An Interview with My Cochlear Implant Surgeon, Oliver Adunka, MD!

0:00:00] Welcome to episode nine of empowEAR Audiology with Dr. Carrie Spangler.
[00:00:16] Welcome to the empowEAR Audiology Podcast. My name is Dr. Carrie Spangler, and I am your host, a passionate audiologist with a lifelong journey living with hearing challenges and this vibrant hearing world. Many of us learn and grow by being in communication and connecting with others. It is my hope that all of you as listeners will learn something new and be empowered after each episode.
[00:00:40] Whether you're a professional, a parent, an individual with hearing loss, or just want to be inspired. I am glad that you are with us today. I would also be grateful if you take a moment to subscribe and give a positive rating for this podcast. Also like us on our empowEAR Audiology and engage in the conversation.
[00:01:01] After each episode, a transcript of each episode is also available on the 3C Digital Media Network website in the podcast section. So let's get started today with today's empowEAR Audiology podcast. This episode is really special for me for a couple of different reasons. First and foremost, I have the incredible honor to interview my own cochlear implant surgeon, Dr. Oliver Adunka.
[00:01:28] And second, the reason that's really special today is that my one-year cochlear implant birthday is in the month of November. So, let me tell you a little bit about Dr. Adunka. Dr. Adunka is the director of otology neurotology and cranial based surgery at the department of otolaryngology head and neck surgery at the Ohio state university.
[00:01:55] He's also part of the department of pediatric otolaryngology at nationwide children's hospital in Columbus. Dr. Adunka specializes in otology neurotology and lateral skull-based surgery and shares his time between the department of otolaryngology at the Ohio State University and nationwide children's hospital.
[00:02:17] He is also a full professor. Dr. Adunka attended the university of Vienna medical school. He completed his otolaryngology residency in Frankfurt, Germany, and he also completed a fellowship at the University of North Carolina. Dr. Adunka conducted research that established temporal bone histology data that served as the basis of cochlear implant electrode insertion trauma hoping to reeducate cochlear implant surgery surgeons about insertion techniques to reduce damage within the inner ear and facilitate hearing conservation.
[00:02:57] So today I am really excited to have Dr. Adunka. Thank you for joining me. Oh, my pleasure. So I always like to start off my interviews. I've um, how we know each other. So do you remember when we first met, um, good questions? Uh, I. I mean again as a patient, but we may have had some interactions prior. So I don't know.
[00:03:22] You probably remember as well. I don't know. No, I do. I, I, you probably didn't know. I knew you better than you knew me. And then you did. Um, because I had in the back of my head that, you know, possibly at some point in time, I might get a cochlear implant. Um, so I, I knew who you were before you knew who I was, but that I, I think we actually first met maybe professionally through Children of Ohio, which was the children's hearing and language development resource network that, um, I think, uh, Dr.Derek Houston, might've introduced us.
Yeah, obviously very great organization. So yeah, that's a great one. Yeah. But in your mind that you may, you may seek out guy about a cochlear implant. What was that again? You may, you may seek out the surgeon about a cochlear implant plan. That's right. Um, but, um, yeah, and then I think we, um, you really remembered me probably last July then when I decided after much hesitation, to begin my own personal journey and schedule an appointment.
[00:04:42] Right. Yeah. Yeah. That's how we met kind of in a different way, but sure. Um, but that kind of leads me to why I'm really kind of excited about this podcast because I think, um, like me, um, there's an, I'm an audiologist that knows a lot about cochlear implants, but I think there's a lot of adults out there who may benefit from a cochlear implant, but have not thought about it.
[00:05:10] And, um, I'm sure there are clinical audiologists that might be listening to this, um, who are patients and their caseload, um, who could be possible cochlear implant candidates, but they haven't made an, a referral. Um, and they haven't had that conversation. So, um, this really, I think hits home to me, um, because I'm hoping that this might.
[00:05:35] Spur others to have a conversation with their patients, or if they happen to have a hearing loss and listening to this podcast that this conversation that we have together, um, well open up their, you know, journey as well. Um, but before we get too deep into that, I was just kind of curious, um, how did you find your way into the specialty area of cochlear implants?
[00:06:03] Yeah, it was a interesting, uh, kind of journey and it, it all happens, um, by accident, really. Um, I was in medical school and, in, Vienna, Austria, which is where I grew up. And, um, I wanted to become a neurosurgeon. Uh, really, that was really what my, what I set out to do in medical school. And as I became more and more familiar with the work of neurosurgery and, you know, the somewhat challenging outcomes and, um, uh, you know, just the work itself, I.
[00:06:39] Uh, I, I developed doubts and, uh, I really wasn't sure anymore. And they're looked at other fields. I knew I wanted to do something surgical and I remembered that, uh, my, uh, what turned out to be my mentor. At some point, I met him in the neurosurgery operating room cause he, uh, collaborated with, uh, the local neurosurgeons on certain cases.
[00:07:04] And um, I thought, well, ENT is kind of cool. So I, um, look more into it and, um, ultimately. You know, we had to write a dissertation too, in order to graduate with a doctorate degree. So I, I talked to this person and we sort of hit it off. And ultimately, uh, he offered me to write my dissertation with him. And, uh, it turned out that, you know, the topic he said, he said, was to write up our clinical results for cochlear implants.
[00:07:38] And again, that was in the 1990s. So there weren't that many, uh, there wasn't a lot of data out on cochlear implants, so, and, um, one of the manufacturer MedEL is from Austria. So that's, um, that turned out to be, um, an important pathway. For me. And, uh, ultimately, you know, after graduating medical [00:08:00] school in Austria, we had to, we have to spend some time in the military.
[00:08:04] So I did that and I had some time in the late afternoons to go over to the general hospital and do some cochlear implant research. So, uh, that's sort of how this. Snowballed into something. I always had a passion for engineering. And, uh, so I certainly liked the fact that this is a device. This is an implant.
[00:08:23] This is. Electrical engineering, which I like even more than just engineering, I would say. And, uh, I like electorsurgical science. So really that was sort of one of the things I was able to combine and, uh, back then, and, uh, this person, uh, Dr. , he's now back in Vienna, but at the time, you know, after I'm military, Um, he became a chairman in Frankfort Germany, and he said, why don't you come with me?
[00:08:51] So on the, he, he sort of was a, was a big part of why I chose to you know, became involved in cochlear implants, et cetera. Right. And, um, ultimately after, after that, after my residency, I stayed on and Frankfurt, Germany, and, um, you know, wanted to be a neurotologist that wanted to add the neurosurgical side to my practice.
[00:09:12] And, uh, that wasn't, uh, Did he really in Europe to do that. And ultimately that's why I came to the United States. Uh, certainly had several hurdles on the way in terms of, you know, credentialing and tests and all that kind of stuff. But, um, so that's why I ended up at UNC and, um, Yeah, here I am now at Ohio state.
[00:09:33] So it sounds like you had some great mentors along the way and able to take lots of your interest in the one area and focus on, on cochlear implants and be there really from the beginning of when cochlear implants. Started. Um, but so just so all of our listeners are kind of on the same page. Um, can you give just a quick, like minute overview of what a cochlear implant is in case some people aren't, aren't sure about it.
[00:10:02] Sure. So a cochlear implant is, uh, he's, uh, is really the only neuroprosthetic that provides, uh, replacement for a sense, right? The sense of hearing and the cochlear implant. Is it really a semi implantable device. So meaning that the only part of it is actual an implant. The other part is worn outside and, um, the implant is inserted into the cochlear, which is the inner ear is shaped like a snail.
[00:10:29] And, um, the cochlea is really special in a way in multiple ways. In one way is that the frequencies are aligned along a certain, um, uh, you know, frequency distribution. So meaning that each pitch in the cochlear has a certain location and with multi-channel and cochlear implants that were FDA approved in 1985.
[00:10:52] And they utilize that principle. To stimulate each pitch at a different location within the inner ear, within the cochlear and really what they do to bypass inner hair cells, which is which of the rate-limiting step of hearing. And luckily it's the most commonly affected part of the hearing. Right? Usually the nerve is pretty good or, or, or.
[00:11:15] Adequate, at least for hearing with a cochlear implant. And we basically stimulate nerve endings, electrically via a cochlear implant, and the, the actual processing is done on, on the outsides. Um, and that may change over or, you know, down the road with, you know, the future of fully implantable devices, et cetera.
[00:11:34] But, um, ultimately. Two processing of the device, the sound pickup, and then the processing is done on the outside, in, through a coil, through a radio-frequency coil and similar to how you charge your, your cell phones these days. Right? It's all a wireless, uh, it's transmitted through a frequency link to the internal components.
[00:11:54] So that's really how worked twice, the only working, um, replacement for a sense. So, um, Yeah, it's pretty amazing technology. I can, I can personally say that by that. Yes. And, and I think it kind of brings me to my next point where, you know, I think a lot of people are still under the assumption that you have to pretty much have no residual hearing in order to, to be a candidate for a cochlear implant, um, and pretty much get no benefit at all from, from hearing aids.
[00:12:32] Um, and I know recently you were involved with a, um, A review publication titled , unilateral, CI’S that severe to profound or moderate sloping to provide profound bilateral hearing loss. And I think one of the main questions was how can we improve awareness about the potential advantages of cochlear implants in adults?
[00:12:57] Um, with, you know, severe, profound or moderate sloping to profound hearing loss. Um, can you let us know, or our listeners know a little bit more about what that publication revealed? Yeah. So, uh, this particular publication you're talking about is a product of Delphi consensus. Uh, which is basically, um, quite an intricate process and a company from the UK, uh, pretty much led that Cochlear corporation, one of the device manufacturers, uh, sponsored it, but advanced Bionics was involved MedEL was too.
[00:13:31] And, um, what it really entails is an expert panel and those were international expert. It's not just the United States who, uh, tackled, uh, several statements. And, uh, the idea of a Delphi process is that a, um, any kind of statement that it's run through it, pretty rigorous process. Like this was several rounds.
[00:13:55] So voting, uh, represents, um, you know, it represents the result of, of multiple people thinking, you know, experts around the globe thinking the same way. So it's really a nice way. And you know, not non of these statements is, uh, Earth shattering for us that have been involved with Cochlear implants. But you know, they're really solidifying, you know, the, um, you know, experts, thoughts on how well cochlear implants work, what, what, are problems, you know, what are things that, um, that need to be improved, et cetera.
[00:14:35] So it's really a nice process. And that was the first time I was involved in a Delphi, uh, consensus statements and process. And again, this publication is a product of that. So it was a quite, quite an intricate process. Dr. Buckman, Greg Buckman from WashU led this process for us. Right. Okay. Thanks. So, um, one thing that I think.
[00:14:56] Comes out of that. And I know you're a member of the, um, American cochlear implant Alliance and they came out with almost a Q & A and a about some, um, different things about adults with who might be candidates for cochlear implants. And one of the, um, Q and A's was basically, um, talked about that adult. Um, typically.
[00:15:24] My wait about 27 years. Um, before they go on that path to a cochlear implant, I feel like that's a, that's a lot of years that they might be. I don't want to say wasting, but you know, the quality of life might not be the same if they would have explore that earlier. So why do you think adults wait so long to even go down that path of.
[00:15:53] Looking at a cochlear implant or getting a consultation for a cochlear implant, you know, it's a multi-factorial and it's really, um, reflects what we see in clinic. Although 27 years sounds like a whole, a whole lot. Right. But you know, there's several problems with, um, within the. , you know, what's known about cochlear plants, uh, and we can break it down.
[00:16:20] One is certainly, and you know, you, you, you probably waited a little bit too, right? I mean, and everyone does, I would say right. And the most common. Comment. I hear in clinic, you know, it would be, see patients that'd be implanted into like yourself. Now we usually see folks after surgery once or twice, and then really just once a year.
[00:16:39] Right. And our audiologists do the majority of the work. And so for us, what I call installers, right. It's um, it's really, um, you know, we're not intimately involved. Well, your audiologist, but what I would say the most common thing I hear about a year or two after [00:17:00] surgeries, I can't believe I waited that long.
[00:17:02] Right. And that's sort of something we hear commonly, I don't know how you feel about it, but we can talk about that later. And, um, but it there's some, there's some psychological barrier to give up, to give up something. Right. And for a lot of folks, is that residual hearing, like you can still hear. You can't maybe not understand speech well, but you know, it's, you still have some function.
[00:17:26] Right. And, um, it's just really hard for people, for anyone really to give up something that still works on what's. Right. And we see that specifically with folks getting a second implant. Right. And. Uh, you know, really feel like they don't want to do that. And you look at the audiogram and there's almost nothing there.
[00:17:47] And you're like, why did they hold on to this little bit of the 110 DB threshold? Right. And it's like, well, they can hear the dog barking. Right. So those are all things that are, that are real. And they they're relevant for a lot of folks for some they're not so much, but it's, it's certainly interesting to hear stories.
[00:18:05] About why that is and why people wait. Do you know the other thing is there are a lot of myths out on cochlear implants. Do you know to the surgery takes four or five hours? And a myth, you know, that's, uh, it's really just the 45 minutes, uh, surgery at this point, you know, maybe an hour, but you know, it's really a much different procedure than it was when I started it.
[00:18:27] Right. And the other thing is that, you know, there's, there are myths about, you know, the risks and those are predominantly. Circulating in, you know, with regards to pediatric client plans, you know, and there are multiple factors for that as well. But, um, I think the, the, the, the issue of giving up residual function with a cochlear plan is certainly, is certainly an issue.
[00:18:57] Maybe one thing that's worth mentioning is. We're not very good about predicting how well people will do with a cochlear implant. Right. We have a hunch and there are certainly some people who we predict they wouldn't do well, and then they do. Okay. But you know, the scary part is that some people who we feel like would do great with a cochlear implant, do not.
[00:19:20] Right in bad performers are certainly a huge problem for cochlear implants. And we try to, with some of the research I've been doing and others have been doing over the years, right. We try to minimize the risk for patient. Right. So I think we use. For all as a, as a physician, as a surgeon, right? Your biggest fear is making anyone worse.
[00:19:42] Right. So I don't want to take that a residual hearing away from you, and then you can hear worse. Right. And that's really why our candidacy criteria are so strict. Right. We really want to just tackle people who are absolutely unable to use the hearing in a meaningful way. [00:20:00] And, um, so it's, it's certainly, we're sort of part of this process.
[00:20:05] And, um, uh, patients' fears are part of the process. Um, understandably so, um, I think as a surgeon, it's always easy to say what a surgeon. Not a big deal, right. Because for me, it's not for start for our patient is a different story. Right. And, and, um, uh, but certainly, uh, those are some of the facts or, yeah, no, I mean, you know what you said about people waiting and I'm an audiologist that works with a lot of kids that have cochlear implants and, um, being on the patient side has really made me realize, um, The decision and the emotion that goes into that decision making process, whether it's for your kid or yourself, um, when you're actually the patient, it's a lot different.
[00:20:51] And I would say I probably, I did wait, um, probably two years longer than I should have waited. And I mean, and when you compare to the 27 years, I ahead of the game, um, but I'm somebody that’s very informed about it and yeah. Uh, I think, you know, because I can share this and, and it's my audio gram, but I have essentially normal hearing in the low frequencies.
[00:21:19] So even without my hearing aid hearing aids, I was hearing a lot of things. So I was really scared to give up those little bit of hair cells that were still left in there. So I think every decibel I, um, Counted on. And I mean, I remember coming to that consult appointment with you or with you and with my husband and having that real conversation about candidacy and, you know, All of that.
[00:21:48] And that kind of leads me to my next question is, um, you know, candidacy has changed over the years, um, from like what we talked about earlier. Like having pretty much no hearing whatsoever, um, to an audio gram like mine, where you have. Pretty much, you know, there's ski slope looking audiogram with a lot of residual hearing.
[00:22:12] Um, can you tell us a little bit more about the research and, and the surgery related to hearing preservation now? Absolutely. So, um, as I mentioned earlier, you know, that, uh, giving up hearing and traditionally, uh, maybe for some of your listeners, so traditionally cochlear implants are unable to preserve.
[00:22:35] Right. And, um, I was fortunate that in my residency, in Frankfurt, Germany the guy who, um, invented really hearing preservation and then using that hearing, um, was a guy that was there and Dr. Van Alberich and he ultimately retired, but. Uh, his, uh, the sort of paradigm of electro acoustic stimulation obviously relies on hearing preservation.
[00:23:02] And it's really interesting that, um, we didn't think that we could save or preserve hearing with cochelar implants, you know, cause when we opened the , you know, we're all born with one set of hair cells and the thought was that by inserting that silastic. A piece, you know, which is really the electrodes right into the coal plant that we would ultimately damage it.
[00:23:26] And that's not far from the truth even today, but we've um, so over the past, really two decades, have provided us with improved electrodes, you know, smaller, smaller, electrodes, um, more flexible electrodes that we can insert into the cochlear. And we've learned a surgeons, right? It used to be done to just make a big hole in cochlear and just insert the electrode.
[00:23:51] That's very different now where we're, we're very gentle. We take. Time with electrode insertion and we have this monitoring system that's available and it's going to be used more and more. So we're just much better preserving here right now. How perfect is that? Certainly not perfect. Right. And as a, as a with future.
[00:24:15] Developments. We hope that we can further refine that technique, for example, where someone like you, maybe two years earlier, right. Where you still had good hearing, but you're like, well, um, I'm I need some clarity and high tones when I'm talking on a phone or whatever, right. That you would not be scared of getting a cochlear implant, because I could tell you when you come to me in clinic that Hey, I think I can just like a hearing aid, right?
[00:24:40] You, you, you add something with a hearing aid you add hearing, right. And when you take it off, it's the same. Right. And ultimately, I think that's where cochlear implantation needs to go in order to, uh, to, to gain further or broader application, uh, you know, um, use, you know, into who knows maybe it's worthwhile that about only three to 5% of cohort implant candidates.
[00:25:04] Actual receive one. Right. Which is, which is kind of mind boggling and crazy. But, um, there's, it's a huge bit, not that, but you know, again, it's more of a tutorial, but there's so many factors that prevent folks from getting a cochlear implant. Right. The first one is what do you trying to eliminate with your podcast?
[00:25:23] And then, you know, That, that the word gets out, but you know, there are other ones too. Right. So I think for, I mean, maybe to complete that list, you know, so a lot of folks have financial considerations on cochlear plants. They don't know that, you know, Medicare and then some state Medicaid, you know, pay for it.
[00:25:42] And, uh, so those are all really important facts. Yeah, no, I agree. A hundred percent. So, um, Another thing that kind of goes along with this is making decisions. And we talked a little bit about those who are not good users of cochlear implants, for whatever reason. Um, but as professionals, you know, we're telling our patients and families that a cochlear implant is not a quick fix.
[00:26:11] Um, so what is some things that you emphasize to your patients and families during that cochlear implant evaluation process in order to set them up for success? So that, that we don't have users non-users I guess. Right. So obviously non-users are our biggest nightmare, right? Uh, because then we've done something that they cannot utilize.
[00:26:35] And so counseling is important and realistic expectations are important. Now, uh, we always say, well, how realistic? And we try to gauge our realistic expectations are I can tell you from my, from my experience, that realistic expectations are often not realistic. Um, it's just, you know, it goes along with just the human nature of having hopes.
[00:26:56] Right. And understanding how socially isolating hearing aid are, uh, hearing losses oftentimes, especially for really profound hearing loss is right. It really is isolating a lot of adults struggle with social isolation and associated too. So I think it's just, people have high hopes, you know, it's really their only chance oftentimes.
[00:27:15] And, um, so it's always easy for us to say, well, that person doesn't have very realistic expectations, but it's really, it's really hard oftentimes to, to curb your expectations or your hopes and when that's, what you're looking forward to. So, uh, just to say that right off the bat, but what I would say is that.
[00:27:32] Um, we, uh, counsel and audiology is really at the center of this. I would say, you know, you know what our counseling entails is the different devices, the different manufacturers. So we let patients choose their device. You know, how to, uh, how. What the, what the process of, uh, the equipment batteries, et cetera, entail, you know, so that people are not so surprised by that fact, you know, what kind of processes are out there, how big they are, uh, let them touch it, feel it, you know, you see this goes behind you a ear.
[00:28:05] Um, so I think those are all important things. And, you know, the things that for us as medical providers that are often simple things. Right. But they're everyday things, right. That do matter. And, um, so we, we try not to just counsel about the, the hearing and thresholds and MCLs and all that kind of stuff.
[00:28:24] We really try to counsel the real life kind of implications, I think from expectations, going back to that, uh, we do tell folks that it's a, it's a, it's a process. That's for some people it's really not a lot of long process, right. From, in terms of appointments and all that. There are a few appointments, especially early on once the once the current levels are stabled and it's really just, you, you won't have that many appointments.
[00:28:48] Right. But I think would be tell folks, is that the more residual hearing you have, typically, even if it's on the other side, usually you have to force yourself more to use it. Right. [00:29:00] Cause it's a different hearing. You probably can attest to that. And, uh, you know, again, that is a process. It takes some training, right.
[00:29:09] Then multiple resources for training, the easiest one being, just watching television with your captions on. But you know, there are more sophisticated ones too. And, um, that, um, you know, surgery wise, we counsel that it's a small outpatient procedure that. Age is really not a contraindication. And, uh, a lot of people come in well, I'm 87 years old.
[00:29:33] I thought you wouldn't do that. That's not true. Right. And debt. Um, there's going to be some pain after surgery, but overall people heal very well. And if it's, if it's done properly, you know, one thing. That always comes up is what I'm going to shave a or I personally don't at all. Uh, you can probably confirm that we just brush it back and all that.
[00:29:55] So it's, it's just surgery wise. You know, again, it's easy to say that as a surgeon, but we're um, I don't think it's too. It's it's too. Right. Yeah. And I think being a patient, um, and I think maybe a lot of people feel this way. The first hesitancy is like the surgery. Um, and you know, going through that process and, you know, after being through the process, I realized that like, the surgery actually was the easy part for me.
[00:30:31] Um, uh, once, uh, the recovery, um, it was everything after. And like what you said, you know, um, I have Dr. LePrete as my audiologist and I feel bad for her having to have an audiologist program an audiologist. I'm probably not the best patient ever, but I give her, um, a lot of kudos for, uh, all of the appointments that she goes through with me, but I, every time it it's.
[00:30:56] Hearing something new. And to know that your brain can go from chirps to beeps and whistles to making sense of the speech is quite amazing that you can go through that. And I, I really do feel that patients, whether they're itty bittiies to older adults, need to understand that. That listening, therapy, and then having somebody coach you through that is critical for this success of, of, of the implant, especially if you're trying to integrate two different signals together.
[00:31:30] Um, I think that has to be a, yeah, absolutely. And I will add here, maybe Carrie that. Um, I feel that our counseling is good and it's, it's important, but I think maybe hearing it from someone who just, who just recently went through the process. Uh, maybe not just recently, but it went through the process period is probably pretty, pretty powerful because it's that different perspective that frankly I don't have.
[00:31:58] Right. And, um, so, uh, we, we often try to, you know, get patients, uh, with connected with candidates, you know, and existing patients. Yes. And, you know, I'm always willing to talk to someone who might be going through that process because it is scary, but once you get through it and just knowing what the expectations are, I think I, I important to you and we actually see that a lot, um, pediatric world or pediatric cochlear implantation.
[00:32:31] Right then. Um, , it's just such a big decision in such a pro such a more involved process, obviously, because we just can't test. Baby's hearing like we can test your hearing, right. So there's obviously much more involved and, uh, getting, getting a peer system in Place is, is, is, uh, in my mind critical.
[00:32:52] Yeah. I mean, I think that's been one of the greatest blessings of, of all of this being an audiologist and a cochlear implant patient, um, is to be able to counsel families, even though my journey is going to be much different than a child. I still have another perspective that most. Professionals don't have.
[00:33:10] And also I've been able to meet people all over the world because they've read my blog and they reached out to me in other ways, um, who are adults who are considering the process. That would been a great connector that way, too. Yeah. So you're sharing your story is fabulous. And, uh, you know, on behalf of everyone, On really in the field.
[00:33:29] We really appreciate that. And it's people like yourself will make a difference. Right. Well, thanks. But, so my, my one other question that I do have for you is that you have been, like you said, involved with cochlear implant since the 1990s, is that. And so, um, for quite a few years now, what do you think the future of cochlear implants holds and what kind of gets you excited?
[00:33:55] Do you have a vision or a thought process about that? So, first of all, maybe not directly linked to cochlear implants is the future of hair cell regeneration. Right? Because we get asked that question. It comes up all the time. Right. And ever since I've been involved with cochlear implants again, since the 1990s, it's going to be in over 20 years.
[00:34:17] Right. And now if you ask someone it's going to be another 20 years. Right. So if, really, if my answer to, to patients and candidates is that don't wait for that. It's not going to happen. It's. You know, just fix your hearing right now. Cause cause you brain and your psyche you're you're you're you as human being need to hear.
[00:34:37] Right. So I think maybe, maybe one, uh, one word on that. Um, I think future developments are again where we can, we can improve a hearing preservation capabilities to the point where we can preserve your. Reliably on everyone who needs to have to hear them for service. Right? So as we expand our criteria and were implanted, we've taken on more and more residual hearing places with more and more residual hearing, we need to, we need to be able to preserve it reliable, right.
[00:35:04] And not meaning, not meaning good. You say, Oh, an 85% or 90%. Uh, I want to say it like in 99%, it's almost certain that we can preserve your hearing. So I think that's really critical and I hope that the future will bring more technologies and techniques, et cetera, and devices that can allow us to do that.
[00:35:24] Right. The other thing is, um, I, do, uh, do you feel like, um, Well, some people don't care about it. I do think for the younger generation, it's ultimately going to be important to have a fully implantable cochlear implant. And I know there's several efforts on the way and really to technology has matured to the point where it's possible.
[00:35:46] Um, so I'm looking forward to a fully implantable cochlear implants. It's it's around the corner. I think it's not even that. But it's something that, uh, will likely come at some point, you know, there are certain disadvantages in certain issues. And what I always say, there's some technology that may allow you to, for example, if you, if you have a cochlear implant or to even, did you want to step into the shower?
[00:36:12] You would jump into the pool. Right. But you don't, you take them off, but you can still here for another 20, 30 minutes. Right. That would be great. Right. It doesn't have to be maybe great hearing, but you know, some kind of, some kind of it would be called invisible hearing. Right. Will be great. So you don't, you don't take your implant off.
[00:36:28] So I think those are all, uh, pretty, um, doable steps, um, that, uh, likely going to, uh, see the light here in hopefully in a few years. Uh, but I know, and I know that it's been worked on it's, you know, their, their efforts, even from the non-traditional companies, but there's some other startups that really work on this.
[00:36:51] So, uh, I think more. Or two done. It's great. Um, it's great to have that friendly competition between the manufacturers. I think it, it, it makes things better, right? It's good for the consumer. And, uh, I hope that that goes on. Right. And one thing maybe a lastly is as we as professionals are better at predicting future performance with a cochlear implant so we can avoid bad performance, right?
[00:37:23] I'd think bad performers or bad or not good for cochlear iplants. We need to identify people, find, uh, you know, alternatives and, uh, Hmm. I think it's really critical to identify folks who may not do well with the cochlear implants early on in the so, uh, we can, uh, we can again and find alternatives on, on, on the other side, if someone comes in and they have 60% or discrimination, but we can guarantee 85%, right.
[00:37:53] Then all of a sudden that patient becomes a candidate. All right. So I think it would be really critical for us to have a better understanding of these interactions and electrode placement. So there's a lot of research to be done in cochlear implants, and some folks argue it's very details and it may not make it, you know, there may not be a big jump in performance possible.
[00:38:13] I would disagree. So I think, uh, the future for cochlear implant plants is bright and hopefully we can, um, you know, we can reach more people with this technology. Yeah. Then it is all exciting, uh, information there. Kind of think about for the future too. So there anything else you want to add? Dr. Adunka, how can people get ahold of you if they're interested in maybe pursuing this route?
[00:38:39] Yeah. So, um, How to get ahold of me. So I'm at Ohio state and Children's and nationwide children's in Columbus. So, um, just look me up online, come make an appointment, come see me or one of my partners. I mean, if I'm blessed, they have a great department on both the pediatric as well as the adult side. So they're great doctors of audiologists.
[00:39:00] So it's just really a great team and it's a pleasure to, uh, to be working there. So I'm just one of the guys, right. And it's really just, uh, it takes a village. Right. So, um, I think I do want to mention that, that, um, we're pretty blessed with just having great teams. And so what I want to say is that, uh, for us as providers, right?
[00:39:21] It's um, we recognize that it's an emotional journey for patients with hearing loss. And again, hearing loss, we see that a lot that patients are really emotional about their hearing loss. Maybe not so much to hearing loss and The social isolation hearing loss comes along with, you know, and, uh, I think, you know, it's, um, it makes my day, if I see someone like yourself, but other people too, who maybe were less functioning before functional before that, and then they can go back out again and the restaurant is a Kroger or, you know, buy groceries.
[00:39:55] And ultimately we integrate themselves. So, um, for us, it's just really one of those things that make us go to work every day. And it's just a great honor, honestly, it's just a great honor to make people hear again. And, um, cochlear implant, a great, it might be an easy, uh, surgery for us, but, uh, Seeing that patient journey pan out, um, is just really priceless for us.
[00:40:20] So it's great. Well, I just want to thank you for being on today and being a part of today's podcast. I think our listeners will have a deeper understanding of. The widening candidacy option for individuals, um, and maybe take that next step and, and realize that it is a journey and it does take time.
[00:40:42] So again, other, thank you for listening. Yeah. Thank you. Thank you. Listen for listening and be sure to share this podcast. If you found that it is helpful with your friends and on social media and join our Facebook page. Thanks a lot. This has been a production of the 3C Digital Media Network.