Dr. Akira Ishiyama, MD, ear surgeon and director of the UCLA Cochlear Implant Program, talks about how a new cochlear implant restored the hearing in 102-year-old, World War II Veteran, Irvin Poff, and could have potentially slowed down symptoms of dementia.
Interview conducted by Ivanhoe Broadcast News in January 2022.
Can you tell me about Irvin’s situation?
DR ISHIYAMA: Irvin came to see me because he was having difficulties communicating with his friends and family members. He came across the idea of cochlear implants when he was reading the AARP magazine and he presented himself to the audiologist in Thousand Oaks and had the audiogram done to see whether he could be a candidate for surgery. He wanted to explore all the options because it was important for him to continue working with his neighbors and continue to be active within the community.
Tell me a little bit about Irvin. I know he has kind of an interesting story.
DR ISHIYAMA: He’s a very remarkable individual. He is 102, still lives alone. He is completely independent, and he functions as a counselor for elderly patients in Ventura County. He drives many of the elderly patients to UCLA in a van. He still drives eight hours to see his family in San Jose routinely.
Wow. I understand that he’s also a World War II Vet. Can you tell me a little bit about that?
DR ISHIYAMA: Yes. He was a pilot. I believe he flew one of the bombers in Europe.
Can you tell me how being around such loud machinery like a plane affect one’s hearing?
DR ISHIYAMA: In the past, when you’re flying a bomber, there really wasn’t any concept of hearing protection. Even in the 1960s, hearing protection was not really considered to be necessary. A lot of the patients who flew airplanes during World War II, or who participated in the wars without any hearing protection, suffer from hearing problems.
What measures did Irvin take to amplify his hearing before he resorted to the cochlear implant?
DR ISHIYAMA: Irvin had a great difficulty communicating with his friends and their families. He was using conventional hearing aids, and obviously he was not able to get adequate auditory information using hearing aids. That’s when he decided to seek further treatment options, including cochlear implants.
Can you describe what his surgery entailed?
DR ISHIYAMA: So, when Irvin first came to see me, I will never forget how he presented himself when he first came to see me. He walked into the office, and he was complaining about the parking structure at UCLA; he was quite upset. But the first thing he told me was that he had completed all the audiologic studies. Then, he said, “I cannot hear well with a hearing aid,” and “Please put the cochlear implant in.” Irvin also said, “I have finished my preoperative medical clearance and I’m ready to go.” So, he basically came to see me just to sign up for the surgery. Since he is 102, we didn’t want to do anything to compromise his cognition because there are some concerns giving general anesthesia for patients with advanced age. We decided to perform the surgery with local anesthesia along with the sedation. The surgery was done within an hour and now, he’s doing extremely well. He’s able to talk to his friends and family members and he is now able to talk on the phone.
That’s incredible. What were your concerns going into a procedure like this?
DR ISHIYAMA: One of the major concerns was decline of cognition due to anesthesia. The second thing was to have deterioration of health due to surgery. But Irvin is remarkably healthy, and he didn’t have any issues at all with the surgery. I actually called him the day after the surgery. He didn’t answer so, I left a message and then he called me back saying, “What do you need from me?” So, I told him, I was just calling him to check in. And he goes, “I was doing my morning exercise walk.” That shows how quickly he recovered; this is within 24 hours following surgery. A lot of patients, especially in this age group, even with profound hearing loss, try not to seek for any medical care because they think they’re old and they think there’s nothing available. But hearing loss in this age group is quite important to treat because it could deteriorate the dementia. It could further make the dementia worse. Also, depression is very common in this setting because they don’t want to be embarrassed not being able to communicate with others and there are a lot of socioeconomic issues. It’s important for patients, even in this advanced age group to seek all the currently available medical treatment, including cochlear implants, if the hearing aid is not adequate. The surgery can be done under local anesthesia with sedation.
How does it make you feel to see a patient, like Irvin, who’s 102, do so well after and lead an active life?
DR ISHIYAMA: It’s amazing, the human ear is so plastic. In other words, even with the presence of profound hearing loss, even in his age group, you can still benefit quite a bit with the cochlear implants. The duration of deafness, meaning from the moment where you lost a lot of hearing loss to the point of surgical intervention, is critical. The shorter the duration of deafness to the point of intervention, the outcome is better. So, it’s important to seek medical care as soon as you’re having difficulty with hearing aids.
Have you seen Irvin since his procedure? Can you tell us how he’s doing?
DR ISHIYAMA: I’ve seen Irvin after the surgery twice and it was at UCLA. Every time he comes, he needs about five minutes to talk about how bad the parking situation is, and I need to apologize. He says, “I love coming to UCLA, but can’t you do anything about the parking?” And then he complains about it for five more minutes.
Can you tell me what inspired you to devote your life to this line of work?
DR ISHIYAMA: That’s a good question. I had a lot of ear infections as a child, and I also had hearing problems growing up. So, when I went into medicine, that’s one area I wanted to get in, to help people with their hearing problems, because I have experienced that as a child.
Wow. It’s rare that physicians have experienced the same issues that they treat. I love that.
DR ISHIYAMA: Actually, the guy who started the cochlear implant company in Australia, Graeme Clark, is the one who did the basic science work to start the cochlear implant in Australia. His father was a pharmacist in Melbourne, Australia, and he was severely deaf. He [Clark] went into medical school trying to help somebody like his father. But as soon as he graduated, he started doing facial plastic surgery, making a lot of money. Then, one day, he said, “This is not the reason I got into medical school.” So, he closed his clinic and got into a Ph.D. program in neurophysiology at the University of Melbourne. From there, he opened the cochlear implant company. Now, they have 80% of the global market share. It’s a very successful company and he’s still alive.
Wow, that is incredible. Tell me, how long have you been doing this?
DR ISHIYAMA: I’ve been doing this since 1997. Initially, at UCLA, when I first joined head and neck surgery back in 1997, we didn’t have cochlear implants, so we had to start from scratch.
What has it been like watching the evolution of what’s available to patients?
DR ISHIYAMA: The technology has changed very rapidly, and this is an extremely rapidly changing field. Twenty years ago, when we started cochlear implants, we could only implant on one side when a patient had bilateral profound hearing loss. Today, the age cutoff and hearing cutoff to qualify as a patient for cochlear implant has significantly changed, so, we are putting cochlear implants in patients with residual hearing because we know that the more biologic structures you have in the inner ear remaining, you do so much better with early intervention. So, things have evolved quite a bit. We also have technology that combines the use of a hearing aid and a cochlear implant, called the hybrid technology. By doing both, we can help patients who have some hearing in the low frequencies, but no hearing in the mid and the higher frequencies.
What is the difference between the hearing aids, like the ones Irvin had, and his new cochlear implant?
DR ISHIYAMA: A hearing aid is essentially an amplifier. You place a hearing aid mold in the ear canal and then there is a hearing aid which amplifies the sound that goes into the ear canal. A cochlear implant is a procedure that requires placement of an electrode in the inner ear, and the implanted electrode gets electronically stimulated to provide auditory information to stimulate the hearing nerve directly.
END OF INTERVIEW
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