Cochlear Implants in Adults

Approximately 48 million Americans suffer from some type of hearing loss. Now, there are different types of hearing loss and differing treatments. Age, genetics, and injury can all play a role in hearing loss.

But there is some good news in the area of treatment. Our experts will join us on this program to discuss hearing loss and what can be done to prevent or help those who are suffering from this debilitating issue. That's coming up right now on At the Forefront.

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And we want to remind our viewers that today's program is not designed to take the place of a visit with your physician. Let's start off with having each of our guests introduce themselves and tell us a little bit about what you do here at UChicago Medicine. We will have two sets of guests on today's show. So we have another pair that will come on after a commercial break. But we're going to start with Dr. Imbery. And tell us a little bit about your role here at UChicago Medicine and introduce yourself to our audience, if you will, please.

Sure. Yeah so I'm Dr. Ted Imbery. I am an otolaryngologist, or an ear, nose, and throat surgeon. And I specialize in treating patients, adults and children, with ear and hearing disorders. So I do surgery to help people hear better. And I also take care of patients with vestibular disorders.

Fantastic. And we're really fortunate today because we actually have a patient who is a guest on the program, Pam Huang, who's going to talk to us a little bit about her situation. And, Pam, thank you so much for doing this. We appreciate you being on the program.

So let's just go right into the questions. And Dr. Imbery, I'm going to start with you. And if you give us just an overview of hearing loss. I know there are multiple types. And I know there are multiple treatments, obviously, as well. So talk to us a little bit about hearing loss in general and then we'll get into the more specific questions.

Sure, yeah. So it's timely being here. May is Better Speech and Hearing Month. So hearing loss is, I think, unfortunately an unrecognized problem. Certainly there are many people affected with hearing loss. If you look at data from the CDC in America, approximately 15% of adults, which would be about 40 million people, will have some reported trouble hearing.

The prevalence of hearing loss does increase as we get older, unfortunately. And about 20% of adults by the time they're 60 will report some difficulty hearing. And men are almost twice as likely to have hearing loss compared to women.

Looking at children specifically, about two to three per 1,000 children will be born with some degree of hearing loss. And the majority of that will be picked up based on universal newborn hearing screening. By the time they're a little bit older, that number will increase to about 10% to 15% by the teenage years, having some detectable hearing loss.

Looking more globally, if you look at data from the World Health Organization, approximately 400 million people around the world will have some, what they consider severe hearing loss that would require hearing rehabilitation. And, unfortunately, that number is only estimated to get more-- increase as time goes on, with about 700 million estimated in 2050 to have some degree of hearing loss.

Why are those numbers rising so quickly?

So part of the problem is probably we're living longer. So age-related hearing loss is certainly a risk factor for hearing. So the inner ear has a lot of delicate structures. They're called hair cells. And as we get older, they just don't tend to work as well as they normally do.

And so we have a finite number of those little hair cells. And when they stop working, we, unfortunately, don't have the ability to grow them back. So that's certainly an area of interest within our specialty to potentially regenerate hair cells. But as the populations are-- people are living longer, we're experiencing more and more of a burden of hearing loss.

And the other thing that gets a lot of attention is occupational and recreational noise exposure. So noise is a very big threat to our hearing. Certainly loud work environments or other things that we do for fun, such as concerts, shooting firearms, and other recreational sports. And certainly now with the advent of a lot of personal media devices, cell phones, tablets, wearing headphones all the time. So we're always exposed to loud noise that way.

I was just going to ask you about that. It seems like everywhere you go, you see somebody with headphones on or earbuds. And oftentimes you can be several feet away and hear what they're listening to.

Yeah, if you can hear that a few feet away, it's probably too loud for them as well. Yeah.

So let's get to our patient, Pam Huang, and talk with you a little bit about your hearing loss, Pam. And can you describe what your situation was and what you went through?

Hi. I'm a retired pediatrician. And I lost my hearing about two and a half years ago after a somewhat extended and puzzling illness. I was finally diagnosed-- I lost my-- my symptoms started in July. And it wasn't until October that I noticed that I was losing my hearing.

The hearing loss occurred over the course of about, I think about two weeks. It just seemed that everyone wasn't speaking loud enough. And I finally ended up in the hospital here at University of Chicago. And during the course of my stay here, they made the diagnosis of viral meningitis, which was probably the cause of my illness and my hearing loss.

I did have an audiogram when I was here. And I found that I basically had lost all my hearing in the left. And my right ear was severely, severely affected. I could still understand people if they literally shouted in my ear, but otherwise it was a shock. I was not left with any good method of communication except for writing things down. So I lived with markers on a whiteboard for a while.

Well, and that had to be a shocking experience for you, as you mentioned, to lose your hearing and lose it that quickly. I mean, was that frightening? What was going through your mind?

Well, being a physician, in particular a pediatrician, I'm well aware that meningitis can cause hearing loss. And I had a feeling that this was probably going to be permanent. And when I met first with Dr. Imbery about four months after I was out of the hospital, he echoed that sentiment. It did not come as a surprise.

I think for a person who wasn't a medical-- had no medical background, that would have been a shock. And he discussed doing cochlear implants. And that might give me some usable hearing back. And I was already familiar with the procedure, having had a couple of patients in my practice who had the procedure. And they seemed to be doing very well on that. So I think about a year after my hearing loss, I was ready to undergo the surgical procedure.

So I should be calling you Dr. Huang instead of Pam. I apologize. So to explain things to our audience who's watching this, because you can't really see this how the studio set up, and we do this because of COVID. We're trying to distance everybody as much as possible.

Dr. Huang is actually over in another corner of the room. And so you're probably 10 to 15 feet away from me. Yet clearly you're hearing me. So the cochlear implants must have been pretty successful.

Yes, I had the right ear done about a year and a half ago. And that was successful. People told me not to expect to be able to hear properly when you first-- when it first gets turned on. And that was definitely true.

But with some help from the speech therapists, I was able to probably about six months later feel comfortable with hearing. My speech therapist was very helpful. And she pointed me in the way of a lot of different things that I could do from home, so listening to podcasts. It's also helpful to have captioning on the television. And that was also a way for me to start being able to understand what was going on.

And then I felt so comfortable with the success of the first procedure that I went back to see Dr. Imbery to see about getting the left ear done. I was a little bit reluctant because I had absolutely no hearing in that ear. And I was concerned that there wasn't anything left that would respond. However, he assured me that was something that he could do.

And the surgery went very smoothly. And when they turned the-- put the microphone on and turn the processor on, I was amazed, after not being able to hear anything from that ear, that I could hear almost as well as I could from the right ear. So that was really a very pleasant surprise. And I really think it miraculous-- it was almost like a miracle.

That's incredible. And, Dr. Imbery, let's talk a little bit about cochlear implants and that procedure. First of all, explain to us how that works, because it must almost seem miraculous, as Dr. Huang mentioned, to people who are hearing impaired to have that turned on the first time.

For sure. I mean, Dr. Huang's story is really quite a remarkable one. And she's certainly one of our all-star patients. But a cochlear implant is a surgically implanted device. And this is indicated for people that have significant hearing loss that is not able to be helped by a normal hearing aid.

And so, obviously, in Dr. Huang's case, she had lost her hearing as a result of this infection, meningitis in particular, which can sometimes, unfortunately, damage hearing. So when the inner ear doesn't work anymore, what we can do is we can put a cochlear implant in. And this stimulates the hearing nerve directly with the electrical signals.

And so the surgery is performed under general anesthesia as an outpatient. And it really has become quite routine. It just involves us making a small incision behind the ear and then creating a little corridor inside the inner ear to put the device in.

The healing time is usually about two to three weeks. And then they come back to clinic. We check the wound. And then they get the device turned on. And so in addition to having the inner part, there's an outer part that they wear.

If you look at Dr. Huang, you can't even see it. It's pretty small. It conceals nicely. But the outer part picks up the sound and then sends it into the inner part. And the electrical signals are processed by the brain. And with time, most people get good speech recognition from it.

And I've actually seen one of these turned on before here at UChicago Medicine. And it was fascinating to me to watch the process. And, in fact, this is a story that John, our guy in the booth, worked on as well. It's a pretty neat story. It was with a little boy.

And I guess there's some adjustments that can be made via computers, so different tones. And can you explain how that works?

Yeah, absolutely. And we'll have Dr. Strauss, one of our audiologists, talk about this a bit more. But the cochlear implant is a fancy piece of technology. So it can be programmed and adjusted to help people hear better. So it certainly is a learning process.

And as you undergo the journey of cochlear implantation, you work with a lot of members on the team to help you maximize the benefit with it. And so some of that involves reprogramming, adjusting some of the-- literally the electricity levels within the implant to help people hear better.

Interesting. And just from your standpoint, and I know, and we'll talk with Dr. Strauss more about this, but just the reaction of patients has to be incredibly gratifying.

Absolutely, I mean if you ask me one of the reasons why I became an ENT and then specifically inner ear specialist, it was for moments like this. I mean, to be able to restore someone's sense of hearing, which we rely on day in and day out, to be able to play a role in that part of a patient's life is amazing. And so it certainly drew me to the field. This technology is remarkable. And so many people, adults and children, can potentially benefit from it.

Yeah. So what should people be aware of? I know you mentioned, obviously, age plays a significant role. But then I think there are a lot of young people that do suffer from hearing loss. And some of it, to your point, is just due to the atmosphere that they're in, the things maybe that we do to ourselves that we probably shouldn't. What are some things that you start noticing? Like tinnitus, is that an issue that if you're having that should be aware of something?

Yeah, so yeah tinnitus or tinnitus is oftentimes one of the early signs of hearing loss, what we can commonly refer to as a ringing or buzzing in the ears. And that can be a sign that there has been some hearing loss or damage to the inner ear. And I make the analogy that's your brain's way of telling you that, hey, there's something going on. And the brain will oftentimes in a way make these sounds to try to potentially fill the void. So, again, if there's been some damage to the ear and the hearing is diminished, the brain is signaling that, hey, something is going on.

So certainly if you have sudden onset tinnitus or very chronic, debilitating tinnitus, that would be something that should prompt a referral to an ear specialist to get a hearing test. Other things to look out for, ear pain or other problems or vestibular dizziness and balance problems, those all potentially indicate that there's something going on with the inner ear that should be further evaluated.

And are those issues that can be fixed or cured?

Yeah.

Or is it--

Absolutely. So there are a lot of things that can potentially be cured, whether it's a problem with dizziness, whether that's through other medical or surgical therapy. And then there are many types of hearing loss. As Dr. Huang mentioned, her hearing loss was related to an infection.

So we have, unfortunately, a lot of different types of infections that can cause hearing loss. In her case, it caused an inner-ear hearing loss. But other infections can cause problems to the mechanical or vibratory apparatus of the ear. So that can be issues with the eardrum, a hole in the eardrum from an infection that ruptured or even damage to the hearing bone. So there are things that we can do surgically to help fix that as well, either patching the eardrum or fixing the hearing bones in a delicate manner.

Interesting. So I want to finish up this first segment with Dr. Huang. And I just I'd like to know from your standpoint how this has changed your life.

Well, I can tell you that like most things, you don't really appreciate your senses until you've lost one. And I have to say that I really sympathize with people who have hearing loss, because it's very isolating. And then to top it off, also I lost my hearing right before COVID hit. So the sense of isolation was really, it really affected me. And I felt like I just couldn't communicate with anyone.

There are some devices that were hopeful. But I have to say that I am very happy with the cochlear implant. And I'm glad for all the research that has gone in to create this really miraculous technology.

That's fantastic. And I think the lesson to be learned here, if you do have an issue like this, make sure you see your physician or contact one of our wonderful caregivers here at UChicago Medicine, because there are certainly options out there. We're going to take a quick break and we're going to switch out our guests. We have a couple of other guests we're going to have on the program here in just a moment. So let's go ahead and take a quick break. And when we come back, we'll have two more people to talk to you a little bit about hearing loss and some of the great things that are being done here at UChicago Medicine.

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(SINGING) I'm a survivor, I'm going to make it, keep on surviving.

All right, welcome back. That was a really great first segment, to hear from one of our physicians and another physician who happened to be a patient. And really interesting, I thought.

So we have two new guests for the second half of the show. I'm going to have each one of you introduce yourselves and tell us a little bit about what you do here at UChicago Medicine. You drew the short straw. You're at the desk. So if you want to introduce yourself to our viewers and tell us what you do here.

Sure. My name is Dr. Brittney Sprouse. And I manage the audiology department, as well as the newborn hearing program. I am also a pediatric audiologist by trade.

Great. And so our next guest, who is in the other corner of the room is Michelle Havlik. And if you can introduce yourself and tell us what you do here.

Sure. As you mentioned, I'm Michelle Havlik. I'm a speech language pathologist by trade. But my first love is specializing in adults and patients who have hearing loss. So I also have a certification in something called auditory verbal therapy, which is a specialty in listening and spoken language development and hearing loss.

So, Dr. Sprouse, I'm going to start with you, because I want to talk to you-- you mentioned pediatrics, which I think is fascinating. And I always think being a physician and working with children is probably-- it's extra rewarding, but it's also maybe a little bit of an extra challenge, particularly when you have the little ones that can't necessarily tell you what is going on with them.

Absolutely.

And describe that to us and your work in your area. How difficult is that, diagnosing children that have hearing loss? And then how difficult and how rewarding is it working with them?

Yeah, great question. I think the most important thing is when a child is diagnosed or there's concerns for hearing loss is getting them in right away. And so we do have state-mandated newborn hearing screenings. And so here at UChicago, all of our patients are screened for hearing before they leave the hospital. And if they do refer on that test, then we do set them up for follow-up testing so that we can further identify if there truly is a hearing loss or diagnose it early.

And then really that critical piece is also finding a provider who specializes in pediatrics, because we know it can be challenging testing around nap times and different behaviors, whatever it is, and so really working with the patient and the family so that we can get the most information from the patient, the most accurate information, getting it early. But truly, if you can see someone who specializes in pediatric, it's going to be much easier to get those results.

Yeah. And when you see that look on a child's face, and, obviously, the parent's reaction as well when you've worked with them and you've helped them through a situation like this, I imagine that's incredibly rewarding.

It's very rewarding, absolutely. So being able to fit a patient with their hearing aids early on, or if it's a cochlear implant that we're activating for the first time, it's absolutely one of the most rewarding things that we're doing in pediatrics, for sure.

And, Michelle, can we talk a little bit about the team approach that we see here at UChicago Medicine? Because it's always interesting to me when we do one of these programs and we have the various guests that come in, because we have a significant team that works with every patient that comes through the door. And I that's just so important.

Absolutely. I think that that's what makes one of-- the fact that I am on the team as an aural rehab specialist really makes us really unique in the Chicagoland area. Especially when working with adults with hearing loss, it's not uncommon to have aural rehabilitation as part of the team plan for children with hearing loss. And it's certainly crucial. And when families are looking at programs, they should make sure that it is a multidisciplinary approach.

We all work very closely together. Myself and Dr. Sprouse and the other audiologists often communicate regularly. I do with the doctor as well in social work. It takes a village. And the family is definitely a big part of that team. However, what makes it unique at this program is that we also provide aural rehabilitation as part of that team for our adult patients with hearing loss as well.

You mentioned aural rehabilitation a couple of times. And can you explain to us exactly what that is?

Absolutely. So aural rehabilitation is a type of therapy and treatment that is focused on eliminating or at least minimizing the impact of hearing loss on daily life, and when we're talking about children, really minimizing the impact it has on their brain development, on their language, on their communication, on their speech quality. This is done through a variety of methods. It's very holistic and individualized to the child, the families decisions on communication mode.

But also with adults, it's, as was seen in Dr. Huang's experience, it can be very isolating. It can be very debilitating, frustrating to all of a sudden not be able to hear. And someone who's not grown up with a hearing loss often doesn't know how to navigate the hearing world, and not just about understanding what they're hearing through a device like a cochlear implant for the first time, but just knowing the resources on how to start to understand what they're hearing for the first time, but also using accessories and different things in daily life modifications to their environment to the speaker, to asking and advocating for yourself in different social situations for accommodations that will really make the quality of life so much more rewarding and help them to be more independent.

Now, Dr. Sprouse, you talked a little bit about diagnosing hearing loss in pediatrics in particular. But explain to us how that works. And how similar is that to diagnosing in adults? I imagine there are some differences.

Yes. So we diagnose hearing loss here at the University of, Chicago we have our audiologist. And so it's a combination of a medical evaluation as well as an audiological evaluation. And so the audiology piece of that, it's going to incorporate a patient's history, behaviors, as well as a series of tests that are done oftentimes inside of a sound booth.

And so some of the differences between adults and children are if a child is, let's say, under the age of six months, there's some testing that we can do under natural sleep, which is very different than the testing that we can do for an adult, where we can have conversations, we can do speech testing. They can let us know when they're hearing the different frequencies, the beeps and things like that. And so a combination of doing these this test battery, we're able to diagnose the type and degree of hearing loss. And then based off of that, we can make the appropriate recommendations and what type of amplification is an option for that patient, if it is needed.

Now, I know from some personal experience, I had some older relatives that were experiencing hearing loss. And I remember taking one of them to the doctor. And they wouldn't admit they had hearing loss, which made it a little bit more challenging, I think, to probably discover this, because they didn't want to admit they had the hearing loss. But be honest with your doctor, because you can't get some help.

Absolutely. We run into that all the time. And I think the most important thing is that there are options. And so while hearing aids are oftentimes the majority of what we see as a nonsurgical option for treatment of hearing loss, there are other things, such as assisted listening devices, alerting devices. So if you're having difficulty hearing the doorbell ring, the telephone, the TV, we can even alert parents if the baby's crying, things like that.

So it's not just hearing aids. There's more that we can offer in that assisted listening, a sort of alerting devices for patients. And so we definitely would encourage you to come in and have the conversation so we can make those recommendations and work with you.

So there is a pretty robust area of nonsurgical options for patients out there. And that's great.

Yeah, absolutely.

Yeah, so can you talk to us a little bit about the program in general here at UChicago Medicine? And if somebody suspects that they may be having an issue, what are the steps that they need to take to get the necessary help?

So you can talk with your primary care physician. If you're already an established patient, absolutely getting back into your audiologist, ENT. If you're a new patient, getting that referral to audiology is step one so that we can do the series of testing that's needed and really talk about what the options are.

Great. And, Michelle, I'm curious, there is a connection apparently between hearing loss and dementia. Is that a thing? And if so, can you talk to us a little bit about that?

Absolutely. It does sound surprising, but actually research has revealed a correlation or a relationship between the diagnosis of dementia and hearing loss. And, in fact, when you adjust for other factors that would put somebody at risk for one of those, it still has a very high incidence of those two diagnoses coming together for a patient. So because this is happening together for patients, there's more research that needs to be done, because we're not exactly sure if there's a causal relationship, where one is causing the other.

However, it's a very important thing to watch, because if hearing loss is a risk factor, which it seems to be, it is one of the most treatable risk factors that's modifiable to avoid or at least delay further cognitive decline. So it's something that we really encourage patients, adult patients that are at risk for either of these factors to follow through, because it's something that can be easily addressed. And it doesn't hurt to try to reduce that cognitive decline risk.

We talked a little bit about cochlear implants earlier. And we discussed or mentioned hearing aids. Can you talk to us just a bit more about hearing aids? The technology I know has advanced tremendously over the years. What kind of results are people seeing with hearing aids today?

Oh, amazing outcomes. The technology has just grown a lot. Hearing aids, cochlear implants, the outcomes are incredible.

When it comes to adults, Dr. Huang mentioned the fact that there's a lot of social isolation, withdrawal from society. So it really opens up a whole world of independence and connecting with your family and loved ones and friends again after, and then, obviously, reducing that possible risk of dementia. But it just overall improves the ability for patients with hearing loss to communicate in day-to-day life and improve their quality of life. I've literally had patients tell me that pursuing getting hearing aids or cochlear implants and the therapy and the treatment that's needed has changed their life. And so it seems like a dramatic statement, but it really does make or break those relationships, reduces frustration.

And with regard to children, pediatrics, this was mentioned by Dr. Sprouse, early intervention is absolutely key. Barring other diagnoses in addition, if you have just a pure hearing loss with children that have brains that are developing at a critical language learning period, if they get fitted with hearing aids or cochlear implants early, get the oral rehabilitation therapy that focuses on listening and spoken language development, that can help them really develop listening and spoken language commensurate or the same as their same-age hearing peers. They can speak and sound just like everyone else. So it's incredible what that can accomplish with a multidisciplinary group of people that are supporting families and patients.

Fantastic. Dr. Sprouse, we're about out of time. But I want to give you the final word for our viewers. Just any thoughts on in general the fact that there's so much help out there and the technology has made so many advancements. I don't know if you want to end us with that.

Yeah, so as Michelle and Dr. Imbery also spoke about, technology has changed so much, even in the last five years. And so the outcomes that we're able to see for patients who are getting hearing aids or getting implants, particularly with pediatrics, if we're able to implant at a younger age, we are definitely seeing that they are able to overcome those obstacles with the right intervention, the use of amplification, that we're able to see increased improvements there.

And then I will say anyone who's struggling or has concerns or if they have questions about whether they're a cochlear implant candidate or even a device candidate for a hearing aid or assistive device, absolutely come in. And we can have those conversations and do the testing that's needed.

That's fantastic. You all were great. This is a really good information. And I really appreciate you doing this. We are out of time, though.

Big thank you to those of you who watched. Please remember to check out our Facebook page for our scheduled programs coming up in the future. To make an appointment, go online to uchicagomedicine.org or give us a call at 888-824-0200. Thanks again for being with us today. And I hope you have a great weekend.