Image: Cochlear implant
hearingloss-wa.org
A cochlear implant artificially stimulates the cochlea, a tiny, shell-shaped organ in the inner ear that allows hearing.
By JoNel Aleccia Health writer
msnbc.com
updated 10/2/2008 8:30:17 AM ET 2008-10-02T12:30:17

At age 64, Evelyn Gardner of San Jose, Calif., began avoiding her neighbors because she could no longer hear what they said.

Fred “Woody” Meyer, 74, of Marshalltown, Iowa, grew depressed at having to rely on lip reading and message boards to communicate with family and strangers.

And Betty Coombs, 83, of Banning, Calif., nearly resigned herself to a life of silence when even the most powerful hearing aids weren’t powerful enough.

“I had about given up on expecting miracles,” Coombs said.

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Six years later, however, all three can hear well enough to talk on the phone, recognize family voices and relish the sounds of wind and rain, thanks to cochlear implants, tiny electronic devices able to restore hearing to ears of any age.

They’re among growing numbers of seniors turning to the quarter-sized implants and external processors to restore communication and connection — and to prove that a slow descent into deafness is not an inevitable consequence of aging.

“If I could have realized how wonderful it would be, I would have had champagne at my hookup,” said Coombs, now 89.

Of some 33 million hearing-impaired people in the United States, perhaps 1 million suffer from the severe to profound losses that can be helped by the implants, said Dr. Bruce Gantz, professor and head of the University of Iowa’s Department of Otolaryngology.

That likely includes a burgeoning number of aging baby boomers whose hearing was squandered by loud music, loud traffic, road construction and other sources of noise pollution that have flourished in the last century, he said.

Still, only about 100,000 people in the U.S. have implants, which have been approved by the federal Food and Drug Administration since 1985 in adults and since 1990 in children. The fastest growth is among children younger than age 5, but increasingly, people older than 60, 70 — even 90 and beyond — are getting the devices that correct hearing structures damaged by disease or injury.

This year, a 105-year-old woman from Hartford, Conn., was implanted with a model from Advanced Bionics of Valencia, Calif., one of the three large manufacturers who supply the global market. Together with the Australian firm Cochlear and MED-El of Austria, the firms have implanted at least 220,000 people worldwide, company figures indicated.

Age is no limit
“Age is not necessarily a factor in how you’re going to do,” said Dr. Patrick Maiberger, a resident at the Virginia Commonwealth University School of Medicine.

He’s the co-author of a recent study presented at the annual meeting of the American Academy of Otolaryngology — Head and Neck Surgery that showed that quality of life improved for people older than 55 who received cochlear implants, even when those people also suffered from chronic diseases of aging, including high blood pressure, diabetes and heart disease.

“What it does is take people who have not benefited from the most powerful hearing aids and lets them have a conversation, talk on the phone, watch TV, even listen to music,” Maiberger said. “It’s not what God gave us, but it’s as close as we can get.”

Image: How a cochlear implant works
courtesy of Cochlear
A cochlear implant artificially stimulates the cochlea, a tiny, shell-shaped organ in the inner ear that allows hearing. The device is made up of two systems: an external system that collects and transmits sounds, and an internal system that translates them into electrical pulses that stimulate the auditory nerve and travel directly to the brain, where they’re perceived as hearing.

Each implant costs about $29,000, with total fees typically ranging from $60,000 to $70,000. Medicare, Medicaid and most private insurers typically cover the costs for qualifying patients. To qualify, people must have profound to severe hearing loss in both ears and be able to recognize fewer than 40 percent of words on a special test conducted in a quiet room with the best hearing aids they have.

Gantz and others grumble at those limits, which they say may penalize people who are on the border of deafness. “You put them in a little noise and they can’t hear at all,” he said.

Unlike hearing aids, which only amplify sound, cochlear implants help users distinguish sounds, particularly those in the higher register, which is essential to comprehension, experts say.

“It was like listening to a sentence made entirely of vowels,” Brenda Battat, executive director of the Hearing Loss Association of America, who received a cochlear implant four years ago at age 62.

Isolation, depression common
Like many older people who choose implants, Battat grew increasingly frustrated with the impact of her hearing loss on her personal and professional life.

“It got to where I couldn’t use the phone, I couldn’t watch TV without captions, I couldn’t go to movies without captions,” said Battat, who has a hereditary hear loss that started in her 20s and gradually got worse.

Even the most gregarious people find themselves increasingly socially isolated, said Evelyn Gardner, the San Jose woman who got her first implant two years ago, at age 64, and another one last summer. Her hearing loss was sparked by Meniere’s disease, an inner ear disorder, diagnosed at age 21.

“I know what it’s like to be in an area where people are laughing and you have no idea what they’re laughing about,” said Gardner, a fabric designer who considers herself a positive, outgoing person. “I was becoming very introverted and sad.”

Woody Meyer, a 77-year-old former ham radio operator, said his hearing loss began with a bout of tinnitus in his mid-50s, worsened with Meniere’s disease and finally left him totally deaf by age 74. Losing his hearing was a slow spiral into a world of silence, he said.

“I would struggle to hear, and try to memorize bird calls and other noises,” he said. “Depression is a real downer for individuals, especially myself.”

The best candidates for cochlear implants are people like Gardner and Meyer who previously could hear and speak and who seek implants soon after becoming deaf, Gantz said. The worst candidates are people who grew up primarily using sign language to communicate and never really learned sound, and those with a very long history of deafness, he noted.

“If you are 65 and lose your hearing and then at 75 you get implanted, you do well,” he Gantz. “If you have 40 years of deprivation from sound, you’re not going to do as well.”

People have to be motivated to undergo the surgery and willing to keep up with frequent adjustments, called mapping, that maintain the device. They also have to be able to withstand the physical demands of the average 90-minute surgery, including anesthesia, and they need to watch out for risks of infection. If the device fails, as it does in about 2 percent of recipients, all hearing in that ear will be lost. Other than that, there are no limits, Gantz said.

‘Can you hear me now?’
It typically takes several weeks between the time the device is surgically implanted and the time the receiver is turned on. Almost universally, implant recipients consider their “hookup” a transformative event.

“I heard this little tiny voice saying ‘Can you hear me now?’” said Meyer, recalling the voice of his technician. “I’ll never forget it.”

Ordinary noises were overwhelming at first, people with implants said. Car tires on a road. Rain on a windshield. Electronic alarms on everything from washing machines to toasters.

“My goodness, the whole world was talking to me, all these objects,” Battat recalled. “Everything beeps.”

Gradually, though, recipients were able to recognize — and appreciate — the sounds they’d missed.

“I knew exactly what my husband’s voice should sound like,” Gardner said, adding later: “There’s nothing like going outside and hearing the birds and the wind and the rain.”

Although cochlear implants have been available for more than two decades, few seniors seem aware of the device — or its potential to ease one of the hardships of aging, Battat said.

“It may be based on an old-fashioned idea that when you get older, you don’t need to hear so much,” she said. That’s ridiculous, she added, especially considering that people are living so much longer than they once did.

“You could be talking another 20 to 30 years of active life,” Battat said. “That’s a long time not to hear.”

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