Cochlear Implants
by Cochlear Guest Author

Artificial Intelligence – Use in Healthcare by Brian Kaplan, MD

August 31, 2018
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Research updates

 

By guest author: Brian Kaplan, M.D. – Chair, Department of Otolaryngology-Head and Neck Surgery at Greater Baltimore Medical Center Director, Cochlear Implant Program at Greater Baltimore Medical Center

Artificial Intelligence (AI) has been around for some time. Every day we see another story about the use of artificial intelligence, machine learning or big data in the news. Advances in medicine have often relied on new discoveries in science and now healthcare is being transformed by the use of these advanced technologies.

In 1959, Arthur Samuel was credited with being the first person to realize that we could not teach a computer everything we know in order to complete given tasks. We needed to teach computers how to learn for themselves1. This discovery, along with the advent of the internet, set into motion the ability for computers to take the next step into current state-of-the-art AI and machine learning. In the 1960s, researchers developed the first problem-solving systems in organic chemistry, which is considered the first application of artificial intelligence. By the 1970s, researchers moved from basic science to applications in medicine with attempts to automate diagnosis2. Today, most AI employed in healthcare revolves around classification using deep learning technologies. It is not that AI systems cannot diagnose certain conditions, but the requirement for machine learning has changed from high cognitive function to classifications tasks. This step in the use of technology requires convincing humans that the classifications are accurate, consistent and repeatable. In a recent study, AI systems were found to be able to identify melanomas (through classification) at a higher rate than expert dermatologists and with greater sensitivity and specificity3. However, the most successful AI solutions are those that augment human action rather than replace it.

There was a time when some experts predicted the use of robots in all areas of healthcare, specifically in surgery. Granted there are some rote aspects of surgery that a robot can certainly handle, but the state-of-the-art techniques employed today are robot-assisted surgery. In LASIK surgery, a skilled surgeon uses a robotic device to complete most of the procedure. The surgeon is still responsible for all of the measurements and calculations required during the surgical procedure and is certainly the crucial asset in the case of an emergency or unexpected anatomy. Machines have an innate advantage during rote tasks of being fast, accurate and operate with a lack of bias, but human discernment provides a successful outcome when unanticipated events occur. Robotic capabilities in surgery may eventually allow remote-robotic surgery. This could change clinical care by providing care to patients who may not otherwise receive advanced care. This increase in access to care is beneficial to remote patients and the clinicians who care for them.

New AI tools help medical professionals change their clinical practice and to standardize care. Allowing AI systems to assist professionals can not only standardize care, it can increase productivity. The key to successful use of AI systems is to ensure the human factor never fades from the healthcare appointment. In the study mentioned previously, once the dermatologists were provided with additional information from the patients, their diagnostic accuracy increased and the article concludes that there was no substitute for a thorough clinical examination to provide a full healthcare picture for patients and their providers.

AI is integrated into many aspects of our lives and we should expect that to continue. Growth in the healthcare sector continues to be strong with one source estimating that artificial intelligence in US healthcare will continue at 35% rate for the next eight years4. Many predictors bemoan the hurdles needed to fully integrate AI into mainstream healthcare. Using AI to standardize care provides assistance to professionals, which allows for enhancing the lives of patients and healthcare professionals.

See the references below for more information.

About our guest author: Brian Kaplan, M.D. – Chair, Department of Otolaryngology-Head and Neck Surgery at Greater Baltimore Medical Center Director, Cochlear Implant Program at Greater Baltimore Medical Center

Dr. Kaplan was born and raised in Boston, Massachusetts. He attended Cornell University before enrolling at the University of Virginia for both medical school and residency training. He currently serves as the Chairman of the Department of Otolaryngology, and Director of the Cochlear Implant Program, at the Greater Baltimore Medical Center.

Past research interests have included cartilage and inner ear hair cell regeneration. Clinical studies have involved various ototopical agents, along with hybrid and traditional cochlear implantation.

Dr. Kaplan spent over ten years consulting in the medical device and services space, working with venture, public and private equity. In 2013 he cofounded the technology company Everseat, providing a novel, mobile platform optimizing scheduling efficiency for medical practices, hospitals and health systems. He was a consultant for several years for Cochlear before becoming the Global Head of Clinical Innovation, focusing on modernizing the delivery mechanism and creating the standard of care for cochlear implantation.

He currently resides in Baltimore, Maryland, USA, with his wife and three children.

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  1. https://en.wikipedia.org/wiki/Arthur_Samuel
  2. Uchan, S. February 8th, 2018, blogpost “AI in Medicine – A Historical Perspective” https://rowanalytics.com/blog-post/ai-in-medicine-a-historical-perspective/
  3. Welch, A. May, 29, 2018, CBS NEWS “AI better than dermatologists at detecting skin cancer, study finds” https://www.cbsnews.com/news/ai-better-than-dermatologists-at-detecting-skin-cancer-study-finds/
  4. Taylor, Phil April 13th, 2018, PMLive “Artificial intelligence in healthcare ‘set for 40% growth to 2024’” https://www.pmlive.com/pharma_news/artificial_intelligence_in_healthcare_set_for_40_growth_to_2024_1231723?es_p=6544595
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In an effort to keep our content fresh and reflective of a diverse industry, Cochlear Americas features a mix of employees and professional partners to contribute to Cochlear ProNews as Guest Authors.

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Counseling new indications and the importance of early access to sound

December 1, 2020

By Ryan Lopez, Director, Nucleus® Product Management & Marketing at Cochlear Americas

For 20 years, cochlear implants have been indicated in children no younger than 12 months of age. Earlier this year, Cochlear received FDA approval to lower the age of cochlear implantation from 12 months to 9 months for children with bilateral profound sensorineural hearing loss.* This important approval ensures that children who are born deaf have earlier access to a cochlear implant which can provide them with the hearing capabilities to develop speech and language at a trajectory similar to their hearing peers.1-3­

As clinicians, counseling parents and caregivers though the decision-making process to implant their child can be an emotional journey. Confidence in understanding why early implantation in children is so important can help to reinforce the vitality of the counseling process.

Age at intervention has been shown to be highly correlated with longitudinal outcomes. Receiving a cochlear implant early in a child’s life provides a greater chance of realizing personal best speech, social and language skills.1 Early access to sound can allow a child’s speech and language development to be on par with normal-hearing peers, enabling a life of possibilities.2-3

In addition to other imperative information surrounding cochlear implantation in children, the Pediatric Evidence Summary for Cochlear Implants take a retrospective approach to clinical data focused on the importance of early access to sound.

Read the Pediatric Evidence Summary now!

References:

  1. Ching TYC and Dillon H. Major Findings of the LOCHI study on children at 3 years of age and implications for audiological management. Int J Audiol. (2013 Dec); 52 Suppl 2:S65-8. doi: 10.3109/14992027.2013.866339
  2. Dettman SJ, Dowell RC, Choo D, Arnott W, Abrahams Y, Davis A, Dornan D, Leigh J, Constantinescu G, Cowan R, Briggs RJ. Long-term communication outcomes for children receiving cochlear implants younger than 12 months: A multicenter study. Otol Neurotol. (2016 Feb); 37(2):e82–e95. doi: 10.1097/MAO.0000000000000915. Copyright 2016 Wolters Kluwer Health, Inc.
  3. Geers AE and Nicholas JG. Enduring advantages of earlier cochlear implantation for spoken language development. J Speech Lang Hear Res. (2013 Apr); 56(2):643-55. doi:10.1044/1092-4388(2012/11-0347).

*In Canada (for CI500 and CI600 series implants) and the United States, the cochlear implant system is intended for use in children 9 to 24 months of age who have bilateral profound sensorineural deafness and demonstrate limited benefit from appropriate binaural hearing aids. Children two years of age or older may demonstrate severe to profound hearing loss bilaterally.

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Three days lost at sea: a Recipient/Audiologist recounts his decision to become a bilateral cochlear implant user

November 28, 2017

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After three days lost somewhere in the Caribbean Sea, Mark Campbell-Foster (AuD. and bilateral Cochlear™ Nucleus® recipient) and his Nucleus® 7 were reunited, thanks to a stranger with an underwater metal detector. 

Vacationing with his mother, Denise, in Aruba recently, Mark’s Nucleus 7 and its Aqua+ spent three days underwater* covered by the island’s white sand which made it impossible for Mark or his mom to locate the lost sound processor.  Luckily, Mark was wearing his Kanso® sound processor on the opposite ear and still had one ear to hear!  Relying on one ear reminded Mark of his decision to become a bilateral Nucleus® cochlear implant (CI) recipient and he shared this story…Mark

As a university junior, Mark Campbell-Foster made the decision to receive his first cochlear implant.  That decision was driven, in large part, by his inability to hear his mom over the television one evening.  Mark and his mom, Denise, have always been close and it was her voice that he says, “his brain remembered the most.”  When he could no longer clearly understand her, he made the decision to receive his first Nucleus cochlear implant. Denied by insurance, Mark’s parents offered to pay for the device out-of-pocket – luckily, a second insurance request was approved and Mark could be implanted during the next school break.

MarkAs a young man faced with the choice between two CI brands, Mark says that he chose Nucleus for what he felts was an “edge on design and the availability of a small headpiece coil.”  Today, he is thankful for the ability to continually upgrade to new technology and, as you read earlier, he is glad that Cochlear now offers the Aqua+ to keep his sound processor dry!

After pursuing an Audiology degree at Northeastern University, Mark made the decision to become a bilateral cochlear implant recipient because he felt he would be more successful on the telephone. At that time, Mark was working at a fast pace clinic, and often had to use the telephone with his cochlear implant. This meant relying on the contralateral hearing aid in the opposite ear whenever someone would speak to him when he was on hold. This made listening challenging. However, Mark feels that the decision to go bilateral was actually made harder for him as an audiologist since he felt his hearing aid provided a qualitative aspect to his hearing that he finds hard to pinpoint in words.

Once implanted, Mark’s friends and family noticed improvements in his ability to communicate, reporting to Mark subtle improvements in the clarity of his speech. From his perspective, Mark felt that the first CI was “the cake” and the second CI became “the icing on the cake.” This allows him to walk into the clinic’s waiting room without worrying whether his next patient was seated on the left or the right side of the room because he knew he would hear them no matter where they were seated.

Able to speak from a point of authority both as a recipient and as an audiologist, Mark routinely works with CI clinics on the east coast and often finds himself counseling patients about the decision to receive a cochlear implant.  Mark was recently recognized as Cochlear’s field team member of the year.

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* The Nucleus® 7 Sound Processor is water resistant to level IP54 of the International Standard IEC60529. The Nucleus 7 Sound Processor with the Aqua+ is water resistant to level IP68 of the International Standard when used with LR44 alkaline or nickel metal hydride disposable batteries.
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