מה רבו מעשך ה’ כולם בחכמה עשית
I don’t have another article ready to post, and likely wont have one before Pesach. The main reason is that we decided right before Purim that Temima would get her second implant put in this week, on April 5th, and we’ve been scrambling ever since to get all the necessary ducks lined up. (Note: no real ducks were harmed in the process!)
Last year, at this post-Purim/pre-Pesach time, I actually put up the post where I talk about Temima’s diagnosis and some of the progress she’s made. I had hoped to follow it up this year with a continuation, especially because so many people wrote to me or called me to share their experiences after reading it. Instead, in light of her upcoming procedure, I’d like to briefly share a little about how implants work.
There’s a lot of misconception about what an implant is—most people understandably assume it’s completely internal, and are surprised to see that Temima’s external implant piece looks just like a hearing aid, only bigger and more noticeable. They’re even more confused when they see me hang the ear piece over her ponytail instead of over her ear, helpfully telling me that her “hearing aid is off.” To explain the beauty of how our sense of hearing works is an exercise in revealing Hashem’s greatness in forming the intricacies of the human body. Let’s start.
Sound is, in essence, vibrations (or waves) that your brain processes. There are several steps to how we hear, and hearing impairment can be caused at any of these steps. Let’s go through the steps.
Hearing starts with your outer ears—the holes on the sides of your head that allow the sound waves to go in.
Hearing loss at this step would be a child born without an outer ear. The inner ear is functional, but certain genetic conditions would result in no opening or outer ear. This child would use something called a Baha until his facial nerves were fully formed and positioned (around age 8) and a typical looking outer ear would be made with plastic surgery.
The sound waves then bounce off of the ear drums, causing them to vibrate, then move along the tiny bones behind it and down to the inner ear.
This is the middle ear, where ear infections happen. If there is fluid sitting behind the ear drum, it can’t vibrate as it should, so everything sounds a bit congested, or muffled. The fluid also is at high risk for getting infected if it’s not draining properly down the back of the throat. Tubes are sometimes put in for young children with frequent ear infections, to help stop the buildup of this fluid—the tube keeps a tiny hole open in the ear drum so that the fluid can drain out through the outer ear, allowing the child to hear more clearly, too. The little bones behind the ear drum can also sometimes be damaged by loud noises or accidents, and can often be repaired (though not to perfection) through surgery.
The sound waves then go through the snail-shaped cochlea, where the small hair-like nerves carry the sound to the auditory nerve and the brain.
This is the step that is most commonly linked to permanent hearing loss. The little hair-like nerves are either damaged, sparse, or absent from the cochlea, so the sound waves can’t be passed on to the auditory nerve.
There are two ways to combat this type of hearing loss. The first way is through hearing aids. These are ideal for mild to severe hearing loss. Hearing aids are basically amplifiers—they make all sound louder so that the sparse or damaged nerves can pick up the sound waves and transfer them to the auditory nerve. While hearing aids used for kids and adults with hearing loss are very complex pieces of technology, where every sound is independently adjusted and every frequency and pitch monitored, at the end of the day, a hearing aid is just an amplifier and will have shortcomings, namely clarity. It’s pretty easy to scream loudly, but it’s much harder to enunciate clearly while you’re screaming loudly! The higher the degree of hearing loss, the louder the hearing aid has to be made, and the more clarity and articulation is lost. At a certain, what the person hears is so distorted from being amplified too much, and the hearing aid, especially for a child trying to learn how to talk, becomes detrimental instead of helpful.
That’s where the cochlear implant comes in. The cochlear implant bypasses the outer and middle ear. A thin wire (called an array) is inserted along the snail-shaped cochlea. On it are little electrodes which will replace the damaged hair-like nerves. A magnet is placed under the skin of the head, where the coil and processor connect externally. This coil and processor, the part of the implant that typically hangs over the ear of the person wearing it, will pick up sound, convert it to electric signals (instead of sound waves) that will then pass through the array in the cochlea and activate the electrodes (instead of the nerves) and will send the sounds to the auditory nerve to be processed by the brain. (Keep in mind that the processor doesn’t have to hang over the ear, that’s just a convenient, well-placed spot for sound-receivers to be—that’s presumably why Hashem put our ears there, too!)
All said, it’s pretty awesome technology, piggy-backing on truly awesome G-d created biology!
Temima got her first implant days before her first birthday. She had been wearing hearing aids for several months, but her right ear had a higher degree of hearing loss than her left ear, and we were approaching the territory of the right-side hearing aid not being able to give her good input. The surgery is usually a “one-and-done” deal—one surgery and it’s in for life. All new technology is made to be backwards compatible, so any updates to her coil and transmitter would just be a matter of buying the new device. As many of you may know, however, Temima did have a number of complications, resulting in several corrective surgeries before the implant had to be removed and re-implanted several months later, in July of 2017.
Baruch Hashem, since then, the implant has been working well and Temima has made great progress, picking up new words and concepts weekly. Last year, for the first time, the hearing loss in her other ear started progressing as well. We’ve tweaked and maxed out her hearing aid, and can’t make it louder while keeping the sound she’s hearing clear and undistorted, leading to the decision to have her other side implanted as well.
I have to admit it was a hard decision to come to. On the one hand, she’s expressive and verbal enough to tell me quite often that she doesn’t like her hearing aid and likes her implant better because it’s “louder”. On the other hand, she’s also able to tell me that her hearing aid ear “works” but that her implant ear is “broken” which shows me that she’s aware that she gets input and hears from the hearing aid ear, but that her implant ear is bypassed completely. Nonetheless, we are confident and optimistic going forward that this will, with Hashem’s unending kindness and help, be the right step for her.
“הנוטע אוזן הלא ישמע אם יוצר עין הלא יביט”
“Will He who implanted the ear not hear, or will He who created the eye not watch?”
Temima’s surgery will be early Friday morning, and she’ll spend a couple of weeks recovering before the implant is turned on. During this time, we do appreciate all tefillos for a successful implant and an easy recovery. Thank you so much!
(To read last year’s article about the diagnosis, click here: https://goo.gl/eXgFbt )