Senior Implant Audiologist Ronel Chester-Browne will share with us her knowledge and insights into Cochlear Implants. This marvelous Australian invention truly changes lives and now a days Cochlear Implants are routinely recommended for when hearing aids are just not enough.
Dan Van Der Meer: [00:02] This is The Ear Science podcast, The Science of Healthy Hearing.
Lize Coetzee: [00:08] Hello and welcome to The Ear Science podcast, The Science of Healthy Hearing. Proudly presented by Ear Science Institute Australia, a not-for-profit medical research Institute. In this podcast, we’ll bring you into our world, the world of ear and hearing science. Together with Ronel Chester-Browne, we’ll discuss the latest in ear and hearing research and what it means to you.
Dan: [00:33] I’m Dan Van Der Meer. I’m a digital content specialist and podcast host, and I’m passionate about raising awareness for the impact of hearing loss.
Lize: [00:40] And I’m Lize Coetzee, I’m a qualified audiologist and the Chief Operating Officer at Ear Science Institute Australia.
Dan: [00:48] This podcast provides information of a general nature and does not constitute medical advice. Today’s guest is Ronel Chester-Browne. Ronel, welcome to The Ear Science Podcast, the Science of Healthy Hearing. You’re a qualified audiologist who has dedicated your career to hearing and cochlear implants. What is a cochlear implant? Why would someone need a cochlear implant rather than a regular hearing aid?
Ronel Chester-Browne: [01:08] Well, Dan, the first multi-channel cochlear implant was designed by professor Graeme Clark at the Bionic Ear Institute in Australia, more than 30 years ago. A cochlear implant consists so of two different parts. There’s the internal electrode, which is implanted into the cochlear through surgery. And then there’s the external device on the outside, which looks more or less like hearing aids, slightly different with the coil cable that’s connected to it, but more or less like a hearing aid. Now a cochlear implant is very different to a hearing aid because it picks up acoustic sound and it changes or converts it into electrical energy. And then that electrode inside a cochlear stimulates the nerve electrically. And that is what makes it so different. Now, then you’ve asked me, why should someone need a cochlear implant rather than a hearing aid? Well, we have approximately 20,000 hair cells inside the cochlear. And as a hearing loss progresses, or as the degree of the hearing loss gets worse, we lose more and more hair cells. And it can get to a point where we have such limited hair cells inside the cochlear that a person can just not get enough speech clarity and understanding why using a hearing aid. And that is the point where they might need a cochlear implant to provide that speech clarity. So, cochlear implants can provide near to normal hearing to individuals who are suffering from a significant hearing loss, and that can result in many other benefits as well. For instance, improved quality of life, possible employment opportunities, and many more.
Lize: [03:01] So really somebody would go from having a hearing aid for some years, and then their hearing gets worse, and then they can’t have a hearing aid anymore. And then they go over to a cochlear implant.
Ronel: [03:16] That’s right. Because the hearing aid cannot overcome the loss of hair cells. Whereas the cochlear was specifically designed to replace the function of those damaged hair cells.
Lize: [03:28] So Ronel, I mean, this is amazing technology and so exciting that something like this has been invented in Australia. So can you tell me a little bit more about how has this technology changed over the last 30 years?
Ronel: [03:44] So, in the beginning of cochlear implants, more than 30 years ago, the criteria was extremely limited to people with a profound or at least a severe profound hearing loss. However, over the years, it has changed, especially in the last 10 years to the point now where more individuals with significant hearing residual hearing in one or both ears can qualify for this implant. For instance, a person with a ski slope hearing loss who still has significant low frequency hearing, or a person with a single sided deafness, whereas that this would not have been the case (crosstalk).
Lize: [04:25] People that are eligible for a cochlear implant, has this changed a lot?
Ronel: [04:29] Definitely.
Lize: [04:30] As technology has changed.
Ronel: [04:32] Yes, the technology has changed a lot because now with the newer technology, we can adjust our criteria, but also because of our experience and what we’ve learned over the years. Initially they thought that a person with a single sided deafness will never be able to wear a cochlear implant, but then they found that when a person has a hearing aid and a cochlear implant, they do very well. So why not implant people with a single sided hearing loss with a cochlear implant?
Lize: [05:03] Very good. And Ronel, you know, for me, as an audiologist, some people sort of still think maybe a cochlear implant is something that we only do for children, or that’s only suitable for children and only really as part of research studies. And it’s so important to make that very clear that cochlear implants are not part of a research study. It is proven technology that is changing people’s lives.
Ronel: [05:32] That’s right Lize. And a significant number of our clients are over 80, even over 90 years of age. Our ageing population is growing and they can benefit as much from a cochlear implant as a child. Dona Jayakody, her research has shown that it can even prevent or slow down dementia, which is a devastating illness to have. And therefore, it’s really important that we look at our adults as well.
Lize: [06:06] So, Ronel, I know Cathy Sucher, one of our implant audiologists and implant research lead at Ear Science Institute Australia is currently looking at the technology where cochlear implants can be adjusted remotely. So, the clinician can be sitting in their office and the person can be sitting on their farm. So, the technology has changed a lot, can you talk to us a little bit more about how the technology in cochlear implants has changed?
Ronel: [06:33] Well, Lize, the technology has improved significantly over the years and tele mapping, telehealth, audiometry, is just one of the aspects that has developed since. Just to look at the device itself, it has become so much smaller. The surgery, the recovery period has become quicker and easier. The connectivity has improved where people can now stream directly via Bluetooth from their telephones. And in this research that Dr. Sucher has performed, we’re also looking at the possibility of sending results directly from people’s telephones to the clinic where they do a online test, and we can see the results and measure the benefits that they’re receiving, and determine how many appointments they require. And we would not have thought that this would be an option a few years ago. So there has been significant improvements.
Dan: [07:32] That’s amazing. So, Ronel, for anyone listening, how would a person know if they are a candidate for a cochlear implant?
Ronel: [07:39] So, Dan, it’s really important that any person that is struggling with their hearing, when they struggle to hear over the telephone, in noisy environments, even one on one at home, if they’re having any difficulties, they have been back to their hearing I have provided several times they have tried everything to optimize the hearing aid settings, but they’re still just struggling, and especially if they start to withdraw from social interaction and become isolated, they should really consider investigating whether they are a candidate for a cochlear implant or not. All hearing aid audiologists have that client that just keeps on coming back with ongoing problems with their hearing aids and everybody’s very frustrated with it. And those patients, those clients might be a possible candidate, so they should contact us and they should speak to a professional to find out if that is an option.
Lize: [08:43] There’s some technology that they can actually use, Dan. It’s on our website. So, you can go there. I’m not sure the exact spot, but where they can do a speech test, where they listen to words with their hearing aids on, and that test is able to show them, will they do better with a cochlear implant? So, it’s quite an objective test. So, for somebody sitting at home thinking, “I’m not sure,” I mean, just contact us. That’s easy. But you could also go on the website and it’s called hearing aid checker. So, it compares your results to a person with a cochlear implant. So, it’s a really interesting test and that’s something that cochlear has brought out to help people make that transition from hearing aids to cochlear implant.
Dan: [09:30] Yeah. Fantastic.
Ronel: [09:31] Now, Lize, you spoke about the hearing aid checker, and that is a wonderful tool, but our clients or any person that think that they might be a candidate for a cochlear implant, or just wondered about it is very welcome to contact Ear Science directly, The Ear Science Clinic. There is no need for a referral from anybody. We have lots of people who refer themselves to our clinic. Even if it’s just for an opinion. You can speak to a trusted and qualified audiologist for opinion as well. And we have relationships with hearing aid clinics that refers to the Ear Science Clinic. But the most important thing is not to delay because it really is life changing.
Lize: [10:17] So, Ronel, I mean, you make it sound so easy, you know, just contact us, book in for a test, but Ronel, you and I know that there’s still 90% of people that need a cochlear implant that doesn’t have one. At the Institute, this statistic is not something that we want and we want to change that. What does the research tell us about why there is still so many people that don’t have a cochlear implant that actually need one?
Ronel: [10:51] So, Azadeh Ebrahimi was a researcher that worked for the Ear Science Institute, and she specifically looked into the barriers and the drivers for cochlear implantation.
Lize: [11:03] So why you would get one or what would stop you from getting one.
Ronel: [11:07] Exactly. And the reason that we investigated this further through her research was that it is actually shocking to think that only less than 10% of the people that need implantable hearing devices are actually proceeding with this. So, Azadeh found that one of the barriers for cochlear implants is unawareness and misunderstanding of non-implant hearing professionals. About the candidacy criteria and the outcomes of cochlear implants, as well as uncertainty regarding the referral pathway. What can also be a barrier is they’ve heard about other people’s negative experiences and fear of the unknown, and the surgery. The surgery is unknown for them. So therefore, it’s so important that we raise this awareness and that people must know that they can contact us directly. They don’t have to follow a specific referral pathway. Then what Azadeh has also found, what is interesting was, it was very important for clients that their audiologists must be focused on their goals and also support them through their rehabilitation journey. And I also felt that they wanted to have confidence in their surgeon. And we only work with very experienced surgeons at the Ear Science Clinic, and then also their trust in their audiologist was a very important driver for them. And we believe we have very experienced and trustworthy audiologists working at our clinic.
Lize: [12:51] So, Ronel, one of the biggest barriers where people that don’t work with cochlear implants, don’t actually know about cochlear implants. So, they’re not discussing it with their patients or clients. So, I believe that this podcast is such a powerful tool to educate the person sitting there listening, thinking, “I think this sounds like me, I think I should go and have a test done,” or somebody you know. It’s so important for you to know that you can bring that up. It’s so important that you can make that decision and say to your GP, your audiologist going, “what about cochlear implants? Can you refer me for a cochlear implant”, or call the Ear Science Implant Clinic. At Lions, it’s so important for us, is family centered care. It’s not just about that person with hearing needs, but it’s everybody. And we consider what you need.
Ronel: [13:45] That’s right. And we often see people who refer themselves through their own research. And by speaking to other people that they see with cochlear implants and asking them about their experiences as well, many of our referrals are by word of mouth.
Dan: [14:01] Word of mouth. Yeah. Great. So, Ronel, you have a client in your clinic who was a candidate for a cochlear implant, what’s involved in the assessment to actually get a cochlear implant.
Ronel: [14:10] So, our protocols and criteria are based on the latest research and we follow a evidence-based approach in our clinic. So, we have very specific protocols for the testing that we perform. We then look at the criteria. We provide the results to the clients, explain to them whether they’re a candidate for a cochlear implant or not. Even if a person is not a candidate for an implant, we will still do our best to try and find the best possible hearing solution for them. And we will support them every step of the way.
Lize: [14:49] Ronel, what is the research currently saying in regards to the outcomes that people can expect when they get a cochlear implant?
Ronel: [14:57] So, Dr. Cathy Sucher researcher has shown that outcomes can be variable depending on many factors. She specifically looked at the hearing loss configurations and how that affected outcomes. And although these outcomes varied, all of the clients who received a cochlear implant performed better with a cochlear implant than what they did with their hearing aids before. So at least 60% of the clients in her study were non-traditional candidates and yet all of them still received significant benefit from implants.
Lize: [15:34] And Ronel, that research that Dr. Sucher did was on our clients. It was 600 of the Ear Science Implant Clinic clients that she brought together and looked at their data. And you know what? This data is so important to inform new people coming in. So, when they’re thinking, “should I get a cochlear implant? How am I going to do?” We can actually say, in our program with our surgeon, with our clinicians, this is how people perform. It’s so, so powerful.
Ronel: [16:10] And it’s a very important counseling tool as well because people, the first thing they ask us in our appointments is, how much better will my hearing be if I receive a cochlear implant.
Dan: [16:23] Yeah. Right. Well, Ronel, you’re clearly dedicated to supporting clients with cochlear implants. What gets you out of bed in the morning when you wake up? Like what part of your day is the driver for you?
Ronel: [16:34] Well, Dan, I’ve performed two switch ons in the last week where it was life changing within the first five minutes of activating their devices. This is not always the case I know, I wish it was, because for some people it can take up to 12 months before they receive the full benefit of their device. But in these two cases, it was just amazing to see how emotional and happy they were and they immediately reported that this is the best that they have heard in many, many years. Something else that also drives me to do what I’m doing is when people tell us, “For the first time ever, we could have a conversation in the car.” Which is something that all of us can do and we just take it for granted. But they have to lipread, people with significant hearing losses need the lip reading and they cannot have a conversation in the car. So, that’s why we try our best to provide the best possible hearing solution for our clients.
Dan: [17:38] And that’s a pretty good reason to get out of bed in the morning. Ronel, you mentioned previously about having mentors available to talk someone through the process. Can you expound on that? So, does that mean someone can come and talk to someone who’s been through the experience of having a cochlear implant?
Ronel: [17:52] Yes. Offering the mentor services is extremely important. We try to match our clients with somebody else who has had a similar hearing history, and then they meet for a coffee or they just email each other. And our new clients can ask our existing clients about their hearing experience. And it is so important for them because they have been through the same journey and they can really guide them.
Dan: [18:24] Oh, and what a service to offer. Yeah. That’s fantastic.
Lize: [18:27] It’s so powerful having somebody that you can speak to that’s gone through the journey. And it’s just one of the ways that we support people through their journey, because it is a journey that they might have never even heard of.
Dan: [18:39] No. that’s right.
Lize: [18:39] You know, so they don’t know the processes to walk through. But at the implant clinic, we really guide them through every step of the way.
Ronel: [18:48] We also offer support group meetings. And this is every three months and there we have at least 30, sometimes up to 40 people attending these meetings. And we don’t only invite people who are possible candidates for implants or are thinking about it, but we all also invite existing clients to come and present and talk to them and they can ask them questions. And also, our clients who have been switched on recently during their acute rehabilitation phase so that they can also come in and either provide support to the new clients, or that they can ask questions as well, if they need that support in the early stages following switch on. And at these support group meetings, we often have the spouses attending them as well. And they can also support each other because the spouses are the ones who live with that person with a hearing impairment. And everybody gets frustrated. And the hearing journey is a family journey. It is not just the person who needs the cochlear implant that has to go through the journey.
Dan: [20:02] That’s fantastic.
Lize: [20:04] Ronel, what are the key takeaways you would like to share with our listeners regarding cochlear implants?
Ronel: [20:09] Well, I think it is extremely important, do not delay. If you need any information, a discussion, or opinion on your hearing, take control of your healthy hearing and contact us. It is part of healthy ageing. If you find that you’re struggling with hearing aids in any challenging listening environment noise, when a person’s not facing you, on the telephone, or even hearing the television, a cochlear implant might just be what you need.
Dan: [20:40] Ronel Chester-Brown, thank you so much for joining us. It’s been a pleasure to speaking to you today.
Lize: [20:43] Thank you, Ronel.
Ronel: [20:44] Thank you.
Male speaker 1: [20:46] Your hearing won’t heal itself, but we can help. Hearing aids help many people but as your hearing loss progresses, a hearing implant may give you the clarity and volume you need to understand speech again. Hearing implants are life changing devices that can help you hear sounds you no longer hear with your hearing aids, restoring your confidence and connecting you to loved ones. Ear Science Implant Clinic is proudly west Australia’s largest private hearing implant program. Translating the latest research into surgical and clinical care with a comprehensive medical team, including ear surgeons, qualified hearing implant audiologists, and other specialists, all dedicated to restoring your confidence with appointments and surgery times to suit you. Search Ear Science Implant Clinic and take our quiz to find out if a cochlear implant is right for you.
Dan: [21:36] If you’ve enjoyed this episode, let us know by rating and reviewing this podcast or sharing it with a friend or family member. Make sure you’ve subscribed so you don’t miss an episode. Next episode, we will learn more about how technology such as invisible hearing aids and Bluetooth connectivity to smartphones and TVs is helping people feel empowered to take control of their hearing.
Male speaker 2: [21:57] Sometimes people don’t do that and they put the hearing aid in the drawer. Nowadays we’ve got a couple things that we can use. So, one of them is remote adjustments. That’s the ability for our client to sit at home in the comfort of their bed or their lounge, whatever it might be, and we can make adjustments in real time whilst having a chat to them from our office.
Dan: [22:19] To view this episode with captions, visit the Ear Science YouTube channel or our website, www.earscience.org.au/podcast. To suggest a topic for a future episode, links to more information, and all the research papers on this topic, visit our website, www.earscience.org.au/podcast. The producer of The Ear Science podcast, The Science of Healthy Hearing is Emma Ireland, with sound engineering and editing by myself, Daniel Van Der Meer. We acknowledge the traditional custodians of the land we are recording this podcast on, the Whadjuk people of the Noongar nation, and the land on which you’re listening from. We pay respects to Aboriginal elders, past, present, and emerging.