Transcription:

Alyne: Losing one's hearing can be so isolating. And for some people with severe hearing loss, hearing aids just don't help. Here to tell us more about who could benefit from a cochlear implant is Dr. Candace Colby-Scott, an otolaryngologist at McLaren Health. This is McLaren's In Good Health, the podcast from McLaren. I'm Alyne Ellis. Welcome, Dr. Colby-Scott.

Dr Candice Colby-Scott: Thank you. Happy to be here.

Alyne: Let's begin with an explanation of what is a cochlear implant.

Dr Candice Colby-Scott: Cochlear implant is an electronic surgically-implanted hearing device. So it is placed during a surgery and then there is an external portion that connects through a magnet, through the skin, that you were on the outside of the ear. And the cochlear implant is different than a hearing aid in that it doesn't amplify sounds from the external environment like a hearing aid does. But rather it takes the sound from the environment and converts it to an electrical signal, which is then transferred to the internal device and stimulates the hearing nerve directly. So your brain interprets those electrical signals as sounds such as speech and different noises in the environment.

Alyne: And how long is the surgery to implant this device?

Dr Candice Colby-Scott: The surgery itself takes usually a couple of hours. So it's outpatient. You come in and go home the same day. It's pretty straightforward. It's not too painful of a surgery generally for most people.

Alyne: So who may be a candidate for this device and are all hearing-impaired individuals a fit for using a cochlear implant?

Dr Candice Colby-Scott: So cochlear implants are really designed for those people with severe hearing loss that no longer benefit from hearing aids. So therefore, people who have severe hearing loss in both ears or complete hearing loss in one ear. Where we used to do this procedure in people who were only profoundly deaf, but now we know that there's benefit to implanting people earlier when there is some remaining hearing, but not enough that hearing aids help.

So not all hearing-impaired individuals are candidates, but really those people that are no longer getting benefit from traditional hearing aids.

Alyne: And I had watched a video on the McLaren website that details this. And they did say that sometimes when you have a little bit of hearing left, you can still preserve that at the same time as getting the implant. Is that right?

Dr Candice Colby-Scott: Yes, that's correct. And again, when we did this procedure, even five, ten years ago, we would expect that all of the hearing in the ear would be gone so that it would destroy any nerve cells or hearing cells remaining. But now, the techniques we use are much less traumatic and the thought is that we actually can preserve as much of that natural structure as possible. And the more natural structure that's preserved means essentially the more nerve cells that are preserved and the better outcomes that people have.

So there are actually what's called hybrid devices where people can use the electrical cochlear implant signals for the high-frequency hearing loss that they have. But then if they have hearing remaining in the lower frequencies, they can use a traditional acoustic hearing aid that is in combination with the cochlear implant. So it's the same device that is essentially two of those devices in one.

Alyne: So let's talk about the implant procedure and the recovery process.

Dr Candice Colby-Scott: So, like I said, it's an outpatient procedure, so there's no upper age limit. There's not a lot of contraindications or reasons why we would not do this procedure on someone. For some people who are on blood thinners, or if they have heart disease or whatnot, we would want them to have an evaluation by their primary care physician or their cardiologists to ensure that they're optimized and healthy enough to undergo general anesthesia.

So you're completely asleep for the procedure and there's a small incision behind the ear. And there's maybe a small amount of hair that's clipped in this region. But for the most part, there's not a lot of hair clipping or no one is shaving anyone's head or anything that dramatic.

And then I have people take about a week off from their normal activities. So most people just feel down from anesthesia for a couple of days. And then they're back to feeling like their normal self after that. But I tell them to just take a week off if they work or have any other activities that they do on a daily basis, just to be safe in case they need a few more days of rest.

Alyne: And how do cochlear implants compare to hearing aids?

Dr Candice Colby-Scott: So cochlear implants are different than hearing aids in that one it's considered a surgical implant. So the reason why that's important is because hearing aids are not traditionally or oftentimes covered by insurance, particularly with Medicare. So there's a significant out-of-pocket cost associated with these most often for people. But a cochlear implant rather is a surgical implant that is covered by most insurance companies, including Medicare. So that is a significant benefit for having a surgically implanted device.

And the other thing again is that they don't pick up just acoustic sound like a hearing aid does, where a hearing aid is essentially just a microphone and a speaker that just amplifies the sound in the environment. But rather the cochlear implant actually converts those sounds into the electrical signals so that your brain then does most of the work to interpret those electrical signals into sounds.

It does require some rehabilitation after the surgery. I do explain to people that is not like a light switch. Like it's not as if you have your knee replaced and then we ask you to run a marathon the next day. There is some rehabilitation process involved where we're retraining the brain to understand what those electrical signals are.

And so it may sound a little robotic or a little mechanical in the beginning, but that improves even just after wearing the implant for hours and days. And there's a significant, growth in the first couple of months and even benefit out to one year, including like music appreciation, hearing the birds chirping and those kind of smaller environmental sounds.

Alyne: So what about wearing implants during typical activities like sleeping and swimming and showering?

Dr Candice Colby-Scott: So the implant is removed just in the same way that you would take off a hearing aid like at night when you sleep. There are actually waterproof devices or containers that the implant is covered in so that you can wear it when showering or when swimming or other activities that you like to do outside.

A lot of times people are concerned about losing the implant. And so there are ways that we can actually clip it on to your hair or your shirt to just ensure that we don't accidentally knock it off and potentially lose it or something like that. So there's not really many limitations at all to wearing a cochlear implant.

And I will also say that the hearing aids require you wear something in the ear canal, which can sometimes be a problem with trapping moisture or causing ear infections for people. And cochlear implants do not require anything in the ear canal. So oftentimes people are more comfortable wearing this device than they would with a traditional hearing aid.

Alyne: Now when you say you take the device off at night, that's the piece you wear behind your ears, is that correct?

Dr Candice Colby-Scott: Yes, that's correct. So that internal portion that's placed during surgery is thought to be a lifelong device, so that requires no maintenance. There's nothing that you can see through the skin. So when the outside device is not on, you can't really tell that there's anything there. But then the outer portion that gets connected via the magnet is worn at all waking hours essentially. It has a rechargeable battery, so there's no small batteries to change or anything like that, again different than a hearing aid. And that outer portion is what people can wear and take off. And then that also gets upgraded through your insurance every five years or so, so that all of the latest technology is available to you throughout your lifetime without having to change anything about the internal device.

Alyne: So, for example, growing your hair long, going to get your hair cut or having a permanent or all of that is just a routine thing after this?

Dr Candice Colby-Scott: That's exactly right. There's nothing you can do to hurt the implant, particularly on the internal portion. So nothing changes about hairstyles or activities or anything like that.

Alyne: Now, I've read that cochlear implants don't necessarily work for everyone who has severe hearing loss. Who does it not work for?

Dr Candice Colby-Scott: Cochlear implant really only requires the location for the implant to be placed, which is the cochlea, to be open and able to receive the implant and then it requires the nerve of hearing. So anyone with a traditional nerve-damage hearing loss usually is a candidate. And the reason why I say usually is because there are always extenuating circumstances. But for the most part, all patients with just a nerve-damage hearing loss are candidates.

The people that who may not be candidates are children who maybe were born without the inner ear structure or if potentially an adult has a tumor on the hearing or balance nerve where they had to have the hearing nerve removed or something like that. But generally speaking, most people we see with progressive nerve-damage hearing loss are candidates.

Alyne: So this sounds very encouraging. What else should we know about cochlear implants?

Dr Candice Colby-Scott: I think the more important thing to know is just about deafness in general. I think that hearing loss, we are learning, is more of a public health crisis than we ever understood it to be previously. And the reason why I say that is because now we're learning that untreated hearing loss causes faster rates of dementia and cognitive decline. And it's the number one way that we can actually change or prevent dementia from occurring besides the traditional things that we think about, like not smoking, eating healthy, those sort of things.

When we're thinking about, as we are able to live longer and longer lives, we want to have the best quality of life when we are able to live to be 90 or 100. So it doesn't really mean much if, you know, you have dementia or you're not very healthy and can't really enjoy those years. So that's why we're trying to be much more aggressive with treating hearing loss, both with hearing aids and with cochlear implants than we ever used to be.

And I also think that it's important to note that, again, there's no upper age limit for this. So I just saw a patient in clinic today who is 101. And. I've said to them that as long as he's healthy to undergo surgery and they understand what's involved with that, there's no reason why he couldn't have a cochlear implant so that he can communicate with his children and hear his grandchildren's voices throughout the last years of his life. He may have another 10 years left. We just have no idea. So I think that everyone deserves to live their best quality of life. No matter their age or no matter their circumstance.

Alyne: Yes. And hearing your grandchildren, what an incentive that is. Thank you so much for talking to us today.

Dr Candice Colby-Scott: My pleasure. Thank you.

Alyne: Dr. Candace Colby-Scott is an otolaryngologist at McLaren Health. To learn more about Dr. Colby-Scott or submit a question, visit mclaren.org/ColbyScott. That's M-C-L-A-R-E-N dot org forward slash C-O-L-B-Y-S-C-O-T-T.

If you enjoyed this podcast, find more just like it by checking out our past episodes and be sure to give us a like and a follow if you do. This is McLaren's In Good Health, the podcast from McLaren. I'm Alyne Ellis. Thanks for being with us.