The Evolution of Cochlear Implants and the Cochlear Care Consensus

Hello everybody, and welcome to another episode of This Week in Hearing. And I’m your host this week, Brian Taylor. And with me today, I have the pleasure of interviewing Dr. Terry Zwolan, who is the Senior Director of Medical Affairs at Cochlear Americas. Dr. Zwolin is a very well-known, very renowned audiologist, and she, over the last couple of years, has joined Cochlear Americas. And our topic this week is the evolution of cochlear implants and the Cochlear Care Consensus. Dr. Zwolan, I want to welcome you to This Week in Hearing. It’s great to have you.

Oh, thank you so much. It’s really great to be here.

And I hope you don’t mind if we just use first names. Terry, okay?

Terry’s perfect. Thanks, Brian.

Sure. Yeah, no need to be so formal. Thanks. I thought before we dove into our topic at hand today, if you can maybe tell our audience a little bit about your background.

Happy to. I recently retired a few years ago from the University of Michigan where I was director of the cochlear implant there. I was at Michigan for 31 years, which means that I would say it’s sort of the beginning of cochlear implants. So it’s really been a pleasure and a blessing for me to travel this journey from the very beginning of when implants were first introduced. And I joined Cochlear a little over 3 years ago.

Okay. Well, so you’re well positioned then to kind of look at the big picture of how things have evolved over time.

Yeah, it’s been a real fun journey to see. If I look back on my younger self and I never would have guessed that implants have— would have progressed as far as they have. The outcomes are just amazing. It’s really been incredible to be part of it.

And so maybe tell us a little bit about some of that evolution over time and maybe how that’s contributed to changes in care.

Yeah, absolutely. With the very first early clinical trials in the ’80s, we didn’t know what to do with implant patients. We were kind of building the pathway of care. And a lot of it was dictated by clinical trials because the manufacturers told us how many times we had to see patients and what we had to do during those appointments. And it’s interesting to look back because a lot of that stuck. A lot of the frequent evaluations that we did to demonstrate safety, efficacy, clinicians have maintained and they keep evaluating our patients and we didn’t decrease appointments. In those early clinical trials, we saw patients 9 times the first year, and it totaled about 26 hours with our patients. But if we think about it, they didn’t have any volume control. So anytime they needed it turned up or turned down, they had to go back to the clinic. They had one program, so they couldn’t try a different program that might sound better. So they had to come back to the clinic. The appointments were really long. Our activations took 8 hours. We had to measure every single electrode and 22 electrodes with a soft and a loud sound. That’s a lot of measurements.

Wow.

Took a lot of work. And now we fast forward to today and our programming is faster. Our processors hold 4 programs. Patients can adjust volume. So our care should change because the technology has changed. The clinical care has changed. Our patients have changed. They used to have no hearing. They were really hard to communicate with. We had to write to them. Now our patients come in with sometimes normal hearing in the other ear, which makes it more challenging to map because their hearing’s too good in the other ear that it sometimes interferes with our mapping. So things have really changed. So it was a good time for us to look at how we’re doing things and have we changed enough. As technology and as clinical care and as our patient base has changed.

Yeah, let’s dig into that a little bit more. I mean, that’s a really interesting and unique perspective to think about all how cumbersome it was 30 years ago to program and work with somebody with a cochlear implant. What are some of the challenges that clinicians face today compared to what you just mentioned?

Yeah, it’s interesting looking back because we had a lot of time. We’d have 2 hours with the patient. We got to know our patients really well, a lot of informal assessment. And in today, in today’s clinical care, I think clinicians are stressed with less time and patients really don’t want to come back as often either. So it’s really a challenge to get them hearing the best that they can in a quicker amount of time or in less time in the clinic. And our patients really expect more and they want to do more independently. So technology changes have done that. Clinicians have tried to foster that amongst our patients. So some of those changes have really been beneficial. The other thing we see is clinicians are multifaceted. When I started with implants, most clinicians spent all their time just doing implants, highly specialized. I would say today clinicians spend about 25% of their time doing implants and 75% of their time doing other things. When you’re just completely immersed in implants, you get really good at it really fast. But when you only spend a quarter of your time on it, it takes longer to try new things, to learn new things, to really get quick and good at it. So I think today’s clinicians, with those time constraints and with those multifaceted career things that they have to do, really want guidance. And want to know how do I get my patient hearing the best that they can as quickly as I can?

Yeah, it’s pretty amazing how things have changed over the last 3 or 4 decades.

Absolutely.

Yeah. Let’s talk about the Cochlear Care Consensus. It’s something new to me. I really don’t know much about it. So if you could tell us a little bit about what that is and why it might be needed.

Yeah, thank you for that question. It’s been such a great experience to be part of this. A group of us were talking and thought, you know, clinicians want guidance, clinicians need guidance, and who better than to give them guidance than a panel of experts. If you look at the literature, not everything that we do with implant care has, has a real strong evidence base. Sometimes we start practicing in clinic and it takes a couple of years for that to reach the literature. So we wanted to give specific guidance to clinicians about clinical care from experts. So the consensus was developed with a lead. Renee Gifford served as the consensus lead. We invited 10 panel experts, and each panel expert was given a topic to look at. They then went and reviewed the literature and developed protocols for that area of expertise. And then sometimes it’s evidence-based. Most of it is evidence-based, but when it’s not, it’s important to supplement with clinical expertise. So this really provides the best of both worlds. It has evidence-based as well as all of the clinical expertise to say, this is how I use the evidence in my daily practice, and to be able to give those clinicians information about how to get the best outcomes for our patients while still being efficient. And really having it be modern and not just doing things the way we did them because we’ve always done them that way. It gives an opportunity for us to look at how clinicians are integrating this new technology into their clinical care.