is never simple. Numerous factors should be considered, including the implant and electrode arrays, device reliability reports, wireless functionality, access to ENTs and audiologists, company support, including aural (re)habilitation materials, etc.

You should discuss your options not only with your implant surgeon and audiologist but also with other professionals—and even other recipients. Social media sites offer forum groups that you can join to learn about current features, issues, or simply have access to others who may have similar experiences. We recommend you search out all resources to help make your decision.

However, please keep in mind that regardless of which company you choose, thousands of people in the U.S. and countless others worldwide have had very positive results with their implants. Ensuring you are a good candidate for an implant and having access to proper intervention, including aural (re)habilitation, is essential.

One resource useful for comparing devices is the Cochlear Implant Help website which offers a comparison chart across the 3 different companies available in the United States. It also provides helpful learning resources. However, at the time of this writing, the chart has not been updated with the new Nucleus 8 speech processor.

Probably the closest competitor to the N8 is the Advanced Bionics sound processors, the Naida CI M and the Sky CI M. Advanced Bionics offers two processors depending on whether the recipient is an adult (Naida CI M) or a child (Sky CI M). Advanced Bionics is owned by the Sonova Holding Group which also produces Phonak and Unitron hearing aids, among others.

In more recent years, Sonova has been generally considered the leader in wireless functionality for hearing aids, and this carries over to their CI speech processors. For example, while Cochlear does offer direct streaming from compatible devices, it does not allow for hands-free calling or synchronized control across devices; Advanced Bionics products do. This also means that steering of internal controls like noise reduction and directional microphones are synchronized across ears, whether in the case of two sound processors or a sound processor and a compatible Phonak hearing aid.

Another feature unique to Advanced Bionics is that their latest products allow for microphone placement not just in the sound processor but also at the canal's entrance via their T-mic™ and/or on the coil worn on the head. The optional T-mic is intended to take advantage of the natural sound-gathering effects of the ear and shield the microphone from wind noise. It can also act as a telecoil when needed.

An optional microphone on the headpiece allows for off-the-ear wearing of the device. However, this is a needed option as Advanced Bionics does not offer another off-the-ear (OTE) option as Cochlear does with its Kanso 2 product.

Med-El, the third cochlear implant company FDA-approved, also offers an OTE sound processor with their Rondo 3 product.

Should I buy the Nucleus 8 sound processor?

Cochlear is the world's leading manufacturer of cochlear implants and bone conduction hearing systems, and the N8 features the company's latest innovations in a long line of successful sound processors. The new device has improvements in several key areas, including unique listening-in-noise features, better sound quality, new wireless capabilities, reduced overall size and weight, and improved water and dust protection.

For those of you who are interested in pursuing a cochlear implant to treat your hearing loss, remember that there are many things to consider when choosing an implant manufacturer and sound processor beyond the technology and features of the device. You are encouraged to visit the manufacturers’ website and talk with a company representative to get answers to your questions.

Most companies, including Cochlear, have a dedicated team trained specifically to help you make the best decision. The companies can also likely refer you to a recipient in your area so that you can talk to someone wearing a cochlear implant. Also, discuss their preferences with your audiologists and surgeons, and ask for reasons behind those preferences.

Regardless of your choice, the improvements that cochlear implants can provide for the appropriate candidate are worth pursuing.

Where can I buy this product?

Cochlear implants are an option for individuals with significant hearing loss, who are not performing well with well-fit hearing aids, and who can qualify medically for implant surgery. A cochlear implant team will evaluate your candidacy, which will include, at minimum, a cochlear implant surgeon and a qualified audiologist. Professionals such as psychologists, speech pathologists, and others may also contribute to the evaluation of cochlear implants.

You can find implant audiologists not only at larger medical centers but also in private practice. If you need help finding someone in your area, Cochlear and other implant companies can help you to a qualified center. For example, Cochlear has an online tool called “Find A Clinic” which can provide you with a list of qualified specialists in your area.