Interview with Samuel Levine M.D.
Share:
AO/Beck: Good Morning Dr. Levine. Thanks for your time this morning.
Levine: Thanks Dr. Beck. I am happy to meet with you.
AO/Beck: Before we get into issues related to cochlear implants, let's talk a little about your professional history. Can you please tell me where you went to school?
Levine: Sure. I went to Northwestern University for undergraduate work, and my bachelor's was actually in engineering, and I earned that in 1976. Then from 1976 to 1980 I was at the Hannemann Medical College, and earned my MD there. I did my otolaryngology residency at the Cleveland Clinic from 1980 to 1985, and then I did my neurotology fellowship under Michael Glasscock, in 1985 and 1986, and since then I've been here at the University of Minnesota.
AO/Beck: Very good. Please tell me about your current practice?
Levine: The university practice is quite large. We have 12 otolaryngologists on staff here, and we service 4 separate hospitals. We also have 7 audiologists, who do pretty much everything, and so the group is large and very busy.
AO/Beck: Dr. Levine, how long have you been a cochlear implant surgeon?
Levine: Since 1986. I started a year or two after the FDA approved cochlear implants.
AO/Beck: Can you recall, back in1986, when you discussed cochlear implants with patients, what was it that you felt comfortable telling patients? In other words, what were the expectations that you had, and what were the expectations you felt comfortable telling your cochlear implant candidates in 1986?
Levine: I used to tell patients that if they got sound awareness - that would be a wonderful and amazing thing. In 1986, I told them they could count on the fact that they would not be able to hear normally, in fact, we tried to disassociate cochlear implants from the actual sense of hearing at that time. I used to tell cochlear implant candidates they would get an awareness of sound, or a perception of sound, and that was about it. The expectations were cochlear implants would be useful to help people read lips, but again, we didn't want to have the patients think of it as hearing back in 1986, because it was too crude, and not really what any of us considered true hearing - back then.
AO/Beck: And how would that contrast to what you tell patients at this time?
Levine: Well, I primarily use the Advanced Bionics Clarion, and of course there are others available too. But I tell patients that 98 percent of the cochlear implant recipients like the implant, they use it on a regular basis, and the cochlear implant is useful for many different sounds and situations. I feel very comfortable telling them about 3/4ths of the current cochlear implant users are able to use the telephone, and they can expect to understand about half of what is being said without visual cues, and that in real sentences such as day-to-day situations, they can expect almost 100 percent comprehension. But I also warn them that we cannot accurately predict outcomes for any individual ahead of time, and that in fact, each patient is different.
AO/Beck: Dr. Levine, sometimes I get email from cochlear implant candidates who write me and ask about failure rates. In other words, I believe they are asking, what percentage of patients who receive cochlear implants, are not able to use it because it simply doesn't work? My answer is that in working with cochlear implant patients for almost 20 years, I have only seen two patients that didn't stimulate, and they were both in the 1980s. What do you tell patients with regard to this issue?
Levine: I tell them about the same. The success rate, if it is defined as successful electrical stimulation or as perceiving sound through the cochlear implant is probably just about 100 percent. I cannot recall the last time someone didn't stimulate, and that is based on our doing about 50 implants per year, or maybe a little more.
AO/Beck: What do you tell patients regarding their aural rehabilitation and the time it will take to learn to effectively, efficiently and maximally use their cochlear implant?
Levine: Like most good surgeons, I refer them to the audiologist! Sharon Smith is our lead cochlear implant audiologist and she addresses this topic with the patients. I think the bottom line is that aural rehabilitation (AR) is necessary and the AR treatment course varies based on the patient and their needs, and we know that the more they work on it and the more they attend to the issues, the better their eventual outcome will be. So it really is driven by the patients. Those that do the best are usually those that work at it the hardest. We know that simply turning on the implant is not enough, and we know that the audiologist working with the patient is the most important factor post-op, in determining their final outcome.
AO/Beck: Can you tell me, when did we actually turn the corner on cochlear implants? When did we go from an awareness of sound, to actually hearing?
Levine: Great question. I'm not sure that there was a singular moment, but we did go through a series of tests that helped lead to the Advanced Bionics CII cochlear implant, and I remember realizing at that time that something had changed dramatically. I like to tell the story that sometimes between the Wright Brothers and the 747, air travel got a lot safer and a lot cheaper, and it's the same with cochlear implants. Somewhere between 1990 and 2002 we've made a few quantum leaps. Not only are the devices significantly better, but the complication rates have fallen way down, and the results are typically excellent.
AO/Beck: What are the surgical and post-op complications you discuss with patients?
Levine: I tell my patients that the biggest complication issue is the wound itself. Sometimes the wound can break down, and sometimes the wound will need medical or surgical attention. Of course that is extremely rare, but it is possible. Once you have a foreign body implanted, there is always a risk that it might need further attention. Again, those are rare issues, but these are the issues I discuss with my patients.
AO/Beck: What was the single most impressive advancement you've witnessed in the last 2 or 3 years with regards to cochlear implants?
Levine: The modiolar hugging electrode array has been evolving for the last few years, and in the last year this has really improved dramatically. So I think that would probably be the most important new development in cochlear implants. Of course the hardware and the software have both improved dramatically over time, and the improvements have been significant.
AO/Beck: Dr. Levine, it has been a pleasure speaking with you. Thanks for your thoughts and insight on this topic.
Levine: Thanks for inviting me Doug. It's been a pleasure for me too.
For more information on Advanced Bionics click here.
Click here to visit the Advanced Bionics website.
Levine: Thanks Dr. Beck. I am happy to meet with you.
AO/Beck: Before we get into issues related to cochlear implants, let's talk a little about your professional history. Can you please tell me where you went to school?
Levine: Sure. I went to Northwestern University for undergraduate work, and my bachelor's was actually in engineering, and I earned that in 1976. Then from 1976 to 1980 I was at the Hannemann Medical College, and earned my MD there. I did my otolaryngology residency at the Cleveland Clinic from 1980 to 1985, and then I did my neurotology fellowship under Michael Glasscock, in 1985 and 1986, and since then I've been here at the University of Minnesota.
AO/Beck: Very good. Please tell me about your current practice?
Levine: The university practice is quite large. We have 12 otolaryngologists on staff here, and we service 4 separate hospitals. We also have 7 audiologists, who do pretty much everything, and so the group is large and very busy.
AO/Beck: Dr. Levine, how long have you been a cochlear implant surgeon?
Levine: Since 1986. I started a year or two after the FDA approved cochlear implants.
AO/Beck: Can you recall, back in1986, when you discussed cochlear implants with patients, what was it that you felt comfortable telling patients? In other words, what were the expectations that you had, and what were the expectations you felt comfortable telling your cochlear implant candidates in 1986?
Levine: I used to tell patients that if they got sound awareness - that would be a wonderful and amazing thing. In 1986, I told them they could count on the fact that they would not be able to hear normally, in fact, we tried to disassociate cochlear implants from the actual sense of hearing at that time. I used to tell cochlear implant candidates they would get an awareness of sound, or a perception of sound, and that was about it. The expectations were cochlear implants would be useful to help people read lips, but again, we didn't want to have the patients think of it as hearing back in 1986, because it was too crude, and not really what any of us considered true hearing - back then.
AO/Beck: And how would that contrast to what you tell patients at this time?
Levine: Well, I primarily use the Advanced Bionics Clarion, and of course there are others available too. But I tell patients that 98 percent of the cochlear implant recipients like the implant, they use it on a regular basis, and the cochlear implant is useful for many different sounds and situations. I feel very comfortable telling them about 3/4ths of the current cochlear implant users are able to use the telephone, and they can expect to understand about half of what is being said without visual cues, and that in real sentences such as day-to-day situations, they can expect almost 100 percent comprehension. But I also warn them that we cannot accurately predict outcomes for any individual ahead of time, and that in fact, each patient is different.
AO/Beck: Dr. Levine, sometimes I get email from cochlear implant candidates who write me and ask about failure rates. In other words, I believe they are asking, what percentage of patients who receive cochlear implants, are not able to use it because it simply doesn't work? My answer is that in working with cochlear implant patients for almost 20 years, I have only seen two patients that didn't stimulate, and they were both in the 1980s. What do you tell patients with regard to this issue?
Levine: I tell them about the same. The success rate, if it is defined as successful electrical stimulation or as perceiving sound through the cochlear implant is probably just about 100 percent. I cannot recall the last time someone didn't stimulate, and that is based on our doing about 50 implants per year, or maybe a little more.
AO/Beck: What do you tell patients regarding their aural rehabilitation and the time it will take to learn to effectively, efficiently and maximally use their cochlear implant?
Levine: Like most good surgeons, I refer them to the audiologist! Sharon Smith is our lead cochlear implant audiologist and she addresses this topic with the patients. I think the bottom line is that aural rehabilitation (AR) is necessary and the AR treatment course varies based on the patient and their needs, and we know that the more they work on it and the more they attend to the issues, the better their eventual outcome will be. So it really is driven by the patients. Those that do the best are usually those that work at it the hardest. We know that simply turning on the implant is not enough, and we know that the audiologist working with the patient is the most important factor post-op, in determining their final outcome.
AO/Beck: Can you tell me, when did we actually turn the corner on cochlear implants? When did we go from an awareness of sound, to actually hearing?
Levine: Great question. I'm not sure that there was a singular moment, but we did go through a series of tests that helped lead to the Advanced Bionics CII cochlear implant, and I remember realizing at that time that something had changed dramatically. I like to tell the story that sometimes between the Wright Brothers and the 747, air travel got a lot safer and a lot cheaper, and it's the same with cochlear implants. Somewhere between 1990 and 2002 we've made a few quantum leaps. Not only are the devices significantly better, but the complication rates have fallen way down, and the results are typically excellent.
AO/Beck: What are the surgical and post-op complications you discuss with patients?
Levine: I tell my patients that the biggest complication issue is the wound itself. Sometimes the wound can break down, and sometimes the wound will need medical or surgical attention. Of course that is extremely rare, but it is possible. Once you have a foreign body implanted, there is always a risk that it might need further attention. Again, those are rare issues, but these are the issues I discuss with my patients.
AO/Beck: What was the single most impressive advancement you've witnessed in the last 2 or 3 years with regards to cochlear implants?
Levine: The modiolar hugging electrode array has been evolving for the last few years, and in the last year this has really improved dramatically. So I think that would probably be the most important new development in cochlear implants. Of course the hardware and the software have both improved dramatically over time, and the improvements have been significant.
AO/Beck: Dr. Levine, it has been a pleasure speaking with you. Thanks for your thoughts and insight on this topic.
Levine: Thanks for inviting me Doug. It's been a pleasure for me too.
For more information on Advanced Bionics click here.
Click here to visit the Advanced Bionics website.
