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The surgery itself, and the approach into the skull, are used
for a variety of other problems. Kwartler, one of only a few
physicians in New Jersey who perform this procedure, explains
that a small area of the head behind the ear is shaved and a
curved incision about six to eight centimeters, or three and a
half inches, in length is made to expose the mastoid. This bone
behind the ear is hollow, like a corrogated cardboard box, and
after the top to the box is taken off, Kwartler and his team go
deeper. Along the way, they identify structures like the sigmoid
sinus, the vein that drains blood out of the head, the lining of
the brain which is just to the north of the mastoid cavity, and
the floor of the temporal lobe where balance canals sit. During
surgery, “you can see them, as well as the nerve which is responsible
for movement of the face and cheek sensations. Once we
have identified these structures, we know we are in the right
spot. We can see the end of the cochlea, an area called the round
window, through which the sealed membrane of the cochlea can
be entered.”
After carving a little seat for the tiny receiver into the mastoid
bone and making a tiny—about a millimeter in size—
opening into the basal, or first, turn of the spiral cochlea,
Kwartler slides the electrode into this snail-shape structure.
Then, “you’re done,” he says. “Just coil it down and close up.”
Though dizzy and in some pain, Mink was in the recovery
area by 11 am and back home by 5 pm with a little help from
her children. She stayed close to bed all weekend with her “head
bandaged and wrapped in a turban. I don’t like to be on
painkillers and I remember being in tears at one point. I had no
sense of balance.” Her instructions were to drink fluids, take
Tylenol and not wash her hair. As Kwartler explains, “There is
nothing we would be doing in the hospital except mothering
her and a patient can get better mothering at home.”
By Sunday, Mink felt a little better. Then, energized and anx-
30
PULSE SPRING 2003
Jed A. Kwartler, MD, and audiologist
Christine Hoffman (center) fine-tune
Dianne Mink’s cochlear implant.
ious to reclaim an ordinary life, “On Tuesday
morning, I got into my car and drove to the
supermarket to buy blueberries,” she says.
“The store is only a half mile from my house
but I felt as if I had accomplished something.”
A week later, she went back for a
check-up but cochlear implants are never
turned on until healing occurs, which can
take up to five weeks.
Mink’s appointment was set for July 18
and the audiologist Christine Hoffman, her
“angel,” would do the honors. Kwartler
believes that the hardest part of making a
cochlear implant work comes alongside the audiologist and lies
with the patient, who must be persistent and fight the urge to
turn away from all the sound. Some users describe the first
experiences to a clamor of noise, like a pinball game, or the
middle of a raucous gambling casino. What is sometimes called
“cross chatter,” as electrodes jump between fields, can also
occur. For sure, implants still can’t absolutely restore normal
hearing.
Yet, “it was amazing,” Mink recalls. Having been warned not
to expect perfection, “Christine’s voice sounded a little like
Minnie Mouse but my brain quickly began to readjust and
compensate.” She could hear even better after months of dedicated
speech processor mapping, practice, and hours of testing.
Voices are clear though all three of her daughters still sound the
same on the telephone. Music is a bit of a mystery. The beat in
a Gladys Knight concert is clear but the melody is missing.
“I have a tiny toggle,” she explains from her desk in the
Alumni Office, gesturing to the side of her implanted ear, “that
can be boosted up or down.” The site of the implant incision
was sore for awhile and until the fall, she couldn’t sleep with her
head to her left side. Designed to last forever, the external parts
are taken off when she sleeps. She is also careful in the rain.
“You can’t get it wet,” she explains. “So I wear a hooded rain
jacket and always keep that umbrella handy.” Otherwise, her
life is more normal than it has been in years. She even went to
the movies, a simple excursion that had become frustrating.
The buzz of students in the hallway, knocks on the door, and
telephones ringing are more than welcome intrusions now that
she is back in the hearing world.
When two surgical roads appeared in his career path back in
the 1980s, Kwartler’s instinct to go small has carried no small
payback. “I am really able to positively impact people’s lives,” he
says. And Dianne Mink would be the first to agree. ●
DAN KATZ