When she’s not working as a regulatory coordinator to help launch clinical trials in the Department of Pediatrics, Oncology and Hematology Research Group at University of Utah Health, Mindy Torman loves to be outdoors. She firmly subscribes to the saying that “outside is the best side.” That extends to her travels, where she and her partner often plan vacations that take them out into nature. Their most recent expedition took them to Alaska, where they got to experience some of the most incredible hiking, viewing bears in Denali and Lake Clark National Parks, and experiencing the splendor of America’s northernmost wilderness.
But last year Mindy’s adventures had to take a back seat after she suffered from a bad episode of vertigo, something she had never experienced before. She scheduled an appointment to see an ear, nose, and throat doctor (ENT). It was the first time she saw an ENT in her adult life, which may not seem too surprising unless you know that Mindy has experienced progressive hearing loss starting when she was about 15 years old.
“Until last year, I had only seen an audiologist and used hearing aids to manage the hearing loss,” said Mindy. The hearing aids worked fine to partially supplement Mindy’s skills as a lip reader. But in recent years, Mindy noticed that the hearing aids were not as beneficial as they once had been.
“The hearing aids just amplified sound, I was still struggling to understand speech,” she said. “That was when the ENT told me that I might be a good candidate for cochlear implants.”
Mindy’s hearing loss was a mystery to her and her doctors. Hearing loss does run in her family, so it may have a genetic component, and she suffered from several ear infections when she was younger. She started to notice the decline in her mid-teens and got her first set of hearing aids in her early 20s. She became a skilled lip reader, and didn’t realize just how much she depended on that until COVID-19 hit and everyone was wearing masks, effectively eliminating her ability to read lips in conversations.
As the hearing loss progressed, she became increasingly anxious in situations where she might have to interact with people – from meetings with coworkers to Zoom calls and social settings like a party or dinner at a restaurant. That anxiety eventually led to a high level of disconnection and isolation. So when the ENT told her cochlear implants could help.
Mindy was immediately interested in learning more.
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“We focus on two populations for cochlear implants – children who are born deaf, and adolescents or adults with progressive hearing loss,” said Dr. Neil Patel, Assistant Professor of Otolaryngology, Head and Neck Surgery at U of U Health. Dr. Patel is a neurotologist and skull base surgeon, which is a type of ENT who specializes exclusively in disorders of the ear and the interface between the ear and the brain. “Many of these adults use hearing aids for a period of time, until some point where their hearing loss is too severe for a hearing aid to meaningfully help.”
A cochlear implant is a neural prosthesis that replaces the function of the cochlea in the hearing pathway, explained Dr. Patel. The device uses an external microphone to pick up sounds in the environment – speech or music, for example – and sends that to a surgically implanted device that stimulates the hearing nerve rather than relying on the tiny hair cells in the cochlea to do so.
Dr. Patel performs about half of the roughly 175 cochlear implant surgeries every year at U of U Health. Because of that high surgical volume, the procedure is relatively quick, and U of U audiologists have a lot of experience programming and optimizing cochlear implants once the procedure is complete.
“What’s unique about the cochlea is that it’s tonotopically organized, meaning that the nerves that receive certain pitches or tones are organized in a specific way along the length of the cochlea,” said Dr. Patel. “The implanted device can take advantage of this organization, activating nerves along the cochlea the same way fingers push certain keys on a piano to create a specific sound.” The brain is able to integrate those signals and perceive sound as nearly normal. Dr. Patel noted that among all the senses, hearing is the only one that we can restore with such high fidelity.
Mindy was referred to Dr. Patel to discuss the benefits of a cochlear implant. The procedure is pretty straightforward – it’s a minimally invasive, 90-minute outpatient surgery under local or general anesthesia. The surgeon threads a small electrode into the cochlea (a bone inside your ear that is shaped like a snail), winding it through the entire length of the cochlea. Today, Dr. Patel and his partners at U of U Health sometimes use robotic assistance to insert the electrode, which is steadier than a human hand and helps preserve as much natural hearing as possible while avoiding any unnecessary damage. That electrode and internal device connect to a speech processor and external microphone, usually located behind the person’s ear.
When Mindy first learned she was a candidate for the surgery, she did some research to better understand what to expect. She also joined a few Facebook groups of people who had undergone the same surgery to learn from their experiences.
“The biggest things I learned are that everyone is different, so the way you experience cochlear implants can vary, and to not go in with really high expectations that the implant will instantly fix your hearing loss,” said Mindy. She talked to Dr. Patel about side effects and risks – there are very few beyond just the risks that come with any outpatient surgery – and felt confident that it was the right choice.
Mindy and Dr. Patel decided to do an implant in both ears, but perform the surgeries one at a time, a pretty standard approach for adults. When the first procedure was complete, she had a little bit of facial numbness and felt a little dizzy for about two weeks, both of which were normal side effects. Dr. Kate Johnson, Mindy’s audiologist at U of U Health, “activated” the device a couple weeks after the surgery and it started sending signals to Mindy’s brain, enabling her to hear sound.
Learning to use the cochlear implant requires a commitment to rehabilitation exercises, which train your brain how to ingest and interpret the signals for various sounds. Mindy would leave the microphone on throughout the day to keep sound coming in , but could also use her hearing aid in the other ear for periods of time as she was learning how to function with the implant.
For some patients, the adjustment period is the most difficult part, says Dr. Patel. The person’s brain is rewiring and learning something new, and it can be tempting to just take the microphone attachment off and go back to the way they were doing things before. To really get the most benefit, patients need to spend the first two to three months intentionally training their brain through audiobooks, podcasts, closed captioning on the television, and apps designed for post-implant learning.
“At first everything sounded very robotic, with a high-pitched ‘Mickey and Minnie Mouse’ sound,” Mindy said. But she was committed to her rehab, spending at least an hour each day working with the hearing development exercises and apps. She also spent time listening to audiobooks and podcasts, making sure to take out her other hearing aid so she could focus on the sounds coming from the implant. By the second surgery and cochlear implant activation, the training and rehabilitation was much easier.
“I find myself constantly asking my partner, ‘what is that sound?’ because there are so many things I’ve never heard before,” she said. Her hearing aids would amplify noise from the environment, and oftentimes those noises would just blur together. But with the cochlear implant she could hear quiet, normal sounds and pick up on small noises she could not distinguish before.
When Mindy attended her first Utah Jazz basketball game after the cochlear implant surgery, she heard the referee’s whistles for the first time. “I was so excited, I texted my friends and family to tell them that I could hear the whistle,” she said, laughing.
Now Mindy can participate in more social settings and conversations, even in large groups or crowded and noisy places like restaurants, without worrying about whether she will be able to hear people well enough. She can also talk to someone who is in another room of the house without reading their lips, something she would have never been capable of with just the hearing aids.
“It surprises people who have known me for a long time when I can suddenly hear something that I would not have picked up on before,” said Mindy.
“The devices have come a long way in recent years, like many technologies,” said Dr. Patel. “The closest thing to compare them to would be similar to noise-cancelling Bluetooth technology.” The microphone on a cochlear implant can capture very specific sounds, like speech, while minimizing background noises like traffic or ambient noise in a restaurant. It creates a hearing experience as close to normal hearing as you can get. Almost universally, patients who undergo a cochlear implant are extremely satisfied with the results.
“Getting cochlear implants has definitely improved my quality of life,” said Mindy. “Anyone who qualifies and is thinking about it, I would encourage them to do their research, join some groups, and talk to people who have been through it. I’m so happy my ENT told me about this option and referred me. Since I can’t get my natural hearing back, this is the next best thing, and I wouldn’t change it for the world.”