Interview with Donna Sorkin Vice President of Consumer's Affairs, Cochlear Americas

Beck: Good Morning Donna. Thanks for your time this morning.

Sorkin: Hi Doug. Thanks, nice to see you again, too.

Beck: Donna, you've been so prominent in hearing healthcare and related issues, it's tough to keep up with you! Would you please start by telling us a bit about your background?

Sorkin: Sure Doug. I started in a very different profession. I started as a city planner in Boston, and after a while we moved to Florida and I worked as the downtown planner for the city of Miami. A few years later we moved to Washington. So, I was doing strategic planning for cities before getting involved with hearing loss.

Beck: And if I recall --your own hearing loss was the impetus that got you involved with hearing loss and related issues?

Sorkin: Right. I had a mild hearing loss as a child. In my 20s I was wearing hearing aids and I was a technology fanatic. I had the newest and the best hearing aids. They were helpful, but not perfect, but that was way before the digital age, and of course, hearing aids were not as good as they are today. To make it worse, I was very hard to fit with hearing aids. I had terrible recruitment. One day, my audiologist told me she had done everything she could and it was time for me to consider a cochlear implant. I investigated cochlear implant options, and in 1992, I got a Cochlear Nucleus 22. I still have the same cochlear implant, but I have had the processor upgraded three times in the last 12 years, and I've gone from the box with wires, to the behind-the-ear (BTE) cochlear implant that I'm wearing today. I expect to upgrade to our new Freedom speech processor soon.

Beck: I know Cochlear has a commitment to be sure the previous internal device is compatible with the newest speech processor, but I'm always thrilled to see the end result. The BTE you're wearing looks very much like a hearing aid...and I can certainly recall quite vividly when BTE-style cochlear implants were just a dream and something to hope for.

Sorkin: That's right. The BTE has made a big difference. But again, it's not just the physical size of the instrument, which is quite nice, but the processing has improved every time I've upgraded. Just when I think "OK, I'm content, the sound cannot get any better....it does."

Beck: Yes, it really has been amazing. Well, after city planning, and before joining Cochlear Americas, you were at SHHH and A.G. Bell too?

Sorkin: Right. As Rocky Stone was retiring from SHHH, I applied for the position and I became executive director at SHHH in, 1993. That was a really busy time for me.... I had my cochlear implant surgery a month before, we were building a house and I was starting a new position...all at the same time. I left SHHH in April of 1999 and became the Executive Director at A.G. Bell, and then finally I moved to Cochlear Americas, which is where I've been for a number of years now, which has allowed me to really focus on cochlear implants.

Beck: Donna, I recall 20 years ago, telling patients that cochlear implants were probably going to be useful as an aid to lip-reading, and CIs would be useful for identifying environmental sounds, too...but the reality of cochlear implants available in 2005 have vastly exceeded my expectations. I wonder if you have any idea as to how many of the children receiving cochlear implants are likely to be mainstreamed?

Sorkin: We recently did two sets of parent surveys regarding their implanted children, ranging in age from 7 to 13 years. Most of the kids were not implanted before age two. Nonetheless, the majority of the kids, some 2/3rds of them in the 2003 survey, were in either private or public mainstream settings.

Beck: That's amazing. What about cosmetic issues and the acceptance of the BTE CIs by younger people?

Sorkin: Well, that's been an important issue for some adults, and certainly for teenagers! The new CI BTEs have allowed more children and young adults to comfortably wear or use their CIs with less stigma issues.

Beck: I can only imagine going through school wearing the old belt-worn processors, the harness and the wires...and the enormous relief the BTEs provide.

Sorkin: Yes, it really can make a significant difference in terms of acceptance. But candidly, although I love not having to deal with the wires on the bodyworn, for me it was always about finding the best possible solution. I was so happy to be able to hear when I got my cochlear implant that I didn't care about having a "box."

Beck: Donna, are you able to use your BTE CI with your cell phone?

Sorkin: Yes, I do that all the time. No special connections required...I just place the CI on the T-Coil setting and it works fine. There are other devices that can be used such as the direct audio input (DAI), but I get by without the DAI most of the time.

Beck: I know this next question is rather broad, but in general, what are your thoughts on the educational structure available to children with CIs?

Sorkin: I spend a lot of time working on these issues at Cochlear. There are still too many educational professionals in the public school environment who are unfamiliar with the needs of children with cochlear implants and unfamiliar with the potential and the ability kids with CIs have -when they are properly supported. Although the range of performance varies depending on the child's individual characteristics such as age of implantation, many children are able to achieve spoken language within the normal range. We need to look at the individual child and what he or she needs to maximize their outcomes. Since most children with cochlear implants will be using spoken language, we need to pay attention to acoustics in the classroom, the auditorium and wherever else the child is expected to listen. We also need to determine what specific supports and services the individual child has, rather than making broad assumptions about the needs of deaf children. For example, many CI children receive speech services at school and over half are using FM systems. We have been gratified to find there is increasing interest among educational professionals—teachers, audiologists speech pathologists and others—in learning more about the needs of children using cochlear implants.

Beck: I totally agree. I've seen many children with CIs that are just amazing. And of course, I always like to mention, that the sooner the child is implanted, the better the chance for an excellent outcome.

Sorkin: Yes, that's been shown many times. I agree, early implantation is one of the key ingredients to success. Another very important issue for children in the schools is the wireless FM system. FM is terrific for the child with a CI in the school, and they're great in other situations, too. For adults, FM is fabulous in noisy restaurants, in cocktail parties and other difficult environments.

Beck: Absolutely, FM systems allow the maximal signal-to-noise ratio and present the best opportunity to maximally discriminate the speech signal. Donna, please tell me about HOPE?

Sorkin: Hope is a new program at Cochlear—HOPE, stands for Habilitation Outreach to Professionals in Education. We provide opportunities for educational personnel to learn more about CIs and the needs of CI children. It represents a major company commitment to our pediatric recipients to help ensure the best possible outcomes with their cochlear implant.

Beck: Excellent. Donna, let me change topics....What can you tell me about insurance coverage for cochlear implants? Are CIs covered by most private, state and federally funded programs?

Sorkin: All Medicaid programs do include cochlear implants, but they reimburse at different levels. I know this is often confusing for patients, but each situation is unique and has to be thoroughly investigated. With anesthesia, surgery and all the associated costs, the entire cochlear implant package is probably some 50 thousand dollars. Some states pay the entire fee under their Medicaid programs, others pay partially. If the Medicaid program partially pays, the hospitals have to "forgive" the balance, and as you can imagine, that would be a tremendous burden for the hospitals, and a reason why some hospitals are not excited to offer cochlear implants! In fact, they may restrict access to CIs because of these problems. Then again, the good news is that probably 90 percent of the commercial and private programs do cover CIs.

Beck: What about Medicare?

Sorkin: Medicare also covers cochlear implants. Medicare coverage for the surgery has improved dramatically in recent years though it still lags on the cost of follow-up. The improvement has been the result of collaborative efforts by manufacturers, individual cochlear implant clinicians, consumer organizations and the associations representing audiologists and ENT doctors--. all working together towards the same goal. So the more people we get on board to make sure CIs are covered, the more likely we'll get a good result in terms of the coverage and payment structure. That collaboration helped to expand coverage for cochlear implants under Medicare recently.

Beck: Donna, thanks for your time. I know we can chat about these issues for hours, but I know you have to run. Thanks for joining me today.

Sorkin: You're welcome Doug, it was a pleasure for me too.

-----------------------------------------------------------------------------

For more information about Cochlear Americas Cochlear implants visit cochlearamericas.com

For more information on HOPE, see www.cochlear.com/HOPE

For specific educational products from Cochlear, go to www.cochlearamericas.com/Storefront/ and key in:

CI School Resource Guide (a compendium of materials for educational professionals)

Here We Go! (CD ROM for speech pathologists working with teens)

Listen, Learn and Talk (videos and guide to be used as a compliment to a young child's habilitation program)