Mending an ear

From: San Francisco Chronicle, CA - Oct 12, 2003

From telephone calls to kindergarten, cochlear implants are opening up a new world for one Menlo Park family

Heather Knight,
Chronicle Staff Writer

Rising before the sun on July 23, Sarah and Todd McBride knew one thing for sure: Within hours, doctors at Lucile Packard Children's Hospital at Stanford would perform a cesarean section on Sarah and the couple would be parents of a second child.

Two questions remained, though.

The couple had opted not to be told the gender of their baby, choosing the names Tucker William and Madeleine Charlotte to cover their bases. In addition,

no prenatal test exists to determine whether a baby can hear; the McBrides wouldn't know for days whether little Tucker or Madeleine would be born profoundly deaf like Sarah, Todd and their first child, Samantha.

Todd had a feeling the baby would be a boy and would be able to hear. Sarah thought the baby would be a girl and would be deaf like the rest of her family.

They were both half right.
The McBrides, who live in a cheery home in Menlo Park, are the first deaf family ever to receive cochlear implants as a group. Two years ago, as recounted in The Chronicle, Todd, Sarah and Samantha, now 3, all had the prosthetic devices surgically installed and began to hear the sounds of everyday life around them.

Cochlear implants, which were approved by the U.S. Food and Drug Administration in 1985, are now used by well over 20,000 people but weren't an option for Todd, 40, and Sarah, 30, when they were young. Along with Samantha, they've worked with speech therapists, but have had varying results.

Todd, who hated wearing his clunky hearing aids as a boy and whose speech suffered because of it, could hear only vibrations with his cochlear implant at first. It's gotten easier, but he still communicates with his family mostly through sign language.

Sarah, who wore hearing aids soon after she was discovered to be deaf at age 3, has had an easier time adjusting. She uses a sign language interpreter for big events, such as her prenatal ultrasound tests, but she mostly uses speech and said that with the implant she can hear "everything, everything."

"The birds singing," she said. "The crickets making noises. Chairs squeaking. Everything."

Sarah owns a cell phone for the first time and can use it to have quick conversations with her mom. Not being able to see her mom's lips move makes it challenging.

"It's a huge accomplishment," said Becky Highlander, an audiologist at Palo Alto's California Ear Institute, who has worked with the McBrides for years. "Telephone use is really difficult. It's one thing we never promise them."

As anticipated, Samantha has fared the best, with Highlander calling her "a true little chatterbox." Because she wore hearing aids as a baby and received cochlear implants when she was 21 months old, she can hear and speak so well that many people don't even realize she's deaf. She can adjust her voice to a whisper or a shout and can understand people without reading their lips.

"Her voice sounds like any hearing kid's - this soft, little girl's voice," said her grandmother Yvonne Petersen, of Palo Alto. "She overhears a lot. She says, ÔWhat are you talking about, Grandma?' She wants the whole story."

Samantha loves swimming, collecting ladybugs, hunting for worms - and after a family trip to Disneyland in October, anything related to Mickey Mouse. She tells make-believe stories about a magical rabbit.

"She's a ham," Sarah said. "She's not mellow. She's always busy."

Samantha attends preschool at Jean Weingarten Peninsula Oral School for the Deaf in Redwood City, where almost all of the kids wear cochlear implants. The McBrides think she'll be ready for mainstream kindergarten when she's 5.

When Sarah discovered she was pregnant last fall, the family naturally wondered whether their new baby would be deaf. ("The likelihood of it being a genetic possibility is there," Highlander said. "To what degree is uncertain.")

One thing was definite: The baby would be given the Algo Hearing Test soon after its birth. A 1998 California law required all state-approved hospitals to begin screening newborns for hearing loss last December. The program ensures the screening of 70 percent of the state's newborns.

Sarah said she wishes she had been screened when she was a baby instead of her family waiting three long years to discover why she wasn't talking.

"It would have been very different if I had been tested as a newborn," she said. "I'd be a different person."

A couple of weeks before giving birth to her second child, she said she didn't care whether the baby was deaf. Seeing Samantha flourish with cochlear implants has given the family confidence that their second baby would have just as much success.

"I think the baby will be deaf - I think so. I just feel it," Sarah said. "Either deaf of hearing, it doesn't matter. It'll be equal, but I want to know if the baby is deaf.

"I need to know."
Since Samantha was born by c-section, doctors determined that Sarah's second baby would be born that way as well. With surgery scheduled at 8:30 a.m.

July 23, the McBrides awoke early to swing by Starbucks for a jolt of caffeine before arriving at Packard at 7 a.m. Sarah was given local anesthesia and was prepped for surgery.

Samantha played with toys in the waiting room along with her grandparents Yvonne and Bill Petersen. Todd joined a sign language interpreter, doctors and nurses in the delivery room. At 9:01 a.m., doctors made their first incision, and by 9:07 a.m., the surgery was over. Doctors lifted the pink newborn up for Sarah to see and announced, "It's a boy! Congratulations!"

Tucker William McBride measured 8 pounds, 5 ounces and was 21 inches long. Sarah called him a "beautiful baby." While Sarah was taken into a recovery room to rest, Todd carried Tucker out to see the rest of the family.

"Todd brought him out and presented him to Samantha," Yvonne said. "I think she didn't know what to say. She just stared and stared."

Todd said that moment sticks in his mind the most from that day.

"I loved the way Sammy looked at Tucker," he said. "It really touched me."

The group then watched nurses clean Tucker in the nursery. Samantha knew right away which baby was her brother, exclaiming, "That's Tucker!"

At 12:30 p.m., the family gathered in Sarah's room for Tucker's hearing test. Melissa Price, a pediatric audiologist and coordinator of Packard's Newborn Hearing Screening Program, placed earphones and three sensors on Tucker's head. The sensors were attached on the other ends to a laptop computer. The system makes noises and can track whether the baby's brain responds to them.

Of 1,000 babies, 970 will pass the first time. The 30 others will be tested again within a few days, with 27 or 28 passing. Between two and three babies out of 1,000 are born deaf.

"The test is finished," Price said after 10 minutes. "The baby did not pass. "

The fact that Tucker was born by c-section placed an extra wrinkle in the test because babies born that way are more likely to have fluid caught in their ears. In any case, Tucker was tested again and profound deafness in both ears was diagnosed.

"Noise would have to be at rock-concert level or louder for him to be able to begin to detect it," Highlander said.

Yvonne said that after the final diagnosis, she was "disappointed, maybe, but that's it. From then on, it's nothing. You just proceed. You do as you need to do.

"It's a lot of work on a lot of people's part, but it's almost like it's a non-issue with the implant," she added. "Samantha hears everything and is progressing very well. Tucker's going to have an even better chance because he's going to start even earlier."

Sarah stayed in the hospital for three days to recover. She said she was fine with Tucker's final diagnosis. "All I cared about was having a healthy baby," she said.

After the delivery and tests, life returned to normal for the expanded McBride family fairly quickly.

Tucker spends a lot of his time in a playpen in the family's living room. Sarah hung her pink Paul Frank pajamas off the sides because Tucker has developed a fascination for the brand's goofy monkey. Samantha initially told her mom she didn't like the baby because he has no teeth; she has since grown to love her toothless brother.

Tucker is a calm, happy baby who only cries when he's hungry and wakes up once or twice a night. He had his first hearing aids installed Aug. 14, and his parents will meet with a doctor in October to determine when Tucker will get his cochlear implant installed. They anticipate it happening when he is 11 months.

"He's just a perfect baby," Yvonne said. "Just really wonderful, just so calm and so easy to take care of.

"Just perfect in every way."

E-mail Heather Knight at hknight@sfchronicle.com.

©2003 San Francisco Chronicle