Saturday, January 19, 2008

Thank you Mishka

I realize your recent blogging has been to examine implants for children, but it has influenced my decision not to go through with an experimental cochlear surgery.

As many of you know, I went for a cochlear implant evaluation last November. Though I don’t hear speech well, I don’t qualify for a regular implant because I have good low tone frequencies. There’s a new, less invasive type of implant in trials called a hybrid, which only has a ten-inch long electrode instead of twenty-four. Because of the shorter electrode, the cochlea remains relatively in tact and residual hearing supposedly isn’t lost.


For those unfamiliar with this new technology, here’s an article explaining in more detail what it can mean to someone like me with good low tone frequencies.
http://www.hearingresearch.org/Dr.Ross/Implants.htm I’ve pasted a couple of relevant paragraphs here.

"Ski-slope" hearing losses are a common occurrence in our clinics, and they always present a hearing aid fitting challenge. Because the person may have relatively good low frequency hearing, it is necessary to ensure that over-amplification of the low frequencies does not occur. Because the hearing thresholds in the higher frequencies are so poor, it is difficult for a hearing aid to provide aided audibility without producing unacceptable distortion or discomfort. Furthermore, as some recent research has revealed, the cochlea hair cells that respond to the high frequencies may actually be missing (cochlea "dead spots"). Amplifying these areas may be more than useless; it may actually be counter productive. While some of these people may obtain some help from a hearing aid (at the lower and middle frequencies) significant hearing problems almost always remain.


Traditional cochlear implants have rarely been considered an option for people who fall in this category. Almost always, the insertion of a long electrode into the cochlea results in the destruction of the surviving hair cells. Perhaps some people who elect this route would wind up better off, even with the loss of their low frequency residual hearing, but then again perhaps not. It is not a chance that many people are willing to take.

I should add that testing phase two for this hybrid closed last fall in the US, and we’re currently waiting on the FDA to approve testing phase three, which may happen sometime this spring if all goes well. I met criteria for phases one and two. Because the FDA hasn’t yet approved test three, I was told there was no guarantee that I would qualify for phase three. The FDA had the prerogative to change test guidelines. However, at this point there is no reason to believe they would change criteria, so I am on a wait list.


I had some initial qualms when I learned I met the criteria. First of all, a small part of the approval process was based on whether one benefits from hearing aids. My hearing aids are nearly eight years old. Though my aids were state-of-the-art when I bought them, the audiologist who administered my test suggested I might be happier with new hearing aids because several advances have been made in the past decade.


Nevertheless, the audiological evaluation took two hours and was more thorough than many I’ve been through, however not the MOST thorough I’ve sat through. I’m not sure how to put this. I picked up on some vibes from the audiologist. I really didn’t think she wanted to add me to the wait list, but the surgeon was more than happy to. I might be wrong about that. I’m an intuitive person and wanted to talk to her some more, but there wasn‘t time. I have since found out that audiologist has left. Maybe I‘m reading more into this than I should. I don‘t know what to think.
Next, I had a consult with the surgeon who performs the experimental surgery. When I asked about risk the of the hybrid, he glossed over the usual risks of surgery, discussed risks of implant surgery, and finally got down to statistics on the hybrid. Fifteen percent lose their low tone residual hearing in the first year. Considering the whole point of this technology is to PRESERVE low tone hearing, I thought that was a rather HIGH rate of failure. Then he went on to say about five percent end up with WORSE hearing than they started with. I asked about newer hearing aids, and he said I would hear much better with the implant-- if it worked. No guarantees of course.

As we left I told my husband I wasn’t sure I wanted to go through with it. He agreed, though tried to remain upbeat. I had a few months to decide, he assured. Later I said the same thing to my dad. His reaction was immediate relief. I didn’t realize how much he had been stressing over the possibility of experimental surgery.


Still. . . I wasn’t sure I was making the right choice. I want to hear. My work is suffering because I deal with the public on a daily basis and I rely on lip-reading with my hearing aids. I hate my hearing aids. They‘re uncomfortable and I have a lot of sound distortion. My hearing is still declining. Anyone with an ongoing hearing loss understands the constant struggle. You’re always adjusting to new lows and readjusting. There’s fluctuation. Tinnitus comes and goes whenever you have a major drop, which also comes and goes. An implant would mean stable hearing on at least one side.
I want to say in NO WAY do I wish to sound as if I'm judging others for their decisions to get a cochlear implant. We're all different with different needs, different bodies, different life experiences. I'm looking at EXPERIMENTAL technology here. If you're a parent of a Deaf child, I can't judge you. I haven't walked in your shoes. My children are hearing. Because of my own deafness, I believe I would have enjoyed raising a Deaf child. Would I wish progressive hearing loss on any of my own children? NO!


For the past several years I’ve been treated by my family doctor, an ENT and a neurologist for excruciating migraines and sinus headaches. While several friends and relatives have suggested maybe the migraines are caused by stress of hearing loss, my neurologist believes the migraines are not psychological. That's OLD science, he says. Most migraines are caused by biological swelling within within the brain. In my case, they are possibly related to sinuses and allergy or an old neck injury.


After reading Mishka’s articles, I realize getting an experimental implant surgery would be adding more fuel to the headache fire. More than a few implantees admitted to Mishka that headache problems resulted from faulty mappings. I’ve seen examples of this first hand myself-- people I know with implants holding their heads in wincing pain. One person I know has had horrible electrical pain running down one side of her face from a faulty electrode. Another I know has been living with cochlear failure for months. I've heard horror stories of testing that rivaled childbirth.

The thing is-- if you read the article it all sounds pretty rosy, doesn’t it?
Then yesterday I went to see my sinus ENT for the first time in several months. Glancing over my chart, he saw the report from my visit to the Cochlear research center last November.

“What’s this all about?” he asked.

.
“Experimental Hybrid Cochlear Implant.” I said.


“EXPERIMENTAL? BE CAREFUL WITH THAT.” he warned.
"I'm not doing it." I told him. It wasn't until that moment I realized I had made up my mind.


I’ve always believed in fate and messages from angels. Someone’s trying to tell me something. Thanks Mishka. You're an angel.

24 comments:

Anonymous said...

Awesome!

I'm pleased to see that you have done your homework and have come to the decision not to do any surgery.

It is easy to want to replace something that has been lost yet I believe it is easier to take the adventure of learning something new.

Jeffrey

Deb Ann and Hannah said...

(tears happily) Beautiful post and thank you, Kim. Amen!

Anonymous said...

Hi kim,

I'm an advocate of Cochlear Implants based on the 15 years of success I've had with mine, but I too was a bit iffy of the hybrid. I know some people have to do the experiments while it's in the experimental stage. Those people are crucial for the development of these things. But i would hate my friends to be part of an experiment, when it could go so wrong.

When you hearing drops away so you are no longer hearing enough sound, and you qualify for a cochlear implant, then you have absolutely nothing to lose and everything to gain. Thats when your decision for a CI will happen, and not before.

Cheers
Robyn

A Deaf Pundit said...

Kim, I'm glad you did the research, asked hard questions and listened to your gut. That is what needs to be done in ALL situations when it comes to something serious like this.

Anonymous said...

Kim!

If not for deafread, you would not know about this....say thanks to Tayler (he runs the deafread.) and Mishka.

The source from Dr. Ross is *VERY* reliable. Congrats, girl.

I would have surprised that NIH and FDA did not provide this credible source to the nation. Humm?

I wanna to hear all the status from the lawmakers in the Capitol Hill.

Hard to believe this is *MUCH* deeper than we thought......

I already sent this source to my family.

By the way, congratulations for researching this reliable source. There you go, girl.

Hugs, White Ghost

Anonymous said...

That's great you did some research. I believe it is very important to do lot of research before doing something. I'm glad your ENT gave you a "warning".

We are very thankful for Mishra to start to gather the information on CI to find out whether that has a side effect. We need more data on those side effect.

Misha :)

Anonymous said...

Kim --

I kept thinking about what you posted this incredible entry for several hours.

You *already* got me tears, but you are my inspiration.

There is a *B-I-G* but.

I must admit that I am pretty furious at the threesome, NIH, FDA and NAD (National Association for the Deaf) for not collaborating this source to the lawmakers and legislators in the Captiol Hill.

For what I understand that we have not received this kind of source from FDA, NIH and NAD. As of now, I researched the cochlear implant - hybrid in the FDA, NIH and NAD's websites....no luck with the reliable sources.

Boy, am I proud of you for this hardest work.

I am thinking of the CI victims alot. SIGH.......

I *WISH* I could be the millionaire so I can bring the CI victims to speak up in the hearing at the Captiol Hill.

Being a latened deaf person, you have the full of circle surrounding you.

White Ghost

Abbie said...

Let me get the one joke I have out of the way, am I reading this right "TEN INCH LONG ELECTRODE?" :) Dang Kim! :)

Moving right along, in all seriousness of course, I was approached 9 years ago when I first started to have these episodes of by an ENT about cochlear implant. I immediately shrugged it off in 1999, I felt technology could have been better. It wasn't experimental but it wasn't something that was concrete proof of giving your hearing back. I totally know your stance, i've been there before. The same speech that they gave you is what they gave most of us for getting a cochlear implant. However, knowing what I know now, if you do any type of surgery to the ear, you are risking losing your hearing. If it gets that point where the implant that was made for moderate hearing loss has progressed the loss to severe, you are out of luck. Its not like a new pair of shoes where you can go to the Cochlear Bank and deposit one in your ear.

I believe if you are at the very end of your wits and have nothing to lose then consider a CI. Otherwise, I agree 100% in your decision. I admire those that do go through the FDA trials but I could never be one of them. The only experiments I like to do involves a kitchen :)

Kim said...

Hi All,
I can't take the credit for finding this article. A friend sent it. She has been considering the hybrid as well.

While I was leaning towards NOT going through with the surgery, it wasn't until yesterday when the ENT said something that I realized I had made up my mind, thanks to Mishka's articles.

It's like a huge weight has been lifted.

And Abbie and Robyn-- because of the type of hearing loss I have, I may NEVER qualify for the regular cochlear implant. My low tones are stable. I will mostly likely have some good residual low tone hearing. This isn't a bad thing. It's just me. I do get some musical enjoyment with my hearing the way it is, which is why I don't want to mess with it. My main problem is communication.

Well-- I guess I'm in good company. :-) **shrug**

Kim said...

White Ghost-- I agree it's very upsetting!! One comment the surgeon made that really bothered me was that some parents were "pushing" to have their kids implanted with the ABI because they knew it preserved the cochlea more than the regular implant. SHEESH! It's experimental!!

It made me wonder if there weren't laws preventing parents from subjecting their children to experiemental surgeries?!?!

This has got to stop!

Anonymous said...

I think you are actually confused between two completely different things. One is called an ABI which means "Auditory Brainstem Implant." This has an electrode directly in the brain, actually.

The hybrid (or shorter electrode) implant is a different animal altogether, much less risky and much, much more like a traditional cochlear implant. It is NOT an ABI. The experiment is more about whether people can benefit from the combination of audition in some tones and electrode tones in the other part of the cochlea, but the surgery is pretty much exactly like cochlear implant surgery which has not occurred for 3 decades. The only thing experimental is the electrode and how much audition will be experienced. It is for people who are not "deaf enough" for a cochlear implant because they have some hair cells left in part of their cochlea.

The ABI and the hybrid are two completely different entities. ABI is only being used in a few select locations and it is for people who do not have a bit of hearing whatsoever and who also do not have a hearing nerve (and no cochlear hair cell function).

Kim said...

Thanks for the clarification Anonymous. I wondered about that myself. My doctor never called it an ABI. I was confused why the article called it an "ABI." So maybe I shouldn't be so concerned about the mapping after all?

The rest of my concerns remain, however. I don't plan to have the hybrid done. But I appreciate that you pointed out the mistake I made, and I plan to correct it.
:-)

Deaf Pixie said...

Thank goodness! you tell ENT about “Experimental Hybrid Cochlear Implant.”

Off topic - Very recently,I read Seattle Times newspaper about hearing with a blind. Often Hearing with a blind, Who cannot hear Hybrid car.
It is quiet different issusethan these of experimental. I was surprised hearing with vision loss cannot hear the Hybrid car . I often wonder what if you use CI if you could able to hear Hybrid car. My question is Doctor with expereince with CI information doesn't want to tell you.

It is hard to beleive CI information might not accurated informed by doctor. Just the doctor often want MONEY !

\ /
$$$ $$$
L
[________]

Kim said...

Yes Pixie,
The hybrids are quiet. I can usually hear cars because of my low tones, but the hybrids are hard to hear. I can see why they would be dangerous for blind people. :-(

Unknown said...

Kim...I am a BIG believer in SIGNS:)love, Jodi

Karen Mayes said...

Hmmm....

I am sure you said somewhere that you started having headaches at the same time you started losing hearing? Sounds like there might be an abnormality and have your doctors checked out the possiblity of it, using MRI, etc?

Man, headaches stink.

Yeah, experimental... if I was dying from any diseases, I'd go quickly for experimental drug therapy, etc. to prolong my life as I have two young children.

I don't know what to say... but I am glad that you did a lot of research which led you to make an informed decision... that is what is important.

Anonymous said...

Anonymous at 7:56 PM

Hybrid vs. ABI does not mean anything.

It's about the hair cells in the cochlea we are talking about. "It's about the relationship between the brain and the hair cells."

There are about 500 ABI Cochlear Implantees in in the worldwide, which is a very small odd. There are *FEW* ABI Cochlear Implantees have already reached their successful in about 30 to 50 percent of the sound frequencies. It's still a very small odd.

Not this source have the statistics on the PABI as well. Nevertheless, the FDA have not approved the PABI.

Dr. Ross' statement on Hybrid CI:

"Furthermore, as some recent research has revealed, the cochlea hair cells that respond to the high frequencies may actually be missing (cochlea "dead" spots). Amplifying these areas may be more useless; it may actually be counter productive. While some of these people may obtain some help from a hearing aid (at the lower and middle frequencies) significant hearing problems almost always remain."

White Ghost

Deaf Pixie said...

KW,

I did not know about Hybrids and Learn alot about blind with a hearing person often start worry about to walk.

Blind person with a hearing tell a truth and being honesty with people. I keep wonder what about. I just curious about CI with a blind cannot or can hear the hybrids car?

Of course It made me worry about blind person with hearing or hearing loss. my concern about blind persons.

KW,Thank you for sharing with me.

Kim said...

Hi Karen-- You might have me confused with someone else. I've had a progressive hearing loss since childhood and didn't start having migraines until late 30s/early 40s. I was in two bad car accidents -- not my fault. My neurologist thinks that might have something to do with it.

Yes-- I agree with you about experimental medicine in life and death situations. Again, I'm not judging those who go in for experimental procedures.

mishkazena said...

Thank you *blushing*

Too many times surgeons gloss over possible complications. Experimental procedures are riskier since the general outcome is fairly unknown. If it's not a matter of life and death, often it pays to wait and see how things go. Good luck

Kim said...

Yes White Ghost-- The article was a bit confusing because there are a few different types of hybrid implants that are being researched right now. The PABI is for people with NF2 I think and the ABI? I'm not sure. Then there's the one for people with ski-slope hearing loss like me.

The word hybrid just means something composed of two different elements. So they are researching three types of hybrids. I think the surgeon I saw said only 90 of the Cochlear hybrids had been implanted in the US so far-- but I could be wrong about that.

It doesn't matter, because the main point of my blog is that this is experimental surgery that could benefit some people, but would not be good for me with my headache issues.

I feel badly for those with NF2. It's very hard to go from hearing to complete and total silence, though from what I understand Deafness isn't as difficult to deal with as some of the other symptoms of NF2.

Kim said...

Yes White Ghost-- The article was a bit confusing because there are a few different types of hybrid implants that are being researched right now. The PABI is for people with NF2 I think and the ABI? I'm not sure. Then there's the one for people with ski-slope hearing loss like me.

The word hybrid just means something composed of two different elements. So they are researching three types of hybrids. I think the surgeon I saw said only 90 of the Cochlear hybrids had been implanted in the US so far-- but I could be wrong about that.

It doesn't matter, because the main point of my blog is that this is experimental surgery that could benefit some people, but would not be good for me with my headache issues.

I feel badly for those with NF2. It's very hard to go from hearing to complete and total silence, though from what I understand Deafness isn't as difficult to deal with as some of the other symptoms of NF2.

Anonymous said...

Kim --

Here it is:

http://www.mayoclinic.org/auditory-brainstem-implant/

then click on "animation" on the picture of the girl.

Sounds scary, though.

White Ghost

Kim said...

Hi WG-- NF2 can cause many other complications besides deafness. Since they have to remove the tumors in the first place, it makes sense to put the ABI in place at that time I guess, though the material you sent doesn't make it sound like there's much benefit other than the patient will hear some noises such as horns. That person will STILL need ASL!! Is it worth it to have a thing implanted in your head just so you can hear noises? I don't know. . .