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Christine Menapace – Identifying the Right Candidates for Cochlear Implants

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Christine Menapace

Christine Menapace is the Vice President of Clinical Affairs for Cochlear, the global leader in implantable hearing solutions. Christine is an expert in clinical audiology, specifically in the field of implantable hearing technology. She has worked with Cochlear for over 25 years collectively, and she previously served as the Director of Clinical Studies. In her current role, she leads a team of 40 professionals that focus on clinical strategy.

Here’s a glimpse of what you’ll learn: 

  • Christine Menapace talks about discovering her passion for audiology
  • How Christine helps patients through clinical affairs at Cochlear
  • Updating the patient care model in audiology
  • The importance of measuring outcomes for hearing tests
  • Tips for identifying the right candidates for cochlear implants
  • How often should you reassess your patients for implants?
  • Looking into the future of cochlear implants

In this episode…

As cochlear implants become more accessible than ever, a new issue arises: How do you choose the right candidates?

It’s a more difficult question than it first appears. Cochlear implants are a powerful tool but are not always a perfect fit for every patient. Additionally, attempting to use cochlear implants with uncooperative candidates can be just as ineffective as an incompatible patient. There’s a lot that goes into finding the proper candidates and tuning the technology. For years, the company Cochlear has been at the forefront of implant technology, and now Christine Menapace is here to share what they’re doing to find the right patients. 

In this episode of the ListenUp! Podcast, Dr. Mark Syms sits down with Christine Menapace, the Vice President of Clinical Affairs at Cochlear, to discuss how to evaluate candidates for cochlear implants. They go through the current systems and studies around cochlear implant solutions along with the technology itself. They also discuss how often candidates should be reassessed for implants. Check out this episode to hear all this and more!

Resources mentioned in this episode

Sponsor for this episode…

This episode is brought to you by the Arizona Hearing Center.

The Arizona Hearing Center is a cutting-edge hearing care facility providing comprehensive, family-focused care. Approximately 36 million Americans suffer from some sort of hearing loss, more than half of whom are younger than the age of 65. That’s why the team at the Arizona Hearing Center is focused on providing the highest-quality care using innovative technologies and inclusive treatment plans. 

As the Founder of the Arizona Hearing Center, Dr. Mark Syms is passionate about helping patients effectively treat their hearing loss so that they can stay connected with their family and friends and remain independent. He knows first-hand how hearing loss can impact social connection and effective communication. By relying on three core values—empathy, education, and excellence—Dr. Syms and his team of hearing loss experts are transforming the lives of patients. 

So what are you waiting for? Stop missing out on the conversation and start improving your quality of life today!  

To learn more about the Arizona Hearing Center, visit https://www.azhear.com/ or call us at 602-307-9919. We don’t sell hearing aids—we treat your hearing loss.

Episode Transcript

Intro  0:04  

Welcome to the ListenUp! Podcast where we explore hearing loss, communication, connections, and hlep. 

Dr. Mark Syms  0:15  

Hello everybody Dr. Mark Syms here, I’m the host of the ListenUp! Podcast where I feature leaders in healthcare. This episode is brought to you by Arizona Hearing Center, I help patients to effectively treat their hearing loss to remain independent and continue to be socially connected. The reason I’m so passionate about hearing loss is because I lost my brother Robbie twice, I lost him first hearing loss from radiation to his brain tumor, and then I’ll ask him again from complications to his brain tumor. I am the E of EMT, I only treat ears I’ve cared for I’ve done over 10,000 surgeries and cared for 1000s of patients with hearing loss and I’m passionate about getting them treated well. I have written a book called Listen Up: A Physician’s Guide to Effectively Treating Your Hearing Loss. If you want to learn more about that go to listenuphearing.com. I’m also at Arizona Hearing Center where you can learn more about my clinical practice. I’m very excited today. Today I have Christine Menapace. She is the Vice President for Cochlear Corporation of Clinical Quality and Regulatory Affairs. She leads a team of 40 professionals that focus on clinical strategy including research, expanding indication, surgical and audiological technical support and clinical care. It’s a big job and she does a great job at it. She has a Bachelor of Arts in Communications disorder from University of Northern Colorado, and a Master of Arts and Communication Disorders, audiology from San Diego State in San Diego, California. That’s where it is amazingly. I’m excited for her to be here. And this is going to be a great conversation. Christine. Thanks. We got over the technical problems. We’re here. Let’s talk, how’re you doing?

Christine Menapace  1:47  

I’m great. Mark, how are you? 

Dr. Mark Syms  1:51  

Nice. Thanks for coming today. Listen, I want to know, how did you get into audiology? I’m always interested in people’s origin story.

Christine Menapace  1:57  

Oh, yeah, great question. So I kind of have quite the path actually. So I think you know, I grew up in a really small town in southern Colorado and probably wasn’t getting the best career advice when to get at that age, and actually wanted to be a fashion designer. So those who know me wouldn’t be surprised by that. But that would have been what I would have told my guidance counselor in high school that I wanted to do. He didn’t love that so much and was like help out a teacher. And I knew I wanted to help people and make a difference in the world. But I also knew that probably being a teacher or social worker wasn’t the right path for me. So my stepmother was a speech language pathologist. And I would on my summer break, go with her, she worked in LA Unified School District and see her and do the work she did. And I thought, oh, that I like this, I could probably do that. So I actually went to college, thinking I would be an SLP. And fairly early on, I was like SLP is not for me. But I did like an embrace the hearing and the science. And that very close relationship they have at that undergraduate level at that time. So I embraced the idea of becoming an audiologist and treating people with hearing disorders and making my impact that way. So you had to at that point, had to get a master’s degree and then a year fellowship to do that. And so by the time we made it to the end of that master’s degree, I also knew I didn’t want to be a practicing clinician in audiology. I also wanted to come back to Colorado from California. And I came back and again, this is in 1990. So Well, long before the internet was the way we communicated and marketed ourselves. Since I started sending letters out to anybody who had a C FY possibility, meaning they were certified by the American Academy of Audiology, to mentor me for my last year of training. And I happened to send one to Judy Greer Macomb, who was the then Vice vice president at Cochlear Americas. And she was so kindly responded to me via a letter. And that letter really changed my world. So I went in for my first interview at Cochlear. right out of graduate school, really. And what I was interviewing for was the first customer service rep. So if you think about the size of Cochlear then, and at that point, all over the world, there were only 3500 People implanted with Cochlear implants when I started, and it was the first customer service job that they were starting there, they were finally getting enough business in the United States that they needed that and they thought that my background in hearing and being able to understand the technology would be a great fit. So I took the job, moved to Denver, and still needed to finish my fellowship. So they then very graciously sponsored a research fellowship, where I worked with what was then the Denver air Institute and Dr. John cell up and David Kelsall and finished my fellowship and my training to be an audiologist as a research cochlear implant audiologist. And then at some point I had to make a decision about if I wanted to stay working with patients and doing research or if I want to take more of the corporate path, which again, based on what you just said about me, it’s pretty obvious, but I chose, and I stayed and continued to, you know, learn and hone my skills in clinical research and study design and working with the Food and Drug Administration, trying to do training and education. And like, as you said, Now, really, a lot of my focus is on that care model. And how does that help us build that whole continuum around access, and awareness, and probably more important, importantly, accessibility to the technology, which I think are all probably sorely lacking, even today? 

Dr. Mark Syms  5:35  

That’s an awesome story. Now, what I want you to know, from my perspective, knowing you personally, you haven’t given up on the patient care side, even though you might have on the organizational chart. So your spirit are very much involved in that perhaps more than some of the people who pretend to be on the patient care side. So I’ll just leave it at that. I’m not trying to Well, thank

Christine Menapace  5:55  

you for that. I still feel like everything I do help maybe not one patient every day, but hopefully 1000s of patients every day. So thank you for acknowledging that. I appreciate it.

Dr. Mark Syms  6:06  

And so, you know, what, what big things are you working on now?

Christine Menapace  6:11  

Well, as I just mentioned, really a lot of focus, probably over the last couple years is trying to look at that care model, meaning how did somebody first find out about a cochlear implant, there’s a whole group of people looking at that about their awareness and education, even get people to acknowledge that CI might be a treatment option for them. And then where myself and my team have come in on what happens when they walk into a clinic such as yours, and start to talk with a professional about a cochlear implant is that the right treat the treatment option for them. And then we’ve looked at everything that happens in that first year of that patient journey. And you do see that there are a lot of visits associated with a cochlear implant. I always say I always joke and say, in my 30 years in this industry, the one thing that hasn’t changed is the patient care model. Right? Back when I started to do cochlear implants, it was very clear why you needed to see somebody frequently. And eight or nine times 10 times in the first year, the technology was much more antiquated, the way we mapped and programmed, we didn’t have imaging, we didn’t have tools to give us feedback from the nerve to tell us that it was working and stimulating it was all sort of hit or miss with oscilloscope hooked up and DOS based software. And for whatever reason that stuck, and it never really changed as the technology changed and allowed us to say wow, we don’t have to see someone who gets cochlear implants, nine times in the first year, you know, I’ve gone out and looked, and I haven’t found any type of treatment option from a pacemaker to a knee replacement to, you know, probably transplants to some degree where you see patients as often as we have, we see the people who get a cochlear implant. And what that does is that creates a bottleneck and a lot of inefficiency, and probably lack of cost effectiveness in providing the treatment. So spending a lot of time Stan, what are those critical points, when they do need to be seen by an audiologist or physician, and what should be happening for that recipient to get the best benefit, and then move on. So focusing a lot on that, and happy to say that the evidence based model we’ve produced has really reduced those encounters from on average about nine times in the first year for most poker implant recipients in the US down to four. And we were able to show that you could get the same benefit and the same outcome, yet not have the patient having to return to the clinic as often and thinking about more what is patient centered care, and I think that is moving it in the right direction. Next step will be to layer on technology such as telehealth and, and things that patients can do remotely or do themselves, as opposed to having to have an audiologist do that for them. So pretty excited about that because it does open up capacity opportunities. So you know, clinic could in theory, create 25, 30, maybe even 40% More patients every year than they do now just by looking at their evaluation schedule and reducing the number of times they see those patients.

Dr. Mark Syms  9:13  

So when you do the outcomes, you’re doing audiologic outcomes or what are you say the outcomes are the same?

Christine Menapace  9:20  

Well, because speech has been such a mainstay in terms of how we look at the success and outcomes of a cochlear implant recipients and probably to be honest, anyway, we measure outcomes in those treated with any type of hearing technology. Yes, I will say speech and then I will say we also looked at quality of life and patient simple patient satisfaction. Was I satisfied with my experience, you know, and that allows you to question Is it the patient or is it the professional that needs to be seeing them frequently and often and we found that they were very satisfied with the experience they had and they reach the same speech perception level with us. essentially less mapping, probably a little less counseling, right? If they needed it, it was there. Very few veered off that schedule, meaning they didn’t come back today. And I really need you I need more help or I’m not doing well. So I think again, it’s just changing that mindset about what it takes in 2021. To get a patient to a successful outcome with a cochlear implant.

Dr. Mark Syms  10:23  

Yeah, I mean, I agree with you 100%. You know, for the mainstream ones, obviously, there are kind of those consumptive patients with a psychosocial issues that are more challenging. And that’s where I see actually freeing up some capacity to be able to spend time with the ones who need more support.

Christine Menapace  10:40  

Right. And that’s even a benefit of it. Right. And, oddly enough, it sounds kind of corny, but it is about 8020 80% really can be on their way, with four visits and 20% absolutely need more support. Keep in mind, I’m fully talking about adults right now, right pediatric butterball wax. But if you free up all that time that 80% don’t need, then you can absolutely help dedicate it to those who need it more. And I also acknowledge that as we continue to see the age and timing implantation continue to get older, those individuals may need more support in the future. And this allows us to be able to treat 90 year old successfully that are healthy, and still get a great outcome from them, because they will need a little bit more support, especially with the technology.

Dr. Mark Syms  11:31  

Yeah, it’s interesting. I saw a 91 year old today who’s a cochlear implant candidate. And my favorite what she said, Well, I know a lot about them, since my son has one. I know her son’s hearing loss have gotten so severe that it was clear that he could benefit but she’s still on the on the fence because you know, she’s like, Well, it did him forever. You know, in her defense, she’s like, Bob 91. I don’t know if I want to do it. But it’s kind of like, wow, that’s a change where I don’t really pay back using their offspring as the index of what it does this technology work? I don’t think I’ve heard that

Christine Menapace  12:04  

before. No, I’ve definitely done heard that before, I’m going to remember that that’s a good story, you have to let me know what he chooses to do.

Dr. Mark Syms  12:13  

And that was totally one where I just said, you know, if you want to do it, learn more about it, we’ll do an evaluation. And if you don’t, that’s okay, too. You know, I say it’s always okay. But in that particular patient population, you certainly don’t want to move people to an intervention when there are so great, how about identifying those patients beforehand? To me, that’s been kind of the Holy Grail, like who are the psycho socially consumptive patients before implantation? That would to me be like the, the thing that we would do, because then we could predict our resources based on that. Because one of the things is, yeah, I think the reason we do eight or nine visits is because we’re assuming the worst. And so if we could gratify them like, Okay, you’re a four visit guy. And you’re an eight visit guy, right? Cuz that’s really what we have to figure out not Oh, well, we could have seen them all in four visits, but we gave a because that’s what we always do.

Christine Menapace  13:08  

Right. So good questions, I think. And again, I’m saying this some knowing about the research that’s going on right now. But I think there’s some very fundamental things that we really haven’t focused intently on, or as much as we may be sort of, over the years, when we were trying to predict outcomes, right? We’ve always focused on what where did they start with their hearing loss, oh, five 10% speech discrimination abilities, and we take them to 60. But yet, there’s still a patient who’s still dissatisfied or doesn’t do well in noise or isn’t, you should

Dr. Mark Syms  13:40  

be dissatisfied with a 60% word recognition score, right? I mean, it’s, it’s

Christine Menapace  13:46  

zero is still a delta 60%. Right. So there is probably some of that is where you start will dictate some degree where you end up. But I think there’s things like really looking at comorbidity factors that would impact that inner ear, right, other high blood pressure, diabetes, things that we know impacts, the vascular systems and other things that are really important for that inner ear. The other one that I’m very teen and would strongly suggest folks start to do as a cognitive screener because I think those two alone will contribute a lot to the variability in outcomes that we see. And when I do say that I’ll often get asked, you know, well, I’m going to implant someone anyway. So what’s the cognitive screener really doing for me? And I’m like, it’s not going to tell you whether you should implant them or not, but it is absolutely going to tell you how much support they’re going to need post surgery. Right. And

Dr. Mark Syms  14:38  

I don’t say issue, right. It’s a counseling issue.

Christine Menapace  14:41  

Well, and understanding what can they take in what maybe it needs to be more spaced out? Maybe they need different support, maybe you need to rely more on a caregiver or a family member to help them out. But I think those two things we will see will help us account for the variability in outcomes. And in some way than predicted I don’t I don’t know for, I don’t know if anything in medicine, maybe you could tell me we’ll ever get to where you go get a knee replacement, someone’s going to tell you, you’re going to get all your range of motion back, right? I think we’re always going to have some degree of unknown. But I think you’re absolutely be able to pinpoint better what people need. This technology is really amazing, because very few people don’t get better in what we’re trying to do, which is restore audibility, and the ability to discriminate and understand and produce beats. Where it does still fall, probably short is in speech and noise, understanding an idea. But again, that’s where you and I and anyone else has the most difficulty to it’s the most complex environment. So I think there’s some improvements there to be had. But I absolutely believe with more competence, you could tell a recipient, how they would do by simply looking at their cognitive state, and other comorbidities that may be impacting that auditory system that we just don’t know about today.

Dr. Mark Syms  15:59  

Yeah, I think one of the issues is the paradigm, right? Because the paradigm is, well, I’m going to implant them anyway. No, the real question is, you know, even when you look at kind of the dialogues we have, we really shouldn’t be talking about the people who are going to implant it’s like, okay, who are the people? Everybody in the room decided not to implant? And why? Right? Because those are actually the hardest. Yeah, why when you like, brings them and you say, like, no, no, I, we really this technology. I mean, we, you know, the technical insertion is not difficult. It’s the, you know, ensuring that they get an outcome commensurate with their expectation. And what really shocked me like, I mean, if somebody is cognitively impaired, or they need a care provider, I’m not saying they should buy it. But that’s a much more like, I would want a cognitive screen, because you might say to them and say to the family, well, you know, yes, but maybe No, maybe we shouldn’t do this. And I think, really, we need to have more of a dialogue about who not to implant. And I know that sounds strange. But if we talk about those people, then actually I think the the pathway or the capacity will open

Christine Menapace  16:59  

up. Absolutely agree because it does, again, it increases the confidence that when we say you are a good candidate, you absolutely are going to get a good outcome. I agree with you. I think it goes both directions. And that’s, that’s good feedback. I do like that. I mean, interestingly enough, both cochlear implant clinics, and it’d be interesting to even know, in your own, they will say there’s very few people that make it to my door through that very hard journey to even identify that a cochlear implant is out there that absolutely aren’t candidate, there’s very few that I don’t implant because by the time they’ve gone through that challenging optical path to get to me, they’re pretty much the candidate. Right. So

Dr. Mark Syms  17:37  

wow, I guess. So, you know, our philosophical approach is, you know, has been, I say, we’re sometimes you know, a little bit more of a rigorous process. And so we kind of make people on the process, because if you put some resistance and make them get there, and I tell you, when we lay out what we expect of people, I’d say about one in 30, we’ll send it over, right, a very nice, no, you know, Dr. Syms, I thought about it, and I don’t really think this is for me right now. And from my perspective, I want them to get what they want for them. But I consider that a little bit of a like, this is a good thing, right? When people actually have reflected upon the commitment to do the oral rehabilitation, you know, even for visits, you know, I mean, like, I’ve tell people, like you can’t get it the first time and say, Well, I don’t like the drive anymore. I’m not going to come right. Like they need some programming, right. And so, you know, nobody says no, to me, I, you know, I say, well, that’s maybe a victory of our screening process where you know, well, because you really want people who are going to go to the whole finish line, right. And so one of it’s the, the idea that the finish line is implantation. And I think that’s just the beginning, if audibility. Right, and so people think the real carrot is getting the implant, but the real carrot is getting hearing. And people don’t think about that.

Christine Menapace  18:54  

Right? No, good points. I completely agree. But even one in 30. That means, you know, what, 29 you’re getting 100 are walking away. That’s pretty well,

Dr. Mark Syms  19:02  

anyway, now, these are the people who qualify, I mean, we have a decent number of people that don’t qualify, because we’re looking at, you know, we’re looking at, you know, I actually had one of our UT students come to me the other day, right. So there’s the 66 year old, right, and we know what the 66 year old, most of those patients are going to be cochlear implant candidates, it doesn’t mean antithesis like that. Everybody who doesn’t meet the 66 year old is not a cochlear implant. And I was trying to say this soon. I said, Look, I sent this patient because they have, you know, 10% discrim on one side, and they have like, 70% discrim. On the other side, I said, but you don’t know what their capacity is going to be in Noy. Right. So that was one of the things like when you get these rules, sometimes they will that means if you’re in the 6060, we look and if you’re not, we don’t but that’s not really the answer. Right? And so it’s obviously contextual of each patient. And you know, what if that patient turns out not to be a CDI, can we see that as a service, right, because we’ve demonstrated you that this technology is not the right technology for you today. As you know, hearing loss as a continuum, it might be two years from

Christine Menapace  20:08  

now. Right. And ideally, they showed up at your door, and you’re going to get them fit and what they need. So it might not be a CID day. And I think that’s where the 6060 rule is nice because it is pulling people in, and then allows a professional that is very knowledgeable across not only implantable technology, but hearing aids and other assistive devices, to help them support and find out what it is they truly need today, and then they are aware of the technology if it comes to the point in time when they do need it. So I think it all worked quite well, I quite like that campaign in terms of raising awareness and at least getting people to, you know, turn the light bulb on and say, hmm, maybe maybe there is another option out there for me,

Dr. Mark Syms  20:46  

agree 100%. It’s just kind of keeping that mindset. And I don’t think you’re in contradiction to this that, you know, hearing treatment is a is a continuum and a reassessment. Right. I mean, it’d be kind of like, wow, you know, my primary care doctor put me on this blood pressure pill 40 years ago. And so that’s what I’m still on. Well, there are developments, and maybe we should check your blood pressure, again, exactly. The continual thing, it’s not. And that was, it’s not as common now, when I first started, people say, Well, I was evaluated for a cochlear implant eight years ago, and they told me I wasn’t a candidate. I was a candidate yet, right? I mean, your hearing was normal. And it’s progressive, right?

Christine Menapace  21:22  

Oh, bingo, bingo.

Dr. Mark Syms  21:25  

You know what to interval to do it back? I do every two years. But I would if there’s a change, I don’t really know if the data supports how often you should reassess them at being interesting question.

Christine Menapace  21:34  

Yeah. I mean, it’s hard, I think, on average,

Dr. Mark Syms  21:37  

give me that answer by my data. Yeah, margins

Christine Menapace  21:41  

that I know have looked at the progression of hearing loss in large number of populations over time, they will say, on average, a progressive sensory neural hearing loss of you know, whether it’s high, you know, noise induced or unknown origin, you’re probably probably progressing about one dB a year out, you know, I’m gonna tell you, that’s the hard number. Yeah, it’s

Dr. Mark Syms  21:59  

also everyone. So the real answer is the cochlear implant candidates, obviously, unless they were born at negative 40 years, you see, I’m saying like for them, it’s like, they’re at 65. And they’ve got a 75 DB hearing loss. So they had to, based on that formula, they had to start losing their hearing at minus 10 years. So these are obviously a stratify group of fast, faster loser losing their hearing faster.

Christine Menapace  22:23  

Yeah, I agree, or agree. And I guess, you know, there is some merit to you know, for our vision were suggested it gets tagged as a screener every year. So what would it hurt to do an audiogram on those recipients, or those potential candidates or hearing impaired population, whatever we want to refer to them as annually just to get them in the habit. So we catch those who are going to progress much faster. And for those who maybe follow that one dB, slow progression over time, at least they know that and they have the confidence that they are monitoring it. So I kind of like the idea of annually, knowing that will catch them and many will continue to go for a period of years.

Dr. Mark Syms  22:59  

Yeah, it’s a fascinating disease. I mean, the biggest thing that I think is so hard about hearing loss is people don’t know what they’re not hearing. Right? And if you really think about that, it’s like, it’s so much different than any other disease, right? Like, well, you don’t know what you hear, right? Like is, which always like people say, Well, my hearing aid, people say, Come back and see me if you need me. I was like, Well, how do you know if you need them? If you just stop hearing things that you don’t know, you’re not hearing?

Christine Menapace  23:25  

It was like putting your reader on? I didn’t know I needed until I put them on? And it’s like, oh, yes, I need him.

Dr. Mark Syms  23:31  

Yes, that the letters look much crisper when I actually have those. Where do you see this going in 510 years from now?

Christine Menapace  23:43  

Oh, you know, I think there’s so many exciting things happening just in the hearing space with, you know, the introduction of some of these gene therapy, companies, pharmaceuticals, I think the implantable technology will continue to get better. I think not only will those improvements come through the product, and continue to enhance it and improve those more difficult listening environments. I think we’ll continue to see technology become more cosmetically appealing to the candidates and the recipients that have to wear it every day. I would like to say that we’ll see people really embracing this idea of treating both ears, because ultimately, what we’re trying to do is get the brain to be able to synergize that and make the most sense of it. Right. And you know, when even though we’re implanting people in one is definitely better than none, ideally, to functioning yours to the best of their capacity is really where you’re going to get the best benefit from your hearing and your brain is going to be happy because it’s getting fed the input that it needs. So I think there’s work to get done there. You know, it’s great that children, a lot of children do get bilateral implants. Adults probably a long way away. I think a lot of that is varied in the reimbursement issues that exist in the way policies are written today. So I would like to see a lot of movement in Some of the policies that do make this technology, you know, for lack of a better word prohibitive to many. So I see that being a big friend, I think, maybe not five years, but I’m hoping in 10 or 15 years, we’ll see the hearing preservation rate for those individuals who have a lot more hearing to lose by going through surgery get improved significantly. And you know, that opens up a whole other avenue of different types of improvement and expectations that we should have. The interesting, one of the interesting spaces for me as we continue to expand indications is the treatment of unilateral hearing loss or SST with cochlear implants. And I feel like that that the far end of the spectrum, and we’re going to learn so much as people continue to explore this treatment option with the FDA approvals and it ensures improving it, I think there’s a lot to learn from that population about how to improve it for everyone else who has all these other types of hearing loss. But that one is quite intriguing to me, because I don’t I don’t know. I don’t know yet. I don’t know.

Dr. Mark Syms  26:06  

It’s not as obvious as you don’t hear from two years. So right, you, right, yeah. It’s like, well, you don’t hear from one ear? And what does that really mean? And I think certainly, satisfaction is a huge part of that. And, you know, when, you know, again, unilateral hearing loss, we know it’s a deficit, but people are not, they’re not aware of bilateral hearing loss. So then being aware of unilateral hearing loss, and then the inconvenience of the technology, which there is some right, those things make it a much more complex treatment equation, interestingly.

Christine Menapace  26:39  

Right. And it seems that, you know, recipients are wearing it and are very happy, it kind of gets stuck in my head, you know, I’ve been treated and watch people get treated with the implants and we I’m always making, usually they’re poor pre surgery, they’re better or post surgery. And with that, uAso patients that you’re you’re implanting will always be there poor air, because they have a totally normal air on the other side. And that is a lot to wrap your head around as a professional that treats hearing loss. Right. So how is the brain integrating that? So again, I think it’s very interesting, and really a lot more to learn on that front and see where it goes. Right? It expanded

Dr. Mark Syms  27:18  

the number of middle ear acicular reconstruction, you know, that concept of intraoral difference, and that you would still notice, and what threshold is that? I mean, there’s that’s a kind of a basic model, the same concept, right? Like, why, yep, no difference that you’re satisfied and part of its counselor. Like the New Year, the implant here is not gonna hear like that other one, if that’s what you want, you know, we don’t have that yet. Maybe you guys will get right eventually. But we don’t have that.

Christine Menapace  27:45  

yet. Not yet. But I think everyone’s striving to say, how would we get there someday?

Dr. Mark Syms  27:50  

Yeah. You know, what I hope is true. medicalization of hearing loss, right? So you know, that this concept that, you know, the answer is go get hearing aids. To me, it’s like crazy, like, you don’t get hearing aids, you get your hearing loss treated with hearing aids, right. Yeah. And so and, you know, some of the things that are afoot right now actually reaffirm that, that it’s the technology, not the care and the technology. So it’ll be interesting to see how the OTCs. And if, you know, we’re for the timing of this recording where the big budget resolution bill hasn’t been passed yet. So if if hearing aid coverage is included in Medicare, it’ll be interesting to see what those outcomes look like, just from a hearing care point of view.

Christine Menapace  28:34  

Right. And I do applaud you for running your clinic. I did read your book. And I think your philosophy is what medical hearing treatment should look like. I think you do a nice job at that. And I hope others start to move. I do see a lot of migration in that direction and interest in people coming from different factions, where there’s private practice audiology or other physician practices, looking to say, how do we really change the concept of how hearing loss is treated? So what we’re

Dr. Mark Syms  29:05  

streaming? Right, right, not just not just given an object, right, like, yeah, sorry. Yeah, no, I mean, it’s kind of it shows the bias, right. I mean, even policymakers are like, you just need hearing aids. Wow, I wish it were that simple. Right? And right, we’re talking about the subtleties that you and I are discussing about treatment, like, it’s, it just doesn’t make sense that you just treat it or you just put the technology on it. And so it’ll be interested. Great. And so that that is that whole psychosocial side of that. That’s to me fascinating about hearing loss. Yeah, that people don’t actually know they have hearing loss. That’s fascinating to me. The brain is amazing. I will say, it was an incredible, actually a year brain doctor, I figured that.

Christine Menapace  29:49  

Yes, you still are because you might be treating the periphery known as the ear, but it’s the brain Mets are really treating. So

Dr. Mark Syms  29:56  

what’s funny, I talked to you about this, like, you know, I’ve got a diagram in my office where it’s like the holy And then on the right hand side, there’s a little thing that says brain. And like so if you do it by brain goes through their ceiling and through the floor. And I go and look at that we don’t even like talk about it. Like, I mean, it’s like, exactly. It is the same. I mean, we’re really just a brain feeding system. Right?

Christine Menapace  30:18  

Absolutely. I always say we’re hearing is just bring food. And that’s really what it is.

Dr. Mark Syms  30:23  

And it is amazing, great food. So that actually brings me to the question I asked everybody, what’s your favorite sound? I love asking people this question.

Christine Menapace  30:33  

Oh, well, you know, I’m a I do love music. I know that that’s a very broad thing. But I like all types of music. But I would say I’m also a yogi. And I think my breath and the breath of others is one of my favorite sounds too.

Dr. Mark Syms  30:49  

That’s great. That’s really great. Well, this has been great. I very much appreciate you coming on and sharing your perspective with us, Christine. This is Christine Menapace. She is the vice president of oh, gosh, regulatory, Clinical Affairs and quality. Yeah, well, I, you know, I hope I hope you get three times to pay for the three different things. But even that’s my wife. That’s my wife. Anyway, if people wanted to get a hold of you, how would they get ahold of you LinkedIn? Is that where they would find yours?

Christine Menapace  31:25  

Yeah, they could definitely find me on LinkedIn, obviously at Cochlear’s website, based here in Denver. And then my email address is cmenapace@Cochlear.com, happy to have people reach out to me that way, too.

Dr. Mark Syms  31:37  

That’s great. Thank you for coming on. This has been great. I really appreciate your time. 

Christine Menapace  31:41  

Thank you, Mark. Always great talking with you. Okay, have a good evening.

Outro 31:48  
Thanks for tuning in to the ListenUp! Podcast. We’ll see you again next time and be sure to click subscribe to get updates on future episodes.

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