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Melanie Cole (Host): Welcome to UF Health Med EdCast with UF Health Shans Hospital. I'm Melanie Cole. Joining me today is Dr. Si Chen. She's an assistant professor in the department of otolaryngology, head and neck surgery at the University of Florida College of Medicine. And she's here to highlight cochlear implants, expanding access to hearing rehabilitation. Dr. Chen, it's a pleasure to have you with us today. As we get into this topic, can you tell us a little bit about hearing disorders that require interventions or that are amenable to interventions? What conditions are we talking about here today?

Dr Si Chen: Good morning, Melanie. Thank you so much for having me on the podcast. I'm happy to talk about hearing loss and in most of the adults that we're focusing on the adults today, we're talking about sensory neural hearing loss as a disease that may have multiple etilogies, including aging, noise, exposure, genetics, and other diseases. We're specifically focusing on the severe to profound level of sensory neural hearing loss when they've had, hearing aid rehabilitations, but have limited benefits from the hearing aids.

Melanie Cole (Host): Well, then let's get into that. Tell us about the limitations of hearing aids and when cochlear implants might be considered?

Dr Si Chen: Human loss, sensory neural human loss, essentially is a dysfunction at the level of the cochlea and the cochlear nerve. When the cochlea and cochlear nerves are not functioning due to either aging, noise, exposure or other etiologies, hearing aids are no longer helpful. So I'm sure you've probably met people who are frustrated with hearing aids or they just found knowhow from hearing aids. The reason of that is that hearing aids, essentially, no matter how advanced the technology is, is still simply an amplification of sounds, they make sounds louder, but cannot make you understand it better.

For example, you may hear, either on the hearing aids or an example of the telephone, you hear wobble, wobble, wobble, at very low tones. It's not clear. So you think if you just increase the volume, it would be much more clear speech, but that's not the case. So instead of hearing wobble, wobble, with the limits of hearing aids, you may still hear wobble, wobble, wobble very loud, but unfortunately not very clear. That's when you really start to think about what is the next step, what are the available hearing rehabilitation options for those patients. And cochlea implants are currently very good option for those patients.

Melanie Cole (Host): So then speak about cochlear implant evaluation, and what's involved and patient selection. Are there some people for whom this is contraindicated?

Dr Si Chen: Absolutely. So, cochlea implants are generally reserved for severe to profound sensory neural hearing loss. So for the cochlea implant evaluation, we take a multidisciplinary team approach. We want to first make sure that you have a older NG physician evaluation, where there are reasons for the hearing loss to be limited to the middle ear, like an infusion infection or tumor obstructing the sound from going through, then those are maybe surgically corrected and patients may improve with good benefits with the hearing aids alone.

So we do wanna make sure there are correctable etiologies identified on physical exam. Other things that may limit access to cochlea implant would be, either a tumor on the hearing, a balanced nerve or central processing disorders, such as neurodegenerative diseases. Although we do, offer cochlea implants, even when patients have Alzheimer's or Parkinson's, those are still good options for them, but we do counsel them carefully in terms of what cochlea implants can do for them.

Melanie Cole (Host): Such a fascinating and exciting time to be in your field. Dr. Chen. So tell us a little bit about the surgery itself and postoperative care. Follow up. Tell us a little bit about what's involved?

Dr Si Chen: So cochlea implant actually is one of the very fascinating innovations in our field. The FDA approval for cochlea implant only came about in 1985 for adults and for kids it's been approved since 1990s, but we've seen this huge expansion in terms what the technology can do thus to follow would be FDA expanded criteria for people to meet candidates for cochlea implant. The surgery is quite sure. I generally tell my patients that surgery only takes about one to two hours. Surgical intervention with the cochlea implant is actually the shortest part of their hearing rehabilitation journey.

They undergo an outpatient surgery, one to two hours. But they have a very long relationship with the cochlea implant program, including the surgeon and the audiologist in order to map the cochlea implant, to have the most comfortable level for them to optimize for their daily activity and improve their hearing and speech outcome. So the performance can be seen to improve dramatically even between six months to a year. So they continue to have significant improvement over time with the device, like that.

Melanie Cole (Host): Now I'd love for you to tell us about your hearing outcomes. And while you're doing that speak about, since we're talking about the adult population, speak about life effects as reflected in measures of quality of life, educational attainment, economic impact. Speak about your outcomes and how quality of life is really such an important factor.

Dr Si Chen: With the cochlea implant, when we test the cochlea implant candidates put before surgery, for example, if you ask them to listen to a test will be sentences. Most of the patients in order to qualify for Coch implant, they understand less than 40% of the sentences by Medicaid and Medicare criteria. That would be equivalent of having our conversation with somebody on the phone and not understanding more than half of the conversation on the phone.

So most of the cochlea implant patients can achieve anywhere between, 75, 85% of the conversation after cochlea implant. That is significant improvement. And some people even are superstar and they understand a hundred percent of the sentences. Obviously we do have, patients who don't perform nearly as well, but on average, you do see any significant improvement in conversation, even without lip reading, visual cues or other cue.

And the one simple, very good example of, the quality of life improvement is really a lot of patients would come and say, I haven't heard the bird chirping outside my window for so many years. It's so nice to hear that. And another example would be that, I went to a game with my grandchildren and I finally understood what they were talking. In a very noisy background before that, I couldn't understand that. So the quality of life impact is significant and people really start to engage socially with other people.

They become happier with their own sort of social interaction, and they're less likely to be anxious or depressed or participating in their own medical care.

Melanie Cole (Host): So what's exciting. What do you see happening in the next. 10 years or so if you were to give us a blueprint for further research, recent advances or ongoing research that are improving cochlear implant, performance, speak about anything you'd like other providers to know about?

Dr Si Chen: Absolutely. So with the Cochlear implant, we traditionally think of a big surgery. It's this external device that's implanted nowadays. it's much slimmer, think of the cell phones we had five to 10 years ago was much bigger and it's definitely slimmer and slimmer. We are looking at devices that are much better battery life. And we're looking at electro devices that are much better at replicating the frequency stimulation of a human hearing and sound. So I think with the programming of the cochlear implant has gotten so much better that we do have better algorithms to replicate natural sound.

In addition, I think a huge improvement is that, prior to 2019, we spent a lot of time counseling patients and say, you're sort of really in the gray area. Really don't like your hearing aids, but you're not quite bad enough for cochlear implants. So we used to have a huge group of patients who are very frustrated with hearing aids, but don't quite meet criteria for cochlea hints. And I really used to dread those appointments and say, we don't have anything for you to do unless your hearing gets worse. That's a terrible thing to sort of offer the patient.

Now with the FDA expansion of the Cochlear implant candidacy, we're really seeing. More and more patients being able to meet criteria to get Cochlear implants when they no longer benefit from hearing aids. So we see more and more people becoming eligible, with more residual hearing and at a younger age. And of course we're focusing on adults today, but the FDA approval really has been approved for patients as young as nine months of age.

Melanie Cole (Host): Do you have any final thoughts? What you'd like to leave other providers with regarding cochlear implants, quality of life and what you're doing there at UF Health Shans Hospital?

Dr Si Chen: Absolutely. So one of the major things, I think if you look at all of the cochlear implant providers, either physicians or audiologists, it's alarming and amazing to see that according to the American and Cochlear Implant Alliance that less than 10% of people who need a meat criteria for Cochlear implant, less than 10% of the people actually go on to receive Cochlear implants. So we do want to increase the awareness of this amazing technology and how far we've come from 1985 from having a honky device to a very slick and modern device.

And the capability of the Cochlear implant is to restore a relatively normal hearing and to improve their lives. And we really want to sort of work on that less than 10% access to the hearing rehabilitation option. We want to bring this option to more people and make it, a life changing experience for them.

Melanie Cole (Host): Thank you so much, Dr. Chen for joining us today, what an exciting time to be in your field and to refer your patient or to listen to more podcasts from our experts, please visit UFhealth.org/medmatters. That concludes today's episode of UF Health Med EdCast with UF Health Shans Hospital, for updates on the latest medical advancements, breakthroughs and research. Follow us on your social channels. I'm Melanie Cole.