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Dr. Lindsay Tucker and Dr. Rachel Goffeney – The 60/60 Guideline for Cochlear Implants

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Lindsay Tucker

Dr. Lindsay Tucker is an Audiologist at Arizona Hearing Center with 15 years of experience. Starting as a dancer, she became fascinated with the connection between audiology and dance. This led to a focus on cochlear implants and research on the vestibular function. She graduated from Idaho State University in 2010 with a Capstone Project on post-rotary nystagmus decay in dancers and non-dancers.

Dr. Rachel Goffeney is an Audiology Extern at Arizona Hearing Center. She recently graduated from Indiana University at Bloomington with her AuD. Both Dr. Goffeney and Dr. Tucker lead the cochlear implant program at Arizona Hearing Center, using the latest research on the implants and corresponding audiograms.

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

  • Dr. Lindsay Tucker of Arizona Hearing Center explains the new research on cochlear implants
  • How Dr. Tucker and Dr. Rachel Goffeney entered the audiology field
  • The 60/60 guideline and how it affects hearing loss patients
  • What are the tests the Arizona Hearing Center uses for cochlear implant candidates?
  • Educating patients on the different implants and providers out there

In this episode…

Cochlear implants continue to be a question mark for many patients with hearing loss. Some are skeptical of the surgery while others don’t bother to consider the procedure because of the required qualifications. However, plenty of research on the procedure’s safety and benefits is pouring into the field. A recent study from Michigan even revealed that the pool of eligible candidates may be larger than we once thought.

At the Arizona Hearing Center, two audiologists leading the cochlear implant program with this new research in hand. Dr. Lindsay Tucker and Dr. Rachel Goffeney are both experienced with cochlear implants and are known for promoting them as a more permanent solution to hearing loss. Based on a recent study, they’ve started implementing the 60/60 guideline — and they’re here to share their findings with you.

Dr. Mark Syms hosts Dr. Lindsay Tucker and Dr. Rachel Goffeney of the Arizona Hearing Center to discuss the 60/60 guideline and what it means for patients with hearing loss. They discuss the cochlear implant program, how they educate their patients, and what the new study has to say about eligibility. Additionally, the two go over their careers and how they entered the world of audiology.

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 health.

Dr. Mark Syms  0:16  

Hey, good morning. This episode is brought to you by Arizona Hearing Center where we help patients to effectively treat their hearing loss and to connect better with their friends and family and remain independent. The reason I’m so passionate about hearing loss is because I lost my brother Robbie twice, first to the hearing loss from the radiation to his brain tumor and then again from the tumor itself. We are at Arizona Hearing Center where we only take care of yours I am the E of ENT. I performed over 10,000 surgeries and taking care of many 1000s of patients with hearing loss. I’m the author of a book called Listen Up. Listen Up: A Physician’s Guide to Effectively Treating Your Hearing Loss. You can find the book at www.listenuphearing.com and if you want to learn more about the practice, you can go to www.azhear.com today. I’m really excited. The people I have on it are part of my team, my audiology team at the practice at Arizona Hearing Center. I have Dr. Lindsay Tucker and Dr. Rachel Goffeney. They are my awesome audiologists. They are spectacular and they’re here. Today we’re going to talk about the 60/60 rule. So I’m going to let them tell their own story. I’m going to start with Lindsay, Lindsay tell me how did you get into audiology?

Dr. Lindsay Tucker  1:25  

So I took the background to audiology. Um, my background is in dance. So I grew up dancing. And so my background is vestibular, um, that’s where all my research is in. And then when I worked at Idaho State, they asked me to take over the wire implant clinic and I did and I did that for 10 years and now I’m here. 

Dr. Mark Syms  1:50  

Yeah, she’s great. She’s leading are the two of them are leading our cochlear implant program. And that’s what we’re going to talk a little bit about today about cochlear implants and the criteria for that. And Rachel, maybe you’ll give us a little bit more detail than Lindsay does. Tell me your story to audiology. Lindsay stories, like I became an audiologist and I was a dancer and now I’m an audiologist, which is a great story. 

Dr. Rachel Goffeney  2:10  

I know I’m gonna cut a lot of like the horse breaking in rodeo out.

Dr. Mark Syms  2:15  

You were able to take classes. So you tried audiology, because you were faculty, and then it’s a good one. She doesn’t want to tell the story. It’s okay. 

Dr. Rachel Goffeney  2:25  

She doesn’t wanna tell the full story tonight. That’s fine. So when I went to college, I didn’t know what I wanted to do. So my college had an Exploratory Studies major, where they brought in deans and faculty every Friday from all the different majors. And the speech pathology Dean came in. And she looked at my personality tests like, hey, just take a class, see if you liked it, I took phonetics was my first class, and I absolutely hated it. And so I was like, This is not for me, that I went to tell the dean that this is just not what I was going to do. And the audiology professor was there. And he said, Hey, wait until next semester, when you take my class and see if you like that better. And so I took his class and I was still wasn’t like super sure. And he’s like, You do realize that you’re getting catching on a lot faster and a lot of people in the class. And there’s other things to do besides just hearing aids. So then I kind of explored this whole world of like cochlear implants and more of the medical side of Audiology. And that’s really where I started to fall in love with it. 

Dr. Lindsay Tucker  3:22  

The one year anniversary is coming up, yeah.

Dr. Mark Syms  3:26  

It’s great. And and what I will tell you is guys are both awesome audiologist you do a great job. You really instill a lot of competence and take great care care of patients. So you know, we have a great cochlear implant program. And that’s because of you guys. You know, I think we do a great job taking care of patients. And so as you both know, there are a lot of people out there who are likely cochlear implant candidates who they don’t know and maybe the people taking care of their hearing don’t know. So what I wanted to explore was, you know, some of the stuff in terms of there being some publications and us kind of adopting what they call the 60/60 rule. Can one of you guys tell us about the 60/60 rule?

Dr. Lindsay Tucker  4:05  

Absolutely. Okay. You want to do the 60/60 guideline is a new guideline that came out of Michigan, where they did a bunch a bunch of research, they brought in over 500 people, and they tested them if they were a cochlear implant candidate, and then they did a retrospective study on what’s back at their original audiogram that they came in with. And they found a very strong correlation between patients who had a 60 Db PTA or higher along with a 60% word rec or lower, were good cochlear implant candidate based on testing. 

Dr. Mark Syms  4:41  

Okay, so let’s talk about that. So a 60 Db PTA that means is 60 Db pure tone average. So, you know, if somebody is you know, I’m watching this podcast and I want to break out my hearing test. What do they do? So they look at certain frequencies. So what are the frequencies they looked at

Dr. Lindsay Tucker  4:58  

501,000 In 2000. 

Dr. Mark Syms  5:02  

So they add those all up? Right? 

Dr. Lindsay Tucker  5:05  

Yeah. And then you’re gonna divide by three 

Dr. Mark Syms  5:07  

So the value of how much you have to turn up the volume on the graph, right? So if it’s like, you know, 70/70 and 65, you add those up. I’m not gonna do the quick math, although I think it’s 200. And then you divide it by three to get what would be called the pure tone average, correct? 

Dr. Lindsay Tucker  5:23  

Yes. Correct. 

Dr. Mark Syms  5:24  

So, if that number is greater than what does that make them a Cochlear? Okay, so it actually doesn’t make them a cochlear implant candidate, it makes it somebody who should be evaluated as a cochlear implant candidate, right? 

Dr. Lindsay Tucker  5:36  

That’s correct. Yes. 

Dr. Mark Syms  5:37  

And then the second 60 rule is, tell me about that.

Dr. Lindsay Tucker  5:43  

Okay, so we want to evaluate their word recognition scores, like the best. 

Dr. Mark Syms  5:49  

So how do you do that test? 

Dr. Lindsay Tucker  5:50  

That’s eight. Yeah, so we’re going to evaluate that at the best aided condition? 

Dr. Mark Syms  5:55  

No, and if that’s the 60 rule on their audiogram, right, so that’s not.

Dr. Lindsay Tucker  6:01  

Right, you’re not aided but it’s gonna be like at a comfortable level, because I’m comfortable. 

Dr. Mark Syms  6:07  

I have, I have a 75. Or I have a 65 Db pure tone average. And you’ve already done that test. Okay, now you’re testing me? How do you do that? That other that percentage, what does that mean? How do you do that test when you guys are doing your awesome stuff in the booth?

Dr. Lindsay Tucker  6:21  

So we’re gonna do that at 40 Db above that level? If that’s comfortable for you.

Dr. Mark Syms  6:26  

You make it louder. Right, And then what do you do?

Dr. Lindsay Tucker  6:30  

And then we’re gonna see how you do at that level.

Dr. Mark Syms  6:34  

But your list of words are what does it in pale?

Dr. Rachel Goffeney  6:38  

So it’s, so it’s basically a word. So the man says, say the word dog, and you would have to repeat back dog. There’s no context clues. There’s no sentence, there’s no visual reading or anything. Oh, no speech reading or anything like that. So a lot of people find that test very difficult, because they don’t have any context clues to go off of that. And after the end is-

Dr. Mark Syms  6:59  

One or two syllable word just out here. 

Dr. Rachel Goffeney  7:01  

It’ll be a single syllable word. 

Dr. Mark Syms  7:03  

It’s hard like cat hat. Matt. Yeah. Sad. Right. So. Okay. 

Dr. Rachel Goffeney  7:09  

And a lot of them sound like other words, so that’s okay. 

Dr. Mark Syms  7:14  

And so they have to get if some people are looking at their audiogram right now, it’s 60%. if, if, if the numbers are around or below 60% on that percentage, or they’re not even measured, which we see some outside audiograms, so that they could come in to be considered for their implant, correct? 

Dr. Rachel Goffeney  7:32  

Yes, absolutely. 

Dr. Mark Syms  7:34  

Okay. And so just out of curiosity, in that study, so of all of those people who came in, and, you know, met the 60 rule, what percentage of them actually ended up being candidates for cochlear implants? 

Dr. Rachel Goffeney  7:48  

90-95. 

Dr. Mark Syms  7:50  

Wow. So that’s a lot. So it’s, it’s pretty dark. 

Dr. Rachel Goffeney  7:55  

And it’s pretty predictable, yeah.

Dr. Mark Syms  7:57  

Did they go up any like if the pure tone average was a little bit better? So in hearing, the lower the number, the better the hearing, because it means they didn’t have to turn it up as much for you, but to hear it, because then number is how loud they had to make it for you to hear it. So it did they find that it really fell off if people had a pure tone average of 50 Db or something like that.

Dr. Rachel Goffeney  8:21  

It says that there is only 10 or 12 patients who had a PTA that was lower than 60, that were actually popular candidates that they found.

Dr. Mark Syms  8:31  

So it’s a pretty good song. Right? So so people could take their hearing test, look at it, kind of take the average of 500 hertz, which is cycles per second. 1000 hertz in 2000. hertz, add them all up, divide by three, if that’s greater than 60, they should probably consider coming in, or if their understanding is 60%. Is that in one year, both years? But how does-

Dr. Rachel Goffeney  8:54  

One ear. Just in one ear. Yes. 

Dr. Mark Syms  8:57  

Okay. All right. All right. So you come in. Alright, so now that’s a great rule, right? Because not only can patients kind of do it themselves, but so can some of our colleagues who are treating people with hearing technology so our hearing aid dispenser and dispensing audiology colleagues can use this as a guideline right to send patients. Right now, that doesn’t determine if their cochlear implant candidate, right?

Dr. Lindsay Tucker  9:21  

No, there’s a lot of stuff that goes into determining their cochlear implant.

Dr. Mark Syms  9:27  

And since we’re all on the same team, we know that it’s not just the hearing, right. There’s a whole bunch of other stuff. And we might talk about that in another episode, but from a hearing point of view, okay, so I come in, I have you know, I meet the 60/60 rule you come in at first thing we do is we’re like carpenters. Right. So carpenters measure twice and cut once, right, so we actually first thing we do is we’ll validate that hearing test to make sure that we’re in agreement of that finding, but that still will only say whether or not you meet the 60/60 rule. So as you know, and I know In our organization, we do what we call a cochlear implant evaluation. Right? And so they that is a separate appointment where people come in and we’re trying to determine if they are from a hearing point of view a cochlear implant candidate or not. Right? And so what does that entail that test? Or testing, it’s not a single test necessarily, right?

Dr. Lindsay Tucker  10:21  

So I logically, we want to test their like word recognition and like the best aided condition to see if they get benefit from hearing needs. If they don’t meet that criteria, then we will bring them back for a cochlear implant seminar to make sure that they understand what a cochlear implant is. But within, like the audiological testing, like we will fit them with our hearing aids to see like, hey, are these hearing aids like benefiting them? Are they not benefiting them? Like, how are they doing with a non surgical approach. And if they’re doing well with an non surgical approach, then we are obviously going to go that route, because we don’t want everybody to go through surgery. And we will set them up with a hearing aid evaluation because what we’re finding is a lot of these patients are under fit. And we want them to hear the best way possible. But of course, we don’t want to put them to through surgery. So if we can-

Dr. Mark Syms  11:24  

So cochlear implant them the best way for a patient if hearing aids don’t work? 

Dr. Lindsay Tucker  11:30  

Exactly. 

Dr. Mark Syms  11:30  

It’s not I don’t like my hearing aids or not hearing aids are too expensive. Those aren’t the answers if hearing aids don’t work. And so it’s not whether or not your hearing aids don’t work. It’s whether or not what we consider very well programmed hearing aids don’t work. And so I do I say to patients, like look, you know, you come in, I can look at your ear, I can talk to you, I can look at your hearing test. But to me, the big black box of your hearing experiences, what’s going on, and you’re hearing it because I can’t look at the programming. And we don’t do that we just take our own hearing aids, program them and test them in what we consider the best day to condition. Right?

Dr. Lindsay Tucker  12:06  

Right. We just want people to hear well.

Dr. Mark Syms  12:09  

Yeah, no, I get it. And so it is a little bit different, though, right? Because do you test one ear or the two ears together?

Dr. Lindsay Tucker  12:15  

We separate the two years. And then we do them also together? Right? Because we are really analyzing while you’re hearing? Yes. Because at the end of the day, we just want you to hear as best as possible.

Dr. Mark Syms  12:32  

Right. And so what I say to people is like the hearing test is like an EKG, right? Like it just says, Hey, your Let me tell you the status of your heart. And like the CI evaluation, the cochlear implant evaluation is like a stress test, right, like, so what they really want to know how well your hearts work, and we put people on a treadmill, and we see if their heart can do exercise. So we’re really stressful, because it’s not just with hearing aids, like we do some stuff in the environment to what what do we do Rachel? Like, what do we do in the environment, in terms of when we test them.

Dr. Rachel Goffeney  13:02  

So the testing usually starts off in quiet, but we know the real world is not quiet. So that will put you in some background noise. And that’s where we really see people struggle a lot is it with background noise, which is an everyday environment, if you even if you just go outside, there’s road noise. But then when you go to a restaurant, you’re really trying to interact with family, and there’s noise around you, and they just can’t do it. So testing them and more is a lab testing them more in a real world environment, they adding background noise really gives us a better idea of how they’re doing functionally when they leave us with those hearings. 

Dr. Mark Syms  13:38  

No that that’s great. So we’re really, and I touch back something you were saying, Lindsay I think you know, it is important for people to understand, we don’t just say, well, we’re just going to do surgery, and we’re just going to put devices in your your ear? The answer is is we do that when a hearing aid doesn’t give you what you need. Now, some people hearing aids, they might do well with them, and they’re not satisfied. And we’re okay with that. Like I always say to people, like you know, it’s okay if you don’t like chocolate ice cream, but you know, that’s a taste issue. But if we give you chocolate ice cream, we give you chocolate ice cream, right? You see I’m saying like there can be people who are dissatisfied with their communication, even though we demonstrate that they’re, they’re hearing well, right. And so, alright, so I’ll yeah, I we go through this testing and that testing takes about how long? 

Dr. Lindsay Tucker  14:27  

It’s about an hour. 

Dr. Mark Syms  14:28  

Okay, so you know, it’s an investment and then you talk a little bit about it. Alright, so, at that point, you basically decide, oh, hearing aids are the answer for you, or cochlear implants are the answer for you. And so we’ll leave the hearing aid thing alone, we send them to some of our colleagues who are excellent at hearing care from a hearing aid technology point of view, we would pass them off and say, Look, you’re not a cochlear implant candidate. yet. That’s what I always say to people because hearing loss, you know, it’s a progressive disease. And that’s one of the things we’re checking all the time. So I tell people like look, you know, you come in this year. You’re not cochlear implant candidate. We’ll see you back next year. And we’ll see or if you have a sudden change, we want to know. Right, but so that somebody is a cochlear implant candidate. And then you started talking about it, Lindsay. So just an overall about the process. I tell patients like, Look, you know, when we tell you your cochlear implant candidate, or we explain a cochlear implant is an option to people, I tell people, they don’t know enough to say they want one. And they don’t know enough to say they don’t want one, right? Like, it’s like you don’t really know anything about it. So we try to educate them to tell tell the audience a little bit about that process.

Dr. Lindsay Tucker  15:34  

Yes, so we are taking a very, like holistic approach, we try not to like lead people into one way or another. So we will give them all the educational tools that they need to educate themselves as far as like the different cochlear implant companies that are out there. Of course, the cochlear implant companies are in like the sales category, and we’re going to tell you that it’s better than the other. There’s no research out there that shows that one company is better than the other, everybody performs the same. So we really just want our patients to determine what works best for them and their lifestyle. And we will work with all three of them. Both Rachel and I are very comfortable with all three of the manufacturers are soon to be four, we will be all comfortable with four. So that’s totally up to you and what you feel like is best for you and your lifestyle. Again, there’s no research that shows that one company is better than the other week, Rachel and I will make sure that you are hearing the best way possible. But we also want to make sure that your expectations are realistic. So again, it takes up to a year to get the benefits that you want to. Right, yes, it’s not a quick fix. I know that you guys will YouTube, a lot of us and you’ll think that it just gets slapped on your head and everything is great. But it takes a lot of work. It’s a long, it’s a long process. But again, Rachel and I Arizona Hearing Center along with Dr. Syms, we’re here for the whole process, we will see you throughout that entire year to make sure that you are programmed the way that you want to be programmed. But on the backside, you also have to be willing to do the work as far as like listening therapy, hearing therapy, if you’re not progressing the way that we want you to progress we will also recommend a speech language pathologist to move you along. But again, what do we have? 580? Yeah, around there. Yes. So we’ve been doing this with a lot of patients. Um, at the end of the day, we will make sure that you are hearing the way you want to.

Dr. Mark Syms  17:55  

Yeah, I tell patients, you know, it’s like going to the music store and getting the violin, right. So we hand you the violin. But that doesn’t mean you know how to play it right. So you need a music teacher need to learn how to read music, you have to practice there’s all this stuff. It’s not like putting an app into your head, you know, like on your phone or on your computer and just saying, Oh, I uploaded a cochlear implant. Now I hear. But I think you know, we touched on one thing, which I think is really if there’s any takeaway for patients is we want you to hear better. And that’s what you said, Lindsay, and I agree 100%. And so really what this comes down to is the rules very useful. But if people aren’t hearing Well, we can evaluate your hearing, we can evaluate your current technology, and we can talk to them about how they can hear better. So you know, there are a couple of questions I always ask most people who are on this. So the first question I always ask people is, and you know, whoever gets to go first, I guess is on the spot a little bit more. is, you know, it’s you’re at an award ceremony. They’re honoring you, who do you like so when you want to thank the people in your life who have helped you? Who do you think whichever one you want to go first? 

Dr. Rachel Goffeney  19:06

I would like to thank Dr. Syms.

Dr. Mark Syms  19:08

Now seriously, your life. I appreciate that. I think we’ve agreed theme and I really appreciate it guys. But

Dr. Lindsay Tucker  19:16  

No, but like, honestly, like if I were at an awards ceremony, like you guys would be the one that I think I’ve been and like the cochlear implant industry for a very long time. And I’ve seen people do things that are very, like unethical to me. Um, and so like if I were at an awards ceremony, like I’m not saying this 

Dr. Mark Syms  19:41  

Oh, I appreciate that. 

Dr. Lindsay Tucker  19:42  

I’m not getting a bonus for this. Because Well, yeah, really great. You guys would be the one that I think because I feel like you guys great thing. I’ve been in this for like 10 years.

Dr. Mark Syms  19:59  

I think we always try to do the right. How about you, Rachel? 

Dr. Rachel Goffeney  20:04  

Oh, who would I think um, I think my work environment here. For sure everyone that I work with because I couldn’t do without Dr. Lindsay or front office, I would not get anything done without our front office because all we’ve been doing is answering the phone. So they’re great. Here undergraduate professor, Dr. Diependor who really pushed me to stay in the field and not just leave it. 

Dr. Mark Syms  20:29  

That’s right. And then the last question, I love to ask, this is a new one. What’s your favorite sound?

Dr. Rachel Goffeney  20:38  

Favorite stat. My favorite sound is thunderstorms and rain, which we don’t get here. So do you miss that coming?

Dr. Lindsay Tucker  20:46  

between your pointe shoes? Yep. pointe shoes. Oh, when you crack at a point, yeah. Cracking the shank.

Dr. Mark Syms  20:53  

Great. minds. Laughter So yeah, well, we have a lot of that here. Yeah, we do. We do. And so we were serious. But we have fun. So that’s great. So guys, I appreciate it. You know, usually I say where can people get a hold of you? So we all know it’s www.azhear.com or 602-307-9919. This has been great. I really appreciate you guys coming on. And hopefully people will start using the 60/60 rule and they can get a pathway to better hearing because that’s really we want people to hear better. And there are a lot of people unfortunately who aren’t who could. So thanks for coming on guys and have a great day.

Outro  21:33  

Okay, thank you. 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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