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Cochlear Implant: A life-changing device
November 15, 2021

Cochlear Implant: A life-changing device

A man and a woman are standing on a sidewalk holding hands.

On July 4, 2020, one little girl experienced a life-changing evening that some of us might take for granted. Do you ever find yourself ready to fall asleep on Independence Day but have trouble drifting off because the neighbor, two houses down, is still shooting off fireworks at 11:00pm? Most of us have been there, except those who cannot hear the fireworks. But this year was different for Emmalyn.


Emmalyn was born profoundly deaf. But Emmalyn is able to hear with the aid of cochlear implants. What are cochlear implants? Cochlear implants, which were approved by the U.S. Food and Drug Administration (FDA) more than 40 years ago, are surgically implanted devices that provide sound representation to people who cannot benefit from hearing aids. The implants do not cure hearing impairment; rather, the device directly stimulates the auditory pathway. Cochlear implants replace the function of the damaged inner ear to provide sound signals to the brain for processing.


Cochlear implants have come a long way since the first recipient of the earliest version of the technology received an implant in 1977. In the more than 40 years since that revolutionary milestone, the precision of this technology and process has been fine-tuned, and more than 500,000 people with hearing loss have benefited from cochlear implants worldwide. As is often the case when technology advances, the devices are now smaller and smarter. They are comprised of two components, which work like this:


1) Internal electrode array. The internal electrode array is implanted by an ear, nose and throat surgeon, also called an otolaryngologist, into the inner ear.

2) External sound processor. The microphones on the external sound processor detect sounds and transfer those sounds through the skin to the internal electrode array. Two options are available for the external sound processor: a behind-the-ear option that sits atop the ear and looks similar to a traditional behind-the-ear hearing aid and an off-the-ear option. The internal electrode array then stimulates the auditory nerve directly and transmits the sound to the brain for processing.


Emmalyn has benefited from this breakthrough in technology since her first implant surgery just before her 1st birthday. But she has always had to adjust to going through periods of hearing and periods of deafness. This happens every night when she removes her external sound processors to go to sleep. This has created a hesitation in Emmalyn and a fear of loud, unexpected noises—the kind of noises fireworks would produce. But this year was different, and Emmalyn made a choice she has never made.


Emmalyn decided she wanted to hear what fireworks sounded like. This year Emmalyn left her external processors on. The joy on that child’s face when hearing fireworks for the first time and exclaiming, “They aren’t that loud!” and “It’s not that scary!” brought her parents to tears. And the life-changing technology and surgery of cochlear implants has made that possible. Emmalyn’s mother Nancy said, “I’m continually amazed at how this little girl finds so much joy in life and in the things that we often take for granted. She keeps us smiling and so full of joy while we get to share these special moments with her.”


“Since 2017, Johnson Audiology has provided support for cochlear implant patients by way of initial diagnostic evaluation and ongoing follow-up care,” says Megan Johnson, Au.D. and owner of Johnson Audiology. Dr. Johnson has been an audiologist for more than 17 years, and her experience as a cochlear fellow began as soon as she embarked on her career. She and Johnson Audiology’s Madison Sakaan, Au.D. serve cochlear implant patients through initial candidacy testing and through post-surgical ongoing care.


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Last autumn, access to cochlear implantation reached a new milestone in the Chattanooga area when Johnson Audiology teamed up with otolaryngology surgeons Dr. Doug Leining and Dr. Alex Sokohl from Associates in ENT to give Chattanoogans a complete continuum of care for cochlear implantation. With the surgery performed right here at Memorial Hospital in Chattanooga, cochlear implant patients no longer have to travel to Nashville or Atlanta to receive that component of their care. Cochlear implant surgery was an elective that was suspended for a time this spring because of COVID-19; despite that setback, multiple patients have moved forward with implantation.


Dr. Sakaan says, “Our cochlear implant program has really taken off. Patients are overjoyed that cochlear implantation and programming services are now offered locally in Chattanooga. At Johnson Audiology, evaluation for a cochlear implant is extremely comprehensive, as it should be. We perform a typical hearing test and then test the patient’s ability to understand spoken sentences while wearing hearing aids. When programming those hearing aids, we use real-ear measurements (REM), which is considered best practice, to ensure the hearing aids are optimally set. Qualification for a cochlear implant is then determined by the difficulty a patient has in understanding the spoken sentences when wearing hearing aids.”


While cochlear implants can be life-changing, it comes with its own set of challenges. It can take time for the patient to adjust as the brain “re-learns” the stimulation it is receiving from the implants. And the programming is subject to adjustments over the life of the device. Having an audiologist and Ear Nose and Throat (ENT) physician that you trust is key as a lifelong relationship is formed from the first consultation through every mapping, or programming, session after surgery. 

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Madison Sakaan, Au.D. (l) and Megan Johnson, Au.D. (r) work with cochlear implant patients at the Gunbarrel Road location of Johnson Audiology in Chattanooga.

“Helping patients with hearing loss and cochlear implants is my passion,” Dr. Sakaan goes on to say. “Being able to walk with my patients from day one when we evaluate for a cochlear implant, to the day of surgery, to initial activation of the implant, and through the hearing rehabilitation journey is the greatest honor. The team at Johnson Audiology and I are here to help patients during every step of their cochlear implant journey. I believe this is what makes our services here at Johnson Audiology so special. Patients' hearing and quality of life is our top priority, and it shines through in everything we do.”


Cochlear implants are a hearing loss solution for those with moderate to profound sensorineural hearing loss—also referred to as nerve hearing loss—who are receiving limited benefit from hearing aids, such as those who only hear half of what is said in a conversation. Cochlear implantation has become the established treatment for children as young as 12 months who have severe to profound sensorineural hearing loss. Cochlear implants are covered by Medicare, many insurance plans, and typically by Medicaid. However, those interested in cochlear implantation need to be aware that the FDA has set specific guidelines that audiologists and ENT surgeons must follow to determine a person’s candidacy.

 

For more information about cochlear implantation, contact Johnson Audiology’s Gunbarrel Road location in Chattanooga at 423.710.1432 or Associates in ENT at 423.267.6738.


March 6, 2025
Chipper Gocke, 28, has had many poignant moments in the last six weeks since his cochlear implant surgery. “A workmate commented recently that my speaking voice is the appropriate volume now. Not being able to hear myself, I probably often talked too loud before. It seems like a small thing, but it is a way to be more normalized in my professional and other settings.” His mother, Amy Gocke, also has noticed the changes. “Chipper has never called me on the phone before. With his profound lifelong hearing loss and even using powerful hearing aids, he simply couldn’t communicate by phone. Now I look forward to his calls every day after he gets off work.” These daily experiences that people often take for granted—communicating with a workmate or calling a family member to say hello—are now possible for Chipper because of his cochlear implant. Hearing loss has been a part of Chipper’s life since he was a small child. Chipper’s father, Ted Gocke, relates, “From the time he was 18 months old, Chipper had ear infections that had us in and out of the hospital. That led to tubes in his ears and the diagnosis that he had a significant hearing loss.” As a youngster, Chipper received early intervention services before he even reached school age. He also got established with local audiologist, Darnell Scafe, and they reconnected recently when Chipper sought out Darnell for hearing health care services as an adult. Darnell, who joined the Johnson Audiology team in 2018, says, “I remember Chipper as a sweet little boy who didn’t let his hearing loss slow him down. It’s wonderful to get to know the fine, capable young man he has grown into.” Last year, Darnell encouraged Chipper to consider a cochlear implant, and she referred him to Johnson Audiology’s Cochlear Implant Program Director, Dr. Hannah Dearth. Dr. Dearth then was able to complete cochlear implant candidacy testing. In November of last year, Chipper’s surgery was performed at Murfreesboro Medical Clinic (MMC) in Middle Tennessee by an otolaryngologist (ENT). A native of Chattanooga, Chipper traveled for the initial surgery since there is not currently an ENT in Chattanooga who performs CI surgeries. However, Chipper then had his cochlear implant activated at Johnson Audiology (JA) by Dr. Dearth in early January. Also, there to celebrate activation day was Darnell. “It felt like a full circle moment when Dr. Dearth activated Chipper’s cochlear implant, and he began to have those first sound perceptions.” Dr. Dearth explains, “People often wonder how a hearing aid and a cochlear implant are different. Cochlear implants are designed for patients whose hearing aids are no longer assisting them in understanding in both quiet and noisy environments. A hearing aid is designed to provide amplification for speech sounds that are unintelligible without said amplification. Cochlear implants are a surgical option for those who are no longer able to achieve meaningful understanding with a traditional hearing aid. Hearing aids rely on the ear’s natural pathway for hearing to accomplish this and so may not work well for someone with severe damage to the inner ear. A cochlear implant, on the other hand, bypasses the damaged parts of the ear by stimulating the auditory nerve directly with a mild electrical current that sends the sound signal to the brain.” Chipper is committed to his own success with his cochlear implant and in addition to listening to the speech of those around him, he is also tuning in to podcasts and audiobooks that give him even more speech exposure. Dr. Dearth says that is a huge factor in any patient’s ability to thrive with the device. “The patients who are committed to the aural rehabilitation as prescribed experience faster progress and higher success rates long term.” Chipper will continue regular follow-up appointments for the rest of his life to maintain successful progress with his CI. He gets emotional talking about the social isolation that can be a common side effect of profound hearing loss and, also, mentions the spatial awareness that better hearing offers. “Being able to pinpoint sound and localize stimuli from both sides of the head has positive effects for living a safe life,” Dr. Dearth says. Dr. Megan Johnson, audiologist, founder, and owner of JA, says, “Johnson Audiology has provided support for cochlear implant patients since 2017 with care offered through the practice’s location on Lee Highway in the East Brainerd area. After implantation, every other part of a CI patient’s hearing journey can be accomplished at Johnson Audiology—from initial activation to routine mapping.”  Chipper and his parents encourage people to explore the possibility of cochlear implants since it can make such a difference in a person’s daily life and function. Johnson Audiology is accepting new patients who currently wear hearing aids but would like to pursue cochlear implant candidacy as well as those who already have a cochlear implant. Call Johnson Audiology at 423.556.7185 or visit www.johnsonaudiology.com/schedule for more information or to schedule an appointment.
By Jan Hollingsworth May 16, 2024
Research reveals that hearing loss actually rewires your neural pathways Your Amazing Brain Your brain is an amazing organ! This wrinkly, reddish-pink mass weighs about the same as your two-slice toaster, tipping the scales at about three pounds. Acting as a master control center, your brain enables every thought, breath, eye blink, heartbeat, movement—everything—that happens in your body. Rivaling the world’s most powerful supercomputer, your brain can download, process, and react in milliseconds to the tidal wave of information coming from your eyes, skin, nose, tongue, and ears. Neuroplasticity and Your Sense of Hearing Researchers have discovered that the human nervous system—made up of the brain, spinal cord, and a complex network of nerves—has incredible capacity to modify itself, both in function and physical structure. This is called neural plasticity . Dr. Megan Johnson, audiologist and owner of Johnson Audiology explains, “Neural plasticity is going gangbusters in a child’s brain as the child develops and matures into adulthood. Based on years of brain research, we also know that the adult brain is far from being fixed. It, too, changes and adapts when you learn new information or skills or as a response to stress, hormonal fluctuations, drug interactions, injury, and much more.” Dr. Johnson also relates that “your brain displays neuroplasticity when you experience hearing loss.” By measuring brain waves using an electroencephalograph, or EEG, scientists have studied how the brain of a person with hearing loss functions compared to a person with normal hearing. The results are both fascinating and sobering as studies reveal that, in those with hearing loss, the portion of the brain devoted to hearing becomes reorganized. This can be true even with early-stage, mild hearing loss, and the process happens quickly, often in months rather than years. The Hearing Center of Your Brain and Beyond What is actually happening when this takes place? Your brain has a right and a left hemisphere and six major lobes. Think of your frontal lobe as your brain’s boss, where executive functions like decision making, emotion and impulse control, and planning occur. Your temporal lobe, which contains the auditory cortex, is doing the heavy lifting when it comes to interpreting sounds and assigning those sounds meaning. The temporal lobe processes speech and language, and it is where initial learning of new information takes place, which is the first step for logging that information into memory. Dr. Johnson goes on to relate, “When the delicate infrastructure of your ear has become damaged through noise exposure, infection, etc. leading to hearing loss, your auditory cortex cries out to your frontal lobe, saying ‘Help! Help! I’m not receiving any sound to process, so I feel lost.’ The frontal lobe ‘boss’ jumps to attention, and your occipital lobe, responsible for processing vision and touch, takes over the areas in which hearing is normally processed. In other words, your other senses seek to compensate for the deficit due to the loss of your sense of hearing.” Amazing, right? So, where’s the rub? Picture a car assembly line; each worker has an assigned task. One day, the worker who installs the windshields is absent, and the worker who attaches the rearview mirrors is assigned double duty, and a duty that was not part of job training. It is easy to see how the worker left juggling both jobs is compromised, and a car might slip through minus a rear view mirror. Similarly, the areas of your brain that are being taxed to make up for a lack of hearing are overloaded and less able to do their assigned responsibilities. “This explains why so many of my patients with hearing loss relate feeling exhausted and frustrated after a big family gathering—where multiple talkers and sounds must be interpreted—rather than happy and invigorated by the experience. We call this listening fatigue ,” states Dr. Johnson. Additionally, when left untreated long enough, researchers point to the brain’s reorganization due to hearing loss as a significant correlation with dementia. Hearing Technology and Your Brain “But here's the great news!” Dr. Johnson says. When a person is fit with hearing aids or a cochlear implant and sound is restored, the brain has the ability to adjust back—partially or completely—to proper function. How swiftly that happens often depends on how long the hearing loss went untreated and is why she encourages patients to treat hearing loss sooner rather than later. “Here is what I tell patients who are downplaying the importance of hearing: If you won’t treat your hearing loss for the sake of your ears, do it for your brain!”
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