- Hey guys.
Welcome back to the Dr. CliffAuD vlog.
This is log number 112.
And today I wanna talk to you guys about cochlear implants.
Now I talk a lot about hearing aids on this channel.
I probably talk about hearing aids too much
but nonetheless, I wanna talk about cochlear implants today
specifically because I had a number of individuals come
into my clinic over the past couple of weeks
who I recommended strongly to get cochlear implants.
But before I get into this topic anymore
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but that out of the way,
let's go ahead and talk about this a little bit more.
So individuals who have really bad hearing
a lot of those individuals find their way
to me because they're always looking online
for a better treatment option.
And after watching a bunch of my videos
and things like that, they determine that
I must be the place to go
to solve their hearing difficulties.
But oftentimes when these individuals come in
or at least some of these individuals come in
we determine that hearing aids,
even if they were fit in program perfectly
they just would not solve the hearing difficulties
that these individuals wanna solve.
And it's due for to a couple of reasons.
So let me try to see if I can explain this in this format.
So when you undergo a hearing test
the first thing that we're looking for is
the severity of your hearing loss.
This is the X's and the O's on your audiogram.
This is where you're clicking the button
or raising your hand for the beeps that we play you.
We're basically looking for the
softest level of sound that you can barely hear.
Now, if we determine that you're
in this like mild to moderate category
then you're probably gonna be using hearing aids.
If you're moderately severe to severe
you're probably gonna be using hearing aids.
But if you start getting down into the severe
to profound hearing loss range, there is potential
that a cochlear implant might be option for you
but let's not put the cart before the horses.
Let's talk about this a little bit more.
So even if you are down
in this severe to profound range, it doesn't mean
that you would be a cochlear implant candidate.
This is why we need to go and do additional speech testing.
So when we're doing speech testing, we're identifying
that when we amplify sound, will you be able to
actually we comprehend the words that we play you
without having visual cues and
without having context of what's being said
and what happens is we get an actual percentage
for this score.
And if you score a really high percentage
let's say like a 100% when sounds are amplified for you,
then it's a a good bet that you're prognosis would be
really, really successful
if you had a hearing aid treatment.
So using hearing aids,
if you end up scoring really low percentages on this
that could indicate that you
if you were to wear hearing aids
that you would not receive a very much benefit from them.
So for instance,
if you scored 20% speech understanding when we play sound
into both of your ears, then that indicates to us that man
even if we put hearing aids on this individual
we can get the sound to your brain
but you can't actually it
by the time that it gets there.
And this is often due to the damage of inner hair cells.
So I know I'm getting pretty complicated and technical
with this discussion, but please try to follow along
because this is extremely important
a very important concept for you to understand.
Inside of our ears, we have something called a cochlea.
This is our hearing organ.
Inside of this cochlea, you have a bunch
of fluid and you have a membrane.
When the vibration of sound comes into the cochlea
it will make the membrane move
but you also have these microscopic little outer hair cells
on the outside of this membrane.
So when this vibration comes in
these hair cells will make the membrane move even more.
It moves enough,
it will trigger a set of inner hair cells
that are embedded inside of this membrane to trigger these,
to take this signal
or take this vibration and send it up to the brain.
So when we start to look at this
when you are raising your hand
or clicking the button for the beeps,
we are measuring how these outer hair cells are
functioning inside of your ear.
When we're testing your comprehension
or discrimination of speech.
What we're testing is the inner hair cells
that are taking this vibration
of sound and sending it up to the brain.
If you have a deterioration of the outer hair cells
it will make the X's and the O's
fall down further on the graph.
If you have a deterioration of the inner hair cells
it will take the clarity of speech
those speech percentages, and drop them down lower.
Now, when you use a hearing aid
you can overcome the outer hair cell damage
by amplifying this sound externally
and forcing that membrane to move enough
to trigger a signal to the brain.
But if those inner hair cells are so damaged
that it can't receive this vibration
and transmit speech clearly up to the brain,
you're in a situation where hearing aids just won't help.
Now I understand that I probably lost
about half of you with this explanation.
And if you were a patient sitting in my clinic
I would go much slower with the explanation.
And I would probably explain it a couple of different ways.
If you didn't get it the first time that I explained it
and we don't have the benefit of actually looking
at an audiogram or some kind of a model when I'm doing this.
But with all that said,
let's talk about this a little bit more.
So when you go in and you get one of these hearing tests
from an audiologist or a hearing instrument specialist
if they determine that your speech scores are very low
so that your speech intelligibility
those percentages are very low, they should be recommending
that you go see an otologist or
at least go to their clinic to have a technology evaluation
to determine if a cochlear implant would be right for you.
Now I do realize that I have not yet explained
what an actual cochlear implant is.
I will put a picture of a cochlear implant up here.
You may have seen it on some individuals before
but essentially the whole concept
of a hearing aid would be to amplify
these sounds acoustically to create more vibration
of this membrane.
If that doesn't work,
if it doesn't actually give you that clarity of speech
then you have to consider going to cochlear implant route.
So what a cochlear implant is is essentially you go
through a surgical procedure to insert an electrode array
inside of your cochlea, that will actually
directly stimulate the auditory nerve to send sound
up to your brain.
So it completely bypasses all
of the damage structures inside of your cochlea.
When you do this, you can get a much cleaner signal
up to the brain and you can usually substantially
increase the clarity of speech.
Now here's the thing,
a lot of individuals that I recommend to go
and get one of these cochlear implant evaluations,
they end up not taking me up on that offer.
And it's not because I'm downplaying it
because I just want to sell them a new set of hearing aids.
I'm like actively trying to convince them
that they should take this next step
and at least get another evaluation to determine
if they'd be a candidate or not.
Now, it's been several years
since they've actually worked inside
of a clinic that did Cochlear their implants
but this basically how the candidacy process works.
Once you get a hearing test from an audiologist
they will typically, if you have bad enough scores
send you into a facility that will do cochlear implants.
Once you're there, they will put you
in your best aid condition.
So typically that means
that you will be using hearing aids that are
programmed properly to your hearing loss prescription.
And they will take you
through additional testing while wearing those hearing aids.
If you score below a certain amount
of speech intelligibility with usually open sentences
then you are determined to be a candidate
for a cochlear implant, meaning that is more likely
than not that you would get significant benefit
from a cochlear implant versus just using hearing aids.
Once they've determined candidacy, at that point,
you'll go through a whole bunch of
different candidacy criteria,
meaning that you're gonna have to go to likely
some kind of a seminar where you can really
understand what it means to go
through the cochlear implant surgical procedure
what it would entail after you get done with your surgery
and then ongoing from a long-term care perspective.
On top of that, you probably will have to get a CT scan
of your ears to make sure that they could actually
do the cochlear implant surgery on you.
And then you're probably also gonna have to get some kind
of vaccinations just to prevent you
from getting some kind of a transmissible disease
by going through the surgery.
Once all of that is done,
the cochlear implant facility will typically
contact your insurance company to get a prior approval
to be able to go through surgery.
So there's no surprises from a payment perspective.
After you go through the procedure.
After that, they will typically schedule you
for your surgery and you will go in
for that surgery usually in the early morning.
And you will be out by late morning
and you literally go home the same day.
It's an outpatient procedure.
I think that a lot of people build it up in their minds
that this surgical procedure is really invasive.
And it's really not.
They basically make an incision behind your ear
drill a little hole down into your middle ear space
and then insert the electrode array into the cochlea.
They basically sew you back up and that's just about it.
A lot of individuals don't even need a lot
of pain medication when they're done.
And like I said,
you literally go home the same day.
After about a week or three or four weeks,
depending on the surgical center,
you will go back in to see an audiologist
to have them activate the cochlear implant.
So they have to put the processor
on your ear and they have to do what they call mapping
which is basically the programming
of the cochlear implant processor.
It is at that point that you will be hearing
with the cochlear implant for the time
because for that week to several weeks
you're not gonna have any hearing inside of that ear.
Now they have been getting better with the surgical process
to the point where they have been able to preserve some
of the lower frequency regions of the cochlea.
So you can potentially even do a
hybrid cochlear implant slash hearing aid
but that's a topic for a completely different video.
The point being is that
when you have this cochlear implant procedure done
it can significantly increase your clarity
of speech understanding.
So you're not just making things louder
you're actually making things more clear for you.
Now, will it take you back to perfect hearing?
Most likely not, but I've literally seen individuals go
from 0% speech understanding in their implanted ear
up to 80% speech understanding in the implanted ear
which you don't have to even sit
and think about it for very long.
That is a huge improvement.
Now let's talk about some of the concerns
that individuals typically have when it comes
down to cochlear implantation.
Number one, a lot of people are worried about the surgery.
And I cannot stress this enough.
I've sat through enough of these cochlear implant
surgeries to basically be able to tell you that
it is really not that big of a deal.
Now I know that there's people out there who say
that no surgery is a minor surgery and I totally get that.
But you know,
you really build up in your mind that like, oh my gosh
you're gonna be doing some kind of brain surgery on me.
And that is just not the case.
The second concern that people have is that
once you go with a cochlear implant, you can never go back.
And I do understand that there's some concern here
especially when you consider
that there are a lot of different companies
out there who are trying to solve hearing loss
or basically cure hearing loss by doing some kind
of a pill or doing some kind
of an injection that will restore these damaged hair cells.
And if you get a cochlear implant, it basically removes you
from the ability to be able to have that done in the future.
But we are probably a long ways away from having any kind
of restorative drug that will regrow these hair cells
to the point where you would be able to have fully
functioning ears without the use of any type of device.
So if you ask me,
is it worth the potential to have a cure 10 to 15 years
down the road worth it to not be able to hear
throughout that entire time?
I would make the argument
that the answer to that is definitely no.
The third concern is a age.
So there are some individuals who are like, I'm just so old
that I don't know if I'd be willing to go through with this.
I don't know if I could make it through surgery
and I totally get that argument.
I mean, I think the oldest individual
that I participated or that I'm aware
of them having surgery is into the, like the mid nineties.
So if you are someone who's in like your 80s
or your seventies you're definitely not too old
to get a cochlear implant.
And the fourth thing that people are concerned
about is the look of the cochlear implant processor
as you're wearing it.
So yes, cochlear implants are a little bit bigger
than hearing aids, but it really, at the end of the day
you have a couple of options here.
You have the ones that actually hang on top of your ear.
Again, I'll put some pictures up here.
You also have the ones that only are this little puck
that you put on top of your scalp that will kind of
like magnetically connect to the implant
that's underneath the skin
which is exactly how all these cochlear implants work.
But it basically creates a way that you have
a little bit less of a footprint on your head, so to speak.
And really when you take them off
you can't even tell that you've had anything done.
So if you do want to, in certain circumstances
not wear it for whatever reason, you don't have to wear it.
You just won't be able to hear in that particular ear.
Now, if you ask me
and of course I am biased when I say this,
I would say that it doesn't matter
what the heck something looks like when you wear it.
If it can make you hear it is totally worth it.
So I don't know if my explanation
of cochlear implants has really done them justice.
All I can say is that, in my opinion
they're the closest thing
to a medical miracle that I have ever witnessed.
And if you're someone who just does not get good benefit
from hearing aids
stop messing around with the hearing aids,
go and get a consultation to determine
if you could be a cochlear implant candidate
because I'm telling you,
if you actually wanna hear, unless you want to,
assimilate into the deaf community
which I am in total support of as well.
But if you actually want to hear,
going with a cochlear implant is a way that you
can actually get your hearing back.
All right that is all that I wanted to talk about today guys
I hope this video brought some value to you
and at least made you aware of what a cochlear implant is.
I do have other videos
on my channel where I explain the process
of getting a cochlear implant
and I've even done some reviews
on different cochlear implants.
If you wanna check out those as well
there's a ton of information online
from the three major cochlear implant companies.
You've got Cochlear Americas, you've got Advanced Bionics,
and you've got MED-EL,
so make sure that you check out their resources as well.
But as always guys, I will see you next week.
(upbeat music)