Helping him hear

From: Sioux Falls Argus Leader, SD - Jan 31, 2006

With a second cochlear implant, Valley Springs 4-year-old enjoys world's sounds

MONICA LABELLE
mlabelle@argusleader.com

January 31, 2006, 2:55 am

Every day holds a discovery for Austin Top. A world of sound has emerged for the 4-year-old since he received a second hearing implant in December.

Now the Valley Springs boy can be seen leaning into his glass of soda, transfixed by the fizzing noise. He laughs with his sister. And, best of all, he can hear his mom say "I love you" without turning his head to read her lips.

Austin is deaf, and he lives with a hearing family. He could rely on sign language, floor vibrations and lip-reading to understand the people around him. But then he wouldn't be able to mimic his big sister's favorite saying: "Oh, you big baby."

Austin's cochlear implants have changed how the family communicates. "Even just the little arguments in the back seat that most parents would get upset over, it's just music to your ears," says Marla, Austin's mom. "You just have to pinch yourself. Is this really real?"

About 13,000 adults and 10,000 children have had the implants as of 2002, according to the Food and Drug Administration. That number is expected to grow because in April 2005, the Center for Medicare and Medicaid Services expanded implant eligibility criteria, according to The Washington Post.

Evidence reported in December in the journal Proceedings of the National Academy of Sciences suggests that the earlier a hearing-impaired child receives a cochlear implant, the better.

Plus, implant surgery is becoming quicker - it can require just a few hours as an outpatient procedure.

Austin wasn't born deaf. He developed jaundice when he was 3 days old, and it became severe enough to damage his auditory nerves. So at age 1, he received an implant for his right ear, but insurance wouldn't pay for a second one.

The procedure costs about $50,000, and the implant itself is around $30,000, says Dr. Greg DeSautel of Midwest Ear, Nose & Throat Associates. The family's insurance company said Austin didn't need it. Marla begged to differ.

Without that second implant, Austin was unable to tell from which direction sounds were coming, she says. And there were some sounds he couldn't hear.

"I had a safety concern. Even with a car coming when he's outside, if he can't tell where it's coming from ... " Marla says, her voice trailing off.

There also would have been a risk to his learning ability with just one implant. Children who receive bilateral, or two, implants by age 3 or 4 have a higher success rate with speech and language skills than deaf children who do not, says Dr. Julie Hitchcock, Austin's audiologist at the Mayo Clinic in Rochester, Minn.

"The academic challenges would be enormous," Hitchcock says. "We're beginning to get research out there that younger is better for bilaterals."

Decision takes thought

But the decision to get implants didn't come easily. Marla recalls a deaf man who was appalled that she and her husband, Brad, would give Austin implants.

Some might object to cochlear implants because the child is less likely to continue to learn American Sign Language and other aspects of deaf culture, says Deb Skjeveland, mother of three deaf children and program manager at Camp Lakodia, a summer camp for deaf children.

"Some people are very sensitive and very much value their deaf culture," she says.

However, not all deaf people think that, Skjeveland says. Many support implants for children in hearing families.

The Tops learned as much sign language as they could manage, with the children learning the most. Sometimes Brooke, 6, acts as the family's translator.

They made their decision to get a second implant once they knew Austin himself wanted to be further immersed in the hearing world.

Marla recalls the day Austin emerged from his bedroom after playing with his deaf friend Colton, who has two implants. Austin had a pensive look on his face, and his mom asked him what was up.

"I want two ears like Colton has," Marla recalls Austin saying.

After changing to a new insurance provider, the implant was approved immediately.

Weighing the risks

But there were risks the Tops had to consider, as they did with the first implant. It's a delicate surgery - doctors must pass an electrode through a tiny window between the facial nerve and the edge of the ear canal to get to the cochlea. One false move and the procedure can result in a facial nerve injury, DeSautel says.

And research has shown that children with cochlear implants are at a greater risk for bacterial meningitis, according to the FDA.

But the family decided the benefits outweighed any risks, and Austin received his second implant in December at the Mayo Clinic.

Now he is experiencing new sounds, and guiding him through the noise has become second nature to the family.

"Almost everything in our home is a speech lesson," Marla says as Austin and Brooke spill the contents of a farm game onto the floor. Soon, the game sings "E-I-E-I-O" in an electronic voice. Games such as this help Austin with his speech and listening skills.

"I did a bawk, bawk, bawk," he says, imitating the game's chicken noise.

Marla narrates each day to Austin - whether she's folding laundry or washing dishes. The habit is so ingrained, she doesn't realize she's doing it until guests point it out. Austin also sees a speech therapist at his preschool in Brandon.

Sound now is so fascinating to him that he insists on wearing his hearing aid to bed.

His attachment is evident on a recent Thursday night as he plays with his sister. When he falls backward into a pile of plastic dinosaurs strewn across the living room, part of his left implant slips off his head onto the floor. He grabs it without missing a beat.

"Mom, help me," he says.

She attaches it, and Austin and Brooke zip off down the hall.

Marla perks her ears, a half-smile on her face.

"I'm listening to him in the other room," she says. "You almost have to pinch yourself."

Reach reporter Monica LaBelle at 977-3909.

Copyright ©2006 ArgusLeader.com All rights reserved.