Bilateral Baby

We have been hoping to get Rachel's right ear implanted for a while now. There are issues. First off, she has a shunt on the right side, which is not coming out. That takes up valuable real estate on her right side. The other issue is that her right cochlea is ossified. This means that the hollow fluid filled space is no longer hollow, but solid bone. The ossification on her right side is what caused the doctor to speed up the initial implant on her left side way back when she was a baby. She was the first one year old to be implanted at Children's Hospital in Seattle. Luckily, her left cochlea had just begun to ossify, and the doctor was easily able to slide the electrode array into the cochlea without any difficulty.

The problem with ossification is that in order to insert the electrode array, the space now needs to be drilled out. They have yet to invent a drill that curves like the cochlea does. However, Cochlear Corp has designed what is called a split array internal device. The electrode array is split into two parts. The doctor drills into the cochlea in two places, and inserts the device into the two straight holes created, hopefully getting all the electrodes within the cochlea, or at least getting most of them inserted.

We met with Dr. Rubenstein on Friday, and he feels that A) he can work around her shunt, and B) he can successfully get the split array inserted well enough into the cochlea to get most of the electrodes to be usable. Of course, this is the easy part. There are lots of unknowns. How many electrodes can he get implanted? Won't know till he gets in there and does the surgery. How healthy is the auditory nerve on her right side? See the answer to the previous question. Even if everything goes well and they get nerve response after the surgery, there is no way to predict how well she will do with hearing on her right side. Her brain will have to go through a frustrating and time consuming process of learning what sound is in her right ear. She has been ignoring that ear for almost 10 years now, and it will be a lot of work to get that ear to pay attention. That is if she can even get hearing in that ear. We won't know if she can get any hearing on that side until she actually gets hearing on that side.

Here is the biggie. The success of implants with meningitis kids is hit and miss. Some, like Rachel do real well with them. Others not so much. Ossification is a big question mark in the process. Is it the ossification itself that damages the hearing process with the implant or is it something else that causes kids with ossification to get such poor results? In Rachel's case, we can rule out damage to the hearing center of her brain. We know it is working well. We also know her auditory nerve was in good shape initially. So now the doctors can isolate it down to the ossified cochlea itself or the potential auditory nerve damage. If it turns out that she can get usable hearing in her right ear, that will answer a big question for the doctors. It seems like our little pioneer is at it again, teaching the doctors at the same time as they are helping her.

So now the journey to bilateral hearing begins. Step one is to get insurance approval. We are aiming at surgery for right after Christmas. Hopefully this will be enough time to get through the approval process. I am hoping for easy acceptance, but am gearing up for them to initially deny the proceedure. Let the battle begin.