AVA CAN HEAR!!!

Activation

Ava's activation was a success! It was the coolest thing ever - like witnessing a live miracle. BUT it was nothing like I expected. There was no drama or a-ha moment for Ava. She was cool as a cucumber. There were no tears nor discomfort - Ava took it as it came. First, the audiologist did a "mapping" of the cochlear implants ("CI's"). I will briefly explain what "mapping" is later in this post. Then one ear was activated first, then other the ear and then both at the same time. In the video below, Ava is hearing through both implants. You will note the change in her eyes/expression when I first start talking to her - she pauses briefly to listen to the sound of my voice.


Mapping

Programming the cochlear implant - called "mapping", refers to the setting of the electrical stimulation limits necessary for Ava to perceive soft and comfortably loud sounds. During mapping, the threshold and comfort levels of each individual electrode (which is in the internal implant) are adjusted in order for Ava to hear a wide range of sounds. There are 22 electrodes. Threshold adjustments are what allows for access to environmental and soft speech sounds. Comfort level adjustment refer to the amount of electrical current needed to hear a comfortably loud beeping signal. These measurements are downloaded into Ava's processors. The initial settings on her CI's are very, very low right now. So, while she will hear environmental sounds like the phone ringing or door knocking and our speech, the settings are too low for her to discriminate the different speech sounds. The audiologist instructed us to increase the sensitivity on her CI's every other day so that there is a gradual introduction to sound, so as not to bombard with so much sound that it would be uncomfortable. Next week we return to the audiologist for another mapping session. Then, her mapping sessions will be on a monthly basis. Mapping sessions are required as over time the settings can become weak due to tissue growth surrounding the implant, thus needing more power or electrical stimulation. Also, when maps are new, they sound really loud to Ava. As she adapts to the volume levels, the volume will seem weaker to her over time and the signal will no longer be strong enough. Therefore her processors will be always be mapped time after time. When a map is performed efficiently, Ava's hearing should be in normal to near normal range!!!

So now that she can hear, what do we do?

Ava will continue with her weekly auditory verbal therapy. There is a hierarchy of learning oral language. First, Ava's receptive language will need to be developed before she can start to talk. She is at square one, like a newborn baby. She now has to learn to listen to all the different sounds in her world. She needs to detect sounds (called Auditory Awareness) - such as the door, phone, a dog barking. Then she has to learn to discriminate sounds such as a cat meowing vs a dog barking or recognize her name being called. There are several additional steps to learning receptive language but I will get into that as we follow her progress. We will be spending our first several weeks pointing out all the sounds for Ava. For example, when the phone rings, we will excitedly point to our ear, look at Ava and say "do you hear that?" and then point to the phone and say "phone". We will praise her everytime she vocalizes. She will learn that language is power.

Ava is already amazing us with her very obvious awareness of sound around her. She is constantly turning her head, although not consistently yet, to the sound of my voice, at close range. She is responding to a knocking sound and clapping sound. I put a baby Einstein video on for her and in the past, she would look at the video then stop to play with something or divert her attention to something else. Today, however, she stared intently at the video and did not move a muscle throughout the whole video! I positioned the speakers so that they were facing towards her. It was incredible to watch!

Stay tuned!!!

Cochlear Implants-What they look like and how they work

Cochlear Implants - Surgery

With Ava's surgery just over two weeks away (two long weeks that is!), many of you are wondering just what exactly will be done to Ava? Last month I came across a webcast of a live surgery of a little boy receiving his second cochlear implant. The webcast is about 1 hour long. The surgery is narrated by the surgeon in real time as well as the audiologist who gives a description of the implant and how it works. WARNING-the webcast is graphic so if you have a weak stomach then I recommend you do not watch it. If you do watch it, you will be amazed at how miraculous the technology really is.

http://www.or-live.com/RainbowBabies/2419/

In the US, I believe the surgery is an outpatient procedure. However here in Toronto the patients are kept in the hospital overnight and discharged the next day.

The small incisions take about 3-4 weeks to heal. At around 3 weeks post-op, we will be given all the external equipment as well as equipment instruction. Ava is to wear the equipment not yet activated for one week to get used to having it on. At around 4 weeks post-op, we will see the audiologist who will then "activate" the cochlear implants and Ava will hear for the very first time! We will be sure to videotape this activation for all to see. Some babies react to the sudden onset of overwhelming sound by crying (which is a good thing because that means they can hear!), some babies don't react much at all at first. This is all very exciting, however, the fact is that once the equipment is activated, it is going to take a few years of weekly auditory verbal therapy for Ava to make sense of sound, to give it meaning and develop language. Essentially, Ava's hearing will be that of a hearing newborn baby once she is activated. She will have to play catch up so that by the time she enters kindergarten she will be even with her hearing peers in terms of speech and language. She has a head start because she is being implanted at such a young age. The rate of success of catching up to her peers is high and quicker than those implanted at a later age. It will take hard work , perseverance and patience. Ava is so lucky to have 5 siblings at home to constantly bombard her with language. We can see she wants to communicate so very much as she is always studying the movement of our mouths while we talk and seems puzzled by it.

How do cochlear implants work?

In normal hearing, sound moves in the ear canal and strikes the eardrum. The soundwaves cause the eardrum to vibrate which move the inner ear bones which in turn cause the fluid in the inner ear to move the hair cells inside the cochlea. The hair cells convert this movement into electrical impulses which are sent to the auditory nerve into the brain thus the brain perceives sound. In sensorineural hearing loss, the hair cells inside the cochlea are damaged therefore the brain doesn't receive sufficient electrical impulses. In persons with mild, moderate to severe hearing loss, such as mine and daughter Lauren's, hearing aids are sufficient to amplify the sounds so that the remaining hair cells can still be stimulated and do their job. In Ava's case however, the hair cells are too damaged or missing altogether so hearing aids cannot help her.

A cochlear implant consists of an internal component and external components. When Ava has her surgery, the surgeon will be placing the internal component, which is a receiver/stimulator that is positioned under the skin in a bed created in the bone behind the ear. An electrode array, consisting of 22 tiny electrodes is surgically inserted approximately one inch into the cochlea.

The external components, which will be on the outside of the head, consist of a light-weight sound/speech processor (resembles a hearing aid) composed of a directional microphone worn behind the ear and a transmitter which is placed over the spot where the implanted receiver is located and held in place by a magnet.

How it works - the external sound/speech processor (which is the device behind the ear that looks like a hearing aid) captures sound and converts it into digital signals. The processor sends the digital signals to the internal implant which is under the skin behind the ear. The internal implants converts the signals into electrical energy, sending it into the electrodes inside the cochlea. The electrodes directly stimulate the auditory nerve bypassing the damaged hair cells and the brain perceives these signals as sound.

What does it look like?

This is what the external components look like. Because Ava's ears are so small, the sound processor is too heavy to stay on her ears. The processor can be separated so that the microphone part, which is lighter, can stay on her ears while the bottom half which is the controller and holds the batteries can be pinned to her clothes or inserted into pockets I will have to sew on or inside her shirts (more like a job for Ava's grandmothers I can barely sew a button). When Ava is about 2 years old or so, her ears should be able to support the full weight of the sound processor and controller (BTE or behind the ear).

Below is a link showing a diagram of Ava's external components. We will be able to choose what colour we want to use - probably dark brown to match her hair.

http://products.cochlearamericas.com/diagram/freedom-babyworn-diagram

I hope I have given a somewhat accurate description of the surgery and components of the cochlear implant. If you come across this blog and note any inaccuracies, please leave me a comment so that I may fix them.

AV therapy and new tricks

Ava's auditory verbal (AV) therapy is every Monday but we had to reschedule this week so we had therapy today. Ava has an amazing therapist named Sandra who was also my daughter Lauren's (4, bilateral hearing aids-moderate loss) therapist. Sandra has been working very hard at trying to get Ava to detect some sound so as to form pathways in the brain so that once Ava starts hearing with the implants, sound won't be so foreign to the brain. Also we have been working on getting Ava to vocalize as a means of communication (other than crying of course). One of the sounds we have been working on is "uh oh!" whenever Ava drops a toy off her high chair. Well today Ava dropped something and Sandra did her usual "uh-oh" and paused for Ava's reaction and Ava actually said "uh-oh" back and looked back at Sandra for her reaction! It was more like "uh uh" but it was definitely a deliberate attempt at vocalizing that sound. Sandra and I looked at each other completely speechless for a few seconds and then we started hollering with excitement. Another new trick Ava did today was while Sandra was showing her this toy where there are different knobs and a Sesame Street character pops up when the knob is manipulated. Ava really loved this toy. I started asking Sandra a few questions about Ava's upcoming surgery so Sandra's attention was diverted to carrying on this short conversation with me when suddenly Ava decides she's had enough of waiting to be entertained so Ava grabbed Sandra's finger and placed it back on the toy so as to indicate to Sandra "ok enough gabbing let's get back to work now". This is all so exciting as there have been times where Ava didn't really respond much at all to therapy but lately she has been demonstrating that she is definitely getting something out of it despite hearing very, very little with her hearing aids.

I didn't make it down to the hospital for Ava's blood test today. We will be going tomorrow morning instead.