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Pardon me?

New technology helps hearing impaired turn up the volume

How we hear How the Vibrant Soundbridge works About Dr. Brian Blakley How to protect your ears Now hear this What should I do if my hearing is getting worse? Hearing loss and children

BY KENTON SMITH
Winnipeg Health Region
Wave, March / April 2010

Starra Slykerman had a reputation around the office for being a bit distant.

Colleagues who tried to engage her in small talk often failed. People who hailed her in the hallway would find themselves ignored, almost as though they were not even there.

Aloof, quiet, snobbish - all these words were used to describe Slykerman. And yet, contrary to appearances, none of these labels were accurate.

That's because Slykerman's apparent social peccadilloes had nothing to do with a quirk of personality or an inexplicable disdain for all those around her. Rather, they had everything to do with the fact that the 42-year-old home-care co-ordinator suffers from impaired hearing, a condition that affects as many as 10 per cent of all Canadians.

Because her colleagues were unaware, Slykerman was often misunderstood.

"Colleagues and co-workers would attribute strange behaviour on my part, stemming from my hearing loss, to other reasons," Slykerman says. "People would think I was a snob, for instance, for not acknowledging them when they greeted me sometimes. The truth, of course, was that I simply couldn't hear them."

Fortunately for Slykerman, that changed last year when she became the first person in Manitoba, and one of the first in Canada, to benefit from a new type of hearing device that is implanted in the ear. The device, called the Vibrant Soundbridge, is one of several new products on the market today that are helping people like Slykerman regain their hearing, and a better quality of life.

The implant was done by Dr. Brian Blakley, an otolaryngologist (a specialist in ear, eyes, nose and throat diseases) with the Winnipeg Health Region, and one of a small number of doctors who are using new technology to help the hearing impaired. He says while these devices are not for everyone, they can be extremely beneficial for certain patients, Slykerman being a prime example.

"She is a very good example of what could be done," says Blakley. "For her, she has a lot better function, a lot better understanding, and she is able to do her job more effectively and communicate with people," he says. "It's a good thing."

The hearing process is an intricate one. Here is how it works: Sound travels down our ear canal and hits the eardrum. The vibration from the ear drum is then passed down to the cochlea, or the inner ear, and causes fluid in the cochlea to move, which, in turn, causes hair cells to move. The hair cells then produce tiny electrical, signals which are picked up by the auditory nerve, which sends information to the brain, which interprets the sound we are hearing. Hearing loss can occur when something interferes with this process.

Many people who suffer hearing loss tend to do so slowly over time, often because of regular exposure to loud noise, which can weaken the hair cells in the inner ear. But some people, perhaps as many as a third of those with hearing loss, can suffer significant loss of hearing over a short time for other reasons, including chronic ear infections.

Slykerman fell into the latter group of Canadians. Born prematurely, in 1967, she was prone to chronic otitis media, a recurring infection that causes a buildup of fluid in the ear, which, over time, impairs hearing.

"That's what started the whole process," Slykerman says. As a child, she had difficulty pronouncing words because she could not always hear them being spoken. "My hearing was never very clear. I never heard words to a song on the radio or anything like that. I was always just hearing the loudest portion of the word," she says. For example, until she was eight years old, she thought her twin sister Serena's name was "Reen."

As she was growing up, Slykerman was largely unaware of what she was missing, and relied on her sister for help. "My sister did a lot of communicating on my behalf - we were twins, right? We worked as a team - I was kind of the eyes and she was the ears. We had our way of communicating and there were a lot of times I would figure things out because she would tell me," she says. "For example, my mother would call us, and I wouldn't hear, so my sister would come get me, something as simple as that."

Eventually, after a few years in school, Slykerman was properly diagnosed with a hearing problem and given a hearing aid. But even then, little was done to address her problem or even correct her mispronunciation of words - everyone just accepted her the way she was.

Despite her hearing impairment, Slykerman made the best of things. She graduated from high school and eventually enrolled in Red River College's two-year nursing program. Upon graduation, she worked up north for a year before landing a job in Winnipeg.

As the years went by Slykerman continued to suffer from chronic otitis media in her right ear. Not only was it painful, it caused her ear to run constantly, and emitted a foul odour to boot. Such infections persist and even recur because the many air cells in the ear make it easy for infections to survive antibiotic treatment.

Slykerman's condition deteriorated to the point where she had to clean her ear several times a day. "The bacteria, the staph, the drainage - it was disgusting. It got to the point where when I was 30 years old, my ear was so gross that if you were sitting next to me you could literally smell it. It was driving me insane. It really affected my personal life."

By 1998, Slykerman had had enough. She visited Blakley and told him to do something. "That was a turning point in my life," Slykerman says. "I walked into his office and said, 'I need help. I can't live like this.'"

After assessing his patient, Blakley offered to do a radical mastiodectomy, a procedure that would resolve the problem with fluid buildup but would also involve taking out a substantial amount of the ear's mechanisms. Slykerman decided to have the procedure.

Blakley was able to successfully isolate and remove the infected mastoid surrounding the air cells. This created a large cavity inside her right ear, facilitating an airway that would prevent the infection's return. It also left Slykerman with little to no cartilage in her ear - in her words, it was just "bone and skin."

The problems associated with the infection were now under control, but by this point Slykerman had suffered an approximate 50 per cent hearing loss in the infected ear. Her left ear had also suffered infections and "was far from 100 per cent" as well.

At the time, Slykerman used a common hearing aid to enhance her hearing. Very quickly, however, she discovered the hearing aid was no solution. She could not hear clearly through the aid and it was extremely uncomfortable to wear.

Frustrated and resigned, Slykerman lived with her hearing impairment for the next decade. "At the time I thought, 'This is the way it's gonna be,'" she confides. "I just tried to accept my circumstances."

But eventually, the impairment took an even greater toll. By the time she was in her 30s, Slykerman decided to head back to university, intent on completing her nursing degree at the University of Manitoba. Professionally, Slykerman had found herself in an unhappy dilemma: although she had found gainful employment as a registered nurse following graduation from Red River College, her lack of a baccalaureate meant she had far less portability within her profession. "I was so behind the eight ball," Slykerman says. "It was a horrible feeling."

Upon entering the U of M's baccalaureate prepared registered nursing program, however, she quickly recognized the hurdles she faced were higher than ever. "I was terrified. The coursework was far more demanding now. And without a tutor like I had at Red River, I was at a double disadvantage." She would have to attend classes with a friend who could decipher to some extent what was being discussed in the lecture room.

Slykerman managed to struggle through most of her courses, until only four remained. However, she recognized she simply couldn't complete these under the same conditions. "Stats and nursing research methods - I really needed to be on the ball for these subjects." In her estimation, the way she'd been working was just not adequate for the task that remained.

Her desire to complete a nursing degree was but one important event in Slykerman's life that motivated her to seek help for her hearing impairment. The other was the serendipitous arrival in her mailbox of a flyer from the Canadian Hard of Hearing Association.

By this time, Slykerman had become more and more socially withdrawn. Unable to find a hearing aid that fit her particular needs, she quit wearing one altogether, which meant she was not able to hear everything that was going on around her. "Now I'm not completely deaf, but I'm in a really bad state. Fortunately, I had a job that allowed me to function well at my desk. When she went to meetings, she participated by simply trying to anticipate what others were saying.

Then she read a newsletter from the Canadian Hard of Hearing Association, which described hearing loss as "the invisible disability" and asked for volunteers to join the board.

"I remember thinking, 'How true is that?'" It came as a bolt from the blue for Slykerman, making clear that while she may have felt terribly alone, she was in fact not. So she called the chairman in October of 2008 and asked if she could sit on the board. The answer was yes.

Her involvement became a tremendous educational experience.

"They're an amazing group of people," she says. "I learned things about my disability, about how commonplace it is. As a nurse, I felt embarrassed, because I felt like I should have known these things."

These life-altering experiences - attending university and becoming involved with the Canadian Hard of Hearing Association - prompted her to again seek a solution to her problem. And that led her back to Blakley in February 2009.

"There's got to be something you can do," she told him. As it turned out, there was.

Blakley suggested that Slykerman consider the Vibrant Soundbridge. It was the first time Slykerman had heard of the device, but she was game. "I needed to try," she says. "I just needed to hear."

Blakley knew that the device was not a good option for every patient who is hard of hearing. But he recognized that Slykerman was an excellent candidate for the device.

First, she still retained good cochlear function, which is to say the nerves in her cochlea were still functioning just fine - they were both picking up vibrations and transmitting them to her brain. Second, Slykerman had demonstrated herself open to exploring alternative solutions, and Blakley observed her noticeable transition from passivity to motivation. After doing some independent research of her own, Slykerman says she was willing to be a "human guinea pig."

With patients like Slykerman, Blakley says it is often wise to keep the mastiodectomy separate from the implant of a hearing device. "With Starra, the first priority is to clear up the infections. Then, the second thing is to make her hearing better, if you can. If you try to do both at the same time, often you fail."

The Vibrant Soundbridge does not work like a hearing aid, which essentially functions by amplifying sound. Instead, the Vibrant Soundbridge has two components: a floating mass transducer, which is implanted on a membrane over the cochlea and an audio processor, which is installed behind the ear. These two components work in harmony to enhance the middle ear's functionality. The processor picks up sound and transfers it through the skin to the implanted coil, which then relays the signal to the floating mass transducer. This stimulates the fluid in the cochlea, which eventually results in a message being sent to the brain, which is interpreted as sound.

(Slykerman's case is somewhat exceptional in that it's actually the adjacent membrane that is made to vibrate. According to Blakley, about one quarter of Vibrant Soundbridge implants in the United States are done this way.)

On June 26, 2009, Slykerman underwent the procedure to implant the device. It was, in Blakley's words, "fairly difficult - there's some tricky anatomy involved." Fortunately, two representatives from Vibrant Med-El, the company that makes the Vibrant Soundbridge, were present to provide guidance.

An incision was made on the side of Slykerman's head, then a hole was drilled to create a well in the skull where the floating mass transducer could be implanted. In total, the procedure took about an hour and a half.

That procedure, to put it plainly, has changed her life. Before the surgery, it was mostly impossible to hear what people around her were saying. Certain possibilities in life seemed off-limits: She was too scared, for instance, to travel to any country where people spoke with some form of accent. Now, she says, "I have the opportunity to do whatever I want, both personally and career-wise."

She is also grateful to Blakley. "He's amazing," Slykerman says of the doctor who changed her life. "Without him . . ." Her voice trails off. Words fail, but the tone in her voice makes her true feelings clear.

In Blakley's view, hearing is under-represented as a health issue in relation to its importance. And while some individuals may require devices like the one being used by Slykerman, others may be better off with a different solution. "The company that makes (Vibrant Soundbridge) hopes to market it to those (with common hearing loss), which is good, except that sometimes individuals (with hearing loss) have a speech discrimination problem. The device will not overcome that." Blakley adds that for people who do have good sound discrimination scores, "very often an ordinary hearing aid is a better idea."

There are other options for the hearing impaired, including cochlear implants and bone-anchored hearing aids. Both solutions involve implanting devices to help patients hear. And all of them, Blakley says, have the potential to significantly improve a patient's quality of life.

For Slykerman, meanwhile, the challenge is to adjust to her new sensory overload - or, as she puts it, the sheer volume of things.

"Oh God, the world is so noisy!" she says. It was actually "freaky" when the processor was attached six weeks after surgery and I could hear, for example, just how loud a car really is. But it was also a thrilling period: she could previously never hear simple sounds such as the jingle of her security badge - now, they have become an endless source of music to her ears. "And the clarity!" she effuses. "I had never heard people's voices as clearly before. Let me tell you, I was giddy."

Her life transformation was even broader in scope than that. No longer, Slykerman says, did she feel she was "in hiding." Eventually, she was able to reveal to more and more people her secret disability. "People would be shocked. They had never guessed," she says.

Slykerman is not the only one who's needed some adjustment. "My children have been floored," she effuses. And it's transformed her life in other ways: this otherwise "pretty private" person is now speaking publicly of her experiences. Last November, she was invited to speak to the weekly Living with Hearing Loss class at the Society of Manitobans with Disabilities. And, perhaps most significantly, she has learned to advocate for herself: from now on, she ways, she will be more assertive about her personal health. "It's embarrassing that, as a nurse, I didn't deal with this sooner."

Kenton Smith is a Winnipeg writer.

	About Wave Wave is published six times a year by the Winnipeg Health Region in cooperation with the Winnipeg Free Press. It is available at newsstands, hospitals and clinics throughout Winnipeg, as well as McNally Robinson Books. Read the March / April 2010 issue of Wave