FEATURE

Two Ears Are Better Than One

Laurie Monsebraaten and Jeff Keay

A family’s decision to get a second cochlear implant, five years after the first one changed their daughter’s life. When our daughter Annie

received a cochlear implant in the fall of 2002, the results were stunning. Our then-31/2-year old daughter, who lost much of her hearing
to meningitis as a baby, was suddenly engaged in what we were saying. Blank looks turned to comprehension. New words and phrases

began tumbling out of her mouth. It was a miracle.

So when the Hospital for Sick Children offered Annie a second implant last year as part of a study of sequential bilateral implants on children deafened by meningitis, we were definitely interested. Annie, now 8, was particularly keen to get rid of her remaining hearing aid that whistled
when she wore a hat or bicycle helmet, especially when tests showed she was no longer getting much usable sound from it anyway.

We had read that children with bilateral implants hear better in background noise. We were excited by the possibility that two implants would make listening less tiring for her. And to have a back-up should her existing implant fail, was an added attraction.

But we were also warned that the second implant wouldn’t produce the dramatic changes we saw when Annie got her first implant and that any improvement in her hearing would be nuanced. The time lapse was also a concern. Would Annie’s newly implanted ear ever hear as well as the first? Would she even like the new sound?

One of the factors that swayed us in favour of surgery was brain plasticity. We could wait and let Annie decide for herself as an adult when

better hearing technology may be available. However I had heard a panel of leading experts speaking at the 2005 AG Bell Convention in Pittsburgh say exciting new stem cell and chemical research is at least 20 years away from clinical practice. Maximizing Annie’s hearing
now when she is young and her brain is still developing seemed to make more sense than waiting. And since most of the new therapies are

being delivered via cochlear implants anyway, a second implant won’t likely cut her off from future advances.

But the dreaded surgery loomed large. In fact when we explained to Annie that she would have to go to the hospital for an operation to get a second implant, she was horrified. We weren’t crazy either about another stomach-churning five-hour hospital waiting room vigil while

doctors at Sick Kids drilled into our daughter’s skull. There were also practical issues. Annie, whose death-defying battle with meningitis
forced her to undergo more medical procedures in her first year than most of us will experience in a lifetime, has an understandable
terror of needles. No problem, we were told: All needles would be inserted after she is peacefully sedated by nitrous oxide. What

about surgical tape? One of Annie’s most enduring (bad) memories from her first implant surgery was when doctors removed the bandages.

She didn’t want any tape on her forehead this time. Now, that was going to be a bit more difficult to arrange, the hospital social workers
said. But after several tearful counselling sessions that included practising on stuffed animals, Annie came around. She would be brave.

But during our pre-op surgical consultation with Dr. Adrian James, Annie could not help bringing it up. To our surprise and delight,

Dr. James told her he doesn’t use surgical tape to keep the bandages in place.“No tape?” Annie asked, astonished. “No tape,” he

assured her. Annie was thrilled. We were relieved.

One of the things Sick Kids wanted to explore with Annie and other post-meningitis children was the impact of a second implant on balance which, typically, is lost due to the illness. So Annie participated in a number of balance tests before and after surgery. The theory is that the second implant will give these children more sensory information to help with balance. Annie is also participating in tests on auditory
synchronicity along with all children who are part of research into sequential bilateral implants at Sick Kids. Early findings show the more time between first and second implants, the longer it takes the brain to synchronize hearing between the two ears.

Annie’s surgery was a resounding success. Thanks to a new anesthetic, she was less groggy coming out of surgery this time. And since Annie’s first implant was switched on when she regained consciousness, we were able talk to her right away – a benefit that certainly made us feel better
about the experience. We knew all was well when she asked to play “I Spy” in the recovery room and requested pizza for supper
later that evening. Sick Kids generally performs implant surgeries on Thursdays and most children are discharged on Friday to recover

at home over the weekend. In Annie’s case, she was back at school on Monday.

Ontario’s Infant Hearing Program provides Auditory-Verbal Therapy (AVT) for pre-schoolers with hearing aids or cochlear implants.

But for children like Annie who receive implants after age 6, there is no AVT coverage in most of Ontario. We are grateful to VOICE

for Hearing Impaired Children for providing AVT services to Annie once a week as she learns how to hear with her second implant.

The service has been invaluable and input from our therapist has helped our audiologist at Sick Kids fine-tune Annie’s MAP. Most kids
receiving second implants receive 6 months of AVT and for us it has really helped Annie navigate her new technology.

We have been told it can take as much as a year to 18 months for kids to become completely comfortable with their second implant.

Although Annie still prefers her old one, she wears both all day and has already successfully used the new one as a back up when her

batteries ran out on her old processor.

Did you ask the teacher for new batteries? I asked her at home that evening. “No, I just used my new implant. Pretty good, eh mom?”

Pretty good indeed.