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Season 2, Episode 2
06/01/2023
Season 2, Episode 2
Esteban is born. Maria begins the cochlear implant evaluation again, but it goes differently than expected. Guest Dr. Nancy Young discusses how she became a pediatric otolaryngologist who specializes in cochlear implants and her impressive career as a pioneer for pediatric cochlear implantation. Episode Transcript Katie Colella [00:00:00] You're listening to Amplified, presented by Lurie Children's. Transcripts of this and all episodes can be found at LurieChildren.org/amplified. Last episode, Maria Venalonzo, shared her emotional journey about her son Eduardo, being diagnosed with hearing loss and receiving his cochlear implant. As we know from Katie's story in season one, getting hearing technology is never the end game. Katie Farnsworth [00:00:26] Many families want to know the etiology or cause of their child's hearing loss. Often, the etiology does not change the course of intervention. But parents want to know the "why." Sometimes, take myself, for example. I don't know what caused my hearing loss. Due to my later identification in life, I don't even know when it happened. When Maria became pregnant shortly after Eduardo received his first cochlear implant, she decided to search for answers. Maria Venalonzo [00:00:51] So when I get pregnant from my second time, I was like, I was worried. I was like, so stressed out about about like having another kid with hearing loss. And then I met my husband in Chicago. I didn't know about the whole, his whole history. So, I noticed that he was having some hearing loss, but it wasn't that bad. And then he didn't share anything with me. So I wasn't like, I feel like, "Oh, what's going on?" So at the time when I get pregnant and I start worry about it is when I start like pulling up and asking questions in his family. So his mother told me, "Oh, my kids, they also have this same hearing loss, but they get better." And then I was like, "How that's gonna be possible?" So I questioned those things and they said, in there, it gets better is it gets worse. And I was like, "Oh. So I was like, okay." So when I got pregnant, they said they'd review me because I had to mention to my doctor about my concerns. And then so she revealed the right way to do this specially. But I find out something really weird that is not this, that you find out that your kids have hearing loss when you're during your pregnancy. So I was like, "Why do I waste all my time for these one? I were like, so stressing on myself? And they, like, worry about it. And then I didn't know nothing. There's nothing that I have to fix." So I like, ugh. So I let it go. Katie Farnsworth [00:02:37] According to the Center of Disease Control and Prevention or CDC, 50 to 60% of babies born with hearing loss involves genetics. If a family chooses, they can undergo genetic testing panels to determine the likelihood of having another child with hearing loss. But like Maria learned, they cannot diagnose hearing loss prenatally. The only way a hearing loss can be diagnosed is after a baby is born, by a licensed audiologist. Maria Venalonzo [00:03:02] I don't know for some reason, but this is my experience. It happened to me. When I got a birth my, my, my, my boy. The only way that I find out is like your pregnancy, you had this history. It was even runs in the family. Because that's the only way that I find out. Like hearing loss runs in the in the family. They they have to find out. Katie Colella [00:03:28] In your husband's family. Maria Venalonzo [00:03:29] Yes, in my husband's family. They had to find out if it runs in the male or female. And I was like, Oh. So it was like in male, let's say. So it was, I had to find out if I was having a boy or girl. I had to find out the gender. So I was like, okay, what's the difference in the differences, is if there's a boy in the front, in the, in the males. The hearing loss runs in the males. The probably my son is going to going to have a hearing loss is high and then he was a girl, it's a lower than the percentage they think it's going to have a hearing loss. So that's the only thing. But it's nothing that we can fix anything. So we're like, okay. So that's that's my experience that I have. Katie Colella [00:04:16] There are numerous genetic markers for hearing loss, but the most common is GJB2 related, also known as connexin 26. It's estimated that about half of babies born with non syndromic genetic hearing loss is due to a mutation of GJB2. When Esteban was tested for connexin 26 back in 2010, his results were negative. However, the geneticist noted the reported family history from Eduardo Junior and Esteban's father indicate an autosomal dominant genetic hearing loss. Meaning 50% of Eduardo senior's children have the chance of being born with hearing loss, not just the males. Maria Venalonzo [00:04:54] So when I found out there was a boy, I was like, more worry. And I like, "Oh, man." I was praying and I was like, you know, like, hoping the, the, the he was going to be fine. Katie Colella [00:05:04] And did, so do you found out before you had... Maria Venalonzo [00:05:07] Yes. Katie Colella [00:05:08] Esteban that... Maria Venalonzo [00:05:09] Yeah, he was a boy. He was a boy. I was like six months of my pregnancy, I let go. So I feel like I know, I just science sometimes, but I don't trust 100%. I know God always is there for us. But for any reason, they forgot to do the hearing test. This when I was like, asking all the time, it waws nurse it was doctors, it was like, a specialist. The specialists show up that day. So I told him, like, "Do you guys did a hearing test?" They told me yes. And my faith, they told me, yes, they he passed it. So I was like, so happy. I said, yes, I think everything is good. So, when I went back to for the first appointment after I got Estaban, his pediatrician, I asked him, "Can I see the test?" Because they didn't give it to me. And he say, "Yeah, yeah, I'm going to show it to you. I'll have it for the next appointment." And I was like, "Okay." So for the next appointment, I was like, "I need to see the test." In about that time is because, it was an accident happened in the house. A glass broke, like a huge glass and he didn't wake up. So I like, I told my husband and then my husband goes "Oh no, no, no, you're gonna go again." I was like, "For real? There's something happening as I can feel it, I know it." And he was like, "You're not gonna do this again, right?" I was like, "Please listen to me." And said "But they told you, that everything was right." I say, "No, but I feel like something is not right. And I know he's so little, but I feel like he's not hearing this." At that time, I got Eduardo was scheduled appointment with Miss Beth. Esteban was like two months in some. And then so I mention to her, I worry about this thing and then the pediatrician having give me the test. So she told me schedule an appointment and then I'll make an appointment. And then let's see. And then we going test the ear. And we're like, okay. So in that time when I was pulling the record and it wasn't the record for a long time, it was like, you know, brand new record. They give it to me, but it was like, copy, on top of another copy. But it wasn't his name. I was like: Wait, this is not my, my baby's name." I was like, okay. So when I, I confront the pediatrician, I say, "Look, this is, this is not right, you guys told me they my baby passed the test and then is not happening. Like this is not his name." And he looking at me like, "Mam, do you have experience in this one? So you think your son is not hearing. You know what to do." And I was like and that's not what I was waiting for. I said, "You know what? You're right. I know what to do. And the first thing, I'm not coming back with my baby. You're not the right doctor that I want to see." Katie Colella [00:08:12] Good for you. Maria Venalonzo [00:08:14] So I walk away. At that time, it wasn't. I was, like, so great. Now I don't have a pediatrician. So I was like, ugh. My first was Lurie. When I talked to Miss Beth, she gave me a list to choose the pediatrician that I went to. And there was one of the, it was, it was the closest one, but it wasn't close to my area. So since then, I've been having the same pediatrician with my kids, and I feel like they always take care of my kids and they always like if I got some issue, they always like, you know, like they're for me, for my kids. But when we find out they did the test, Miss Beth did the test and he didn't pass it. So I look, I look at my husband and he was looking down he was like, "I'm sorry, I didn't believe you." I was like, is, because I was you know, I took some time off when I, I had a baby. So, you know, I got more time. And then, I mean, it's not your fault, you know, like you wasn't there, but at least we know we got experience. We did Eduardo. When Esteban, when we find out that he was having some other heart murmur. I was like, ugh. So it was a heart murmur and there was suspicion about that tumor in his brain. So they couldn't do the surgery for cochlear. When she called me, when we did the MRI, the MRI. So she's the one told me this isn't this is this is the issue that we have now. And I was like, great, so what's going to happen? So she referred me to their neurologist, and to find out. But at that time, she told me, like, you know, these are the situation that we have and these are the situation that we had to work on. So, and this is your options. My option, it was like, to do that surgery with or without the magnet. Katie Colella [00:10:23] When Esteban had his MRI, standard for a cochlear implant candidacy evaluation, an abnormality was found. The neurosurgery team now needed to monitor the finding with serial MRIs to make sure it wasn't malignant. Standard cochlear implants rely on an implanted magnet to connect to the external processor worn on the head of the patient. But an internal magnet was no longer an option for Esteban due to the need for serial imaging and the shadow effect that would be created by the magnet. Maria Venalonzo [00:10:54] So in that way, the, they got to be more scanning. And then, so um, then neurology is going to work on and going to be able to see better in his brain. I was like, because it wasn't going to be anything blocking. So we're like, okay, so but we have to work harder than that because we had to shave it in the place that we were supposed to be put a sticker and put the magnet. I was like, okay. So I think that wasn't that hard. So we're like, okay, so we're going to do this. It was it wasn't easy, but when we are the site to do any. So my husband, he was in – so we got. In that year we got two surgeries. It was one for Esteban, it was another for Eduardo. Katie Farnsworth [00:11:45] Wow, big year. Maria Venalonzo [00:11:46] Yeah. So, so, now we have, you know, two kids. But now, like it was, I feel like I got a lot of support from my husband because now he knows about the cochlear and he know, that they, they was working on my son. Katie Farnsworth [00:12:02] Maria witnessed her two young boys undergo five surgeries over the course of a few years. Trust in her boy's care team had fueled Maria's faith through this process. So who is this surgeon she had allowed into her confidence? Maria Venalonzo [00:12:15] And then, the Dr. Young, the double surgery. So that's the reason he got three surgeries, basically like doing one. But he was hearing that the thing he was like hearing and this is what I found out, the more younger you are, the get this the cochlear to decide to go for the surgery, is the better because now I compare three years, then 18 months. And it is a lot. But always stand up for them. And then I always told them "You, you, are right, you are normal, you are - it's the same as the other kids doing. Don't you ever feel you're a special because you're no special. You're always going to be a special because you're special, but not because somebody has better than you. Don't go in that way." And I wouldn't me okay because for me, my older kids and my younger kids, they are the same. I came to this country. It wasn't easy. I had to learn different language. And then because you guys, I had to learn different things. So you see like everybody has the same way. You got some strong one things,just had to work more harder because I feel like everybody is the same, they some people's good for one things and some people good for another things. But it doesn't mean like, you know, you cannot do it. It's only in your head. So you have to keep it up. Esteban got the surgery at young age and his speech is more clearly, and that's for sure. When you decide to do the surgery at a younger age, your brain developmental way in a different way. Because I feel like you got the information, you got all the tools and put all together and it's just a miracle like. You do. But when I'm in, sometimes I know they, they, they as a parent, it's not easy, but I feel like your kid got diagnosed with hearing loss. The more that we work together, there is it's communication between doctors and and you know like the option because we always have options. Like back then we wasn't having options right? But now like is getting better and better and better thank to technology. I don't I haven't met many of our surgeon doctors, but I feel like she's the best that I ever met. That's one other reason when I they they asked me to volunteering for parent way so I always connect with families and with families and share my story. And then it is true like sometimes we don't know and we we need support. And then like I always told my kids, when you don't share things, people don't know, and then when you don't like, share your pain, you feel like you are alone and you're not alone. Because other parents went through the same situation. Some parents got through the same issue that's as true. And then like support them. I feel like I you I feel like at that time when I wasn't having all of those things in the other hospital. So I feel like there were like more supporting me there. Supporting families because they were sharing a lot, of a lot of stuff, a lot of like experience that we don't had. And I think one not that the, that made me feel like that I was doing the right thing. Because like hearing them, talking to them, asking questions and and getting answers, I feel like like I did the right decision for my kids. Because when they're young, I mean, parents have to decide, you know, they they know, they not decide by themselves. So we had to do either like let them be like that or let them or like make this decision that is going to hurt like a parent, parent a long way is going to benefit them. So I feel like sometimes you get the right support not only from doctors in in in families. I feel like it is more easy for parents to take on this issue. I don't know about many other parents, but most of the parent that I met, that's one of the biggest concerns, if the cochlear implant is going to work. Oh, that's going to be good. The first time when I met Dr. Young and today I still remember those words because she told me 5% is the surgery, 10% is the speech therapy, about 80% is your work. And I didn't get it in the in that time because I was like, how is going to be my work? But now I know what she was talking about because it was like driving my kids over here, driving my kids over there talking with them all the time and teach them. Dr. Nancy Young [00:17:36] I'm Dr. Nancy Young, and I am the head of the Section of Ontology within Otolaryngology, and I'm also the medical director of the Department of Otology and the medical director and founder of the Lurie Children's Cochlear Implant Program. Katie Colella [00:17:55] I'm curious what led you to the field of cochlear implants? Dr. Nancy Young [00:17:59] When I was doing my neurotology fellowship, which is advanced ear surgery, but the patients you deal with are primarily adults. Some kids, primarily adults, though. And cochlear implants had recently been FDA approved for use and adults were not yet approved for use in children. And in fact, there was a lot of skepticism about whether how effective they would be in children who were born with hearing loss. So it was clear to me that this was an emerging field that was very exciting. And I always had faith that the technology would work in children. And I knew that there, coincidentally, I knew that at about that time there was interest in bringing someone to the Children's Hospital in Chicago, we now called Lurie Children's, to spearhead development of ontology in general, including cochlear implant, even though it wasn't yet, the device was not yet on the market. So I knew I knew that this would I really felt this, I felt this had a future. So I thought this was an exciting opportunity. I don't think too many other people would have at the time would have looked at it that way. But that's what happened. Katie Colella [00:19:37] It's crazy that I think there was a time where people questioned the efficacy of cochlear implants in children, with the culture and the success that we know today. Dr. Nancy Young [00:19:47] Well, cochlear implants from the very beginning have been, were viewed very skeptically for many different reasons. The first device in use in the U.S. was a single channel device, and there was a lot of skepticism that a single channel would provide benefit. Certainly multichannel are better. But what's amazing is there are individuals who are adults who lost their hearing, who got at a device with a single channel, who were able to actually understand speech without visual cues. I actually have videos of that. So so that was very early technology and everyone was skeptical. The other part of that skepticism was that the thinking at the time by neuroscientists was that adults who were the ones getting the implants originally right? That adults did not have enough neuroplasticity to make use of the limited information provided by either a single channel or a multi-channel device. And in fact, Dr. Merzenich, who is by many now considered to be the father of neuroplasticity. He was a young scientist at the time, and he was pulled into a multi channel device development situation at his university. And he has some wonderful stories written about this because he based on the thinking of the time, he just was like these surgeons are you know, they don't know what they're doing. And this doesn't make sense because this is going to require too much neuroplasticity and adults don't have it. And then he writes about how he was present at the activation of an adult who lost their hearing, who got this new multi-channel device. And he could understand words right away. And it's like a light bulb went off on his head. He realized that what he had learned about neuroplasticity was incorrect and that this was an area that he needed to research. And he didn't stay in the implant field in the long term. He really did a lot of research looking at adult brain neuroplasticity in general. So there was skepticism from the scientists. And then, of course, there were people who felt that the deaf shouldn't hear. So there was controversy from those quarters. And that made it challenging for people doing implants in the early days because it just made optimism and for benefit and acceptance more difficult. Katie Colella [00:22:54] We all learn about cochlear implant history and I like hearing it from you though. So I feel like whoever taught it to me at some point in undergrad or grad school hasn't been as engrossed in the field as as you are. So I love hearing what it's like from someone who was really in the trenches before it was so widely accepted. Dr. Nancy Young [00:23:16] Yeah, it was. It was very interesting and it was very interesting. I think that in the early days, a lot of teachers didn't want it and didn't want to...
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