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June 19, 2003

Tricky cochlear implant lets man hear again

From: Cincinnati Post, OH - Jun 19, 2003

By Roy Wood
Post staff reporter

In March, Roger Ledonne was so profoundly deaf he couldn't carry on a conversation.

And because other medical conditions make it unsafe for him to undergo general anesthesia, his prospects of receiving a cochlear implant to help him hear seemed dim.

On Wednesday, however, Ledonne could not only converse, he could hear his audiologist quietly clicking her fingernails together behind him.

Ledonne, of New Richmond, is one the latest success stories at the Neuroscience Institute at University Hospital. He's believed to be the first person in the United States to receive a cochlear implant under local anesthesia.

"They did a great job," Ledonne says. "They treated me real good."

Ledonne says he still doesn't watch much TV, and he doesn't try to listen to the radio, but he is able to talk on the telephone. He can also talk with contractors who are doing some work on his house.

He says he lost his hearing suddenly, about two years ago. When his primary care physician referred him to the Neuroscience Institute, he scored about 8 percent on word discrimination tests, said Cochlear Implant Coordinator Sharon Hepfner. He's now scoring 72 percent, and Hepfner and Ledonne are continuing to try various hearing aids and adjustments to the implant device to improve his hearing even further.

Even though doctors have been performing cochlear implants since 1983, Ledonne's situation -- the need for the implant and the inability to endure general anesthesia -- is rare, said his surgeon, Dr. Myles Pensak, director of the Otology/Neurology and Skull Base Surgery Division at University. When doctors researched whether it was possible to perform a cochlear implant using a local anesthetic, they discovered it had been done four times in Europe, Pensak said.

The situation made anesthesiology tricky, said Dr. Dirk Younker, a UC professor of clinical anesthesia who oversaw Ledonne's anesthesia.

Ledonne had to lie on his side throughout the three-hour operation. He was given the local anesthetic as well as a mild sedative and kept comfortable, Younker said.

Younker and Ledonne communicated by tapping, Younker said.

Most of the time, Ledonne simply rested quietly, Younker said.

Ledonne said he was aware of everything that was happening around him but felt no pain. He left the hospital the same morning as the surgery.

For Pensak, the procedure presented "the potential for a moving target" while he was operating.

Because the incision is magnified during surgery, even the slightest movement could cause difficulties, Pensak said. In the end, it was little different than other implants.

The implants themselves, like two discs about the size of quarters, are implanted in the skull behind the ear. Unlike hearing aids, which merely amplify sound, the implants transmit signals to the brain through a series of electrodes, bypassing damaged parts of the ear. A speech processor is worn outside the scalp.

The electrodes are activated and adjusted about a month after the system is implanted, giving the area around the implant a chance to heal before adjustments begin, Hepfner said.

Ledonne received his implant in March; it was activated in April.

Patients progress at varying rates after receiving implants.

Hepfner says she's excited by what's happening with Ledonne.

"It's the greatest pleasure when we look somebody in the eye and say 'You don't have to be deaf,' " she said.

"If you would see Roger now and Roger before the operation," she said, "this is a whole new man."

Copyright 2003 The Cincinnati Post , an E.W. Scripps newspaper.