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A patient's storyThere couldn't be a prouder grandfather than Wilbur Goerke of Cleveland, WI. But something was always missing in his relationship with his 8 grandchildren, who no range in age from 5 to 20: noise. Severely hard of hearing since young adulthood, Wilbur had never been able to enjoy the sounds of his grandchildren laughing, playing and even squabbling with one another. But thanks to today's medical technology and the expertise of Steven Millen, MD, Wilbur now hears it all and loves every moment of it. "I have Dr. Millen to thank for my ability to hear again," says Wilbur, who had cochlear implant surgery at Aurora West Allis Medical Center. A cochlear implant is an electronic device designed to provide sound information for people who have severe hearing loss or "nerve deafness" in both ears. Candidates for cochlear implants are those people who can no longer be helped by hearing aids. "I was on my sixth hearing aid – the best one made at the time – and still couldn't hear a thing," says Wilbur. Dr. Millen, along with his associate, Steven Harvey, MD, who both are on staff at Aurora West Allis Medical Center and Aurora St. Luke's Medical Center, are among only a handful of physicians in Wisconsin who specialize in neurotology and are trained to perform cochlear implant surgery. Dr. Millen, in fact, was the first practicing neurotologist in Wisconsin. He was also the first physician in the state to offer cochlear implants. "The original implants allowed individuals who were totally deaf to hear environmental sounds such as a car horn or a door bell," explains Dr. Millen. "That was remarkable, but it was only the tip of the iceberg for what was to come. Today's cochlear implants allow patients to hear most sounds. They can have normal conversations, hear everyday things, and even talk on the phone. The new technology has opened the door to a whole new world for people who lived in silence before." The cochlear implant is vastly different from a hearing aid. Hearing aids simply take sound and amplify it, explains Dr. Millen. The cochlear implant works to stimulate the nerve deep inside the ear. The cochlear implant actually is a system of 2 components. A small electronic receiver about the size of a quarter is surgically implanted in the skull behind the ear. The most start-of-the-art model has 24 separate electrode wires that are inserted into the inner ear to stimulate the nerve of hearing. The other part of the device is external and fits neatly and comfortably behind the ear. It consists of a microphone and computerized speech processor that converts sound into electrical impulses that are then transmitted through connecting cables to the implanted receiver. The implant then stimulates the hearing nerve in 24 different places to send useful sound information to the brain. "I'm 71 years old and started losing my hearing 50 years ago," says Wilbur, who suffers from a congenital disorder that caused his deafness. "I really hadn't heart much of anything for 20 years or so. Then, after being fitted for the external unit one month after cochlear implant surgery, my wife and I were driving home from the doctor's office when I noticed a 'clicking' noise in the ear. I asked my wife what it was, and she turned to me with astonishment. When she said it was the turn signal, I couldn't believe I could hear such a subtle sound! It was quite a moment! "Today, I can't begin to tell you what a difference the surgery has made in my life," he continues. "I can hear birds signing for the first time in two decades. One day, just for the simple joy of it, I saw in our sun room and listened to the rain. Finally, I can have two-way conversations with people, talk on the phone again, and listen to my grandchildren. I feel extremely fortunate and very, very happy." Years ago, people who could not be helped by hearing aids had little hope of ever hearing again. With the improved technology of cochlear implants, Dr. Millen says more people than ever can benefit from the surgery, from children as young as 18 months who are born deaf, to older adults with severe age-related hearing loss. Acoustic neuromas are another problem of the ear in which Dr. Millen and his associates, Dr. Harvey and Dr. Arvind Ahuja, are leading the way with the best of the best in technology and state-of-the-art care at the Neuro-Otologic Skull Base Surgery Center of St. Luke's Medical Center. An acoustic neuroma is a non-cancerous tumor that grows on the nerve of balance, adjacent to the nerve of hearing. Hearing loss is usually the first symptom of an acoustic neuroma, although the loss occurs so gradually that many people don't even notice it. The tumor may also be associated with ringing in the ear or "tinnitus," headaches, facial numbness and tingling, balance problems and difficulty walking. In most cases, acoustic neuromas occur in people between 30 and 60 years old. The cause is unknown. It is usually a slow-growing disease, says Dr. Harvey, but it must be treated. "Without treatment, acoustic neuromas can affect other nearby nerves, such as the nerve of facial sensation and nerves that affect speaking and swallowing," he explains. "Eventually, if the tumor grows large enough, it can press on the brainstem and become life-threatening." There are three approaches to treatment for acoustic neuromas: observation, surgical removal and stereotactic radiotherapy. The circumstances of each individual case determines the best approach to use. Dr. Harvey explains that in older patients, observation may be all that is needed for a low-growing tumor. For young and middle-age patients who are otherwise healthy, surgical removal of the tumor is usually the recommended treatment. Stereotactic radiotherapy – a one-time dose of precisely delivered radiation – is an option for patients who do not want or cannot have surgery. With radiation therapy, the goal of treatment is to halt or slow the tumor's growth. It will not cure it, says Dr. Harvey. At. The St. Luke's Skull Base Surgery Center, surgical removal of the tumor is accomplished with two highly specialized doctors working as a team. A neurosurgeon, Dr. Ahuja is responsible for removing the part of the tumor from the brain. As specialists in otolaryngology, Drs. Millen or Harvey remove the portion of the tumor within the ear bone. "Every time we do the surgery, it's a combined procedure," says Dr. Harvey. "It takes two different specialists to take these tumors out." While the team approach is one reason St. Luke's has become a major referral source in Wisconsin for treatment of acoustic neuromas, the Skull Base Surgery Center also is one of just a few facilities in the country that uses "intraoperative monitoring" of auditory nerve function by placing electrodes directed on the nerve, itself, during surgery. "Intraoperative monitoring provides physicians with highly accurate information about the nerve function during the surgery," says Dr. Harvey, the first doctor in Wisconsin to evaluate a new, recently available electrode specifically for this purpose. Facial nerve monitoring has been the standard of care during this surgery for over 10 years. That information guides surgeons in altering their techniques in order to provide the best possible outcome. Intraoperative monitoring ultimately provides patients with improved chances of saving residual hearing. "This is just another example of how physicians working together can provide the very best outcome for patients to lead a normal, health life," adds Dr. Ahuja.
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