The UNC Ear and Hearing Center, directed by Dr. Kevin Brown, is a regional center that provides specialized diagnostic and surgical care to adult and pediatric patients with diseases of the ear, skull base, head, and neck. The Center represents a comprehensive multidisciplinary approach to service delivery and patient care. Multiple professionals trained in varying aspects of hearing disorders staff the Center. Specialists of the Center are from the Division of Neurotology & Skull Base Surgery, the Division of Pediatric Otolaryngology, and the Carolina Children’s Communication Disorders Program (CCCDP)/CASTLE, and the UNC Hospitals Division of Audiology & Speech Pathology. These specialists include pediatric and adult audiologists and otolaryngologists, auditory/verbal therapists, speech pathologists, and a designated Ear & Hearing Center nurse.
The Ear and Hearing Center serves as a resource, not only for UNC Hospitals, but also for patients, physicians, nurses, audiologists, and other healthcare professionals throughout the State of North Carolina. Staff services range from consultation, diagnosis, disease treatment, and medical/surgical interventions, to rehabilitation and follow-up.
Extensive audiology services, in conjunction with Otolaryngology/Head & Neck physicians, are an integral part of the Ear & Hearing Center. Newborn to geriatric hearing screening; hearing aid assessment, fitting, and dispensing; and cochlear implantation evaluation are offered. American Sign Language interpreter service is also readily available through “Deaf Talk”, a video interpreting system. Diagnostic exams available include behavioral, evoked response, and vestibular testing. Patient education, on a wide variety of hearing related conditions, has been developed for patients and families. Center staff also participate in 1) community-based efforts in the promotion of hearing wellness for schools and other groups, 2) professional organizations focused on the hearing impaired and related disorders, 3) development and involvement in local and national conferences promoting the goals of the Center and academic interests of the University, and, 4) ongoing hearing-related research. Otology physicians, Ear and Hearing Center nurses, audiologists, speech pathologists and other staff are also committed to student teaching, and the development and provision of continuing professional education, both on the UNC Hospital campus and the state.
In the last year, the Ear and Hearing Center at UNC has been very busy locally, nationally, and internationally. Clinically, our team of professionals evaluated more than 400 children with newly identified hearing losses from around the Southeastern United States and abroad. Given our extensive experience and unique multidisciplinary approach, we continue to see a number of tertiary referrals for the diagnosis and management of challenging pediatric hearing loss cases. Last year alone, over 100 new hearing aid fittings and nearly 100 cochlear implants were performed in the pediatric population. It has not been unusual for amplification to be undertaken before 3 months of age at UNC and cochlear implantation to occur before 12 months. Professionals from the Ear and Hearing Center continue to collaborate closely with professionals from around the state to provide additional services for these children.
The Ear and Hearing Center also evaluated more than 100 new adult patients with hearing loss for possible cochlear implantation last year, implanting nearly 100 new patients. Recent advances in surgical techniques and device technology has allowed surgeons at UNC to implant patients with more residual hearing than ever before. Patients with hearing loss no longer need to be deaf before considering cochlear implantation. Drs. Adunka, Buchman, Clark, and Pillsbury have begun to test the effects of combining hearing-preserving cochlear implantation with amplification (also called Electro-acoustic stimulation or EAS) in an effort to serve a greater number of patients with sensorineural hearing loss. Preliminary results from these studies are very encouraging. Many of these patients have significant improvements for hearing in noise when compared to their performance with their hearing aid alone.
Another area of interest is bilateral cochlear implantation. Drs. Brown and Pillsbury have been actively involved in bilateral implantation in selected patients more than 6 years. In their early studies, bilateral implants showed a distinct advantage for both hearing in noise and sound localization abilities. While not for all patients, bilateral implantation is more common than ever, now being extended to the pediatric population as well. Today, more than 80 patients have received bilateral implants at UNC. Many of our previously implanted recipients are requesting second side implantation with the hope of improvements in sound localization and hearing in noise.
While cochlear implants are useful for most patients with severe to profound sensorineural hearing loss, occasionally patients may not benefit from implantation because of disorders related to the cochlear nerve or cochlea. In such cases, direct brainstem stimulation may provide improvements in communication abilities. Such brainstem stimulation has been used for patients with tumors of the brainstem in the past but has never been applied to non-tumor patients in the United States. In an effort to provide this specialized technology to patients in need, Dr. Brown and Dr. Matthew Ewend from the UNC Division of Neurosurgery recently performed a brainstem implant in a patient that suffered from cochlear ossification following meningitis. This patient has now been using his device for more than 9 months with significant demonstrated benefits. For this patient, the brainstem implant has provided dramatic improvements in sound awareness and enhanced lipreading abilities thus far.