Madison Miller of Grove City was born with moderate to severe hearing loss, but wore hearing aids from the age of 6 months, so she had some hearing ability.
But then her hearing worsened when she was about 3 1/2 or 4, with no definite cause identified, and her otolaryngologist, David Chi, recommended she get cochlear implants. She got her right ear done at Children's Hospital of Pittsburgh of UPMC at age 5 and then waited, while still wearing a hearing aid in the left ear, to get the other cochlear implant a year later.
Cochlear implants are small, complex electronic devices with internally implanted and external components that carry auditory signals to regions of the auditory nerve. According to the National Institutes of Health web site, cochlear implants give a person with hearing loss a "useful representation of sounds in the environment and help him or her to understand speech."
Despite Madison's previous experiences with hearing, the cochlear implants provided auditory revelations, for her and her family: She had never heard the sound of the family's black Labrador retriever's toenails clicking across the floor. When she went outside to play, the sounds of birds chirping caused her to look up for the source of the sound. "Thunder and lightning never bothered her until she got her first implant," her mother, Renee Miller, recalled. "Those were very emotional times for us."
After a couple years of intense therapy at DePaul School for Hearing and Speech in Shadyside, Madison now has been mainstreamed this fall into a school with hearing children in the Grove City School District. She easily acclimated to some summer classes in math and reading with hearing peers and Mrs. Miller expects the same to occur as she starts first grade this week.
"She loves school. It's been easy transitioning her so far," Mrs. Miller said.
"She's very auditory ... She loves learning. I've had to have a class for her every day [this summer]."
Madison is one of 14 DePaul students mainstreamed into schools for hearing children this fall. That's the largest group to mainstream at one time from a DePaul student body that totaled just 68 last year, including students age 18 months to 14 years.
Some of those moving into mainstream classes did so with hearing aids, but nine of them, who range in age from 5 to 7, did so wearing cochlear implants, also a record number. Seven of the students had their cochlear implants done at Children's Hospital and the others at the UPMC Eye and Ear Institute.
That the kids with cochlear implants were mainstreamed at such a young age and in such a large number are tributes to improved technology, earlier auditory testing and implantation, and advances in rehabilitation therapy.
It's "because of early amplification, intensive early intervention with an intense focus on development of speech and oral language, and it's all possible because of the cochlear implant," said Mary Jo McAtee, education director at DePaul.
"Evidence supports the earlier the better for the implant, the better the speech and language outcome," Dr. Chi agreed. "The [Food and Drug Administration] approves for implants at 12 months and they also have been done in selective individuals at less than 12 months. ...
"Early diagnosis, implantation and rehabilitation have made a tremendous impact in its success and mainstreaming of children." he added.
Early diagnosis was helped along beginning in July 2003, when the state of Pennsylvania made auditory testing of newborns mandatory, said Debbie Johnston, audiology coordinator and educational audiologist at DePaul. "It used to be parents had to figure out their child had hearing loss and bring it to their pediatrician's attention. Now it's done at birth."
That means the children can be evaluated as to whether hearing aids or cochlear implants are suitable and, if the latter, implanted at a younger age than they were 10 years ago.
"Typically [they're done] between 1 and 2, closer to 1," said Barry Hirsch, director of the Ear and Hearing Center, at the Eye and Ear Institute. Ten years ago, the age of implantation was "probably in the 3, upward even to 5, range," he said.
Once implanted, the children can begin early intervention therapy at home (auditory oral approach, sign language or both) at 12 months, and at 18 months they are eligible for the two- or three- half-days-a-week toddler program at DePaul. At age 3, they can move up to a preschool program very similar to a mainstream preschool.
In the toddler program, they are "learning to listen, respond to sounds, sing along with music, respond to their names, use language to ask for a snack," said Ms. McAtee. "They're immersed in vocabulary and language through audition."
It's an intense program that becomes even more so when they move up to preschool at 3.
"They're surrounded by trained professionals pouring in language and vocabulary and putting it out," Ms. McAtee said. "We're holding children accountable for using speech and language."
But it all begins with the early detection of deafness.
"The earlier we have access to the auditory portion of the brain [the better]. There's a window of opportunity there," Ms. Johnston said. Those who are implanted later "are the ones that tend to be here [at DePaul] longer before the gap [with hearing children] is closed and they can go into the mainstream and be able to be on a par within a grade level of their peers."
The Haas brothers, Declan, 6, and Bennett, 4, of Glen Osborne are good examples of what a difference earlier implantation can make.
The boys' hearing loss had a genetic cause. Declan had early moderate-to-severe hearing loss that got progressively worse; he had his first implant just before his third birthday and his second just after he turned 5. Bennett, on the other hand, was diagnosed as deaf at 1 week and got both his implants simultaneously at 61/2 months, when their family lived in Chicago. Hadley Haas, their mother, explained the family moved here in late December 2007 so the boys could attend DePaul.
Declan started at the school the following January; Bennett started the toddler program a couple months later when he was about 22 months old. Still, Mrs. Haas felt Declan had lost valuable time.
Now, nearly three years later, Declan recently started first grade at Quaker Valley School District's Osborne School. Bennett goes two days a week to DePaul but already does three half-days in a typical, mainstreamed preschool in Sewickley. His adjustment has been easier than Declan's, and Mrs. Haas believes it's because of the earlier timeline of his implantation and therapy.
"If you didn't see the equipment, you wouldn't know Bennett is deaf. ... Nothing indicates he has hearing loss," she said.
"It's been a harder road for Declan. ... To someone meeting him for the first time, his speech isn't as smooth. There's a halting quality to it sometime. We're trying to smooth it out, give it more inflection."
Nevertheless, both Mrs. Haas and Mrs. Miller are thrilled with the progress their children have been able to make because of the advances in medical, therapeutic and educational technology.
"It's reinforced for me how fortunate it was my kids were born when they were able to take advantage at such a young age [rather than] 10 or 15 years ago," Mrs. Haas said.
Pohla Smith: firstname.lastname@example.org or 412-263-1228.