Dr. Jack Wazen - COCHLEAR IMPLANT BASICS
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Dr. Jack Wazen

I recently overheard Dr. Jack Wazen mention a study he was conducting at the Silverstein Institute in Sarasota regarding pre and post-operative vestibular issues of cochlear implant recipients.

It is a subject of interest to many candidates and I was fortunate that Dr. Wazen agreed to find time in his schedule to sit down for an interview and talk about the study and a wide range of issues relating to cochlear implants; success rates, MRI compatibility, age issues and implant success rates and most of all issues he has faced in his decades of experience as well as his vision and hopes for the future of cochlear implants.

This is an interview you won’t want to miss.

 

Transcript

Voiceover: Cochlear Implant Basics is a site for candidates, recipients, and their families and friends. If you or a loved one is profoundly hard of hearing, newly deaf, or have experienced sudden hearing loss, we are here to share our stories and tell how receiving a cochlear implant can be a life changing event. This site is not medical advice nor is it brand specific. Within these podcasts and videos, you will meet recipients who faced hearing loss situations and hearing aids could no longer provide comprehension of speech or music. They share the stories of how they lost their hearing, their struggles with growing isolation from their family and friends, their inability to compete in the world of business, their difficulties of navigating air travel without hearing, how the joy of music disappeared and the panic of not being able to use a telephone to contact 9-1-1 to get aid for a loved one.

Voiceover: They will talk about their fears and the reason they procrastinated to get a cochlear implant and the reasons they moved forward. How receiving a cochlear implant changed their lives and the lives of those who surround them. You will meet audiologists and surgeons and those who support the deaf and hard of hearing communities. Welcome to Cochlear Implant Basics. Reminder Cochlear Implant Basics is not offering medical advice. Please consult your own healthcare provider.

Richard: It’s not often I get to have a casual conversation with one of America’s best doctors. Dr. Jack Wazen mentioned during a recent encounter that the Silverstein Institute, where he is a partner, was in the process of doing the study on vestibular or balance issues in connection with cochlear implant recipients. That’s a topic dear to the heart of many recipients and candidates and I reached out to him to request some time to let him share his experiences and talk more about the study. His curriculum vitae runs 27 pages of close type. His experience, skills, and his research are simply breathtaking. He’s a surgeon trained to restore hearing through a complex and broad range of skills including but not limited to cochlear implants. This is his story.

Dr. Jack Wazen: I was on the faculty at Columbia University in New York for many years, was associate professor up there, Director of Otology, Neurotology. I was in charge of the cochlear implant program there. Moved here to Sarasota in 2006. So yeah, I’ve been here for a while to build a cochlear implant program here. Our program has been growing steadily every year. We have great success with implant program. We’re very proud of it.

Richard: Did you originally start doing cochlear implants before you came here or was that something you added on later?

Dr. Jack Wazen: No, I was doing them in New York before I came here.

Richard: Okay.

Dr. Jack Wazen: Yeah. [crosstalk 00:03:03] But Dr. Silverstein, here, was doing cochlear implants before I came.

Richard: Oh, okay.

Dr. Jack Wazen: So there were implants performed here before I moved to Sarasota.

Richard: But then you used your skills to become better.

Dr. Jack Wazen: Well they recruited me here to raise this division to a higher level and to bring it into the future.

Richard: For the past 13 years you’ve been growing with cochlear implants. It’s my understanding, just in the Tampa Bay area, there’s something like 350,000 people with hearing problems is huge population here.

Dr. Jack Wazen: Yeah. The incidence of hearing loss, not just in the Tampa Bay area, but all over the world is massive. And it is disheartening to see how many people with hearing loss actually are not being helped with either hearing aids or cochlear implants.

Richard: And why is that, in your opinion?

Dr. Jack Wazen: Well there, there are two main reasons for that. One, is denial and people not wanting to be seen wearing hearing devices and so on. And two, is ignorance. People are afraid of implants. They think a cochlear implant is some major brain surgery. We’ve been asked this question again and again, is this brain surgery? How dangerous this is? How risky is it? And it is none of that. It’s a procedure that is done as an outpatient procedure. You don’t even spend a night in the hospital with this.

Richard: I understand that. I spend about 40 hours a week on social media. I work in 24 times zones around the world to help create awareness and to bring people together and to say, “if you have a hearing problem and a cochlear implant has been suggested to you, not to be afraid.”

Dr. Jack Wazen: Right. And we need people like you and many others who are successfully wearing implants to spread the message that this is not major surgery and that it makes a difference. Because, living in deafness leads to isolation, leads to depression, aggravates potential cognitive decline and dementia. There’s a lot of things that happen if you are isolated without hearing and we have the opportunity today to make deaf people hear and yet when you look at statistics, only about five or 10% of people who need implants are getting them.

Richard: I’m going to step into a dangerous territory right here. The question of deaf community versus the hearing community, because you just mentioned the isolation of living in deafness and yet the deaf community is very protective of not getting a cochlear implant. Is that changed at all?

Dr. Jack Wazen: I think that’s changed a lot. A few years ago it used to be a big thing. I don’t hear much of it anymore and I think there’s an understanding that you can communicate with nonverbal ways, you could sign and you could communicate, and you could be a happy, successful citizen without hearing if this is what you choose. Now, most people who stick to that are people who are born deaf or people who are children of parents who are deaf. But if you are a hearing couple and you have a deaf child, you’re doing the best to get that child to hear. There are people who believe in preserving the quote unquote deaf culture, but that’s not for everyone.

Richard: I think that number is shrinking from what I’ve seen. In your opinion, yes or no?

Dr. Jack Wazen: Yes, it is shrinking. Actually, what is also shrinking are the schools for the deaf.

Richard: Yes, I’ve read that and I understand at Gallaudet University more and more classes have people with cochlear implants there as well.

Dr. Jack Wazen: Yes, and it’s all because technology is evolving and cochlear implants today are not what they used to be. The outcomes and the results and the change of life that they provide is very different.

Richard: What kind of success rate do you see when somebody is implanted? I know there are no guarantees in life, but in your experience, what kind of success would you say on a number basis?

Dr. Jack Wazen: I could predict normally that if I put a cochlear implant in a person, their hearing level, their hearing thresholds are going to be far superior to their preoperative implant levels and they’re going to be better than their best hearing aid that they’ve ever used. That is predictable. What is not predictable? In cochlear implant is the speech recognition. How well can you understand speech with or without visual cues? That’s the part that so far, we cannot predict. That depends on how many nerve cells are alive and able to be stimulated by the implant. And we do not have yet a way to measure that before we put in an implant. If you look at the statistics in general, you’re going to see people who do extremely well. We’ve had people, we activate the implant three, four weeks after surgery and on that day they’re hearing and they are smiling from ear to ear.

Dr. Jack Wazen: Like it’s a miracle that happened that day. Now, unfortunately not everyone responds like that. And you have people who need to practice listening with the implant.

Richard: Rehabilitation.

Dr. Jack Wazen: Rehabilitation over a period of one or two or three or six months to reach that level of performance. And there’s a small group of people who just don’t get what we call the open speech, which means understanding me as I’m talking to you. They still need to use visual cues as well as hearing to understand speech.

Richard: Normal people do too.

Dr. Jack Wazen: Normal people do too. Of course.

Richard: One of the other questions people ask me all the time, not only about success, “Will I hear speech again?” But they’re also worried about vestibular issues. “Will I get dizziness from this.” I see this repeated time after time on social media. I understand you’re doing some kind of a study or working on a study of vestibular issues and cochlear implants. What can you tell me about that?

Dr. Jack Wazen: The inner ear has two components. It has the hearing part and it has the balance part and they’re interconnected. It’s often that you see people who have hearing loss, they also have vestibular problems, balance issues, dizziness issues and so on. Yes, operating on an ear can lead into a temporary dizziness postoperatively. We see that often, but that recovers. And the question that we’re trying to ask and answer through our research is how many people who are candidate for a cochlear implant have an underlying concomitant balance issue in that ear. Sometimes people have symptoms, some people do not have symptoms yet. And I want to recognize those people before implantation. I want to see how they respond to the implant and I want to see how does your vestibular system change after implantation?

Dr. Jack Wazen: That’s the subject of our study and we’re collecting all of this data now. We have more than a couple of hundred people that we’re studying now. So it’s a decent number of patients, which allows us to make significant statements. It’s not like a couple of patients here and there and then there’s no statistical significance to that. No, we’re going for good statistical significance.

Richard: How long has that study been going on and when do you expect to have results from that study?

Dr. Jack Wazen: We should have our preliminary data within the next couple of months.

Richard: So it’s close.

Dr. Jack Wazen: It’s close.

Richard: I’m sure everybody listening to this podcast is going to be sitting with bated breath waiting for that one.

Dr. Jack Wazen: I’ll let you know as soon as it’s out for presentation or publication.

Richard: Another topic that people are very interested in are the MRIs. There’s constant battles on social media. “My cochlear implants better your cochlear implant,” when it comes to MRIs. But in my experience over the past six months, more and more hospitals are refusing to give an MRI no matter which brand you have. We’re here at Sarasota Memorial. Can you tell me a little bit about the protocol? What goes on here if somebody needs an MRI at Sarasota Memorial?

Dr. Jack Wazen: Good question. First, the new implants are all MRI safe. If we implant somebody today they’re not going to have any issue in getting an MRI and that’s huge. In the past we used to say, “You cannot get an MRI.” Just like if you had a pacemaker you could not get an MRI. The fact that you could not get an MRI is not unique to cochlear implants. However, the industry has changed and now you can get an MRI with a cochlear implant. The question is what is the hospital protocol. Let’s not just talk about the hospitals, any radiology place where you go because the hospital does only a small portion of MRIs for the public. There are a dozen other MRI centers where you could go and get an MRI. I’ve had this discussion with the head of radiology at Sarasota Memorial.

Dr. Jack Wazen: I said, we’re getting patients saying “We’re not going to do an MRI because you have a cochlear implant.” His response was very understandable. He said, “We have not changed our position that if you have an MRI we’re not going to do an implant. However, it’s up to you to call us and say, ‘this person has a MRI compatible cochlear implant and we are asking you to do the MRI,'” because they do not want to leave it up to the receptionist who knows nothing about what kind of implant do you have. So the safest thing for them to say is “no, with exceptions.” So, that’s how they do it. Once this generation of old implants is over, that’s a different issue. But if somebody calls any radiology office, they would need to research it. How old is your implant? What kind of an implant is it to see whether it’s MRI compatible or not? And if it is, is it with the 1.5 Tesla MRI, is it with the 3.0 Tesla MRI? So they’re going to leave it up to the person and their restorative physician to specifically say what it is, but it’s feasible.

Richard: So now they say “no” and you say, “well we can take it out and send you over without the magnet to have an MRI.” How often does that happen? Have you done those on? I assume

Dr. Jack Wazen: I have and I try to avoid that as much as I can because it’s not pleasant neither for me nor for the patient.

Richard: Okay.

Dr. Jack Wazen: Yes, you can explant the magnet and put it back in, but you know it’s a big deal. You risk infection, wound healing issues and so on. Today all the implants we do are MRI safe and I hope I’ll never have to remove a magnet. If I have a patient with an older implant that needs scanning, I would prefer them to get a CAT Scan with and without contrast it’s safe and I don’t have to expose the implant to potential trauma.

Richard: Excellent. Okay. I appreciate that. I’d also like to know a little bit more about Meniere’s disease because I understand you’ve had patients with Meniere’s disease. Is it preferable to have a BAHA or cochlear implant or depends on the situation. Can you tell me a little bit more about your experience with Meniere’s disease and cochlear implants?

Dr. Jack Wazen: Meniere’s disease is one of the reasons one loses the hearing to a level that would require a cochlear implant. This difference between being a candidate for a BAHA versus a cochlear implant is a big difference. A BAHA, in this particular scenario, is to transfer sound from the deaf ear to the better ear. If I put in a BAHA, I’m not reactivating the deaf ear, I’m transferring sound transcranially, through the skull base, so that the good ear is picking up the sound coming into the deaf ear. And that works. It’s good. It’s covered by Medicare and all insurance. And it’s the simplest way to provide a patient with hearing from the deaf side. Cochlear implants’ advantage is that they reactivate the hearing in the deaf ear. So you are reproducing a two ear hearing situation instead of a one ear hearing. Anytime we can put a cochlear implant in a deaf ear, it is the better option as long as we have a nerve that is connecting. Somebody who has an acoustic neuroma, for instance, who does not have a nerve is not going to benefit from that. For them, the BAHA is still the answer.

Dr. Jack Wazen: Now, here’s the limiting factor is insurance coverage. Because Medicare, for instance right now will not cover a cochlear implant. If you’re only deaf on one side, you have to be deaf in both ears. If you are dependent on Medicare or insurance, you may be stuck in accepting a BAHA for a single sided deafness situation. If the two ears are out, there’s no problem getting a cochlear implant.

Richard: I’ve understood from my conversations that I’ve had that Medicare is starting to change that protocol. You haven’t heard anything on that scale?

Dr. Jack Wazen: We are requesting and asking and pleading and begging Medicare to change the policies on a bilateral cochlear implants, on single-sided deafness cochlear implants. We have not reached that level of freedom yet. Medicare today will not cover a single-sided deafness person for a cochlear implant

Richard: Not you particularly, is there an organization of doctors that are pressuring Medicare for this? Is there a lobbying group of some sort?

Dr. Jack Wazen: Yes, we are all doing that. The Organization of the Cochlear Implant Association, which basically includes all of us surgeons who do cochlear implants, all of the audiologists who program cochlear implants, and the industry of the three main companies. We all belong to that association. They are doing their best to contact Congress, FDA, Medicare, et cetera.

Richard: There was a meeting recently in New Orleans. Was that cochlear implant surgeons or there was some kind of convention recently?

Dr. Jack Wazen: Yes. That was the American Academy of Otolaryngology-head and neck surgery. That’s our biggest annual meeting. It’s not just for cochlear implants. It’s for the whole specialty.

Richard: Okay. My next question for you, particularly, when you decide on a cochlear array, does the candidate choose a company first or do you help the candidate choose which company they’re going to go with? What’s the surgeon’s point of view on that?

Dr. Jack Wazen: We use all three implant companies and we are happy with all three of them. If you come to me and you say, “I want a Cochlear device or an Advanced Bionic device or a Med-El device,” I have no reason to dissuade you or change your mind. In the end you’re going to do well with any of these devices. We leave it up to the patient. When the patient is identified as a cochlear implant candidate, we provide them with all the documentation for all three companies, let them study it. Sometimes they come back with questions, sometimes they know what they want. And I’ve had a couple of patients who would say, “You’re the doctor, you decide this is too much for me.” And then we could help them with a decision based on need and so on. But you cannot go wrong with any one of them.

Richard: Okay, that’s fine. And my question again is, do you ever advise candidates not to proceed? Any situations you would say it’s really not for you?

Dr. Jack Wazen: Yes. I had a patient this morning, she’s 68. She was deaf since she was one. She’s never used a hearing aid or a cochlear implant all her life. And now 68 years later, they’re considering an implant. The potential response and the outcome for somebody who has not been stimulated for so long is really not so good. I would say if I put an implant in that person, maybe they will have sound awareness, but they’re not going to have any speech awareness. And that person is quote unquote deaf mute. But she’s never heard speech, she cannot speak, will never speak. We have always to put things into perspective in a long period of deafness without brain stimulation is not a good setup for a successful cochlear implant.

Richard: But it can happen sometimes. I had no hearing for 35 years and after I was implanted I got 85% speech. So it can happen, but generally…

Dr. Jack Wazen: It can happen. But generally the odds are not for you. But since you mentioned yourself, did you use hearing aid?

Richard: Yes.

Dr. Jack Wazen: Okay. So you are not..

Richard: I didn’t use a hearing aid for those 35 years. My hearing went off a cliff when I was 30 so no hearing for 35 years.

Dr. Jack Wazen: And no hearing aid?

Richard: No. I was obviously outside statistical norm.

Dr. Jack Wazen: You’re lucky.

Richard: That’s why I’m asking you about statistical norms.

Dr. Jack Wazen: Yes. You were on the edge of the statistical norm. You’re not in the middle of the bell curve.

Richard: I’ve been on the edge of everything my whole life. I’ve asked you about the ones who wouldn’t implant. My question is, what’s your greatest success story that you can tell me about?

Dr. Jack Wazen: My greatest success story? It’s not just one story enough because I’ve seen it happen more than once is when we turn on the implant and the person is like, “Oh my God, I can hear.”

Dr. Jack Wazen: That gives me goosebumps every day. I’ll tell you a funny story. We put in an implant on a person and I see him right after they’re activated and then he goes to the bathroom and he walks out of the bathroom and his face is all bright red and I said, “You okay? What’s wrong?” He said, “Did you hear that?” I said, “What?” He said, “I went to the bathroom and it sounds so loud.”

Richard: The first time they hear the toilet flush.

Dr. Jack Wazen: The first time he heard himself pee. He walked out absolutely embarrassed.

Richard: I have two more questions. One about pediatrics. Do you do pediatric cochlear implants yet?

Dr. Jack Wazen: Yes.

Richard: And they’re successful?

Dr. Jack Wazen: Yes, very successful. The age of implantation has been brought down to now one year or even younger. And a child who was born with deafness who is three or five years old, believe it or not, is labeled as too old. Children can be implanted at a young age and when the children are implanted at a young age, they grow up in a normal hearing world. They go to normal schools and they are main streamed. They are not in deaf schools or in special classes. And that’s a remarkable feat.

Richard: And my last question to you is, what would you like to see for the future of cochlear implants?

Dr. Jack Wazen: Education, education, education of the public and of the physicians. There are as many physicians who are ignorant about implants as there are people who are ignorant about implants. And I think that’s a disadvantage to the general public.

Dr. Jack Wazen: I think we try our best to keep educating. We’ve given talks, we give lectures, articles, things like that. I think better recognition and better acceptance. The ability to put in two implants, I think, would be a good thing. We’re born with two ears and for a reason because the brain gets better input from both sides and from both ears. Now, most of the people who get implants get on one side. Fortunately, the other side may have some response to hearing aids. If they don’t, then a lot of insurance companies or Medicare would not pay for a second implant on the other side. I would like to see that changed. I would like to see the technology changed so that when we put in an implant, we could always predictably preserve hearing in the implanted ear. Right now it’s not always a predictable thing that we put in an implant that we’re going to preserve the natural hearing. We know that the implant will work. The question is can we do an implant and a hearing aid in that same ear?

Richard: The hybrid.

Dr. Jack Wazen: The hybrid style, so that we could stimulate the high frequencies with the implant and the low frequencies with the hearing aid. That’s what gives the ear the widest range of stimulation.

Richard: Excellent. I thank you so much for your time.

Dr. Jack Wazen: You’re welcome.

Richard: Pleasure. Thank you.