20 Years of Cochlear Implants

Cochlear implant pioneers reflect on relationships as a key component to success

In 1996, cochlear implants (CIs) stood at the verge of a revolution in transforming how the profoundly deaf could return to the world of sound. Betsy Bromberg, cochlear implant audiologist, was there 20 years ago when New York University Medical Center surgeons performed the first cochlear implants in the United States, including that of pioneering patient Chris Warner.

Bromberg, Warner and MED-EL North America President and CEO Raymond Gamble sat down to discuss the relationships they’ve built over two decades as they have celebrated successes and overcome setbacks, as well as reflect on how far CIs have come.

Forever Changed

“Adult candidates for cochlear implants in 1996 were essentially post-lingually deafened with a profound hearing loss that scored 0% on open-set sentences tasks. In a relatively short amount of time, cochlear implant technology has come to be viewed as mainstream,” Bromberg said.

That year, Gamble was beginning his career as an audiologist at Duke University Medical Center, where he was learning how to map CIs.

“Cochlear implants were definitely not considered routine 20 years ago,” Gamble recalled. “As Betsy mentioned, the candidacy criteria was very strict and was really reserved for people who were profoundly deaf. Also, keep in mind this was before e-mail was really heavily used, and there was certainly no YouTube or Facebook. The activation videos that circulate online are so emotional each and every time we see them, because that person’s life experience has been forever changed.

“Because the criteria was so strict, many of the early cochlear implant recipients felt like they didn’t have anything to lose, and were counseled as such,” Gamble continued. “They were told not to expect much – understanding speech, having a conversation with someone face-to-face and maybe even being able to talk over the phone were realistic expectations. Today, there have been such incredible advancements, particularly related to processing. For example, 20 years ago, a recipient might have recognized that a song was playing. Now, they tell us, ‘that Beatles song didn’t sound quite like the Beatles I remember.’ And that’s pretty amazing. However, realistic expectations are still important. Sometimes an activation experience is not like what you see online, and that can be frustrating, even though it’s completely normal. Cochlear implants take work, and they take time, to really maximize all of the functionality. And that part hasn’t changed.”

“I was approached by my family doctor, who asked me if I had ever considered having a cochlear implant,” recalled Warner of his first experience with the technology. “I told him I’ve heard of them, but CIs were beyond my financial means.” Because Warner had lived with hearing loss since birth, his doctor told him he was eligible for Medicaid, which would cover the device.

“I met with Dr. Noel Cohen to schedule an appointment for surgery at NYU, and his first question to me was, ‘Why do you want a cochlear implant? You seem to speak and hear very well!’ I said that was due to my parents and my siblings, who worked hard to ensure that I learn to speak properly and to pay attention to people.” Warner recalled that his main goals at the time included hearing his 5-year-old son and the birds singing in the woods more clearly.

“When Chris received his first implant in 1996 for his right ear, it was his poorer ear at the time; his left ear was his better ear,” Bromberg said. “We were concerned how he would perform once activated. He performed well and made significant progress with this ear, so much so that he decided to be implanted bilaterally in 2006, 10 years after his right ear. And incredibly, his left ear performed even better than his right shortly after he was activated. This is not always the case when there is such a long gap between ears. Things were really going well for Chris and he found that over time, he continued to make progress with both of his implants. He was able to communicate using the telephone, enjoyed group discussions in quiet and noise, and felt he was truly part of his community.”

Technological Evolution

While candidacy criteria have changed dramatically over the past 20 years, so has the internal and external technology. “We have gone from bulky body speech processors with long wires, to behind-the-ear processors and now completely off-the-ear processors that have no wires at all. All designed with great clarity and comfort. It just keeps getting better,” said Bromberg.

“Technology has really advanced over the past few years with cochlear implants. I am even learning more and more on a daily basis. I think the majority of my patients are doing quite well with some of these technologic advances and I just hope I can continue to keep up with them. I think the most important thing to remember is patience, give them time to build up their confidence and just practice with them. I try to review accessories at follow-up appointments to be sure they get the most out of all their equipment,” she continued.

“This is so exciting for us, because it demonstrates just how far candidacy criteria have come over the past two decades, as Betsy mentioned. It would have been really inconceivable that someone with any residual hearing would not only be a candidate for a hearing implant, but they could retain some of that hearing,” said Gamble.

Warner feels that continuity of care with Bromberg has been critical to his CI success.

“One of the best things you can do for yourself is to have a positive attitude about the amount of hard work that goes along with cochlear implants,” said Warner. “I would tell someone that, if possible, keep going to the same audiologist you start out with. He or she knows you from day one and you’ll end up sharing stories with each other over time. Working together with Betsy and with NYU, now for 20 years, has been a very pleasant and rewarding experience for me and my wife Andrea.”

“Since we see our patients so frequently, we really get to know them and even some of their family members,” Bromberg said. “It’s not just about their programs or equipment, it’s really about the recipient as a whole. The most important thing I find that matters is listening to your patients, hearing what’s on their mind, their fears, concerns and worries. We try and guide and advise them and just be there for them. Over the years, I have been invited to many of my patients’ homes for barbecues, weddings and other celebrations. We are really a cochlear implant family.”

Bromberg also cites trust as an important factor. “The recipient needs to know they can count on you to be the primary source for all of their cochlear implant needs. They feel secure in knowing that I will always be there for them, and they will not be shuffled around from one audiologist to another. Of course there are patients who have moved away over the years, but I find many still return when they come to New York for a visit.”

“CI audiologists change lives every day,” Gamble concluded. “They are there, of course, for the ‘wow’ moments that everyone has come to know and love, but they are also there for the setbacks. I’m hard-pressed to think of an area of medicine that values relationships as much as that between an audiologist and their patient. Betsy and Chris are a great example of just how special those relationships can be.”

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