"Hear, hear! Cochlear implants are here"

November 2006

(reprinted with permission by LifeTimes, published by Blue Cross/Blue Shield of Illinois)

By Robert Seidenberg

Doctors, social workers, audiologists and others recently gathered in an examining room at the Silverstein Institute in Sarasota, Fla., where a 4-year-old girl was about to hear for the first time. The child, severely hearing-impaired since birth, had received a cutting-edge device called a cochlear implant. Surgically implanted in the ear, the device bypasses damaged cells and stimulates the auditory nerve directly, allowing sound to register in the brain.

Dr. Jack J. Wazen, an expert in hearing disorders, was anxious to see how the girl would react once the implant was activated. Would she be frightened when the first sound waves registered?

Just the opposite. “You should have seen the excitement, the enjoyment,” he says. “The parents are crying, the girl is laughing out loud. There was not a dry eye in the room.”

Cochlear implants are just one of the advances in audiology now being used to improve or restore hearing in a wide range of cases. The advances are taking place in a field where there is a strong need likely to grow.

An estimated 28 million people in the United States suffer from some type of hearing loss, according to the Hearing Loss Association of America, a national educational and advocacy group. For every 1,000 births, one baby is born with a profound hearing loss (the most severe degree of impairment). Another two or three infants will be diagnosed with partial hearing disorders, statistics show.

Age-related loss

At the other end of the spectrum, an estimated 40 percent of people 65 and over experience age-related hearing loss. However, many don’t pursue help. That’s because many people remember their parents’or grandparents’ experiences with the old-fashioned hearing aids that ended up in a drawer “because they didn’t work very well,” observes Dr. Robert Battista, a Chicago-area neurotologist who specialized in ear disorders.

Dr. Battista and Dr. Wazen both stress that technology has advanced far beyond the hearing aids of the past. Today, there are sophisticated digital hearing aids and directional microphones on the market, and the use of cochlear implants is rapidly being expanded. Adults who have received the implants in recent years include radio talk show host Rush Limbaugh and the 1995 Miss America, Heather Whitestone McCallum.

“The advances in hearing re-adaptation have really revolutionized the concept of deafness,” says Dr. Wazen, director of research at Silverstein Institute Ear Research Foundation in Sarasota.

“We have plenty of treatments and technologies to offer people with mid hearing loss to the most profound (cases),” Dr. Wazen says.

Great strides

Perhaps the most dramatic break-through is the cochlear implant, inserted under the skin behind the ear. It has internal and external features.

The external device, worn outside the ear, includes a microphone and miniature computer, Dr. Wazen explains. The external device takes in sounds or speech and transmits them via radio frequency carrier through the skin to the internal device, a receiver-stimulator that sends the signal on to an electrode array.

The electrode array in turn sends very small electric signals that directly stimulate nerve endings-the same nerve endings that previously could not be stimulated due to damage. Now amplified, the electrical impulses travel from the ear to the brain, where they miraculously register as sound.

“Without an implant, the people who qualify for the treatment would probably hear nothing,” Dr. Wazen says. However, when the implant is activated, “they hear levels pretty close to you and me.”

The procedure is costly and generally has been reserved for those with the most severe cases of hearing loss. The surgery itself can cost $20,000 or more, and follow-up procedures can run total costs up to $50,000 or beyond. However, many insurers, including Medicare, have helped cover costs of cochlear implants for qualified candidates. About 25,000 people in the United States have had a cochlear implant, according to the Hearing Loss Association, which maintains a Web site at www.hearingloss.org. Nearly half of implant recipients are children.

Traci and David Triplitt of Fresno, Calif., began investigating cochlear implant surgery for their 4-year-old daughter, Toryn, after other procedures failed. Mrs. Triplitt says her daughter was diagnosed with hearing loss at age seven months and eventually was fitted with hearing aids in both ears.

When Mrs. Triplitt asked about cochlear implants, she was told that her daughter’s condition was not severe enough to qualify her as a candidate. After her first birthday, though, new tests showed the girl was profoundly hearing-impaired in both ears. The family put renewed focus on cochlear implants, making the three-hour trip to Palo Alto, Calif., to visit with doctors at the California Ear Institute.

Toryn received her first implant when she was 17 months old, and the device was activated a month later. Soon she stared babbling, a normal development in young children who are preparing to speak.

By the time she was three-and-a-half years old, Toryn’s language skills were fairly comparable to other kids her age, her mother says. At four-and-a-half, Toryn has very minor speech delays and articulation problems. “But if people didn’t see her implants they would not assume or guess she’s deaf,” Mrs. Triplitt says.

Cochlear critics

Ironically, Toryn’s transformation spurred controversy in some circles of the deaf community, where some parents see deafness as a way of life rather than a disability. Parents who share this view are unlikely to consider implants for themselves or their children.

Mrs. Triplitt says she tries to understand critics’ perspective. “I possibly would feel differently about the need for implanting Toryn if we were a deaf family,” she says. “However, we are a hearing family, and for us it was a matter of wanting to provide Toryn access to hearing and oral speech.”

Toryn seems to have accepted the implants. When her older brother, Dawson, or the family cat Skeeter-both with normal hearing-ignore orders, she advises her mother: “Let’s get them implants.”

Such success stories aren’t confined to youngsters. Dr. Battista, an assistant professor of otolaryngology at Northwestern University Medical School in Chicago who maintains private practices in Evanston and Hinsdale, Ill., says the cochlear implant surgery he performs is limited to adult patients.

“Certainly for children it’s going to help (throughout) a longer life span,” Dr. Battista says of the procedure. “But as for adults-especially for adults who had hearing and then had loss-it brings them back to a world they had before.”

Dr. Battista says adults present fewer problems than children when it comes to cochlear implants, “simply because they acquired speech already. They don’t have that challenge.”

If adults face any difficulties, it’s learning to cope with the cochlear implant device visible behind their ear, he says. But now, with many people wearing wireless technology devices behind their ears, such high-tech appurtenances have become a common sight.

For less severe hearing loss, several options are available, such as traditional hearing aids. Signs of hearing loss include having to ask people to repeat what they said more frequently and experiencing difficulty in hearing when there is the slightest amount of background noise, Dr. Battista says. People who are having problems hearing need to have an audiometric exam, a full and complete hearing test conducted under the direction of a physician, he says.