Cochlear implantation: truly life-changing.

Cochlear implantation began 30 years ago in Slovakia, more precisely in Bratislava. The process of CI-program enrollment began long before that. We spoke to Prof. Dr. Milan Profant, who held a key position in the process.

It must have been 1984 or 1985 when I first heard about cochlear implantation.
At that time there were some pioneers in Europe: I heard about the work of Prof. Dr. Banfai in Düsseldorf and Prof. Otto Ribári MD Phc in Budapest. I traveled around to see the operations there and to find out about implantation.

My first article was published in 1986 in one of the Czechoslovakian ENT journals: an overview of cochlear implantation. Then we formed a team and I invited one of my colleagues to do a PhD on cochlear implants. Everyone said that this had no chance, that it would never be done in Bratislava. But MUDr. Zuzana KábatováCSc did her doctorate in cochlear implantation.

The people in Warsaw already had experience. So eight of us traveled to Warsaw for training.

Why did people assume that cochlear implantation would never be performed in Bratislava?

At the end of the 1980s, there was a group of Czech engineers in Prague who developed a single-channel, extracochlear neural prosthesis. That was back in the days of communist Czechoslovakia. We were one country. So it was understandable that when a Czechoslovak prosthesis was developed, we didn’t want to buy the Western prosthesis. These Czech prostheses from Prague worked. But after they were implanted, more and more of them were explanted.

After the changes in 89, we tried harder and harder to get our official representatives to opt for the official international products, which were of a certain quality and systematic.

The first cochlear implantation was performed in Bratislava in June 1994, wasn’t it?

The first patient was a 12-year-old boy who’d become deaf after taking heavy antibiotics. His mother was a doctor, a neurologist. She found out about cochlear implantation and asked our Ministry of Health to cover the costs of the operation in Germany, where Prof. DDr. Ernst Lehnhardt also performed intracochlear implantations on children. I was asked to confirm the request as the minister’s expert. And I said: instead of paying for the trip, we could buy the implant and invite the surgeon to implant the patient in Bratislava. And that’s exactly what we did.

The patient turned out to be excellent. Today, this young man is a lecturer in nuclear physics at the University of Bratislava. When the implantation was carried out, those present probably did not realize the seriousness of the moment. But in any case, this implantation dramatically changed this boy’s life.

For many other ENT specialists, cochlear implantation was so foreign that it took many, many years to convince them that we could offer such treatment in our department.

Eventually it became a regular treatment there. How many CIs have you performed so far?

In my department we have done about 600 implants, and internationally I have done many, many hundreds more. For example, I have been to Tuzla in Bosnia and Herzegovina and many other European countries, but also to Africa, Zimbabwe, Algeria and Libya – I have traveled all over the world to perform the implantation. Unfortunately, I don’t have any current statistics, but there must be far more than 600 implantations abroad. All in all, 1000 to 1500 in Slovakia and internationally.

In Slovakia, we organize a meeting for implantologists every two years. The entire implantation team from the clinic takes part. Since we started in 1994 and are now in 2024, there are many patients who were very young children at the time of the implantation and are now beautiful young women or men who are truly integrated into the lives of hearing people. When we meet them and their parents, they still talk to us as someone who has changed their lives. This is something that is very encouraging not only for me but also for the rest of our team: when we can see and touch the real result of our work.

What changes in cochlear implantation have you seen over the last 30 years?

Cochlear implants have changed in terms of size, quality of electrodes, coding strategies, speech processors, reliability and miniaturization of speech processors. The results of cochlear implantation are also constantly improving, but there are no changes as significant as when MED-EL introduced the CIS strategy. That really was a revolutionary change! Since then, the outcome has steadily improved.

I think the next revolutionary step is to look for a way to treat the causes of deafness. Just like we give antibiotics for tonsillitis and then the patients are cured.

Are current CI candidates queuing up for such treatment – or should they wait?

Sometimes parents do not agree to bilateral implantation as they are waiting for the second ear for a new therapy. We know that there is a time when a child can be helped to hear and develop speech and language understanding, and we need to continue supporting them during this time.

Parents see the first implant as something that has changed their baby’s life. But some parents think that the other ear can be cured one day. We have to tell them the following: we know that bilateral implantation helps much better than unilateral implantation. Yes, after implantation the ear is probably not yet ready for certain treatments. But today we are far from being able to cure your child’s deafness. Yes, we need to take a step forward and look for something that will cure the deafness, not a prosthesis. But your child needs help now. And right now we only have this help, and bilateral implantation is definitely more effective than unilateral implantation. You can get this help from us, but it’s your decision.

The time window for speech development is not an urgent matter for deafened adults, is it?

We don’t even know yet how a therapy for adults will work. But many of these neurological diseases like Alzheimer’s, Parkinson’s and others are directly dependent on hearing, because hearing is very important for the socialization of the elderly. When people do not hear well, they remain alone and do not want to make new friends nor communicate. This loneliness contributes to the development of neurological diseases. We need to give these elder people the opportunity to socialize. Not just watching TV without understanding anything, but getting in touch with neighbors and friends. And we need to give them this chance now.