Hybrid Implants Could Help Millions Hear Better

One of the major complaints about hearing aids is that they don’t work well in noise. Dinner in a restaurant can mean choosing to be assaulted by the din and still not hear your dinner companions, or taking the hearing aids out and trying to get along by lip reading.

The reason for the din is that most age-related hearing loss (and much noise-related loss) occurs primarily in the high frequencies, with low-frequency hearing often less severely affected.

Unfortunately hearing aids are not yet sophisticated enough to adequately amplify only the frequencies that are needed, although some “ noise” programs help. In general, a hearing aid is an indiscriminate amplifier, providing wanted and unwanted sound. For people with more severe hearing loss, this can negatively affect their daily activities.

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Last week, a team of scientists led by cochlear implant specialist J. Thomas Roland Jr., M.D., of New York University, published a new study showing that hybrid cochlear implants may be the answer to this problem.

The researchers implanted Cochlear’s Hybrid L24 into 50 subjects with moderate hearing loss in the low frequencies and severe loss in the high frequencies. The scientists wanted to measure how much the device improved the subjects’ speech comprehension and speech-in-noise comprehension.

The study found that scores on the subjects’ word recognition tests increased dramatically — from an average 21 percent to an average 67 percent in the year after implantation. “Our study offers early evidence that potentially millions more people with high-frequency loss, who cannot benefit from a hearing aid, could instead benefit from a hybrid cochlear implant,” Roland said in a prepared statement.

Hybrid implants were approved by the Food and Drug Administration last year for use by people with some residual low-frequency hearing. Unlike in a conventional implant, the hybrid’s electrode array is shorter and only extends partway into the cochlea. High-frequency receptors are at the outer portion of the spiral cochlea, with the low-frequency receptors deeper into the spiral. A conventional cochlear implant destroys hair cells as it is inserted. By not going the full depth, the hybrid implant never touches the still-healthy low-frequency hair cells.

Cochlear implant surgery may seem like an expensive and possibly grueling treatment for someone with this degree of residual hearing. But, in fact, the surgery is not difficult for the patient, although  the surgeon must be highly skilled.

People in their 90s have received implants successfully, and the surgery is done on children as young as 6 months. It is expensive, however. The price for the implant itself is about $30,000, with doctors’ and hospital fees added to that. Medicare reimburses for the implant if the patient meets FDA criteria. The patients in this experimental trial would not have qualified because their residual low-frequency hearing was above the FDA cutoff threshold. What this study suggests is that the FDA criteria should be relaxed to allow implants when hearing aids no longer help.

Is the price — and the surgery — worth it for an older person to hear better in noise? Most cognitive health specialists and gerontologists would answer with an unqualified yes. Insufficient hearing, and especially difficulty hearing in noisy places, is strongly associated with isolation and depression, and these in turn are known contributors to dementia.

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Improving hearing in order to engage in social activities is not only good for the individual, but it can have a significant impact on the nation’s health care spending as well.

The Alzheimer’s Association predicts dementia will affect 1 in 30 adults by 2050. The monetary cost of dementia is now an estimated $159 billion annually, a fraction of the real cost because most care for those with dementia is unpaid, usually by a spouse or an adult child. In 2011, hearing researcher Frank Lin, M.D., an associate professor of otolaryngology at Johns Hopkins University, estimated that delaying the onset of dementia by even one year would save billions of dollars.

By helping improve hearing, the use of hybrid cochlear implants could make a major impact on the prevention or delay of dementia.

Photo: skynesher/iStock

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