Tuesday, October 16, 2012

Evaluation Process

[I'm going to jump backwards in time here.  Lest you worry that I don't come out of the surgery OK, let me remind you that I have indeed lived to tell the tale.  So, there will be more posts about surgery and recovery, including one from William. His side of the story is pretty important, too.]

The evaluation process for a cochlear implant is fairly involved.  Because an implant is so expensive, insurance companies want to make sure that their money won't be wasted on someone who will not benefit from the implant. The question to answer is, "Are you deaf enough to benefit from the implant, or can you get by with just a hearing aid?"  Perhaps there's a more scientific way to put it, but that's the gist.

There were three parts to the evaluation, and we started in June 2012.  The first step was simple enough, a hearing test with my audiologist Amy Gensler. Because they're trying to determine whether a patient will continue to derive benefit from a hearing aid, the hearing tests are done with the hearing aids on to see how well the patient performs. 

Amy tested my right ear first, then my left ear.  The test had two parts: one involved listening to tones and indicating when I could hear the tone by pushing a button, and the other had me repeat sentences that were played.  The tones were used to plot my audiogram, to show the range of pitches and volumes that I could hear.  The sentences were played from a recording of several different people, men and women, saying stuff.  It was played from a recording to determine how well I could hear without any external cues, like context, social setting, or lip reading.  The sentences were played up to two times, and I had to repeat back whatever I understood.  Even if it wasn't the whole sentence, I could repeat any words or phrases that I heard.  There were 20 sentences altogether. 

With my right ear, Amy played all 20 sentences, and I had 25% intelligibility rate.  With my left ear, Amy played the first 10 sentences and when it became clear that I couldn't understand any of them, she ended the test.  At best, I could tell whether it was a man or woman speaking, but nothing came close to being intelligible. No surprises there. The minimum criteria is 50% comprehension, so I came well below the standard.  Amy also spent some time during that appointment showing us the implant equipment and explaining more about the surgery. William had a great time playing with all of the equipment, probably because there were all kinds of buttons and cables to look at.

After determining that I was indeed deaf enough, Dr. Slater's office ordered more medical testing to determine whether my ears' anatomy would accommodate an implant.  That required a CT scan to look at the cochlear anatomy and an MRI to look at my auditory nerve.  Those scans happened at a radiology clinic here in Austin, a few weeks after my initial appointment with Amy. The clinic would do the scans and send them to Dr. Slater for evaluation, so I didn't learn anything from doing those tests.  Doing an MRI is kind of like being buried alive except way noisier. Claustrophobia at its worst. I hope I never have to do that again!

I had my first appointment with Dr. Slater after these two tests. Up until this point, I'd been under the impression that we would play it safe by implanting my left ear first, so that if the implant didn't work, I would still have my hearing in my right ear to go by.  Dr. Slater indicated otherwise.  Because my right ear had been my dominant ear for so long and the neural pathways to my brain were far more developed, my right ear would adapt much more quickly to an implant than my left ear.  In a best case scenario, my right ear could be at a 75-90% comprehension within 4-6 weeks of implantation, while my left ear could take up to a year to be truly proficient at recognizing sounds and turning them into something meaningful. That's quite a steep learning curve. The next question was whether to do one implant, to implant both ears simultaneously, or to implant one ear and then the other at a later time. Dr. Slater's opinion, which I was inclined to trust, was that the best approach would be to implant my right ear first, get it up and running, and then to implant the left ear later.

My cochleas are malformed, which put me at a higher risk for dizziness after an implant.  So, Dr. Slater ordered vestibular testing to see what kind of side effects to anticipate post implant.  Vestibular testing was done in his office and basically consisted of me sitting in a La-Z-Boy with a bunch of electrodes attached to my head.  I also had to look at a bunch of bright lights while an audiologist watched how my eyes tracked them.  The last part of the test involved blowing air into my ear and seeing how dizzy it made me.  It sounds way worse than it was, and I didn't have any problems driving myself home after the test.  

After all this, Amy put together the paperwork for insurance approval.  All of this testing and documentation was sent to my insurance company where a medical director there would have the final say on whether implants would be approved.  On September 14, 2012, we received a letter that indicated that I'd been approved for implants in both ears. I didn't anticipate any problems with the approval because my hearing is just so poor, but it was nice to have confirmation at last. 

1 comment:

  1. Thanks for all the background information. It is very helpful to know what's involved in the approval process. Cousin, I'm totally enjoying your blog. Thank you for sharing all of this.