Quick Case Study

Restoring a Patient’s Hearing and Ability to Understand Speech

Cochlear Implant Surgery
From early childhood, a woman experienced hearing loss due to both congenital sensorineural hearing loss and otosclerosis. In her mid-60s, she underwent surgery to improve her hearing in her right ear, which was her better-hearing ear.

The surgery failed, leaving her with no hearing in her right ear and forcing her to rely on her left ear, which already had profound hearing loss.

Even with the use of a hearing aid, it was difficult for her to talk on the phone or hold conversations in a group. For years, she researched her treatment options.

Question: Given the severity of her hearing loss and inability to successfully use hearing aids, what treatment option allowed the patient to regain her ability to understand speech at age 78?

View case conclusion  

Answer: The patient learned about cochlear implant surgery and sought out ear surgeon Debara L. Tucci, MD, director of Duke’s cochlear implant program. Tucci implanted the cochlear device, which allowed the patient to better interpret sounds, thereby significantly improving her quality of life.

Because she received some benefit from a hearing aid in her left ear, the patient had been told that she would not be eligible for cochlear implant surgery. However, she soon learned that research by Tucci and other experts in the field demonstrated that the procedure could still benefit patients with substantial residual hearing.

“Whereas in the early days of cochlear implantation—the 1980s and 1990s—we expected patients to be almost completely deaf before we offered cochlear implantation, now we routinely provide implants to patients who have the ability to hear sounds but, despite this residual hearing, have poor ability to understand speech and communicate effectively,” Tucci says.

When the patient arrived at Duke, an audiologist performed a cochlear implant evaluation, which demonstrated that, even in ideal listening conditions, the patient could understand and correctly repeat only 38% of the phrases presented to the left ear and 0% of those presented to the right. Using current Medicare criteria, the patient was eligible to receive an implant.

The device was implanted in her right ear soon after the initial consultation and then activated and programmed 1 month later (Figure). As a result, the patient's level of speech understanding in her right ear improved from 0% to 54% while using the hearing aid in the left ear.

FIGURE. Cochlear device in the right ear of the patient

“One of the greatest joys of my practice is helping people hear again,” says Tucci. “It’s what we’re really all about. I love the fact that we can significantly help patients who struggle to hear by using this technology, which I think is just fantastic.”

She adds that cochlear implants can help reconnect all patients, including elderly patients (the program has helped patients in their 90s), to their families and friends and increase the social engagement necessary for healthy aging.