Pretoria - When little Eli Anderson was wheeled into theatre for the first time, he was on top of the world knowing that his long wait for a permanent hearing solution and external ear reconstruction was finally over.
A few months later, this brave and enthusiastic 6-year-old is thriving.
Eli was only the fifth patient in South Africa to receive the leading edge Cochlear Osia System, implanted by ear, nose and throat surgeon, Dr Maurice Hockman, who practises at Netcare Linksfield Hospital.
“Eli was born with atresia or an absent ear canal. This results in single sided deafness that can impact learning and language development,” Hockman said.
Normal hearing is bilateral – functioning on both sides of the head – which gives the stereo effect to hearing, he said, but it very importantly acts as a GPS system where the two ears are like satellites combining information to locate the sound source.
With single sided deafness it is considerably more difficult to interpret sound and focus in a busy, crowded space such as a classroom.
“With this type of hearing loss, sound cannot reach the middle ear, unlike hearing loss affecting the inner ear or cochlear. As there is no external ear canal a conventional hearing aid cannot be used.”
The doctor said, however, as the skull transmits sound, a bone anchored hearing aid, such as the Osia System, is an ideal solution. With this system the sound bypasses the ear canal and middle ear, going directly to the inner ear.
“The new Osia is a more potent system, delivering superior sound quality for better communication. The sound transmitter, which attaches to the bone of the skull, is completely subcutaneous with no need for any parts to come through the skin to join with the external speech processor.
“With the Osia, this external component is slimmer and more comfortable, and simply attaches to the outside of the head magnetically, which greatly reduces the risk of infection.”
Eli’s parents, Warren and Claire Anderson, said the possibility that something may be wrong with his hearing became apparent shortly after he was born.
“When Eli had just come into the world it was noted that Eli’s left ear was not fully developed. Not long after, during his first hearing screening test, it was confirmed that he had single sided deafness,” Warren said.
His wife conducted research and they decided to consult Hockman. Being a world renowned specialist, they immediately felt comfortable in his hands, and took his lead on plotting the way forward.
“This meant waiting for Eli’s physical development to progress before surgery. In time it became clear that this would not simply be a case of opening his ear canal, and that some form of hearing implant would offer the best outcomes, for which we would need to wait until he was 6,” Warren said.
As he had hearing on one side, it was best to allow his skull time to grow, but performing the implantation of the device before he began his primary school education.
A cat scan of Eli’s skull was done to map the optimal placement, measurements and angles for the sound transmitter, in preparation for the procedure. To avoid damaging the bone, a specialised non-reusable drill system was used, which helped ensure exact placement.
“Eli was incredibly brave. Approximately three weeks after the procedure the system could be switched on and adjustments to obtain the right sound levels began,” Hockman said.
In addition to his hearing loss, Eli was also born with a condition called microtia, a congenital abnormality affecting the outer ear. This aspect had been difficult for Eli, as other children and even adults would make comments on his different ear. At one point it became necessary to move schools due to the bullying Eli faced.
When Eli was ready for his implant, it provided an opportunity to address his microtia as well.
“As plastic surgeons we try, if feasible, to use any available tissue of a particular area of the body and build from there. In some cases a rib graft is taken from the patient’s own body or a special mouldable material may be implanted to create an ear. Fortunately in Eli’s case we were able to work only with his underdeveloped ear and reshape it, said Dr Gabriel Doucas, a plastic and reconstructive surgeon.
By about the age of seven, he said, ears have reached 80% of adult size, so the time-frame worked well for Eli and his newly shaped ear will continue to grow at the normal pace.
According to Eli’s parents, the decision to proceed with the operation was one that the family made together, with Eli very much involved in the conversation.
“He may only be 6, but Eli has grown up with these conditions being part of his everyday life and we felt he should have the final say on what happens to his body,” his father said. “Since undergoing his procedure Eli has completely come out of his shell. He is doing well at school and enjoys playing hockey and soccer. The work done for him was truly transformational,” his father said.
Pretoria News