In a rare and complex case of ENT Surgery, doctors at Max Super Speciality Hospital, Dwarka, successfully performed a cochlear implant procedure on a blind patient with schizophrenia who had recently developed severe to profound hearing loss in both ears. The procedure restored a vital sense on which he depended to navigate and connect with the world around him.
The patient, a 52-year-old man resident of New Delhi, had lost his vision seven years ago due to an untreated cataract that progressed to an advanced stage. Since then, he had relied mostly on his sense of hearing to navigate daily life. A few months ago, he experienced a sudden drop in hearing in both ears following a viral infection. Over time, this worsened to profound hearing loss (more than 90% hearing loss), leaving him almost completely cut off from his surroundings.
Seeking expert medical care, the patient consulted Dr. Sumit Mrig, Director & Unit Head – ENT and Cochlear Implant Surgery at Max Super Speciality Hospital, Dwarka. However, his condition posed multiple challenges. Living with schizophrenia and significant dual sensory loss, he was unable to undergo routine diagnostic tests in the usual manner. As a result, key investigations, including MRI scans to assess the inner ear and Brainstem Evoked Response Audiometry (BERA) to evaluate hearing nerve response, had to be carried out under sedation. These assessments were conducted to confirm the extent of hearing loss and determine his suitability for cochlear implantation.
After a detailed evaluation, Dr Sumit Mrig, along with the multidisciplinary team of doctors, including specialists from anaesthesia, audiology, and psychiatry, decided to proceed with cochlear implant surgery in both ears. Care was taken during the anaesthesia to avoid drugs that could increase the psychotic symptoms. Cochlear’s CI532 perimodiolar electrode array was used during the surgery. In simple terms, this advanced electrode array is designed to sit closer to the hearing nerve inside the ear. Because of this positioning, it can deliver sound signals more efficiently using very low electrical current. This not only helps preserve any residual hearing but also improves sound clarity, especially in noisy environments, while using less battery power.
In a notable step, the sound processor of the implant was activated on the third day after surgery, following the global best practice of the early switch-on protocol. In many cases in India, activation is typically done after three to four weeks. Early switch-on helps patients begin their hearing journey sooner, providing patients with the ability to hear better faster.
The patient has already started responding to sounds, marking the first step in his recovery. According to Dr Sumit Mrig, “This was a highly challenging yet rewarding case. Managing a patient with dual sensory impairment and a psychiatric condition requires meticulous teamwork, planning, and surgical expertise. While the initial experience of sound may be unfamiliar, structured therapy and device programming (mapping) will help him gradually interpret and adapt to auditory inputs”.
This case stands as a testament to how modern medical advancements, combined with multidisciplinary expertise, can overcome even the most complex clinical challenges, offering hope where it once seemed limited.
