Sound Connection: A Family Gets Cochlear Implants Together Samantha McBride’s parents had a vision for their daughter. It was the promise of being able to hear the rain pattering on the sidewalk. The wind blowing through the trees. To be able to learn her first words without a struggle. And three years from now, to be able to ... Features
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Features  |   February 01, 2002
Sound Connection: A Family Gets Cochlear Implants Together
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Hearing Aids, Cochlear Implants & Assistive Technology / Features
Features   |   February 01, 2002
Sound Connection: A Family Gets Cochlear Implants Together
The ASHA Leader, February 2002, Vol. 7, 6-21. doi:10.1044/leader.FTR2.07022002.6
The ASHA Leader, February 2002, Vol. 7, 6-21. doi:10.1044/leader.FTR2.07022002.6
Samantha McBride’s parents had a vision for their daughter. It was the promise of being able to hear the rain pattering on the sidewalk. The wind blowing through the trees. To be able to learn her first words without a struggle. And three years from now, to be able to enter kindergarten with kids in the neighborhood.
That’s why Samantha sat in a high chair, just a few months shy of her second birthday last July at the California Ear Institute at Stanford Hospital in Palo Alto, CA. For nearly a year, Samantha’s parents, Todd and Sarah, had waited for this day. The parents, four grandparents, and friends all watched expectantly as audiologist Becky Highlander placed the magnetic headpiece of the cochlear implant on Samantha’s head.
Samantha reached up and brushed it off. Highlander put the headpiece back on. Once again, Samantha knocked it off.
“Anything is possible with a 2-year-old. It’s a lot of fun to go through the hookup process with kids, but it can be challenging,” said Highlander, who later found out that Samantha didn’t like anything in her hair.
Samantha wasn’t going through the experience alone. Her family has become one of the few in the United States in which every member has a cochlear implant. Their story has been featured on three segments of ABC’s “Good Morning America,” in the San Francisco Chronicle, and in Health magazine.
Sarah showed her daughter her implant. She took it off, shook her head, and said, “I can’t hear.” Then Sarah stuck the headpiece back on and said excitedly, “I can hear!”
Now it was Samantha’s turn to wear it. And she did. Highlander stimulated an electrode, slowly increasing the sound. Each time the beeps were heard, Highlander tried to encourage Samantha to look at the remote-controlled toy dog on the countertop. The dog would spin and everyone clapped and cheered for reinforcement.
But the task proved difficult for Samantha. “We do the best we can and get the most information in the shortest amount of time—that’s the goal,” Highlander said. “I took the responses—even though very limited—and developed a program that was conservative but gave her some sound awareness.”
A week later, Highlander decided to give conditioned-response audiometry one last try. This time it clicked. Each time Samantha heard the beeps through the implant, she turned and looked at the dog as reinforcement for listening. “I was so proud of her,” Highlander said. “It’s a longer fine-tuning process than with an adult, and the sooner we can get her to do the conditioned-response task, the quicker it goes.”
The family’s experiences are a contrast between a generation of children reaping the benefits of early identification and technology, and generations, including Todd and Sarah, that grew up with prelingual severe and profound hearing losses that were identified at age 2 or later.
Todd’s loss may be due to genetic causes, and it’s not known what caused Sarah’s hearing loss. Their hearing losses were identified at age 3, and both could hear loud sounds, but the soft, high-frequency sounds were completely missing. Neither could understand speech without speechreading.
Todd, 38, and Sarah, 28, did not know whether their children would be able to hear. But when Samantha failed a hearing screening at birth, the couple made the same decision their parents did: Samantha would learn to listen and speak.
“We wanted her to be oral so that she can communicate with everybody. Since the hearing world is dominant, we wanted to make sure that her life fits into this world,” Sarah said.
Hopes and Dreams
For the McBrides, the thought of getting an implant took root gradually. “Before Samantha came into our lives, we had not heard much about cochlear implants,” Sarah said.
When Samantha was 1 month old, her parents took her to a pediatric audiologist at San Jose Valley Medical Center. In the waiting room, Sarah watched a little girl playing who had a cochlear implant.
“As the little girl talked to her mother, she didn’t rely on speechreading, and she spoke just like a hearing person,” Sarah recalled. Sarah turned to the girl’s parents and asked their opinion of the girl’s speech, and they replied that her speech was excellent. The thought of getting a cochlear implant grew slowly.
When Samantha was 3 months old, Sarah and Todd enrolled her in the Jean Weingarten Peninsula Oral School for the Deaf (JWPOSD), a private auditory/oral school in Redwood City, CA. The majority of children at JWPOSD have cochlear implants, and Samantha was the only child in her class who didn’t have one. And like the little girl in the audiologist’s office, Samantha’s classmates were developing excellent speech skills.
The McBrides hoped that the implant would help their daughter develop listening and speech skills. “With a cochlear implant, Samantha will be able to develop language skills, without experiencing delays, and be able to communicate with other children without any problem,” Sarah said. “And if we were going to have Samantha get a cochlear implant, we both wanted to get one too, so we would be able to share some of the same experiences.”
Having an entire family go through the implant process together is more demanding for the implant team, Highlander said. As the family moved through the candidacy process—which involves aided and unaided audiologic testing and testing for speech understanding, a computerized axial tomography (CAT) scan to evaluate the cochlea for implantation, and an otologic consultation—there was a lot more counseling involved.
“Working with the whole family is a lot of fun,” Highlander said, “but it’s important to make sure everybody is on the same page. Everybody needs to understand what to expect, what the device will sound like, and the amount of auditory therapy needed.”
Scheduling three surgeries also proved challenging. After discussion, Todd and Sarah opted to have their surgeries and cochlear implant activations a month before Samantha to make it easier for their extended family to care for them during recovery and to give them time to adjust and then help their daughter.
“Once they’ve gone through the candidacy process, we tell them that it’s a team effort,” Highlander said. “It’s not an easy process—but they are succeeding.”
Just after dawn on June 16, Sarah prepared for surgery while Todd sat in the waiting room of Stanford Hospital, surrounded by family and complaining that “one butterfly in his stomach called for another and another.” Soon, it was his turn.
A month later, the whole family gathered in the waiting room once again, this time for Samantha’s surgery. “When a child has surgery, it’s hard to guess how it will go. They haven’t eaten for a while, so they don’t always sleep well, and somehow children have a way of knowing what is going on,” Highlander said. “But Samantha was laughing and very happy.”
Waiting and Wondering
After four interminable weeks, Sarah and Todd’s implants were activated on July 26. When Sarah heard the first soft beeps through her implant, she burst into tears.
When the implant was turned on, Sarah pressed her hand to the magnet and leaned forward. “I could hear people laughing in the background and I told everybody to be quieter,” she said. When Todd gave her a kiss, she heard his lips against her cheek.
“Sarah had an easy time identifying the pitch of sound, and she noticed a difference in the quality of her voice when she began speaking,” Highlander said. In a listening test using common words and phrases, Sarah could identify 80% of what Highlander said.
Todd, who has a more profound hearing loss and didn’t wear hearing aids consistently, had a much different—and more disappointing—experience. Sounds were not heard, but perceived more as dizziness, vibration, or pressure. “The auditory pathway was not stimulated as much, and it will take a little time for Todd’s brain to catch up and understand what he is hearing,” Highlander said.
When they walked out of the office, the world sounded different than when they went in. Sarah could hear footsteps, and knives and forks clinking on plates. She could hear Samantha’s heartbeat, breathing, babbles, and burps. The cars and trucks that whizzed by the busy street in front of their house in Menlo Park never bothered them—until now.
Separate Paths
While the McBride family shared the experience of going through the implant process, almost immediately their paths began to diverge.
A month after implantation, Todd’s perception of dizziness began to give way to sound. “Many times when someone has been deaf for a long time, it’s very hard to tolerate sounds and programming tends to go slowly as patients build their tolerance for sound and their thresholds can be increased,” Highlander said.
The implant gave Todd a newfound ability to modulate the volume of his voice, and understand his daughter’s emotions by the inflection in her voice. But three months later, he still could not understand speech without speechreading—when Sarah called him, he didn’t recognize his name or respond. “He likes using the implant,” Highlander emphasized. “He understands that it’s a process and he’s very good about working with it.”
The sounds in Sarah’s environment began to sort themselves out. With hearing aids, Sarah could only perceive one sound one at a time, by thinking about what she heard. A month later, she could identify environmental sounds without concentrating. At the pool, she could hear Samantha talking, water splashing, a baby crying, and bits of other people’s conversations. Three months later, Sarah could hear musical melodies. Friends encouraged her budding musical appreciation by recommending bands, and Sarah found herself enjoying everything from the Rolling Stones to Madonna to music piped into the Banana Republic store.
Another friend encouraged her to use her cell phone to call her parents. Her father—overwhelmed that he could converse with his daughter on the phone for the first time in their lives—immediately bought Sarah her own cell phone. Sarah can now understand about 80% of the conversation when speaking to a familiar person.
Before the implant, Samantha communicated primarily by babbling and occasionally using words, said Sharon Nutini, a teacher at JWPOSD. But in the months following the implant, her language development began to take off. Samantha began to use words more consistently and is now beginning to connect her newly acquired words into short phrases.
“She is still behind her age counterparts in language development, but we’re delighted with the progress she’s making,” Nutini said. “At the rate that she’s now acquiring language, mainstreaming in kindergarten may be a possibility.”
But for now, as a holiday gift, her parents presented her with a toy that would have been unthinkable a year ago—a walkie talkie.
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February 2002
Volume 7, Issue 2