Hearing Loss: Cochlear Implant
Guest: Dr. Ted Meyer – Otolaryngology/Head & Neck Surgery, MUSC
Host: Dr. Linda Austin – Psychiatrist, MUSC
Dr. Linda Austin: I’m Dr. Linda Austin. I’m interviewing Dr. Ted Meyer, who is Assistant Professor of Otolaryngology; Ear, Nose, and Throat. In this podcast, we’re going to talk about a fascinating technology, cochlear implant. Dr. Meyer, what is a cochlear implant?
Dr. Ted Meyer: A cochlear implant is an electronic device implanted into the inner ear, or into the cochlea, to provide sound for patients who are deaf.
Dr. Linda Austin: And these have been around for quite awhile, I understand.
Dr. Ted Meyer: The first implant was actually performed in 1957. So they’ve really been around for 50 years. But those were very early experimental devices. The FDA approved cochlear implants for adults, and then for children, in the 1980s, so they have been in common practice for over 20 years. Worldwide, I believe the number has surpassed 100,000, at this point, and may be even 120,000. But this is a very small fraction of the millions of people throughout the world who are actually deaf.
The percentage of patients who are potential candidates for cochlear implants, who’ve actually received a cochlear implant, is probably two to four percent at most. So there are a lot of potential candidates out there.
Dr. Linda Austin: Who is a good candidate for a cochlear implant?
Dr. Ted Meyer: Adults who have lost their hearing gradually, over time, or even suddenly, are excellent candidates for cochlear implants, as long as they have good general health, and good ear health, or good otologic health. Someone who’s had chronically draining ears for years and years isn’t necessarily a good candidate. Children with severe to profound sensory neural hearing loss are also excellent candidates for cochlear implants.
Children are now being implanted below the age of one, commonly. I would guess that, worldwide, the youngest child has actually been three to four months of age at the time of implantation. Cochlear implants for children do allow many children to develop language at very good levels, sometimes in the normal range. Children who hear well with a cochlear implant develop an appropriate accent. So, children from South Carolina sound like children from South Carolina, and children from Minnesota sound like children from Minnesota, with cochlear implants.
Dr. Linda Austin: Now, in another podcast we had talked about the two main types of hearing loss, and in thinking about older people, the sensory neural, or nerve, loss, versus conduction, can either group get a cochlear implant?
Dr. Ted Meyer: Cochlear implants are only for patients who have sensory neural hearing loss. If the conductive component isn’t working, it can be fixed or bypassed; fixed surgically, or bypassed with a hearing aid, or by some other mechanism. Patients with sensory neural hearing loss are cochlear implant candidates, assuming that the anatomy of the inner ear is good, and that they have a functioning auditory nerve.
Dr. Linda Austin: How difficult is this procedure surgically? How long does it take, and what is the recovery like?
Dr. Ted Meyer: Surgically, a cochlear implant may seem quite difficult to somebody who doesn’t do that. But for those of us who perform cochlear implants commonly, it’s not really that challenging of a surgery. Don’t get me wrong. It’s a tricky surgery. But, cochlear implantation takes one to two hours, and it’s an outpatient surgery. There are potential complications, certainly. But experienced centers that do a lot of cochlear implants have been able to minimize the majority of these complications.
Dr. Linda Austin: What is the cost of the surgery?
Dr. Ted Meyer: The cost of the surgery is in the ballpark of $60,000 to $70,000. The actual devices themselves cost somewhere around $30,000. Surgery in itself is a very small part of what’s involved with a cochlear implant. The evaluation is extremely important. The surgery is important. And postoperatively, the rehabilitation that occurs, either at home as an adult, or with a speech therapist, and at home as a child, is really what’s important for development with speech and language with a cochlear implant.
Dr. Linda Austin: Does Medicare pay for this?
Dr. Ted Meyer: Medicare, Medicaid, and virtually all insurances pay for the devices. Some of the companies do not pay very well. And that’s important because hospitals can lose a tremendous amount of money on a cochlear implant program. If insurance doesn’t cover the cost of the device, then the hospital is required to cover the remainder of the cost of the device. Around the country, many hospitals have decided that they don’t want to do this, and then cochlear implantation is not available at their hospital.
Dr. Linda Austin: That must be a big political issue, I would imagine.
Dr. Ted Meyer: It is a big political issue. And certain states, such as South Carolina, had very major problems, especially with Medicaid. But there have been some happenings. In 2007, South Carolina changed their compensation rules for cochlear implantation with Medicaid.
Dr. Linda Austin: I understand that, in children, there is a critical time period in which this surgery should be performed. Can you comment on that?
Dr. Ted Meyer: Yeah. If a child is born without hearing, or born with severe to profound hearing loss, the earlier the implantation occurs, in general, the better for the child. So, I can’t say, for sure, that three months is better than six months, than for a year. But when large groups have been studied, children implanted between two and three do significantly better than children implanted at four and five. Data is now coming that shows that children implanted around the age of one do better than children implanted at the age of two to three. Whether that will continue as younger and younger children are implanted will remain to be seen. But, yes, in general, when you stimulate the auditory system, language and speech development is better.
Dr. Linda Austin: Because you really hear with your brain. And your brain has to develop properly. And without that stimulation, that doesn’t happen.
Dr. Ted Meyer: Absolutely. Those neural pathways need to develop as well as they can. And if sound is not getting in through the ear in the normal way, then a cochlear implant is a very good alternative.
Dr. Linda Austin: Dr. Meyer, thanks so much for talking with us today.
Dr. Ted Meyer: Thank you.
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