In 2005, at age 74, severely hearing impaired and getting worse, my audiologist, Cathy Kurth, recommended hearing aids as they were not helping me distinguish speech well anymore. My kids would understand this, as phone conversations with them were getting to be rather humorous as we played games trying to converse with me, "What was that number?" "Let's try again." "Let me go through numbers and stop me when I come to it ... 1, 2, 3."

Cathy told me there was a new experimental type cochlear implant that was recently approved for clinical trials and that because it was experimental, Medicare restrictions as to who would qualify for Medicare re-imbursement was less restrictive. This brought me into the world of Cochlear implants and an adventure that would greatly impact my life and my family's.

I have a precipitous drop in my audiogram curve and my hearing has been limited to low frequency sounds. I had been using BTE aids, the Diva by Widex, which had helped me somewhat in the past (I was 74+ at that time, I'm now 76 and aging), but I noticed an increasing loss of speech recognition for some time. Concerned about that loss and the impact of not interpreting conversations appropriately (I'm a physician), I felt that I needed to stop practicing medicine. My word recognition was only about 20%, and that was in a quiet room.

I researched all I could about the implants and discovered that there are two basic types of implants, the regular implant (RI) that allows electrical stimulation of cochlear nerve endings to the full range of hearing, and the shorter implant, also called the "Hybrid (HI)" or "Short Array" that preserves whatever low frequency hearing one still possesses yet stimulates the higher frequency nerve endings that are not longer working for me. Though there are several brands of RI, there is only one manufacturer, Cochlear, whose implant is currently (as of January 2006) approved by the FDA in a clinical trial environment.

Living in Phoenix, Arizona I made an appointment at one of the clinics in this area. After being tested I discovered several interesting tidbits; presently there are only 7 FDA approved centers for the Hybrid (as of January 2007 there are now 20); because of Medicare regulations it is possible for one to NOT qualify for Medicare re-imbursement if the RI is implanted, but one can qualify for re-imbursement if the HI is used; that the literature put out by the implant manufacturers is more hype than informative; that information about reactions and improvements in hearing due to implants seems to apply only to the regular implant, not the hybrid as little is written about the HI.

Being a physician and research oriented, I obtained second and third opinions (something I strongly recommend to everyone) to get a better understanding of my choices and expectations, particularly about the Hybrid, for the HI made sense to me. In May 2004, Dr. Gans from the University of Iowa reported on the use of this short implant with results showing that with proper placement one can retain one's natural low frequency hearing and have marked improvement of high frequency sound recognition via the electrodes of the cochlear implant. It is based upon the theory that most of us, especially those with age related hearing loss have significant low frequency hearing, but just cannot hear in the higher frequencies. Since the high frequency nerve endings are located deeper within the cochlear, it was thought possible to place the implant electrode a shorter distance, thus the name "Short Array" and in the process preserve one's own low frequency hearing yet still be able to produce high frequency hearing.

This "dual" hearing produced a more natural sound recognition than what one finds with the regular implant, because you have the implant (for high frequency sounds), PLUS a hearing aid (for low frequency sounds), one wears two devices on the implant side, and your usual aid on the other ear.

One of the risks of a cochlear implant is that if it does not work well or at all (very rare), one is left deaf in the implanted ear. That is not a significant problem especially to the person that is totally deaf prior to the RI implant. However, in those of us with some low frequency hearing, failure of the implant would leave one with a greater hearing deficit. This could then be corrected by placing the regular cochlear implant into that ear.

From that research I came in contact with multiple implant centers, personally interviewed regular implanted people (none hybrid patients), and had spoken directly (me "speaking" on the phone, my wife doing the talking and I asking the questions to be answered) with the lead person dealing with the Hybrid at Cochlear.

After 8 months of searching and researching what did I find and why did I make the choices I finally made?

Internet: The best way for me to communicate is via the Internet. Thus, if a center did not respond to my questions promptly, and or completely, I lost interest in them. Hearing loss is what they deal with, and if they cannot understand my oral communication problems and my need to use the Internet then what expectation would I have that they would be able to assist me AFTER my surgery. Unfortunately there were many centers that took months to answer my initial questions. Why would I want them to do my surgery for if they did not respond rapidly before surgery I had little faith that they would be there for me after surgery?

Phone: Believe it or not, but there are centers doing implant surgery that have a machine answering the phone and giving you choices of different numbers to push for different services provided. Come on now! I can barely understand my wife when she talks to me on the phone. How am I going to understand the choices of what buttons to push? If an implant center does not understand my hearing loss, what confidence would I have that they can understand my surgical and post-operative needs? None!

Just those two issues narrowed down my choice of centers dramatically. Next issue for me was the contact person, the implant coordinator. Having spent most of my life in cutting edge medical technology I know the importance of the coordinator. That person runs the show %u2013 answers questions, solves problems, and makes the patient%u2019s experience calm, comfortable and reassuring. Three of the centers I dealt with fit that very, very well but unfortunately one of those centers did not implant the Hybrid and the center in Iowa was too far away to consider.

Surgeon: Experience of the surgeon to me is also vital. This is not listed first because if the surgeon is the most experienced in the world and has a disorganized and uncaring practice I%u2019m long gone from that place. Most surgeons you see for surgery and rarely will see thereafter. The coordinator will be my major contact person pre-operatively and post-operative. But, I would want my surgeon to have done many, many implant surgeries (the Hybrid surgery does differ significantly from the RI surgery) for me to be comfortable in decreasing my surgical risks.

After all the above, I felt that the House clinic was one of the best that I had contact with and because of their organizational skills (Dawna Mills, their coordinator is terrific), their HI and RI experience, and the positive comments from Cochlear, I chose House for the surgery though I do not live in California. I have not regretted those decisions, either the place for surgery or choice of having the Hybrid implanted.

Surgery

My experiences after surgery, I feel are important and so will not go into details of the surgery per se.

Before surgery, in the pre-operative area of St. Vincent Hospital in Los Angeles, Dr. Luxford shaved my head in a small area behind by right ear where the incision was to be made. I must say that if he feels that the stresses and strains of medicine get too much he does have a future as a barber. Surgery took about 2 hours and I was in the recovery room for about another 2 hours. Pain or discomfort was minimal and I was able to walk that day. I did have some dizziness and for several weeks walked with a wide gait, think of a duck. I did have "fullness" in my right ear similar to the feeling of water in my external ear. That "water feeling" lasted many months, though it was barely noted. I just said to myself, "Look, there is something in my right ear and I should notice something different." Discomfort for me was never a problem and when home I never took any medication beyond Advil.

So, how are things since surgery?

The HI is not activated for about 4 weeks after surgery. During this time, due to swelling from surgery, one does not wear the ITE hearing aid on the implanted side and one will have absolutely no hearing in the implanted ear. I was surprised that my hearing (left ear with aid) was markedly decreased during this time. I never thought that I was that dependent upon both aids. About 1 week post surgery I decided to put my BTE aid in my implanted side to see if I could hear anything. YES!! I did hear sounds! Muffled, distant, faint sounds, but they were lovely. This is from my email to Dawna Mills on January 25, 2006, "Though I still have 'stuffiness' in my right ear, I placed the old hearing aid in my right ear. I do not hear very well, but I can very definitely hear the beeps as I change programs in my old right hearing aid. Thought you would like to know."

Each day sounds seemed to be better recognized. And two days later on January 27, 2006 I sent the following, "Doing very well post-op. No fever, pain essentially gone though am tender behind my right ear."

"Plugging my left ear with your foam plug (I kept after the last testing) I can hear my wife tell me things very clearly in the right ear, especially if I'm up close and she talks by my right ear and this is WITHOUT my right BTE aid!!! The full feeling in my right ear is still there (I know that this is normal - just added in for your info)."

The implant is activated about 4 weeks after surgery and that is an experience I will never forget and brings me now to the questions of what I gained and what I have "lost." First of all, and most importantly for me, I have retained ALL of my low frequency hearing that was present prior to surgery. From my standpoint I did very well taking the Hybrid gamble for I lost nothing by having the Hybrid.

Then what did I gain? Lot's of things; I now have perfect hearing in my implanted ear, at least by audiogram. When tested to hear sounds, I can hear the highest frequency sound that Dawna used when my implant was activated about 4 weeks post surgery (I cried). At 6 months post activation I still hear those low frequency and high frequency sounds (nothing degraded) and I now properly interpret 40% of words presented to me in testing. I'm a happy camper!

Do these new sounds, sound different? Yes! Are they tinny? Perhaps, to some degree. What I sense is that I'm hearing sounds I have either never heard or surely have not heard in many a year. I'll use one example, an example I try to tell people so that they can understand how us hearing impaired people hear differently than they do. Take the word "the." I have always heard that word. But now with the Hybrid I hear it differently because I hear the Hybrid activated implying that the word "the" has some higher frequency aspects to it that I never heard before. At first these extra "sounds" were more of a hiss than a "pure" sound. Today, it is just the word "the."

Are those sounds annoying? In the beginning it took time to become adjusted to them. An interesting aspect of it all is that you will find that at each visit after activation they will increase the Hybrid power, but they leave an old (previous) setting in one of the 4 programs. After working with the new setting for a while I have tried the old setting and find that I do not hear well with it. My nerve endings have become accustomed to the increased power and requires it and must be enjoying it for I hear better with each increase in power.

Are things perfect? No! But I hear better than I Have heard for years. I hear conversations behind me when I'm driving my car and someone in the back seat is talking, something I could not hear prior to surgery. Like many of you, I do lip read and require closed caption.

Thus, what are the imperfect parts to the Hybrid? First of all some of the downsides are related to the fact that only 1 implant is placed so you will never have high frequency binaural hearing. I can hear birds singing (and can distinguish the song of 4 different birds in our area), keys jingling and seatbelt warning sounds, but only in my implanted ear (right ear). I never expected to have perfect hearing, surely will never without binaural high frequency hearing. But I do hear better, and I hear more words, and I do not have to interrupt people as often asking, "What did you say."

I still have trouble watching television (I'll come back to that again) without closed caption. I do not go to the movies (I get movies from Netflix) because I need the closed caption. Plays are still difficult for me but probably more from the fact that two people might talk at the same time, or more than likely they talk too fast for me. Movies are obviously the same problem with that background music.

Music is also a problem though I think it is getting to be less so. High frequency sounds come across as squeaks rather than a clear sound of say a violin playing high C over C. On the other hand, I hear instruments playing sounds I have never heard before such as cymbals. Those squeaks seem to be less over time. At about 11 months post-operative, I still find that my hearing is getting better and better. How much better? Tune in for I will have my 1 year test next month.

I have just recently, about 3 months ago, acquired some assisted hearing devices so that I can augment sound in ALL three devices, my BTE, IE and implant. That has helped significantly. One example is the phone. I can plug my neck loop into my mobile and hear the conversation in ALL three devices. Dramatic! Didn't have to once ask for people to repeat what was said. The same applies to television in that I can hear better without looking at the set. But...if they talk too fast it is still a problem for me. I have been to the theatre and symphony using my FM assisted devices and can understand most of what was said on stage and unfortunately the symphony hall I was in uses an Infrared system and though I heard quite well I believe it would have been better if I had the proper assisted system with me.

I have tinnitus in both ears. With the implant turned on it is gone in my right ear, but still have some in my left one.

When you first put on the implant each morning you will hear "white sound" that will disappear soon after. Not sure why, but suspect that the implant is activating nerve endings and this is how they respond to the initial "shock."

If may hearing was never to improve beyond where it is now (though there is a good chance that it will be over the next 6 months or more) I would be still thrilled that I had the Hybrid implanted. I'm 100% ahead of where I was before, and enjoying my life so much better.

Would I do it all over knowing what I have experienced? You bet...in a millisecond! I have no regrets except that insurance only pays for the implant in one ear rather than both.

One last issue, the controller. Dawna will ask you if you want the BTE controller or the tethered one. Cochlea only gives you one or the other (they give you two units in case one gets damaged or does not function) rather than one each. I wish they would change that policy so that they would give patients the tethered controller to "play" with the different programs and settings and then several months later offer to take either the tethered or BTE unite back and give you your second unit of your choice at that time. The BTE controller is somewhat annoying to constantly manipulate. Don't get me wrong; I do NOT NEED to change programs/settings often. It is more that my life has been in research and I constantly experiment with things. Today, I rarely feel a need to alter settings that Dawna has put into the controller.

Robert H. Tamis, M.D.

P.S. So that there is transparency%u2026I am not employed by either Cochlear or House Ear Clinic and do not get any compensation from either.

Bob