The Potomac School

There’s a genre of Youtube video that has gone viral over the last few years – it usually starts with a parent in a doctor’s office, holding a squirming baby with an intriguing-looking device attached to its head. An audiologist makes a few adjustments, counts to three… and suddenly, a shocked and delighted expression comes over the baby’s face. It makes a few experimental noises; it jabbers and claps and squeals. The camera pans to its parents, who are beaming – and often, crying. The day is pronounced a success and the family goes home to celebrate.

These videos chronicle infants who have received cochlear implants – small, surgically implanted devices placed to stimulate the cochlear nerve of the inner ear, which allow people with significant hearing loss to detect sounds. The children in the videos have severe to profound hearing loss, and many have never heard anything before – not bedtime lullabies, not their parents’ voices, not even the cadence of their own breathing. For these infants, the day their cochlear implants are turned on is the first time they’ve ever heard a sound.

From there, these children can be mainstreamed into the same schools as their hearing peers, develop language skills quickly and fluently, and listen to and understand speech just like any other child (though they may choose to get in touch with Deaf culture through learning sign language, too). To their parents, their cochlear implants are nothing short of a miracle.

To Dr. Brendan O’Connell ’02, however, they’re part of everyday life – the results of many years of study in the medical field in which he has found his niche. As a surgeon and neurotologist at the University of North Carolina at Chapel Hill, he performs operations, teaches classes, and connects on a personal level with his patients.

Brendan says, “I always knew I wanted to do surgery, and I always liked the kind of work where I could be hands-on and really make a difference. I wanted to do something where I could offer interventions that have the capability of improving situations fairly quickly. But I didn’t know what I wanted to specialize in ear surgery until my residency training at the Medical University of South Carolina, where I studied otolaryngology.”

Otolaryngology, a surgical field that deals with the relationships between the neck, ears, nose, and throat, covers a wide variety of issues and conditions that may arise in those areas. Brendan became especially intrigued by neurotology, an otolaryngologic subspecialty that focuses on the anatomic area where ear structures interface with the brain and central nervous system. As he went through his residency, Brendan decided to follow his interest to its logical conclusion and make neurotology his specialty.

He explains, “I did a two-year fellowship at the Vanderbilt Otology Group in Nashville, and now I’ve been at the University of North Carolina for about a year and a half, working as an assistant professor and doing ear and skull base surgery. A lot of the patients I see – patients of all ages, children and adults – have issues related to hearing. They might have issues related to chronic ear infections, holes in the eardrums, or tumors of the inner ear and brain stem – that’s the overview of the practice. But what really caught my attention about UNC was the fact that we do so many cochlear implants – and that the team has a long-standing international reputation in the field.”

The relative simplicity of a cochlear implant might be the most extraordinary thing about it. Essentially, an internal device is inserted beneath the skin, and an attached electrode is implanted into the cochlea, which is stimulated by the auditory nerve. The patient then wears an external sound processor – a device that looks like a large hearing aid – which captures sound and transfers the signal to the internal device. The internal device converts natural acoustic sound into electrical impulses and delivers them to the auditory nerve through the electrode array. By stimulating the auditory nerve directly, the cochlear implant bypasses the regions of the cochlea that are typically damaged in cases of severe to profound hearing loss.

According to Brendan, the University of North Carolina at Chapel Hill hosts the busiest cochlear implant center in the United States. He is part of a team dedicated to the process that includes more than 30 members – surgeons, speech pathologists, audiologists (hearing specialists that program cochlear implant devices), and more. In the past year, Brendan estimates that 150 children and 130 adults have received implants at UNC.

“There’s this misconception that everyone who receives a cochlear impact is a young child,” he says. “That’s just not accurate; these implants have come a long way, and they’re just as useful for adults as they are for young children. Back in the 1980s, when they were first invented, only a few implants were done per year at any given institution. The hope was that the patients could develop some sound awareness, but there weren’t many expectations that they would be able to understand speech or talk on the phone. But now, the technology has improved. Cochlear implants capture more sound from the environment, and more and more people are benefiting from them.”

While all prospective cochlear implant patients must have some form of sensorineural hearing loss – a nerve-related condition – in order to be a candidate for surgery, that often means different things for different age groups.

Brendan notes, “Generally, the children I work with were born deaf. In that case, we want to put a cochlear implant in so that they can hear and develop speech and language. For adults, it’s a little different – the range of hearing levels varies a lot more there.”

Many adults who receive cochlear implants were born with the ability to hear but developed sensorineural hearing loss over time because of the natural aging process or for other reasons. A number of these people still have some level of hearing but find that their comprehension abilities have eroded to the point where even hearing aids can’t help.

“If you get to the point where you can’t carry on a phone conversation, you’re probably a cochlear implant candidate,” Brendan says. “Unfortunately, most adults with hearing loss don’t know that cochlear implants are an option for them. Only about 10% of adults who would qualify actually end up having the surgery. There’s a whole population out there that could benefit if they just knew about the possibilities, so it’s important to spread awareness about what cochlear implants can do.”

Brendan cites one of his favorite stories, the experience of a man who had hearing in one of his ears but had gone deaf in the other. “With just one ear, you can’t localize sound – you can’t tell where sound is coming from – and this individual really relied on that skill for his job. He was on the verge of not being able to work,” Brendan recalls. “We put an implant into his deafened ear, and he was able to go back to work almost right away. For me, this highlights how much things have changed. It would have been crazy to do something like that 25 years ago, when cochlear implants were only given to adults who were profoundly deaf in both ears. I love that we’re now helping people who have single-sided hearing loss. It’s nice to see how much these things have evolved.”

Brendan adds that, whether he’s working with children or adults, his job never stops being rewarding. However, as a surgeon, he isn’t one of the doctors in those viral Youtube videos. In fact, he’s rarely present for the moment of truth, when a patient’s cochlear implant is turned on for the first time. Instead, he finds meaning over time, in the lives that are forever changed by his work.

“Seeing how people’s lives change so dramatically after surgery is a special kind of satisfaction,” says Brendan. “I think it’s a bit more instant with the adults. They go from being isolated and disconnected from the world to reengaging in life, to going back to what they love to do. And they often share that right away during their follow-up visits. With the kids, you get that appreciation a couple years down the road. You start out with infants, and they make slow but steady progress. A few years later, those kids are talking to you, carrying on conversations, and they’re in school in the hearing world. That’s an incredible feeling, too.”

As for the more difficult parts of his career, Brendan says that the most demanding aspect was the rigorous training – after college, he did four years of medical school, five years studying otolaryngology, and two years focusing on neurotology. But, he says, his career was worth the effort. “I’m incredibly grateful to my wife and family for having been so supportive,” he says. “I look back sometimes and I’m amazed at all the time that has passed – everybody in medicine puts so much energy into their training, and it takes forever. You just have to put your head down and push on despite the challenges you face, but it’s so rewarding at the end of the day.”

Brendan believes that his Potomac education is one of the reasons he was able to stay so resilient. “Potomac prepares you for everything. I felt so ready for college, and actually found it easier than high school,” he says. “I felt like I had such a step up; I already believed that anything was possible. I’m incredibly grateful for the education I got at Potomac, and I truly believe that I would not be where I am today without the time that I spent there.”

Potomac has also influenced Brendan’s life in ways that might not be immediately apparent. He says, “One thing that’s really helped me is the interest in Spanish that I acquired at Potomac. I loved Alex Thomas’s classes, among others. That inspired me to major in Spanish in college – I did that while taking the appropriate pre-med classes. Lots of people in North Carolina are primarily Spanish speakers, and being able to communicate with them in their own language has been key to developing a level of trust in the doctor-patient relationship.”

Now, Brendan continues to learn and grow at UNC. In addition to his surgical work, he spends time writing and researching, adding to the impressive list of book chapters (five) and peer-reviewed articles (more than 60) that he’s authored. He also teaches residents and medical students in his position as assistant professor of otolaryngology. And he travels widely.

“UNC is an academic medical center, which means it has three missions,” Brendan explains. “We take care of patients, we teach, and we do research aimed at providing better patient care. This means that I always have a trainee of some sort with me in an operating room. Additionally, my team and I attend a number of conferences every year. We were recently in Belgium at a cochlear implant conference, where we were invited speakers; I’ve also been to Australia and Ireland, and we travel all around the U.S. It’s been amazing to talk to people about this subject as an expert after studying it for so long.”

Asked what advice he would give young people who are looking to enter the medical field – or any other field where they can make a life-changing difference – Brendan says, “I’ve learned that, no matter where you are in your career, it’s important to set yourself up for success by working hard, even if your ultimate goal is not completely clear. If you do that, I really believe that things are going to work out for you.”