Specialist Spotlight: Joseph Manjaly – A Day in the Life of a Cochlear Implant Expert

Introduction

Mr Joseph Manjaly is a consultant ENT surgeon, otologist and hearing implant specialist at Welbeck. 

Specialising in all aspects of ear and hearing problems in adults and children, he has advanced surgical skills and is an expert in all types of cochlear implants as well as awake middle ear surgery, stapes surgery for otosclerosis, and all types of bone conduction and middle ear implants.

In addition to his work at Welbeck, Mr Manjaly is the Clinical Lead for adult ENT at the Royal National ENT Hospital, and is the Clinical Lead of a research project looking at robotic cochlear implant insertion to preserve natural hearing.

We sat down with Mr Manjaly to learn about his journey into the specialism and what a normal day at Welbeck’s Ear, Nose and Throat centre looks like for him. 

During medical training, what drew you to specialise in ENT?

“I was always quite keen to be a surgeon – the thought of using my hands to change someone's life was incredible. I was drawn to ENT because, from my experience, the speciality was full of really nice people. It also offers a really good mix of working with adults and kids, which plays into my own personality and characteristics.

ENT is one of the best examples of true multidisciplinary teamwork you'll find in healthcare. It relies not just on me as a surgeon, but also on the input of specialist audiologists, speech and language therapists, and specialised teachers of the deaf, clinical nurse specialists, and radiologists.

In terms of my interest in cochlear implant surgery specifically, that came much later in my training. I've always been into tech, and cochlear implant technology, in a way, is one of the most remarkable biotechnologies of a generation, combining cutting-edge tech with life-transforming healthcare. So when the opportunity came to work in that niche, it was a no-brainer for me.

I was fortunate enough to train in a couple of the UK's biggest centres for cochlear implant surgery. So by the time I became a consultant, I was really well placed to take on this work.”

What does a normal day at Welbeck look like for you?

“My days at Welbeck are either half days or full days, consisting of clinics and/or operating.

On a day when I do both, I’ll head to the operating theatres first thing to prep the afternoon's consent forms, then go up to the ENT floor to prep all the notes for my morning clinic.

My morning clinic will be a mixture of new patients and follow-up patients. They might be patients I've recently operated on, or patients who’ve had scans and are now thinking about surgery. Each consultation will consist of understanding what a patient's situation is and getting the relevant details to make a diagnosis. It might also involve a procedure such as microsuctioning of the ear, arranging hearing tests, interpreting hearing tests, and looking at scans, in order to make a forward plan.

After clinic, I’ll pop down to the operating theatres again to speak to each of the patients having surgery. I’ll run them through all the details, answer any questions, and talk through the paperwork. I’ll then operate in the afternoon – I might have either one major procedure lasting several hours, or I might have three or four shorter ones.

I specialise in hearing implant surgery and also awake middle ear surgery. But all of my work aims to restore my patients’ ability to listen and engage in their social and professional lives. I look after everyone from age 0 to 100+, so it's very enriching.”

How have you seen treatments change and advance over the years?

“Like any tech, biotechnology iteratively improves over time. With cochlear implantation, for example, when it became part of NHS healthcare in the late 80s, early 90s, it was an absolute game-changer for people who otherwise would have had no access to sound. But back then, it was a long operation and involved quite bulky devices. You couldn’t expect any natural hearing you had left to be preserved, so the surgery would only really be offered to people with really no usable hearing at all. 

Over time, there have been advancements in the design of the electrode, the part that’s installed into the patient's inner ear, to make it softer, meaning we can preserve natural hearing more effectively. That's opened up the possibility of people who still have some hearing, but not really enough to function as they would like, to have cochlear implants. 

Patients want their implants to have a long battery life, and they want them to be light and not look onerous. The advances in tech have allowed implants to become smaller, more stylish, more connected – patients can now connect to their phones, stream calls, etc.”

How does Welbeck support advancements in treatment?

“Pretty much every year, I’m working with a new iteration of a hearing implant of some kind, whether that be the internals, which is the part we install with surgery, or the externals. The beauty of the Welbeck setup is that because there are enough of us surgeons doing this work, the hospital can confidently invest in the resources required to undertake what is quite a complex and multi-disciplinary treatment. 

We have supply chains set up with all the hearing implant manufacturers, so that when a patient comes to us needing a cochlear implant or a bone induction implant, we can offer a complete package, including the surgery itself, the implant, the device, and aftercare. It's classically been quite difficult to access this level of treatment in the private sector in the UK, so this is very unique.

At Welbeck, we perform cochlear implantation for people with single-sided deafness, not just those with deafness in both ears. This isn't funded by the NHS, so the only way for someone in that scenario to access it is via the private sector. Because we've got the setup here, our Ear, Nose and Throat centre sees the biggest cohort of people with single-sided deafness wanting a cochlear implant in the UK.”

How have your patients' lives been impacted by your work?

“I always encourage my patients to leave an online review. It's a great motivator for me to go back and read them when I've had a long, hard day. They bring colour to just how much this kind of work impacts people's lives – people have talked about restoration of their marriage, and relationships with their parents and kids. 

You only realise how precious your hearing is when you lose it, but it’s such a window to your world and to your potential, socially, professionally, and personally. It feels particularly precious when you perform hearing loss surgery on kids because you see their speech and language, and learning and developmental trajectory just uptick.”

What makes working at Welbeck so special?

“I was part of Welbeck ENT right from the start, and it's been a game-changer for me in many ways.

Working alongside your colleagues who do similar work and who previously trained me means we can pool resources and offer things that are not possible in other places. 

Being in a building that’s full of London's finest selection of tertiary medical specialists is fantastic because if I need a dermatology, neurology, or endocrinology opinion, we've got people right here. 

On the operational side, Welbeck’s set-up is in a league above every other private facility I've ever experienced. You come up with an idea for innovation or a better patient experience, and it just gets done.”

Why should patients come to Welbeck for ENT care?

“General awareness of treatment options is still very poor. People often go to their local high street for care and will be told it's clunky hearing aids, or that’s it.

At Welbeck, our ENT consultants specialise in helping people who’ve reached an endpoint in other places. We provide specialist hearing tests and an examination to determine whether a patient has reversible or irreversible hearing loss, and provide the most appropriate and effective treatment.

I would always encourage people affected by hearing loss to have an assessment with us.”

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From ear pain to hearing loss, our experts diagnose and treat the full range of otology issues using the most advanced tests and procedures. 

If you’re looking for advice or treatment, get in touch today to book an appointment with one of our specialists. Our consultants are available 5 days a week in our dedicated Ear, Nose & Throat centre, with same-day and next-day appointments often available. 

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