For Immediate Release Contact: Tripler Public Affairs Office, 808-433-5785
When silence is not golden
Cochlear implant surgery offers
hearing-impaired the gift of a lifetime
Note: The listing of websites in this release and the appearance of information, products or services on these websites do not constitute
by Les Ozawa
“I was behind her and said, ‘Push!’ Dr. Ramsey just happened to be walking down the hallway when she said, ‘Tush!’”
“Dr. Ramsey said, ‘She heard you! She wasn’t looking and she heard you!’ Makayla had understood and came back with her version of the same word,” said Grau.
That was just one hurdle, but a very significant one, for the then three-year-old, strong-willed toddler, in her journey towards learning speech as a means of communication. Grau renewed her efforts to go over dozens of sounds and carefully selected words with Makayla, teaching her to control the movement of her breath and parts of her mouth and throat, and to correctly imitate and reproduce the speech sounds she heard.
For centuries, deaf people have developed a separate, but rich cultural space in which to live with the rest of society. They have developed their own ways of communicating to others, through signing, lip-reading and other silent cues.
Technology developed in the 1980’s, however, has aided tens of thousands of people who could not be helped with conventional hearing aids. “Cochlear implants have brought hope to many people who are hard-of-hearing or deaf,” said Maj. (Dr.) Mitchell Ramsey, co-director of Tripler’s cochlear implant program.
“At first, people thought this would never work,” said Ramsey. “Through a number of different engineering advances, auditory research, safety trials and most importantly, working with patients, cochlear implants have become a large success.”
technology has taken off, according to the Tripler otologist (ear specialist).
While cochlear implants (CI) are still relatively rare in
“It’s widely accepted as the medical standard of care for patients with severe to profound hearing loss, who don’t benefit from hearing aids but who choose aural/oral communication,” said Ramsey. The procedure, first approved by the FDA in 1985, is covered by most medical insurance, including Medicare and TRICARE. In 1999, the FDA approved the surgery for children as young as one year old.
the surgery itself runs in the tens of thousands of dollars, cost-effectiveness
is not an issue. A
the past two years, Ramsey has performed nine implant surgeries on adults as
well as on young children. While his practice is limited to Department of
Defense (DoD) beneficiaries, a former Tripler pediatric otolaryngologist, Dr.
Lenhanh Tran, has recently started a CI program at
The surgery is technically challenging, performed almost entirely under a microscope. However, selection and rehabilitation are the most critical aspects to the overall success of the program, especially for young children. CI users have to work hard at linking meaning with sounds. A coordinated effort between the state’s Department of Education (DOE) and Department of Health, and the medical providers is needed to ensure success.
Tripler has found its team approach successful in treating CI patients. The team consists of program co-directors Ramsey and audiology chief Amy Hines, speech therapists, a psychiatrist, and social workers. For children attending public schools, the team includes DOE special education specialists. The team meets monthly to discuss the status of all patients and ways to improve their progress.
help CI users and their families,
The human ear consists of many parts that convert sound vibrations into electrical signals understood by the brain. In a normal ear, sounds go in the ear and vibrate the eardrum. The eardrum passes the vibrations to the inner ear, where three small bones conduct the vibrations into the cochlea.
The cochlea consists of a chamber filled with 16,000 hair cells floating in a fluid. The sound vibrations cause the cochlea’s fluid and hair cells to move. The cochlea’s thousands of hair cells vibrate at the many frequencies of sound, allowing a person with normal hearing to hear a sound’s richness, including its loudness, pitch, and “color.” The hair cells then generate electrical impulses in the auditory nerve that travel to the area of the brain that recognizes them as the sound of raindrops, spoken words, etc.
Hearing loss involves damage to any of the vital ear organs, including the eardrum and the three small ear bones. Damage to the inner ear, or cochlea, however, is the most common cause of hearing loss. If the cochlea is damaged to a large enough degree, conventional hearing aids are of little help.
Today’s cochlear implants use up to 22 channels on computer chips to transmit sound signals to the auditory nerve. It’s not as sensitive as the 16,000 hair cells, but accurate enough to allow thousands of people to carry on phone conversations, enjoy concerts, and react to everyday sounds like someone’s footsteps. Over half of implant users recognize speech without lip-reading.
In a normal ear, sounds travel through the eardrum to the cochlea’s hair cells. A CI bypasses that route. Its implanted electrodes send signals directly to the auditory nerve endings in the cochlea.
The device usually has three main pieces:
The sound processor converts sounds received by the headpiece’s microphone into distinctive electrical signals that are sent back to the headpiece, where its transmitter sends the signals through the electrodes to the auditory nerve in the inner ear.
CI surgery carries the normal risks of major ear surgery requiring general anesthesia. The surgeon cuts a small flap in the skin behind one ear to drill a hole in the bone to access the inner ear. A wire is threaded into the inner ear and its receiver coil is set in the bone behind the ear. The surgeon then sutures back on the skin flap. Most patients spend the night in the hospital and are discharged the next day.
People with hearing loss differ in what frequencies they cannot hear. After the device is activated, it must be “tuned” or adjusted to that person’s needs and comfort, somewhat like an equalizer on a high-end home entertainment sound system. Older children and adults learn how to adjust the processors themselves during therapy.
How much benefit can a person get from a cochlear implant?
It depends on:
Much information about cochlear implant surgery is available at various websites. Listed below are a few. On the last site below, you can listen to what a cochlear implant patient would “hear” through the device.
by Les Ozawa
Sgt. Jason Houston
(from left) goes over flashcards with his daughter, Makayla, to help her practice
speech sounds, while she is coached by her mother, Jessica, during a speech
therapy session at Tripler Army Medical Center. The
by Les Ozawa
Cheyune Glover (left)
by Les Ozawa