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Cochlear implant interest growing by Cindy Abole Public Relations It's not good enough to just hear—if you can't hear your loved one's voice. For more than 11 years, MUSC has provided cochlear implant services that  have helped the Lowcountry's deaf and hard of hearing population learn to listen, hear and understand their loved ones voices.  Growing interest in and popularity of implants have increased the opportunity for institutions and hospitals to organize programs as part of a multidis-ciplinary approach to care. The concept helped launch MUSC’s Cochlear Implant Center in August 2000 to assist South Carolina’s newborns, children and adults. The center provides guidance, rehabilitative therapy and other support services in a comprehensive and caring medical environment.  For more than 20 years, cochlear implant technology has gained acceptance and increased demands. Celebrities like radio talk-show host Rush Limbaugh gained public attention a year ago after revealing to 20 million fans and listeners that he was suffering from severe hearing loss. He was implanted with a cochlear device in his left ear last December and has successfully returned to the airwaves since January.   “There’s no one that an audiologist can’t test for hearing,” said Tamala S. Bradham, Ph.D., assistant professor of Otolaryngology-Head and Neck Surgery and center director. Individuals with profound hearing loss, newborns or children who are deaf, involved in good auditory programs and possess a strong family support base are considered as good cochlear implant candidates. Nevitte Swink, speech-language pathologist, works with 4-year-old Daniel McArthur, an implant recipient since last May. Sitting with Daniel is mom, Debbie White. A new statewide program has been instrumental in detecting hearing loss in newborns. MUSC became one of eight hospitals participating in the First Sound program, an inexpensive, noninvasive test that screens infants before leaving the hospital. But the real issue, according to Bradham, may not lie in selecting from one of the three types of implants available through the center, but determining what mode of communication a patient or parent of a child with severe hearing loss is comfortable with based on their needs and expectations. “Parents should explore all types of communications options available,” Bradham said. “If it is the parents' desire for their child to develop spoken language, a cochlear implant is a good option along with intensive therapy.” For adults with progressive or sudden severe to profound sensorineural hearing loss who possess some hearing memory, they may be able to detect speech and environmental sounds like birds singing, a telephone, cars approaching, etc. with the cochlear implant. Although hearing loss is caused by damage or failure of the hearing organ’s hair cells to trigger electrical signals in response to sounds, some nerve fibers are still usable and can be directly stimulated with the aid of an implant to transmit sounds to the brain. “Cochlear implants are a great option for adults who’ve grown up with normal hearing all of their life and then experience a sudden or progressive hearing loss,” Bradham said. “We’re able to give them back the sounds of their environment including the voices of people and loved ones. It’s good if it helps them gain confidence in themselves to want to communicate with others.” Like most medical prostheses, cochlear implants are expensive. Recent articles in the Journal of the American Medical Association (JAMA) outlined a cost-utility analysis of cochlear implants in both children and adults. Their results confirmed a positive effect in the quality of life and costs involving children. It was also determined that adults suffering from profound hearing loss had a substantial health-utility loss. It concluded that more than half of that loss is restored after cochlear implantation. Statewide cuts in Medicaid/Medicare may affect the ability for some patients to benefit from cochlear implants. Lambert hopes that greater patient advocacy throughout the state may increase availability to underserved patients who meet the criteria as implant candidates. “The efficacy is there,” said Paul Lambert, M.D., chairman of MUSC’s Department of Otolaryngology-Head and Neck Surgery and  neuro-otologist for the center. “It is our desire to make cochlear implants more widely available without costs being an issue.” This multidisciplinary approach to care involves the coordination of a network of people, services and components within the medical center, community and throughout the state. It’s a network that Bradham helped develop more than a year ago. It begins with a pre-operative assessment and evaluations with each of the staff, patients and family. The center’s team is composed of audiologists, neuro-otologist, radiologist, speech-language pathologist, psychologist, financial aid counselors and other specialists.  “The center has made tremendous progress in the short nine months we’ve provided our multidisciplinary level of service,”Lambert said. “Dr. Bradham and her staff certainly deserve the lion’s share of the credit for guiding the center to where it is today.” Every two weeks the team meets to discuss candidates and non-candidates. They plan and make decisions regarding priority and need, review of hearing aids/devices, discuss family issues and other challenges including transportation, insurance, etc. Team psychologist Pam Ingram meets with the implant candidate and family to conduct a developmental assessment. She evaluates the child's overall development, including cognitive abilities, language skills, and day-to-day adaptive functioning. She also evaluates the family's understanding of the process, the need for follow-up care, availability of support to the family and other issues. “I remind families that therapy doesn’t end at the therapy appointment,” Ingram said. “It’s just like a diet; for it to work it needs to be integrated into the family's daily life and can't be successfully accomplished in just a couple of hours a week.” After a candidate has been approved, the surgery is scheduled and performed as an outpatient procedure. Several visits are made following surgery to activate and fine tune the implant as the patient learns to listen and adjusts to new sounds. Children may require more follow-up visits than adults as they learn to listen and develop speech.  Although the quality of sound from the cochlear implant may differ from the quality of sound from natural hearing, adult implant users learn to adjust and adapt to speech and conversation through training and practice. “It usually takes awhile before a child’s auditory system is developed to listen and comprehend things,” Bradham said. “It’s during this time that children can benefit a lot from therapy and continuous practice.” Speech-language pathologist Nevitte Swink is the team’s newest member. Formerly with McCloud Medical Center in Florence, Swink conducts Speech-Language-Auditory evaluations on pediatric and adult patients prior to implant and post-implant. She is trained in auditory verbal therapy (AVT), which teaches children to learn to listen and understand spoken language. Her sessions invite children to practice their listening skills, speech sounds putting them in words, phrases, and then into sentences. Swink reports that it is important that parents are an active part of therapy in order to carry these skills home and into the child's everyday living. For implant adults, therapy focuses on improving quality of life. She provides activities that help to improve conversational skills though auditory means, telephone skills and other activities that they can perform and practice independently.  “Seeing these children progress and become successful in the classroom helps make others aware that if their child has a hearing loss, they can learn to develop spoken language and  listening skills through advancements in technology, commitment to therapy and consistent management of their cochlear implant programming,” Swink said. This attention towards excellence helps to ensure that an implant recipient receives the maximum potential of needed care using speech language pathology, school visits, periodic mapping of devices and an overall commitment to patients and their support families. “These components and individuals make a big difference between something that’s good and something that’s very good,” Lambert said. Lambert, Bradham and the staff are excited about the continuing advancements and improvements in cochlear implant technology. “There are still many significant technical developments being made with cochlear implants,” Lambert said. “The devices that are implanted today are significantly more sophisticated than those implanted just five years ago.” About 20 years ago, adult implant patients relied on single channel devices that could provide basic sound and clarity without the ability to understand speech. But the advent of micronization and improved chip technology have yielded an array of multi-channel devices that have enabled implant users to comprehend speech, use the telephone and participate in group conversations with little difficulty.  One of the biggest advancements in cochlear implant technology is the age of cochlear implant candidates. Today, implant systems are available for adults and infants, age 1 and older. Research have confirmed that the earlier a child receives sound stimulation to their auditory system, the greater the benefits. Lambert and Bradham would also like to increase outreach and education opportunities for potential candidates. Fortunately, the wide use of cochlear implants among a varied population have increased the number of statewide advocates and ambassadors favoring the procedure. Team members hope to travel throughout state to conduct public education sessions and participate in professional forums to discuss the values of cochlear implants. An other area of improvement and opportunity is research work. Lambert plans for the center to be involved in more collaborative research as it relates to voice/speech pathology and  technological advances in implants. He hopes that the Cochlear Implant Center becomes recognized as a test center for new devices, designs and other studies. One area of research interest is whether two implants are better than one. “There’s still a lot to be learned about how the normal ear processes sound,” Lambert said. “As we appreciate the intricacies of that process more and more, we may hopefully be able to mimic it better through custom-designed computer chips and other related technologies.”  To celebrate their statewide successes, the Cochlear Implant Center will sponsor their first statewide picnic for implant recipients Saturday, May 18, at Charles Towne Landing.    Attorney praises implant technology Almost a year ago Charleston Attorney C. Mac Gibson Jr.’s world fell dark and silent. The 43-year old Gibson got the shock of his life after losing all residual hearing. About 14 years earlier, he suffered from hearing loss in his right ear, although he was already hearing-impaired since birth. He called friend and audiologist Tamala Bradham, Ph.D., director of MUSC’s Cochlear Implant Center. He and Bradham collaborated as members of the S.C. Chapter of the Alexander Graham Bell Association for the Deaf and Hard of Hearing organization, which Bradham currently serves as president. Bradham provided him with basic information and advice about the benefits of cochlear implants. It wasn’t long before he had scheduled an appointment and program evaluation. By June 18, Gibson underwent his cochlear implant surgery by neuro-otologist Paul R. Lambert, M.D. Two weeks later, he was fitted with a behind-the ear speech processor that was fine-tuned by Bradham.  “It has been incredible,” Gibson said. “No one can imagine how much this device has helped me, especially in my professional life. There’s no question how it limited me in my abilities to talk and have conversations with people. I am very pleased with the outcome.” Prior to the implant, Gibson remembers the constant stress and effort as he struggled to understand telephone conversations. About 75 percent of the time, he relied on lip reading in conversation. The remaining 25 percent was attributed to his hearing aid. As an attorney, the impairment interfered with everything from court appearances to other professional abilities related to his job. He praises the team efforts of the center. Not only is team expertise, patient care and convenience an important asset for the patient, but so is the variety of implant devices. After much review, Gibson chose a Med-El Cochelar Implant System, both thin, light and boasting the latest in natural sound technology. The device is easy to use, requires minimal maintenance and presents no specific warnings except avoiding direct injuries to the head. “In all of this, I have to recognize the phenomenal job of Dr. Bradham and her staff for helping me reconnect to the world again,” Gibson said. “Today, I feel more comfortable in the courtroom or just meeting and talking to people. I’m much more confident.”  Cochlear Implant Center Team Department of Otolaryngology  Head-Neck Surgery 876-1308 Dr. Tamala S. Bradham, audiologist and director; Dr. Paul Lambert, neuro-otologist and department chairman; Abby Turick, audiologist; Nevitte Swink, speech language pathologist; Pamela Ingram, psychologist; Judi Buckman, clinical coordinator; Nina Gathers, financial counselor; and Cynthia Martino, administrative assistant