30 years of the Polish school of otosurgery 

In 2022, the Institute of Physiology and Pathology of Hearing celebrates the 30th  anniversary of the first cochlear implant surgery in Poland performed on a deaf person and the 20th anniversary of the world’s first surgery to restore hearing to a patient with partial deafness. Both surgeries by Prof. Henryk Skarżyński were turning points in otosurgery and milestones in treating hearing disorders. This year also marks the 25th  anniversary of presenting the world’s first concept of preservation of preoperative residual hearing and inner ear structure in New York. For the clinical practice, this meant an expansion of the indications for cochlear implants applicable at that time – from tens of thousands to hundreds of thousands of patients. The surgical strategy developed and presented then provided new opportunities and possibilities for using cochlear implants in incompletely deaf patients.

Henryk Skarżyński, an associate professor at that time, performed the pioneering surgery at the Warsaw Medical Academy. The Polish Academy thus joined the small group of highly specialized centers worldwide that perform implant surgeries to restore hearing in deaf people. The surgery was also the first step toward launching a cochlear implant program in our country for thousands of deaf and hard-of-hearing people in subsequent years. The groundbreaking procedure in Polish otosurgery was widely covered in the press, and the topic of surgical treatment of deafness was taken up by the major media of the time – television news programs and press and radio services.

– Anniversaries are an opportunity not only to reminisce but also to reflect, formulate conclusions and even further dreams. Looking back at what my team and I managed to do, gives me great satisfaction and a conviction that we did not waste time. I feel that thanks to our work, profound hearing defects, which 30 years ago ruined the chances for patients to function normally, today are not an obstacle to effective learning, work, and developing artistic passions. –  Prof. Henryk Skarżyński said. – Nowadays, as I often say, thanks to progress in medicine, it is possible to help almost every person with a hearing disorder. Polish patients are the first or among the first in the world to access the latest medical technologies and treatments. I am a doctor by vocation, so – even though I have placed thousands of hearing implants and performed some 220,000 other surgical procedures over the past 30 years – I enjoy each new successful surgery. I draw strength from the joy of the people to whom the otosurgical procedures performed at the World Hearing Center restored good hearing and thus enabled them to communicate and interact with others efficiently, thus increasing their chances for a happier, more fulfilled life. As Wiesław Bator, a patient who was the first in Poland to receive a cochlear implant in 1992, said, “The ability to understand people, the ability to communicate their feelings is a great wealth.”

Until 2002, cochlear implant surgery was preferred worldwide for only profound hearing loss and total deafness. Still, a significant group of patients with so-called partial deafness was left out without the chance of receiving effective treatment. This specific group of patients has efficient or normal hearing in the low-frequency range, but their hearing of high-frequency sounds is impaired. In practice, these people have a good sense of sound but are not always able to understand speech well – they usually understand only about 5-15% of the information through the auditory channel and under good acoustic conditions. Prof. Henryk Skarżyński was determined to give also these patients a chance to hear well.

After the commencement of the cochlear implant program in 1992 and performing more than 1,500 implant surgeries in children and adults, I looked at the problem of partial deafness and preservation of residual hearing from a different perspective than before. – I concluded that the modern understanding of partial deafness is somewhat different than before and that the criteria for selecting acoustic and electrical methods provided by hearing aids, middle ear implants and inner ear implants may modify and complement each other. – Prof. H. Skarżyński recalls. – This new approach provided opportunities to treat patients who did not benefit from classic hearing aids and, at the same time, did not qualify for cochlear implant surgery, given the past practices. This approach meant that by looking at the results of hearing tests indicating partial hearing loss, it was possible to start talking about treating it with state-of-the-art technology using cochlear implants, thanks to the developed otosurgical strategy.

Since 1997 Prof. H. Skarżyński has conducted research and regularly performed surgeries on patients with profound hearing loss that allow preservation of preoperative auditory residuals after implantation in the low-frequency range. The results of the tests indicated that proper implant electrode placement in the inner ear preserves existing auditory residuals in both adults and children.

– Eventually, my many years of work on the problem of partial deafness resulted in the performance of the world’s first cochlear implant surgery on 12 July 2002 in a patient with such a hearing disorder, and thus – the start of the world’s first partial deafness treatment program. –  Prof. H. Skarżyński recalls – The first patient was Kasia, who could only hear sounds within the low-frequency range, while she could not hear medium and high frequencies at all. As a psychology student, she understood perfectly well what risks she was taking by deciding to undergo pioneer treatment. Without the patient’s proper attitude, it would have been difficult for me to decide on the surgery that no one in the world had yet performed.

The development of a surgical procedure that solves the problem of treating partial deafness has opened up a new perspective for development. After all, in ageing societies, especially in Western countries, there are increasing problems with various partial hearing losses. Meanwhile, one of the cornerstones of the development of modern societies is the advancement of human contact and access to and exchange of information. At the beginning of the 20th century, about 95% of a person’s functioning and position in society was determined by manual skills; today, more than 94% is determined by the ability to communicate. Good hearing is essential for it. The development of a procedure for treating partial deafness has provided a real opportunity to help tens of millions of people who cannot function normally in the modern world due to various types of hearing impairment.

– We had humble beginnings in a small laboratory with just eight working stations.  – Prof. H. Skarżyński says – Today, at the IFPS World Hearing Center we have the best and largest laboratory in the world for practising surgical techniques. We have built the Center for Advanced Surgical Techniques with a unique laboratory equipped with 30 stations for otosurgery and rhinosurgery, modern equipment for practising anatomical preparations and computer simulators. During the 64  Window Approach Workshops (WAWs), together with the IFPS World Hearing Center team, I conducted more than 1,300 demonstration otosurgeries, presenting the method of treating different types of deafness, including the treatment of partial deafness with preservation of the intact inner ear structure.

In many cases, these were pioneering, original surgical solutions for treating new target groups of patients of different ages. More than 8,000 specialists from all continents witnessed these surgeries on-site at the World Hearing Center.

Currently, more than 12,500 hearing implant users remain under the care of specialists from Kajetany. To date, nearly 4.5 million tests and consultations have been carried out at the Institute, and more than 600,000 surgical procedures have been performed.