Cochlear implants can be life-changing, but few receive them. Medicare expansion could help.

It is clear from even one conversation that Mariane Fahlman describes herself accurately. The New York native is gregarious, extroverted, and outgoing.

But a year or two ago, she started turning down invitations to dinner parties, get togethers or events.

Why go only to be disappointed and frustrated?

Fahlman, 68, of Warren could not hear. She had lived most of her adult life with hearing loss, but it was getting worse.

It affected her work as a professor at Wayne State University in Detroit. She could not understand her students. A Dominican sister, she stopped going to church, started to isolate.

“I cannot tell you what it was like to think that this was going to be my life,” she said last week.

“To think you’re just going to have to be a recluse is just horrible.”

She says a cochlear implant, an electronic medical device designed to restore the ability to perceive sound and understand speech, saved her life. It kept her working and engaged.

Without it, she said, “I think I would have gone into a really deep depression.”

Cochlear implants improve sentence recognition, often significantly, for people with severe hearing loss who find hearing aids no longer affective. One 2020 US study found 91% of 96 participants at 13 institutions showed 15% or more improvement on a word test in their implant year in six months.

Those with implants are better able to perceive different sounds, talk on the phone, watch TV with out captioning, and communicate without lipreading. They experience improved quality of life.

However, less than 10% of candidates in the United States receive the surgery, according to a decision memo from the Centers for Medicare and Medicaid Services, which cites a 2021 study published in the journal Seminars in Hearing. Large patient financial responsibilities for implantation and related services are one reason.

The rate could improve.

Last month, the centers broadened the patient criteria for cochlear implantation and removed restrictions for some to participate in a research study. This means more patients covered by Medicare could receive implants.

Henry Ford Health Dr. Kristen Angster, a neurotologist and Fahlman’s surgeon, advocated the last year for the change along with Henry Ford Health audiologist Chelsea Conrad. Angster said she wrote a lengthy recommendation and promoted it to state representatives.

Dr. Kristen Angster is a neurotologist at Detroit-based Henry Ford Health.

Other professionals, too, supported the proposition. There was a national petition campaign.

Teresa Zwolan, director of the cochlear implant program at Michigan Medicine in Ann Arbor before he retirement last year, was one of two authorities who penned the formal request.

Under the old criteria, people were having trouble communicating, but could not undergo implantation because they did not meet the criteria, Angster said. “And people would get, upset, obviously, and frustrated because they were struggling, and the hearing aids weren’t cutting it for them. And we had a good solution that we know was appropriate, but we couldn’t offer it. “

The cost of implants – a total of about $ 130,000, including surgery, Angster said – make it almost impossible for people to obtain them without insurance.

The centers concluded evidence is sufficient to determine implants may be covered for treating bilateral, sensorineural, moderate-to-profound hearing loss in people who have limited benefit from amplification, meaning test scores “of less than or equal to 60% correct in the best -aided listening condition on recorded tests of open-set sentence cognition. ” (Sensorineural means damage to the inner ear.)

Previously, limited benefit from amplification was defined by test scores of less than or equal to 40%. The implantation was covered for people with greater ability if the provider participated in a trial.

With the national change, professionals can advocate too to private insurers, often receptive to keeping up with the latest standards.

Insurance was not an issue for Fahlman, covered by employer insurance and Medicare; she had little out-of-pocket expenses.

She first discovered her unexplained hearing loss when she was in her 20s, teaching and working on the weekends as an emergency medical technician. “And all of a sudden, I couldn’t hear any blood pressures, like everybody was dead, and I knew they weren’t dead.”

She went to have her hearing checked. Back then, all she needed was a stethoscope with a microphone, but the condition progressed.

Fahlman long navigated the world with hearing aids. A health and physical education professor at Wayne State for the last 26 years, she noticed when she returned to the classroom after the pandemic break, there was a significant change. “I literally could not understand my students.”

Increasing her hearing aid volume did not help. “It didn’t matter.”

She messaged her audiologist in November. Testing showed she was recognizing only 60% of words. “Which would be fine if you’re just a normal person and you’re missing things in conversation. But I can’t miss four out of six words that my students are saying. “

She wasn’t – and still isn’t – ready to retire.

She sees teaching as her ministry, her way of bringing the love of God into the community, not by converting people, but by showing them they are valuable.

“You should leave your job because you want to, not because you have to,” her audiologist, Erica Bennett of Henry Ford Health, told her. “I almost cried when she said that,” Fahlman recalled.

In March, Angster surgically implanted an electrode, which attaches to an external device with a magnet.

Mariane Fahlman after surgery

Mariane Fahlman poses after surgery. The photo is titled “home and happy.” She had an electronic device surgically implanted. The side effects were minimal, she said, and the benefits “life-changing.” A professor at Wayne State University, she can understand again her students, even when they are masked.

Angster makes an incision behind the ear. She removes a portion of the bone with a drill and inserts the device through a membranous window into the cochlea, the hearing part of the inner ear.

Several electrical contacts along that electrode send signals down the nerve for hearing. “So, it kind of skips the part of the ear that aren’t working for the patient,” Angster said.

An external piece picks up sounds with a microphone, processes the sound and transmits it to the internal part.

Results, for carefully screened, evaluated, and counseled patients, are usually good, said the doctor, who does several of the surgeries every month as part of a program Henry Ford Health is trying to grow. She has given implants to teenagers and to people as old as 96. On average, patients are in their 60s, she estimated.

The US study of 96 patients, led by a doctor from Washington University in St Louis, Missouri, found the word score in the best-aided condition improved six months after surgery by a mean of 37.3% for people 65 or older and an average of 50.4% for younger people.

Henry Ford Health maintains a list of patients who would have benefited but an insurance issue prevented implantation. “So, it’s great to be able to reach out to those people and say, ‘Hey, look, the guidelines updated. Come back in, ‘”Angster said.

She – and the patients – know how much the implants could help.

“(Hearing) affects relationships. It affects your ability to be social, even just on a day-to-day basis when you’re trying to navigate the world, ”Angster said.

When patients, especially older ones, start to withdraw socially, there are implications. Such isolation has been tied to memory loss. They are more likely to develop dementia.

There are potential side effects – everything for a while tasted salty to Fahlman, but “that’s nothing,” she said. More serious possibilities include facial nerve damage, loss of residual natural hearing and device failure, but they are rare, Angster said.

“One of the things I love about ear surgery is that you help people and fix them and sent them on their way. They don’t need me anymore. “

The implants, however, are not like eyeglasses, which improve sight almost from the moment someone begins to wear them.

They require rehabilitation.

Initially, people often describe hearing only a noise or beeping.

“And as your brain practices listening to that, it becomes more and more clear and becomes words again,” Angster said.

Fahlman, a former marathon runner, proved to be a motivated patient. “I know what training takes and do whatever is necessary to be successful with this.”

The implant can connect with a smart phone. She has an app with advancing exercises. It started by asking her to distinguish between vastly different words and progressed to subtly different words. She would watch YouTube videos using her implant ear. She listened to podcasts.

At first, everyone sounded like Mickey Mouse, but eventually the brain normalizes the sounds, as hers first did with Jeopardy host Ken Jennings. Suddenly, she realized he didn’t sound like a cartoon character.

The hardest part is listening “through the air,” but at Fahlman’s six-month checkup, she had excellent results.

Though students continue to wear masks in classrooms at Wayne State University, Fahlman can comprehend their comments in their classroom discussions.

At a recent lunch, to Fahlman’s delight, her co-researcher, accustomed to such interventions, did not have to repeat the question of a masked waiter.

A couple weeks ago, she attended a large celebration at the motherhouse of the Dominican Sisters of Adrian. “I understood the homily. I understood the readings. I was like, ‘Oh my gosh, this is so nice.’ “

Fahlman was shocked to learn such a small percentage of eligible people – she was told it was 5 to 7% – receive the implants.

“Why would you not do this?”

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