UK doctor points up treatment for 'hidden disability' of hearing loss

By Rick Childress

University of Kentucky

Forty years ago, there was no effective treatment for deafness.

Now, a nine-month-old infant can get a cochlear implant — a procedure that first got Food and Drug Administration approval in 1984.

“In my opinion, it is one of the greatest achievements of modern medicine,” said Dr. Beth McNulty, a UK HealthCare neurotologist — a doctor who specializes in the ears, nose and throat, commonly known as an ENT.

In the inner ear, a cochlear implant converts acoustic energy into electric energy, stimulating the auditory nerve electrically. It may restore hearing in those born with congenital deafness, as well as patients with slowly progressive hearing loss for whom hearing aids no longer work.

“Cochlear implants are performed on infants up to 103-year-olds,” McNulty said. "I always counsel patients that there's no age limit. We treat each patient individually as far as candidacy for surgery.”

The sense of sound can help a deaf mother hear her crying infant, or help a baby born deaf learn to speak. In honor of World Hearing Day Sunday, March 3, McNulty wanted to highlight how the gift of hearing can connect people and change lives.

“As the hearing loss progresses to the point of cochlear implantation, a lot of patients feel isolated, they feel like they have no hope,” McNulty said. “Communication is what ties you to the world.”

World Hearing Day brings awareness for hearing loss — so often an invisible disability. That became particularly apparent during the Covid-19 pandemic and patients who were hard of hearing couldn’t read the lips of masked people.

“It caused frustration for them, for those trying to communicate with them, like, ‘Why can't you get this?’” McNulty said. “Because they don't have a sign on their forehead that says, ‘I have hearing loss’ or ‘I have deafness.’”

Many of McNulty’s patients are in their mid-life and have had hearing loss that has progressed to where their hearing aids are no longer effective. Sadly, in some places in Kentucky, those individuals aren’t referred for cochlear implantation because of a lack of awareness of the treatment options.

“Through World Hearing Day we want to bring awareness to hearing loss as a disability, an often hidden disability, and bring awareness to the fact that nowadays we have options for treatment,” McNulty said.

Starting in 2019, the surgery can also be performed on those who are deaf in one ear.

Candidates for the surgery often score less than 50% of word understanding during audiology testing. After the surgery, average word recognition increases to 70-80%.

Before surgery, McNulty speaks directly and slowly or uses dictation software when talking with a patient. On activation day, she loves to “test the water” and speaks normally to see if the patient responds. While speech clarity may take time, often, they do respond and describe hearing sounds they haven’t heard in years.

“It’s opening closed doors for patients, bringing back the connection to their loved ones, their friends and family,” McNulty said. “It is such a rewarding part of my job.”

An infant who is born deaf would start with hearing aids by the time they’re six months old, then get a cochlear implant before their first birthday.

“If we do all those things, they will have speech,” McNulty said. “They will be in a regular classroom and may progress like nothing ever happened.”

Few in Kentucky perform the surgery; the state has only six neurotologists. Four work at UK, which also has pediatric otolaryngologists who perform cochlear implants on children, as well as audiologists who are specially trained for cochlear implantation. The audiologists are key members of the team.

“This is their passion,” McNulty said. “They work with these individuals about once a month for a whole year, programming and reprogramming to try to get this to sound just right.”

The team also consists of two cochlear-implant coordinators who help schedule appointments, answer questions and are adept at working with deaf individuals and their families.

McNulty recommends considering getting your hearing checked starting at age 50 — based off data that shows getting hearing loss treated at that age can help slow the onset or progression of dementia.

Other reasons to get your hearing checked:

• Family history of hearing loss
• History of noise exposure like in construction or the military
• Asking people to repeat themselves
• Struggling with background noise
• Tinnitus (Hearing ringing, buzzing, crickets in your ears)

Cochlear implants are a treatment option for nerve hearing loss, but hearing loss may also be conductive, or due to a mechanical problem such as a hole in the eardrum, or a bad infection. Sometimes this can also be treated surgically and reversed.