A pioneering new surgical technique for patients with profound hearing loss has been trialled at Queen Elizabeth Hospital in Birmingham.
Professor Philip Begg and Consultant ENT Surgeon Richard Irving carried out the procedure which involved drilling through one of the thickest parts of the skull to reach the back of middle ear. This meant that Mr Irving's drill was less than 1 cm away from the membrane that protects the brain and he also had to avoid two very important nerves in that area, the nerve that allows the facial movement and the nerve that supplies taste. This obviously represents a huge number of risks to the patient, from infection to losing his sense of taste.
Then a tiny microphone is implanted in the middle ear - a process which involves drilling into one of the smallest bones in the body - the Incus. The Incus bone, or Anvil is in the middle of the ossicular chain, the three bones in the middle ear which amplify the changes in sound pressure level detected by the tympanic membrane, or ear drum.
In the current cochlear implants, the microphone is placed outside the body and is still a relatively large piece of equipment. New technology has enabled the microphone size to be reduced to such an extent that it can be placed inside the body, into one of the smallest bones of the middle ear. Mr Irving said before the surgery: "If this really works, then in years to come there could be surgeons all around the world putting this technology in, benefiting tens of thousands of patients".
That day is still some way off as the trial of this operation took a gruelling five hours, after a whole year's preparation. There were several hitches encountered, not with the surgery, rather the technology.
In order to test that the implanted microphone was working, a speaker was taped over the ear and once the microphone was in place, test sounds were played into the ear to see if the microphone picked them up. When the speaker was first turned on the surgeons could hear no response from the implant and as they started to investigate the cause, became increasingly worried that they had damaged the tiny implant when inserting it into the incus.
As is often the case however, there was a very simple explantation for the lack of response from the implant - the speaker had been dislodged during the procedure and was not playing the test sounds into the patient Paul Heaney's ear! Once the speaker had been replaced into the correct position, the surgeons could hear that the implant was functioning correctly and were happy with the early results of the surgery.
Following his rehabilitation from the surgery, trial patient Paul Heaney went back to the hospital to test the new technology out. When the middle ear microphone was switched on and Paul heard with it for the first time he said that:
"[I] haven't heard with this much clarity for the last 20 years. General background noise is completely gone, [there's] much more volume and much more clarity.
It definitely gives me a lot of hope to be more social, it's a fantastic device"
As hearing aid users will know, background noise can be very difficult to ignore and greater clarity is a constant need. The early evidence of this trial is very encouraging and will hopefully become more and more available as the techniques are developed.
BBC 2 documentary 'Surgeons: At the Edge of Life' Episode 3: The Pioneers was shown on BBC 2 on 22/01/2018 and is available to view on iplayer.