Date: 23/08/2023
Published in ThisAbility - Disability Awareness Newspaper
Multi-disciplinary team gives little Eli new lease on life
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 six year old is positively thriving.
Eli was just 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 (SSD), a condition that can impact learning and language development,” says Dr Hockman.
“Normal hearing is bilateral – functioning on both sides of the head – which gives the stereo effect to hearing, but very importantly acts as a GPS system where the two ears are like satellites combining information to locate the sound source. With SSD it is considerably more difficult to interpret sound and focus in a busy, crowded space such as a classroom,” he notes.
“With this type of hearing loss, which is a conductive 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. However, as the skull transmits sound a bone anchored hearing aid, such as the Osia System, is an ideal solution to this problem. 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. Furthermore, 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,” he explains.
A long road for Eli
According to Eli’s parents, Warren and Claire Anderson, 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 and I was undergoing my ‘daddy crash-course’ on newborn care, 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 SSD,” notes Warren.
“My wife conducted an enormous amount of research and we then decided to consult Dr Hockman. Being the world renowned specialist that he is, we immediately felt comfortable in his hands, and took his lead on plotting the way forward to find a solution for Eli.
“This meant waiting for Eli’s physical development to progress before operating. 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 six years old,” says Warren.
Dr Hockman explains that the decision-making process was guided by how Eli was progressing, and since he had hearing on one side it would be best to allow his skull time to grow, but performing the implantation of the device before he began his primary school education.
“When the time was right, I worked together with Clare Standfest, a radiographer practising here at Netcare Linksfield Hospital and we conducted a cat scan of Eli’s skull 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 is used, which helps to ensure exact placement.
“Eli was incredibly brave and took it all in his stride. Approximately three weeks after the procedure the system could be switched on and adjustments to obtain the right sound levels began with the wonderful team from Southern ENT and Linksfield Audiology here at the hospital,” says Dr Hockman.
Eli’s choice
In addition to his hearing loss, Eli was also born with a condition called microtia, a congenital abnormality affecting the outer ear. His father Warren says that this aspect had been difficult for Eli growing up, as other children and even adults would make comments on his different ear and at one point it became necessary to move schools due to the bullying that Eli was being faced with.
Dr Gabriel Doucas, a plastic and reconstructive surgeon practising at Netcare Linksfield Hospital, notes that microtia begins during the embryonic stage when the ear does not develop normally. “Microtia can occur without significant functional hearing loss but in Eli’s case he had both microtia and SSD. Therefore, 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. By about the age of seven, ears have reached 80% of adult size, so the timeframe worked well for Eli and his newly shaped ear will continue to grow at the normal pace,” says Dr Doucas.
“Being part of the team with Dr Hockman, who does such miracle work, was very rewarding and Eli handled the entire process with great grace, which is no surprise as the Andersons are an exceptional family.”
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 six years old but Eli has grown up with these conditions being part of his everyday life and we felt he should have the final say over what happens to his body,” says Eli’s father, Warren.
“He was very excited and the day before the operation we went for a haircut together, as we knew they were going to shave that area of his head. He was so excited. In addition to the work that Dr Hockman and Dr Doucas did, Southern ENT and Linksfield Audiology have been truly incredible and even took the time to do an interactive talk at Eli’s school, explaining the procedure. They have truly gone above and beyond to create a sense of normalcy around Eli.
“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 that was done for him was truly transformational to his daily experience and it’s just so wonderful that such medical teams and options exist,” concludes Warren.