A Unique Perspective: A Radiologist With a Cochlear Implant
Mercedes Garcia is in a unique position. As a specialist in radiodiagnosis at University Hospital Virgen Macarena (Hospital Universitario Virgen Macarena) in Seville, Spain, she comes across patients with hearing implants in her everyday work. But she is also a cochlear implant recipient herself, having experienced sudden hearing loss, hyperacusis, and tinnitus in her left ear. It gives her a deep insight into both life with cochlear implant, as well as the considerations that radiologists encounter when dealing with implanted devices.
We talked to her about her hearing journey so far, the important role that MRIs play in diagnostics, and what can be done to inform radiology professionals about MRI and cochlear implant compatibility.
Experience as a Cochlear Implant Recipient & Medical Professional
In general, how has your ability to hear improved?
After getting sudden deafness in my left ear, my hearing has improved. My cochlear implant has allowed me a better capacity for understanding.
It is very important to be able to receive auditory stimuli in both ears, and my CI gives me security with respect to the environment. Although my healthy ear remains my major source of hearing, my implant is a great support and allows me to increase understanding and intelligibility without the need to continuously turn my head towards the source of the sound.
The feeling when I disconnect my CI for any reason is like “switching off” the middle of my head. I feel fully aware of my deafness.
What audio processor do you use and how has your experience been with it?
I have been using RONDO 2 since 2018. It is really comfortable. What I like the most is that because it is compact and leaves the auricular region free, it allows me to use glasses with ease. This fact has also been important as, since the pandemic, it is essential for me to use a mask at work for hours at a time—sometimes even the whole day.
Aesthetics weren’t crucial to me when choosing an audio processor, but I think my RONDO 2 goes practically unnoticed.
Charging the battery at night is also very convenient without the need to use batteries.
Do you listen to or play music?
Listening to music again has been a new learning experience, and I have started to enjoy it again and little by little can perform pieces on the piano. The most difficult thing for me has been to tolerate the acoustic piano’s sonority because it is not possible to adjust the volume unless without pedals.
Improvement in Hyperacusis and Tinnitus
Do you still experience hyperacusis and tinnitus?
Although the hyperacusis has not completely disappeared, it has dramatically improved compared to before my cochlear implant surgery.
This fact has been essential for me because the hyperacusis and tinnitus following the sudden deafness were honestly the limiting factors in my return to family, leisure, and work life.
Regarding tinnitus, I only perceive it when I switch off my implant at night. This improvement is very important because, during the day, I almost don’t perceive it.
Rehabilitation Tips for Single-Sided Deafness
What rehabilitation tips have been especially helpful for you?
Rehabilitation is an essential part of the hearing process with the CI. It is a long journey but indispensable for performing with my CI. The support and tips from the speech therapists are essential in the rehabilitation process.
I think that the rehabilitation for people with single-sided deafness is hampered by the “interference” and the leading role of the healthy ear.
The rehabilitation technique of masking the healthy ear is possibly more complex and slower. In this sense, connectivity devices that allow the sound to enter directly to the implant, simplify it, just because it doesn’t interfere with natural hearing.From a Radiologist’s Perspective
When was the first time you encountered cochlear implants in your work as a radiologist?
During my first years in the profession, there were very few implanted patients. My first contact with cochlear implants was in around 2000. I was working at the regional hospital when a child with a CI came to the emergency room to have a CT and was referred for radiodiagnosis.
What is the perception of cochlear implants in the field of radiology today? Are radiologists adequately informed about hearing implants?
Personally, as a recipient who also works in an implant center, I have more interaction with the ENT team and other implanted patients.
In general, I think this depends on which field the radiologists work. After all, radiology is a very broad field, and it tends to have many specializations within it depending on the technique usually used and dedication to a specific area of the body. Radiologists specialized in the head and neck area (Otoneurology) will tend to have more knowledge about this topic and more awareness related to implanted patients.
On the other hand, the number of pre-surgical studies using both CT and MRI scans for cochlear implant candidates has substantially increased in the last few years. This forces us as radiologists to constantly be updated.
As the number of patients with implanted medical devices have increased, how have radiologists adapted?
There are clinical guides, scientific publications, and protocols both from the scientific organizations for radiologists and from the different manufacturers available for consultation.
Ideally, the patient should bring detailed technical information about the compatibility and type of device, company (factsheet), and, if necessary, we may need to contact a specialist clinician.
MRIs and Cochlear Implants
In your experience, do radiologists get enough training and informative materials to stay up-to-date when it comes to MRIs and cochlear implants?
Referring to MRIs, I think the amount of information is not enough.
All the radiologists and radiologic technologists who work with MRIs are aware of the contraindication to perform MRIs on implanted patients, but there is not enough information about the fact that it is a relative contraindication.
As radiologists, it is not usual for us to have specific and updated information regarding these devices in particular, so there is a general lack of knowledge about the safety measures and compatibility of the different implant types.
Fluent communication with other medical specialists involved with these devices would be ideal, with shared clinical sessions, and updated clear and precise information not only to the radiologists but also for radiologic technologists.
The technical staff and nurses get the consent from the patient and review it before doing the examination: In this consent form, the patient should specify which electronic devices and implants to be able to ensure MRI compatibility.
The problem is that many times, not even the patients themselves know what type of specific device they have or from which brand. This impedes the work of the technologists and radiologists.
There is considerable confusion among the general public and therefore people with hearing implants between the different diagnostic techniques such as CT, MRIs, and ultrasound. Unfortunately, many recipients don’t know which kind of diagnostic test can be performed and what are the safety measures they should take.
The SYNCHRONY 2 implant’s freely rotating S-Vector magnet aligns with the magnetic field as it changes, thus allowing MRIs even at a strength of 3.0 Tesla.*
Are MRI scans carried out in your radiology department for cochlear implant patients?
In my center, we have a protocol agreed with the ENT department regarding MRI scans for cochlear implant users.
The patients have an outpatient appointment in the ENT department before the scan. At this appointment it is determined if the examination requested can be done with the specific device according to its manufacturer, and whether a compression bandage or magnet removal are needed.
Have you needed an MRI scan since you got your cochlear implant?
I have not needed an MRI scan, but the fact that this diagnostic exam is MR-conditional was a strong argument for me to choose an implant from MED-EL.
In your view, is there anything that could be done better to assist radiologists when working with patients with implanted medical devices?
I think that progress can be made in the management of implanted patients in terms of their access to radiology services, especially in clinics where this surgical technique is practiced.
The number of implanted patients, the implantation age, and thus the appearance of other pathologies is increasing progressively. But at the moment, examinations of implanted patients are still relatively rare.
The first clinical guides considered having a CI to be a contraindication for MRIs. It would be very useful if newly updated guides could be published and distributed to all radiology departments. These guides should detail device compatibility and safety measures.
These guides should be available not only for the radiologists but for the technologists too, as they will attend the patient, review their information, and perform the examination.
It is also important that the patients themselves receive information from the implant clinic about their implant, and the possible contraindications or precautions to consider regarding medical procedures and diagnoses.
A Deeper Understanding
What advice would you offer to other radiologists on dealing with cochlear implants?
I would like to clarify so that other radiologists understand that a CI is not an absolute contraindication for an MRI and that every case has to be reviewed individually.
Today, MRI is an important diagnostic technique, and in many cases, it can’t be replaced with other diagnostic techniques. Therefore, it is necessary to have updated training and information before contraindicating it for implanted patients.
First of all, I believe that before undergoing the procedure, it should be checked that an MRI was indicated, and that the information provided will decisively influence the management or treatment of the patient.
It is also important to make sure, depending on the clinical belief and patient’s pathology, that the MRI cannot be replaced by another alternative diagnostic technique (CT or US) that can bring similar diagnostic information.
In the case of fulfilling these points, CI and MRI compatibility have to be reviewed carefully in each case, so the examination will take place with the highest safety conditions for the patient.
How has having a cochlear implant yourself changed the way you approach patients with an implanted medical device?
Obviously, my knowledge of the topic has increased significantly, and this has allowed me to better understand how to live with deafness and how everyday life with a CI is, along with the difficulties it entails. As much as possible, I try to ensure that communication is always appropriate to meet the needs of patients and, if necessary, their families.
I am also aware of the current health situation because the use of face masks is an extra challenge when communicating with patients with hearing loss. That’s why I try to talk clearly and in an understandable way.
Is there anything else you would like to add?
I would like to thank all the professionals that have been part of my journey and that have helped me to normalize many aspects of my life thanks to my cochlear implant.
I would also like to raise awareness about deafness and hearing loss in general. My experience during recent years makes me feel that deafness is the “invisible disability.” Society is not aware of limitations that people with hearing loss have and the isolation they are often subjected to.
I would also insist on the need for a more updated and fluent communication between the different medical specialties and medical device companies.
Thank you for sharing your insights and experience with us.
MRIs with MED-EL Cochlear Implants
All MED-EL cochlear implants since 1994 enable access to MRI scans* without the need to surgically remove or replace the implant magnet.** In this blog article, we share more information on MRIs with cochlear implants, including short, instructional videos.
Detailed MRI conditions and safety information for all our hearing devices can be found at https://www.medel.com/isi as well as in our blog article about MRI and VIBRANT SOUNDBRIDGE and BONEBRIDGE implants.
* MED-EL cochlear implants since 1994 are MR Conditional. Recipients with a MED-EL cochlear implant may be safely MRI scanned following the conditions detailed in the Medical Procedures Manual.
** Unless magnet removal is required for diagnostic reasons.
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