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Dr. Nael Shoman, an associate member of the Neurosurgery Division with the Saskatoon Health Region, is now performing cochlear implant surgeries at both Royal University Hospital (pediatric surgeries) and St. Paul's Hospital (adult surgeries). Here, Dr. Shoman holds the internal electrode which is surgically implanted in the cochlea (inner ear).
Since the early 1990s, cochlear implant surgery has transformed the lives of hundreds of Saskatchewan residents who have a profound degree of hearing loss. The Saskatchewan cochlear implant team, which includes physicians, audiologists, speech pathologists and geneticists, has worked with patients of all ages, providing assessments, pre-and post-surgical treatment and rehabilitation.
However, one important element of the program was absent - an Ear Nose Throat (ENT) surgeon to perform the surgical procedures. For over two decades, Saskatchewan patients have had to travel to Edmonton, Alberta for these life-changing surgeries. As many as 45 to 50 Saskatchewan patients a year have received cochlear implants in Edmonton over the past five years.
Recently, these surgeries began to be performed in Saskatoon by Dr. Nael Shoman, a member of the Division of Otolaryngology - Head and Neck Surgery, and an associate member of the Division of Neurosurgery with the Saskatoon Health Region.
Shoman graduated from the University of Saskatchewan's College of Medicine and then completed his residency in otology and neurotology at the University of British Columbia. He went on to practice for two years at the University of Cincinnati Medical Centre.
The doctor's passion for "the ear" and cochlear implantation was ignited during his residency. "The more I learned about it, the more fascinated I became. It became a focal point for me and one of my main interests. I knew at some point I'd like to come back to Saskatoon and help establish this program here," says Shoman.
In 2011, the ENT specialist accepted a position with the Saskatoon Health Region. "When I came back to Saskatoon, we started talking about adding the last piece of the puzzle, which was the surgery," says Shoman.
"The program entails quite a few people, including audiologists, speech pathologists, geneticists, the ENT physician involved in the assessment of the patient and the ENT surgeon who does the cochlear implant. There are also people involved in the rehabilitation phase, which can range from members of the audiology team to social workers. We were fortunate because those parts of the team were already established. We just added the surgical aspect."
Almost two years of planning, budgeting and specialized training followed before the first adult cochlear implant surgery took place in October of 2013 at St. Paul's Hospital. The first pediatric cochlear implant surgery took place in January of 2014 at Royal University Hospital.
Designed to replace the function of a damaged cochlea (inner ear), the electronic medical device provides sound signals to the brain. The cochlear implant consists of two parts: an internal device with an electrode array that is surgically inserted in the inner ear and an external sound processor that is placed behind the ear.
"The internal device has an electrode that is implanted in the cochlea. About a month after that surgery, the patient receives the external device, which captures sound through microphones and sends it to a processor which analyzes the signal and sends it through a magnet to the electrode that has been implanted in the cochlea. The electrode stimulates certain aspects of the hearing nerve and relays those impulses to the brain. The brain analyzes that signal and makes sense of it, restoring the ability to hear in a lot of patients," says Shoman.
Who can benefit from a cochlear implant? Dr. Shoman explains, "A cochlear implant is a device for people who have a profound degree of hearing loss who have not befitted from hearing aids. Most have sensorineural hearing loss, also referred to as nerve deafness. They have lost a lot of the hair cells in the cochlea but the nerve itself, even if it's affected, still has some viable aspects to it."
There are approximately 15,000 hair cells in the cochlea which convey signals to the auditory nerve. Damage from disease, loud noise, certain medications or the aging process can permanently damage the hair cells, leading to severe hearing loss or deafness.
Although the cochlear implant program is based in Saskatoon, patient referrals are accepted from across the province. "It's a province-wide initiative," says Shoman.
He notes that a growing number of young children are being referred to the program as a result of the universal screening program that was implemented by the province of Saskatchewan within the last five years. "It catches more of the newborns. More kids are getting diagnosed with sensorineural hearing loss early on in their lives."
According to research conducted by the Canadian Agency for Drugs and Technologies in Health, the most common age range for children to have cochlear surgical implantation is between 12 and 24 months. "A patient who is born with hearing loss will do better if the implant is received early on, versus when they get older. The same thing applies to adults. If they receive an implant closer to any loss of hearing, as a group, they will do better than someone who receives an implant later on," says Shoman.
The surgery itself takes several hours, requiring a one-to three-day hospital stay, depending on the age of the patients.
Hearing is not achieved instantly after surgery, says Shoman. "There's about a month of post-op healing. During the first post-operative session, when they get their implant turned on, there's a fair amount of 'mapping', which is trying to fine tune the signal to a sequence that is comfortable for the patient - not too loud, not too soft. That may be fine-tuned, over the next few sessions," says Shoman.
"It's important to emphasize that there is a period of time, sometimes six months to a year, or longer, of rehabilitation where we train the brain to use this device."
During rehabilitation, the patient will work with an audiologist trained in cochlear implantation. "It may also involve working with a speech pathologist. The family plays a big role as well, as far as being supportive and providing encouragement," says Shoman.
"It's interesting to follow these patients through training and see how their lives change."
Since the devices were first approved by Health Canada in 1990, cochlear implant technology has improved dramatically, notes Shoman. Advances in integrated circuit and electrode technologies and sound coding strategies have improved performance and outcomes for a wider range of patients.
"Wireless technology has expanded the potential benefit of the cochlear implant," says Shoman, adding that the introduction of waterproof processors means the device can now be worn while swimming or bathing.
Having completed its first "trial year," Shoman says the cochlear implantation program "is going quite well."
He anticipates the number of cochlear implant surgeries performed in Saskatoon will continue to increase. "The answer comes down to demand. The hope is that every patient who qualifies for a cochlear implant receives a cochlear implant. We're working towards that goal."
http://www.thestarphoenix.com/health/Hearing+believing/10766621/story.html
Since the early 1990s, cochlear implant surgery has transformed the lives of hundreds of Saskatchewan residents who have a profound degree of hearing loss. The Saskatchewan cochlear implant team, which includes physicians, audiologists, speech pathologists and geneticists, has worked with patients of all ages, providing assessments, pre-and post-surgical treatment and rehabilitation.
However, one important element of the program was absent - an Ear Nose Throat (ENT) surgeon to perform the surgical procedures. For over two decades, Saskatchewan patients have had to travel to Edmonton, Alberta for these life-changing surgeries. As many as 45 to 50 Saskatchewan patients a year have received cochlear implants in Edmonton over the past five years.
Recently, these surgeries began to be performed in Saskatoon by Dr. Nael Shoman, a member of the Division of Otolaryngology - Head and Neck Surgery, and an associate member of the Division of Neurosurgery with the Saskatoon Health Region.
Shoman graduated from the University of Saskatchewan's College of Medicine and then completed his residency in otology and neurotology at the University of British Columbia. He went on to practice for two years at the University of Cincinnati Medical Centre.
The doctor's passion for "the ear" and cochlear implantation was ignited during his residency. "The more I learned about it, the more fascinated I became. It became a focal point for me and one of my main interests. I knew at some point I'd like to come back to Saskatoon and help establish this program here," says Shoman.
In 2011, the ENT specialist accepted a position with the Saskatoon Health Region. "When I came back to Saskatoon, we started talking about adding the last piece of the puzzle, which was the surgery," says Shoman.
"The program entails quite a few people, including audiologists, speech pathologists, geneticists, the ENT physician involved in the assessment of the patient and the ENT surgeon who does the cochlear implant. There are also people involved in the rehabilitation phase, which can range from members of the audiology team to social workers. We were fortunate because those parts of the team were already established. We just added the surgical aspect."
Almost two years of planning, budgeting and specialized training followed before the first adult cochlear implant surgery took place in October of 2013 at St. Paul's Hospital. The first pediatric cochlear implant surgery took place in January of 2014 at Royal University Hospital.
Designed to replace the function of a damaged cochlea (inner ear), the electronic medical device provides sound signals to the brain. The cochlear implant consists of two parts: an internal device with an electrode array that is surgically inserted in the inner ear and an external sound processor that is placed behind the ear.
"The internal device has an electrode that is implanted in the cochlea. About a month after that surgery, the patient receives the external device, which captures sound through microphones and sends it to a processor which analyzes the signal and sends it through a magnet to the electrode that has been implanted in the cochlea. The electrode stimulates certain aspects of the hearing nerve and relays those impulses to the brain. The brain analyzes that signal and makes sense of it, restoring the ability to hear in a lot of patients," says Shoman.
Who can benefit from a cochlear implant? Dr. Shoman explains, "A cochlear implant is a device for people who have a profound degree of hearing loss who have not befitted from hearing aids. Most have sensorineural hearing loss, also referred to as nerve deafness. They have lost a lot of the hair cells in the cochlea but the nerve itself, even if it's affected, still has some viable aspects to it."
There are approximately 15,000 hair cells in the cochlea which convey signals to the auditory nerve. Damage from disease, loud noise, certain medications or the aging process can permanently damage the hair cells, leading to severe hearing loss or deafness.
Although the cochlear implant program is based in Saskatoon, patient referrals are accepted from across the province. "It's a province-wide initiative," says Shoman.
He notes that a growing number of young children are being referred to the program as a result of the universal screening program that was implemented by the province of Saskatchewan within the last five years. "It catches more of the newborns. More kids are getting diagnosed with sensorineural hearing loss early on in their lives."
According to research conducted by the Canadian Agency for Drugs and Technologies in Health, the most common age range for children to have cochlear surgical implantation is between 12 and 24 months. "A patient who is born with hearing loss will do better if the implant is received early on, versus when they get older. The same thing applies to adults. If they receive an implant closer to any loss of hearing, as a group, they will do better than someone who receives an implant later on," says Shoman.
The surgery itself takes several hours, requiring a one-to three-day hospital stay, depending on the age of the patients.
Hearing is not achieved instantly after surgery, says Shoman. "There's about a month of post-op healing. During the first post-operative session, when they get their implant turned on, there's a fair amount of 'mapping', which is trying to fine tune the signal to a sequence that is comfortable for the patient - not too loud, not too soft. That may be fine-tuned, over the next few sessions," says Shoman.
"It's important to emphasize that there is a period of time, sometimes six months to a year, or longer, of rehabilitation where we train the brain to use this device."
During rehabilitation, the patient will work with an audiologist trained in cochlear implantation. "It may also involve working with a speech pathologist. The family plays a big role as well, as far as being supportive and providing encouragement," says Shoman.
"It's interesting to follow these patients through training and see how their lives change."
Since the devices were first approved by Health Canada in 1990, cochlear implant technology has improved dramatically, notes Shoman. Advances in integrated circuit and electrode technologies and sound coding strategies have improved performance and outcomes for a wider range of patients.
"Wireless technology has expanded the potential benefit of the cochlear implant," says Shoman, adding that the introduction of waterproof processors means the device can now be worn while swimming or bathing.
Having completed its first "trial year," Shoman says the cochlear implantation program "is going quite well."
He anticipates the number of cochlear implant surgeries performed in Saskatoon will continue to increase. "The answer comes down to demand. The hope is that every patient who qualifies for a cochlear implant receives a cochlear implant. We're working towards that goal."
http://www.thestarphoenix.com/health/Hearing+believing/10766621/story.html
