Hearing Evaluation in Children
Delayed Speech and Language Development
At 15 months, Sophie Garris was diagnosed with progressive hearing loss. Now four, she hopes to get a “new ear” on Thursday thanks to the Upstate’s first pediatric cochlear implant surgery.
For her parents, the availability of the surgery and the required intensive follow-up so close to home is a godsend.
“It’s just such a gift to be able to do this in Greenville,” said Sophie’s parents, John and Lesli Garris. Once the surgery itself is done, patients go through a month-long series of weekly programming sessions lasting several hours each.
“This is just what the Upstate needs. They are filling a void that no one else fills in this area. Weekly doctors’ visits with a two-hour commute each way are very difficult for families who have to juggle child care, work and medical needs,” said Mrs. Garris. “I want to help other parents, I want to help them know the extraordinary resources available in their own back yards.”
The surgery is the result of collaboration between the Children’s Hospital of the Greenville Health System, Greenville Ear, Nose and Throat Associates and one of the nation’s foremost otologist-neurotologists, Dr. John T. McElveen Jr. Kidnetics pediatric therapies of the Children’s Hospital is also available to support speech and language therapy.
Cochlear implants offer a hearing alternative when hearing aids are no longer effective, said Dr. McElveen. Under the right circumstances, they can restore conversational hearing.
“Cochlear implants are probably some of the most gratifying surgeries I do,” said Dr. McElveen. “To see the expressions of adults and children when the implant is programmed and activated is very heart warming. I’m thrilled that we’ve been able to expand the GHS program to include children.”
Dr. McElveen, who is a board-certified surgeon in both otolaryngology and neurotology, performed GHS’ first multi-channel adult cochlear implant surgeries in October 2007. GHS Children’s Hospital in conjunction with Dr. McElveen’s cochlear implant audiologist, Erin Blackburn, has developed a pediatric support program that enabled Dr. McElveen to expand his Greenville practice to include pediatric cases.
Dr. McElveen is one of only 350 surgeons in the nation who limit their practice exclusively to ear surgery. He has performed more than 600 cochlear implants in adults and children.
“This is a wonderful opportunity for deaf and hard of hearing children to reach their full potential by speaking and understanding language,” said Dr. William Schmidt, medical director of Children’s Hospital. “Better yet, all of this will happen in an environment created especially for children.” Several more pediatric cases are planned in the near future.
A cochlear implant receives sound from the outside environment, processes it and sends small electric currents to the snail-shaped structure in the inner ear called the cochlea. The electric currents stimulate the neural elements in the cochlea, activating the auditory nerve, which then sends a signal to the brain. “The cochlea is in some ways like a piano, with the high pitched tones at the bottom and low pitched tones at the top.” said Dr. McElveen. “By electrically stimulating different parts of the cochlea, we are able to simulate sound.” The brain learns to recognize this signal and the person experiences this as hearing.
Sophie, a vivacious red-haired cutie, simply calls it her “new ear.”"
Sophie began wearing hearing aids at age 15 months and has since undergone extensive speech and hearing therapy. “We were stunned – we hadn’t even thought that hearing loss was a possibility,” said Mrs. Garris. “Everything has been a process and really hard, but she’s worked hard at it. She’s a fighter. But every ounce of hearing affects speech so much. Aiding is not the same because you lose some of the sounds.”
The situation became critical when the hearing loss in the left ear became so profound that, even aided, most sounds couldn’t be differentiated. What was initially diagnosed as mild to medium hearing loss has now progressed to almost total deafness in her left ear. The right ear can still benefit from its hearing aid, but the hearing loss is projected to deteriorate there as well.
It is estimated that one out of 1000 infants are born totally deaf and up to 6 per 1000 have a significant sensorineural hearing loss. The universal newborn auditory screenings being performed in GHS facilities can detect hearing loss within the first 24 hours of life. “Although Sophie passed all of her early hearing tests, some types of hearing loss are progressive, getting worse with time” said Dr. McElveen.
“Parents need to be aware of this as a potential problem,” said Mrs. Garris. “If they suspect their child is not speaking, babbling or hitting their milestones, they should talk with their doctor right away. The sooner that child is hearing, the sooner that child can be talking.”
“Whether for adults or children, this is a terrific benefit to our patients, who in the past had to be referred to physicians in the Atlanta, Charlotte, Charleston or other tertiary care centers,” said Dr. Michael Cooter, with Greenville ENT.
Each patient is unique, and sound acquisition can vary widely, even with extensive therapy. Sophie’s cochlear implant is scheduled to be activated in December. The Garris’ hope is that Sophie is able to hear the family’s musical ornaments by Christmas -- and to start kindergarten in two years, indistinguishable from the rest of her tiny cohorts.
“Sophie is a bundle of energy and a very determined child,” said her mother. “We feel this will help her cope with any obstacles that she might encounter. Our prayer is that this surgery will allow her to talk just like any other kid, hear a sound as small as a whisper and be able to read and communicate with her sisters, Gracie and Cassie, as they grow together.”
Dr. John T. McElveen has performed more than 600 cochlear implants in adults and children. Click here to visit Dr. McElveen's site.