July-September, 2003

Children's Health

Cochlear implant allows  Eli Thurman to hear a whisper

When 5-year-old Eli Thurman of Conway, who was born deaf, underwent surgery at St. John’s three years ago to receive a cochlear implant, his parents hoped he might gain enough hearing from the device to protect himself from danger.

“He can hear a whisper,” says his mom, Stacy. “The implant gave him so much more than we expected.”

At 2, Eli was the first cochlear implant recipient in Springfield. St. John’s otolaryngologist (ear, nose and throat specialist) Scott Estrem, M.D., who has been performing cochlear implants since 1987, performed Eli’s surgery in 2000.

“I have to admit it was scary, Eli being the first implant patient in the area, but it would have been scary regardless,” Stacy says. “I think the staff at St. John’s Clinic - Ear, Nose & Throat went above and beyond to make sure that everything was …”  “Perfect,” says Eli’s dad, Greg, finishing his wife’s sentence. Stacy nods her head in agreement.

The quarter-sized device, which takes about three hours to surgically implant in the skin behind the ear, is an advanced electronic device with a soft electrode array that is threaded into the spiral-shaped inner ear, or cochlea. The electrodes send impulses directly to the nerve fibers in the cochlea. The external components of the implant include a headpiece and a sound processor. The small headpiece contains the system’s microphone. Eli wears a miniature version, which looks like a traditional hearing aid, behind his ear. The sound processor converts speech and other sounds into electrical signals, which travel through the skin by radio waves to the implant, then to the inner ear and on to the brain where they are interpreted as sound.

Patients must wait 30 days after cochlear-implant surgery to allow the swelling to subside before the device can be activated. The patient then meets with the audiologist who programs the sound processor and instructs the patient and family members how to program it.  

The Thurmans remember every detail about the day Eli heard for the first time.

  “We were all in a small room with Stacy’s mom and (St. John’s audiologist) Lisa (Geier, Ph.D.) Lisa was holding up a picture of a dog and barking and asked him to bark, too. Eli barked, so we knew that he was hearing. It was kind of a tear-jerker moment,” Greg says.

After the implant was turned on, Eli visited St. John’s Clinic - Ear, Nose & Throat weekly for hearing tests until Geier felt the implant’s program was adjusted properly. He then began making monthly visits and now comes in about every six months. Eli occasionally uses sign language to communicate if the batteries are low in his sound processor or if he doesn’t have it on.

“He doesn’t wear the headpiece and sound processor to bed, but they go on first thing in the morning,” Stacy says.

Eli receives speech therapy at school. When other kids ask about his implant, he says “it makes my ears work.”

“He fits in with the other kids and is well liked. This really hasn’t seemed to have affected him socially,” Stacy says.

Geier, Eli’s audiologist, is dedicated to working with cochlear implant recipients. She has worked to educate patients with hearing loss and specifically cochlear implants for more than 15 years.

“Most cochlear implant patients adjust quickly and progress well,” she says.

St. John’s Clinic - Ear, Nose & Throat, located in the Fremont Medical Building, employs six otolaryngologists, six audiolgists and two nurse practitioners.  

A. Dan Pinheiro, MD, PhD, and a team of speech-language pathologists recently joined the center and work as a team to provide professional voice care. Pinheiro completed his training at the Mayo Clinic. Prior to coming to St. John’s Clinic - Ear, Nose & Throat. Pinheiro practiced at a voice center in Baltimore, Md., where he introduced new modalities to diagnose and treat voice problems.

"We are excited to establish a comprehensive program for diagnosis and treatment of voice disorders, because these centers exist in only a few places around the country. With this program we should be better able to serve the needs of all voice professionals including singers, actors, ministers, salespeople, public speakers and attorneys," says Shawn Shanklin, administrator for St. John’s Clinic - Ear, Nose & Throat.

Hearing Q&A

Most children hear and listen from birth. They learn to talk by imitating the sounds around them and the voices of their parents and caregivers. But that's not true for all children. In fact, about two or three out of every 1,000 children in the United States are born deaf or hard-of-hearing. More lose their hearing later during childhood. Many of these children may need to learn speech and language differently, so it's important to detect deafness or hearing loss as early as possible. St. John’s Regional Health Center’s Newborn Nursery screens newborns for hearing problems before they leave the hospital.

 
How early should I have my baby's hearing screened?

Your baby should have a hearing screening within the first month of life. If hearing loss is suspected, make sure an audiologist tests your baby's hearing by 3 months of age. If hearing loss is confirmed, it's important to consider the use of hearing devices and other communication options by 6 months of age.

How will my baby's hearing be screened?

Two hearing tests are used to screen babies. In both tests, no activity is required from your child other than lying still.

• Otoacoustic emissions tests can show whether parts of the ear respond properly to sound. During this test, a sponge earphone is placed into the ear canal. The ear is stimulated with sound, and the "echo" is measured. The echo is found in everyone who hears normally. If there is no echo, it could indicate a hearing loss.

• Auditory brain stem response tests check how the brain stem (the part of the nerve that carries sound from the ear to the brain) and the brain respond to sound. During this test, your child wears earphones, and electrodes are placed on the head and ears. A mild sedative may be given to help keep your child calm and quiet during the test. The nurse or doctor sends sounds through the earphones and measures the electrical activity in your child's brain when he or she should be hearing.

If your child doesn't respond consistently to the sounds presented during either of these tests, your doctor may suggest a follow-up hearing screening and a referral to an audiologist for a more comprehensive hearing evaluation.

Why is it important to have my baby's hearing screened early?

The most important time for a child to be exposed to and learn language is in the first three years of life. In fact, children begin learning speech and language in the first six months of life. Research suggests that those who have hearing impairment and get intervention have better language skills than those who don't. The earlier you know about deafness or hearing loss, the sooner you can make sure your child benefits from strategies that will help him or her learn to communicate.

How can I recognize hearing loss during early childhood?

During the first year, notice whether your baby reacts to loud noises, imitates sounds, and begins to respond to his or her name. At age 2, does your child play with his or her voice, imitates simple words, and enjoys games like peek-a-boo and pat-a-cake. Is he or she using two-word sentences to talk about and ask for things? At age 3, does he or she begin to understand "not now" and "no more" and follow simple directions? If for any reason you think your child is not hearing well, talk to your doctor.

Source: National Institute for Deafness and Other Communication Disorders