Nov 2020 RACGP NewsGP
Cochlear implants are a treatment option for people with severe, profound, or moderate sloping to profound bilateral sensorineural hearing loss who experience little or no benefit from hearing aids.
While hearing aids amplify sound for people with some hearing ability, cochlear implants assist hearing by directly stimulating the auditory nerve. And, yet, this treatment remains under-utilised.
That is what otolaryngologist Professor Stephen O’Leary believes. Professor O’Leary has been working in the field of cochlear implants for more than 20 years and has been Chair of Otolaryngology at the University of Melbourne since 2008. He told newsGP it is well known among otolaryngologists that cochlear implants are under-utilised – and this occurs for a number of reasons.
Some patients are unwilling to physically travel far from their homes to be assessed for cochlear implants in the first place. Others may be reluctant to move on from their care under an audiologist to seek information regarding cochlear implants. ‘The idea that they’re going to a different set of people to get their hearing care is affronting for the patients and sometimes for the audiologist, too, [as] they understandably see that person as their patient,’ Professor O’Leary said. ‘There’s a long and trusted relationship with the audiologist [so] sometimes it’s difficult for either party to want to do something differently, even when it’s perhaps in the best interests of the patient.’
Professor O’Leary says another potential roadblock is fear of having implants put in. ‘Some people are a little bit scared of the process,’ he said. ‘It does involve surgery, but the surgery itself frankly takes an experienced surgeon about an hour these days, so it’s not a big deal anymore. ‘Overcoming those kinds of fears is really important.’
Other patients are concerned that simply meeting to discuss cochlear implants means they must commit to the process. ‘It’s really important for people to understand – and GPs to impress upon their patients – that if they’re sending someone for a cochlear implant assessment it’s not a slam dunk that they’re actually going to be a candidate,’ he said. An assessment is more about understanding a patient’s options. ‘Probably a third to even half of the people that I see and that are assessed aren’t really quite yet a candidate,’ Professor O’Leary said.
Some people can have hearing loss that on the surface would seem to make them suitable for a cochlear implant. ‘But it may come out that their speech perception is still way too good,’ he said. ‘Some people are clearly better with an implant and some people are clearly better with their hearing aids. ‘So not everyone that on paper might looks like an implant candidate really is.’
Professor Stephen O’Leary says hearing loss in adults is often under-diagnosed
Even if a patient is not a candidate for cochlear implants, it can be helpful to assess them to determine their baseline. ‘We can then start to open the door to a conversation if their hearing starts to drop and if their communication is decreasing,’ Professor O’Leary said. Potential under-diagnosis of hearing loss is a further concern in this field, according to Professor O’Leary, who suggests clinicians ask patients three key questions:
- Are you feeling more socially isolated?
- Can you follow the TV?
- Can you use a telephone?
‘And if the answer to those questions is, “Yes, I’m socially isolated, I can’t follow the TV and I’m struggling to use the phone,” then they’re certainly in the zone [of needing to be assessed for hearing loss],’ he said.
‘The next thing we always ask – and, in fact, we never assess anyone for an implant without this having been addressed – is, “When did you last see your audiologist? And how old are your hearing aids?” ‘Sometimes we see people that have been running around with the same hearing aids for eight or nine years.’
In those cases, Professor O’Leary says patients need to have their hearing aids ‘at the very least, properly tuned up’ and then they can have an assessment for cochlear implants. ‘Another thing that GPs may or may not be aware of – though they probably are; they’re very good readers of human character – is that the last person to realise they have hearing loss is the person with the hearing loss,’ he said. ‘Some people are in denial and a strong message is: listen to your family.
‘I often have conversations with someone with the relatives shaking their heads in disbelief in the background. And what I say to people when they’re starting not to cope with hearing aids is, “You don’t need to listen to me, but listen to your family. They’re the only ones who will be honest with you. The rest of the world is not going to tell you how much difficulty they’re having communicating with you.”’
Professor O’Leary says people often under-estimate the effect of having a cochlear implant. ‘There’s no doubt cochlear implants are life changing,’ he said. ‘You’ve got no idea what it’s like when people come back and they’ve stared to socialise again. The one that really gets me is hearing the grandchildren for the first time. Patients often do not realise how challenging it has been not to be able to communicate with their grandchildren. Then all of a sudden [after receiving a cochlear implant] they can speak to their grandchildren for the first time. It’s remarkable,’ he said.
I’ve heard this story a thousand times but it never ceases to affect me.