April 25, 2014

Hearing loss helped by cochlear implants

After 40-plus years of declining hearing, communication had become a puzzle for Lucia Story.

After 40-plus years of declining hearing, communication had become a puzzle for Lucia Story.

“I could hear, but I couldn’t hear like most people do. I would get a word here and there, but I was missing so much,” said Story, 66, of Lake Worth. “I got to be a really good guesser.”

Embarrassed to admit how bad the problem was, Story said she tried to resign herself to learning sign language.

“If someone was face to face, it was OK, but if they were in another room, I had to go to them,” she said.

With hearing loss in both ears, Story had tried different hearing aids over the years with limited success. Last June, she received a cochlear implant in her right ear at the University of Miami Miller School of Medicine.

Cochlear implants are used in patients whose inner ear has been damaged and who need more than the amplification provided by a hearing aid. The implants come in two pieces, a surgically implanted internal device, and an external speech processor worn over the ear. The internal device is made to bypass the inner ear and directly stimulate the hearing nerve, said Dr. Diane Martinez, a cochlear implant audiologist and assistant professor at the University of Miami Miller School of Medicine.

More than 188,000 people worldwide have received cochlear implants, according to the Hearing Loss Association of America. The University of Miami does about 120 implants a year, split evenly between children and adults. About 30 percent of the adults are 65 and older.

With a cochlear implant, the interior portion is like replacing the keys on a piano and directly striking the chords, said Dr. Sergio Guerreiro, assistant professor of otolaryngology at the University of Miami Miller School of Medicine. The device bypasses the damaged inner ear, and creates electrical impulses that are sent to the speech transmitter. The results are a range of sounds that the patient must learn to reinterpret.

“At the beginning, we paint a lot of doom and gloom, because there is a lot of relearning that the brain has to do,” Martinez said. “On day one, sounds may be very unclear for most patients. They may hear knocking sounds, but there won’t be any clarity.”

The rate at which the person gains clarity is different for every patient, she said.

“The fastest I’ve seen it in adult patients is about three weeks. The longest time seeing them come along … is about two years,” Martinez said.

Story said about a month after the surgery, she began to hear subtle sounds: lettuce tearing, scissors cutting through fabric, the car key turning in the ignition.

“It was amazing,” Story said. “I was lucky, because I remembered some of these sounds, so I recognized them.”

After an implantation, the device is periodically adjusted or “programmed,” Martinez said, and patients are advised to wear it all working hours.

“There is a rewiring of the brain that is going on, so we advise the patients that once we turn it on, they have to wear it from sun up to sun down,” she said.

Adult patients can seek speech therapy, like many child patients do, but most adults find it difficult to fit into their schedules, Martinez said. “So we tell them that the best therapy is speaking with their families, talking with their friends … and continuing to use the visual cues and face-to-face communication that they were using before the surgery,” she said.

Many insurance companies and Medicare cover the cost of cochlear implants. Candidates have to be healthy enough to undergo surgery, and they must have a moderate-to-profound nerve hearing loss, Martinez said. Doctors also look at the duration of the hearing loss, and a patient’s word recognition rate to determine if the patient is suitable.

“We typically don’t recommend implants for those who have been deaf since birth,” and who are seeking an implant in their later years, Martinez said. “It’s like being in a dark room all your life, and then coming out into the sunlight. It’s too much, and people can’t adjust.”

But she has seen some cases where patients were born hearing, lost it in their 40s, and sought implants after 20 years of being deaf. “Slowly but surely some of them do well. It’s all on a case-by-case basis,” Martinez said.

Story said she feels lucky that the cochlear implant has worked so well for her.

“When you don’t have all five senses working, the others have to compensate. If you cross a street, and you cannot hear, you have to make up for that visually,” she said. “To be given my five senses, a God-given gift — to have a medical team help me reclaim it, brings me to tears.”

In her experience, Martinez said about 85 to 90 percent are happy with the result.

“Some perform at 70 percent, but they’re happy,” she said. The remaining 10 to 15 percent are usually not satisfied because there is some issue with the cochlea, such as prior illness or anatomical issues, which prevent them from getting optimal use.

Aging can present limitations. “When someone experiences hearing loss, there can be an unwiring of the brain, so sometimes if an implant provides a signal again, with aging there is sometimes an issue with processing the sound,” Martinez said.

“But in terms of age alone, we don’t have limitations. My oldest patient was 92 and she did amazing,” she said. “Probably about two months out, I could stand behind her, and without any visual cues, she could hear everything I said.”

Functionality varies per patient. About 70 percent are able to use the phone and hear a television, Martinez said.

Patients are advised about success rates before they get implanted, she said. “We don’t want to get their expectations really high, and they get bummed out when it doesn’t work,” Martinez said.

There are assistive devices available, such as microphones that patients can use in noisy areas, or assistive listening devices that can be plugged into their speech processors.

“Accessories are available, but most don’t need it,” Martinez said. “Most of our patients can use their devices as is.”

The implant has changed many lives, she said.

“We’ve had people who have gone into seclusion, separate themselves because they can’t hear, or they’ve lost their job, and once they get this device they do a 180, and they pick up right where they left off,” Martinez said.

Story said one of the greatest benefits is that she can hear her grandchildren.

“Every morning I put my processor on, and my world wakes up,” she said.

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