Tucson Lifestyle September 2012 : Page 50

In Health New Gains For Hearing Loss Just a few months ago, those suffering from hearing loss and other diseases of the ear had limited treatment options available to them in Tucson. Patients in need of specialized services oftentimes had to travel to Phoenix or even other states to be treated. Now, state-of-the-art procedures are being offered through the new University of Arizona Ear Institute. BY SAR AH BUR TON 50 TUCSON LIFESTYLE | SEPTEMBER 2012 www.tucsonlifestyle.com Girl listening, iStockphoto/Thinkstock rriving in Tucson after five years as faculty at The Ohio State University’s Department of Otolaryngology — Head and Neck Surgery, Abraham Jacob, M.D., has hit the ground run-ning by creating and branding the multidisciplinary UA Ear Institute. “Tucson has had excellent ear, nose and throat physicians in the commu-nity for years,” says Dr. Jacob, “but the lack of neurotology ser-vices meant that surgically com-plex ear disease required referral to specialists in Phoenix.” This is no longer necessary. Dr. Jacob’s recruitment by Department of Surgery Chairman Rainer Gruessner, M.D., and Division of Otolaryngology — Head and Neck Surgery Chief Alexander G. Chiu, M.D., was support-ed jointly by the University of Arizona College of Medicine, the UA Department of Surgery, the Arizona Cancer Center, and The Bio5 Institute. Dr. Jacob is both a surgeon and a scientist. Designated a comprehensive investiga-tor in the University of Arizona Cancer Center and The Bio5 Institute, he has brought his five-year, $1.2-million grant from the National Institutes of Health (NIH) to UA. Such federal funding — often considered a benchmark A for excellence in research — doesn’t come easily. Able to translate meaningful research findings to the patient’s bedside, he is a valuable addition to the UA Health Network team. “At Ohio State, I was one of four neurotologists serv-ing central Ohio,” says Dr. Jacob. “Now, as the only neu-rotologist in Tucson, I’m able to provide unique surgical services that were previously unavail-able here; this has been incred-ibly rewarding.” And, he is not the only recent addition. The entire ear, nose and throat divi-sion at UAMC is brand new, with six faculty members recruited from all over the country. “Just over a year ago, there was no Otolaryngology division at UAMC. Now, our group has busy clinics and performs complex surgical procedures every day,” he says. “We are very fortunate to have an ear surgeon of Dr. Jacob’s quality and renown at the University of Arizona,” Dr. Chiu says. “Not only is he one of the top research minds in the country, but he is an excellent surgeon and Tucson’s only fellow-ship-trained ear specialist.” Dr. Jacob has several clinic days each week, where he evaluates new patients and

In Health: New Gains For Hearing Loss

Sarah Burton

New Gains For Hearing Loss<br /> <br /> Just a few months ago, those suffering from hearing loss and other diseases of the ear had limited treatment options available to them in Tucson. Patients in need of specialized services oftentimes had to travel to Phoenix or even other states to be treated. Now, state-of-the-art procedures are being offered through the new University of Arizona Ear Institute.<br /> <br /> Arriving in Tucson after five years as faculty at The Ohio State University’s Department of Otolaryngology — Head and Neck Surgery, Abraham Jacob, M.D., has hit the ground running by creating and branding the multidisciplinary UA Ear Institute. “Tucson has had excellent ear, nose and throat physicians in the community for years,” says Dr. Jacob, “but the lack of neurotology services meant that surgically complex ear disease required referral to specialists in Phoenix.” This is no longer necessary. Dr. Jacob’s recruitment by Department of Surgery Chairman Rainer Gruessner, M.D., and Division of Otolaryngology — Head and Neck Surgery Chief Alexander G. Chiu, M.D., was supported jointly by the University of Arizona College of Medicine, the UA Department of Surgery, the Arizona Cancer Center, and The Bio5 Institute.<br /> <br /> Dr. Jacob is both a surgeon and a scientist. Designated a comprehensive investigator in the University of Arizona Cancer Center and The Bio5 Institute, he has brought his five-year, $1.2-million grant from the National Institutes of Health (NIH) to UA. Such federal funding — often considered a benchmark for excellence in research — doesn’t come easily. Able to translate meaningful research findings to the patient’s bedside, he is a valuable addition to the UA Health Network team.<br /> <br /> “At Ohio State, I was one of four neurotologists serving central Ohio,” says Dr. Jacob. “Now, as the only neurotologist in Tucson, I’m able to provide unique surgical services that were previously unavailable here; this has been incredibly rewarding.” And, he is not the only recent addition. The entire ear, nose and throat division at UAMC is brand new, with six faculty members recruited from all over the country. “Just over a year ago, there was no Otolaryngology division at UAMC. Now, our group has busy clinics and performs complex surgical procedures every day,” he says.<br /> <br /> “We are very fortunate to have an ear surgeon of Dr. Jacob’s quality and renown at the University of Arizona,” Dr. Chiu says. “Not only is he one of the top research minds in the country, but he is an excellent surgeon and Tucson’s only fellowship- trained ear specialist.” Dr. Jacob has several clinic days each week, where he evaluates new patients and Performs in-office procedures such as ear tube placements, mastoidectomy cavity debridement, and placement of medications under the eardrum. Ear surgery is performed at UAMC as well as the Alvernon Surgery Center.<br /> <br /> What Is the UA Ear Institute?<br /> <br /> Almost everyone is touched by hearing loss in some way, whether it is due to one’s own hearing troubles or hearing loss in friends and family. “Our overall mission at the UA Ear Institute is to effectively prevent, detect, treat and rehabilitate ear disease,” explains Dr. Jacob. “Through excellence in patient care, surgical technique, research and education, we hope to one day end human suffering from hearing Loss and other diseases of the lateral skull base.” With technology in the field advancing rapidly, this is about more than hearing aids. “The average person with hearing loss doesn’t always know all the options that might be available to them for treatment,” says Dr. Jacob. “Conventional hearing aids are best for some, but others may benefit from an ever-expanding set of surgically implantable hearing devices.” <br /> <br /> Since its inception, Dr. Jacob’s team has established a meaningful clinical interface with Neurosurgery at the UA Ear Institute. Working with Michael Lemole, M.D., Dr. Jacob now provides unique lateral skull base access to posterior cranial fossa tumors such as acoustic neuromas, meningiomas, epidermoids, etc. “Team surgery offers our patients the best possible outcomes,” explains Dr. Jacob. “This UA Ear Institute service fills a significant clinical void in our regional patient population of over a million people.” <br /> <br /> In addition to expanding surgical services, the UA Ear Institute’s robust research component — housed in a new 1,200-square-foot lab within the Arizona Cancer Center — is looking toward the future. “Our goal is to one day cure hearing loss,” Dr. Jacob explains. “For example, my laboratory is now testing novel drugs that may protect people from certain types of hearing loss using a zebrafish model system. These fish, because they have hair cells on their body surface similar to those found in human inner ears, can help us better understand how toxins, noise and aging damage the inner ear.<br /> <br /> To find solutions, we need to understand problems at their most fundamental levels. As we grow the research program, federal grant funding, philanthropy, and partnerships with industry will be critical to our long-term success.” <br /> <br /> “We’re really going beyond merely rebuilding the clinical services of the Division of Otolaryngology,” adds Dr. Gruessner. “We have created a state-ofthe- art research program that will bring 21st-century innovations in head and neck surgery to Arizona.”<br /> <br /> Cutting-Edge Implants <br /> <br /> A comprehensive array of implantable hearing devices now is available locally. For those with bilateral, severe to profound hearing loss and poor word recognition ability, benefit from hearing aids will be limited. The UA Ear Institute offers its patients cochlear implants from all three FDA approved manufacturers (Cochlear Corporation, MedEl, and Advanced Bionics). Candidacy is determined by specific hearing tests, a temporal bone CT scan, and medical clearance for about two hours of general anesthesia. For most patients, this is an outpatient procedure, and the device is activated about one month after surgery. Bone-anchored implants for singlesided deafness and conductive/mixed hearing loss (devices that work using direct bone conduction) like the Baha from Cochlear Corporation and the Alpha 1M from Sophono also are available. Because sound energy transfers well through bone, these implants can bypass a poorly functioning eardrum or middle ear to directly stimulate the inner ear on the same or opposite side. In other cases, hearing can be Improved directly by simply replacing native hearing bones with synthetic total or partial ossicular reconstruction prostheses. Most recently, semi-implantable (Vibrant Soundbridge from MedEl) and completely implantable (Esteem device from Envoy Medical) hearing aids have revolutionized surgery for hearing loss.<br /> <br /> The Esteem device from Envoy Medical is an exciting newcomer to implantable devices. It is currently the only FDAapproved totally implantable hearing aid. The Esteem can be implanted in anyone who currently wears a hearing aid for moderate to severe hearing loss and has reasonably preserved word recognition ability. A temporal bone CT scan is required to determine whether there is adequate space for the implant, and each patient’s general medical condition must be appropriate for anesthesia. The device is placed under the skin behind the ear, lasts from four-anda- half to nine years based on usage, and changing the battery requires just a short outpatient surgery. There are no external components so hearing is on in the shower, swimming pool, playing sports, while in bed, etc., and there are no annoying squeals from feedback.<br /> <br /> “Unfortunately, most insurance companies do not cover the cost of the Esteem,” explains Dr. Jacob. “As this new technology gains momentum, however, this is likely to change.” With less than 15 surgeons in the United States certified to do Esteem implants, Dr. Jacob finds himself in very select company. He and the Ear Institute team envision fostering an international practice at UA within a few years, with patients traveling to Tucson expressly for the procedure. <br /> <br /> TOP RIGHT Typical scar one month after cochlear implant (left); cochlear implant external processor and coil are put in place (right).<br /> <br /> MIDDLE Audiologist Stephanie Adamovich, Ph.D., CCC-A, shows approximately where the patient’s component is located under the skin. A magnet in the internal component keeps the coil in place.<br /> <br /> RIGHT Dr. Adamovich begins the patient’s first “mapping” session to determine the right amount and type of electrical stimulation. Numerous sessions are necessary over a period of months in order for the brain to listen to and understand speech with a cochlear implant. All photos this page by Kris Hanning.<br /> <br /> “Team surgery offers our patients the best possible outcomes. This UA Ear Institute service fills a significant clinical void in our regional patient population of over a million people.” — Abraham Jacob, M.D.<br /> <br /> “Our overall mission at the UA Ear Institute is to effectively prevent, detect, treat and rehabilitate ear disease. Through excellence in patient care, surgical technique, research and education, we hope to one day end human suffering from hearing loss and other diseases of the lateral skull base.” — Abraham Jacob, M.D.

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