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Posted 3/06/12 (Tue)
High-tech hearing . . . The external unit worn by Philip Zimmer
after his cochlear implant includes a transmitter coil, top left,
attached to a microphone and speech processor above the ear.
The transmitter sends electrical code from the unit to a receiver
and electrode array implanted in the ear's cochlea, so the brain
can process the information and interpret the sounds.
By Caroline Downs
Philip Zimmer of Kenmare is walking around these days like a new man, delighted in every aspect of life as he hears sounds--a zipper on a suitcase, a bird singing at a city intersection, his grandchild’s voice--for the first time in years, or ever, thanks to a cochlear implant.
“I played a lot of basketball when I was in school,” he said, “and you know how you get ready for a game, you get pumped up? This is like that!”
For Philip, his hearing loss has long been the source of frustration. “I think I’ve had this for 20 or 30 years, but I didn’t always know how bad it was,” he said. “By the mid- or late 1990s, I could sense I was speaking awfully loudly. There was a lot of ‘What was that?’ and now you’re starting to doubt what you hear.”
He shook his head and added, “You think you’re invincible, but it doesn’t work out that way.”
By the time of his son Chris’s wedding in December 2005, Philip couldn’t ignore the problem any longer. “We were at the rehearsal and they were all up at the front of the church doing what they were supposed to do,” he recalled. “I went to the back of the church, but Chris was trying to get my attention. He called ‘Dad’ three times before I even knew he was saying anything to me. Then I realized it was time for me to think about hearing aids.”
Philip started with a hearing aid company he’d seen advertised in Minot, where he was tested. “They told me my right ear was not good,” he said, “and showed me a scale of where I should be able to hear.” He shook his head to indicate he couldn’t hear much according to the chart they provided.
He purchased a pair of the aids the store’s staff recommended after determining they improved his hearing. Philip smiled as he described coming home to flick the light switches and flush the toilet, simply to hear the noises. “So, that was good,” he said, adding that the inconvenience of cleaning the sensitive digital aids was offset by the ability to hear better.
He returned to the company for periodic testing through the years and upgraded to a second set of hearing aids. He also kept repeating the process of testing and resetting the equipment until his hearing deteriorated beyond the point where the aids, which were never covered by health insurance, helped much. “They told me, ‘We can’t do a lot more with this right ear,’” he said.
That was last summer. Some time after receiving the bad news, Philip and his wife Gail happened to be traveling through Williston and decided to take a break from the long lines of traffic through town by stopping at Dairy Queen. As the couple stood waiting, Philip noticed a man ahead of him wearing a device around his ear and attached to the back of head. “So I said, ‘Excuse me, have you got a cochlear implant?’” Philip said and the two started a conversation that changed Philip’s life.
The man described the procedure he’d had done in Oklahoma City and the dramatic results. “I thought right then and there, it’s an idea for me,” said Philip.
The Zimmers made an appointment with Dr. Jerrica Maxson, an audiologist at Trinity Hospital in Minot, who ran tests in a soundproof room to determine what sounds, words and sentences Philip could hear from both ears. She told him his right side was especially bad and recommended an evaluation at Mayo Clinic in Rochester, MN, for a cochlear implant. “She said they would be the top-of-the-line if I should do the implant,” Philip said.
By the first week in December, the Zimmers were seated with Ann Peterson in the audiology department at Mayo Clinic, starting on two days’ worth of testing that revealed Philip retained only 4 percent hearing in his right ear and 38 percent in his left. “They used their best hearing aids on me. The sounds were loud, but I couldn’t determine what they were,” Philip recalled. “Now, I’m on the depressed side, and I’m taking her recommendation right then and there. I’ve got nothing to lose.”
The appointment included an MRI to determine if Philip was a candidate for the surgery and a visit with Dr. Brian Neff, who would perform the implant and who strongly encouraged Philip to pursue the option.
The Zimmers scheduled the implant for January 12th at St. Mary’s Hospital in Rochester. Philip reported for surgery at 5:45 am and went through the same-day procedure under a general anesthetic that allowed him to leave the facility by 6 pm. “I had a cup over my right ear, and a bandage wrapped like a turban around my head,” he said.
The cup covered an incision of less than two inches, and Philip was only required to wear the protection for the first 24 hours. He and Gail spent a restless night in Rochester, then returned home with antibiotics and salves to help with healing. “It was three weeks of laying low at home,” Philip said.
For a day or two after the surgery, Philip reported hearing some noises on his right side, perhaps where the cochlea and nerves in his ear had been impacted by the surgery. “Now, this is dead,” he said as he touched his right ear. “It’s so quiet, and that’s not good within yourself. I knew then this thing better work, or I’ve got nothing.”
The fun part
The Zimmers returned to Mayo Clinic on February 7th, after the incision healed, and met this time with Lee Belf of the audiology department. “That was fun because she came out and she was so excited,” Philip said. He held up a black bag, about the same size as a briefcase. “‘This is what you’ve purchased,’ she told us.”
“She told us, ‘This is my favorite part of my job,” Gail added.
Philip unzipped the bag to reveal a dozen yellow and white boxes that hold the components of his CochlearTM Nucleus 5, the equipment that allows him to interpret sounds.
The Zimmers both reported being amazed at the array of items in the bag. In addition to the processing unit Philip wears, he has a back-up unit, a remote control with four settings to adjust for conditions and circumstances around him, a charger for some of the batteries complete with a variety of adapters for travel in foreign countries, additional non-rechargeable batteries, extra microphones and minuscule protective covers for those, plastic covers to protect the processing unit when he wears it, and specific tools to clean the unit’s elements.
Before Philip learned the function of any of those pieces, however, the audiologist used her computer to activate the implant in Philip’s head. The two spent nearly two hours testing several sounds at different volumes for Philip, to establish his comfort levels. “By this time, I was so excited,” Philip said. “I wanted to get activated.”
Finally, Lee proclaimed Philip was ready. The processing unit was connected to take control of the implant, and Lee asked Philip, “What do I sound like?”
Philip was astounded to hear a mechanical voice, almost like a robot. “That feeling lasted for two or three days, and they don’t really know why that is,” he explained. “It was like robots were talking to me, and when I talked, it wasn’t my own voice I heard.”
But he admitted to a second response, too. “I’m almost crying at this point,” he said. “I’m 60 years old and this is probably a new beginning, as far as hearing goes, for the rest of my life! I just haven’t heard this stuff.”
Lee sent the Zimmers from her office with instructions to go out for supper and test the implant and processing unit. The couple chose the busy Outback Steakhouse, where sounds pounded at Philip. “I had so much stuff coming at me, I had to shut the sensitivity down to nothing,” he said. “Normally, your brain is filtering this. But she told me to get out and about and see what I feel like.”
The Zimmers returned to Mayo Clinic the next morning to meet with Lee and Dr. Neff. They worked together to adjust the program settings for Philip’s comfort levels at the time. “The doctor looked at my ear and said it was healing great,” Philip recalled. “Then he told me to go home and get out and have a conversation.”
Before the couple left Rochester, they stopped at a Target. While Gail made some purchases, Philip wandered around the store listening to customers until he noticed two women talking and shopping several feet away from him. He decided to test his processing unit and the remote control at different levels to determine if he could hear any of their words, but after a few minutes, he noticed both women looking at him with suspicion.
Zimmer approached them to apologize. “Excuse me,” he said and touched the unit perched on his ear. “I just got this on and I’m testing it to see what I can hear.”
The women’s expressions immediately changed from fear to joy. “Right then and there, they congratulated me,” Philip said, adding that he was surprised at their response and at the fact he was speaking so normally with them.
“It’s absolutely awesome,” Gail said as she talked about Philip’s transformation. “It’s so nice to have a decent conversation with your husband.”
“One of the first things everybody noticed is that my voice is about half of the volume that it used to be,” Philip added. “I had to talk that loud to even hear myself.”
The bag filled with equipment cost $35,000, with the whole process of testing and surgery approaching $80,000. Several health insurance companies, including the Zimmers’, cover expenses related to the procedure. “It comes down to what are your eyes and your ears and your arms and legs worth?” Philip said.
Although no one has told him specifically, Philip believes his hearing loss was hereditary. “My mother couldn’t hear, and her mother couldn’t hear,” he said. “My brother Loren had trouble. My sister has great hearing, but my brother Harold wears a hearing aid. I just didn’t realize how bad mine was.”
Philip now has about 80 percent hearing ability in the right ear, when the processing unit is activated. “To go from four percent to 80 percent is awfully good odds,” he said. He is still learning to work with the remote control, its four programming levels and various situations, such as telephone calls and large group events such as weddings, concerts, church services and casual meetings with friends. The Zimmers made another trip to Rochester on February 29th to continue making adjustments to the settings for his implant.
He also has to prepare himself for the eerie feeling he experiences whenever he removes the processing unit and has absolutely zero hearing on his right side.
For several days after returning home, Philip caught himself operating appliances in his house, running the microwave and dishwasher and hearing their motors and timing signals. “I’m hearing sounds I’ve never heard before,” he said, laughing as he talked about hearing, for the first time in years, gravel plinking against the back of his pickup as he drives down the road to his farm. “This is what goes on right now.”
may be in the future
He continues to wear a regular digital hearing aid in his left ear, at 38 percent hearing, although he plans to return to Mayo Clinic for more testing on that side. “They want to evaluate that one again in September,” he said. “I know they want balance between the two ears, as much as possible. If the doctor says I should [have the implant], I’m going to do it.”
Philip encouraged other people with severe hearing losses to consider a cochlear implant for their own situations. “I had stopped going to things because I couldn’t hear,” he said, “and I was so tired of asking ‘What was that?’ But now, it’s been fun! Take the time to get tested and see where you’re at as far as getting an implant. What I do know is that this is a good option when there’s not a lot left.”
While cochlear implants are performed at a number of health care facilities across the country, Philip appreciated the attention and care he received at Mayo Clinic. “Down there, it’s a humbling experience,” he said. “I did not realize what we really had just 800 miles away in Rochester. You’re confident with everything they do.”
He knows the processing unit will require extra attention when he begins his work in the fields this spring. “I’ll have to keep this clean,” he said, “which means I’ll probably take it off in the cab, but if someone comes out to the field [to see me], I’ll have to stop and hook up the unit so I can hear them.”
Taking meticulous care of the processing unit doesn’t faze Philip in the least. “This spring, I’m going to be energized,” he said. “I guarantee you, the first flock of Canada honkers coming from the south, I’m going to take my chair outside and sit and listen. If life expectancy is 80 years, then I’ve got 20 years of good hearing left!”
Cochlear implant transfers sound by electrical code
By Caroline Downs
Philip Zimmer’s cochlear implant was typical of those performed at the Mayo Clinic in Rochester, MN, which provides patients with information explaining the basic procedure.
According to a brochure about the surgery, a cochlear implant is “a surgically implanted electronic device that provides hearing to a person who is severely or profoundly hard of hearing or deaf.”
The Mayo Clinic audiology department explains that ears hear sounds as sound waves hit the eardrum, sending vibrations through three tiny bones in the middle ear to the cochlea. Hair cells in the cochlea transform those vibrations into electrical impulses that travel along the auditory nerve to the brain for interpretation.
A cochlear implant involves the surgical implantation of a receiver under the skin behind the ear. A microphone over the ear picks up sounds, which are converted by a sound processor into an electrical code. That code travels to a transmitter held in place on the outside of the head, with the code then transmitted to the receiver.
The receiver sends an electrical signal to electrodes threaded into the cochlea during the implantation procedure. The brain then interprets those signals.
After a cochlear implant, the body’s cochlea no longer functions on its own. However, the electrode array that is implanted is expected to operate for decades.
According to the Mayo Clinic information, most cochlear implant technologies combine the microphone and the processor in a small unit worn behind the ear.
The cochlear implant team at Mayo Clinic cautions potential implant candidates that hearing outcome cannot be predicted before implanting the device and that the benefits of an implant vary widely by person. However, with commitment, motivation and time, people with implants tend to notice hearing improvement during the first six months following the procedure.
Those improvements may continue for years, which is why Zimmer was looking forward to beginning life again at age 60, able to hear everything around him and carry on normal conversations with friends and family.