Hearing with both ears

From: Bend Bulletin, OR - Nov 7, 2003

By Kelly Kearsley

The Bulletin

PORTLAND — Don Plapinger, an Oregon Health & Science University audiologist, covered his mouth with his hand Thursday afternoon and asked Kyle Anderson, of La Pine, to repeat the words he said.

"Can you say cupcake?" Plapinger said.

Kyle, 5, paused, laughed, then repeated "cupcake" back to Plapinger.

Kyle, who lost his hearing after a bout of bacterial meningitis two years ago, is the first person in Oregon to have bilateral cochlear implant surgery performed here. That means the kindergartener now has an implant in each ear to help him hear.

Plapinger turned on the second device, implanted in Kyle's right ear, Thursday afternoon at the university.

In the United States, bilateral cochlear implants are less common because, physicians said, research is still being conducted on the long-term benefit of having two implants. Plapinger and Dr. Sean McMenomey, an Oregon Health & Science University (OHSU) head and neck surgeon, said they hope Kyle's experience with the two implants paves the way for more Oregonians with severe hearing loss to benefit from the procedure.

"Kyle is going to be teaching us, probably more than we are going to be teaching him," Plapinger said.

OHSU surgeons perform 95 percent of the cochlear implants in the state, which is about 60 surgeries per year.

The Juniper Elementary kindergartener hasn't taken notice of his place in Oregon audiology history. He was simply excited to have hearing back in both his ears.

"Now I can use the phone on this side and on this side," Kyle exclaimed, as Plapinger programmed his new cochlear implant so that it wouldn't be too loud or too soft.

Kyle attends Juniper in Bend so he can go to classes for children who are hard of hearing.

He has had a single implant in his left ear since he was three.

Before getting his second cochlear implant, Bridget Anderson, Kyle's mother, said she frequently had to repeat what she said to her son. He also had a difficult time distinguishing which direction a sound came from.

"He asks 'What? What?' all the time, " Anderson, 29, said Wednesday evening.

The bilateral implants should solve both those problems.

Plapinger, the OHSU audiologist, said having cochlear implants in each ear should help Kyle discern which direction a sound is coming from and pick out speech sounds from background noise.

"You hear with two ears," Plapinger said. "The trick with Kyle will be coordinating the two devices."

Kyle lost his hearing two years ago after he contracted bacterial meningitis.

After several days in a Portland hospital, his step-father, Ryan Lightle, 29, noticed the toddler wasn't responding to his favorite movie, "Toy Story."

"He put the speakers right next to Kyle's head and he couldn't hear it," Anderson said.

The toddler spent a couple months reading lips before he received the first cochlear implant in his left ear. His speech also deteriorated, Anderson said.

The cochlear implant made an immediate difference. The implants are different from a hearing aid in that the devices actually capture the sound and then send signals to the brain, which interprets what the person is hearing. Hearing aids only amplify sound.

The cochlear implants do sound differently than using natural ears to hear, Plapinger said.

"I don't know because I've never heard it," he said. "But adults with the implants say it can sound more mechanical or they hear echoes. It can improve as the brain adjusts to the new signal."

Shortly after he received his first implant, Anderson said she and Kyle were driving in the car listening to a tape of Kyle's grandfather playing the guitar.

"He kept telling me to turn it up," Anderson said. "I looked back and saw he was tapping his hands to the music."

In February, Kyle got meningitis again. Children who have had meningitis are at increased risk of getting meningitis again. There's been some research that shows children with cochlear implants also have a small, increased danger of the disease, according to the Associated Press.

Meningitis can cause the cochlea, the snail-shaped tube in the inner ear, to turn to bone. His right cochlea showed early signs of turning to bone, said McMenomey, Kyle's surgeon, prompting him to suggest another cochlear implant before that happened.

The second implant surgery took place on Oct. 15.

"I usually like the patient to participate in the decision making," the surgeon said. "But in Kyle's case (his parents and doctors) were forced to decide because if we didn't do it now, we may not have the opportunity later."

There are less than 200 people in the United States with bilateral cochlear implants, though there are thousands who have one implant, according to information from two of the three companies that manufacturer the devices.

Dr. Bob Shannon, head of the department of auditory implants at the House Ear Institute, said the bilateral cochlear implants are more common in Europe. In the United States, companies are still researching whether the bilateral implants have a proven, long-term benefit over having only one implant.

The House Ear Institute, a nonprofit organization specializing in ear problems, is in Los Angeles.

Shannon said some research has shown one-third of those with two cochlear implants don't experience any additional benefit. That research may make some insurance companies reluctant to cover a procedure that can cost $50,000 per ear.

OHSU, however, received authorization from the Oregon Health Plan, Kyle's insurer, to implant the second device, Anderson said.

The cochlear implant shouldn't hinder Kyle's ability to do much of anything, though doctors do recommend that he not play football.

Kyle bounced in his chair Thursday as Plapinger asked him to point to the cartoon picture of a monkey that best described the sound in his ears. One monkey was covering his ears signaling it was too loud and another was holding its hands by its ears signaling that the sound was too quiet.

"He's not listening to speech, he's just hearing a pulsing sound," Plapinger said.

The kindergartener laughed some more before pointing to the monkey covering his ears.

"Too loud, too loud," he said.

Kelly Kearsley can be reached at 541-383-0348 or atkkearsley@bendbulletin.com.

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