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Focus on Jonathan McJunkin, MD

Jonathan McJunkin, MD, is an otolaryngologist who specializes in cochlear implants, neurotology, hearing loss and skull base tumors.

Dr. McJunkin sees patients at:

Ear, Nose and Throat Center, Center for Advanced Medicine, 4921 Parkview Place, Floor 11, Suite A. PLEASE CALL 314-362-7509 FOR AN APPOINTMENT.

605 Old Ballas Road, Suite 124. PLEASE CALL 314-432-4110 FOR AN APPOINTMENT.

What happened in the course of schooling to influence you to choose your specialty?

I didn’t have a real inclination as to what specialty I wanted to choose when I started medical school. However, the anatomy of the head and neck was intriguing, given the complexity and the variety of diseases that could affect the area. The ENT department at Jefferson Medical College in Philadelphia was very strong, and my experience during medical rotation in that specialty really appealed to me.

I had a mentor, Edmund Pricktin, MD, who was a sinus and facial plastic specialist. He was great with patients and his professionalism was a real influence on the way to carry oneself on a day-to-day basis in the medical field.

What brought you to Washington University?

The honest answer is the residency match. Washington University has a top residency program and I was fortunate enough to be accepted here.

I really enjoyed my time at Washington University during my ear nose and throat (ENT) residency and was impressed by the level of health care that’s provided here on a daily basis. After completing a fellowship at the Ear Institute of Chicago in 2011, I was proud to be able to return and join faculty.

Which aspect of your practice do you find most interesting?

My main focus is cochlear implants for adults who have the ability to speak, but who have lost their ability to hear. Cochlear implants are a way to restore hearing to patients who have lost hearing and are no longer helped by hearing aids.

Cochlear implants can be a real improvement in a patient’s quality of life by giving back the ability to communicate. That’s been a very rewarding part of my practice.

I also frequently work with our neurosurgery team to operate on skull-based tumors. Those can be long and challenging cases but it is satisfying when we are able to remove the patient’s tumor safely.
 

What is a cochlear implant?

A cochlear implant is an electronic medical device that replaces the function of the damaged inner ear. Unlike hearing aids, which make sounds louder, cochlear implants do the work of the damaged parts of the inner ear (cochlea) to provide sound signals to the brain.

During surgery we implant the internal device (an electrode array) into the cochlea. About two weeks after surgery we attach the external device, which looks like a hearing aid. This contains the speech processing acoustic hardware and sends the signal to the internal device.

I would also like to emphasize that at Washington University, we have an excellent team of audiologists dedicated specifically to rehabilitating patients with cochlear implants. Along with the rehabilitation, there is extensive pre-operative and post-operative counseling that makes our program outstanding.

Much of the success of the cochlear implant relies on the patient’s neuroplasticity – the ability of the brain to be flexible and learn how to interpret the new signal it’s getting from the implant. Our team is very good at determining if a patient is lagging behind in the rehabilitation process.

The success rate for cochlear implants to restore some form of hearing to patients is amazingly close to 100%.

What would cause someone later in life to lose his or her hearing?

The most frequent cause would be presbycusis, or age-related hearing loss. For the vast majority of the population, hearing loss is part of the natural aging process.

In some cases, a person can have a higher frequency hearing loss that may progress to the point where hearing aids are no longer helpful because they do not provide enough amplification.

Hearing loss later in life can also be the result of some genetic, as well as environmental factors.

Is there an upper age limit where you would not recommend a cochlear implant?

I had a patient in her early 90s who had a very conversational personality and was dependent on hearing out of one ear. She had a sudden hearing loss that affected the residual hearing in her good ear. It put her into a state of isolation for weeks. She had to rely on writing to communicate– which was difficult for her because her vision was poor.

So even at the age of 91, we gave her a cochlear implant. When I saw her two weeks after her initial activation, she was a new person and could communicate without any written assistance. If you didn’t know her, you would have a hard time even telling she had a hearing disability, which was an exceptional outcome.

So the answer to your question is -- it depends on the patient. Normally I wouldn’t advocate elective surgery for most 90-year-olds, but she had the overall health of a 60-year-old, and it benefited her well.
 

What new developments in your field are you most excited about?

There have been a lot of refinements in cochlear implant technology recently. However, there are still some details which are being worked out as to the number of electrodes, how long an electrode array to use, and what patient factors affect the cochlear implant outcomes.

Eventually we will move towards a completely implanted cochlear implant, but that is still several years away because there are some big obstacles to overcome – such as the microphone and battery life.

Even if you can get a microphone underneath the skin, you will hear every day noises like brushing your hair and your teeth. Those noises are hard to filter out and can be distracting.

Battery life is the next hurdle. If you have a device completely implanted, how do you have a battery that runs for years and years?

Other new developments include the genetics of hearing loss. Oftentimes we look at a hearing test and can’t distinguish the cause of the hearing loss, other than age-related or sound-related.

There are certainly genetic markers that set people up for a hearing loss. Researchers are trying to figure out the mechanism of why people are losing their hearing or why certain people’s hearing organ is more sensitive to damage than others.

Being able to examine hearing loss on a genetic level to determine which specific gene mutations cause different types of hearing loss, would be the first step towards cell-related therapy.

Where are you from?

I’m originally from West Virginia, my family moved there when I was in 3rd grade. I went to prep school at Choate, CT; Northwestern University in Illinois for undergraduate; Jefferson Medical College in Philadelphia for medical school; and Barnes-Jewish Hospital for my residency. I’ve been everywhere but the West Coast.

My parents still live in West Virginia. It’s a beautiful state and whenever I go back I’m impressed by the mountain scenery.

Is there a particular award or achievement that is most gratifying?

Teaching is one of the things I take a lot of pride in -- during residency I won the resident teaching award. I also received the faculty teaching award this year. It is motivating to hear from the residents with whom I’ve trained or had the honor of teaching, and it is gratifying when they tell me I had some influence on their careers.

Also, providing a health service that is such a benefit to a patient, like cochlear implants, is a very rewarding process. Just being able to do what I do is a real honor – my patients are grateful and I don’t take that for granted.

What is the best advice you’ve received?

On a professional level, this is certainly clichĂ©, but “do no harm” is the best advice I’ve received. In my field of otology (ear surgery), it’s important to be honest and open with the patient. It’s good to have a discussion and give them a choice about intervention. The benefits need to outweigh the risks in order to go forward with any procedure.

On a personal level, as the song goes: “Don’t worry, be happy." Happiness should be everyone’s top priority.

If you weren’t a doctor, what do you think you would be doing?

I asked my kids what’s the coolest thing your dad could be if he weren’t a doctor? They said, “Astronaut.” Honestly, I always was drawn to the arts and sciences, so I probably would have been an engineer.