Feb 2019 Digital Trends
It wasn’t until my brother told me they were concerned that I noticed my niece couldn’t hear like other kids. When children are very young it can be extremely difficult to determine their level of hearing. “Around her first birthday, we realised she wasn’t responding normally to sound,” Steven Hill said. “She didn’t react to a lot of sounds, and when she was sleeping it was very difficult to wake her.”
Because Maddie still had some hearing, it was a long struggle for her parents to get her diagnosed properly. Poor results in hearing tests are sometimes attributed to fidgety kids, and she was smart enough to compensate for her lack of hearing. They tried hearing aids for a while, but they just amplify sound. If you can’t fundamentally hear certain frequency ranges, then a hearing aid can’t do anything for you. They taught her some sign language to make it easier for her to communicate. But once it became clear the hearing aids, even at the highest volume, weren’t helping, Maddie was finally diagnosed with profound hearing loss.
The next step suggested was a cochlear implant, and because of the delay in her diagnosis, the doctors wanted to proceed with it as quickly as possible. If the brain’s auditory pathways aren’t stimulated in the first three to four years, then the capacity to hear and learn to speak normally can be dramatically reduced, because the brain focuses on other functions.
“We didn’t get as much time as we’d have liked to find out everything we wanted to,” Hill said. “Our overriding rationale was that if she decides later in life she doesn’t want to hear, and instead use sign, then she can remove them. But if we didn’t implant when we did, it would have been removing a choice from her.”
Every new version of the Cochlear system has folded in the latest advances in miniaturisation and sound processing improvements, but Nucleus 7 is the first to take advantage of our smartphones. Cochlear worked closely with Apple to bring audio streaming support, so you can stream sound directly from your iPhone or iPad to the sound processor. This brings several important benefits.
“If you have hearing loss, talking on the phone has historically been really challenging. It’s hard to know how to orient the handset, and there’s a lot of signal loss between the phone and your hearing device,” Cochlear said. “Bypassing that and streaming directly really improves the clarity, and allows people to talk on the phone in a way that many were unable to before.”
For people with family overseas, this is a game changer. It enables grandma to FaceTime with the kids, when before they may have only been able to talk directly face-to-face once a year. It also makes everyday life easier, from ordering a pizza to fixing an appointment. People used teletype services in the past, where they typed what they want to say, and an operator read it out for them. Other solutions have been developed but nothing is as good as being able to talk directly.
This direct sound streaming also enables people with implants to do other things most of us take for granted, like listen to a podcast on the train on the way to work, or stream music while you walk down the road. But the streaming audio with an implant is only audible to them, there’s no tinny headphone leakage. You would never know they were listening to something unless they told you.
“The latest update we added in 2018 was forward focus, which allows you to directionalise the noise that you’re hearing,” Cochlear said. Forward focus suppresses all the background noise and concentrates on processing the sound directly in front of you, so you can pick out what the other person is saying, even in a busy environment like a café.
The Nucleus 7 mobile app does also work with Android, but Android devices can’t stream audio directly yet, like the iPhone can. Google has announced a protocol for audio streaming for hearing aids which Cochlear hopes to take advantage of soon, but it’s not yet available.
Both the Android and iOS app also allow people to change the volume and set different sound programs. It’s common for people to have a particular sound profile for an activity. For example, they may have one for watching a movie, and a different one for walking down the street. Your phone connects to the sound processor via Bluetooth Low Energy and so the app can also be used to locate it if it should fall off, which can be a worry with young kids.
Maddie calls the external apparatus “her ears” and if she gets tired or fed up, she takes them off. Because she’s so young at four years-old, she hasn’t developed her own sound programs yet, so noise like the inside of a car on a long road trip can be overwhelming, but for the most part she wants them on all the time. “She is happier, she understands a lot more of what’s going on, and she can engage better with friends and family,” Hill said. “We still don’t know the long-term effects, but signs are there that she should catch up verbal speech and understanding to be able to continue at mainstream school with her peers with little support.”
The recovery time and success level differ for everyone who goes ahead with a cochlear implant. It depends on the degree of hearing loss, how long they’ve been unable to hear for, and how their brain reacts. We spoke to a 24-year-old man who got an implant at the age of four after an accident caused his hearing loss, and he said it was like a switch being flicked and he could hear again, but for some people it can take weeks or months of rehabilitation exercises. “When there are sounds that you haven’t heard in a really long time, it takes your brain a while to adjust and relearn them,” Sharp said. “Something people often describe is the sound of a pencil writing on a piece of paper. It’s a quiet sound and if you have hearing loss you don’t hear it, so it can be very distracting all of a sudden when you do and don’t know what it is.”
A part of the process is learning what sounds your brain can disregard, so that you can pick out the sounds you want to hear. “One of the best moments since she got the implant was when Maddie burst into the kitchen while I was listening to “Hey Joe” by Jimi Hendrix and danced about doing the air guitar,” Hill said, grinning. “Music has been such a big part of my life, so seeing her get that feeling of elation that the right song at the right time can give you was poetic.”
Cochlear is always working on adding improvements, and it rolls out a firmware update at least once a year. The technology is also designed to be backwards compatible – the company’s motto is “Hear now. And always” — so upgrading your external apparatus can bring all the latest improvements. The next thing Cochlear is working on is the ability to stream hearing tests directly to the cochlear implant. People with implants have to go back for tests around eight times in the first year post-surgery and then at least once a year for the rest of their lives. If they can perform a series of tests remotely and send results to their health care professional or audiologist, who can then determine whether or not they need to come in for a visit, then they wouldn’t have to miss school or work just to find out that everything looks great.
Cochlear is also working on creating more digital rehabilitation tools that can help people optimise the sound processing and gain a better range of hearing.
More than 5 percent of the world’s population lives with disabling hearing loss, defined as hearing loss greater than 40 decibels in people over the age of 15 and 30 decibels in children, according to the WHO. That’s 466 million people. Most people, especially those who are older, are slow to seek treatment, or never seek treatment at all. Kids don’t always get the chance of a cochlear implant either. A 2016 study found that while 97 percent of eligible children receive access to the technology in Australia, thanks largely to an effective infant screening program from the government, only 50 percent of eligible children in the U.S. get a cochlear implant.
The expense is a key factor. Costs vary, but you can easily pay between $30,000 and $50,000 or more for the implants and surgery. Some private medical insurance policies will cover it and Medicare and Medicaid may cover you if you meet certain criteria. But even if you are covered, there are limitations on how often you can upgrade your system.
“We are very lucky that the [National Health Service] do this procedure in the U.K.,” Hill said. “It would be heartbreaking to weigh up the potential benefits for your child but be unable to afford the implant.” While the NHS does offer cochlear implants, they are only for people considered profoundly deaf. That’s defined as people who can’t hear sounds below 90 decibels, though the National Institute of Health and Care Excellence (NICE) recently reduced that to 80 decibels – still a long way short of the WHO’s definition of disabling hearing loss at 40 decibels.
In the U.S. ,it may be possible to get an implant with severe to profound hearing loss, which would be defined as being unable to hear sounds below 70 decibels, but it depends on your insurance coverage. You have to draw the line somewhere, but for people with kids on that border, it can be incredibly tough. It’s actually a strong argument for making the technology available to more children, despite the high upfront costs. Some studies show that cochlear implantation can lead to net societal savings if you factor in lifetime educational costs, because kids with cochlear implants don’t need as much extra support and the earlier they get them, the better they tend to work.