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Hearing Implants

Online Health Chat with Dr. Erika Woodson and Dr. Sarah Sydlowski

February 10, 2011


Introduction

Cleveland_Clinic_Host: Hearing loss ranges from mild to profound and can affect people of all ages. Based on the most recently figures available from the National Center for Health Statistics (NCHS), while most people with hearing loss are older - individuals who have lost hearing with age - approximately 12 out of every 1,000 persons with hearing impairment are under 18 years of age. There are different types and causes of hearing loss. Similarly, there are many types of devices that are used to partially restore hearing to people with hearing loss.

Cochlear implants are hearing implants that are appropriate for individuals with sensorineural hearing loss for whom hearing aids fail to provide adequate benefit. While hearing aids make sounds louder, the goal of cochlear implants is to make sounds clearer through direct stimulation of the hearing nerve. Cochlear implants have been used on patients from 8 months to more than 90 years old.<>/p>

Osseointegrated auditory implants are appropriate for two different types of hearing loss: (1) conductive hearing loss in one or both ears, or (2) single-sided deafness, meaning complete hearing loss in one ear and normal hearing in the other ear. Osseointegrated auditory implants provide auditory input through bone conduction. BAHA, one type of osseointegrated auditory implant, is a brand name, not a type of implant in and of itself.

Take advantage of this rare opportunity to chat live with two specialists in the fields of neurotology and audiology regarding developments in auditory implants. Ask Dr. Erika Woodson and Dr. Sarah Sydlowski questions about implant surgery, expectations, programming, and maintenance.

Erika Woodson, MD, an otologist/neurotologist/skull-base surgeon, earned her medical degree from Virginia Commonwealth University School of Medicine in Richmond, Va. She completed her residency and a fellowship in neurotology and skull-base surgery at the University of Iowa Hospitals and Clinics. She joins the otology-neurotology section, and is the Medical Director of the Hearing Implant Program.

Dr. Woodson’s research interests include hybrid cochlear implantation and acoustic neuroma surgery. She is available at Cleveland Clinic’s main campus and the Beachwood Family Health and Surgery Center.

Sarah Sydlowski, AuD, PhD, is Audiology Director of the Hearing Implant Program. She completed her clinical doctorate in audiology at the University of Louisville in Kentucky, and her PhD in audiology at Gallaudet University in Washington, D.C. Her dissertation focused on the auditory and vestibular impact of superficial siderosis of the central nervous system. She previously coordinated the cochlear implant program for the Department of Audiology at the Mayo Clinic in Scottsdale, Ariz.

Dr. Sydlowski is a fellow of the American Academy of Audiology and holds her Certificate of Clinical Competence in Audiology from the American Speech-Language-Hearing Association. Her clinical and research interests include auditory implants, electrophysiology, and auditory and vestibular pathology. She sees patients at Cleveland Clinic’s main campus.

To make an appointment with Erika Woodson, MD, or Sarah Sydlowski, AuD, PhD, in the Head & Neck Institute at Cleveland Clinic, please call 216-444-0354 or call toll-free at 800.223.2273, ext. 40354. You can also email the Hearing Implant Team at hipteam@ccf.org or visit us online at clevelandclinic.org/hearingloss.

Cleveland_Clinic_Host: Welcome to our Online Health Chat with Drs. Erika Woodson and Sarah Sydlowski. We are thrilled to have them here today for this chat. Thank you both for joining us today. Let’s begin with the questions!


Understanding Hearing Implants

X00Y11: What do I need to know to figure out if a loved one or even I can benefit from an implant?

Dr__Sarah_Sydlowski: There are several common signs that a loved one may be struggling as a result of their hearing loss. You may notice that they are withdrawing from social situations. They may stop attending what used to be favorite functions, or they may stop initiating conversation. You may also notice that their responses during conversations may be vague, or they cannot understand you if they are not facing you. If this is the case, then they should speak with a hearing health provider who can determine the appropriate intervention. 

Hardhats: Can you discuss middle ear implant technology? When does it work the best?

Dr__Erika_Woodson: Implantable hearing aids, such as the Esteem and the Vibrant Soundbridge, are just that--implantable hearing aids. If your hearing is already too far damaged to use standard hearing aids, these devices may add a little bit of additional gain to make it better. However, these devices would also work best if you have a NORMAL middle ear, without previous surgery or ear disease. A visit with a surgeon who performs these types of implantable devices would be your best option for determining if you are a candidate for these. Typically, a good CI candidate or an osseointegrated implant candidate would not be a good candidate for an implantable hearing aid.

loescher1: With an implant, will the sound be natural or more “synthetic”?

Dr__Erika_Woodson: This is a very common question. If you are considering a cochlear implant, the sound at first will be very different from what you remember as "normal" hearing. Voices may sound mechanical. The pitch may seem different. Over time, with practice and programming adjustments, voices sound better, but it will always be different than what you remember before your hearing loss.

Osseointegrated implant sound will also sound somewhat different - more like sound coming through a speaker or microphone than "natural" hearing. Again, this will sound different than what you remember, but it may be a considerable improvement over your current performance with hearing aids.

loescher1: Is it true that implants do NOT help in noise?

Dr__Sarah_Sydlowski: No. It's not that they DON'T help in noise; it's that noisy situations will always be more challenging than quiet environments. There is constantly improving technology for these situations, but people with hearing loss - even using CI, hearing aids, or OI - will still find noisy environments challenging. There are many options that your audiologist can discuss with you to optimize your understanding in background noise. These may include different programs on your device, special accessories, or supplementary devices, such as an FM system.

loescher1: Are hearing implants directional, as a hearing aid is? That is, will an implant on the left side help in hearing on the right side also?

Dr__Sarah_Sydlowski: For the first part of this question – yes. Auditory implants also have directional capabilities. Directionality is a technology that is intended to help with speech understanding in background noise. Both osseointegrated and cochlear implants have directional capability, and your audiologist will talk with you about the best options for using this technology.

The second part of your question is really not related to directional technology, but it's a good question. For cochlear implants, a CI on the left will only provide hearing to the left ear. However, using a hearing aid on the right side may complement the hearing with the CI on the left side. So in that way, yes, a CI can benefit both sides, even without getting two implants. For osseointegrated implants, the cochleas (or hearing organs) on both sides are stimulated. If you have two working cochleas, you will hear on both sides. This also means that it is not possible to tell what direction sound is coming from, however.

loescher1: Are implants sensitive to moisture? Can they be used when perspiration is expected, as when exercising?

Dr__Sarah_Sydlowski: Yes. They are sensitive to moisture because they are tiny computers. Some of the current cochlear implant external equipment has moisture resistant ratings that make them splash-proof, so activities such as exercising, walking in a light rain, etc., aren't a problem. They are not submersible, however. The hearing processor that comes with osseointegrated implants, on the other hand, are not water resistant.

For both devices, you will have a drying kit in which to store the device at night that will help draw out moisture and keep it working well. With the sound processor off, both the cochlear and the osseointegrated implant are safe for swimming and other water activities.


Hearing Aids and Implants

camper999: What is the different between a hearing aid and a cochlear implant?

Dr__Sarah_Sydlowski: Cochlear implants are very different from hearing aids. Hearing aids make sounds louder. Sound still travels through all the parts of your ear - the outer ear, middle ear, and inner ear - to the hearing nerve. The hearing aid just amplifies sound. A cochlear implant bypasses the damage that you have in your cochlea (hearing organ) in the inner ear. An electrode array is inserted during surgery directly into the cochlea, and the hearing nerve is directly stimulated using electrical energy. This stimulation results in sounds that are more audible and clearer than hearing aids can provide for individuals with substantial hearing loss.  A common complaint from possible cochlear implant candidates is that they can hear, but not understand speech. The main objective of a cochlear implant is to improve understanding.

TinaProper: I currently wear hearing aids and hear much better with them than without. However, I still struggle understanding things in many situations. Would I be a candidate for implant surgery?

Dr__Erika_Woodson: Yes. Hearing aids can make things louder, but cannot improve clarity. If you find that your hearing aids are “maxed out,” and you still cannot use the telephone or communicate with loved ones, then you may be a candidate for implantation.

Dr__Sarah_Sydlowski: Making this determination is actually a very important part of the cochlear implant candidacy process. At your audiologic evaluation, we will test your current hearing aids to determine if they are appropriate for your hearing loss. Then we will test your understanding while wearing the hearing aids to measure the benefit that you are receiving. Based on this testing, we will either recommend pursuing cochlear implantation or investigating different hearing aids. We may require a trial period with new hearing aids as part of your evaluation. Using all of this information, we can determine whether you may receive more benefit from a cochlear implant than amplification.

Dr__Erika_Woodson: Cochlear implants are for people who have little to no benefit from hearing aids.

DerekJames: If I get a hearing implant, will I still be able to use my hearing aid in the other ear?

Dr__Sarah_Sydlowski: The recommendation to continuing using a hearing aid in the opposite ear from a cochlear implant is an individual decision based on a variety of factors. However, there are many known benefits to having hearing in both ears, including better ability to localize sound (meaning knowing where it’s coming from), safety, and understanding speech in background noise. Many patients also report enjoying the sound quality with a CI and HA combined. Implants generally do a better job than hearing aids of restoring higher pitched sounds associated with speech, but hearing aids provide good low-pitch information. Together, sound may seem richer and fuller to some people. Your implant audiologist will regularly test you with your cochlear implant alone and your cochlear implant and hearing aid together in order to determine the best options for you to understand speech in a variety of situations.

Dr__Erika_Woodson: Also, if someone is considering a second implant, I encourage them to continue wearing their hearing aid until that time, so that the nerve and brain are getting “exercise” in the form of some type of sound stimulation.


Implant Considerations

kk213: When you have hearing loss in both ears, is it best to have both ears implanted at the same time? If not, which ear should I have implanted first?

Dr__Sarah_Sydlowski: There are definite benefits to having two ears working together, whether with a cochlear implant and hearing aid, or two cochlear implants. The recommendation for bilateral (two) CIs is based largely on your hearing history, including cause of hearing loss, use of amplification, and duration of hearing loss. You will discuss this option with your implant team. For some people, the hearing loss is not equal in both ears, and you may benefit from using a hearing aid in the non-implant ear. For others who cannot benefit from hearing aids, cochlear implants in both ears may be the best option. This decision is also dependent upon insurance approval.

ljkmer: My right ear has slight hearing loss; my left ear is completely deaf. I have a Wi-Fi hearing aid system. All is well when I'm one-on-one, but I miss out entirely when out with my husband, three kids, and their spouses/friends. Also, I'm so afraid of the day I wake up and find that the prosthesis in my right ear is no longer working. Background noise is a problem almost everywhere I go. What do you recommend?

Dr__Erika_Woodson: Unfortunately, the worse your hearing is, the worse you will do in background noise. This is the same with traditional hearing aids, Wi-Fi systems, osseointegrated implants, and cochlear implants. The best means of filtering out background noise is by sitting facing a wall, so that all of the noise is in behind you, and making sure your speaker is looking directly at you. If you notice any changes to the hearing in your "good" ear, do not hesitate to see your ENT immediately!

Dr__Sarah_Sydlowski: I would also recommend talking to your audiologist about three options.  First, there may be the possibility to adjust the programming in your device based on your listening environments.  Second, depending on the age of your device, you may want to consider some newer technology.  Current devices have much better technology for hearing in noise than even a few years ago.  In particular, WiFi (or CROS hearing aids, which I believe is what you are describing) have had some very recent advances even in the past few months which may help you in these more challenging environments.  Finally, supplementary devices such as an FM system are great for reducing reverberation and background noise.  The speaker wears a microphone (or you set it in the middle of the table in restaurant, for example) and the information is sent wirelessly into your hearing aid.  This reduces what is called the signal-to-noise ratio and distance from the speaker to your ear. 

Trudy075: I have a CI but still have problems hearing on the phone. And I don't know how to hear well on a cell phone. Is there some place where I can get information on this?

Dr__Sarah_Sydlowski: Telephones and cochlear implants can be challenging. First, in order to understand speech on the telephone, you need to have a certain degree of speech understanding in quiet, without the need for visual cues, such as lip-reading. If you have a relatively good level of understanding and still have trouble with the phone, there are a few options. First, you should talk with your CI audiologist about using a special setting, called telecoil, to connect better with phones. This may be accomplished through the device itself or with special accessories.

With cell phones, telecoil is still an option but you may do better with a special program in your cochlear implant. Your programming audiologist can also work with you on this. Some cell phones are better rated for use with cochlear implants or hearing aids than others. This is indicated with special ratings (M, microphone and T, telecoil, compatibility). Check with your local cell phone provider regarding the compatibility of your particular phone.

Moosedreams: Is there a difference between a cochlear implant and an osseointegrated implant?

Dr__Sarah_Sydlowski: Yes. A cochlear implant is indicated for moderate to profound, bilateral sensorineural hearing loss. Sensorineural hearing loss is a specific type of hearing loss where there is damage to the cochlea - the hearing organ. This usually results in decreased word understanding over time. Bone anchored or osseointegrated implants are for conductive hearing loss, where sound simply can't reach a normally functioning cochlea, or single-sided deafness, where one cochlea works normally and the other is completely non-functioning.

man815: What types of hearing loss do implants help most? My hearing loss is the opposite of hearing loss from aging or exposure to too much loud sound. The doctors were not able to identify the reason for the hearing loss.

Dr__Sarah_Sydlowski: Osseointegrated implants and cochlear implants are for two very different types of hearing loss. Cochlear implants are for moderate to profound sensorineural hearing losses in both ears with decreased word understanding for which hearing aid technology has been unsuccessful.

Osseointegrated implants are indicated for two types of hearing loss: conductive hearing loss and single-sided deafness. Conductive hearing loss means the cochlea - or hearing organ - is functioning normally or with minimal damage, but sound can't reach it. Single sided deafness means completely normal hearing on one side and complete deafness on the other. In terms of your personal hearing loss, implants are helpful for hearing loss resulting from a wide variety of causes, so even though you don't know the cause of your hearing loss, you could still be a candidate for an implant. Candidacy depends on type of hearing loss and current performance with and without traditional hearing aids, among other factors.

PappyZ_: How old must you be to be a candidate for a cochlear implant? Does the age range differ for other devices?

Dr__Sarah_Sydlowski: Cochlear implants can benefit people of all age. We typically consider cochlear implants in children starting at around 12 months. However, in special situations, we may consider CI even sooner. There is no age limit to the technology. More important than age is duration of deafness and years of amplification use.

Dr__Erika_Woodson: With the OI, again there is no age limit. However, the youngest age that an OI can be performed is about age 6. Since this is an implant that sets in the skull, the skull must be thick enough to support the device. For many children, this is around age 6, and a CT scan would be performed to measure skull thickness prior to surgery. If the skull needs to grow more, a soft band is an option. This allows the user to wear a sound processor on a headband prior to surgery.

Gaga00512: What improved hearing results can I expect? Will it sound normal? I want to be able to enjoy music again.

Dr__Sarah_Sydlowski: Hearing with an implant does not sound like normal hearing. With a cochlear implant, you are hearing sounds you have not heard in a long time in a very new way. Learning to listen with a cochlear implant takes time and practice. Familiar sounds will be different; voices may not be understandable at first. Cochlear implants are primarily designed to improve speech in quiet. However, many recipients can understand speech in noise and talk on the telephone. Music is the most challenging, because it is a complex signal. Some people learn to enjoy music again, especially music that was familiar to them before implantation. This is a gradual, very individual process, and understanding this is a very important part of success with a cochlear implant. 

man815: I have hearing loss in one ear. I am basically deaf in the left ear. I tried a hearing aid years ago, but did not like it. I had a lot of tinnitus and discomfort, and the sound quality was not that great. Would one of the implantable devices be good for someone like me?

Dr__Erika_Woodson: If you are "basically deaf" in one ear, then a hearing aid in that ear is probably not going to be very useful. In situations such as this, an osseointegrated implant may be a good option for improving your hearing in certain situations. The sound quality continues to improve as the technology of the speech processors do. Also, the sound quality from hearing aids has actually come a long way as well. There are non-surgical options for single-sided deafness, called the CROS and BICROS hearing aid systems that would be worth evaluating as well. It would be well worth a visit to see if the newer hearing aid technology would be better for your needs, or if the osseointegrated implant is interesting
to you.


Cochlear Implants (CI)

pleased2: Why have a cochlear Implant? What are the advantages? What are some of the disadvantages?

Dr__Sarah_Sydlowski: A cochlear implant is a wonderful option for people who can't benefit or have limited benefit from hearing aids. The advantage is the ability to have better speech understanding that hearing aids simply can't provide after a certain point. Most recipients report that it allows them to reconnect with family and to get involved with favorite events and activities that they weren't able to previously due to hearing loss. There are certainly risks associated with any surgical procedure; but for most CI recipients. the advantages far outweigh the risks and any possible disadvantages.

SanduskyRules: How do I go about getting a cochlear implant? How long will I have to wait for surgery?

Dr__Erika_Woodson: The first step is a visit with your otolaryngologist (ear, nose, and throat specialist - ENT). He or she will listen to your concerns and obtain a hearing test with an audiologist. If your hearing loss is severe enough, your audiologist may refer you to a cochlear implant center. At our center, I meet with the patient and discuss their hearing health history, as well as examine them. Then, you meet with an implant audiologist for further evaluation.

Dr__Sarah_Sydlowski: During the audiologic evaluation, we will discuss your listening environments, your hearing goals, and your ability to understand speech with your current amplification. This may occur in one appointment or a series of appointments.

Dr__Erika_Woodson: After we’ve assessed your candidacy from both medical and audiologic perspectives, we meet as a team and make a recommendation about implantation. Other important parts of the evaluation include a radiologic study to look at the inner ear (such as CT scan or MRI). Vestibular testing or a communication evaluation may be recommended based on your particular case.

Dr__Sarah_Sydlowski: Once the team approves your candidacy, the next step is to submit your case to your insurance company for pre-authorization. After your insurance company approves the procedure, we can schedule surgery. The whole process from evaluation to surgery may take several weeks to several months, depending on your insurance provider.

FancyPants222: How many different types of cochlear implants are there? How do you know which one is the best for you?

Dr__Erika_Woodson: There are currently three manufacturers of cochlear implant technology in the United States. These are: Advanced Bionics, Cochlear Corporation, and Med-EL. There are subtle differences between the different devices, as far as features and appearance. Although the internal components have slightly different design, they each provide users with similar benefits. An audiologist would discuss with you the different implants available to you at your center.

Moosedreams: How many channels are current cochlear implants? What does the future look like for number of channels?

Dr__Sarah_Sydlowski: Current cochlear implant technology is multichannel. There are a variety of strategies in terms of number of electrode contacts and how the stimulation is applied to the hearing nerve. These physical characteristics are likely to stay consistent moving forward, but there are some exciting advances on the horizon that aim to improve clarity of speech, especially in noise, and possibly appreciation of music. These are still in development and certainly have a ways to go, but research is constantly ongoing.

loescher1: Will these help in understanding dialogue on television or in movies?

Dr__Erika_Woodson: Yes. Cochlear implants should definitely help in understanding conversation in movies and TV. Some users still find closed captioning helpful, however.

Trudy075: Are there completely implantable CI's in the future with no external hardware?

Dr__Sarah_Sydlowski: Completely implantable CI is certainly something that would be a great development, and manufacturers’ research and development departments are working on this issue. There are several challenges, though, including batteries and not picking up internal body noises. This technology is not something we expect to see available in the near future - but it's an exciting long-term idea!

flowerchild: I heard when you get cochlear implants you can no longer use a phone. Is that true?

Dr__Erika_Woodson: No. Many CI users are able to use the telephone successfully. The duration and cause of your hearing loss may affect this ability.

Dr__Sarah_Sydlowski: It is not something that will likely happen right away. Our first goal is always to understanding speech in quiet, and we will build up to telephone use.

hh9432: If I’m deaf in one ear, will a cochlear implant allow me to hear? Is the implant guaranteed to work?

Dr__Erika_Woodson: Currently, there are some experimental trials looking at cochlear implants for single-sided deafness and tinnitus. This is not the standard of care yet. However, there are several other options available now for single-sided deafness, including OI, and BICROS and CROS hearing aids. Cleveland Clinic is not currently participating in any trials for CIs and single-sided deafness.

Dr__Sarah_Sydlowski: As far as implants being guaranteed to work, all cochlear implant recipients hear sound with an implant. Your successful speech understanding with an implant depends upon many factors. I can’t emphasize enough the importance of listening practice.

Trudy075: What factors can cause a CI to fail?

Dr__Erika_Woodson: I consider a CI failure under several circumstances:
1. Pain with wearing the implant. - This may include discomfort or possibly shocking sensations.
2. Decreased performance for no other reason.
3. Electrical testing of the device that indicates a problem during routine testing.

In counseling a patient regarding CI failure and possible replacement, we always carefully consider their current performance with their device and what they may have to gain by device replacement.

pammiller007: What is the probability of device failure after receiving an implant?

Dr__Sarah_Sydlowski: For cochlear implants, device failure is possible, although it occurs in a very small percentage of patients. There are several potential reasons for failure. The probability of the device itself actually failing is only about 1 percent. Other factors - such as medical issues, failure after trauma (like hitting your head), or unexplainable decreases in performance - are slightly more common, about 10 percent. In these cases, your implant team may recommend removing your current device and replacing it with a newer device. Most patients do quite well after revision, usually improving their performance if it had dropped prior to revision surgery.

Dr__Erika_Woodson: It is important to note that the implant manufacturers have aimed for a life expectancy of around 80 years for their devices. Therefore, a CI that a child gets should be “good for life.”

dandoore16: I am an athlete and world traveler. Will I be able to maintain my active lifestyle with a cochlear implant? Any issues with air travel?

Dr__Sarah_Sydlowski: Absolutely. Most cochlear implants are now water resistant, which is great for athletes. With both CIs and OIs, you can swim safely, so long as the external processor is removed. CI and OI recipients can go through airport metal detectors without concern. We recommend wearing a medical alert bracelet and carrying a CI recipient identification card.

Dr__Erika_Woodson: A consideration you may wish to make in your device selection is rechargeable versus disposable (hearing aid) batteries. Some devices only have a rechargeable battery, and this may be less than ideal for travel outside the US.


Osseointegrated Implants (OI) -- BAHA

Ohio2011: What is the main reason someone would need a BAHA implant?

Dr__Sarah_Sydlowski: First of all, to be clear, BAHA is a brand name for one particular osseointegrated hearing implant (OI). There are currently two devices on the market, the Cochlear Corporation BAHA and the Oticon Medical Ponto. We will be using the term OI today during our conversation. OI is typically recommended for two specific types of hearing loss: (1) conductive hearing loss, which is a type of hearing loss where sound cannot travel to an otherwise functional inner ear (cochlea), and (2) single-sided deafness, which is complete hearing loss on one side and normal hearing on the other side. There are several different types of hearing devices that can be used for each of these types of hearing loss. OI is one option. Other options may include traditional hearing aids or a special type of hearing aid called a CROS or BICROS, which wirelessly sends sound from the non-hearing ear to the better hearing ear. The appropriate device depends on your individual situation.

lunarbody: When I was younger, I chose to only have one BAHA implanted. Now I would like to know if I have a second BAHA in the other ear, what are the advantages? Will it really help me hear better? Will I be better able to distinguish where sounds are coming from?

Dr__Erika_Woodson: There are many advantages to a second osseointegrated implant if you have conductive hearing loss in both ears. It will help you with determining sound direction, as long as you have TWO healthy inner ears (cochleas) to receive the sound. It will also give you "surround sound," so that you can hear things on all sides.  A visit with your otologist and audiologist would help you determine if a second implant may help.

jujubee: Two questions: 1) how does a BAHA implant work and 2) how well will I hear with a BAHA?

Dr__Sarah_Sydlowski: An OI implant uses sound vibration through the bones of the skull to stimulate the cochlea - the hearing organ - in the inner ear. People who are candidates for OI have normally functioning cochlea(s), but for a variety of reasons, sound can’t reach the cochlea normally. With OI, a post is implanted in the bone of the skull. An external processor is attached to this post. The microphone picks up sounds and sends vibrations through the post and the skull to the cochlea. One important thing to know about OI is that, because all the bones of the skull are connected, both cochleas will be stimulated equally. This means that recipients are not able to tell which direction sound is coming from.

For people with conductive hearing loss, hearing with OI is usually a fantastic experience, and improvement in hearing is usually achieved almost immediately. Sound will not be “normal,” because you are still hearing speech through a microphone. Additionally, hearing in background noise will be challenging. However, the improvement with OI is remarkable, and most recipients are extremely happy with their new ability to hear.

tomsmith01: As the BAHA technology improves will I be able to access it?

Dr__Sarah_Sydlowski: Yes! With both OI and CI, device manufacturers make newer technology available to past recipients through upgrades to external equipment that are retroactively compatible with older internal parts. Both devices are designed to be used for a lifetime, and manufacturers are committed to keeping recipients up-to-date with technology with non-surgical updates. There are individual requirements for different insurances that govern when you can pursue these upgrades, but they are always available if you are covering them out-of-pocket.

Moosedreams: Does an OI have an external volume control?

Dr__Sarah_Sydlowski: Yes it does. There is both a volume control and a button to change programs depending on how your audiologist sets your device.

ReneeCoe003: My daughter is almost 2 years old and she was born with complete deafness in her left ear. Her doctor recommended by a BAHA implant when she turned 5 years old. My husband objected when he saw how the BAHA worked, fearing she would be ridiculed at school. I’m trying to understand all the pros and cons involved. Any input or research you can share would help me make the best decision for my daughter.

Dr__Sarah_Sydlowski: OI can be a great option for people with single-sided deafness. It is important to hear sounds on both sides, not only for speech understanding, but also for safety. As children get older and are in more challenging situations, like a classroom, you may notice them struggling more with only one hearing ear than they did when they were little. That being said, there are many options for single-sided deafness that may be appropriate for your daughter. These include a personal FM system, a CROS hearing aid, or OI. I would recommend that you make an appointment with an audiologist who is well-versed in all three devices. He or she can discuss the pros and cons of each with you and even let your daughter try all of the devices. Also, remember that you can always start with a non-surgical option and keep OI as an option down the road, depending on your daughter’s progress and hearing needs.

Dr__Erika_Woodson: The earliest we would consider placing an OI would be about age 6. At that time, I would expect the child to be involved in the decision making process as well. This is a totally elective process, and the decision could also be deferred until her teenage years or beyond. Of note, the device is very difficult to notice on certain hairstyles, especially on girls and women. Additionally, there are several colors available to match different hair colors. My advice though, would be to give it some time, continue keeping up-to-date with what the manufacturers are changing about the design, and see what your daughter would like to do. I think it should be what SHE wants.


Before Surgery

Moosedreams: It sounds like I may be a candidate for OI. If I made an appointment at Cleveland Clinic, how long would the initial testing take?

Dr__Erika_Woodson: You would meet with the surgeon, as well as the audiologist. The audiology evaluation would take about 90 minutes. The surgical evaluation takes roughly half an hour. If you would like to make an appointment, please make it clear to the scheduler that it is for an osseointegrated implant evaluation so that the appointments may be coordinated together the same day.

toysoldier: How much testing is involved before you can get implants?

Dr__Sarah_Sydlowski: During the CI evaluation, there is testing both with and without hearing aids. We use a variety of special listening tests to evaluate your ability to listen to and understand speech. We will also test your hearing aids and make sure they are fit appropriately for your hearing loss.

Dr__Erika_Woodson: The testing prior to OI surgery is simpler. It is a hearing test with and without a demo device to determine potential benefit.

Carrie227: I still can’t decide if I should get CI or BAHA. How long does each surgery take and what is the recovery look like? What’s the best way to choose one device over another?

Dr__Erika_Woodson: We need to take a step back, and discuss the differences of each. A person would not simultaneously be a candidate for a CI or an osseointegrated implant (OI). A cochlear implant is converting sound into an electric impulse, so it is used to bypass a deaf/damaged cochlea. An OI relies on normal cochlear function in at least one ear.

Dr__Sarah_Sydlowski: That’s right. The two devices are for completely different types of hearing loss, so in general, your otologist and audiologist will discuss with you which device may be most appropriate for your hearing loss.


Implant Surgery

STK0003: What are the risks involved with implant surgery?

Dr__Erika_Woodson: Risks with OI surgery are minimal. There is always a chance that the implant may not take, but this is very uncommon. A more common complication would be skin overgrowth around the implant. Usually, this does not require revision surgery, but if it is extensive, then more tissue could be removed in the operating room. Infections of the site are more common in children, but still quite rare. There is a very small chance - but not zero - that the drill hole may bridge the entire skull and touch on the dura (brain covering). This could potentially cause bleeding in the head, but again, this would be a very rare scenario. There have been a few case reports, but I have had no experiences like this myself.

DaddysGirl: What are the risks of surgery? Will I be able to hear immediately after surgery? Will I have a visible scar?

Dr__Erika_Woodson: Risks of surgery in general include anesthesia problems, bleeding, and infection. Risks specific to ear surgery include hearing loss, tinnitus (ringing), dizziness, facial weakness, and taste changes. Risks specific to CI surgery include the risks of meningitis (rare after vaccination) and device failure. You will have a scar, but it is behind the ear, near the hairline and not visible without close inspection.

You will wait approximately two to four weeks after surgery before your device is activated. CI requires a series of follow-up appointments for programming, or mapping. At the first appointment, we will make a series of measurements to set your initial program. You will hear sound, but it will not sound how you remember. Speech understanding takes time and practice, and we will re-measure your progress often during the first year.

me2you2: What is involved in the surgery? Can you explain what happens during the procedure?

Dr__Erika_Woodson: Cochlear implant surgery is done as an outpatient procedure under general anesthesia. It takes approximately two to three hours. An incision is made behind the ear, and part of the mastoid bone is drilled away. The internal device is placed under the chewing muscle (temporalis), and the electrode is threaded into the cochlea (inner ear). Testing is performed intra-operatively to ensure a functional device. After surgery, you will have a large pressure dressing for a day and sutures that will need care and removal about one week after surgery.

rabbitears: How should I expect to feel after surgery? Will I have to take much time off work after the surgery?

Dr__Erika_Woodson: Most people feel well after surgery, and many do not take any prescription pain medicine at all. Some people may have dizziness temporarily after surgery, which may slow their recovery. You may wish to take off the time period between surgery and activation because you will not be able to hear out of the implant ear. Others may feel like returning to work after a few days.

Mommy414: My son and I would like to know what happens during BAHA surgery. 

Dr__Erika_Woodson: With children, the process is a little different. We need to make sure that the skull is thick enough to support the implant, and that requires a CT scan. Most children would be ready to implant at around age 6 to 8. The child’s surgery is two-staged. First the implant is placed but is left under the skin. After six months of healing, the child is taken back to the operating room for the abutment (the part that sticks out of the scalp for the processor) to be attached to the implant. (In adults this is done as a single surgery). Then, a typical child would need about a month of healing time before the processor could be fitted.

Daywoo76:  I’m scheduled for surgery next month. What should I expect after my BAHA surgery? 

Dr__Erika_Woodson: After surgery, you will have a large pressure dressing that you can take off the next day. There is a healing cap underneath that is holding a dressing against your scalp. That needs to stay in place. I see you again a week after surgery and remove this cap, and give you permission to wash your hair. I see you again in a month to check the wound and again right before hookup. Pain is minimal after surgery, and most patients have numbness around the surgical site. I use re-absorbable sutures, so none are removed at any point after surgery. You should discuss specifics such as these with your individual surgeon, as everyone does it a little differently.

melloyello: How soon can I resume exercising after surgery? Can I go swimming?

Dr__Erika_Woodson: You may resume exercising and strenuous activity after two weeks, even swimming.

fkd8432: Can I talk to someone who has had a hearing implant before I get the surgery?

Dr__Sarah_Sydlowski: Definitely, and this is a great idea! Past recipients are often happy to share their experiences, and there is no better way to understand what the process is like than to talk to someone who’s been through it. Keep in mind that various factors like age at implant, residual hearing, cause of hearing loss, and duration of deafness impact an individual’s success with a CI, so your experience may be different than other CI recipients. But talking to another recipient is still a great place to start. Also, some good Web sites for information are www.cochlearcommunity.com and www.bionicear.com. These are manufacturer-sponsored CI support groups. Cochlear Community also supports OI recipients. Locally, you can attend meetings of the CI Friends of NE Ohio and PA; they meet monthly at the Euclid Library. 

Dxy8900: Please explain the steps involved with a BAHA implant.

Dr__Erika_Woodson: I do this surgery under sedation for most patients, and it takes me about 30 to 45 minutes to place the device. It is outpatient surgery, and you can go to work the next day. I typically do not shave any hair, except in special circumstances, which we would discuss ahead of time. I make an incision line behind the ear over the skull and then thin the scalp. A drill then makes a guide hole, and then the appropriately sized implant for your skull and scalp thickness is placed into the hole. There is a healing cap placed at surgery that will remain in place for one week. After about three to four months of healing time, the audiologist can fit your external processor.

Dr__Sarah_Sydlowski: After the post has integrated with the bone (after several months), we will fit the device. At this appointment, we will make measurements to set the program appropriately for your hearing loss. We will also conduct testing to measure your improved speech recognition with the device in quiet and in noise. Finally, we will show you how to use all the parts/pieces and how to care for the device. We will also talk about how often you need to return for follow-up. Usually we will see you at your fitting, about one month later, and then annually after that.


Costs

Howie1954: How much do BAHA implants cost? Is it an out-of-pocket expense like most hearing aids or would there be an insurance reimbursement?

Dr__Sarah_Sydlowski: Many insurance companies recognize OI as a medically necessary device and will cover the costs, although some do still consider it a hearing aid and therefore exclude its coverage. Also, most insurance companies will only cover the device when it is bundled with the surgery. So once the device is out of warranty and needs repair or replacement, then it is usually an out-of-pocket expense.

carpentertom: Will insurance cover my surgery and my device?

Dr__Erika_Woodson: Insurance plans vary greatly, but in general, cochlear implants are considered a medical necessity and are covered. CIs are currently covered by Medicare and Medicaid.

Dr__Sarah_Sydlowski: OIs, on the other hand, are more complicated, especially for single-sided deafness. Many insurance companies consider OI to be a type of hearing aid and may have carve-outs that prevent coverage. If an OI is right for you, there is an appeals process in place, and we can help guide you to the appropriate resources.


General Questions

Moosedreams: I have bilateral Meniere’s disease, with ringing, dizziness, and loss of hearing. Between 20 to 25 years ago, I had three shunts put in at the Shea Clinic in Memphis. About 48 hours after the last one, I lost all hearing in my left ear. I have about 40 percent to 50 percent hearing in my right ear and use a latest generation hearing aid. Is there anything that can be done with my left ear situation? Interestingly, but sadly, my hearing came back in my left ear for about 15 to 20 minutes four years after the surgery and then went silent again. Any thoughts on this?

Dr__Erika_Woodson: Bilateral Meniere’s disease is a debilitating, but fortunately rare, disease. I am sorry that you have had such a difficult time with it. If your hearing is roughly these levels, and has been stable for some time, you are possibly a candidate for cochlear implantation. If you are still having vertigo attacks, that must be considered as part of your treatment plan and work-up as well. You should really see an otologist who specializes in Meniere’s disease and cochlear implantation to figure out if it is right for you. In my experience, Meniere’s disease sufferers actually do very well with implantation, depending on how long they have had a hearing loss.

Baldmagic: I have had two Silverstein implants, which don't seem to help drainage and hearing loss. My hearing had been going downhill fast. Do you have any suggestions?

Dr__Erika_Woodson: I am sorry. I do not know what a Silverstein implant is, aside from Dr. Silverstein's micro ear wicks. Please clarify.

Baldmagic: If I am not mistaken, the Silverstein implants are to help with drainage of fluids but I still get a build-up of fluid anyway. I also have had and still have tubes put in my ears. Right now, according to the doctor, my tubes are out but the holes are still clear and working. All I know is that my hearing keeps getting worse.

Dr__Erika_Woodson: This sounds like too complicated a problem for this webchat. You should raise your concerns with your regular ENT doctor. If you would like a second opinion with one of our neurotologists (myself or Dr. Tom Haberkamp), we would be happy to talk more about your specific case.

loescher1: Can my local audiologist be involved with the adjustment phase?

Dr__Sarah_Sydlowski: That depends on whether your local audiologist is a cochlear implant audiologist or an osseointegrated implant specialist. There is special equipment, software, and knowledge that is required to work with both devices. I usually recommend that patients return for follow-up care to the center where they received the device. Of course, for some people distance can be challenging and there are many follow-up appointments required, so alternatives for follow-up may be necessary.

U2CANHELP: Where can I get more credible information about hearing loss?

Dr__Sarah_Sydlowski: There are many great resources about hearing loss both nationally and locally. In the Cleveland area, there are several self-help groups for the hard of hearing in general and cochlear implant recipients specifically. Implant manufacturers also have support groups where you can meet other recipients and learn about CIs and OIs. We provide information on these groups, as well as aural rehabilitation (listening practice), when you come for your appointment.

Trudy075: I have a CI with a positioner that is no longer used. Would this make it easier or cause more problems if I ever have to get the internal device replaced?

Dr__Erika_Woodson: Good question. For the general audience, I will say that positioners are no longer used, because they were found to raise the risk of meningitis after CI surgery. To answer your question, yes, it may cause more problems if your device ever needed to be replaced. On a side note, due to the increased risk of meningitis, please make sure you are up-to-date on your PNEUMOVAX, or pneumococcal vaccination. For any CI user, we recommend staying up-to-date with their pneumococcal vaccination to avoid the risk of meningitis.

Baldmagic: Since I don't seem to be getting better with the help of hearing aids, would it be advisable to make an appointment at the Cleveland Clinic for evaluation. I make several trips a year to Cleveland to see customers.

Dr__Sarah_Sydlowski: Definitely! If you have hearing aids and don't feel that you are receiving benefit, we'd be happy to evaluate you. We can evaluate the hearing aids and your performance, and discuss whether different hearing aids, an implantable auditory device, or even aural rehabilitation may help you improve your hearing abilities.

Moosedreams: Are there any major breakthroughs in hearing aids on the horizon? What about transplants, pigs’ ears, or ears grown from stem cells?

Dr__Erika_Woodson: There are many exciting areas of research in inner ear hair cell regeneration going on in multiple centers around the world. However, the ability to do this in a human is still probably decades away. Hearing aid technology continues to improve as well, with more sophisticated programming strategies in smaller and smaller packages coming out every year.


Closing

Cleveland_Clinic_Host: I'm sorry to say that our time with Drs. Erika Woodson and Sarah Sydlowski is now over. Thank you again Drs. for taking the time to answer our questions today about Hearing Implants.

Dr__Erika_Woodson: Thank you for logging onto our webchat today!

Dr__Sarah_Sydlowski: It's been a pleasure talking with you all today. Thanks for great
questions!

Cleveland_Clinic_Host: Some participants have asked about upcoming web chat topics. If you would like to suggest topics for 2011, please use our contact link www.clevelandclinic.org/webcontact  to submit your suggestions. In the question/comment section, choose Health/Disease Information so that we receive your comments.


More Information
  • To make an appointment with Erika Woodson, MD, or Sarah Sydlowski, AuD, PhD, in the Head & Neck Institute at Cleveland Clinic, please call 216-444-0354 or call toll-free at 800.223.2273, ext. 40354. You can also email the Hearing Implant Team at hipteam@ccf.org or visit us online at www.clevelandclinic.org/hearingloss.
  • A remote second opinion may also be requested from Cleveland Clinic through the secure eCleveland Clinic MyConsult Web site. To request a remote second opinion, visit www.eclevelandclinic.org/myConsult.
  • If you need more information, click here to contact us, chat online or call the Center for Consumer Health Information at 216.444.3771 or toll-free at 800.223.2272 ext. 43771 to speak with a Health Educator. We would be happy to help you. Let us know if you want us to let you know about future web chat events!
  • Some participants have asked about upcoming web chat topics. If you would like to suggest topics, please use our contact link www.clevelandclinic.org/webcontact.