This is Chris Sosa with the Becker's Healthcare
podcast.
I am thrilled to be joined by doctor
Abby Meyer, medical director of ENT and facial
plastic surgery at Children's Minnesota, and Chelsea Kimlinger,
an audiologist at the health system. They're with
us to discuss Children's Minnesota's pediatric cochlear implant
program. Doctor Meyer and Chelsea, thank you for
joining us today.
Thank you for having us.
Thank you.
Wonderful. For those of us,
for those of us in the audience rather
who do not are not familiar with your
work, could you please introduce yourselves and tell
us a bit about your backgrounds?
Happy to. So my name is Abby Meyer.
I'm a pediatric otolaryngologist.
I did my training at the University of
Minnesota and at Seattle Children's Hospital, and I've
been in practice for a little over 13
years now.
I am the medical director at Children's Minnesota
for ENT for and I've done that for
2 years. And then prior to that, I
was the director of audiology services at Children's.
And one of the main focuses of my
practice is caring for children who are deaf
or hard of hearing.
I am Chelsea Kimlinger, pediatric audiologist at Children's
Minnesota.
I work with children of all ages
and their families to help,
reach individualized
hearing and speech and language outcomes.
I am one of 2 audiologists that helped
to start the cochlear implant program here a
little over 10 years ago.
So I have a passion for working with
children and their families
entering the cochlear implant process.
Fantastic. Thank you both so much for filling
us in, and thank you for all the
wonderful work that you do in this area.
As you mentioned, Chelsea, Children of Minnesota is
working on 10 years of this pediatric cochlear
implant program. My question is, what do you
see as the biggest changes in cochlear implants
over the last 10 years?
Yeah. I would say that one of the
biggest changes we have seen in this first
decade of our program
is the expansion of who is a candidate
for a cochlear implant, particularly
for 2 populations of children,
that first group being single sided deafness.
So in this population a patient has typical
hearing in one ear and no functional hearing
in the other ear. And until recently we
didn't really understand how the brain could combine
the acoustic hearing in the typical ear and
the electric hearing from the cochlear implant in
the other ear,
together in a meaningful, useful way.
And we know that one of the many
factors that contribute to successful outcomes with a
cochlear implant is dedicated practice with the cochlear
implant.
But when you're listening with a cochlear implant
in one ear and you have typical hearing
in the other ear, your brain is gonna
crutch onto that typically hearing ear because it
obviously does so well.
But in order to achieve maximum benefit from
your cochlear implant, you really have to exercise
the device by itself.
In
most recent years, we've seen technology advancements
where cochlear implant processors are now incorporating Bluetooth
technology
into their processors,
and this has really opened the door for
successful hearing rehabilitation in this population.
Streaming through Bluetooth allows our single sided deafness
patients to strengthen the auditory pathways with their
cochlear implant without crutching onto the other side.
And this has led to greater acceptance and
success with their cochlear implant
and offers the ability for these patients to
take advantage of binaural hearing.
And some of those examples of binaural hearing
include improved listening and noise, better localization,
better sound quality, and reduced listening fatigue.
The other population we are serving more of
now is younger infants.
In 2020, the FDA actually lowered the approved
age for cochlear implantation in infants with bilateral
profound hearing loss from 12 months to 9
months of age.
However, the literature actually overwhelmingly
supports implantation
in these children even earlier, as young as
6 months old.
And implanting at 6 months old is really
becoming the gold standard here in the United
States at pediatric,
cochlear implant centers, and it has actually already
been the gold standard in Europe and many
places,
in Australia as well.
And this is wonderful because we know that
early implantation leads to a more typical trajectory
of spoken language development. So the earlier that
we can get these patients started with this
process, the better.
Thank you, Chelsea. It sounds like there have
been some huge strides made, and I do
wanna touch about on the future of these
implants a little bit later.
But before we get to that, doctor Meyer,
could you do us a favor and please
describe the connection between the surgeon and audiologist
when it comes to these cochlear implants?
Absolutely. Well, I mean, I I hope the
feeling is mutual, but I just, I can't
stress enough just
how valuable a strong relationship between a surgeon
and an audiologist is.
We have to be on the same page,
and, you know, we need to make sure
that what we're thinking also,
aligns with what the family wants for their
child, their goals for their child. So that
communication,
that open communication, frequent communication
is just so critical to the success of,
of any cochlear implant program, but especially for
children.
So we, we're very fortunate. I think we
have just really strong relationships between our surgeons
and our audiologists.
I've been working with Chelsea and,
Lisa, who was another one of the original
audiologists who started the program
for the entire 10 years,
and
it's just been a joy to to work
with both of them and all of the
other people that have been added to our
team since that time. I think what was
really great is I constantly learn from our
audiologists, and I think that I'm hoping, anyway,
that they learn some things from us as
surgeons too. And, you know, we both bring
different perspectives, different experiences, different expertise,
to this kind of partnership, but I think
that they're complementary and we really continue to
grow and I think also push each other,
to stay up to date on what's, you
know, the newest in the literature and and
push each other to say, well, how can
we make our program better? How can we
take better care of our patients? So
having that just open dialogue,
open relationship, and also open to feedback is
just so critical, and I feel very lucky
that our program has all of that.
Thank you, doctor Meyer. I'm glad you mentioned,
commune the communication
aspects
of making this program work. And, Chelsea, you've
already touched a little bit on on some
of the different types of patients that you're
dealing with at Children's Minnesota.
Building onto that, what strategies have been most
effective in meeting each child and and families'
individual hearing goals?
Yeah. I find that one of the most
important things that we can do as provide
providers in the cochlear implant,
specialty
is counseling on realistic expectations.
We know that each child has their own
unique circumstances
and that that is going to contribute not
only to their candidacy for a cochlear implant,
but also what their outcomes with the cochlear
implant may be. So it's really important for
us to have honest and open conversations with
families
about the outcomes we may expect for their
child so that they can make an informed
decision on if a cochlear implant is the
right thing for this child and their family.
So, again, making sure that we are being
honest and open with families,
from the very beginning
about what their child could potentially get from
a cochlear implant so that they can make
the best decision.
One of the reasons I really love working
with cochlear implants in Audiology is that there
are a lot of appointments,
and you get to know patients and their
families pretty well.
And when we have a better idea of
what a patient's day to day life is
like, we are able to better help them.
For example,
who is spending time with the child during
the day? If both parents are working outside
of the home, you know, who is watching
that child? Because they are spending a lot
of time with that child and we are
going to need their support,
in helping achieve the goals that we are
hoping to achieve with this child.
So I like to encourage families to invite
these family members
to some of our appointments so that they
can learn more about cochlear implants and ask
questions
so that they feel more empowered to help
support these children in their when they're in
their care.
Another example of this is, you know, getting
to know does the patient spend time between
2 different households?
This is actually really helpful for me to
know because when I'm ordering equipment for the
child, in these cases, I like to make
sure I have, you know, 2 full sets
of batteries, 2 full sets of chargers
so that these can be split between the
households and parents don't have to constantly be
worrying about packing everything every time the child
transitions from one home to the other.
So yeah. Really getting to know the kids
and the family dynamics so that we can
best support them because, you know, no 2
child no 2 children are exactly the same,
and we really need to get to know
them better to help support their best outcome.
This is a question for either doctor Meyer
or Chelsea, but what sort of feedback have
you gotten,
from parents and
really the children who have been receiving these
implants and how it's enhanced their lives?
I I mean, I think it's incredible as
you see, you know, now that we've have
you know, some of the kids that we
implanted in the early years of our program
are now
know, in late elementary and even, you know,
thinking about middle school. And to see them
grow into these just, you know, really lovely
people and see how far they've come. You
know, when you meet a family
and they receive the news that their child
has
you know, that is deaf or hard of
hearing, and especially if it's a very significant
hearing difference that puts them,
you know, on the path towards cochlear implantation,
it can it it often comes out of
nowhere for these families. So you see,
where they start, you know, where they start
this journey. And then when you see them
on the other side of the journey where
their their kids are, you know, out on
the soccer field, they're having sleepovers with their
friends, they're, you know, they're just living their
best life. It
I mean, it is pretty it is a
very special and remarkable thing. And I think
I mean, families,
for the most part, are, I I think,
just incredibly grateful and and but it's kind
of their normal life. You know? It just
becomes, like, well, this is what we do.
And
and that's another special part to see how
they come so far
and and, you know, saying how am I
going to do this? How are we gonna
do this as a family?
To then being, like, well, this is just
what we do is is is pretty remarkable.
That's certainly very heartwarming, and hopefully, more children
will have
access to this technology as time goes on.
Another question for you, doctor Meyer, and that
simply is what are you excited about or
focused on when it comes to the future
of pediatric cochlear implants?
Yeah. I mean, it's an an incredible time
to be in our field. There's just so
much that's changing all the time. Some of
the things that Chelsea,
you know, pointed out as far as where
we've come in the past 10 years. I
think a couple of the things, you know,
and most of what we're working on is
really maximizing the benefits, knowing
who could best benefit from this amazing technology
and when. When is the best time to
do it? How can we,
put the child in the best position to
meet their potential,
with this implant and this technology?
So, one example that we have,
is, you know, unfortunately we do see children
that have meningitis and meningitis,
is a very,
significant risk factor for developing a significant hearing
loss. So,
and it's
a cause of hearing loss that if it's
not identified early and intervened for early, it
can,
it may not ever be able to, have
a cochlear implant, for example, that's very time
sensitive. So,
there really wasn't a meningitis protocol to follow
that was published, and it was the standard.
So we had a very small,
baby that came into our hospital with meningitis.
And,
we actually, she was the youngest patient to
receive a cochlear implant. We did it here
at Children's Minnesota, and that really
helped us develop a meningitis protocol.
Basically,
a protocol to follow when a child is
admitted to the hospital for meningitis, how to
follow their hearing so you don't miss that
critical window, and we've since published that protocol,
for other centers to use. So that's, you
know, an an exciting thing that we're very
proud of. I think in Minnesota, you know,
we're the only state that screens all infants
for congenital cytomegalovirus,
and that is a virus that can cause,
hearing loss later in life or it can
cause a child to be born deaf or
hard of hearing.
And so we're in in a very exciting
position in the state of Minnesota
to,
be able to follow these children and understand
because a lot of them, are not I
shouldn't say a lot, but several of these
children that are born of this end up
being cochlear implant candidates and and determining, okay,
when when is the best time to do
it? What are the other things we should
be watching for?
We're in a really great position that we
can,
you know, share this knowledge that we're learning.
I think even things like,
like gene therapy. So there is,
there is a specific
genetic cause of hearing differences that actually causes
something called auditory neuropathy that
there are successful gene for gene therapy for
this specific gene change.
And I think this is probably just the
start of
other
genetic causes of hearing differences to potentially have
that option of, gene therapy. So it's really
exciting. And then figuring out, well, how does
the role of cochlear implantation,
you know, how do we
tie that into these advancements in in medicine?
And and do we learn more about, you
know, again, who should have a cochlear implant?
When should we do it? And is the
gene therapy, how does that play a role?
So it's it's really kind of exciting. There's
all of these new things. And and I
think the other thing is that the implants
themselves
continue to just get better and better all
of the time. The tech the advances in
technology,
you know, like Chelsea mentioned, just being able
to stream to practice with the implant, which
is really critical for some patients.
It's just crazy to think how much things
have changed in the 10 years that I've
been doing this surgery or actually 13 years
that I've been doing this surgery, but 10
years here at Children's. And then to think,
well, where are we gonna go over these
next 10 years is is just is pretty
amazing to to think about and to be
a part of.
Doctor Mein, Chelsea, thank you so much for
being so generous with your time and insights
on this program. We cannot wait to share
them with our audience, and we look forward
to connecting with you guys again soon.
Thank you so much. Thank you for having
us.