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You are here: Home / Advanced Bionics / Selecting a Cochlear Implant
Surgeon
Advanced Bionics, Auditory Neuropathy Spectrum Disorder, Cochlear,
Cochlear Implant, Jace Wolfe PhD, John Niparko, Kickbacks, Kickbacks,
Med-El, Neurotology, Uncategorized 11 Jun 2015
85 Comments
Hiring a cochlear implant surgeon for yourself or your child is just as
important as selecting the right implant manufacturer, as the quality of the
outcome is at stake. Unlike fitting hearing aids where the Best Practices are
well documented and easily available to the consumer, the same cannot be said
for CI surgery, as these practices are mostly scattered throughout hundreds
of journal articles behind paywalls.
CI_Electrode_insertion
Video fluoroscopy courtesy of Med-El ^10
Click to view full YouTube video
We at The Hearing Blog are addressing this issue, with our information
having been vetted by several industry insiders for accuracy, with this
article taking over six months to research, edit, and vet. However,
when you cut to the proverbial chase, it comes down to the “touch” in
the surgeon’s fingertips as s/he threads the inch-long flexible
electrode resembling a wet noodle into the pea-sized hearing organ
without making hash of the delicate structures inside, let alone
folding over or kinking the electrode array. Almost everything else,
uch as bedside manner, number of papers published, or standing in the
community, is no more than mere window dressing.
Update (6/23/2015): The 9^th & 10^th paragraphs on operating room electrical
testing and radiographic imaging were edited to clarify terminology. Also,
please see Brief Addenda to Selecting a Cochlear Implant Surgeon for
additional discussion.
With CI’s, there is no 30 Day Return privilege, so choosing wisely at
every step of the process is vitally important for the best outcome.
Unfortunately, especially here in the United States, there are factors
that conspire against making an informed choice, not the least of which
is the CI manufacturers quietly keeping reams of information on each of
the approximately 700 or so US CI surgeons’ outcomes. The problem is
that the manufacturer’s patient reps and support personnel maintain
omerta, lest they offend the delicate feelings of the audiologists or
bruise the fragile egos of the surgeons, both of whom guide the brand
election.  Unfortunately, the CI manufacturers’ patient reps — as nice
as they are to get you to select their brand — will give you zero
guidance on selecting a surgeon, let alone a CI program, as you are
.NOT. the customer: The CI center is their customer, and the
manufacturers will do nothing to offend their customers.^A  This even
extends to when there is a problem during MAPping: The patient reps &
tech support audiologists are not allowed to touch the MAPping
computer, lest s/he offends the audiologist’s delicate ego, instead
looking over her shoulder “suggesting” changes.
There is some effort to gather “tribal knowledge” amongst the various
facilities by the Association for the Advancement of Medical
Instrumentation (AAMI) into a sort of “standards” or “best practices”
document.^1 However, it’s still in draft form, it’s complex; and one of
the experts who reviewed this document just made us aware of this as
the draft was published only days ago.
Here are pertinent questions for which you need to get answers from the
urgeons and audiologists, preferably in writing on the consent forms,
and other things to watch out for:
First, just exactly who is threading the electrode into your or your
loved ones’ cochleas, anyway? While it’s vitally important to train the
next generation of CI surgeons, in fact at many programs in teaching
hospitals it’s the resident, not the surgeon you believed you hired
performing this delicate task. It’s one thing to have a resident
performing the “grunt work” of grinding out the pocket for the implant
package and cutting the mastoid opening without nicking any nerves;
however drilling the cochleostomy and threading the electrode is what
eparates the top surgeons from the rest, especially when residual
hearing preservation is required for hybrid (EAS) procedures (and more
on this later). Our attitude on this is “go train your residents on
omeone elses’ ears.” Make sure you get this in writing on the consent
form, as often in the fine print you really provide consent for the
resident to perform the surgery’s actual delicate tasks, with the
urgeon you think you hired “supervising;”
A cochlea with a MED-EL electrode array partially inserted. Photo
courtesy of Adrien Eshraghi MD, University of Miami Miller School of
Medicine, Miami FL
A cochlea with a MED-EL electrode array partially inserted with lateral
placement in the scala tympani. Note how the outside edge of the
laterally placed electrode scrapes the outside surface of the duct,
which can cause trauma.
Photo courtesy of Adrien Eshraghi MD, University of Miami Miller School
of Medicine, Miami FL ^10
Second, as we alluded to above, you want to assure your surgeon will be
using hearing preservation techniques to get the best performance, even
if there is no residual hearing remaining, in order to keep the
electrode in the scala tympani (bottom of the three chambers) to get
the best outcome ^2, 3 and to minimize the chance of triggering or
exacerbating tinnitus. ^12 [Worth noting is that on May 28^th Advanced
Bionics received the CE marque by TÜV for their Naída CI Q90 EAS
combination hearing aid/CI speech processor, which unlike the Med-El
and Cochlear systems uses a full length electrode insertion. We’ll have
much more on this in an upcoming article, as we already know one person
participating in the FDA clinical trials.]
October 5th 2015 Update: Two new articles on residual hearing
preservation have just been published: The Impact of Perioperative Oral
Steroid Use on Low-frequency Hearing Preservation After Cochlear
Implantation ^11 by David Haynes MD & his crew at Vanderbilt; and
Effects of CI Electrode Insertion on Tinnitus ^12 by Thomas J Balkany
MD in The Institute for Cochlear Implant Training blog. Although
Balkany talks about how tinnitus can be generated when the basilar
membrane is pierced, in fact “when CI electrodes ruptured intrascalar
partitions and traversed between the scala, tinnitus had a 16% chance
of being generated or becoming worse; while when electrodes did not
traverse scala, tinnitus was not made worse. We’re going to have a
brief article breaking out these two articles;
Third, how many implant surgeries per year of each brand does this
urgeon perform? cochlear_duct_cross-section_thumb You want a surgeon
who performs at least 50 implants per year, and at least 25 implants of
your particular brand choice in the last year: Experience pays;
Fourth, will the surgeon be advancing the electrode array off the
tylet the proper way with the tip just inside the cochleostomy or
round window opening, or will he be inserting the stylet down to near
the basal bend 5-6mm in? [This paragraph was edited for clarity on June
12th, 2015.] If the stylet is inserted down into the cochlea to near
the basal turn to avoid array kinking, it can act like a “spear”
piercing the basilar membrane and protrude into the scala tympani (the
topmost of the three chambers in the cochlear duct), instantly
destroying residual hearing and, more importantly, causing a poorer
quality stimulation, with resultant lower word recognition scores.^2, 3
Although this is not an issue with AB’s Mid-Scala and Helix arrays as
their stylet can be reloaded in the operating room in the event the
urgeon accidentally kinks the electrode, this is not the case with the
Nucleus Contour array; and what’s more, if the Contour electrode array
becomes kinked on insertion because the surgeon does not have adequate
“touch” in his fingertips to feel the interference, Cochlear Americas
will not honor the warranty. This goes to explaining why, in one
informal survey of CI surgeons, 85% use the potentially more traumatic
method of inserting the stylet too deep when placing the 22 contact
Contour electrode array. [6/12/2015] To clarify, it’s the combination
of the inability of the Contour array to be reloaded onto the stylet
.AND. Cochlear Americas’ not honoring their warranty if the surgeon
kinks the electrode which conspire to cause 85% of surgeons to
improperly insert the stylet too deep risking trauma.
Here is an example of an improperly placed Advanced Bionics HiFocus 1j
electrode that was folded between the 3rd & 4th electrodes during
placement. Because neither the implant was booted up and impedance
checked during surgery, nor was there post-surgery radiography
performed to detect the problem in a timely fashion, fibrous tissue
tarted to grow by the time this x-ray image was taken a month post-op
during switch-on, making revision surgery impossible. This patient was
referred to a medical malpractice attorney.
Click to enlarge in a new window
Fifth, it’s mandatory that the implant be booted up in the OR by the
audiologist with a cleaning cycle and an impedance check performed:
This takes about 10 minutes but is necessary to detect electrical
problems. Also, the inter-electrode impedance test (also known as
Electric Field Imaging (EFI)  test; if the audiologist performs it and
knows how to interpret the result matrix) will usually detect folded
electrodes. For the example in the picture on the right, the impedance
between electrodes 1 & 8, and 2 & 7 will be abnormally low, revealing
the folded-over electrode. The problem is that OR time is booked in 15
minute increments with anesthesiologist fees the cost driver, with
prices ranging as much as $1,000 per 15 minute block: The cost
containment pressure is to skip this step; and when skipping boot-up is
combined with delayed or even no post-op radiography, disaster can
result. [Paragraph edited 6/23/2015.]
Sixth, it’s vitally important for radiologic imaging to be performed
preferably in the OR before closing up. The reason for this is
two-fold: First, you will not need to go through a needless second
“revision” surgery if the surgeon makes an error; and second, that
fibrous tissue starts growing around the electrode almost immediately,
making revision surgery for a folded or kinked electrode more
difficult, if not impossible after a few days — And this applies to a
decade or two when the CI needs replacing, as well. At university
hospitals there is tremendous pressure from the Ivory Tower to cut
costs, and often this step is either postponed until the switch-on, or
even skipped altogether, with the surgeon & audiologist crossing their
fingers that all will turn out OK. The gold standard is to wheel a
mall CT scanner for the head into the OR, which is about the size of a
breadbox, to verify the precise electrode placement; however an x-ray
plate will suffice to spot gross problems such as a folded-over
electrode. What’s more, by not using radiographic imaging the patient
with the improperly placed electrode would need to be reimplanted,
which involves additional trauma to the skin flap, an increased risk of
infection, and also needless additional pain and lost time due to the
econd surgical procedure which could have been avoided. We are aware
of a medical malpractice case at a major Michigan program where both
the boot-up and imaging steps were skipped and the electrode was folded
over between the 3rd & 4th contacts. This was not discovered until
witch-on when there were major problems; but because this was four
weeks after the surgery, fibrous tissue had already started to grow,
making revision surgery impossible. [Paragraph revised 6/30/2015.]
Seventh, and this one should almost go without saying, but given
cost-cutting measures you never know, so it’s better to specify that
facial nerve monitoring be used. This is just about de rigeur but it’s
better to be safe than sorry, so make sure you get this in writing;
Eighth, how will the implant electronics package be fastened down to
the skull? It takes the surgeon time to carefully cut the pocket in the
kull without going too deep and nicking the dura mater, and to drill
the holes for the tie-downs. In the aforementioned Michigan MedMal case
the surgeon used a “slip and go” method to reduce the OR time even
further, which allows for movement of the implant package, and more
harmfully puts unnecessary stress and strain on the delicate electrode
array wires where they emerge from the package, which can result in
premature device failure. As we understand it, a prominent Atlanta CI
urgeon with over 1,000 procedures is also now using “slip and go,”
needlessly compromising the device reliability;
Ninth, and often overlooked, is post-surgical infection control.
Because of very limited blood circulation in the scalp, it’s easy for a
“biofilm” infection to set in, which can spread into the cochlea
causing ossification; and if the infection jumps the dura mater
barrier, can cause life-threatening bacterial meningitis: Be sure to
discuss post-surgical infection control with your surgeon and carefully
follow his or her instructions;
Tenth, what is guiding the CI brand recommendation by the audiologist
and surgeon? The best ones are comfortable implanting and MAPping all
three major brands, so sometimes financial “considerations” are in
play, such as exclusivity deals for better device pricing; or outright
kickbacks, through Cochlear Americas’ unethical and unlawful Partners’
Program;^4 and as we just discovered a few days ago but not publicized
in the industry press, just two months ago by Med-El by providing them
[the surgeons] free meals, overseas travel opportunities and honoraria
requiring little to no actual work by the physicians.^5, 6 What’s more,
although for an American corporation it is highly illegal under the
Foreign Corrupt Practices Act^7 (FCPA) to pay any kind of bribe or
kickback to any party anywhere in the world (under penalty of the CEO
going to prison), this is not the case elsewhere, as in both the
European Union and Australia these overseas bribes are considered a
legitimate business expense that can be deducted from corporate taxes
(though it is unlawful for EU corporations to pay bribes to entities
inside the EU itself);
Finally, as you look at the list of surgeons we like, you’ll notice
that there is only one pediatric program listed: If you have a deaf
infant or child, you’ll quickly find out that the audiology & CI
programs at many (but not all) “Children’s Hospital of [insert city
name]” or “[insert big donor name] Children’s Hospital” are generally
rather lousy (especially at diagnosing & managing ANSD), despite the
“halo effect” from their name and “standing in the community;” so
you’ll do much better by going to a CI center that also implants
adults. As best we can tell, based on numerous off-the-record
conversations, the problem with pediatric hospital audiology
departments centers on very poor Medicaid reimbursement due to the
indigent patient load;^D and since adult hearing aid sales are a profit
center, the audiologists at pediatric hospitals are generally at the
bottom of the pay scale… And they get what they pay for.
CI surgeons & programs we like&c.
Just because the CI surgeon is not listed here doesn’t mean he or she
is not good: This is merely a brief list of surgeons who have proven
track records of good outcomes, in no particular order:
across the street at Hearts for Hearing to MAP your CI, you’ll be
in superb shape);
also really ♥Love♥ her Thirty Million Words project she developed);
though sadly he stopped performing CI surgery two years ago to
concentrate on “administrative tasks.” We just found out he’s
implanting again, confirmed by their PR rep, with 15 implant
procedures in the last two weeks alone. Needless to say, we are
quite pleased at this development; and we know he will give the
excellent surgeons across town at House a run for their money.
On The Other Hand, certain cities such as Philadelphia, Atlanta, and
(especially) Las Vegas have no decent CI programs; and candidates or
parents of candidates would be wise to contact one of the facilities
above. In fact, in Atlanta the pediatric CI centers and their
associated audiology programs are so dodgy (especially with diagnosing
and managing ANSD), your humble editor has literally established a
“conveyor belt” to Vanderbilt’s world-class program just four hours
away.
Choosing a CI brand:
On choosing a CI brand, The Hearing Blog recommends you focus on the
implant electronics package itself, as that is what will be wired into
your head for the next 20 or so years; and except for the Advanced
Bionics HiRes 90k which is software upgradeable, is what you’ll be
tuck with. (For more on this, see Prof. Mike Marzalek P.E.‘s tutorial
here.) In addition, as we previously documented, Cochlear (and now
Nurotron) have too many electrode contacts (for marketing
purposes?) forcing them too close together, causing undesired channel
crossover and poor performance, especially with music.^9 Yes, some
manufacturers’ have “sexy” externals; but the processors are replaced
every 3-5 years; and also once one manufacturer has an “innovation” in
their externals the others soon follow along, as with over 400,000
users worldwide and one million predicted by 2020, it’s a Big,
Competitive Market out there.
We also recommend you go on a “CI Shopping Trip” to the Hearing Loss
Association of America (HLAA) &/or Association of Late-Deafened Adults
(ALDA) conventions and hang out in the noisy Expo hall (Expo hall-only
passes are free at the HLAA convention). The CI manufacturers will all
have their lavish parties and dog-and-pony shows with their “rock star”
users flown in from all over; however what you should do is talk to the
hundreds of actual CI users there, but when you do, shift to
“anthropologist mode” to observe how well they are actually
understanding what you are saying, preferably without them
peechreading (lipreading). Good speech perception in the quiet of a
ound booth is one thing, but you don’t live in a sound booth, either;
and since the manufacturers will all fly in their “rock star
performers” to man their booths, you’ll need to seek out others to get
a better perspective of performance. Yes, they will all lay in front of
you their “research studies” they paid good money for, each claiming
how well their devices work — But of course, they’ll not show you the
ones showing their wares don’t work well. However, most of these
“studies” they will show you cannot withstand engineering level
crutiny — Especially for speech-in-noise claims — and they will not
release the underlying raw test data;^E so at the end of the day you
need to trust what you hear and see with actual, random CI recipients
in the busy expo halls; and then choose your brand accordingly, as
you’ll be “married” to that CI company for the next 20 or so years.
References:
1. Public review draft of AAMI/CDV-2 CI86, Cochlear implant systems –
Safety, performance and reliability: Association for the
Advancement of Medical Instrumentation, May 21^st, 2015
2. Cochlear Implant Programming: A Global Survey on the State of the
Art (31 authors). The Scientific World Journal Volume 2014 (2014),
Article ID 501738, 12 pages
3. Role of electrode placement as a contributor to variability in
cochlear implant outcomes (Charles C. Finley and Margaret W.
Skinner). Otol Neurotol. 2008 Oct; 29(7): 920–928.
4. United States Settles False Claims Act Allegations with Cochlear
Americas for $880,000: US Department of Justice, June 9th, 2010
5. Medical Device Maker Agrees to Pay $495,000 to Settle Allegations
it Improperly Rewarded Military Physicians for Choosing Company
Devices: US Department of Justice, US Attorney’s Office, Western
District of Washington, February 13th, 2015
6. Med-El Pays $495,000 to Settle Allegations it Paid Kickbacks to
Military CI Surgeons: The Hearing Blog, April 24th, 2015
7. Foreign Corrupt Practices Act of 1977, as amended, 15 U.S.C. §§
78dd-1, et seq: Overview.
8. Wolfe, Jace, and Schafer, Erin C. 2014. Programming Cochlear
Implants 2^nd Edition. San Diego: Plural Publishing. ISBN-13:
978-1-59756-552-3 ISBN-10: 1597565520
9. First Person Report: Cochlear Implant Channel Crossover. The
Hearing Blog, June 1, 2011;
10. A Photographic Tour of the Cochlea. By Melissa Waller, The Med-El
Blog, October 31, 2013.
11. Impact of Perioperative Oral Steroid Use on Low-frequency Hearing
Preservation After Cochlear Implantation. Sweeney, Alex D.;
Carlson, Matthew L.; Zuniga, M. Geraldine; Bennett, Marc L.; Wanna,
George B.; Haynes, David S.; Rivas, Alejandro. Otology &
Neurotology: October 2015 – Volume 36 – Issue 9 – p 1480–1485
12. Effects of CI Electrode Insertion on Tinnitus, by Thomas J Balkany
MD. Institute for Cochlear Implant Training, October 1, 2015
Bootnotes:
A. We give props to Envoy Medical, maker of the troubled Esteem
implanted hearing aid, for tossing out one surgeon from their program,
as this individual, who is also well known in his region as a butcher
CI surgeon, was taking as long as nine hours to implant the hearing
aid. What’s more, this particular surgeon took almost six hours on a
friend’s routine CI surgery (normal time for a good surgeon is 70-90
minutes), yet still bungled it, rendering her ear completely destroyed
and unimplantable in the process;
B. These gentlemen are also trained electrical engineers, which gives
them a leg up over their peers when working with CI’s, as they have
been trained to have an intuitive grasp of the underlying very complex
ignal processing involved with these magical devices;
C. These gentlemen also implant Auditory Brainstem Implants (ABI),
which truly is “brain surgery;”
D. At the March Auditory Neuropathy Spectrum Disorder Conference 2012
held at All Children’s in St Pete, the CI program coordinator told the
attendees that 100% of their CI patients in the last year were
Medicaid;
E. We had this same problem as well with Siemens not releasing the
underlying raw data for their dodgy Binax speech-in-noise claims.
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About the author
Dan Schwartz
Electrical Engineer, via Georgia Tech
1.
Mary Pat bibel
June 11, 2015 at 7:55 pm
I was implanted three days ago. I wish I had this to guide my
questions prior to surgery. Now I just hope for best. Reading this
article scared me.
Reply
______________________________________________________________
June 12, 2015 at 8:55 am
Mary Pat: Since you are a nurse you should request a copy of
your surgery report, as here in the United States it is you
who owns your medical records. Also, you can print out this
article to discuss the points discussed in this article with
your surgeon, specifically on the measured impedance values
after cleaning when the implant was booted up, and the
post-surgical imaging to verify electrode placement.
Also, now that your bandages are off, you should request a
residual hearing test: You received an AB implant which uses a
reloadable stylet, so there is no reason your surgeon should
have improperly inserted the stylet down to the basal turn,
risking spearing of the basilar membrane.
_________________________________________________________
Mary Pat Bibel
June 15, 2015 at 7:22 pm
I will be reviewing my records. I do have concerns with what
you have shared or how it was shared. Indicating that you have
access to access to industry related data/persons who vetted
your post without sharing sources is rather disturbing and
uggestive of covert conspiracy like arena.
I don’t know how anyone can have knowledge of an each cochlear
implant surgeon’s skill at threading a electrical array into a
cochlea. I wish you would share that with us. You indicate
that publications, standing in community etc. are not of merit
to determine this. Please do share what is?
Please do share if you evaluated each and every surgeon by
this criteria.
Is it possible that you might have missed one of value? Could
that one been mine?
I am disturbed by lists of “the best” when it comes to health
care. There doesn’t have to be any “the best” just a great
great number of really competent.
I would have appreciated an article articulating the value of
hearing preservation and in what circumstances it is indicated
and how, engineering wise, it is accomplished.
June 16, 2015 at 4:50 am
Mary Pat: Unlike with hearing aids, CI manufacturers pay very
close attention to outcomes, including residual hearing
preservation, which is directly tied to how the skilled the
urgeon is, and the “touch” in his or her fingertips, feeling
for obstructions. Now, how does publishing an academic paper
relate to the physical skills and judgment in the OR?
As for our list of CI surgeons & programs we like&c., it
involves more than just skills: It also involves their
programs following Best Practices. Just like there are Best
Practices for hearing aid dispensing including using Real Ear
Measurement (REM), there are Best Practices for CI surgery,
including imaging in the OR to verify electrode placement.
These cost time — and hence money — and in today’s ruthless
ObamaCare-driven cost-cutting environment, these Best
Practices are often skipped, especially imaging to verify
electrode placement in the OR
What’s more, on occasion their scientists & engineers as well
as tech reps scrub in and watch surgery, especially during FDA
clinical trials, as knowledge exchange is a two-way street.
Also, a manufacturer rep is present in the OR when there is an
explant due to device failure to witness the procedure, due to
chain-of-custody verification.
In any case, we cannot reveal who our sources are.
A Not-Evil Reader
June 28, 2015 at 8:20 am
Geez, Dan it’s not like he’s Deep Throat or something. I’ll
bet he wouldn’t really mind if you told Mary Pat his name.
2.
Courtney
June 13, 2015 at 8:40 pm
Please don’t be scared. My daughter was implanted 12 years ago and
has had no issues. It’s been a tremendous miracle :) I wouldn’t
have changed a thing!!!
3.
Pamela Tonello
June 12, 2015 at 11:34 am
I find your opinion, which is what it is, on pediatric hospital
implant centers as totally off base. My son was implanted at 4 and
we had the best surgeon (who isn’t even on your list – Thomas
Balkany) and received beyond excellent mapping services at UM
Children’s, all Children’s St. Pete and Nemours before moving to
New England. The audiologists at the Children’s hospitals were well
trained and versed in working with children and their language
levels and working very closely with the parents/care givers.
June 12, 2015 at 2:27 pm
@Pamela: Dr Thomas Balkany would probably have made our list,
except for one minor detail you overlooked:
He’s Retired!
[laughingcat.gif~c200]
Anita Michaels
June 12, 2015 at 6:32 pm
How unprofessional!(Actually are you a professional? Or just
one of those Internet trolls that lives to create trouble?) I
was not aware that Dr. Balkany had retired,either. So does
that get me a laughing kitten response too? Clearly I am
hocked that I was not personally informed of his retirement.
He implanted my daughter over 19 years ago. I should have been
the first on the list for his retirement party.
Sarcasm aside, my daughter was a Medicaid patient. What did
he miss out on? The fancy hospital room and the better dinner
were all that were missed. She had her surgery at a world
renowned hospital and was cared for by a team of professionals
who were second to none. Audiologists,doctors,nurses, and
upport staff who all treated her as though she was their own.
People who still love her and support her to this day. (Ok,
Dr. Balkany does not call but her entire crew of audiologists
hare her with me and are considered family.)
Not once has any of them ever mentioned Medicaid. In fact, we
have been privately insured by an excellent company for more
than 10 years now and I have never noticed any difference in
care. True medical PROFESSIONALS care about people, not
wallets. Yes, they have bills to pay and draw a salary, but
you cannot compensate someone for their devotion to their
patients.
Children’s Hospitals in particular draw a special type of
caregiver. Pediatric patients are the most vulnerable and are
completely unable to make decisions for themselves. Their
parents are frightened and lost. Staff at Children’s Hospitals
embrace the entire family. They find ways to get things done.
They offer solutions, compassion, and even love.
Facilities that serve adults and children tend to be colder
and less personal. ( Please note, I am not impugning their
kills, just am painting a portrait of a much different
dynamic). I dearly miss having my daughter cared for by
pediatric specialists.
Do not scare prospective patients away from Children’s
Hospitals.You are creating additional stress and are obviously
ignorant to the many additional perks to being surrounded by
professionals dedicated to the care and nurturing of children
AND their families. The quality of care received by these
practioners is priceless; unable to be compensated by ANY
means of Healthcare insurance or private pay.
June 13, 2015 at 11:54 am
Anita, Pamela, (or whoever you are), your temper tantrum
demanding I include your favorite surgeon without even first
checking is what was so hilarious!
[temper_tantrum-e1434210688911.jpg]
4.
Genny A
June 12, 2015 at 11:53 am
As a CI recipient at a children’s hospital, I’m curious to
understand how does Medicaid = substandard service as you had
implied in your reference to a statement collected in your boot
notes. On the contrary, the only two other adults I know that are
CI recipients at my job have gotten the procedure done at adult
hospitals, and both have had issues. One actually had it done from
a doctor at the University of Miami (you recommended that hospital)
who completely botched the operation and intensified her dizzy
pells to the point where she couldn’t do her job, and the CI never
functioned correctly altogether. Prior to that, my family at the
time had actually considered going there, but opted to go with a
children’s hospital instead since they felt it was the best
decision for us. Since I was in my older teens when I got the CI,
I’m confident in saying that the service I received from the entire
CI staff was beyond exceptional and has propelled me in my career
further than I’d ever imagined. My parents agree as well.
I took a look at your background, and as someone that is an
audiologist and not a CI expert, I think you’d do better to refrain
from equating facts such as insurance used to service. You are
potentially hindering families with children from going the CI
route when they see you stating that children’s hospitals are a bad
option and cannot afford to go to a profit center.
While I feel that this article was intended to help deaf and
hard-of-hearing folks in making a decision about cochlear implants,
I am a bit disappointed when I saw that you made worldly
assumptions about children’s hospitals from “numerous
off-the-record conversations” with only a single statement
regarding Medicaid as a reference to back up your opinion that you
tate as fact. Really? Is this middle school? Please, add more
ources, with contact information so your readers can be
well-informed and not mislead.
For readers. How does:
Dan: “As best we can tell, based on numerous off-the-record
indigent patient load”
equal:
Bootnote: “At the March Auditory Neuropathy Spectrum Disorder
Conference 2012 held at All Children’s in St Pete, the CI program
coordinator told the attendees that 100% of their CI patients in
the last year were Medicaid”
Give me a break! I highly recommend looking at other places for
better information on CI.
June 12, 2015 at 12:53 pm
It’s ironic how University of Miami figures prominently in the
anecdotal reports of Genevieve’s friend’s bad experience and
Pamela’s son’s good experience. However, if you actually read
the article, you will clearly see two salient points:
1) We didn’t pull the surgeon list out of thin air: This list
of top surgeons was compiled with the significant help of
experts inside the CI manufacturers who quietly keep tabs on
each surgeons’ results. If your favorite surgeon was not on
the list, there may be a very good reason why his or her name
is missing;
2) The subhead reads CI surgeons & programs we like&c. Just
because you went to a given program doesn’t mean you used a
urgeon on the list… Or even that the surgeon & not a resident
drilled the cochleostomy and placed the electrode.
@Genevieve: Your friend who had problems — most likely related
to electrode insertion trauma — should request a copy of the
urgery report to find out exactly who did what during the
procedure. Here in the United States, by Federal law, the
patient owns their medical records.
Also, you are conflating full-service hospitals with
for-profit facilities when you write
children’s hospitals are a bad option and cannot afford to go to a
profit center.
What you don’t know is that I also created and moderate the
largest Auditory Neuropathy Spectrum Disorder (ANSD) group in
the world with almost 1000 members, including CI and ABI
urgeons, audiologists, and (mostly) parents of ANSD kiddies,
along with a sprinkling of adult-onset ANSD patients; and not
only do I get to see the complaints from parents, I also get
to read the 20+ page audiologic workup reports people send to
me for evaluation; and quite frankly, many of the ones from
“Children’s Hospitals” stink, with improper test protocols
used, missed diagnoses bordering on medical malpractice; and
also poor management once the ANSD diagnosis is made. What’s
more, it’s almost always the same “Children’s Hospitals” that
are repeatedly appearing in the group. Fortunately for parents
in Atlanta and here in Philadelphia, world class surgeons and
programs are just four and two hours’ drive away.
Finally, it’s rather obvious you are not familiar with abysmal
Medicaid reimbursements, which are just pennies on the dollar
of Medicare and insurance company reimbursements: This is why
many doctors in general do not accept money-losing Medicaid
patients to begin with; and the problem was exacerbated by
ObamaCare’s perverse incentives for small employers to simply
discontinue employee insurance & push employees onto the
exchanges & into Medicaid, and on the push to get States to
expand Medicaid rolls.
The upshot of all this is that many audiologists at the
various “Children’s Hospitals” are at the bottom of the
audiologist pay scale, with higher salaries to be had by just
hanging hearing aids at Costco.
Jeffrey Simmons
June 12, 2015 at 6:17 pm
I’m sure it took a lot of expertise to create a group on
Facebook and then send out lots of invitations to people to
join it, but I can’t for the life of me see how that possibly
makes you an authority on anything. Where are your
peer-reviewed publications? Where are your presentations at
professional conferences? Where are your professional medical
or audiological credentials?
June 13, 2015 at 12:28 pm
Actually, the now-950+ member Auditory Neuropathy Spectrum
Disorder group was created by your humble Editor on Friday,
March 16th, 2012 at the big ANSD 2012 Conference, moderated by
Chuck Berlin & Linda Hood. In fact, Dr Berlin suggested I
create the group; and when he announced it at the Conference
to the 100+ professionals in attendance, about half signed up
right there. Although it was created for professional
discussions, in fact all are welcome.
What’s more, my interest in ANSD was an outgrowth of the older
Reverse Slope Hearing Loss group, where after learning about
ANSD for the first time in a Chuck Berlin workshop in March
2010, I went back over the many audiograms posted and
uncovered a veritable rats’ nest of undiagnosed congenital and
adult-onset ANSD, with the upshot that a number of members
went back, received a proper diagnosis, and about 15 adults
(so far) having received their CI’s.
5.
Kashmir Roy
June 12, 2015 at 12:27 pm
When it comes to make a informed decisions regarding choosing
cochlear implants and surgeons. I cannot ask for a better staff and
teams at all children’s! Dr. Peter Orebello is the best surgeon,
whom you didnt list, I have ever known. I felt very informed about
the complete process. I never felt I was cheated out of recieving
the best care I can get. I as a patient felt confident and had
complete trust in my team of specialists. If the patient is not
feeling comfortable,they should consider other options or seek
different specialist.
June 12, 2015 at 2:38 pm
Top surgeons don’t make bone-headed mistakes:
‘Wrong-site’ surgical mistakes are rare, preventable
By: Letitia Stein, Times Staff Writer, June 20, 2010:
A surgical procedure to relieve pressure was performed on the wrong
ear of a 10-year-old boy at All Children’s Hospital in St.
Petersburg in 2007…
:
…These medical mistakes belong to a rare and completely preventable
category of errors known as wrong-site surgeries. Experts and
doctors agree they should never happen, but struggle with the
realities of human error.
Timeouts before the first cut, body parts marked with permanent ink,
urgical checklists — step after step has been put in place in
recent years to better safeguard patients. And yet, wrong-site
errors still happen.
In the 10-month period ending in April, the Florida Board of
Medicine disciplined 34 doctors for wrong-site surgeries, roughly on
par with the 41 actions taken in the previous year. Just this month
[June 2010 Ed.], it fined the physician who made the wrong ear
incision at All Children’s…
Further down in the June 2010 article Stein lays out the
details:
Before the first incision, surgeons in Florida are required to take
a timeout. They must confirm they have the right patient, the right
procedure, the right surgical site. The pause rule, as it’s known,
was adopted by the Board of Medicine in 2004 and reflects nationally
followed safety standards.
But it wasn’t enough to prevent the error involving the 10-year-old
boy at All Children’s Hospital.
The boy’s right ear was correctly marked for a procedure to relieve
fluid buildup, state records indicate. However, Dr. Peter Orobello,
a pediatric ear, nose and throat specialist, cut the left ear,
inserting a small tube before realizing his mistake.
Orobello corrected his error immediately, records show, and informed
the patient’s family.
“In the 22 years of the otolaryngology program at All Children’s
Hospital we have had one case in 2007,” Orobello said in an e-mail
ent through his lawyer. “With the excellent systems in place, this
was identified in surgery, corrected, no harm came to the patient
and no claim was filed.”
He did not say how the error happened. As discipline, he agreed to
pay a $7,500 fine.
All Children’s Hospital officials say they have for many years
followed national patient safety standards, including a timeout
established by the Joint Commission, the hospital accrediting group.
They use a safety checklist tied to the electronic medical record in
the operating room.
6.
Mindi Thibodeau
June 12, 2015 at 1:07 pm
My son is a patient at All Children’s in St. Pete also he is a
Medicaid recipient. He was implanted at 15 months of age. He
receives the best care we could have ever imagined. Our audiologist
and our surgeon are amazing!!!! The fact that their pay my not be
that of other facilities just means they are that much more
dedicated to helping our children from the goodness of their
hearts. I believe it takes a very special person to sacrifice what
they deserve, to work in a field that they truly believe in. Never
for a moment did we feel pressured. They gave us every bit of
information before we decided. Our sons surgery went flawless and
his aftercare had been the same. Our audiologist takes time to
understand and get to know our children. They take the time to
console us and care about us! They are extremely experienced and
knowledgable. You can not group them all together that is wrong!!
Until you have spoke to all of the parents and the recipients at
these facilities ( the opinions that really matter) you don’t have
a right to scare future CI recipients away from a life changing
opportunity. I would not bring my son anywhere else other then All
Children’s. That is where he receives the very best care!!!!
June 12, 2015 at 1:49 pm
Actually, All Kids in St. Pete was an unexpected beneficiary
of Hurricane Katrina: When the Kresge Hearing Research Center
in New Orleans blew apart in 2005, the team that discovered
Auditory Neuropathy Spectrum Disorder scattered to the four
winds, with Linda Hood landing at Vanderbilt, Thierry Morlet
landing at Nemours in Wilmington Delaware, and Ben Russell &
team leader Chuck Berlin landing at USF… And one of the
achievements of (the now semi-retired) Prof. Berlin was to
whip the ANSD portion of All Kids’ audiology program into
hape.
That Being Said, Dr Loren Bartels‘ CI program across the bay
at Tampa General is better; and in fact he just about made our
cut for surgeons we like.
7.
Kris Robinson
June 12, 2015 at 1:27 pm
Dan,
I absolutely do not agree with you regarding the audiology team at
our local Chidren’s hospital in St Petersburg, we have an amazing
group of audiologist. I have two daughters that receive their
mapping their, and I chose to do that. I am privately insured, so I
am pretty sure the comment you made regarding 100% Medicaid was
incorrect. That being said I adore Shelly and Sybil and the rest of
the audiology team and I chose them because they can spend the time
and they do to ensure the mapping is just where it needs to be. My
urgeon Dr Bartels did not seem to make your list either and he was
exceptional.
June 12, 2015 at 2:15 pm
@Kris: In fact, our comments crossed, as I discussed All Kids’
ANSD program and also Dr Bartels. In fact, several years ago I
referred our mutual friend Regina from Sarasota to him for
Gianna’s implants.
I’ll also reply to you privately on Facebook messenger.
8.
Constance L.
June 12, 2015 at 6:46 pm
My daughter had her right side cochlear implant at 26 months of
age, her left side done when she was 7 years old. She is now 16
years old. Thus, we have been around cochlear implants for many
years. We have lived in 4 different states since she was diagnosed.
The first thing I would recommend to a family with a child that is
HI is to join the cicircle group on Yahoo. There is also a group
for parents that have children with Auditory Dysnchrony. Parents
have always been my best resource. Talking to families that live
and breathe this 24/7 is priceless. If there are any local groups,
go and talk to recipients and parents of recipients in person. AG
Bell, Minutman Implant, Hands and Voices, etc. etc.
Second, I would definitely talk to the different cochlear companies
(about anything and everything). I had a very lengthy discussion
with Jim Patrick, one of the first engineers at Cochlear regarding
various current surgical procedures. It was very enlightening and
furthered my research for what was best for kid for her second
implant.
When our daughter was first implanted, AB had a serious issue with
cases of meningitis. I believe all of the implants slightly
increase the risk of meningitis. Therefore, it is important for
parents to make sure their pediatricians are familiar with what the
CDC (Center for Disease Control) is recommending for these kiddos
vaccinations. I know there were some scared families when AB went
through its buyout. I also considered financial history of the
company. Having the best equipment at the time of implant, but the
company goes under, is not a situation I would want my child to be
in as an adult. Also look at the history of updating older devices.
When a child is deaf there can be other issues to consider (things
that caused the deafness, etc). This is why we felt so much more
comfortable going with a Children’s Hospital. Once the child is
implanted, the hard work starts. I believe it is crucial to the
uccess of the child and their implant to have the best pediatric
audiologist possible. The speech and listening therapy is also
crucial and parents must do their part in carrying over the
therapy.
Children are not little adults and should not be treated as such.
Our family has always been fortunate to have an excellent job with
really good insurance and yet, we have chosen Children’s Hospitals.
One last word about doctors, if you don’t feel comfortable with the
urgeon, you do not owe them anything, CHANGE doctors. This is your
child and you want what’s best for him/her. For us personally, it’s
a Children’s Hospital.
June 13, 2015 at 1:04 pm
@Constance: I notice you didn’t name the “Children’s Hospital”
which serviced your daughter: If it was so praiseworthy and
her outcome so fantastic, you should have identified both the
facility and the team.
Auditory dys-synchrony (AD) was folded together with auditory
neuropathy (AN) and then rolled into auditory neuropathy
pectrum disorder (ANSD) at the 2008 Lake Como Conference,
moderated by Prof. Charles Berlin. For more, please see the
proceedings: Management of Individuals with Auditory
Neuropathy Spectrum Disorder, by Charles Berlin PhD (2008;
Lake Como Conference proceedings).
[Separately we at The Hearing Blog argue that AN and AD should
be separated again as diagnosis, management, and prognosis
varies greatly between the underlying pathologies (the
“bottom-up” view); while others, including Prof. Nina Krause
argue that central auditory processing disorder should also be
included into an even-bigger spectrum. You can follow the
discussion here.]
The issue with the connection between CI’s and higher
incidence of meningitis is somewhat tenuous, as in fact the
incidence of it occurring in deaf people is higher than
normal, with one possible vector being enlarged vestibular
aqueduct syndrome (EVAS). That being said, AB’s use of the
“positioner” in 1999-2000 appears to also be a culprit,
omewhat depending on the method the surgeon used to seal the
cochleostomy.
All that being said, the issue of maintaining meningitis
vaccinations for CI recipients was settled over a decade ago.
[Latest CDC recommendations are here] and in fact Advanced
Bionics has a vaccination reimbursement program for their
recipients who do not have insurance coverage.
As for the CI manufacturers’ financial stability, in fact this
is a big factor for FDA approval of any implanted device
manufacturer — And has been for decades, such as back in 1985
when 3M exited the CI business, the FDA brokered an agreement
till in effect today in which Cochlear took over all support
for the many hundreds of 3M/House single-channel devices, a
few of which are still in operation.
June 13, 2015 at 8:53 pm
Boston Children’s Hospital. The surgeon was Dr. Margaret Kenna
and the audiologist was Dr. Mariylyn Neault. These two women
and the hospital were not only amazing in their skills and
knowledge, but also emphatic and caring. The fact that they
taught/teach at Harvard, I believe, is a blessing for all the
parents that will need their students services for their
children. Our daughter being born at 26 weeks and suffering
from necrotizing entercolitis in Cincinnati, was transferred
to the Cincinnati Children’s Hospital Medical Center when the
level III NICU couldn’t help her. The surgeon who worked on
her as a 1 lb 6 oz baby was Dr. Frederick Ryckman.
We will forever be grateful for all of the Children Hospitals
that we have used and continue to use across the U.S. The
Doctors, Audiologists, Nurses, Surgical staff, administrative
taff are amazing people following their passions to save the
lives of children and/or enhance to the children’s lives to
the fullest extent humanly possible.
It was Dr. Neault who first told us that our daughter had
ANSD. Dr. Neault also told me about Dr. Berlin, whom I
contacted. I actually sent him all of our daughters paperwork
tests, etc. as I am quite fond of second opinions. It was Dr.
Berlin who told me that Auditory Dy-synchrony was a better
word than Auditory Neuropathy since it wasn’t the nerve that
was the problem. I was also fortunate enough to hear him speak
and to meet him at a conference in Rhode Island. That was
about 12 or so years ago.
Since things change, AN to ANSD, one small example, I truly
believe that parents should continue to educate themselves
regarding issues of meningitis. What is tenuous to you might
not be tenuous to the families that have been affected.
Parents of children that are deaf soon learn that “rarely
happens” actually can happen.
There have been companies approved by the FDA that have gone
under. Just because a company has been approved doesn’t ensure
they will be financially viable for the life of your child. It
certainly doesn’t hurt to look at a companies financial
history. Know what you are buying into.
All that being said, I still believe one of the most important
factors for parents to consider is to connect with other
families. Internet groups, local groups, etc. I would strongly
urge families not to rely on one source for all of their
information and education.
June 13, 2015 at 9:44 pm
Brian Fligor PhD actually did a nice job running the audiology
program at Boston Children’s, as we had few issues with them
in the ANSD group. However, he departed about a year & a half
ago to become Chief Audiology Officer at Lantos Technology.
On The Other Hand, Daniel Lee at Mass Eye & Ear made our list
as he is a truly outstanding CI and ABI surgeon who trained
under Dr John Niparko at Johns Hopkins.
Cincinnati Children’s is, overall, a very good hospital; and
Lisa Hunter PhD does a decent job running their audiology
department.
June 15, 2015 at 11:42 am
Just to clarify, the FDA is extremely strict with the
implanted medical device industry; and when one is sold it
typically takes at least six months for the FDA to perform
it’s own due diligence: It took that long for Boston
Scientific to buy Advanced Bionics in 2006; and more recently,
it took an unusually short 3 months for FDA to investigate
when Sonova (Phonak) purchased AB in late 2009 for $480
million, probably because they were established in 1966 &
their market capitalization (VTX: SOON) at the time was over
$6 billion (and today is over $9 billion), traded on the
Zurich stock exchange.
Cochlear Pty. is also a publicly traded company on the Sydney
Exchange (ASX: COH) with a market cap of US$3.6 billion; plus
ince it’s a “star” in the Aussie tech sector it gets
extensive support from the NSW government.
Oticon has been around since 1904, and is owned by William
Demant Holdings (CPH: WDH), and has a market cap of US$4.5
billion. They purchased French CI manufacturer Neurelec two
years ago; and they will have a Major Product Announcement in
Toulouse this week — Stay tuned!
Med-El is privately held by the Hochmaier family; and they
have repeatedly turned down offers to be acquired by almost
every one of the Big Six hearing aid manufacturers.
9.
Going Deaf Girl
June 14, 2015 at 2:40 pm
Thank you for the article. Any insight on a surgeon in Texas? Been
referred to Brian Peters, James Kemper, or Joe Kutz.
June 15, 2015 at 11:18 am
Although there are some decent CI surgeons in Texas, none are
outstanding; and none are any good in Austin. My suggestion is
to drive or fly to Dr Stanley Baker in OKC: Although we didn’t
rank the surgeons in our list, if we did, he’d be about 2nd or
3rd.
Melissa Benton
June 15, 2015 at 12:03 pm
Going Deaf Girl: Dr. Brian Peters at Dallas Ear Institute is
EXCELLENT! He did my CI surgery in 1998 and I had AMAZING
results! He has being doing CI’s since 1992, he’s a very
killed surgeon and he sincerely cares about his patients as
much as any physician can possibly care. He has an excellent
team of audiologists and auditory-verbal therapists. I HIGHLY
recommend him! I would suggest that you research reviews by
actual patients of Dr. Peters. You will find that his pristine
reputation precedes him! This person who writes these blogs
has his own opinion, and as you can see from reading the
comments, a lot of people who have experienced cochlear
implants themselves do NOT agree with him. Please let me know
if I can answer any questions for you!
June 15, 2015 at 12:20 pm
Melissa, unfortunately neither of us are qualified to rate CI
urgeons, which is why we received inside information from the
CI manufacturers who are qualified to rate them. Let me remind
you, from the second paragraph of the article:
With CI’s, there is no 30 Day Return privilege, so choosing wisely
at every step of the process is vitally important for the best
outcome. Unfortunately, especially here in the United States, there
are factors that conspire against making an informed choice, not the
least of which is the CI manufacturers quietly keeping reams of
information on each of the approximately 700 or so US CI surgeons’
outcomes. The problem is that the manufacturer’s patient reps and
upport personnel maintain omerta, lest they offend the delicate
feelings of the audiologists or bruise the fragile egos of the
urgeons, both of whom guide the brand selection. Unfortunately, the
CI manufacturers’ patient reps — as nice as they are to get you to
elect their brand — will give you zero guidance on selecting a
urgeon, let alone a CI program, as you are .NOT. the customer: The
CI center is their customer, and the manufacturers will do nothing
to offend their customers.
That Being Said, UT-D’s Callier Center is a very good, but
very busy audiology clinic. Also, the UNT clinic in Denton is
quite good; and is on the rise with new Program Director Erin
Schafer PhD.
Separately, a prominent member of the Dallas CI community had
all sorts of problems with her two CI’s; and she had to go to
the above-mentioned Dr Baker in OKC to get reimplanted to get
good results.
June 15, 2015 at 1:00 pm
Yes, I am very familiar with the Dallas CI Community. My
cochlear implant was so successful that it transformed my
life. My experience was 12% with a hearing aid to 92% with the
CI. Prior to my CI, I could count on one hand the number of
people I could understand on the phone. Within a month, I was
hearing well enough on the phone to become a volunteer and
eventually the Administrator for the Dallas Hearing
Foundation, which Dr Peters founded to help people who cannot
afford hearing aids and cochlear implants. I worked with Dr
Peters and his CI team for many years prior to relocating to
my hometown in Indiana. I was the organizer and leader of the
CI support group meetings in Dallas and I literally met
hundreds of Dr Peters’ CI patients. They are extremely happy
with their results and with him personally. It is rare for a
CI surgeon to never have a patient who ends up having a
problem. Dr Peters is a very prominent neuro-otologist who has
done extensive published research on bilateral cochlear
implantation. He is an excellent, very experienced surgeon.
And he has a heart of gold. I would trust him with my life and
I know his patients feel the same way.
June 15, 2015 at 1:11 pm
Melissa, let me be blunt: Although you did a good job with the
Dallas Hearing Foundation, you are Not Qualified to rate CI
urgeons, which is why we relied on inside information from
the CI manufacturers who do keep the records and who are
qualified to rate them.
June 15, 2015 at 1:25 pm
I didn’t claim to be qualified to rate CI surgeons… It is
ridiculous to tell a candidate to travel to another state when
he could receive excellent care locally.
10.
Mom of HOH child
June 17, 2015 at 7:11 pm
Going Deaf Girl: I can’t speak much on the side of CI but I can
give you some input on Dr. Brian Peters (just my experience). Dr.
Peters in Dallas was just one of the doctors that I took my child
to. After a lengthy but wonderful day at UNT it seemed like we were
on the right track for a diagnosis of Meniere’s. UNT was wonderful
but we still needed the doctors “stamp of approval” for the next
teps in our journey. So, we ended up seeing Dr. Peters in Dallas.
I had heard great things about him. What we encountered with him
was very disappointing as parents trying to do anything and
everything for our child. He was nice but really didn’t answer any
of our questions. He gave vague answers that really just seemed
like a response to try to please me. He took a tuning fork and
touched the side of my child’s head with it and came up with some
answer from that. He nixed the test from UNT with a response of
“kids don’t have Meniere’s Disease, they just don’t get it.” After
that he signed a form for a hearing aid and sent us out the door.
Needless to say it was all I could do to fight back the tears of
disappointment and of feeling lost on what to do to help my child.
I was not impressed at all. We are still looking into other options
as where we need to go next.
I hope you find the answers that you are looking for. Just a little
input from a mother who wouldn’t take my child back to Dr. Peters.
11.
Mike Levad
June 15, 2015 at 9:08 pm
I have been scheduled with Sam Levine at the University of MN in
Minneapolis. Sam has been doing implants since they were invented.
Should I be excited or nervous to have him as my surgeon?
June 16, 2015 at 5:38 am
Congratulations Mike on taking the step to hear well again —
We wish you well in your journey!
Our suggestion is to print out this article outlining Best
Practices and discuss this with Dr Levine.
12.
Miss Kat's Mom
June 16, 2015 at 12:16 pm
Interesting article. We had the opportunity to have our daughter
implanted by Dr. Clough Shelton in Utah. He is an excellent surgeon
and does all the things mentioned in this article.
While the surgeon is a critical piece to the puzzle, I believe that
the audiologist is FAR more important and unfortunately, there are
a HUGE number of pathetic doctors masquerading as pediatric
audiologists today.
June 16, 2015 at 1:29 pm
Melissa, both the CI audiologist (or in UK & Europe, CI
Engineer) .AND. the surgeon’s technique + adherence to Best
Practices are required for a great outcome: If the surgeon
makes hash while inserting the electrode, the outcome will not
be nearly as good.
For more, please see Role of electrode placement as a
contributor to variability in cochlear implant outcomes
(Charles C. Finley and Margaret W. Skinner). Otol Neurotol.
2008 Oct; 29(7): 920–928.
13.
Shannon Davis
June 17, 2015 at 6:18 pm
Just saw your info on Dr. Niparko who just performed bilateral
implants on my son. We could not be more thrilled. I called his
office and learned that he has been elected President of USC Care,
but has kept his surgical practice going full speed. You are
correct about one thing, however, he is probably the best of all of
them. Given his schedule, he must be the busiest surgeons in Los
Angeles!”
June 17, 2015 at 8:13 pm
Dr Niparko is implanting again?! That’s the best news we’ve
heard all week! He implanted my former girlfriend in 2003, as
well as implanting a number of friends here in the Delaware
Valley who drove the 90 miles down to Baltimore. In addition,
he saved a dear friend from facial paralysis after another
urgeon badly bungled a procedure.
14.
C, J.
June 24, 2015 at 9:35 pm
I know for a fact that at least one of the surgeons on your list
allow residents (not fellows but residents–and not senior residents
either) do parts of the surgery including placing the electrode
array into the cochlea on both adults and children. As one
neurotologic surgeon told me, it is one of the easiest surgeries he
does because the is working with a healthy cochlear and many of the
other surgeries he does that is not true.
June 24, 2015 at 11:21 pm
@CJ: What you write about CI surgeons allowing a resident to
perform the electrode insertion is precisely why we put this
in the article, as oftentimes in general the surgeon is
watching the resident perform a given procedure — And often
this is buried in the consent forms, which is why we are
alerting our readers to this issue
However, the surgeon is pulling your chain (or maybe something
else) when s/he tells you “it is one of the easiest surgeries
he does” as in fact it is quite difficult, especially when
placing the Med-El Flexsoft array, which is like pushing a wet
noodle, or when placing a curved AB, Oticon or Cochlear
electrode, which is prone to kinking.
June 24, 2015 at 11:29 pm
I don’t think it is for anyone but another surgeon to comment
on how challenging any particular procedure is compared to
another.
June 24, 2015 at 11:48 pm
I think you missed my point. These surgeons you mention as
best track record doesn’t mean that they are actually doing
the surgery so in those cases their track record is
irrelevant.
I know my surger was done by a fellow because I read the
hospital report but others might not realize that these
urgeons you mention as best track record might not even be
doing the insertion so it is a moot point.
As for the surgeon pulling my leg about the cochlear implant
urgery. I can tell you that this surgeon is highly regarded
in the otolaryngology field, has a very prestegious position,
and does very complicated cases so I believe he knows of what
he speaks.
15.
Chad Denning
June 26, 2015 at 12:49 pm
Dr Niparko did my CI surgery on February 5,2015. He has to be the
most humble Dr I have ever met. As my hearing has worsened, he said
to me, “Please, let me implant you and resolve your issues.” I
believed him and let me tell you, it was the best decision of my
life. By old implant standard’s, I had to much residual hearing at
40%. But I was missing more then half of everything said. Dr
Niparko told me the sooner we implant, the faster the results. Not
only did I preserve most of my residual hearing, the placement of
my electrode by medical standpoint is optimally perfect. In 3
months I was at 99% on sentences in quiet, 86% in noise and 93% on
word recognition. Now coming up on my 5th month activated, my
hearing in my implanted ear is so great, I am considering going
bilateral. For the record, I did not choose AB but Cochlear. It
really doesn’t matter which brand you choose, if your surgeon does
a bad placement, you will struggle. I feel extremely blessed to
have Dr Niparko for a surgeon and his vast knowledge of implantable
device’s. USC was very smart in hiring him, he has raised the bar
for surgeon’s at House and UCLA. He has also secured millions of
dollars in funding to further advance the research coming out of
USC.
June 26, 2015 at 1:08 pm
Chad, we are very pleased you are achieving such good results
advantage of the “sexy” externals’ features, especially the
Unite wireless accessories. To that end, we recommend the
ReSound Enzo 7 or 9 hearing aid for your opposite ear,
possibly programmed to linear for speech envelope
preservation.
We published a comprehensive list of accessories for the
ReSound & Cochlear systems last year at this link. Whether you
choose to use an Enzo or not for your non-implanted ear, we
recommend purchasing accessories which are compatible with it,
as the forthcoming Nucleus 7 processor will require them, so
it’s better to maintain forward compatibility.
June 26, 2015 at 2:04 pm
Dan, I have an ReSound Alera in my left ear which is effected
by Meniere’s. So some days I can hear great with that ear and
others… well it sounds like a broken speaker with Tinnitus
that sounds like a freight train in my head.
By the way, I didn’t choose Cochlear because of it’s “Sexy”
features, but for reliability, longevity and promise to leave
no one behind. The fact that the FDA just aproved the N22 for
upgrade to the N6 processor tells me that I made the right
decision for me. As for perks, such as the wireless
capabilities of the N6, I believe that they are one of the
major reasons for my success. Besides have beautful impedence
numbers (thanks Dr Niparko), my Dynamic range is huge (between
38 and 72) and stimulation of 900hz X 8 for 7,200. Back to the
wireless capabilities… I can now talk on the Phone again… been
2 years, the Mini Mic… I use it to stream my computer at
chool while editing shows (Studio Production Student) and
listening to tutorials for my Didgital Multimedia stuff, I
also plug it in to the intercom system/party line in the
tudio and they talk wirelessly to my head… NO MORE HEADPHONE
that I so struggled to hear with and I also use it at my men’s
group, setting it at the end of the long table so I can hear
the guys at the other end with ease, while everyone else
truggle, I enjoy loud clear voices. Last but not least… The
TV streamer… AHHHHH I can blast my TV away in head and my
Family doesn’t have to hear it! My Dad asked me if I could get
that for my Mother… She is getting hard of hearing in her old
age and kidney disease. So I actively am listening to
omething in my CI ear pretty much 10-12 hours a day and using
my HA ear for my local surroundings. I will be remapped on
Tuesday and look forward to even hearing better.
I am not posting to get into brand wars… But to tell you the
honest truth, regardless of monopolar or bipolar… if you don’t
put the hours of rehab in, you spiral ganglion are severely
damaged or have a bad placement, you will struggle. It breaks
my heart to see those that strugle after surgery, have
componet failure, bad placement, infection or whatever the
matter. The whole goal is to hear better! Regardless of if you
Choose AB, MedEl or Cochlear… it’s all rubish if you get
implanted for any other reason then to be able to continue to
communicate with the world. Some will hear Music, Some will
truggle with Music, if you got implanted with the thought
that you will hear music again like you did with your regular
ear, you are being set up for failure. I am fortunate in the
fact that I am an early implatee. My recovery and my learning
to hear again has been incredibly easy and a lot of workalong
with a great relationship with my Audiologist. Placement,
Mapping and Hard Work/Therapy are the 3 major factors in the
outcome of you CI journey. The lack of one of those can make a
huge difference how fast you return to hearing.
So like I said earlier, “I feel blessed to have Dr Niparko as
my surgeon.” I trust him 100% and we have an amazing
relationship. He also takes time out of his busy schedule to
go to many awarness meeting here in So Cal, both for Patients
and Physicians to spread awarness. How many Presidents of
University medicine do this.. How many Internationaly Renowned
Scientist and Researchers do this??? Dr Niparko does… So if
you are in So Cal and reading this, look up Dr Niparko at Keck
School of Medicine, USC. It may just be the best decision you
will ever make, it sure is for me!
16.
D.D.
July 27, 2015 at 3:12 pm
I am considering a cochlear implant. What information do you have
about Dr. Rick Friedman at USC-Keck?
July 28, 2015 at 6:41 pm
I don’t have any info on him; however we highly recommend Dr
John Niparko
17.
Hadron
September 3, 2015 at 2:52 pm
What do you think of the reputation of Dr. Patrick Antonelli and
his body of work at the Universiiy of Florida at Gainesville?
Thanks.
September 3, 2015 at 11:05 pm
Not familiar with him.
18.
Jim Flesch
September 22, 2015 at 6:29 pm
Mr. Schwartz,
Our 29 year old daughter has profound hearing loss and the ENT
recommended that she receive a cochlear implant.
Do you have a recommendation for someone to see in the Phoenix
area?
We are being referred to Dr. John Macias.
Thank you.
September 23, 2015 at 12:45 pm
No, I do not recommend any of the CI surgeons in the area. Hop
a shuttle to LA to USC-Keck or House Ear Clinic, for Dr’s
Niparko, Wilkinson, or Slattery.
19.
Di
September 25, 2015 at 2:25 am
Hi Dan,
I have some personal questions seeking your advice. If you don’t
mind, can we chat over emails?
Thanks
September 25, 2015 at 7:44 am
Sure! Message me on Facebook.
September 25, 2015 at 11:43 pm
I sent you two messages on facebook, but it’s said the message
ent to your “other folder”. Please check your other folder.
September 26, 2015 at 2:41 pm
Di, it is my pleasure to point you to the right neurotologic
urgeons to straighten out your SSDS (SCDS) as well as hybrid
CI!
20.
John David Stegeman
October 5, 2015 at 9:56 am
Very interesting information, and certainly it’s not something that
you see discussed much on the Internet.
Are you able to name the Michigan program and surgeon that had the
malpractice issue with the kinked electrode array? I’m being
implanted next week in Michigan, and it would be good to know…
My surgeon is Dr. Eleanor Chan at the Michigan Ear Institute – do
you have any information on her or the program there? I’m not on
Facebook…
October 5, 2015 at 10:05 pm
John, I have no information on the surgeon or CI center.
Incidentally, I’m about to update the article, adding in these
two new articles which go directly to atraumatic electrode
insertion and residual hearing preservation:
• Effects of CI Electrode Insertion on Tinnitus By Thomas J
Balkany MD
• Impact of Perioperative Oral Steroid Use on Low-frequency
Hearing Preservation After Cochlear Implantation by a group at
Vanderbilt.
21.
Lettie
October 19, 2015 at 2:51 pm
Hi I am interested in your comments as we are currently researching
CI for our daughter who has been approved as a candidate. It’s
interesting that you have such bad things to say about CHOP. Our
daughter currently has medicaid, and maybe we will look into the
possibility of going to NYU. Do you know the doctors at NYEE? I’ve
heard good things about them as well.
Our current plan was to implant with Brian Dunham at CHOP and
programming by Melissa Ferrello.
My husband and I are professional musicians and am curious if you
have input on the best implant or programming for musical access,
pecifically pitch perception.
October 19, 2015 at 4:52 pm
NY Eye & Ear is good; but we recommend Dr Tom Roland at NYU
Langone, as that center has the best outcomes; and as we
discussed, he tries for residual hearing preservation
As for brand, we recommend the Advanced Bionics implants, as
there’s a new 1024-channel stim for music being developed
which will run on the HiRes 90k implant. Also, although the
externals are not as important as the implant circuit, we
really like the Phonak processors; and as we recently
discussed here, their radio technology is already very good,
and will be getting much better mid-to-late next year.
The Med-El i100 is a decent implant, but although twice as
fast as the Nucleus CI522 and with the electrodes spaced far
enough apart, it’s OK. However, it’s a smaller company and
they aren’t also in the hearing aid business, so their
processors lack the advanced noise reduction processing that
Phonak brings to the table.
November 29, 2015 at 9:30 pm
I apologize if this is a double post, but I’m not seeing my
last comment. We live in Philadelphia, and unfortunately, I
can’t get Keystone first medicaid to pay for us to go to New
York to get CI for our daughter. That leaves CHOP, Dupont
Nemours, or St. Christopher’s I guess. I know you said you
weren’t a big fan of any Philly CI programs, but since these
are our options, do you have any input whatsoever on surgeons
or programming audiologists?
We are looking at either AB or Med-el at this point, and
unfortunately CHOP does 75% Cochlear, so I’m not sure we’re
going to find a surgeon who does a ton of the other brands.
Thanks!
November 29, 2015 at 11:14 pm
Try Willcox at Jefferson
November 30, 2015 at 6:57 pm
It looks like Jefferson only implants adults currently.
December 1, 2015 at 6:56 pm
Since you’re getting Advanced Bionics for your daughter, talk
to the patient coordinator (I think it’s still Katie Peter
Skipper) for guidance. Also, Hershey has a good program.
22.
Rene Moerman
October 25, 2015 at 2:38 pm
Would you have any knowledge about the the Audiology center at
Emory in Atlanta.
October 25, 2015 at 2:51 pm
We recommend Auditory-Verbal Center of Atlanta in Century City
(404-633-8911), and the Atlanta Speech School on Northside
Drive: Both places have full pediatric & adult audiology
clinics including MAPping CI’s, and both places do a very good
job.
If you or your child needs CI’s, you’ll be driving up to
Nashville, as the surgeons up there are much better than any
in Atlanta. One of my longtime patients who still had
ignificant high frequency hearing was just implanted a few
weeks ago (I’ll not name the surgeon), and even though the
electrode was an AB mid-scala for atraumatic insertion, she
woke up with her residual hearing destroyed, with resultant
poorer outcome (see Effects of CI Electrode Insertion on
Tinnitus by Balkany for the research) — Nice going, schmuck.
23.
Rob Cunningham
November 17, 2015 at 1:05 pm
My 89 year old mother just had a consult with an audiologist in
Cincinnati about the possibility of a cochlear implant…she’s been
totally deaf in one ear for decades, and is progressively losing
her hearing in the other ear. Many years ago, she consulted with Dr
House in Los Angeles, but there have been advancements since then…
The news from the audiologist was not good regarding her
candidacy…however, we’d like a second opinion. Please advise: who
are the very top Otolaryngology docs in Cincinnati?
Would it be worth traveling to Los Angeles to consult with Dr
Niparko?
Thank you in advance for your reply…
kindly, Rob
November 17, 2015 at 2:32 pm
Rob, the age record for CI’s is 99 in the US, and 100 in UK.
The biggest issues are motivation and ability to tolerate the
urgery, which takes about 90 minutes.
Dr Ravi Sami is an excellent CI surgeon in Cincinnati — Talk
to him first. Any of the surgeons on the list are outstanding.
I asked Dr Niparko at the 2010 HLAA convention if a CI can be
done under a local (it was for a friend who is a dwarf, and
dwarves don’t tolerate general anesthesia well): He said he’s
implanted under a local for a couple patients in their 90’s,
November 19, 2015 at 11:04 pm
Many thanks, Dan…
As it turns out, mom’s audiologist also recommended Dr.Ravi
Samy…so that’s who she’ll go to if/when she decides to pursue
this course. It was also recommended that she attend an
upcoming conference/meeting of CI patients, to gather info and
ask questions, which she’ll do.
The service that you’re providing here is invaluable, Dan…Just
having Dr. Samy’s expertise confirmed is a great comfort.
Again, many thanks.
November 20, 2015 at 1:00 pm
Rob, thank you for your kind words, as it makes what I do
worthwhile!
24.
Jane Richman
November 18, 2015 at 8:25 pm
Can you recommend a CI surgeon in Chicago?
Thank you!
November 20, 2015 at 1:03 pm
For pediatric CI’s I recommend Dr Dana Suskind and her
excellent program at UC/Comer Children’s. None of the
Chicagoland adult CI surgeons made the list; but the adult
program at UC is rather good.
November 20, 2015 at 5:26 pm
thanks, Dan. I also appreciate the work you do to share
information and optimize outcomes! Is there someone special at
U of C you would recommend? I’m looking for a CI surgeon for
an adult (myself). Also, if I go out of state, can my local
audiologist do the fine tuning post op, or do I need to return
to the site where the implant was done?
November 29, 2015 at 11:17 pm
Unfortunately, Dr Dana Suskind at UC/Comer Children’s only
implants pediatric patients. If you get implanted in another
city, then Yes, you can be MAPped locally; however switch-on
(1st stim) and the first couple of MAPpings would be where you
were implanted, especially if there are any “issues.”
25.
Kimberly
December 1, 2015 at 11:25 pm
I live in southwest Colorado and have been referred to Dr. Stephen
Cass of University of Colorado Hospital in Denver for a CI (adult).
I am also investigating surgeons/clinics in Albuquerque, NM. Do you
have any recommendations?
December 2, 2015 at 1:48 pm
Hop a plane to LAX for Dr’s Niparko, Wilkinson, or Slattery.
26.
Ruth Katz
December 2, 2015 at 9:19 pm
This is incredibly helpful! Thank you! Do you have any experience
with Colorado implant surgeons? We have been referred to Dr.
Kelsall and Dr. Feehs in Englewood. I would love an outsiders
opinion on either surgeon. Thanks!
December 3, 2015 at 9:24 am
December 3, 2015 at 9:35 am
Unfortunately that is impossible. We must use a surgeon in
Colorado for insurance purposes.
December 8, 2015 at 4:53 pm
Then I can’t help you. Sorry.
27.
Ralph Roesler
December 6, 2015 at 10:34 am
Dan, thank you for your excellent blog post on selecting a cochlear
implant surgeon. I am 53 years old, have worn hearing aids
bilaterally for most of my life, and am considering a CI. There is
a bewildering array of (conflicting) information out there, so I
find your blog very helpful. I live in Houston, do you have any
information on surgeons in the area you would recommend or not
recommend? Thank you in advance for your help.
December 8, 2015 at 4:56 pm
Yes: Hop a plane to OKC for Dr Stanley Baker for your surgery;
and use Jennifer Wickesberg Summers AuD at the Center for
Hearing & Speech for your MAPpings
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