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Cochlear Implants: Expanding the Benefits for More Patients

While cochlear implants have been approved to treat severe to profound sensorineural hearing loss since the 1980s, recent advances in technology and implant design have not only made the devices more effective, but also increased the pool of device candidates. For Jeffrey Vrabec, MD, FACS, board-certified otolaryngologist and neurotologist, and his team at Houston Methodist Hospital, unique treatment approaches also serve to enhance outcomes and quality of life for more patients.

Jeffrey Vrabec, MD, FACS

Kenny Lin, MD

Utilizing Technological Enhancements

Unlike a hearing aid, which acoustically amplifies low-frequency sounds, a cochlear implant electrically stimulates the cochlear nerve to enable patients to perceive sound, restoring speech perception. “Typically, we see a bimodal distribution of patients: very young children or older adults. For older people, they reach a point where hearing aids are ineffective,” said Vrabec, who has been treating ear disorders for over 25 years and is one of the most experienced ear surgeons in the Greater Houston area. “Patients at this point often struggle to participate in phone calls or, nowadays, video calls.” After training, older adults can learn to associate the signals from the implant with sounds they remember, achieving significantly improved understanding of speech. However, while older adults make up a significant population of cochlear implant candidates, in the recent past, the device hindered patients’ ability to undergo MRIs. “As patients get older, we know it’s more likely for them to need a brain MRI,” said Kenny Lin, MD, a board-certified otolaryngologist who works alongside Vrabec at Houston Methodist Hospital. “In the last few years, all implant makers have converted to MRI-compatible devices, increasing candidacy.”

The Houston Methodist Difference

Cochlear implants are typically implanted under general anesthesia, which presents significant risks for certain patients, and may drive lower adoption among older adults. The use of local anesthesia and sedation is an option, but one that requires significant knowledge and expertise due to, in part, the need to perform the procedure more quickly — limiting availability to highly specialized centers. Vrabec reports successful outcomes utilizing local anesthesia for these patients, significantly reducing risks and making the device available to patients who may have been unable or unwilling to undergo the procedure otherwise. In addition to opening the opportunity for more patients, the team is also actively researching whether preoperative vestibular dysfunction is a risk factor for dizziness after surgery, given that balance problems are one of the most commonly reported side effects postoperatively. “Currently, there’s not a lot of research available to predict which ear would be better to implant from a vestibular function standpoint,” said Vrabec, who has authored more than 70 peer-reviewed articles on otology and neurotology. “One of the ways we approach this challenge is to test for balance function preoperatively, which helps inform which ear to implant.” By choosing the ear with lesser vestibular function for implantation, Vrabec said, the team works to preserve balance by leaving the higher-functioning ear untouched. The team continues to gather data on postoperative vestibular function with the intent to publish its findings in 2022.