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Pump up the Volume

A Centreville couple receives cochlear implants at the VCU Medical Center

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Something magical happened the morning after Joe Duarte’s second cochlear implant was activated. As Joe drove back to the Virginia Commonwealth University Medical Center’s Cochlear Implant Center for a follow-up appointment, he decided to check out the quality of his new stereophonic listening ability.

“I screamed, ‘Yes! Yes! Yes!’... It was amazingly beautiful. I listened to Elvis Presley and the bass was so rich that it left me in a state of awe,” Duarte said. “The voice, the words and the music and the clarity of it all was very overwhelming.”

And Joe was by no means alone in his revelation. His wife of 25 years, Meg Duarte, was seated by his side. She told him to keep calm and keep his screaming down because he was hurting her “new ear.” Meg herself was in discovery mode, also experiencing sounds she had not heard before. She too had had a cochlear implant activated the day before – only this was her first.

“It was an awakening of the senses - I became so alert with the sounds coming in,” said Meg, describing her first impressions after her cochlear implant was turned on. “It was a relief to discover my ear was just deaf, not dead, which was the sensation I had been feeling before the cochlear implant surgery. I feel that a balance of sound will be returning to my life once again.”

She further described the new sensation of gross sounds coming to her newly activated ear, including dishes and silverware rattling in a restaurant the pair visited, doors shutting, Joe sneezing and the high frequencies of people’s voices - especially the “s” and “sh” sounds.

For the greater part of their lives both Joe and Meg, who live in Centreville, have had severe to profound hearing loss. The origin of Joe’s hearing loss is unknown, but he began using hearing aids when he was just 4 years old. Meg had severe hearing loss in both of her ears since birth, and five-years ago – it was literally overnight – she experienced further hearing loss in her left ear. Not even a hearing aid could help her.

Now thanks to a team of doctors, nurses, anesthesiologists and audiologists at the VCU Cochlear Implant Center, the Duartes are able to experience sound in color and more fully explore the word around them.

A visit to VCU

Joe did a lot of research before deciding where to have his cochlear implant surgery done. For 10 years, he had been keeping a mental tab on the various cochlear implant centers across the country based on the surgery experiences of friends and associates.

It was after meeting the team at the VCU Cochlear Implant Center — Daniel Coelho, M.D., co-director and medical director of the VCU Cochlear Implant Center; Sean Kastetter, senior cochlear implant audiologist at the VCU Cochlear Implant Center; Suzanne Hasenstab, Ph.D., former director of audiology and professor of otolaryngology; and Aristides Sismanis, M.D., former chair of the VCU Department of Otolaryngology Head and Neck Surgery — that he was sold. Joe said the team consists of “top notch professionals that inspired a level of confidence.”

“The success of my cochlear implants, and of many other people who had their surgeries at VCU, is proof of the quality of the cochlear implant program at VCU,” he said.

On Sept. 21, both Joe and Meg underwent cochlear implant surgery performed by Coelho and his team. The Duartes are the first couple in the history of cochlear implant manufacturer, MED-EL, to receive cochlear implants on the same day.

A cochlear implant is a device that allows individuals with severe hearing loss to convert received sounds into a series of electrical impulses – thereby helping them to hear.

“A cochlear implant is a way of electronically bypassing the parts of the inner ear that are not functioning,” Coelho said. “For patients with severe hearing loss, a hearing aid may not provide adequate volume or clarity. However, for the right patient, a cochlear implant is able to provide both with amazing results.”

According to Coelho, the benefits of cochlear implants are numerous and substantial.  For patients who previously had hearing, it allows the recipients to return to a more normal life filled with sound, voices and music.

“For those who never had hearing, particularly in children, it opens up a world of sound that hearing people take for granted, and that never would have been possible without this technology,” he said.

In addition to the auditory benefits of cochlear implants, the ability to hear has profound effects on our ability to develop speech, hold a job, enjoy socializing, attend public events, participate in religious services, elevate mood and enjoy many other benefits that are only just now being discovered. 

During the cochlear implant surgery, which takes about one-and-a-half hours, an electrode array is inserted in the cochlea through a minimally invasive incision made just behind the ear. Following surgery, pain is typically minimal and most patients are able to return to their daily activities within one week and the device is usually activated three to four weeks post-surgery.

Sean Kastetter, senior cochlear implant audiologist at the VCU Cochlear Implant Center, activated and programmed both Joe and Meg’s devices. During their appointment, Kastetter sat in front of a laptop with a screen that looked similar to a soundboard or equalizer on the stereo. He introduced Joe and Meg to a range of frequencies by adjusting the volume based on their recommendations.

“There is a learning curve with cochlear implants – it’s not like putting on a pair of glasses – when you put glasses on, all is clear immediately,” Kastetter said. “With the cochlear implant, a patient’s brain will need a little time to transition and re-learn what some sounds are. The brain needs to build a dictionary of all the new sounds. Usually by six months or so, the patients are doing well.”

For this reason, according to Kastetter, the first two months following cochlear implant activation can be difficult, and at times frustrating, for patients. It can take a few months just to figure out where the sound is coming from. However, between six months and a year, patients can expect big gains – and during this time there will be improvement in speech as well.

Although cochlear implants have been around for nearly 30 years, the technology continues to improve at an astounding rate. For example, today the speech processor can be placed on the ear, looking just like a hearing aid.  As speech processing strategies improve, Coelho said, the quality of sound improves, and now some users can enjoy complex sounds such as music as they once did when they had “normal” hearing. 

The application of cochlear implants has expanded to patients at extremes of the age spectrum. Patients younger than 1 and patients older than 80 represent a rapidly growing segment of cochlear implant patients.

“Patients with better, but still poor hearing, are beginning to benefit from advances in programming technology – making this technology available to large segments of the hearing aid population that up to now would not have been considered candidates,” explained Coelho. 

According to Coelho, VCU is currently one of only a few sites nationwide participating in a study on “hybrid” cochlear implants – a combination of cochlear implant and hearing aid technology that allows patients to keep what natural hearing they still have, while the implant electronically stimulates only the frequencies that have lost hearing. 

First impressions

Two years ago, Joe, who engineers and sells hearing accessible systems through his company, Duartek, received his first cochlear implant in his left ear. Joe described the first year with his first cochlear implant as a “journey of discovery.” He was constantly in awe as he experienced new sounds everywhere. Prior to his first cochlear implant, his hearing aid had been his only connection to world of sounds.

“I couldn’t believe what I’d been missing all my life and wondered how I had survived all these years without it,” recalled Joe. “The first thing that made an impression on me was the ability to hear the high frequencies. It also made me realize that the world was full of sound to an extent that was almost unbelievable for me.”

“One of the most amazing things for me was hearing the crackling and clicking of the branches and the flapping of the leaves as the wind blows through – wow,” he said. These experiences made it a very easy decision for Joe to go back for the second implant.

According to Joe, the second year with the first cochlear implant was mostly focused on refining his speech discrimination and correcting his speech deficiencies, which is no easy task.

“After talking the way I do my entire life because of my limited hearing, it’s hard to change the motor skills to speak more clearly. I am still working on it,” he said.


How does a Cochlear Implant Work?

A cochlear implant can help individuals by replacing and mimicking the functions of the outer, middle and inner ear.

  1. Sound is picked up by the microphone of the speech processor. 
  2. The speech processor analyzes and converts sounds into a special code.
  3. This code is sent to the coil and transmitted across the skin.
  4. The implant interprets the code and sends electrical pulses
    to the electrodes in the cochlea. 
  5. The auditory nerve picks up this signal and sends it to the auditory
    center in the brain. The brain recognizes these signals as sound.

For Meg, a science teacher in the deaf and hard of hearing department at W.T. Woodson High School in Fairfax, Va., it was the simple, everyday moments that Joe would describe that got her thinking about a cochlear implant for herself. For years, the thought of surgery had turned Meg off – but after seeing the changes for Joe, she decided to go for it. She received her first implant in her left ear.

New communication, new lives

Joe and Meg, who have four children – all with normal hearing – have both commented that their new abilities will allow for improved family togetherness. Prior to the cochlear implants, they encountered a lot of frustration in missing out on communications with their children, which hopefully now will be reduced significantly, if not, eliminated.

“Discussions at the dinner table will be much more lively and dynamic. I tended to get impatient with the kids when there was side talk or when more than two people were talking at the same time,” said Joe. “Our kids noticed that their communications with me (after the first implant) have improved dramatically.”

“Getting the cochlear implants was totally worth it just to be able to have the ability to talk with our kids without having to ask them to repeat things frequently,” he added.

Meg added that their children have said they are a little nervous that both parents will have cochlear implants.

“They are used to talking without worrying about us overhearing them. They are concerned that this will be a major change for them. This alone makes me wonder what they are talking about?” she said.

Meg is looking forward to getting reacquainted with listening to music – which she had stopped doing – and having groups of friends to the family’s home for dinner parties.

She said that socializing with groups of people made it difficult for her to pinpoint who was talking, and said it was “comparable to watching a tennis match, only in this case the players have already made their move and you are lagging behind in reaction time following the ball.”

And their ability to enjoy their new sense of hearing will only improve as they get more acquainted with the technology.

“We are looking forward to our expanded and improving auditory capabilities and the impact that it will all have on our communications skills, our relationships, our careers and more,” Joe said.

Sean Kastetter, senior cochlear implant audiologist at the VCU Cochlear Implant Center, programs Joe Duarte’s cochlear implant. Image courtesy of Tom Kojcsich/VCU Creative Services.
Sean Kastetter, senior cochlear implant audiologist at the VCU Cochlear Implant Center, programs Joe Duarte’s cochlear implant. Image courtesy of Tom Kojcsich/VCU Creative Services.
Jennifer White, a cochlear implant audiologist with the VCU Cochlear Implant Center, helps Meg Duarte get acquainted with her new cochlear implant device. Image courtesy of Tom Kojcsich/VCU Creative Services.
Jennifer White, a cochlear implant audiologist with the VCU Cochlear Implant Center, helps Meg Duarte get acquainted with her new cochlear implant device. Image courtesy of Tom Kojcsich/VCU Creative Services.
Joe and Meg Duarte, who have been married for 25 years, had their cochlear implants activated on the same day. Image courtesy of Tom Kojcsich/VCU Creative Services.
Joe and Meg Duarte, who have been married for 25 years, had their cochlear implants activated on the same day. Image courtesy of Tom Kojcsich/VCU Creative Services.
Joe and Meg Duarte chat with Daniel Coelho, M.D., co-director and medical director of the VCU Cochlear Implant Center who performed their cochlear implant surgery in September.  Image courtesy of Tom Kojcsich/VCU Creative Services.
Joe and Meg Duarte chat with Daniel Coelho, M.D., co-director and medical director of the VCU Cochlear Implant Center who performed their cochlear implant surgery in September. Image courtesy of Tom Kojcsich/VCU Creative Services.
Something magical happened the morning after Joe Duarte's second cochlear implant was activated. As Joe drove back to the Virginia Commonwealth University Medical Center's Cochlear Implant Center for a follow-up appointment, he decided to check out the quality of his new stereophonic listening ability. "I screamed, 'Yes! Yes! Yes!'... It was amazingly beautiful. I listened to Elvis Presley and the bass was so rich that it left me in a state of awe," Duarte said. "The voice, the words and the music and the clarity of it all was very overwhelming."