CHICAGO – Sept. 18, 2024 - While cochlear implants have been around since the mid-1980s to improve hearing, a vast majority of the eligible population does not have one. A recent research letter published in JAMA Otolaryngology-Head & Neck Surgery, co-authored by Kevin Zhan, MD, director of Northwestern Medicine’s Cochlear Implant Program, found that less than five percent of potential candidates in the Chicagoland area have received a cochlear implant.

 Until recently, Sabur Ajao was one of them.

 Ajao’s hearing issues began after high school. He initially used hearing aids, but his hearing continued to decline as he moved to the United States for graduate school.  As a student at the Northwestern University Kellogg School of Management, he found that hearing aids were no longer sufficient for his needs.

 “What I didn’t realize about hearing aids is that they also amplify unnecessary sounds,” said Ajao. “This often led to headaches from prolonged conversations and background noise, causing me to avoid unnecessary interactions.”

 He was referred to Lindsay Kandl, AuD, audiologist at Northwestern Medicine. Kandl determined Ajao was a good candidate for cochlear implants, with only 20 percent hearing in his left ear and 22 percent in his right ear.

 “The cochlear implant is an electrode that is placed into the cochlea during an outpatient surgical procedure,” said Alan Micco, MD, Chief, Section of Otology and Neurotology at Northwestern Medicine. “The electrodes replace the hair cells, the tiny little cells in the cochlea that pickup vibrations so that we can hear. We are repairing the organ by putting this electrode in. The electrode then stimulates the nerve and patients can hear again."

 To install a cochlear implant, surgeons make an incision just behind the ear and open the mastoid bone to create a path to get underneath the eardrum and expose the cochlea to place the cochlear implant. The surgery takes about an hour. Patients return 10 days later to get their processor to start stimulating the implant. And about 10-12 days after surgery, patients are starting to learn how to hear again. 

 “We typically tell patients that it can take about six months before they hit a nice plateau to see where they’re at,” Dr. Micco said. “But Sabur was day one off the charts. The first day he got his processor on, he was asking when he could get the other ear done. Most patients nowadays with hearing loss will eventually get the second side if the hearing is poor on the other side because binaural hearing is just like your vision. If you close one eye, you lose depth perception. There is depth to hearing as well.” 

 For Ajao, the improvement was life changing. He recalls a friend noticing the change when he could immediately respond to a joke.

 “Understanding and responding to jokes instantly was a new experience for me,” Ajao said. “I told my friend, ‘The difference now is I can get your jokes immediately and respond right away.’”

 Ajao had his first cochlear implant surgery in his left ear four months before a summer internship at a major consulting firm in downtown Chicago. His hearing improved to 60-70 percent in his left ear. He later received a second implant in his right ear in August 2023. After graduating with his MBA in Winter 2024, he started working full-time at the firm where he had interned.

 "Anything I say would be an understatement,” Ajao said about the impact of cochlear implants. “I really cannot compare what it used to be to what I have now. It’s like comparing going somewhere on a horse to flying on a plane. It’s just different.”

 For more information or to make an appointment with a Northwestern Medicine otolaryngologist, call 312-695-8182 or visit nm.org.

CHICAGO – May 22, 2024 – As cicadas emerge across the United States, the harmless insects are bringing their traditional “sounds of summer” with loud, high-pitched noises that sound like a buzz, shrill or shriek. Cicadas have a lifespan of approximately four weeks, so while their noises are short-lived, another sound continues for millions of Americans long after summer has ended.

Tinnitus is a buzzing, ringing, hissing, whistling or clicking sound in one or both ears, which occurs in the absence of external noise for nearly 20 million Americans. Some people refer to tinnitus as sounding like “cicadas in their heads.” Five million Americans with tinnitus have pulsatile tinnitus, a rhythmic pulsing noise in one or both ears that tends to synchronize with their heartbeat. The noise is often described as a “whooshing” sound heard when the heart beats. The Northwestern Medicine Pulsatile Tinnitus Clinic is one of a few clinics in the U.S. dedicated to evaluating and treating patients with pulsatile tinnitus.

“While cicadas bring loud noises for a short period of time, it’s nothing compared to what patients with pulsatile tinnitus are hearing every single day. Some describe it as a ‘whooshing’ sound or very similar to a baby’s heartbeat on an ultrasound machine pulsating through their ears,” said Ali Shaibani, MD, interventional neuroradiologist at Northwestern Medicine who sees patients in the Pulsatile Tinnitus Clinic. “For many patients, the noise interferes with everyday life and can be debilitating. I’ve had patients come to me with suicidal thoughts or even compressed their own jugular vein to try and make the noise stop.”

Patient Story

In October 2022, Dana Pulciani woke up with a horrible “heartbeat noise” or “whooshing noise” in her left ear. If she wanted to hear people talk, she’d have to push on her jugular vein. Pulciani had been a medical assistant for 20 years before moving into an administration role at a pain management clinic, so she knew something was wrong.

The then 38-year-old scheduled an appointment with Alexander Schneider, MD, an ear, nose and throat (ENT) specialist at Northwestern Medicine, who immediately thought she might have pulsatile tinnitus, telling her he had only seen a handful of cases in his career. Dr. Schneider ordered an MRI, which showed a narrowing of the artery next to a small aneurysm in her brain. 

Meanwhile, Pulciani started taking yoga classes to try and train her brain to ignore the “whooshing” noise. She also joined a Facebook group called the “Whooshers” and one of the group members recommended Dr. Shaibani. That same week, Dr. Schneider was able to get Pulciani an appointment with Dr. Shaibani. 

In November 2023, Pulciani underwent minimally invasive surgery with Dr. Shaibani who placed one stent in her artery and another in the aneurysm. Immediately after waking up from surgery, the “whooshing” noise was gone. 

Pulciani is back to living a normal life and can’t thank Drs. Schneider and Shaibani enough for their care. 

Causes of Pulsatile Tinnitus

Pulsatile tinnitus occurs due to issues with blood vessels in the head and neck. Conditions range from harmless to dangerous. The causes of pulsatile tinnitus are diagnosed through a series of hearing, physical examination and imaging tests to show what’s happening inside the patient’s skull.

One of the most common causes of pulsatile tinnitus is idiopathic intracranial hypertension (IIHTN), where the pressure inside the head is elevated. Many patients with this condition have a narrowing involving the two main veins that relieve the pressure in the head, by taking blood and cerebrospinal fluid back to the heart.  

“When the two large veins that bring blood out of the brain are narrowed, it can cause the ‘whooshing’ sound. It’s similar to how a whistle works – it pushes air through a narrowed space. In most cases, this can be treated with medication, but in severe cases where the patient’s vision is threatened or the medications aren’t adequate, we must open up the vein through minimally invasive endovascular surgery to reduce the pressure and relieve the tinnitus,” said Dr. Shaibani.

Aside from hearing the “whooshing” noise, the most common symptoms associated with IIHTN include daily headaches and vision issues. Symptoms can increase or decrease when a patient lies down or turns their head. Symptoms can also change when pressure is placed on the jugular vein. Pulsatile tinnitus can often be cured once the underlying cause is treated.

A less common but potentially more dangerous cause of pulsatile tinnitus is the development of a short circuit connecting arteries directly to veins (arteriovenous shunt) close to the base of the skull. The battery of tests ordered by the Pulsatile Tinnitus Clinic staff is designed to also look for this cause. Fortunately, this condition is also treatable in the vast majority of cases using minimally invasive endovascular techniques.

Treatment Options

- Medication used to tread underlying conditions such as hyperthyroidism, anemia, elevated intracranial hypertension or high blood pressure.

- Endovascular minimally invasive surgery such as stenting, can correct certain underlying conditions, including an aneurysm.

- Self-management techniques may help ease symptoms if there’s no underlying cause. These may include sound therapy, cognitive behavioral therapy and tinnitus retraining therapy.

Very few clinics in the U.S. have a multidisciplinary team of pulsatile tinnitus specialists. The Northwestern Medicine Pulsatile Tinnitus Clinic is made up of experts in many fields, including neurointerventional surgery, otolaryngology (ear, nose and throat), neurology and neuroradiology. 

To schedule an appointment, call 312-926-3185 or visit nm.org for more information.