Dr. Steven A. Telian

University of Michigan: Steven A. Telian, M.D. (Co-Principal Investigator)

Implanting the device is a delicate microsurgical procedure that takes an experienced surgeon from 90 minutes to three hours, according to Steven A. Telian, M.D., professor of otolaryngology and medical director of the U-M Cochlear Implant Program."First, we make a recessed area in the mastoid bone behind the ear to hold the electronic receiver/ stimulator," Telian says."Then, we drill an opening into the cochlea and insert the electrode.To access the cochlea, we have to work right next to the facial nerve, so the surgeon has to compromise between being able to see well and making sure the nerve is not damaged."

Cochlear implants can't help people without an auditory nerve, which carries sound from the ear to the brain.For people without an auditory nerve, there's a new type of technology called an auditory brainstem implant."Instead of a string of electrodes placed in the cochlea, there's a patch of electrodes placed on part of the brainstem called the cochlear nucleus," says Telian.

"Cochlear implants have been around for 20 years in commercially available form," says Dr. Steven Telian, professor in the department of Otolaryngology and medical director of the University of Michigan's Cochlear Implant Program.
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A cochlear implant works in a similar manner, Telian says.
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Telian says about 70,000 people worldwide have cochlear implants -- more than 1,000 of which were done at U-M.Still, he says, that's about 10 times less than the number who should have them.
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Telian says patients must heal for 30 days before the external transmitter can be fitted and programmed.After that, they will likely need speech and other auditory training.Initial improvements in hearing are recognized about three months after the tuning session and continue over several years.

Doctors say generally children are slower to adapt to the new sounds than adults and need a lot more training.

"It's not natural hearing because it's electronic," Telian says."Some people who have had normal hearing in the past say it's cartoonish.But with adjustments, they can eventually tell male and female voices, talk on the phone, recognize different sounds."

Like any surgery, Telian says, this one has risks.

"The most common thing is that the internal device can fail electronically," he says, adding that statistics show that has happened in only 2 percent of cases in the last decade.

Steven A. Telian, MD John L. Kemink Professor of Otorhinolaryngology, Director, Division of Otology, Neurotology, and Skull Base Surgery, Medical Director, Cochlear Implant Program, Department of Otolaryngology-Head and Neck Surgery

But Dr. Steven A. Telian, medical director of the Cochlear Implant Program at the University of Michigan Medical School, says that bilateral implants do not make sense in our current health-care system.

Telian has studied the use of cochlear implants in blind people."The benefits of the first implant are immense.The second is incrementally much smaller," he said.

Most implant centers barely break even with the reimbursement they receive for the implant surgery and especially for the follow-up care that patients require, Telian said.

"From a public health standpoint, it's not possible," he said.

The paper's other authors are audiologist Angelique Boerst, M.A., and Steven Telian, M.D., medical director of the UMHS Cochlear Implant Program, one of the largest and oldest in the nation.

The paper's other authors are audiologist Angelique Boerst, M.A., and Steven Telian, M.D., medical director of the UMHS Cochlear Implant Program, one of the largest and oldest in the nation.