Interview with Sharon Smith

HH/Beck: Hi Sharon, thanks for joining me today.

Smith: Hi Doug, thanks for the invitation.

HH/Beck: Sharon, before we get to the topic of the day, which is cochlear implants, can you please tell me where you went to school?

Smith: I did my undergraduate work at the University of Wisconsin- Eau Claire and I received my Masters in Audiology at Syracuse University in upstate New York.

HH/Beck: Sharon, I know you have lots of experience with cochlear implants, and in particular with adults. Can you tell me a little about the cochlear implant program?

Smith: Sure. The University of Minnesota Cochlear Implant Program began as a tiny program around 1984. Since that time, we have evolved from a program from one cochlear implant recipient in 1984 to a program with more than 300 patients. In the mid-80s we had an average of about 9 adult recipients per year; this year we will have over 60 adults and children receive cochlear implants at our facility. And, we have evolved from a one-audiologist/one surgeon program to a team consisting of 4 audiologists, two health psychologists, a speech/language pathologist, a behavioral pediatrician and 2 surgeons.

HH/Beck: How many children receive cochlear implants at the university each year?

Smith: Children began receiving cochlear implants at our facility in 1990, the same year the FDA approved pediatric implantation. That year we implanted three children; the number of pediatric recipients has been rising steadily ever year since then. Last year 30 children received cochlear implants at the University of Minnesota.

HH/Beck: What is the age of the youngest child that has been implanted?

Smith: At our facility the youngest recipient was12 months old, although I believe that worldwide the youngest was 5 months of age. Next month we will have a six-month old undergo the procedure.

HH/Beck: Can you describe the differences between the children implanted in 2002, as compared to the kids implanted ten years ago?

Smith: Absolutely. There are many differences. First, the implant technology today is far more advanced than the technology from 10 years ago. Better technology has yielded better speech and language outcomes when combined with appropriate aural rehabilitation. For instance, speech and language milestones which used to take a year to reach are now achieved in months.

Another difference is that children are getting implanted at younger ages than they were 10 years ago. With the FDA lowering the age criteria, in combination with todays infant and newborn hearing screening programs, we are now identifying, amplifying and implanting children at younger ages than we were 10 years ago. This in turn, with appropriate intervention, has allowed for earlier and earlier acquisition of receptive and expressive spoken language than we were seeing 10 years ago.

Education and aural rehabilitation are other areas which have expanded over the past 10 years. Our school systems have become accustomed to addressing the needs of cochlear implant children, and we have become wiser about the amount of rehab children need, and we have see the emergence of oral schools for the deaf across the nation.

HH/Beck: So you are indeed implanting children at an earlier age, and you are seeing clinical outcomes that demonstrate improved results?

Smith: Yes. Ten years ago, kids were implanted later, for instance, 24 months or older, and it usually took a year for a child to respond to his or her name or to begin to produce speech. Today we have children implanted at 12 months of age, responding to their names two weeks after hook-up and reaching near age-appropriate milestones by the age of 24 months, following appropriate aural rehabilitation.

HH/Beck: Can you tell me a little about post-implant aural rehabilitation for children?

Smith: Aural rehabilitation is a must for all pediatric cochlear implant recipients. It includes at a minimum; speech and language services provided by the childs school system, and individualized auxiliary rehab through our speech pathologist on the team or a practitioner in the community. Having private rehabilitation allows additional needed therapy and helps distribute the responsibility of the therapy from just the school, to another professional and allows another professional to be looking at the child in a one-to-one setting. Many of the parents of our pediatric recipients have opted to enroll their children in the Moog Oral School here in town, to enable them to receive intensive speech and language therapy all day long in an oral educational environment.

Parents are a key component to a childs aural rehab program. Cochlear implantation requires a high level of commitment from parents- both for getting the child to their rehab and programming appointments, as well as being able to continuously provide the child with auditory input. The cooperation among the clinical and educational audiologists, the speech-language pathologists, the parents, the school administration and the educators is essential. They each provide a building block toward the childs ultimate success with a cochlear implant.

HH/Beck: What about your adult cochlear implant program?

Smith: Our adult program is currently larger than our pediatric program. We have more than 190 adults whom we follow, and probably 100 of those come in every year for reprogramming, or to check on their units, or just to have an annual follow-up.

HH/Beck: What is the typical entry point for adults into your cochlear implant program?

Smith: There is a bit of variation there. Sometimes they are referred by their family or friends, have seen an article somewhere and come self-referred, but most often they are referred by their doctors or their audiologists.

HH/Beck: And then once they come in to see you?

Smith: We put them through pretty much the same diagnostic work-up that most cochlear implant centers do. Our pre-implant evaluation requires a current hearing test, and a trial period with appropriate hearing aids. With todays digital technology and the benefits realized with it, it is important that the patient is offered every opportunity to try out all amplification options before settling on a cochlear implant.

When the patient comes in for a cochlear implant evaluation, their aided open-set word and sentence recognition is tested, with the criteria being set at 30% or worse on open set word recognition (CNC test) and 50% or worse on sentence recognition (HINT scored for percentage of words correct). If the patient meets these criteria, we spend over an hour discussing how implants work, what they look like, the surgical procedure and its associated risks, and the bulk of the time spent discussing appropriate expectations.
Following the appointment with the audiologist, the physicians go through the medical history and their diagnostic work-up too, to make sure that the patient is a candidate from a medical and surgical viewpoint. Patients are required to undergo a CT scan, and at this facility, they also undergo a consultation with a Health Psychologist.

HH/Beck: What is the largest diagnosis code, or etiology, of the adult implant candidates you see? In other words, what is the cause of their hearing loss?

Smith: Interestingly, for adults, it is cause undetermined. In other words, we really dont know why some of these people lost their hearing. Probably the second largest category is otosclerosis, and then after that, perhaps Menieres disease.

HH/Beck: One question I get lots of email on, usually from adult cochlear implant candidates is.what percentage of patients can expect to use a telephone after they receive their cochlear implant?

Smith: Thats a question we get too. I usually tell people that there are two important parts to the answer. The first is, nobody can guarantee any results with a cochlear implant! The second is, of my patients, and with the current cochlear implant technology, about 70 percent of the post-lingual cochlear implant patients will be able to use the telephone.

HH/Beck: Thats quite a bit better than the results from ten year ago too!

Smith: Yes, it really is. Ten years ago, it was the exceptional patient that could use the phone, and now its the exceptional one that cannot. Its the same with music too. Id guess that probably some 70 percent of the patients are able to appreciate music while using their cochlear implants too.

HH/Beck: Very good. Thank you so much for the information and for your time today.

Smith: Its been my pleasure, thank you for the opportunity.

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