Institute’s July Anniversaries

In July, the Institute of physiology and Pathology of Hearing is celebrating anniversaries of the most important events in its history. In 2017 we have as many as three jubilees: 15th anniversary of the first in the world surgery restoring hearing to a partially deaf person, performed by Prof. Henryk Skarżyński, 20th anniversary of the program ‘Preservation of the preoperative residual hearing’ and 25th anniversary of the first in Poland cochlear implantation in a deaf parson, which has been performed by Prof. Henryk Skarżyński.

25 years ago on 16 July 1992, Prof. Henryk Skarżyński as the first in Poland had performed a cochlear implantation in a deaf person. One day later, on 17 July, he had performed the same surgery in the first child in Poland. With these groundbreaking surgeries Prof. Skarżyński has opened a new chapter in the history of otosurgery.

The first cochlear implantation in a deaf person performed in 1992 by Prof. H. Skarżyński, pioneering this program in Poland, has given a chance and hope to the thousands of deaf patients in Poland. On the day of surgery, seven TV stations and a host of journalists were present in the hospital. This was a surprising development – usually information about a pioneering surgery is released after it has been successfully brought to a finish. But Prof. Skarżyński had informed the media about the planned surgery already a week before. It was an act of courage and good preparedness, as well as social trust, which is still being remembered by the journalist who 25 years ago had witnessed that groundbreaking medical event.

Anna Leszkowska, journalist of the monthly journal „Przegląd – Medycyna” had reported the course of the operation:
„When Ass. Prof. Henryk Skarżyński came to the table, surgical field had already been prepared. On the skin, directly behind the right ear he delineated a skin incision. (…) The following, microsurgical stage of operation required much patience from the surgeon. With microscope visualization he had to carve a several cm deep bed in the bone avoiding its overheating which would endanger the facial nerve that lies in direct neighborhood of the surgical field. Irritation of the facial nerve could result in facial paresis. (…) When the bony bed is prepared and implant, measuring 2-3 sq. cm, fitted to its place, the operator started the most difficult stage of the procedure: introduction of the electrode to the inner ear, specifically to the cochlea. Made of titanium, tantalum and platinum alloy it is millimeter by millimeter advanced into the small opening invisible to all but the operator. ‘Nobody can know what surprises await us during such procedure, for example previously undetected anatomical malformation, like atretic channels. I had to be prepared for any eventuality. This is why eng. Otokar Klasek has prepared three implants, although we have had planned two surgeries. If we would have discovered intraoperatively that cochlea is impatent, we would have inserted another type of an implant, with different electrode.’ – explained shortly after the surgery Ass. Prof. Skarżyński.  Luckily, there were no surprises and after fixing the implant in the bony bed with a special cement and insertion of the electrode into the cochlea the surgery was almost finished. When the electrode was fixed, all that remained to do was to replace muscles and skin and suture the incision.”

On the following day – 17 July 1992, Ass. Prof. Henryk Skarżyński operated the first in Poland and Central and East Europe child – 5 year-old Łukasz. Pediatric cochlear implantations had been a rarity in the world at that time, so it was a remarkable challenge for Ass. Prof. H. Skarżyński.
Łukasz, when he was 3 years old, fell ill with suppurative meningitis. When he came back from the hospital, his horrified parents found that he cannot hear. The ORL doctor they consulted advised them to go to the audiology clinic in Warsaw. There Łukasz underwent full workup and was diagnosed deaf. Deafness, combined with partially retained speech, degree and type of hearing loss, as well as age and character of the boy allowed qualifying him for cochlear implantation.

My husband and I had no doubts that Łukasz should be implanted. – had said his mother in an interview with Maria Karpiuk-Domagała for the ‘Twoje Dziecko’ (‘Your child’ monthly magazine – It is another thing then child is born deaf. Parents learn to live with his disability from the beginning. Our Łukasz was a healthy, bright child and we could not accept his disability. When we have heard about the opportunity of surgery in a clinic of Ass. Prof. Henryk Skarżyński, we were sure that he can help our Łukasz.

Surgeries performed in 1992 were the start of Polish program of treatment of deafness, initiated one year prior. For the needs of this program, Prof. Henryk Skarżyński had initiated creation of the first in Poland ad second in Europe Diagnostic-Treatment-Rehabilitation Center for the Deaf and Hearing Impaired “Cochlear Center” for comprehensive patient care. The Center has been ceremonially opened by the Prime Minister of Poland, Ms. Hanna Suchocka on 14 July 1993. In the Opening participated such personalities as Minister Jerzy Koźmiński, Bishop Alojzy Orszulik, Bohdan Jastrzębski – Voivode of Warsaw, and Minister Grażyna Andrzejewska-Sroczyńska – government commissioner for disabled persons. One week before the opening, the ‘Cochlear Center’ visited the First Lady of France, Ms. Danielle Mitterrand. Her Foundation had donated to the Center a new surgical microscope.

I remember the incredulity of the whole delegation accompanying Ms. Danielle Mitterrand and their questions are we sure that we will be able to open our center in just a few days – recalls Prof. Skarżyński. – We had ready only the entrance hall and one consulting room, in which we have put our state-of-the-art surgical microscope. Few people from the outside of our team knew that we were working with almost no sleep, 24/7. But we were on time! – adds proudly Prof. Henryk Skarżyński.

The opening of the Center had been an enormous success. At that time, creation of a unit with such international importance had been a sign of Poland’s opening to the world, to new solutions and new needs. A couple of weeks after the opening, the center consulted several tens of patients daily, performed about 200 specialized examinations. It was, however, only a drop in the ocean of needs. Since its establishment, the „Cochlear Center” had been conducting also scientific activities. Two weeks after its opening it had been hosting the 1st International Scientific Conference on Cochlear Implants.

Ten years after the first Polish cochlear implantation in a totally deaf patient, Prof. Henryk Skarżyński undertook to break another barrier – the started treating patients with partial deafness. On 12 July 2002, he performed the first in the world cochlear implantation in an adult patient with partial deafness. Thus he has started a new program – ‘ Treatment of Partial Deafness’.

The late Krzysztof Zbytniewski form the „Super Expres” newspaper, in an interview titled ”It is a chance for people with hearing loss” had asked prof. Skarżyński why is this surgery a breakthrough. „Because it opens a new road for several hundreds of Poles with hearing loss for whom, until now, hearing implants had not been good. Electrical hearing through an implant is ‘artificial’. Doctors had assumed that natural hearing is by definition better, even if it is very weak. This is why nobody wanted to perform such surgeries’.

Our first patient was a student of psychology, which was very helpful because she understood very well what she is doing and what in entailed in the process. Without her good attitude the decision about this surgery would have been much more difficult. Kasia could hear sounds in low frequency range, was deaf to the mid-range and high sounds. – recalls Prof. Skarżyński – After having performed all possible tests that we could do at that time I decided that we will try not only to perform this first-in-the-world surgery, but also to show through an Internet transmission.  

K. Zbytniewski related the operation in an article ”To hear the whole world”: „Eleven o’clock. Surgery begins. In the corridor waits Marek, Kasia’s boyfriend, architect. He has been her translator, her go-between to the world. In the surgical room Kasia sleeps in a tangle of tubes, squeak of computers, with microscope overhead. Incision behind the ear, exposure of the skull surface. Then tapping of a hammer and drills, starting from the large ones, but when Prof. Skarżyński will reach the middle ear drilling near the facial nerve, the drill will be smaller than 1mm. ‘Smallest mistake means failure! This is why I hold my breath when I make any move!’ – explains professor. At 11:40 the window – entry to the inner ear (cochlea) – is exposed. It is the size of the dot at the end of this sentence. Through this opening must be inserted an electrode with four contact points that will excite nerve endings. In the skull behind the ear professor fixes the implant, the size of a large button that will send microimpulses to the cochlea. At 12:40, looking into the microscope, professor slips the electrode into the cochlea. Precision work! After 2.5 hours the surgery is done.”
Like 10 years prior, also this surgery Prof. Skarżyński performed in the presence of cameras, transmitting the procedure live to the Internet and to the conference room, where it was witnessed by journalists from the radio, TV and press.

It was the first approach to something that today we call telemedicine, tele-otosurgery – recalls Prof. Skarżyński. – At that time organizing that transmission, managing connection capacities, all technical details, it has been a challenge. But I have told myself so: ‘If it fails, let the people in the world know, why it did not succeed. And if it goes well, I will be able to say, until the end of my life, that the first in the world surgery of partial deafness, where patient could hear some sounds and partially his ear was inactive, I have performed witnessed by other people. – adds Prof. Skarżyński.

Until 2002, cochlear implantations had been performed only in cases of profound hearing loss and total deafness. A large group of patients, with so-called partial deafness, was outside the possibility of effective treatment.

Today, the World Hearing Center of the Institute of Physiology and Pathology of Hearing is the undisputed leader in otolaryngology, audiology and phoniatrics. There have been until today about 400 thousand surgical procedures performed in the Institute. In the last 20 years it has introduced to the daily clinical practice more than 150 different scientific projects, including virtually all innovative otosurgery implantology solutions. Polish patients have in the Institute access to the newest technologies as the first, or one of the first in the world. The center in Kajetany is the world’s unchallenged leader in terms of the number of hearing improving surgeries being performed there (yearly about 15 thousand procedures). Specialists from the World Hearing Center have under their care more than 5.5 thousand hearing implant users.

The Institute of also a prestigious education and training center, where physicians from all continents come to study surgical techniques and medical procedures developed by Prof. Henryk Skarżyński. Kajetany are the best place in the world to train surgical techniques. We have managed to build an Education center with the unique laboratory equipped with 30 workstations for otosurgery and rhinosurgery, modern equipment for training on anatomical specimens and computer simulators. The Institute has been conducting also for the last several years the program of population screening for early detection of hearing disorders in children starting school education.