Enhancing Hearing Accessibility Through Cochlear Implants

The November rains were an epiphany for Dave Modrell.

For years, the retired paving excavation contractor was unable to hear the most subtle sounds. After wearing hearing aids for two decades, the devices had lost their effectiveness.

Modrell and his wife, Debbie, were running out of options to improve his hearing until coming to the Pacific EarClinic, operated by the Pacific University School of Audiology. Assistant Professor Jennifer Ratigan presented a new option for the Modrells: a cochlear implant. Her suggestion proved to be a new lease on life.

The device allowed Dave, Pacific’s first cochlear implant patient, to hear the rain for the first time in years.

“We laid in bed and I said, ‘Honey, can you hear the rain?’ He said, ‘I can hear the rain,’” Debbie Modrell said. “You hear rain and leaves rustling all of the time, but this was the first time he had heard raindrops for a very long time.”

Approved for use in 1985, cochlear implants are recommended for use by patients who are deaf or significantly hard-of-hearing, or for people like Dave Modrell who have reached the limits of effective hearing through the use of hearing aids. According to the National Institutes of Health, over 736,000 cochlear implants have been implanted worldwide as of 2019, including over 118,000 in the United States.

With over 20 years of experience as an audiologist, Ratigan, who joined the School of Audiology faculty in 2023, is committed to not only spreading the word about how cochlear implants can help the hearing-impaired but also to providing Pacific students the experience to make the implants options in their own practices.

“Integrating implantable technology education and making the training equivalent to traditional hearing aids is my mission,” Ratigan said, “but it is also the mission of our team to make sure students know it is not an either/or. When we counsel patients, we want everyone equipped to say that we have a big spectrum of technology available.”

A SOUND SOLUTION
Where hearing aids simply amplify sound, cochlear implants enhance the ability of the brain to interpret the sound waves. The device consists of an external unit with a microphone, speech processor and stimulator, which is implanted behind a patient’s ear. The signals are transmitted to an electrode array, which sends sound waves to different regions of the cochlea, stimulating the nerve directly.

Cochlear implants do not restore hearing, but instead provide patients a representation of sounds that help them better understand speech.

For patients like Dave Modrell, cochlear implants provide another option when hearing aids aren’t doing the job anymore. He had worked on machines and large engines since he was 18 years old. And after wearing hearing aids for 18 years, his hearing was better without hearing aids than it was with them.

“I was missing so much of conversations,” Dave Modrell said. “I went from about a seven down to a two in a matter of three to four months. It dove very quickly towards the end where it was impossible to carry on a conversation.”

The Modrells picked the Pacific EarClinic off of a list of audiologists provided by their health insurance provider. It was also the closest audiology clinic to their home outside of Gaston. Dave was seen by Ratigan and student AveryAna Palermo AuD ’26, who put him through a comprehensive hearing exam.

“Based on the exam, it seemed that he would be a good candidate for a cochlear implant,” Palermo said. “After that referral process and discussion, they understood how this could help him and continued with the process.”

Dave Modrell had his cochlear implant installed by a surgeon in Portland before returning to the Pacific EarClinic for activation in October 2024. While the implants often take time to take full effect for a patient, Palermo noticed an immediate difference in Dave and how he sensed the world.

“As soon as we activated it, he took a moment for himself,” Palermo said. “As my professor continued to talk, it was like her voice was new to him, it sounded different from what he was used to hearing. For someone who has hearing loss and hasn’t had access to certain sounds for so long, it could be a new experience for them.”

Since his cochlear implant was activated, Dave’s hearing has incrementally improved. He can now hear the clicking of the turn signal in his car. He can hear the sound of buttons on his television remote control. He hears music and “complains” of songs being stuck in his head. And, of course, he hears the rain on the roof.

Debbie Modrell notes that she has had to counsel friends that improved hearing with a cochlear implant is not immediate. It takes time for the ear and the brain to adjust to the new way of interpreting sound. “We’ve been educating other people because they don’t know,” she said. “They think that maybe it just doesn’t work so well. From day one until now, it is like night and day, but it isn’t perfect yet.”

The gift of sound is changing how the Modrells are planning their future. Travel is once again in the cards, with trips to the San Juan Islands, Alaska and Europe on their bucket list. Dave is looking forward to hunting again, where hearing is critical in tracking game. And he can participate in conversations now that he can understand speech more clearly.

“When people talked, it felt like Mickey Mouse was way off over here,” Dave said, pointing over his shoulder into the distance. “Each week, I can tell the difference.”

INCREASING EAR CARE ACCESSIBILITY
Like many of Pacific’s health profession programs, the School of Audiology incorporates making hearing care more accessible for everyone into its mission. While the Portland metro area has at least 15 audiology clinics, Pacific EarClinic director and audiologist Katy Mawson said that most are attached to ear, nose and throat clinics or major hospitals. Patients often experience longer wait times at those clinics than what Pacific provides as an independent clinic.

The addition of work with cochlear implants, Ratigan says, offers a broader range of options to patients without sending them to multiple providers, increasing the accessibility to services and further reducing wait times.

“For clinics that do not offer implantable devices, it is an easy referral to our clinic,” Ratigan said. “By the expansion of these services and referring in, our other preceptors and students will be seeing a lot more of this treatment.”

Now in her second year of the School of Audiology’s three-year doctor of audiology program, Palermo is excited to see how working with cochlear implants enhances her own educational experiences and how it allows the Pacific EarClinic to make a difference with more people.

“I am very interested in cochlear implants as well as the balance system, so I am looking forward to seeing how this program continues to evolve,” she said.

Ratigan adds that the ability to offer cochlear implant training is a great evolution in audiology education and one that places Pacific students at the forefront of providers immediately upon graduation.

“One of the weaknesses (of audiology schools) is that students get the philosophical training of implants in the classroom and then they leave for their fieldwork,” Ratigan said. “And if you are privileged enough to go to a clinical placement that services implants, you will have access to that learning.

“It’s been a big movement to say it’s our responsibility to our students to ensure that we’re comprehensive in what we’re teaching them and equipping them for the full scope of practice.”

Dave Modrell is grateful for his cochlear implants and Pacific’s ability to set his life in a different direction through better hearing.

“Would I recommend it to somebody going through what I was? Gladly. There’s no comparison,” he said. “It changed my life from where I was going.”

The Pacific EarClinic is open to the public and offers appointments Monday through Thursday, 8:30 a.m. to 4:30 p.m. The clinic is located in the Seventh Avenue Medical Plaza at OHSU Hillsboro Medical Center. Visit their website to learn more or call 503-352-2692 to schedule an appointment.

COCHLEAR IMPLANT INFORMATIONAL SEMINAR: The School of Audiology will present an informational seminar on cochlear implants on Saturday, Jan. 25, 10 a.m., at Pacific University's Hillsboro Campus. The seminar is open to the public. For information and to register, please call the Pacific EarClinic at 503-352-2692.