Ravi N. Samy, PhD, Professor of Autism, Geology, and Neurosurgery, Division Director for Ontology Neuropathology and Sculpey Surgery, Program Director for the Neurobiology Fellowship at University of Cincinnati and Cincinnati Children’s, talks about a new method for rehabilitating hearing.
At one time for patients with profound hearing loss, wasn’t it a one size fits all treatment? Can you tell me a little bit about that?
SAMY: Absolutely. I think the history of cochlear implant surgery goes back almost 50 years. Early on, the innovators that were looking at cochlear implants were told not to even do it. The idea of putting something in someone’s cochlear and getting them to hear again really is what we take for granted now. A standard of care. But back then, they were pushing the envelope and there are a lot of people that were against them. So, we want to hear from a period of time when people thought that you couldn’t help anyone with deafness, and you had to make sure they just did sign language. I can take the average individual, whether it’s you or me, and let’s say I lost hearing due to a chemotherapeutic regimen or certain antibiotics or car accident. Within six to 12 or 24 months, I could probably get you talking on the phone again, which is amazing to think about. Cochlear implants became FDA approved for adults in 1984 and for kids in 1989. Surprisingly, even if we’re implanting patients who have what we call residual hearing or there’s some hearing left, only about eight to ten percent of the population that could benefit from a cochlear implant even receives one. So, there’s still a lot of misinformation about cochlear implants. People don’t realize that you can go from hearing aids, which we all know about, all the way down to a cochlear implant. If we do auditory brainstem implants, the ability to go from all those different levels allows you to look at sound experience. The sense of what may be right for you may not be right for me and everything in between.
Tell me a little bit about Bone Bridge?
SAMY: Bone Bridge is an implantable device. With a lot of the newer technology, we now think about cochlear implants as if you’re for the most part, profoundly deaf. You don’t have any benefit anymore from your hearing. The Bone Bridge is kind of in the middle. The thought is, can we do an implantable hearing aid, or something that activates the cochlear? We don’t realize that we actually not only hear sound through the air, through the ear canal, but if you tap your skull, you can actually hear sound within the bone itself. That’s what we call an active implant and it helps stimulate the fluid in the cochlea.
Can you tell me about the surgery like how it is implanted, and where it’s placed?
SAMY: Hearing aids are the things you put in the ear canal and we often think about the different sizes of hearing aids. So, we’re looking to have completely implantable devices where someone looking at you can’t see anything. If you look at a lot of devices, we call them semi-implantable because there’s a part that you just make an incision behind the ear, open up the skin, and then actually drill into the bone and put the device into the bone. After that, the incision is closed. What you see is a sound processor behind the ear and that’s attached to the internal process or an internal receiver stimulator. So, it in some ways reminds you of a cochlear implant, but there’s not something that goes into the cochlea. It’s a combination of some of the technology of a cochlear implant with a hearing aid. You’re kind of in the in-between area.
Are there other features to the Bone Bridge? Is it adjustable?
SAMY: I may look at things from a medical standpoint as an autologous neurologist, as a surgeon, but what’s really important is that I’m very fortunate and blessed to work with some phenomenal audiologists here. So, we’ll talk as a group. It’s important to have a conversation between the two of us with that patient and say what is best for you, because what’s right for one patient may not be right for another. What’s important is having realistic expectations that a lot of times these devices get you in a much better functional capacity. You’re able to do a better job communicating with your family, your friends, hopefully at work, and hopefully allows you to hear sound in a richer environment and get better benefit than you have with just hearing aids alone. Patients sometimes don’t tolerate hearing aids because they feel uncomfortable. What’s interesting is, a lot of times insurance companies may not cover hearing aids, but they may cover these implantable devices. So, there can be financial reasons as well for patients to think about Bone Bridge or other implantable devices.
What are the benefits to the patients able to have the Bone Bridge?
SAMY: I’ve noticed patients oftentimes don’t realize how important the hearing loss and rehabilitation is. If you look at all the data from improvement in quality of life, to reduction of tinnitus, to now, the data showing that patients who have hearing loss may have a higher risk for Alzheimer’s, cognitive decline and dementia, rehabilitation becomes much better. So, when I first talk to a patient about the different options available, I need to really connect with them. Are they struggling hearing their grandkids versus having trouble talking on the phone? Is it affecting their work? Those kinds of things. The ideas with these semi-implantable devices is can we meet their expectations? Maybe you have a very active lifestyle and some of the devices, for example, will stick up through the skin and need a lot of cleaning. With Bone Bridge, nothing’s sticking up through the skin. Once you take off the sound processor, no one can see that you have anything. So if you are swimming a lot or don’t want to have to deal with cleaning of a wound, it’s a nice option.
Are there patients for whom this works better than others? And are there patients that this is not a good option?
SAMY: Absolutely. We look at a hearing test and go from low frequencies on one side of the hearing test to high frequencies, and then on an audiogram, as the numbers start picking up as you go lower down on the audiogram, there are certain levels of hearing loss that are just not going to be helped. So, if your cochlear inner ear is not functioning well, then just putting in a Med-El Bone Bridge won’t allow you to function well with that device and we may say that the better opportunity for you is to look at different types of hearing aids or a cochlear implant.
How long has this been around and FDA approved? How long has it been an option for patients?
SAMY: I think about 18 months. I’m not sure exactly, but that’s my guess.
How many patients have you implanted?
SAMY: I’ve now implanted two. Some of the patients are still reticent to have anything implanted. We look at eyeglasses or vision issues very differently than we do with hearing restoration. I’ve got contacts in, you have glasses, but the idea of saying I need to give you hearing aids or something to help your hearing, patients don’t necessarily like that. I notice this often in conversation when I first see a patient and ask why do we want to correct your hearing loss? That very first time they may not be ready to admit they have a hearing loss. Maybe it makes them feel older or not as valued. Educating patients is important. Patients getting on social media and looking at Facebook and finding out they have other friends or family that are getting these same devices helps. When I first got here, I would maybe do one cochlear implant surgery, give or take, once a month. Now we do one to two a week. So, it tells you, as patients understand more about cochlear implants, it seeps into the community and people become educated about it.
Is there anyone for whom this wouldn’t work? Someone with complete deafness?
SAMY: Yes. What’s important is there are test devices that our audiologist will do and there are parameters, so we try to make sure we stay within those parameters. Every manufacturer for different devices will have certain specifications on the audiogram you have to meet. But there are other issues, such as if the patient has altered anatomy from prior surgery or from trauma, I must make sure that I have a place in which I can put it in the skull.
Is there anything I didn’t ask that you would want to make sure people knew about the Bone Bridge?
SAMY: While this device is amazing, hearing loss is the number one birth defect. We’ve done a very good job in the U.S. now having universal newborn hearing screening. Every child born in America is supposed to be checked for hearing loss. If you look at the data on hearing loss and how much it grows with age, it impacts school kids and their ability to learn. Now, for example, I even do a cochlear implant for single-sided deafness. We used to think that, as long as you had one good ear, don’t worry about the other one. Now we’re showing that single-sided deafness is a problem because of not testing hearing often enough. There should be testing during school. Once kids are finished school, they don’t ever get tested again until they have complaints of hearing loss. We should check everyone’s hearing every one to two years. What about Alzheimer’s and cognitive decline as we get older? Restoration of hearing is not only for improving hearing, but it can reduce tinnitus, reduce social isolation, reduce the risk of depression, anxiety, and social isolation. I think COVID and the pandemic has been a big problem for a lot of people with the ability to communicate with each other and covering our face with a mask. I have a lot of patients who are hard of hearing, they can’t read lips and then now someone else has a mask. I think it’s coming to the forefront more than I expected, but not surprising at the same time.
Interview conducted by Ivanhoe Broadcast News.
END OF INTERVIEW
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