Cochlear implant now an easier option for JGH patients hoping to overcome deafness

Surgery helps many, including cancer patients, to regain hearing

It took 28 long years—years of deafness or severely limited hearing, years of debilitating vertigo, years of intermittent depression—before Diana Wood finally regained the ability to hear and, once again, confidently embraced life’s simple pleasures and everyday tasks.

“It feels like I’m truly part of society again,” says Ms. Wood, 82. “I now know what people are saying when they speak with me on the phone. I understand my neighbour if we happen to meet on the street. It makes sense when my little grandchildren talk to me and I can participate in book club conversations.

“I’m also aware of my environment when I walk or bike or swim. And I’m a keen bird watcher, so I’m thrilled to be able to differentiate among bird calls.”

The watershed moment for Ms. Wood came in 2023 when she underwent a surgical procedure known as a cochlear implant, in which an electronic device is surgically embedded in the ear. It allows sound (in the form of electrical impulses) to bypass the malfunctioning part of the inner ear and make its way to the brain.

Changing the rules for western Quebec

For many years, the operation was available only in Quebec City, a source of great inconvenience and burdensome travel expenses for patients and their families in the western regions of the province, including the Montreal area.

However, after approval was granted by the Ministry of Health, cochlear implants came to Montreal in 2023 are now being performed at the McGill University Health Centre (at the Glen site) by a surgical team that includes Ms. Wood’s JGH otolaryngologist, Dr. Emily Kay-Rivest.

If any JGH patients feel they might be suitable candidates for a cochlear implant, they can be referred to Dr. Kay-Rivest for a consultation, which is the first step in a process that might lead to surgery that she would perform.

This even includes individuals who may seem sick or frail due to cancer treatments that have left them deaf or with a substantial hearing impairment. “There’s a great amount of evidence that regaining hearing and undergoing hearing rehabilitation play a role in preventing dementia,” Dr. Kay-Rivest explains.

“Even if these patients don’t seem like the best candidates, it’s important to remember that the surgery itself is not very difficult, and it’s not hard to recover from. Physicians shouldn’t shy away from referring their cancer patients or older patients to us.”

The search for an accurate diagnosis

For Ms. Wood, the difficulties began in 1995, when she experienced bouts of severe vertigo (along with vomiting) and hearing impairment that came and went at random intervals and left her unable to function.

Fortunately, she found sympathy, strength and support in her husband, John (who died in 2015), and in her colleagues at the public library where she worked.

What Ms. Wood lacked, though, was a firm diagnosis and a solution. Early on, a specialist in the West Island simply told her she had an undefined condition and she should just avoid driving for a couple of weeks. Later, she underwent numerous tests to determine whether she might have a brain tumour or some sort of allergy.

In 2000, Ms. Wood began seeing Dr. Jamie Rappaport in the Department of Otolaryngology at the JGH and was eventually diagnosed with Menière’s disease.

According to Dr. Kay-Rivest, the symptoms—those that Ms. Wood experienced—alternate unpredictably between heavy and light in the short term, but they worsen over time, ultimately leading to full or partial deafness. The cause of the disease is unknown (although an overload of fluid in the inner ear is suspected) and there is no cure.

Finding out about Menière’s disease provided Ms. Wood with some comfort, as did her high-quality hearing aid. She also benefited from the ongoing advice of JGH Audiologist Yolaine Hernandez, as well as the support she received from the volunteer organization, Hear Quebec.

Although the subject of a cochlear implant came up with Dr. Rappaport, Ms. Wood quickly dismissed it, believing she would not be an acceptable candidate for the procedure, since she was not completely deaf.

By 2021, Ms. Wood’s stamina was wearing thin and she recalls wearily telling Dr. Rappaport, “It’s been 26 years and I just can’t cope any more.” Fortunately, Dr. Kay-Rivest had just arrived at the JGH and Ms. Wood was sent to see her.

That was the turning point.

How does a cochlear implant work?

In this close-up, the processor for the cochlear implant can be seen curled around Diana Wood’s ear. Sound (in the form of electrical impulses) travels over a short wire from the processor to the transmitter that Dr. Emily Kay-Rivest is holding. The transmitter relays the electrical impulses to a receiver under Ms. Wood’s skin near the ear and, eventually, to a nerve that connects to the brain. (Click on this photo to enlarge it.)

Normally, sound travels from the outer ear to the eardrum and, eventually, to the cochlea, which plays a key role in converting sound into impulses that are sent to—and are interpreted by—the brain.

However, if the cochlea isn’t functioning, a “work-around” solution—a cochlear implant—is needed.

In this new arrangement, sound is captured by a microphone on a small processor that is sometimes curled around the ear. The sound—transformed into electrical impulses—then travels along a short wire to a circular transmitter. (The transmitter adheres magnetically to a receiver that sits on the bone of the skull, just below the skin.)

The electrical impulses are relayed by the transmitter to the receiver. From there, electrodes take the impulses deeper into the ear—bypassing the damaged cochlea—to a nerve that carries them to the brain.

On the road to a solution

Dr. Kay-Rivest thought Ms. Wood could benefit from a cochlear implant, but only after a lengthy series of tests and evaluations. Among the most important was a hearing-aid test: if a patient is equipped with a well adjusted, high-quality hearing aid, but can only understand 40 to 60 per cent of what’s said, an implant would appear to be appropriate.

Dr. Kay-Rivest notes that 25 years ago, only totally deaf individuals received implants—which explains why Ms. Wood was initially under the impression she would be an unsuitable candidate. However, over the years, the threshold has gradually changed to the current range of 40 to 60 per cent of comprehension with a hearing aid.

During rehab, the patient consults with an audiologist, a speech pathologist, a technical expert and even a social worker, all of whom help the individual get comfortable in the new aural environment.

The change has been enormous, Ms. Wood says, “but it’s important to be realistic, because it’s not all brightness and light. For instance, I can’t hear music properly, which is something I was hoping for.

“Also, you have to deal with technology, so if you’re not really into technology, you need to be patient. It takes time, but it’s like anything else: you get used to it.”

On balance, however, Ms. Wood has no hesitation about recommending the procedure because of its many benefits. “If you’re wondering about having a cochlear implant, do it!” she states emphatically.

“It involves quite a bit of pre-operative preparation and work-up, plus post-operative recovery. But it’s well worth it. I haven’t met anyone who didn’t think it was a great idea.”