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Why Wait?

September 9th, 2008 by | Tags: , , , , , , , , , | 10 Comments »

One of the most common concerns expressed by people considering a cochlear implant is, “What about new technology?  What about hair cell regeneration or fully implantable CIs?  Is now really the best time to take this leap of faith?”

Now, these are prefectly legitimate questions.  In fact, I’d be a little bit concerned if someone considering surgery, any surgery, didn’t think long and hard about all the possible ramifications of that choice.  But for cochlear implants, the time is NOW… and here’s why:

(I’m going to omit the “number crunching” aspect of this topic from the main body of this post, just to spare readers who couldn’t care less about the tech aspects, but, for my fellow CI historians and technology geeks, anywhere you see an asterisk (*) check at the bottom of the page for more information on that topic!)

Technologies like a fully implantable device or scientific advances like hair cell regeneration may very well be in our future.  Who knows?  I may live to see them in my lifetime.  But though these exciting discoveries are on the horizon, to say they are in the “near future” is simply untrue.  Though recent advances have yielded exciting results, the research is extremely preliminary.  Even if such technology was 100% ready today (meaning ready to be used in humans), it would still have to undergo the FDA approval process* which is incredibly long and grueling (as it should be!).  Drugs as simple as an over-the-counter allergy pill can take years for approval, so imagine how long a drug for cochlear hair cell restoration would take to make it through the process?  As for a fully implantable CI, it would have to go through the FDA’s medical device approval process and, because of it’s implantable nature, would be placed under Class III regulations, the strictest the agency provides*.  So, there’s a good chance that these technologies may happen one day, but for now, I wouldn’t suggest holding your breath.

Also, who’s to say that current implant recipients couldn’t benefit from this new technology when it becomes available?  Cochlear hair restoration is supposed to restore absent and/or damaged hairs in the cochlea — remove the internal electrode array from the cochlea of someone with a CI and — voila! — that’s what you have — damaged and/or absent hair cells!  As for a fully implantable device, there’s no reason why your current CI couldn’t be removed and replaced with the newest fully implantable device.  CIs are explanted and reimplanted easily in the case of device failure.  I don’t see any reason why that couldn’t be just as commonplace to explant and replace with a fully internal device.  The current technology is constantly updated*, too — and current users CAN benefit from these upgrades WITHOUT a new surgery!

So yes, new and exciting developments in hearing science very well may be in our future.  But is it really worth sacrificing REAL benefit now for POSSIBLE gain at some indeterminate time in the future, especially when partaking of today’s technology does not necessarily preclude benefitting from later advances?  I would say no.  For children, there is a small and precious window of time to give them access to hearing if you desire listening and speech.  For adults, espcially adults who have lost hearing as they’ve aged… haven’t you waiting long enough?  There’s a lot of life out there to hear and experience.  If you’ve been thinking about a cochlear implant, you owe it to yourself to at least check it out.  Whatever decision you make, at least you can know that you learned all that you could to make the very best-informed decision for you.

There are so many beautiful things to hear out there.  Why wait?

*Okay, techie-friends… here’s the nitty-gritty:

  • See a diagram of the FDA approval process for drugs HERE
  • For more information about the FDA’s approval process for medical devices, click HERE
  • Since 1985, Cochlearhas had 6 different internal implants (Mini22, Nucleus® 22, Nucleus® 24, Nucleus® 24 Contour, and Nucleus® Freedom) and 7 different external processors (WSP – Wearable Speech Processor, MSP – Mini Speech Processor, Spectra Bodyworn, SPrint Bodyworn, ESPrit BTE, 3G BTE, and Freedom Babyworn/BWP/BTE).  The past five upgrades of the “modern era” are all fully compatible for older types of implant arrays (the first 2 were in the ’80s during the trial phases of the technology).  So, if you received one of the first N22 internal components, you would be able to benefit from FIVE processor upgrades (which include upgrades in comfort, water-resistence, and, most importantly, microphones and programming strategies) without ever undergoing an additional surgery.  The internal/eternal upgrades for the other companies are impressive, too.
  • MED-EL has had 2 types of internal implants (PulsarTI100 and SonataTI100) and just released it’s second generation processor, the Opus2.
  • Advanced Bionics has had multiple internal implants (Clarion, CII, and HiRes90K) as well as external processor upgrades (Platinum Sound Processor Bodyworn, CII BTE, Auria BTE, and Harmony BTE)

Written by

Elizabeth Rosenzweig MS CCC-SLP LSLS Cert. AVT is a Listening and Spoken Language Specialist Certified Auditory Verbal Therapist. She provides auditory verbal therapy, aural rehabilitation, IEP advocacy, consultation, and LSLS mentoring for clients around the world via teletherapy. You can learn more about Elizabeth's services on her Website or Facebook.

10 Comments

September 9, 2008 at 12:05 pm

Good article. You touched on one subject that needs some expanding. For little ones who don’t benefit from hearing aids, waiting for better technology is the same as choosing CI failure. Even if you can eventually get perfect hearing in to the brain, if it cannot understand the sound, it does no good. That window you spoke of is very short, and not very tolerant of time. The brain needs to learn to hear as soon as possible in order for any kind of hearing to work.

Elizabeth

September 9, 2008 at 4:07 pm

K.L. makes a good point… waiting to choose IS choosing!

September 9, 2008 at 4:38 pm

Hi– Likewise the FDA approval process is exactly the reason I’m waiting on the cochlear hybrid (combination implant and hearing aid). Though it has been approved in Europe, it hasn’t been here. Doctors in my area have perfomed only a measly few of these. The surgery is similar to the CI, but not exactly the same. Additionally there is a 15% chance that you lose low tones– the very tones the hybrid is supposed to preserve. Finally, with each new trial they improve the product. For example, with trial two, the hearing aid and cochlear processor components were separate. When I went for my last evaluation, I was told Cochlear was in the process of combining them and were hoping for FDA approval on the combined unit.

Another point for those who are borderline. I met a few people at the IFHOH who said they were only borderline qualified (like me) when they were implanted. They admitted they prefered their aided ear over the implanted one. Lesson– if you’re borderline, you may not do well with a cochlear implant.

It’s important to realize that hearing aids keep getting better too. Borderline people who qualified for the CI awhile ago are now getting better results with hearing aids than in the past.

Still, I’m not against the implant if you don’t get much benefit from your aids and you aren’t a borderline qualifier. The problem is many of us with severe-profound skislope hearing losses are in a difficult spot– with neither option adequately addressing our needs.

It’s good to explore all your options, talk to more than one person. I agree with you the decision for young children learning to speak is probably more critical than late-deafened adults.

Lori

September 10, 2008 at 5:29 pm

HI- I have a two year old daughter who is profoundly deaf, born that way. We were looking into a CI last year at this time because her audiologist and speech/launguage therapist thought she would benifit from the CI. Unfortunatly last August she was diagnosed with cancer so a CI was out of the question. We of course have spent the last year keeping her alive not worring about her hearing. Funny how priorities change. Anyway, she is doing well and back on track for her CI only now she is two. I’ve just found your site and it looks as if you were around 2 1/2 when you received your ci. How is your speach and language and what can I realisticaly expect for my daughter. Any advice?

Rachel

September 11, 2008 at 2:07 pm

Hi Lori,

Yes, I did receive my first cochlear implant when I was two and a half years old and am doing very well with it today.

The first thing that I would like to say that it’s definitely not too late for your daughter to receive a cochlear implant. At the time when I received my cochlear implant, and throughout the 90′s, it was very common for children to receive their cochlear implants at the age of two years old as at that time, the earliest age that children could be implanted was at the age of two years old.

To give you an idea of my speech and language today, you can view this video – http://www.overstream.net/view.php?oid=utnmugmqunsn

I would also recommend visiting this page which has a selection of videos of me when I was younger which will show you how my speech progressed throughout my life – http://cochlearimplantonline.com/index2.php?video

If your daughter receives PROPER rehabilitation such as AVT, she will reach to where several CI users who were implanted at the age of two to three years old and I are today.

Please feel free to e-mail me – filmmakersdream@hotmail.com . I would also be happy to put you in touch with my mother to get a perspective from a parent.

April 2, 2012 at 2:43 am

[...] Why should I not wait for a newer technology?         LIFE [...]

Angela Smith

September 26, 2014 at 7:35 am

I not sure how to start saying here but i have my cochlear implant of Neclus 5 and had for 3 years now …I do not know if any updates or anything new on the way for my cochlear implant as well and also need to know that I do know that we couldn’t have MRI but now been 3 years so I wondering if like have MRI just on knee or still can’t have MRI completely … please let me know thanks and have a great weekend

October 20, 2014 at 1:34 pm

There is a new N6 processor from Cochlear that has some improved functionality over the N5. I would make an appointment to discuss this with your audiologist to see if you are eligible for an upgrade.

As for the MRI, Cochlear Nucleus implants are FDA approved for MRIs up to 1.5 Tesla with the internal magnet removed (this can usually be done under local anesthetic). Before having an MRI (even if it’s on your knee, remember that your whole body is in a giant magnetic tube!), you must consult your surgeon (who will also consult with the CI company).

miemen kingsley

November 4, 2014 at 7:40 am

When will the TIKI be released subjected to FDA approval and any contrasting effect provided genuine (biological) cure is underway

November 5, 2014 at 2:15 pm

The TIKI is still experimental and is not even in the FDA trials process at this point, so there is no telling when it will be FDA approved for marketability. As for biological cures, though there are many experiments being conducted, they are also quite far from ready for use in human subjects for initial trials, let alone FDA approval. In short: exciting things are coming, but not fast enough to gamble your future and your quality of life today by waiting for them.