On the cutting edge: doctor is a pioneer in the field of cochlear implants

Most people don't think twice about the sounds that are part of everyday life, whether it's birds chirping, the telephone ringing, someone typing on a computer keyboard or screeching tires as employees make a mad dash for home after work. In fact, they are so routine that people tend to completely ignore them. This is not the case for Dr. Charles A. Syms of San Antonio.

For Syms, who specializes in otology and neurotology, hearing is his life's work and calling. A lieutenant colonel individual mobilization augmentee at Wilford Hall Medical Center, Lackland Air Force Base, Texas, Syms works in the ear, nose and throat clinic. In his private medical practice, he is a partner in the Ear Medical Group in San Antonio.

"After completing general ear, nose and throat residencies at Wilford Hall and Andrews (AFB, Md.), I wanted to get into skull base surgeries," he said. "I applied for an Air Force-sponsored fellowship to the House Clinic in Los Angeles. The clinic is world famous for accomplishing the first cochlear implant, and that is how I got to this place in my life."

Syms spent 12 years on active duty before becoming an IMA and partner at the Ear Medical Group in 1998. Today, he spends an average of four days a month at Wilford Hall seeing patients in the ENT clinic and assisting residents with patient care.

"I enjoy working with the staff at Wilford Hall," Syms said. "I learn 10 times more from the residents than they do from me. Being an IMA here is a great job, and it is a privilege to be a part of what I do, helping with whatever cases come in the door."

The doctor said his military and civilian jobs closely parallel each other, with both requiring him to be on call, conduct rounds with residents, teach, give lectures and perform investigative research. Patient work load is divided with about 40 percent involving children and 60 percent adults.

Syms enjoys treating adult patients, but his true love is helping children with hearing problems regain their freedom to live a normal life through the use of a hearing aid or a cochlear implant, or with the help of some other medical procedure.

"If I was in an academic environment, I would be working in either an adult or children's hospital," he said. "I didn't want to do that, so I am able to see all patients who need assistance."

In his civilian practice, Syms specializes in the use of cochlear implants. A cochlear implant is an electronic device that bypasses the damaged hair cells and stimulates the hearing nerve directly. The implant provides people with useful hearing and improved communication ability. The device is a safe, reliable and effective treatment for severe to profound hearing loss in adults and profound hearing loss in children. Cochlear implant surgeries have been in existence since 1982, with more than 55,000 people regaining their hearing as a result of the device, according to medical literature on the subject.

Syms said studies have shown that adults who receive cochlear implants understand more and improve their communication skills better than those who receive hearing aids.

For children, he said the implant aids in speech development during early childhood, making it easy for children to begin speaking and learning at the same level as their peer once school begins.

The implant works by receiving sound through a speech processor then analyzing and digitizing the sound into a coded signal. The signal is transmitted to the hearing nerve fibers in the cochlea. Inside the cochlea, fluid in the inner ear sets off an electrical response in thousands of tiny nerve cells, which transmit the signal to the brain, where the signal is recognized as a sound.

Syms said the cochlea can turn into hard bonelike material due to illness, disease or continuous exposure to loud noises. Once the cochlea turns into bone, there are no medical procedures to reverse the condition, resulting in a loss of hearing.

One young patient who benefited from Syms' expertise was 2 year-old Nicolas Schilders. When he was 16 months old, Nicolas was stricken with pneumoccal meningitis. He spent six weeks in a hospital in Fort Worth, Texas, battling both meningitis and kidney failure.

One of the possible side effects from meningitis is a loss of hearing While in the hospital, doctors tested Nicolas' hearing and discovered that he was totally deaf in both ears.

"We were devastated," said Nicolas' mom, Jannie. "I remember feeling entirely defeated by something we could not even see. Nicholas had battled so hard just to stay alive, and this did not seem like a fitting reward. We wondered about his future."

While their son was still in the hospital, Jarmie and he husband, Ben, began researching cochlear implants. Someone of the information they found included testimonials from deaf adults who said implants were not ethical and that the surgery was too invasive. Furthermore, they discovered that some medical professionals believe the effectiveness of implants is overrated and that the devices only provide minimal hearing gain.

Faced with conflicting information, Ben and Jannie turned to family friend Lt. Col. Mike Xydakis, an ear, nose and throat surgeon stationed at Landstuhl Regional Medical Center in Germany, for assistance. Xydakis and Jannie were co-workers while she was on active duty as a medical officer.

"Col. Xydakis was so impressed with Dr. Syms' credentials and work that he insisted we contact him," Jannie said. "He knew we were struggling to make the right decision and felt strongly that Nicolas would be in the best possible hands with Syms."

Within a couple of days, the Schilders had contacted Syms and were actively involved in discussions to determine the best course of action for their son. Conversations between the family and doctor would go on for some time before the Schilders realized they had more in common with Syms than just their desire to do what was best for Nicolas. Syms and Jannie are both reservists. Jannie is a captain in the 301st Medical Squadron, Naval Air Station Joint Reserve Base Fort Worth, Texas. Ben is a captain in the Royal Netherlands Air Force stationed at Sheppard AFB, Texas, as an exchange instructor pilot.

After considering all of their options, the Schilders decided to go with Syms' recommendation to conduct bilateral cochlear implant surgery. In other words, put an implant in both ears at the same time. However, there was one small problem.

"In the United States, it is the norm to do only one implant at a time, primarily because of the cost of the device to the hospital, about $24,000," Syms said. "With the cost being the major issue, bilateral implant surgery has not progressed to the point of being the norm."

On the other hand, Syms said doctors in Germany and other European countries have had success with doing two implants at the same time. Bilateral implants help children determine where sounds come from and have better understanding of sounds without the competing background noises he said.

"If we waited to implant the second device at a later date, it may not have been possible," Jannie said. "As a family, we made the decision to insert an implant in both ears at the same time even though it was rarely done. We wanted him to have as much hearing as possible, even if we were doing something that was out of the ordinary."

With the decision made to proceed with the bilateral implant surgery, the only other hurdle was to pay for the procedure. The Schilders' insurance wouldn't pay for the surgery. Syms sent a letter to the Netherlands embassy explaining Nicolas' condition and how the operation was becoming more prevalent in Europe. Within two weeks, the request was approved and surgery was scheduled.

On Sept. 4, 2002, Nicolas became the first child in Texas to undergo bilateral cochlear implant surgery. The next day Syms programmed Nicolas' implants allowing him to hear for the first time since his bout with meningitis.

Normally, Jannie said, it takes up to a month before patients who undergo cochlear implant surgery can hear again. She said that Nicolas regaining his hearing only one day after the surgery is a testament to Syms' years of military and civilian training that have led to him becoming one of the world's finest otolaryngology surgeons.

Since his surgery, Nicolas has had to attend auditory-verbal therapy and see Syms and audiologists within his private practice to have the implants adjusted and preventive maintenance performed. Their last meeting was in June at a picnic for patients of the center Syms said Nicolas is doing just fine.

"He is doing just fantastic," the doctor said. "He has far exceeded my expectations along with those of his parents. Nicolas will develop speech language and reading ability equal to that of his peers. The only thing that holds Nicolas back now is his own limitations and desires."

Ben and Jannie are grateful for Syms' help.

"We can now communicate with Nicolas using what comes naturally our voices," Jannie said. "Ben and I are extremely grateful for the expertise and efforts of Dr. Syms. There is no doubt he is at the top of his held in this profession. The Air Force should be proud to have such a fine surgeon in its midst. He has changed our lives forever."

(Second Lt. Lance Patterson, Headquarters Air Force Reserve Command Office of Public Affairs, Robins AFB, Ga., contributed to this article.)

How a cochlear implant works

1. Sounds are picked up by the small, directional microphone at ear level. 2. The speech processor filters, analyzes and digitizes the sound into coded signals. 3. The coded signals are sent from the speech processor to the transmitting coil. 4. The transmitting coil sends the coded signals as FM radio signals to the cochlear implant under the skin. 5. The cochlear implant delivers the appropriate electrical energy to an array of electrodes, which has been inserted into the cochlea. 6. The electrodes along the array stimulate the remaining auditory nerve fibers in the cochlea. 7. The resulting electrical sound information is sent through the auditory system to the brain for interpretation.

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