Cochlear Implants: 2010 and Beyond - Part One

By Cheryl Heppner

May 2010

Editor: The folks in Virginia recently held their third cochlear implant conference, and reporter extraordinaire Cheryl was there to record the proceedings. I think she was just warming up for the summer conferences! Here's her report. This is part one of three parts.

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Here's Part Two

Here's Part Three

Here's Part Four

Congratulations to Arva Priola, the team at the Disability Resource Center, and conference supporters AT&T, Mary Washington Healthcare, Med-El, Virginia Department for the Deaf and Hard of Hearing, and Virginia Relay. The third state cochlear implant conference held in Fredericksburg on Saturday, May 22 was terrific! I saw a lot of familiar faces in the audience, including some I haven't seen for a long time, and met lots of interesting new people.

Opening Remarks

State Senator Edd Houck, who represents Virginia's 17th District, gave the conference welcome and opening remarks. I enjoyed his stories about how people in his life taught him about deafness and hearing loss, and how it has influenced him. Years ago Sen. Houck, the father of two children with disabilities, became director of special education in Fredericksburg. At said that time he had compassion and passion, but didn't always have the information to know how to help children with hearing loss.

He talked about being a teacher of a young student with hearing loss. He met the child's mother, who told him that her child had a cochlear implant. Sen. Houck was puzzled because he had no idea what she was talking about. He was grateful that this "kind-hearted advocate" didn't comment on his ignorance; instead she pulled out written information about the cochlear implant, offered it to him, and explained the technology.

Sen. Houck praised the attendees for being involved at conferences like this, and for making information available to others such as policymakers and public safety officials. He recognized Arva Priola, calling her a "real advocate" in the General Assembly, and said he had been blessed with the opportunity to work with her as she educated others.

"She even talked me into trying to fight the insurance industry to pay for hearing aids for children," he said. "It is like trying to climb Mount Everest."

Overview of Cochlear Implants

Thomas Frank introduced the conference's keynote speaker, Dr. Daniel Coelho, who is a cochlear implant surgeon at Virginia Commonwealth University. Mr. Frank called Dr. Coelho one of the busiest cochlear implant surgeons in the area, and probably the nation.

Dr. Coelho opened his presentation with a disclaimer. He said that the most important thing when considering a cochlear implant is to have reasonable expectations before stepping into an operating room, because individuals with cochlear implants have a wide variety of outcomes.

Past History

Next Dr. Coelho, a history major in college, took us on a little trip. We learned about Alessandro Volta, whose research found that hearing has an electrical component. A hands-on guy, Volta tested electricity on himself. He first heard a "boom within the head", followed by a sound like thick soup bubbling.

Fast forward to the early 1950s, when two French surgeons operated on a deaf man, using a piece of metal with electric wires, just to see if it worked. In the early 1960s and 1970s, people started getting interested in this technology from a capitalist perspective. A single-channel cochlear implant was developed by labs in Los Angeles and Melbourne. It basically gave a result of sound on or off but no real discrimination of what the sound was.

The big breakthrough came when Australian Graeme Clark developed the first multi-channel cochlear implant that gave different sound frequencies.

Dr. Coelho showed us a slide of an early cochlear implant processor, a real behemoth compared to today's slim behind-the-ear version. The computer used to run that processor took up an entire room.

Where We Are

Today, Dr. Coelho told us, there are three main FDA-approved cochlear implant manufacturers. "All are great and work wonderfully," he said. "There is little advantage of one over another." Altogether there are an estimated 130,000 cochlear implants worldwide.

The Ear and Cochlear Implants

The cochlea in each of our ears looks like a snail. Different parts of it encode different frequencies of sound. Scientists have learned to exploit the architecture of the inner ear to deliver different frequencies. There are even parts of the ear that encode for frequencies we can't perceive.

A cochlear implant doesn't deal with the hair cells in our ear as a hearing aid does. During surgery, an implant is threated through the cochlea. Little bands on the implant have electrodes that send information up the coil to the transmitter where the magnet sits. The "brain" of the cochlear implant is on the outside of the head, in the processor.

Adult Candidates

There is no age limit for adults who want cochlear implant surgery. Dr. Coelho said there are people high up in their nineties who did great. One of his interests is in these older patients. He has found that a very healthy individual of 80 can do better than one in poor health who is 25.

To qualify for a cochlear implant, an adult must have a bilateral hearing loss in the severe to profound range of about 70 decibels or greater, with little or no benefit from hearing aids after a 6-month trial. Dr. Coelho points out that "little or no benefit" can be very subjective, as you may feel you do very well with the hearing aid or that your hearing is terrible with it.

You must be also be found psychologically suitable, have no anatomic or medical contraindications, and you must have a cochlea. One of the audience asked whether sleep apnea of more than 15 years would rule out cochlear implant surgery. Dr. Coelho explained that the issue would be the use of anesthesia. There could be a higher risk of complications depending on the severity of the sleep apnea.

Children

Children 12 months and older with bilateral, severe to profound hearing loss may also be candidates. Determining the extent of their hearing loss can be tricky, Dr. Coelho said, as babies can't raise their hands to let you know that they've heard a sound. Testing is done by individuals who are experienced in recognizing a child's behavior and other clues that indicate a sound has registered. There must also be a commitment to a child's doing speech therapy and auditory/verbal therapy.

A question was raised about why children have to go through a trial to receive cochlear implants. Dr. Coelho said this is because some children do well with a hearing aid, and even the best objective measures of hearing can be wrong. In evaluating for surgery, attention is also paid to learn whether the child will wear the hearing aid and whether the parents will encourage them to do so.

Here's Part Two

Here's Part Three

Here's Part Four

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