Cochlear Implants

Surgery, Activation, and Life with CIs

27 January 2021

On this episode, we spoke with Peter, who is a cochlear implant user. He talks about his journey to implantation and his hearing post-surgery. We are also joined by Dr. David Powell, who talks about the evaluation process and Dr. Chad Ruffin, who is a CI surgeon and CI user himself.

Cochlear Implants: Surgery, Activation, and Life with CIs

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Podcast transcript

Steve:  Science fiction has always depicted a future where humans and robots live side-by-side. We've seen stories where robots help with daily activities, return from the future, and others where humans obtain robotic body parts. Blurring the lines between human and machine altogether. Today, thanks to advancements in medical sciences, our reality isn't that far off from these once futuristic stories. And some of these advancements have allowed us to interface with our hearing system in an almost unthinkable way.

On this episode, we spoke with Peter, who is a cochlear implant user. He talks about his journey to implantation and his hearing post-surgery. We are also joined by Dr. David Powell, who talks about the evaluation process and Dr. Chad Ruffin, who is a CI surgeon and CI user himself.

Can you hear me now?

This is the Hearing Tracker Podcast from HearingTracker.com.

Peter:  I had the most incredible hearing. I could hear a bat like a flute. It was so loud and clear. It was just brilliant.

Steve:  That's Peter, and like millions of people around the world with hearing loss, he started struggling in his day-to-day activities.

Peter:  It was becoming impossible to do anything. You could sit in a room. I couldn't join the conversation. I couldn't listen to a telephone call. When the phone rings I hand it to my wife, because there was no way I can hear on the darn thing.

Steve:  Peter was diagnosed with hearing loss and he did try hearing aids. While they helped him for a while, his hearing loss progressed, causing more problems.

Peter:  It brought back the hearing, but the hearing just went gradually down and down. You know, so the hearing aid became ineffective. And, uh, I went for a two or three tests and everybody said, okay, I think you need a cochlear implant.

So, of course I looked up on the web and saw there's about four or 500,000 been done. And it sounds like Donald duck and all the good messages that one sees on the internet.

Steve:  If you're familiar with hearing aids, you probably already know that there are lots of questions around the technology levels, companies, and pricing. When people are told they may need a cochlear implant, there tends to be a whole other level of uncertainty as they're not as common, and they involve a surgery.

In a nutshell, hearing aids are very advanced pieces of technology that take into account a person's hearing profile to improve audibility of sounds that wouldn't otherwise be heard. They do not fix hearing loss. Rather they aid your hearing injury and work with any hearing you still have. That's where they get their name.

On the other hand, a cochlear implant involves a surgery where a roughly one inch long electrode array is inserted into the cochlea of your hearing system. This replaces the damaged hair cells that would normally communicate with your hearing nerve. A processor is also worn over the ear, similar to a hearing aid to capture and process sound. From there, the electro-acoustic information is sent to the electrode array, stimulating your hearing nerve, creating the sensation of sound.

At this point in a person's hearing journey, there tends to be a lot of frustration as hearing loss tends to be more severe, and the benefit from hearing aids minimal. Fortunately, this is where an audiologist or a cochlear implant surgeon can perform a cochlear implant evaluation.

David:  There's a couple choices that people face when transitioning from being a hearing aid user.

Steve:  That's Dr. David Paul. He's an audiologist who's been working with patients in cochlear implants for years.

David:  When beginning the process of looking at implantation. Generally, you're going to be talking with either the audiologist or hearing provider that you've been seeing and kind of discussing if a cochlear implant is an option. One of the things that you should consider though, is not as many people are familiar working with cochlear implants is you might want to find a team, a surgeon, ear, nose, throat physician, an audiologist who have worked with cochlear implants to begin determining if first off you are a candidate based on your hearing loss.

And in order to do that, they'll do various tests to determine the level of hearing that you have remaining, and also, what is your functional ability by assessing word and sentence testing, both in quiet and a noise.

Steve:  Fortunately, advancements in both medicine and technology have helped reduce the barriers for people who may not have direct access to professionals and these types of evaluations.

David:  There are many ways in which the barriers have been reduced to try to help make cochlear implants available. Sometimes you might find that the surgical teams have partnered with satellite clinics and they will do telehealth appointments to do the assessment and a psychological assessment to make sure you're prepared for the implantation.

Steve:  Another concern and many people have is what costs are involved with obtaining a cochlear implant. After all, the average cost of a single hearing aid is over $2,000. And since a cochlear implant involves surgery, it must cost even more. But the answer to this question might surprise you.

David:  The majority of insurances do cover cochlear implants. Insurances do cover the surgery. They also cover the follow-up care. Sometimes there are referral requirements needed based on the various types of insurances you have, but these services are covered by insurance. Insurances view cochlear implants differently than they do hearing aids. While insurances consider hearing aids to be a cosmetic device, and thus do not always cover hearing aids, cochlear implants fall under a surgical medical procedure, and therefore the insurances do cover them.

Steve:  When we come back from the break, we'll be speaking with cochlear implant surgeon Dr. Chad Ruffin regarding the remainder of the evaluation process, the surgery, and post-operation.

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We began our story with Peter, who is struggling to hear during common activities like watching television, while talking on the phone, and even while holding on a conversation. This led him to pursue hearing aids, and then later a cochlear implant. We then spoke with Dr. David Paul, about the process of having a cochlear implant evaluation. During this evaluation, your hearing will be assessed to determine if you're a candidate for cochlear implants. Various speech tests, both in quiet and noise will also be performed to get a better understanding of the residual fidelity of your hearing.

The next step in our journey for people like Peter is to visit a cochlear implant surgeon. Then your candidacy can be assessed from a medical standpoint.

Chad:  When they come to me, we usually have a first appointment where we talk about their hearing history, medical history, establish that they are a candidate.

Steve:  That's Dr. Chad Ruffin, a cochlear implant surgeon and user. He is a strong advocate for best practices, cochlear implants, and finding the right hearing help.

Chad:  My goal is to get them thinking about it so that they don't waste a decade, and most people wait about 10 to 12 years before getting an implant. I tell patients that it is extremely rare for people not to benefit from a cochlear implant. It's more rare to actually do worse with a cochlear implant than they were doing with their hearing aids. It's exceedingly rare for people to totally regret the entire process and want the thing completely gone.

If they are a candidate and they want to go forward, we have to get imaging to make sure that their cochlea can ... their inner ear can accept the electrode ... that you can successfully put it in.

Steve:  This routinely involves a medical workup, such as a CT scan and magnetic resonance imaging, or an MRI.

Chad:  The surgery lasts one to two hours and they go home usually the same day. And they're activated about two weeks later.

Steve:  Activation refers to the first time that your cochlear implant is turned on. As Dr. Chad mentioned, this happens several weeks after the surgery and that's needed to give your body time to heal. But once a cochlear implant is activated, what is it like? And what are the expectations?

Chad:  About half of people or just over half of people can talk on the phone with a cochlear implant. A lot of implant patients enjoy music, but that enjoyment is going to be much different than a person who had normal hearing prior. Right now we expect people to hear about 80% of what's said in quiet.

The rehabilitation process is pretty intense for most people. It's kind of like learning to walk again. Some people will go really, really quickly and their brains will be able to make sense of the information super quick. And then we have patients who take a long time to get up to speed. So generally there's going to be a lot of appointments in the first month to fine tune and then fewer and fewer appointments over the span of the next year. Most patients will experience a good deal of benefit between the second and sixth months. They'll get most of their benefit there. They'll continue to improve more slowly between six months and a year.

Speech and noise it a little bit different and hearing with two ears, being able to lateralize sound is a little bit different. Those improvements can continue for years after the implant, but they're usually pretty minimal.

Steve:  When considering cochlear implants, it's important to remember that we're providing a very different form of stimulation than our brains are used to. So in many ways it is similar to learning a new language or sport. It takes time to develop the skills that eventually, and hopefully, become more second nature.

At the beginning of this podcast, we heard from Peter and his experiences before being implanted. So where did Peter land on this process and what was it like for him when he first had his cochlear implant activated?

Peter:  So, a year and a half ago, I had the op, and, um, it's been incredibly successful. It was successful from the word go. Of course the switch on, can you hear me? Yes, I can hear you. What does it sound like? A man or a woman? Haven't a clue. It sounds really more like a man, I think

Within minutes it started sounding like a lady because the audiologist is a woman. What happened was there, you get what I call an upper channel. You've got two channels, you've got your voice channel, and then this chirpy chirpy chirp noise at the top. "Ch", "ch", "ch", "ch". And, uh, that was present immediately. And I said, you know, jeepers, what's this chirping going on? Oh don't worry about that. That'll disappear. Over the period of the next three weeks, a month, I just listened to masses of audio books and the speech came fast.

I was given a mini mic, and, um, I was able to make a telephone call with that. I didn't need to go through the procedure where somebody's read me something and I would repeat it back.

What was fascinating was that it took about three months for birds to become birds.

I suddenly listened, and gee, that sounds just like a bird now. It's got a lovely chip. And when you stirred your your cup of tea, that sounded like a chink on the cup.

So it was a big change. All of a sudden, you suddenly noticed that all these noises, they were ... you could hear them before, but they were different. And then all of a sudden they slotted into place on my birthday, which was five, six weeks after my activation. I could have a conversation on my cell phone with my son for my birthday. I mean, that was just magic. Really was.

Steve:  Another concern Peter had before implantation was how would music sound after the surgery? As he's a musician and lover of the arts, it was important for him to keep this part of his life and both play guitar and enjoy musical performances. Music is a very complex signal for our ears and brains to process. There are constant pitch and volume changes, and this is compounded by multiple instruments and the interactions between the notes being hit.

This can be a lot to ask of a cochlear implant. While they are marvels of modern science, they still don't match the original fidelity of our hearing system. Furthermore, there are a lot more variables, as we're introducing sound to our hearing nerve by a processor and electrode array.

Peter:  The thing that I was immediately interested in was trying to get hold of ... listen to music. So, I mean, I came home immediately and picked up the guitar and it sounded absolutely terrible.

Steve:  Now there's currently no way to say exactly what a cochlear implant sounds like, because it will be different for everyone, but that's an emulation based on the processing sound goes through in a cochlear implant. Could you tell what it was, how about now?

Peter:  But what I did find was percussion was perfect, straight away. Just amazing. Absolutely. You could hear the snare drums on the [Peter verbalizes drum noise] . That sound came across so beautifully. I could listen to Beethoven's Emperor, and apart from the loud orchestral passages, I could enjoy Beethoven straight away. Five weeks after my implant, I actually went to a live concert and I listened to Berlioz Symphonie Fantastique. And it was absolutely amazing. I enjoyed every minute of it.

Steve:  Peter has experienced great outcomes from his cochlear implant. As he mentioned earlier, he made an effort to listen to many books on tape. Now doing this, and other forms of rehabilitation, helps your brain relearn how to hear through your cochlear implant, Peter attributes much of his success to this rehabilitation.

Peter:  There's so few people interested in actually trying to improve their hearing. Rehab is a non happening.

Steve:  Realizing this problem and the benefits he's experienced, Peter explored different ways to help others like himself. Ultimately, this resulted in him creating a website around rehabilitation and designing several apps to help with the process.

Peter:  So here we go. Now see here's a ... I've got a website now with a forum and all the references that will take anybody who's interested around the CI / hearing aid universe. It's got masses of stuff on it. I've just added about 400 odd words into the app, words beginning with C, D, M, N, "Ch" and "Sh". So there are masses of words. You can play these to your heart's content.

For example, there's a progressive sentence. It's, um, I like. I like to play. I like to play in the park. I like to play in the park with my brother. I like to play in the park with my brother and sister with the football, duh, duh, duh, duh, you know? So, so that's, that's one of them. What I've tried to do is make them different. I've given them different slants and a different way of working. hopefully.

Steve:  Peter hopes that by creating content like his website and apps, others that struggle with hearing can learn and hopefully get the most out of their hearing aids and their cochlear implants. Ultimately allowing them to get back to enjoying the world around them, like he did.

Peter:  I think it was the beauty of the birds, because we've got a lot of birds in the garden, and it's just... I wake up in the morning now and I put my CI on and you can hear the dawn chorus, and I think that's probably one of the most fantastic things.

And today, which is a year and a half later, I was listening last night to Neil Diamond and Simon and Garfunkel and enjoying it. And so it means that there's absolute definite progression and it's coming better.

Steve:  There's a lot to take away from Peter's story, but a big part of it is that advancements in medical care and technology means that there's almost always something that can be done to aid hearing problems. And those solutions and outcomes are getting better with every year.

If you are a hearing aid user, and wonder if you may be a cochlear implant candidate, speak with your audiologist right away. There are also lots of online tools, such as Cochlear's Hearing Aid Check, which is a free online tool to help assess whether you may benefit from a cochlear implant. You'll fill out a short questionnaire, and depending on your results, it may recommend that you speak with your hearing healthcare provider. Take the hearing aid check now, at www.hearingaidcheck.com/us.

The Hearing Tracker Podcast is hosted by me, Steve Taddei. Each episode, we reach out to people with hearing difficulty and / or industry leaders to talk about the hearing system, innovative technologies, and what's to come. This episode was written, produced, and sound designed by me with help from Abram Bailey and TJ Belek.

We'd like to thank our guests, Peter, Dr. David Paul and Dr. Chad Ruffin. If you'd like to learn more about Peter's story or the resources available, you can visit his website and we'll include a link within the transcription of this episode. You can also check out his Android-based apps, Bend My Ear, and Get an Earful.

Dr. Paul is an audiologist and VP of professional services at a non-profit in Rockford, Illinois. If you'd like to learn more about their services, you can visit CSHNI.org. Lastly, if you'd like to learn more about Dr. Chad and the fantastic work he's doing visit ChadRuffinMD.com.

If you have a unique story related to your hearing, or if there's another show topic you'd love to hear, share it with us and send a line to steve@hearingtracker.com.

Finally, you can find much more helpful content and keep up to date by visiting us on Facebook, Twitter, or HearingTracker.com. Thanks for listening.