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Advancements of Cochlear Implants for the Hearing Impaired
Ashkan Monfared, MD, discusses the advancements of cochlear implants for restoring hearing in patients who have lost the ability to hear naturally. Dr. Monfared explains which individuals are candidates for this surgery, the pre- and post-operative measures taken, and recovery considerations based on the wide spectrum of patients who are eligible for this treatment. He also shares information on the difference between hearing aids and cochlear implants.
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Learn more about Ashkan Monfared, MD
Ashkan Monfared, MD
Ashkan Monfared, MD is board-certified in Otolaryngology and was recruited from Stanford University to serve as the Director of Otology and Neurotology, and is a member of the medical staff at George Washington University Hospital and is affiliated with The George Washington University Hospital and GW Medical Faculty Associates.Learn more about Ashkan Monfared, MD
Transcription:
Advancements of Cochlear Implants for the Hearing Impaired
Dr. Mike Smith (Host): Welcome to GW Healthcast. I’m Dr. Mike Smith. Today’s topic is cochlear implants. My guest is Dr. Ashkan Monfared. Dr. Monfared is an Otologist and a Member of the Medical Staff at the George Washington University Hospital and is affiliated with The George Washington University Hospital and GW Medical Faculty Associates. Dr. Monfared, welcome to the show.
Dr. Ashkan Monfared (Guest): Thank you. It’s nice to be with you.
Dr. Smith: Let’s just start with what are cochlear implants?
Dr. Monfared: Cochlear implants are devices that can restore hearing to patients who have lost the ability to hear naturally and particularly with hearing aids. These are implants that are placed under the skin, into the bone behind the ear, and there is this fine electrode that goes into the inner ear, known as the cochlea, and will send electrical signals to the nerve of hearing, bypassing all the conduction mechanisms of hearing.
Dr. Smith: And so when these cochlear implants are placed, what kind of sounds are the patients able to hear? Can they hear clearly? Are there some limitations to it? Explain a little bit about what that experience is like.
Dr. Monfared: Yeah, and it’s a wide spectrum and depends on the residual hearing that the patients had. In the past, we used these for patients who were completely deaf, but over the years, there has been more and more use in patients with more and more residual hearing. Now, there are studies even in patients who have excellent hearing in the other ear on the other side and is being implanted in to the ear with poor hearing.
It has been called a bionic ear because the sound that is produced is quite electric. The best analogy that I can give you is listening to a singer whose voice is going through a synthesizer, which is a techno kind of sound, or if you think about an acoustic guitar versus an electric guitar. The quality of the sound is not the same as regular sounds. It also cannot play music very well because it does not provide both amplitude and frequency modulation. However, unlike hearing aids, which only make things louder, cochlear implants have the ability to make sounds clearer because they are not dependent on the function of the cochlea itself, they bypass the little cells of hearing that we all have in the inner ear and directly stimulate the ear nerve.
Dr. Smith: Tell us – or walk us through a little bit exactly how the procedure is done starting when the patient is first seen and to when the procedure is complete.
Dr. Monfared: Sure, it is a rigorous process in the sense that before, during, and after surgery, quite a few steps have to be done. The first thing is making sure that the patient meets the guidelines established by the FDA and CMS in terms of ability to receive the cochlear implantation. They will go through a battery of comprehensive hearing tests and balance test before the surgery. They receive vaccinations because cochlear implants have a slightly higher rate of meningitis in patients who have received them than the general population, imaging studies like MRI and CT scan, and once everything is set up we will proceed with implantation.
Surgery takes about between one and two hours depending on the patient's anatomy and age. The implant is placed behind the ear and on the skin and goes into the inner ear or the cochlea. We wait about two to three weeks for the incision to heal and then they can use the external processor and activate the internal implant.
The internal implant is passive as it does not have any battery in it. The energy is conveyed through coils that are on the external processor. The external processor and the internal processor clip to each other using magnets, so it stays on the skin. When the patient is not wearing their external processor, we can’t see that they actually have an implant. You can only tell when they wear the external processor, and they communicate by coils around the magnet and convey the sound to the patient.
From then, it’s a matter of our audiologists or hearing specialists finding the best algorithm assimilating these electrodes for the patient to hear, and also, it’s for patient’s brain to get used to these electronic sounds and deciphering what the signals mean, and gradually -- gradually, the two meet in the middle, and the patients are able to identify words and hear a lot better.
Dr. Smith: And I would assume that process of being able to identify words is different for each patient?
Dr. Monfared: Yes, much of it is dependent on the patients’ age, how long they have been without hearing in that ear, what was the cause of the hearing loss. For example, patients whose hearing loss is particularly from inner ear deficits, this would be patients who, for example, received an antibiotic that is toxic to the ear – they’ve lost all of their inner cells. They do very well with cochlear implants. Patients who have nerve degeneration and they have been without hearing and deaf for maybe three, four, five decades, they won’t do as well – they don’t perform as well, but with hard work, patients continue to get better and better hearing from surgery.
Dr. Smith: Now, right after the surgery – so maybe a day or so – what kind of recovery period are we talking about? Or, are they – do they start that therapy to learn how to translate the sound of words immediately or is there a recovery time?
Dr. Monfared: There is a recovery time because the two magnets couple to each other, they will exert pressure on the skin between the two magnets, so we need to allow the skin from the time of surgery to completely heal before we exert that pressure. On average, we wait between two and four weeks depending on the patient's age and skin thickness to allow for the skin to heal. Then, that is what we call the activation day. They come on that day and meet with the audiologist and the implant on the inside – and the implants get activated.
For most patients, it’s an outpatient procedure, meaning that we don’t keep the patients in the hospital after surgery. They go right home. And it is a spectrum in terms of how fast people tend to recover. A small portion of patients who receive them will have some balance issues for a few days, but many are up and about that evening and return to work within three to four days.
Dr. Smith: So, in summary, Dr. Monfared, what would you like people to know about cochlear implants?
Dr. Monfared: The best thing that I can say is if your hearing cannot be rehabilitated as well with a hearing aid -- if you’re suffering from hearing loss and cannot use a hearing aid to hear your loved ones to talk on the telephone, to hold a conversation with people who are not facing you directly in a very quiet room, it’s time for you to think about cochlear implantation as an option. It is not a good option for everybody, but it is a great option for a large group of patients who are not receiving benefit from hearing aids.
Dr. Smith: Well, Dr. Monfared, I want to thank you for coming on this show today, and thank you for the work that you are doing. You're listening to the GW Healthcast. Please visit GWDocs.com to get connected with Dr. Monfared or another provider, or call 1-888-4GW-DOCS to schedule an in-person or virtual appointment.
This is Dr. Mike Smith. Thanks for listening.
Advancements of Cochlear Implants for the Hearing Impaired
Dr. Mike Smith (Host): Welcome to GW Healthcast. I’m Dr. Mike Smith. Today’s topic is cochlear implants. My guest is Dr. Ashkan Monfared. Dr. Monfared is an Otologist and a Member of the Medical Staff at the George Washington University Hospital and is affiliated with The George Washington University Hospital and GW Medical Faculty Associates. Dr. Monfared, welcome to the show.
Dr. Ashkan Monfared (Guest): Thank you. It’s nice to be with you.
Dr. Smith: Let’s just start with what are cochlear implants?
Dr. Monfared: Cochlear implants are devices that can restore hearing to patients who have lost the ability to hear naturally and particularly with hearing aids. These are implants that are placed under the skin, into the bone behind the ear, and there is this fine electrode that goes into the inner ear, known as the cochlea, and will send electrical signals to the nerve of hearing, bypassing all the conduction mechanisms of hearing.
Dr. Smith: And so when these cochlear implants are placed, what kind of sounds are the patients able to hear? Can they hear clearly? Are there some limitations to it? Explain a little bit about what that experience is like.
Dr. Monfared: Yeah, and it’s a wide spectrum and depends on the residual hearing that the patients had. In the past, we used these for patients who were completely deaf, but over the years, there has been more and more use in patients with more and more residual hearing. Now, there are studies even in patients who have excellent hearing in the other ear on the other side and is being implanted in to the ear with poor hearing.
It has been called a bionic ear because the sound that is produced is quite electric. The best analogy that I can give you is listening to a singer whose voice is going through a synthesizer, which is a techno kind of sound, or if you think about an acoustic guitar versus an electric guitar. The quality of the sound is not the same as regular sounds. It also cannot play music very well because it does not provide both amplitude and frequency modulation. However, unlike hearing aids, which only make things louder, cochlear implants have the ability to make sounds clearer because they are not dependent on the function of the cochlea itself, they bypass the little cells of hearing that we all have in the inner ear and directly stimulate the ear nerve.
Dr. Smith: Tell us – or walk us through a little bit exactly how the procedure is done starting when the patient is first seen and to when the procedure is complete.
Dr. Monfared: Sure, it is a rigorous process in the sense that before, during, and after surgery, quite a few steps have to be done. The first thing is making sure that the patient meets the guidelines established by the FDA and CMS in terms of ability to receive the cochlear implantation. They will go through a battery of comprehensive hearing tests and balance test before the surgery. They receive vaccinations because cochlear implants have a slightly higher rate of meningitis in patients who have received them than the general population, imaging studies like MRI and CT scan, and once everything is set up we will proceed with implantation.
Surgery takes about between one and two hours depending on the patient's anatomy and age. The implant is placed behind the ear and on the skin and goes into the inner ear or the cochlea. We wait about two to three weeks for the incision to heal and then they can use the external processor and activate the internal implant.
The internal implant is passive as it does not have any battery in it. The energy is conveyed through coils that are on the external processor. The external processor and the internal processor clip to each other using magnets, so it stays on the skin. When the patient is not wearing their external processor, we can’t see that they actually have an implant. You can only tell when they wear the external processor, and they communicate by coils around the magnet and convey the sound to the patient.
From then, it’s a matter of our audiologists or hearing specialists finding the best algorithm assimilating these electrodes for the patient to hear, and also, it’s for patient’s brain to get used to these electronic sounds and deciphering what the signals mean, and gradually -- gradually, the two meet in the middle, and the patients are able to identify words and hear a lot better.
Dr. Smith: And I would assume that process of being able to identify words is different for each patient?
Dr. Monfared: Yes, much of it is dependent on the patients’ age, how long they have been without hearing in that ear, what was the cause of the hearing loss. For example, patients whose hearing loss is particularly from inner ear deficits, this would be patients who, for example, received an antibiotic that is toxic to the ear – they’ve lost all of their inner cells. They do very well with cochlear implants. Patients who have nerve degeneration and they have been without hearing and deaf for maybe three, four, five decades, they won’t do as well – they don’t perform as well, but with hard work, patients continue to get better and better hearing from surgery.
Dr. Smith: Now, right after the surgery – so maybe a day or so – what kind of recovery period are we talking about? Or, are they – do they start that therapy to learn how to translate the sound of words immediately or is there a recovery time?
Dr. Monfared: There is a recovery time because the two magnets couple to each other, they will exert pressure on the skin between the two magnets, so we need to allow the skin from the time of surgery to completely heal before we exert that pressure. On average, we wait between two and four weeks depending on the patient's age and skin thickness to allow for the skin to heal. Then, that is what we call the activation day. They come on that day and meet with the audiologist and the implant on the inside – and the implants get activated.
For most patients, it’s an outpatient procedure, meaning that we don’t keep the patients in the hospital after surgery. They go right home. And it is a spectrum in terms of how fast people tend to recover. A small portion of patients who receive them will have some balance issues for a few days, but many are up and about that evening and return to work within three to four days.
Dr. Smith: So, in summary, Dr. Monfared, what would you like people to know about cochlear implants?
Dr. Monfared: The best thing that I can say is if your hearing cannot be rehabilitated as well with a hearing aid -- if you’re suffering from hearing loss and cannot use a hearing aid to hear your loved ones to talk on the telephone, to hold a conversation with people who are not facing you directly in a very quiet room, it’s time for you to think about cochlear implantation as an option. It is not a good option for everybody, but it is a great option for a large group of patients who are not receiving benefit from hearing aids.
Dr. Smith: Well, Dr. Monfared, I want to thank you for coming on this show today, and thank you for the work that you are doing. You're listening to the GW Healthcast. Please visit GWDocs.com to get connected with Dr. Monfared or another provider, or call 1-888-4GW-DOCS to schedule an in-person or virtual appointment.
This is Dr. Mike Smith. Thanks for listening.