Health Talk Podcast: Cochlear Implants

Devices known as cochlear implants enable many patients to overcome hearing loss. This episode of Health Talk by TriHealth features with TriHealth Otolaryngologist  Brian Goico, MD, who shares information about cochlear implants which are enabling patients to regain their lost hearing after it has deteriorated beyond the use of hearing aids. Joining Dr. Goico is Shanice McGrew, a 26-year-old nursing student who recently received cochlear implants after her own hearing loss progressed to the point where hearing aids were no longer an option.

Health Talk by TriHealth is a monthly podcast to help you take charge of your healthcare and live a healthier happy life.

Transcript:

[Tom] Thanks for tuning in to Health Talk by TriHealth, a monthly podcast to help you take charge of your own health care and live a healthier, happier life. I’m Tom Tombush.

If you're listening to my voice, a part of your inner ear known as the cochlea is stimulating the nerves in your head that recognize sound. Even if you have to turn up the volume a little. But for a lot of people with hearing loss, the cochlea isn't doing its job. Unlike the body’s other senses, however, devices known as cochlear implants enable many patients to overcome hearing loss.

Here to tell us how is Dr. Brian Goico, a TriHealth otolaryngologist. He specializes in medical and surgical treatments for children and adults with ear, nose and throat issues. And he’s particularly interested in some of the newest technologies for treating those areas.

Also joining us in the studio today is Shanice McGrew, a 26-year-old nursing student who's had progressive hearing loss in both ears since childhood. In 2017, she lost the ability to benefit from hearing aids and became entirely dependent on reading lips to communicate. She received her first cochlear implant in March of 2018 and her second in December. Dr. Goico, Shanice, welcome to Health Talk.

[Shanice] Hello.

[Dr. Goico] Hello. Thanks for having us.

[Tom] Alright. So, Dr. Geico, we’re talking today about cochlear implants. Could you tell our listeners what the difference is between these implants and, say, hearing aids?

[Dr. Goico] That’s a great question. So, when people have more mild degrees of hearing loss, hearing aids are a great option. What they do is they amplify sound usually in frequency-specific ways in order to allow people to hear and understand sounds a little bit louder and usually a little bit better. When hearing loss becomes more severe, sometimes the ability to understand words, even when they’re at a louder volume, starts to decrease and when that happens cochlear implantation is a very good option. What a cochlear implant does is it actually directly electrically stimulates the cochlea.

[Tom] What is that?

[Dr. Goico] That’s the hearing organ in the inner ear. So that is what actually takes sound vibrations and turns it into nerve impulses that allow us to hear. When the cochlea starts to get damaged and you start to have worsening hearing loss, sometimes the cochlea’s ability to do that decreases. And when that occurs then directly electrically stimulating it with an implant can sometimes allow for a much better hearing function.

[Tom] Now what causes the cochlea to become damaged in that way?

[Dr. Goico] It varies. There are different reasons for different people sometimes it can be due to genetic or environmental factors, sometimes it's due to the aging process.

[Tom] Now, Shanice, do you know what it was that caused your progressive hearing loss?

[Shanice] Um, the cause has always been unknown.

[Tom] Uh huh. But it started when you were very young.

[Shanice] Yes, I didn’t notice until I was in the sixth grade.

[Tom] Ok. Were you more or less able to hear normally up until the time you started noticing you had progressive hearing loss?

[Shanice] I didn’t really notice. My mom and my teacher noticed, because I wasn’t, like, paying attention in school and I started to fail. But, like, I knew things.

[Tom] But, it wasn’t so much that you weren’t paying attention, it was that you couldn’t hear.

[Shanice] Correct.

[Tom] So, before you had your implants, what types of sounds were difficult for you to hear as you started having that progressive loss?

[Shanice] Um, the majority of all sounds. Like I wasn’t able to hear like water running or the ambulance or fire trucks going past. Just like the little sounds I couldn’t hear.

[Tom] Tell us a little bit more about how the implant works. You said the electrical stimulation is part of the process, but break it down for us a little bit more.

[Dr. Goico] Sure. So, what we do, first of all what the surgery involves is we make a small incision behind the ear so it actually camouflages by the ear so you really can’t see it very well. You can attest to that.

[Tom] I can’t see Shanice’s at all.

[Dr. Goico] And then you drill into the bone behind the ear to identify an area in the middle ear called “the round window” which is at the very base of the cochlea. And then you take a small electrode and you put it through the round window into the cochlea. And what it does is it has 22 little electrodes along the length of it. And, the way the cochlea is organized not to get too technical but it's tonotopic, which means different areas on the location of the cochlea stimulate different frequencies of sound.

[Tom] Kind of like your tongue, you know, different parts of your tongue respond to different flavors.

[Dr. Goico] Mm hm. And so what happens is you place a processor on that attaches via a magnet to the implant and then the implant stimulates those different areas along the length of the cochlea to stimulate different combinations of sound and allow people to start to recognize speech again.

[Tom] Ok. Now, the cochlea is sort of spiral shaped. It looks kind of like a seashell. The implant, does it sort of spiral around inside of that?

[Dr. Goico] Yes, that’s exactly right.

 

[Tom] OK and there is an internal portion of the implant and there's also an external portion, is that right?

[Dr. Goico] That’s correct.

[Tom] Ok, so you mention a magnet is that like on the outside for those two parts to connect?

[Dr. Goico] That's right. There is a sound processor that connects via magnet to the internal components that are what stimulate the cochlea.

[Tom] OK. So how does the tonal range of the implant compare to what a person who doesn't have hearing loss can hear?

[Dr. Goico] It is more limited so it's important when we're looking at cochlear implantation to realize that it is for people who have lost ability to understand speech and sound. And that is really when implantation becomes the best option. Native hearing is going to be much better at understanding things like music appreciation, going to a symphony, going to a concert, those sorts of activities. However, when hearing loss becomes more impaired, people do start to reach a point where doing this electrical stimulation will allow them to understand and recognize speech again.

[Tom] So this technology can actually restore hearing to someone who's almost completely lost their native hearing. Is that right?

[Dr. Goico] It does and it’s actually really exciting to see and you could probably attest to this. Where sometimes people will say, “You know, I couldn’t really participate in conversations around the family table, around the holidays, and now I can understand speech and I can understand what people are saying over the noise of background conversations and sounds. People are able to really re-engage in a lot of areas of their lives they weren't able to do before.

[Tom] Shanice is nodding her head vigorously over here. Tell us, Shanice what led you to look into cochlear implants.

[Shanice] Um, ok, I was wearing the hearing aids, but it just made sound louder, but I was never understanding what was being said. So, I was missing out on conversations. I couldn’t talk on the phone. At all. Period. As far as like conversations face-to-face, I always did the “Huh? What?” So, what led me to the cochlear implants was that one day I went to the doctor and I was telling them that the hearing aids wasn’t helping me at all. I thought that I would never ever even be able to like engage in conversations again. Then the audiologist told me to look into cochlear implants, but I was told that I wouldn't be able afford them. So, I switched over to TriHealth and it got me going right away.

[Tom] Did someone at TriHealth work with the insurance company to help you get coverage?

[Shanice] Yes.

[Tom] So has this been a life-changing experience for you? Now, you’re relatively new to your second implant and that one was just turned on, what, earlier this month.

[Shanice] Two weeks ago.

[Tom] Ok. What's it like having both of them operating now?

[Shanice] I got to do the oral rehab to get the new implant working the correct way. But, I love it so far. It’s cool. It’s helping me out a lot already. When I had the surgery I couldn’t hear in the new ear, in the right ear at all. So I was just using my left implant. I was just hearing out of that ear. So, when it got turned on, everything was coming back to normal.

[Tom] Right because you were working with one implant since March of last year, if I remember correctly. Um, based on what I know of your background, it sounds like you do the surgery and then the implant itself doesn't get switched on until sometime later. How long does the patient typically have to wait before you're able to turn it on?

[Dr. Goico] it's usually about one month and that's to allow the site to heal and allow everything, the body to basically heal itself so that then we can start using the implant. And I think that you brought up a great point which is that once you start to turn the implant on, you still need to work to learn to use the implant and it does take time and a lot of dedication. But, you’ve done fabulously with the implant from last year and so I'm almost certain that the other one is going to do just as well and it's just a process of, I guess the best way to describe it is it's sort of like learning to hear Donald Duck speak. So, the sound is a little bit abnormal and, you listen to Donald Duck and you can understand what he’s saying If you spend enough time listening to him. But, you have to learn and train yourself to do that.

[Tom] So, what have you been able to do with the implants that you couldn’t do before? Or, just, you know, has it affected your life in other ways?

[Shanice] It affected my life in a big way because, like I said, I was in school before, but I had stopped going to school because I couldn’t, you know what I’m saying, hear my teacher. I hear her but I couldn’t understand what she was saying. I always wanted to go to school for nursing, but my hearing stopped me because people’s lives are in my hands. So, if I couldn’t hear what my patient is saying and I can’t talk to doctors on the phone, then I can’t do that. So once I got my implant, I noticed a big difference and I was able to go through with my dream.

[Tom] Have there been any kinds of sounds that have been sort of new or unexpected for you?

[Shanice] Um, driving hearing the ambulance going past or in back of me, At first I couldn’t hear it at all. I’d be driving and the cars would be stopping. And the fire truck would just go around me. And I’m like, “Oh, my god, I didn’t know they were behind me.” Or the water running. I can hear the heat coming out of the vent. Um, let me see. Writing on paper. Just little bitty sounds. Writing on the chalkboard. Conversations down the hall.

[Tom] What’s it like to listen to music with the implants?

[Shanice] I love music. But, like, as my hearing decreased, I’m more of a… Let me see. I like the old music because that’s when I was able to hear better. So, I knew the words to the songs. But, as my hearing decreased, I stopped listening to music because I couldn’t understand what was being said in a song. So now I love listening to music and catching up, trying to learn different songs.

[Tom] Nice. So, how does someone with hearing loss know if they are a good candidate for cochlear implants? Because these don’t necessarily work for everybody.

[Dr. Goico]  That's a great question. Uh, sort of a complicated answer technically speaking, but at the end of the day if you have hearing aids and you find that despite really trying to reprogram them diligently, working closely with your audiologist, you're still not understanding sound and speech, that's when it's probably worth doing some additional testing to find out if you're a candidate. The additional testing is done in a sound booth, similar to the way a basic hearing test is done, but they do some more complicated tests, looking at hearing over background noise and sentence understanding that help to determine if you would benefit from a cochlear implant.

[Tom] Now, I understand that patients need to have hearing loss in both ears to qualify for cochlear implants, is that right?

[Dr. Goico] That is correct based on current FDA approval.

[Tom] And why is that?

[Dr. Goico] That’s the way they did the studies when they applied for FDA approval. There is some data that’s newer for some single-sided deafness about cochlear implantation, but it's an off-label use.

[Tom] So I understand Shanice that you're using your iPhone to improve your hearing experience. Can you tell us a little about how that works?

[Shanice] Yeah, I listen to the podcast an hour and a half a day. And it teaches me how to hear with the implant. Like basic words and learning.

[Tom] Do you listen with headphones or do you have like a Bluetooth in the implants?

[Shanice] I have Bluetooth from my implant to my phone. So, that’s where I talk on the phone. I talk on the phone a lot and it goes straight to my implants. No one else can hear it. So, I don’t have to hold my phone up to my ear.

[Tom] That’s handy. You don’t have that big Pop Tart right up next to your head. Do you listen to Health Talk by TriHealth?

[All laugh]

[Tom] So, what other capabilities does the iPhone link have with the implants, Dr. G?

[Dr. Goico] You can control the settings on the implant though the phone, which is very nice.

[Tom] And very discrete, too.

[Goico] Um huh. And it’s, talking on the phone was something that traditionally was hard for people with hearing aids or implants; and the blue tooth technology has really made that nice because it just steams directly through for both hearing aids and cochlear implants now. And before, you could imagine trying to hold a phone next to a hearing aid in order to talk. It was not ideal and very difficult to do. And so the blue tooth capabilities are great.  And I think you’re now getting a blue tooth stethoscope as well.

[Shanice] yes.

[Tom] And what would she use that for?

[Dr. Goico] For her patients. So she can then have the chest sounds go directly to the… so the blue tooth capabilities of some of these things have really exponentially grown within the past few years which is very nice. Very exciting.

[Tom] Excellent. How was your experience with TriHealth, getting the implants?

[Shanice] It’s very wonderful because, as I said before, I was having difficulties getting the implants. It took me several months until I just decided, hey, I’m going to call another audiologist and see if they can me and as soon as I did that, it was right on from there.

[Tom] So if someone else that you knew was thinking about getting a cochlear implant, what advice would you give them?

[Shanice] Go for it. It changed my life tremendously. Um, my mom lives out of town and our conversation was over the phone. And I never really talked to her because I couldn’t hear through the phone. Now we have a wonderful relationship. We talk every day on the phone. Um, me and my friends, I can hold conversations, I can go places now. So the cochlear implants helped me a lot.

[Dr. Goico] Glad to hear how well you’re doing with talking to your mom on the phone. That’s the kind of stuff that really excites me about doing this kind of surgery. That really means a lot to me to hear you say that.

[Shanice] It’s the one thing that I’ve been able to hear conversations, but like being able to talk on the phone was like really, really, really one of the worst things for me. So, me being able to talk on the phone with my friends; like I couldn’t even do FaceTime; I couldn’t hear. So, I didn’t really talk on the phone. I just texted all the time. Like handling business I had to go in person. I couldn’t talk over the phone or somebody else had to talk for me.

[Tom] And I know that the implants are improving all the time as the technology is getting better. Are there any exciting developments on the horizon that you’re aware of?

[Dr. Goico] One thing that I think is starting to occur and it’s still, in a lot of places, in the research phases, but MRI compatibility. So, traditionally, cochlear implants were not compatible with MRI scanners. We’re seeing more and more ways that you can get MRIs when you have a cochlear implant.

[Tom] How does that benefit a patient?

[Dr. Goico] If they needed a diagnostic MRI for any situation. So, if you get a cochlear implant but then down the road you have some concerning headaches or some other sort of symptom that might require an MRI scan, traditionally you couldn’t do that with the implant. I mean you could do it, but you had to take the magnet out, which is a small surgical procedure. And now, with splinting techniques, you can do MRI scans with the implant in. And I think the next generation we’re seeing is implants that don’t even need the magnet taken out, where you can do an MRI scan while the implant is there.

[Tom] Well, I really appreciate you both taking the time to be with me on the program. Thanks for joining us on Health Talk today.

[Dr. Goico] Thank you so much.

[Shanice] Thank you.

[Tom] You’ve been listening to Health Talk by TriHealth, where leading local care professionals help you to stay up to date on proactive health care strategies and to live a healthier lifestyle. New episodes of Health Talk by TriHealth are released on the first Tuesday of every month. I hope you’ll join us next time. You can listen to Health Talk online at TriHealth.com or search for Health Talk by TriHealth on SoundCloud, Apple iTunes or your favorite podcast source. This is Tom Tombush. Thanks for listening.

This podcast is intended for informational purposes only. It should not be relied upon to make a diagnosis or for treatment purposes. And this podcast does not create a physician-patient relationship. Please consult your health care provider or contact TriHealth to make an appointment if medical attention is needed. The views and opinions expressed in this podcast are those of the individuals interviewed and do not necessarily reflect the official policy or position of TriHealth or any of its affiliates. This podcast is the copyrighted work of TriHealth, which owns the exclusive rights thereto. Unauthorized use, copying and dissemination are illegal. Copyright 2019 TriHealth. All rights reserved.