- The Washington Times - Tuesday, January 8, 2002

Jay Johnston's father and uncle both suffered significant hearing loss in their later years, so when his own hearing began to decline, he figured a quiet blanket soon would drape itself over his world.Mr. Johnston, 75, of Waldorf, Md., tried using hearing aids but found them less and less effective as his hearing worsened during the past decade.
When his daughter told him about an implantable hearing device that promised greater sound clarity and strength than hearing aids, he decided to give it a try.
Today, thanks to a Vibrant Soundbridge implant, Mr. Johnston can hear well enough to carry on a casual telephone conversation.
Experts warn that the Vibrant Soundbridge, produced by Symphonix Inc., of San Jose, Calif., isn't a cure-all for hard-of-hearing patients. It's expensive, for one thing, with a price tag of up to $18,000.
It boasts the approval of the Food and Drug Administration, but the procedure is too new for researchers to know of any long-term complications.
Those who find hearing aids too uncomfortable or too limited in their scope, though, may hear news of the technology as music to their failing ears.
"It is worth it if you're having problems hearing," Mr. Johnston says.
He underwent the implant surgery in mid-November and had the device turned on more than a month later after his ear sufficiently healed.
He wasn't elated at first.
"It was a lot better, but it still wasn't what I thought it should be," he says.
After a few modifications to the external processor that feeds sounds into the ear, his disappointment receded.
"It's [clearer]; I can talk on the telephone with it on. With hearing aids, I'd get that whistle feedback," he says.

The Vibrant Soundbridge, a middle-ear hearing device, consists of two distinct components, an implanted receiver the size of a grain of rice and an external audio processor 1 inch in diameter. A magnet is implanted under the skin right behind the ear to hold the latter disc in place. It can be covered by the patient's hair to hide it.
An audiologist programs the digital processor based on a particular patient's hearing needs.
The battery-powered external device contains a microphone to pick up sounds and transmit them across the skin to the implanted, rice-size receiver.
The implant directly vibrates the incus bone, one of three bones in the middle ear, much like what happens in a person with full hearing, only stronger. This sends an enhanced signal to the fluid-filled inner ear, or cochlea, setting that fluid in motion. That, in turn, stimulates the hair cells, which stimulate the auditorynerve, which the brain interpretsas sound.
Most people with hearing loss suffer from degenerated or damaged hair cells, which prohibit the inner ear from detecting the full range of sound coming into it.
Such impairment can come with age or with repeated exposure to loud noises.
The Vibrant Soundbridge sends a stronger audio signal to the weakened hair cells than hearing aids, providing higher frequency gains and clearer sounds.
The procedure requires general anesthesia and involves doctors' going through the mastoid bone behind the ear.
As with any surgery, levels of discomfort vary from patient to patient.
"I didn't have any pain at all," Mr. Johnston says. "I came home and went about my ordinary business."
"This is just a tremendous advance from a digital hearing aid," says Dr. Sanjay Prasad, president of the Metropolitan Ear Group and the neurotologist who performed Mr. Johnston's surgery.
Dr. Prasad, the only physician in the D.C. region to surgically implant the Vibrant Soundbridge, has three patients who have undergone the procedure and more who are candidates.
"Over time, as there's more awareness, people will embrace the technology," says Dr. Prasad, who spoke to many satisfied implant patients before incorporating it into his own practice.
"Some people just don't tolerate a hearing aid in the ear canal," he says. Others bristle at strangers staring at the clearly visible aids.

David Fabry, section head of audiology at the Mayo Clinic in Rochester, Minn., says Vibrant Soundbridge surgery involves a different area from cochlear implant surgery.
The cochlear implant, a device that can restore a semblance of hearing in profoundly deaf patients, is inserted directly into the inner ear, while the Vibrant Soundbridge involves the middle ear.
Also, the cochlear implant, once inserted, destroys any residual or remaining hearing in the ear in question. The Vibrant Soundbridge doesn't affect such hearing.
Mr. Fabry has worked with a small group of patients with the technology, and the results, so far, have been promising.
"It can't be thought of as a panacea, but a revolution in hearing aids," says Mr. Fabry, who suggests patients always should use traditional hearing aids first before considering the surgery.
The technology also offers room for improvement, Dr. Prasad says.
If advances are made with audio technology, it would involve the outer receptor, not the implanted device, Dr. Prasad says, making it easy to update.
Implant recipients should visit their doctors at least once a year to make sure the device settings remain accurate and to check for any change in hearing loss, Dr. Prasad says.
Dr. Stephen Epstein, a Maryland ear specialist with offices in Rockville and Wheaton and a member of the advisory board of the Alexander Graham Bell Association for the Deaf and Hard of Hearing, sounds a note of caution regarding the implantable devices.
"It's too soon to tell their long-term impact," says Dr. Epstein, whose District-based organization provides advocacy and information for parents and hearing professionals concerning hearing loss. "What happens if something goes wrong with it?
"We don't know the long-term effects of the wear and tear on the bones," Dr. Epstein says. "Are we 'overdriving' these bones?"
The Journal of the American Medical Association says in an October 2000 report that in initial clinical trials patients reported worsened hearing (2 percent), permanently altered taste (2 percent), long-term pain (5 percent) and a permanent feeling of fullness in the ear (16 percent).
Nevertheless, the latest crop of digital hearing aids represent stark improvements over earlier models, says Dr. Epstein, who wears such aids himself.
The Vibrant Soundbridge, like traditional hearing aids, isn't covered by medical insurance. Patients can purchase two digital hearing aids for less $5,000, according to Dr. Epstein.
Vibrant Soundbridge isn't the only audio technology available for the hard of hearing.
Soundtec, an Oklahoma City company, just earned FDA approval for its own implantable device, known as the Direct System. The surgical procedure to implant it requires only local anesthetic. The implanted device, which costs about the same as a high-end hearing aid, vibrates the small bones with electromagnetic waves transferred from sounds without directly touching the bones.
Some patients will appreciate how easily such new devices can be hidden.
Mr. Johnston chuckles at the cosmetic benefits.
"I'm at the age now it doesn't bother me," he says.
Dr. Prasad recalls the reaction many patients have had to the device, particularly older ones longing for the sound of their grandchild's voice or even the songs of a chirping bird.
"When you get older, those things are rather precious," Dr. Prasad says.

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