Deafness: Cochlear Implantation

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Guest: Dr. Paul R. Lambert  Otolaryngology

Host: Dr. Linda Austin – Psychiatrist

Dr. Linda Austin: I am Linda Austin. I am talking with Dr. Paul Lambert, who is Professor and Chair of the Department of Otolaryngology - Head and Neck Surgery. Thank you for coming today.

Dr. Paul Lambert: Thank you.

Dr.Linda Austin: Dr. Lambert, I know you are quite an expert in a fascinating area, which is implantation of cochlea. First of all, what is the cochlea?

Dr. Paul Lambert: Well, the cochlea is the inner ear and that’s what processes sounds and sound comes in through the ear canal, strikes the eardrum, and vibrates it, that vibration then in turn is carried by the three middle ear bones, the hammer, anvil, and stirrup into the inner ear and that inner ear is called the cochlea and the cochlea takes the mechanical vibrations and transforms them into an electrical impulse and that electrical impulse then goes through the hearing nerve up to the brain and the brain then interprets that as sound.

Dr. Linda Austin: So, I would imagine that some, but not all deafness is caused by cord function or lack of function of the cochlea, is that right?

Dr. Paul Lambert: That’s correct. Some of the more simple causes of hearing loss might be fluid in the middle ear space, that happens to children frequently and that can be corrected either through medications or occasionally in the eardrum. There could be damage to an ear bone that is also surgically correctible. The inner ear, the cochlea, when that malfunctions, that type of an injury typically is not amenable to most surgeries and that’s the type of hearing loss that happens as we age, it happens as we are exposed to excessive noise, there are some genetic factors that can cause damage to the inner ear as well, and it’s actually a particular structure within the inner ear called the hair cells and the hair cells -- they are called hair cells because they have tiny little hairs projecting from their surface and those hair cells that actually do the transforming of the mechanical sound into the electrical impulse.

Dr. Linda Austin: So, then who is an ideal candidate or a good candidate for this type of surgery?

Dr. Paul Lambert: Well fortunately, most people that have an inner ear type of hearing loss, we call that a nerve loss. Most of those individuals can be helped with a hearing aid and it is worth mentioning that hearing aid have become markedly better over the last four to five years with digital processing and so forth. So your grandmother’s hearing aid is not the type of hearing aid that you will get today from an Audiologist. The hearing aids today are significantly enhanced with digital processing and so on and that can rehabilitate most people, who have a nerve type of hearing loss. For some people though the hearing loss is profound, that is near 100% or so and a hearing aid simply offers no benefit whatsoever. You can think of it as all those hair cells and there are about 30,000 hair cells within the inner ear. All those hair cells have been damaged or they are actually dead. So in that case, we could put a hearing aid on, the best possible hearing aid you can have you wanted to, but there is no receiver. Those situations; however, all are amenable to a cochlear implant and a cochlear implant is an electrode, an electronic device that actually patches in through the hearing nerve, a reasonable analogy is a phone that doesn’t work because the receiver is bad. This receiver would be the same thing as the hair cells. So the receiver is bad, yet the cable volume from the phone is still operational so if you could patch into that cable, perhaps you can get sound to a person on the other end.

Dr. Linda Austin: How successful is this surgery?

Dr. Paul Lambert: Well, the surgery is very successful. You can take someone who is totally deaf and they can now hear whispers, they can talk over a telephone. Before the surgery, they probably would not hear a gun that would be fired behind their head, but now with the implant, they can hear quite well and understand very well.

Dr. Linda Austin: It must feel miraculous enough.

Dr. Paul Lambert: Well, it makes a huge difference. When someone is deaf, they are really cut off from the world, I think 04.37 that she would much rather be blind than deaf, because deafness just removes her from the community of a fellow person.

Dr. Linda Austin: Do you typically do both ears?

Dr. Paul Lambert: We would initially start with one ear for most patients, although as the implant system has gotten better and better over the last decade or so, we are now beginning to consider implanting both ears.

Dr. Linda Austin: How long does a surgery take?

Dr. Paul Lambert: The surgery takes about three hours and it’s actually is an outpatient procedure both for adults and children. The youngest patient that who have never done the surgery on is about 10 months of the age, a child born deaf and the oldest is about 91 and a very healthy 91 year old, who still want to live and participate in all of the family activities.

Dr. Linda Austin: Does Medicare cover this?

Dr. Paul Lambert: It does.

Dr. Linda Austin: Well, that’s good news.

Dr. Paul Lambert: It’s excellent news.

Dr. Linda Austin: Dr. Paul Lambert, thank you so much for talking with us today about this extraordinary development for those many, many people, who are hearing impaired.

Dr. Paul Lambert: My pleasure, thank you.

Announcer: If you have any questions about the services or programs offered at the Medical University of South Carolina or if you would like to schedule an appointment with one of our physicians, please call MUSC’Health Connection at (843) 792-1414.

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