Cochlear implants open up new possibility for the hard of hearing
Ron Farwig either didn’t know or couldn’t remember the sound of a bird chirping.
He first realized he was hard of hearing when he sat in the back row of his third-grade classroom and got in trouble for not paying attention. It was the 1950s, and doctors figured his hearing loss was due to a childhood case of mumps. Farwig got hearing aids, but the benefit wasn’t worth the bullying he faced at school. So he tossed them out and learned to manage his slight hearing loss in other ways — always sitting up front, letting teachers know about his disability — and it didn’t matter much once he started flying planes in his teens.
“A lot of the airplanes I flew in the ’60s didn’t have radios, so hearing wasn’t a problem,” he said. “Airplanes are loud, but everybody is talking loud, so I didn’t have any trouble.”
Farwig became a professional pilot, flying commercial jets, charter airlines and instructing others before becoming an inspector with the Federal Aviation Administration in 1989. Finding himself in an office environment, he struggled to hear again and went back to using hearing aids.
Then, about 10 years later, an adverse reaction to some medication left him with profound hearing loss in both ears, meaning he couldn’t hear anything.
Megan Johnson, a doctor of audiology and owner of Johnson Audiology, said Farwig’s situation made him a candidate for a cochlear implant — a surgically implanted device that helps people who cannot benefit from hearing aids.
Hearing aids work by making sounds louder. Cochlear implants replace the function of the damaged inner ear to provide sound signals to the brain for processing. The implants don’t cure hearing impairment but directly stimulate the auditory path.
“Patients will get to a point where their underlying hearing loss can be so distorted that even with hearing aids they rely more and more on visual cues. And at that point, some patients will become cochlear implant candidates,” Johnson said, adding that patients must meet specific guidelines and need a doctor’s approval to receive an implant.
Farwig, who was living outside Chicago at the time, got his cochlear implant in 2010, and his world changed.
“I actually was able to hear birds for the first time in my life, and cicadas. I’m on the golf course saying, ‘What in the world is that noise?’” he said. “I was at a stoplight as a truck comes up and hits the air brakes — that scared me to death. Then I realized it was a truck. I’d never heard that before.”
Aside from gaining a newfound sense of sound, the implant allowed Farwig to keep working for several more years. He retired at the end of 2012 and moved to Ocoee, Tennessee, eventually becoming one of Johnson’s patients.
Johnson has provided diagnostic and follow-up care for patients with cochlear implants for years, but the surgery to implant the device has been unavailable in Southeast Tennessee despite the U.S. Food and Drug Administration approving the device more than 30 years ago.
Patients from the area who needed cochlear implant surgery had to travel to a bigger city. But Johnson has since teamed up with surgeons from Associates in ENT to make the surgery available at CHI Memorial Hospital in Chattanooga.
“You kind of had a choice between driving to Nashville or driving to Atlanta, since there’s a number of visits associated with this procedure,” said Dr. Doug Liening, an ear, nose and throat surgeon with Associates in ENT. “If you’re going to receive a cochlear implant, that’s a lot of travel time, so this has been an underserved area.”
It’s a milestone for those with hearing loss in Southeast Tennessee, but Farwig and the doctors say there’s more work to be done.
OFTEN MISUNDERSTOOD
“I wish that it wasn’t so, but America is not very kind to the deaf, and we’ve got a ways to go to both recognize their needs and give them the support they need,” Liening said, adding that typically the public’s first conclusion is to think someone who’s hard of hearing has an intellectual disability.
While cochlear implants or hearing aids can be life changing, Johnson said the devices don’t produce “normal” sound.
“It’s important for your family and friends to realize you’re doing everything you can to improve your hearing, but they do have to be patient, understanding and work with you to make sure you stay in the conversation,” she said.
Farwig said people often get frustrated with him because they think he’s not paying attention.
“They’ll start being very loud, yelling, and that distorts the sound,” he said. “With hearing loss, you find out very quickly who your real friends are.”
Because of his disability, Farwig has some extra considerations in life.
He always tries to get to restaurants and other public places early so he can position himself to hear better. He has to remind his golf buddies not to talk to him while they’re walking away or riding in the cart due to the background noise.
He uses a simple flip phone instead of a decked-out smartphone. That’s because the angle of the flip phone works better for him to hear and talk with the cochlear implant’s external, behind-the-ear processor.
He’s extra conscious around water. People with cochlear implants can swim, but they need to take off the external piece or wear a protective cover. And he can’t wear certain hats, because they rub against the microphone.
He takes the processor off when he sleeps but feels vulnerable, especially when staying in hotels. That’s one of the reasons he retired. He can’t be sure that he’ll wake up if a fire breaks out.
Farwig said there’s a different stigma associated with deafness. Hearing aids don’t have the same appeal as glasses, and people assume that wearing a device makes you able to hear just fine.
“Even with the implant, even to this day, I have difficulty calling people,” he said. “I’m a grown man, and I’m afraid to call people, because I’m afraid that I’m going to miss a word or two or they’re going to get mad at me.”
Farwig said he doesn’t need sympathy or letters, just “understanding.”
“Most of my true friends will call me, and if I ask them to repeat something — which is rare — they don’t mind,” he said.
Lack of awareness also leads people to delay important care when it comes to their ears, and many people don’t realize the other health implications of hearing loss, Johnson said.
“You want to keep the auditory system stimulated with sound as much as possible,” she said. “Whether you’re a cochlear implant candidate or you need hearing aids, be proactive about your hearing, because it’s really what helps you communicate with all your families and friends. It keeps you active. It’s such an important part of your overall health.”
Addressing auditory issues promptly is also important, because profound hearing loss or deafness is a risk factor for other conditions, including social isolation and loneliness, depression, balance problems and falls, cardiovascular disease and dementia.
Johnson said Farwig’s success with the implant was due in part to the fact that he wore hearing aids for years leading up to the procedure.
COCHLEAR IN CHATTANOOGA
The device is comprised of two parts: an external sound processor and an internal electrode array, which is surgically placed into the inner ear. The microphones on the external sound processor detect sounds and transfer them through the skin to the internal electrode array, stimulating the auditory nerve and transmitting sound to the brain.
After implantation, surgeons see patients back for a follow-up visit, and patients continue visiting the audiologist as they work on training and tuning the device.
The group is scheduled to perform its first cochlear implant surgery in Chattanooga this month and expects to serve between 10 and 20 patients in the first year, with that number increasing in the future.
To perform the surgery, they make an “S-shaped” cut behind the ear and drill through the bone to place the electrode.
Dr. Alex Sokohl, an ear, nose and throat surgeon who practices with Liening, said even though the surgery is completed the same day — it typically takes about two hours and isn’t too painful — the word “surgery” often scares people. He’s encouraging people to schedule an appointment to learn more.
“The data in general show the earlier you intervene with a cochlear implant, the better off you do,” Sokohl said. “The brain is still pretty plastic and can adapt, but if you wait a long time, your results may actually be worse than those who addressed it sooner.”
Devices are typically covered by health insurance, and more information is available by calling Johnson Audiology’s Gunbarrel Road office in Chattanooga at 423-710-1432 or Associates in ENT at 423-267-6738.
“You still miss the punchline of a joke every now and then,” Farwig said. “But even if you only live a month, you’ll be glad you did it. It’s worth it.”