In December 1996, Robert Zurga became the third US patient to receive a MED-EL cochlear implant. In the fall of 2016, Zurga, who has since moved to Austin, Texas, made a return trip to Duke University for a reunion with his surgeon, Debara Tucci, MD. Their special reunion wouldn’t have been complete without audiologist and MED-EL North America CEO, Raymond Gamble—Zurga was the first cochlear implant that Gamble had ever programmed while on an audiology rotation at Duke.
The meet-up gave the three an opportunity to reminisce about the past and how far Zurga has come with his cochlear implant. It also gave them the chance to reflect upon the significant advances that have occurred in hearing implant technology over the past two decades.
Zurga was just 28 years old, living in what was then Yugoslavia, was on his way to his first date with a special woman, when the unimaginable happened. Zurga was involved in a serious car crash and sustained major injuries. In the pre-cell phone era, Zurga had no way of notifying his date, Sanja, that he wasn’t going to be able to meet her at the restaurant as they had planned, and he didn’t want to let her down. He asked the ambulance driver and crew to stop by the restaurant where he was supposed to meet Sanja so that he could tell her. The crew of first responders ignored his request and rushed him to the hospital instead, where he fell into a coma. He ended up getting an infection at the hospital that required powerful antibiotics to save his life, but unfortunately, the medications were toxic to his ears (ototoxic) and left him almost completely deaf.
“I lost my hearing very, very quickly,” Zurga recounted in a recent interview. “It was in a span of about two or three weeks. I noticed that the nurses were picking up the phone in my room, but I hadn’t heard it ring. So, that sounded the alarm to me and they brought in the audiologist to test my hearing. I had profound hearing loss.”
Zurga ended up staying in the hospital for about three months. During that time, Sanja had somehow heard the news about his accident and managed to find him, becoming a regular visitor at the hospital during Zurga’s convalescence. After Zurga’s recovery, Sanja became his wife, and later, the mother of their three children.
For the next 10 years, Zurga wore hearing aids, but relied on his family, friends, co-workers and his own resourcefulness to communicate. “There were a lot of really amazing people around me that I relied on. But I didn’t want to impose too much on these people. You don’t want to bother people to tell you every joke or everything that has been said around you.”
The Zurga and his family eventually moved to North Carolina where he worked as a software engineer. A friend had shown him an article about a new technology called a cochlear implant that enabled people with hearing loss to regain their sense of sound. He recalled that when he first explored the possibility of getting a cochlear implant, his audiologist was very upfront about making sure that his expectations weren’t too high. He was advised that, at most, an implant might improve his lip reading, which he said he had never been very good at. So, he decided to defer implantation.
Three years later, Zurga was really struggling with how much sound he was missing and started thinking about cochlear implantation again. He thought, “How much worse could it be?” He went to Duke University and visited with the director of Duke’s cochlear implant program, otolaryngologist Debara Tucci, MD.
During their recent reunion, Zurga’s care team reminisced about Zurga’s first visit to their clinic. “It’s amazing. I do remember Robert from 20 years ago,” said Dr Tucci. “He was a very memorable patient, and he was also our first patient implanted with a MED-EL device. He had a significant hearing loss, and he was struggling quite a bit with his hearing. He had challenges communicating at work, as well as at home with his wife and his family.”
Zurga was again counseled to keep his expectations low and to be happy with what sound the cochlear implant could help him get. They didn’t want him to be disappointed.
“At that time, to be able to offer a cochlear implant to a patient, we had to demonstrate that the patient would potentially do better with an implant than they did with their hearing aid,” said Dr Tucci. “In Robert’s situation, that was not a difficult call because he really heard and understood very little with his hearing aids.”
In recalling Zurga’s results with his implant, Gamble added, “In those days, we expected enhanced lipreading, perhaps identification of male or female voices, and maybe some sound awareness in quiet. I never in my wildest dreams expected someone with a cochlear implant to be able to have a full conversation with me, even with their back turned to me, or with background noise. It was a real life-changing moment for me.”
In December 1996, Zurga became one of the first people in the United States to receive MED-EL’s COMBI 40H cochlear implant. Twenty years later, Zurga still hears with the same implant. He had his choice of several implants, but as a “computer geek,” he wanted to go with what was at that time the latest technology.
After his processors were activated, Zurga remembers his first hearing experiences very well. He remembers the sound of his daughter, whose voice he had never heard. He recounts the emotional experience of being able to call his mother in Croatia and talk to her over the phone for the first time in 10 years. Even hearing ordinary, everyday sounds after 10 years of silence made an impression on him.
“You start noticing that there is noise when you walk, there is noise when you wash your hands. You hear these ordinary sounds again and it reminds you that life is actually the same as you once knew it. It is these trivial sounds that become, once again, part of normal life. These sounds may not be important in and of themselves, but they remind you that things are once again as they were when you heard before,” Zurga explained.
Although some cochlear implant patients undergo surgery to get a new, updated implant inserted, Zurga still uses his original COMBI 40H cochlear implant. Because of MED-EL’s forward-thinking design approach, the internal components of the implant have been engineered since the beginning to accommodate the latest external technology. Zurga was successfully upgraded to the SONNET and RONDO processors last year, which represent significant advances in size, power, comfort, and processing algorithms over his original body-worn processors.
“The technology has changed tremendously over time,” said Dr Tucci. “For example, patients who would not have been cochlear implant candidates at the time that Robert was implanted are implant candidates now. We’re implanting patients with more and more residual hearing.”
One example of this is that Duke recently participated in a clinical trial with MED-EL to study the use of Electric Acoustic Stimulation (EAS) technology. EAS devices are implanted in patients who still have some residual hearing, usually in the low frequencies. The new device from MED-EL, the SYNCHRONY EAS Hearing Implant System, was approved by the FDA in September 2016 and is now commercially available.
“Cochlear implant technology has changed the world for my patients, and it has changed my practice,” said Dr Tucci. “Treatment with implants is a significant part of the care I provide, and it’s my favorite part of my practice, because it enables me to give people the gift of hearing.”
“It’s really gratifying work,” Gamble agreed. “In the early days, I knew all of the patients’ names—we started with just a handful of patients. Now we see thousands every year getting this amazing technology. The patients always seem to guide us— they take us in directions that I would have never expected, as far as what they want and need based on their lifestyle demands.”
Gamble noted that the ultimate goal for patients is to have something completely implantable–without the need for externally-worn components. He explained that while the company continues to make great strides in improving the ability to hear music and listen in noisy environments, these can still be challenging situations for implant recipients. As one step towards further improving listening experiences for patients, Gamble reports that MED-EL now offers Triformance, which is a combination of Fine Hearing, Complete Cochlear Coverage, and Structural Preservation, designed to be the cornerstone to providing the best benefit to MED-EL’s patients, today, tomorrow, and always.
“We don’t know what tomorrow will bring, but we want to make a device that doesn’t do any harm to the patient so they can take advantage of those technologies in the future,” said Gamble. “With MED-EL products, we don’t ever want to leave our patients behind…we want to bring our patients forward.”