Episode 6 Cochlear Implants

The Transcript

Dale Johnson: We get excited about your hearing every Saturday morning at this time on KFOR FM 103.3, 1240 AM. This is Dale Johnson alongside Dr. Sandra Miller of Complete Hearing here in Lincoln. 4200 Pioneer Woods Drive in Southeast Lincoln. Thank you very much for coming in.

Dr. Miller: I’m always glad to be back.

Dale Johnson: And for bringing a special guest today to the conversation.

Dr. Miller: I know. I’m super excited. You know, one thing I think that patients sometimes think is that, in our clinic we do fit hearing aids of course, but we get to a point sometimes when our patients are struggling when hearing aides are no longer benefiting them. And the question always is, “What do I do then? Am I going to have to live this way for the rest of my life with not being able to conversate, not being able to connect?” And so, one thing that we do talk about in our clinic is the possibility of having a patient have a cochlear implant.

Dr. Miller: And so we want to talk about that today. So there’s a little education piece to know even what a cochlear implant is. And I’m so excited to have Dr. Wang with us today. She is actually a researcher at the university and she’s going to share a lot of great information with us today too. I told Dr. Wang today, sometimes when we talk about cochlear implants, my patients get very nervous. They’re scared about the process. They don’t know that this is even going to be something for them, because the word surgery is always scary.

Dr. Wang: Mm-hmm (affirmative).

Dr. Miller: And I think a couple of things that we tell our patients is, “Surgery is scary and it’s always the last option,” I tell my patients too. But when we get to a point that, “I’m struggling in conversation, my understanding is so poor, I can’t conversate with my family anymore, and these hearing aides are no longer helping me. What is the option?”

Dr. Miller:  And so today I wanted to bring Dr. Wang in just as a guest, because she’s doing some great research, and I want to talk a little bit about just … I just want to tell our patients what a cochlear implant is, and then also talking about why your research is so important, so I want to welcome you, Dr Wang.

Dr. Wang: Thank you. Thank you for this great opportunity. I’m very excited to be here as well.

Dr. Miller: So I want to tell you a little bit about how our process works and then Dr. Wang’s going to tell you a little bit about what’s happening on her side, because I think when we think about cochlear implants and the surgery side of it, we can tell our patients, “Hey, we’re going to look at your audiogram and tell you, yes, definitely you’re a candidate and we have all these measures we’re going to take to make sure that you are a good candidate.”

Dr. Miller: I’m going to call it on the outside and that just means we’re going to measure objectively, yes, you meet the criteria. This is going to be great. But my patients always say, “Well what’s going to happen?” And we talk about the predictors of success, I think the things that you’re doing in your lab are amazing in terms of what’s happening, because I tell all the patients we’ve been talking with Dale about, we hear with our brain.

Dale Johnson: Mm-hmm (affirmative).

Dr. Wang:
Mm-hmm (affirmative).

Dr. Miller: So I’m really want you to share with the listeners today what you’re doing in the lab in terms of research with this particular area.

Dr. Wang: Mm-hmm (affirmative). Yeah, sure. So let’s start with the the device.

Dr. Miller: Awesome.

Dr. Wang: So what is the cochlear implant device is, yes? So cochlear is the organ very crucial in our inner ear to give us the ability, let the brain to process the sound. And then the cochlear implant device have two components. One is the external components, one is internal one. So the internal one is a very actually small electrodes on which can be implanted into your actually cochlear in your inner ear. And then the external part is actually the part that have some electrical devices can converting the speech sound to the signals through radio frequency modulation. And then sending to the internal part so the brain can converting the speech sound that way.

Dr. Wang: So, if you are not really benefit from hearing aids, but then, if you have a intact auditory nerve through our imaging scan. So I’m a neuroscientist. So I’m interested in how the how the brain plays a role to predict outcome. So my research in my lab is trying look into before the surgery, I will get a brain imaging scans and then we will study the structural and then the function of the temporary lobe, which is where the auditory cortex laying.

Dr. Wang: So auditory cortex means, is the brain function region in charge of converting the sound waves to auditory inputs, which you can hear. And then I follow you longitudinally and then after surgery, three months, six months and 12 months trying to see how your brain adapt to this new device and to learn, to hear, to understand the speech using this device. So that’s kind of my research area. And then we are actively recruiting, actually. So anyone from as young as a baby, and then to as old as 80 years old.

Dr. Miller: We often tell our patients that cochlear implants are this process of, ‘This is going to take your brain a really long time to adapt to and I don’t want you to expect it work and turn it on and things are going to sound great.’ It’s not this fix-all.

Dr. Wang: Yes.

Dr. Miller: And we hear with our brain, and so I tell my patients sometimes this is an artificial sound to you in the beginning.

Dr. Wang: Yes.

Dr. Miller: And the capability of the brain to be able to relearn how to convert that energy into something that’s meaningful. And so, for some patients I tell them that’s going to happen more quickly than others.

Dr. Wang: Right.

Dr. Miller: And so, is your research looking at candidacy wise how you think they’ll perform or this is more what happens to the brain after they’re implanted?

Dr. Wang: The goal definitely is to use this research findings to actually let us understand this candidate’s process much better, because right now as you said, you mentioned that we can do off audiogram tested there or their hearing profile before the surgery. However that’s peripheral, it’s outside, it’s not really the internal thing. So my goal right now is to look in the internal, however it is very little have been done. So we have some ideas. For example, how actually when you process, when you actually before the surgery how your auditory cortex, which is the in the temporal lobe, process auditory sound stimulation, which actually predict how well your brain can adapt to the new device to learn this new skill.

Dr. Wang: And then, definitely there’s also the age of implantation as well. So when you get older you might take a longer time to learn this new device because the brain plasticity reduce with age. Your brains not as easier, it’s not like easily it can be mold anymore. So you need to take a little bit efforts to learn that new skill. It’s not like when you actually have a baby, a lot of things come very naturally. So that’s my research right now is really trying to pinpoint what exactly. We have some idea in the temporal lobe, however we don’t know exactly what sub domain in that big cortex is really going to help us to understand who is going to benefit most, and also to give you a better outcomes which you can expect. Because you don’t want to say thinking about, “Oh okay, I get this prescription, I had these new glasses, I’m going to see the new word.”

Dr. Wang: No, no, no. It’s a little bit different. It takes a process longer. Can be taking … Some people can take three, maybe some people three months they can do that, and six months, but some people might take a year to relate to learn this new system, to learn this new process because the sound is at artificial.

Dr. Miller: Yes.

Dr. Wang: Yeah, as Dr. Miller said. It’s not really exactly the sound that you hear before the surgery.

Dr. Miller: Off the cuff question, is there a way that people can hear what a cochlear implant sounds like before they get a cochlear implant?

Dr. Wang: Good question. I think you can.

Dr. Miller: Oh.

Dr. Wang: They actually, I believe, I think the University of Nebraska Medical Center, they have some simulation device. They can actually put you in that and then let you to mimic and simulate what you’re going to hear when you actually have a cochlear implant.

Dr. Miller: I think that’d be so valuable because to try to explain it to someone, you just can’t explain it. It’s not going to be how you hear now. And we see great success with implants and then we’re fortunate to be a part of this technology and what we can do with that, but to have the … I just love the outcome part of this to say if this is a good predictor, if we can kind of figure out what your brain is going to do with this information and have it be a better indicator. I think your research is fascinating.

Dr. Wang: Thank you so much. But I think, yeah, cochlear implant is really the great way to really actually is because there’s a difference with cochlear implant with a hearing aids. The major difference is, hearing aids only give you amplified of sound, but a cochlear implant really is directly giving your brain the stimulation without just simply amplify the sound.

Dr. Wang: So that’s kind of a mechanism rise, mechanistic is totally different. So that’s why it’s almost like saying, “Hearing aids is a way just to assess you to hear a little bit louder, but however, on cochlear implant can really make the sounds clear to you not just louder in a way. And also you can hear more clear.

Dale Johnson: Dr. Miller, you mentioned that on the onset about people become candidates for and you take the brain scans. So I want to circle back if that brain scan reveals that maybe I’m not a candidate for a cochlear implant, can you take another brain scan.

Dr. Miller: Yes.

Dale Johnson: … a year, two years, three years-

Dr. Miller: Yes.

Dale Johnson: … and the patient then becomes a candidate for a cochlear implant?

Dr. Miller: Oh, that’s a great question.

Dale Johnson: And if it’s not appropriate now, can it be appropriate in the future?

Dr. Miller: The future. Right, great question.

Dr. Wang: Yeah, so I think that’s a wonderful question. And then, so for my research, it’s also one thing we are looking into as well. I wouldn’t say I would recommend someone just because the reimaging at this point, because it’s still in the very beginning stage. So we’re still in exploring, we’re exploring things, however, there’s a great potential in the future. So one thing you mentioned like, one candidate maybe they come in, they still wearing hearing aids, they come in, they got a brain scan. The brain scan didn’t look very optimistic, but then later on, it could change because there’s aging for affect. And also, there’s the environment change can induce their brain and then your plasticity change as well, but there’s a lot of unknown. That’s why it’s necessary right now for us to do this research because just so much is not really being studied, and then so many questions not being answered. So that’s why we use research here can help us to do a better job in the future.

Dr. Miller: And I’m going to relate it back to this is we’re at the ground level, right? We’re getting into this to try to figure out. We know so much about how the brain is so important for processing information in terms of speech, and what happens through a hearing aid versus what happens through a cochlear implant. And just more for the fact that I think it’s fascinating to say, “Why are some of our patients successful and some of them are not?” You can have two exactly the same hearing test results and maybe even the same clarity numbers for understanding speech, but they perform completely different.

Dr. Wang: Right.

Dr. Miller: Right?

Dr. Wang: Yes.

Dr. Miller: And you think about, “Well, why is that?”

Dr. Wang: That’s the thing we’re interested in too. Well, why the variance is there? As you said, the outside factor will look very similar, however the outcome is dramatically different. So then we’ll look at the brain if we can find something. That’s actually going to really help us to find what is really exactly in the brain.

Dr. Miller: Yeah.

Dale Johnson: Before time escapes is, you have an event coming up on Thursday.

Dr. Miller: We do. Because we’re talking about cochlear implants and if you are out there thinking, “I’m wearing a hearing aid, I’m struggling, I’m not doing as well as I want to. Am I a candidate?” We’re having an event next Thursday, September 19th at our location from 6:00 PM to 7:30 PM. It’ll be our team, the team from cochlear who is a manufacturer of cochlear implants as well as Dr Thedinger. He’s a neurotologist from Omaha. And so we’d love for you to join us. This is honestly just about education.

Dr. Miller: We want to give you more information. As you’ve heard some things today is, “Is this for me?” And we’d love to have you join us. Call the office, and we can definitely give you all the information you would need.

Dale Johnson: Dr Wang, can you stay for a second portion?

Dr. Wang: Yeah.

Dale Johnson: The second conversation next week?

Dr. Wang: Sure, I’m happy-

Dr. Miller: Absolutely.

Dr. Wang: Yeah.

Dale Johnson: I think there’s much more-

Dr. Wang: Oh, I’m so excited.

Dale Johnson: … that we can talk about. So we’ll continue this conversation next week. Every Saturday morning here on KFOR. We are concerned about your health. We want you to hear better. Complete Hearing with Dr. Sandra Miller. The conversation starts here on KFOR.