Dr. George Alexiades, Pioneer in Cochlear Transplants
With what can only be called serendipitous coincidence, Education Update caught up with Dr. George Alexiades, an amiable and expert ear surgeon of Greek extraction, to talk about “cochlear” implants. The word “cochlear” comes from Greek, kochlias, which means snail with spiral shell—which is exactly what the cochlear implants look like. Dr. Alexiades, who has been performing the operation in the Department of Otolaryngology at the New York Eye and Ear Infirmary (NYEEI)—now “the only such institution in the city”—notes that the surgery, which has been around since the eighties and was once considered experimental, has now entered the mainstream, though for sure, the entire procedure, including device and hospitalization, can be costly—approximately $50,000. Still, as cochlear implants become more common—NYEEI performs about 120 a year and, Dr. Alexiades says, “the number is growing”—and as insurance companies now cover one ear—the public can probably look forward to some diminution in cost, especially because the field of ENT (ear, nose, throat) itself, of which cochlear implant research and surgery is a specialty, has become incredibly competitive, particularly in New York City.
There has also been a remarkable change in the deaf and hearing-impaired community. Formerly opposed to cochlear implants, the community now supports cochlear implants and in fact sees its own role growing as a provider of ancillary social services. Indeed, as Dr. Alexiades points out, though cochlear implant surgery can be performed on infants as young as seven months and on elderly adults into their nineties, as long as they are in general good health, the best candidates are the very young, children two years old, for example, which means that older children who receive implants will do well if they also receive assistance from the hearing-impaired community, instruction in lip reading or ASL. And no doubt this community will also be providing pre-surgical counseling as well as assist in general education. It’s important to note, for example, that a cochlear implant will not create so-called normal hearing conditions. What it will do is provide a child (or adult) with sound that is interpreted as speech. (Hearing aids, by contrast, amplify sound.) Cochlear implants involve a microphone, a speech processor, a transmitter and electrodes, all of which work together to allow a profoundly deaf child or adult to process speech sounds and communicate. Those who receive an implant early on can even talk on the telephone.
Of course, there is great need for post-op therapy to assist in the development of language and social skills, but Dr. Alexiades, a well regarded researcher as well as surgeon, does feel that cochlear implants have had marvelous results. He cautions, however, that prospective candidates should understand what “success” means, and he notes that this tricky word means different things to children and adults. A government health web site indicates that so far approximately 22,000 adults and 15,000 children have received cochlear implants. (Australia and Austria have also forged ahead making the devices.).
The device itself, which looks like a hearing aid, with a wire and coil, and can be made of titanium or ceramic, has two parts: an internal component—receiver /stimulator, which receives signals from the processor and by way of electrodes carries those signals to the brain, is surgically imbedded under the skin, behind the ear. The external component—a microphone, which picks up sounds from the environment, and a speech processor—is removable at night. As the technology is refined this component can easily be upgraded.
Research does not yet show why some children are born with severe hearing deficits—whether the malfunction is genetic or congenital—but down the line, says Dr. Alexiades, say “15 to 20 years” stem-cell research may be able to make such determinations. Meanwhile, he is thrilled to be part of a unique field of medicine, the only area that can restore a sense. What “an incredible fact,” he says. And what a remarkable man to say so.#