Dr. Héctor Ruiz: “Implant indications on the increase”


Hector E. Ruiz at the IFOS
"Undoubtedly, one of the best ever fusions has been that of hearing aid technology with implants, because they complement each other" © K.H.M.

Cochlear implants have made a tremendous contribution since they were brought in for the only sense-related organ that can be replaced. This has proved a major revolution. Interview with Dr. Héctor E. Ruiz, recently elected IFOS regional secretary for Central and South America, who came to see Audio Infos/Audiology Worldnews' team at their booth.

With the recent International Federation of Oto-rhino-laryngological Society’s (IFOS) Congress in full swing, in Paris from June 24 to 28, Audio Infos found a chance to talk to the Argentinian otorhinolaryngologist and otologist Dr. Héctor E. Ruiz, who was elected regional secretary for Central and South America of this organisation, but who is also the president-elect of the Pan-American Association of Otorhinolaryngology-Head and Neck Surgery.

Ruiz is a genuine “globetrotter” in audiology, and thanks to this trait he has been able to widely circulate his country’s research studies, consolidate international scientific committees, and position himself on the global agenda, especially in relation to cochlear implants.

How did you begin to become active on the international otorhinolaryngology scene?

Many years ago, I began to attend the scientific events of the American Academy of Otorhinolaryngology-Head and Neck Surgery (AAO-HNS). I managed to take part in some 30 congresses, realising at these that the biggest group of professionals in attendance, after the American group, was from Latin America, so the first thing I did was set up an International Committee in which all American countries from could participate, called SPAG (Spanish–Portuguese Advisory Group), and which then grew into the Pan-American committee.

Since that time 18 years ago, I have focused on the Pan-American Association, taking various posts, and I will shortly (2018) take over as president in Peru. The main strategy I have led from the Association is the dissemination of academic events and activities, not just in Argentina but all over the world. I created the Association’s newsletter that currently has 25,000 subscribers, and it has made us known as an association. I’ll have some new challenges ahead in my new position as Secretary of one of the six world regions that make up the IFOS.

How has the evolution and perception of otology transpired in the field of otorhinolaryngology?

At the level of specialty, we have grown considerably, and the great contribution in otology has come from cochlear implants, which were brought in to replace the only sensitive organ related to the senses. This has proved a major revolution. I remember that when I began to operate on ears, the inner ear was untouchable; today any form of hearing loss can be provided with equipment, operated on, and given an implant whether it be a middle ear type, inner ear, or a brainstem implant. There is such a variety of ways to substitute for hearing that it is unforgivable for hearing loss to go on without treatment and rehabilitation.

When implant surgery came into being, it faced many economic difficulties that we would later overcome when social security took charge of it, which allowed us eventually to show how magnificent hearing replacement and rehabilitation are. Today, people who suffered from total deafness, sign-language users, have almost normal hearing. What have also evolved satisfactorily in our specialty is rhinology, with nasal endoscopy, and otoneurology; both of which have enjoyed extraordinary development.

Cochlear implants generate great expectations. What is the reality?

This is one of the areas that has, perhaps, had the greatest growth, year after year seeing something different, and we see this at these events. Of course, electromedicine has advanced and this favours implants. Right now studies are under way on how to replace an organ with a totally-implantable device, and a totally-implantable inner-ear cochlear implant is even being tried out on people. We shall see increasingly smaller implants, more longer-lasting and more easily-chargeable batteries, as in hearing aids and with more wireless accessories of all kinds. The main revolution in implant surgery was triggered by the great long-term benefi t demonstrated.

Hearing aid technology has also evolved. What impact is this having on patients and professionals?

Undoubtedly, one of the best ever fusions has been that of hearing aid technology with implants, because they complement each other, and this is fantastic for the patient. Today you have Bluetooth, FM, wireless apparatus available that allow for communication in groups, telephone conversations, watching TV and so on. And this is only a part of it all, because the whole topic of connectivity and patient access to it is right there too.

In respect of implant professional groups, it is important for their training to keep up with technology. Otosurgeons must be up to scratch on all the scientific advancements; for example, in electrode placement they are now analysing what drugs should be placed within the ear, and this did not exist before now. Today’s electrodes are much thinner and more flexible to avoid the trauma of the insertion. The electrode must preserve the residual hearing and preserve the inner-ear structure and remain close to the modiolus for a better stimulation, and it must be adapted to the cochlear length. All in all, our efforts are oriented towards the preservation of residual hearing. We should not “mortgage” patients’ futures –even more in the case of very young children. We must protect all we can with the greatest possible delicacy, so there is no inflammation and nothing is damaged. To reach this point, we have changed our surgical approach route - now the cochlea is not perforated with a drill.

Generally, what is the follow up protocol for the implant? ¿Is multidisciplinary cooperation advised?

Today, with internet, there is very precise and fast control by professionals in the medical team. The most important thing following an implant operation is rehabilitation, since if I operate on a patient and do not carry out rehab it is as if nothing has been done at all. This is where profound awareness creation must exist on the part of parents, for example, and we as professionals must insist on patient rehabilitation. Some believe that the implant is sufficient and do not continue the process. This is nonsensical. The world has high-quality speech-language pathologists, rehabilitators and audiologists who do this very well.

In terms of practising the profession, has the political panorama in Argentina had an influence?

Different policies affect the delay of implant delivery. We had populist policies, which did not work. Then there was a change, but in these transitions we were not affected. We can carry out implants, do the state and private hospital part, and in general we have carried on. Implants are being indicated with more frequency. Today we have around 900 implants taking place annually in the country, and all hearing devices are imported.

Source: Audio Infos América Latina 58 (Spanish and English)

M.B. and J.E.