Medical NETworking

Through the power of Internet technology, medical experts in New York have switched on an inner-ear device, allowing a man in Uganda to hear for the first time in two years.

Through the power of Internet technology, medical experts in New York have switched on an inner-ear device, allowing a man in Uganda to hear for the first time in two years. Activating the device from halfway around the world is a first and highlights a trailblazing way in which telemedicine8212;conducting medical procedures from remote locations8212;can enhance lives of people in struggling nations.

David Nuwagaba, 23, of Kampala, Uganda, had to drop out of college after becoming deaf from the toxic effects of tuberculosis medication. But when Dr. J. Thomas Roland, co-director of New York University8217;s Medical Center8217;s cochlear implant center, learned of his plight, he knew he could help.

A cochlear implant is a tiny electronic device that is surgically placed in the inner ear, allowing the patient to receive and process sound. It is sometimes referred to as a bionic ear. But since the technology emerged in the 1980s, most of the devices have been implanted in developed nations where patients can afford them. The device is far more complicated than a hearing aid8212;and dramatically more expensive.

The American Academy of Otolaryngology estimates the cost of patient evaluation, surgery, the device and rehabilitation to run 40,000. Among the more than 100,000 cochlear implant surgeries performed worldwide, none have been in Uganda.

Roland, who frequently volunteers in the country, found that the surgical suite at Makerere University8217;s Mulago Hospital in Kampala could support his efforts to help the young man hear.

But Dr. William Shapiro, chief of audiology at NYU Medical Center, underscored that a cochlear implant is a device of numerous complexities that go well beyond the intricate surgery. Once in the ear, the implant has to be turned on8212;and that8217;s where the Internet came into play.

Electronically crossing time zones and cultures, Shapiro, who activated Nuwagaba8217;s device, conducted the programming. Eight time zones away in Kampala, Nuwagaba knew the operation was a success because he could respond to questions Shapiro posed by cell phone. 8220;That8217;s what8217;s so fascinating about telemedicine,8221; Shapiro said, 8220;when you can reach people in faraway places to provide technology that they normally wouldn8217;t have.8221;

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Nuwagaba received the operation without charge, and the device was donated by its manufacturer. Shapiro said all signs point to a successful outcome. 8220;He was a great candidate,8221; Shapiro said. 8220;He had a very short length of deafness. We really had a sense that this kid would do really well.8221; What the cochlear implant does is bypass the damaged hair cells in the inner ear and stimulates the auditory nerve, directly allowing a deaf patient to perceive sound. Shapiro added that the implant itself 8220;is composed of an internal and external portion.8221;

8220;The surgeon implants the internal device that is composed of an electrode array that8217;s threaded into the cochlea,8221; Shapiro said of the spiral-shaped structure in the middle ear that contains vital hair cells, which are responsible for sensing sound. Within the device itself are 22 electrodes.

Each of those electrodes has to be activated, which is the job Shapiro performed remotely from NYU Medical Center.

8220;I had to obtain a threshold on each of those electrodes,8221; Shapiro said.

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The device performs the work of the eardrum and hair cells of the inner ear.

8220;We are able to implant patients we never would have implanted 15 years ago,8221; Shapiro said, 8220;and now the Internet is making the world a lot smaller. And that8217;s really very exciting to me, it really is.8221;
-Delthia Ricks LAT-WP