Kelli, Michael & Landry

Kelli, Michael & Landry
Our daughter, Landry, was born in December 2007 and was diagnosed as being profoundly deaf in March 2008 at 3.5 months old.

Since Kelli was pregnant, we have kept a blog so that family and friends could stay connected to Miss Landry; until now, we have lumped Landry's clinical updates in with her kid updates. Recently, we decided to start a new blog with the intention of keeping "the girl" and "the diagnosis" as separate as possible. For tons of updates and photos on "the girl," visit Landry's website; for updates on "the diagnosis," visit us here. On Landry's blog sidebar, we will include links to updates on this page so that you don't have to check both pages each time...

We hope that you will find this site informative on many levels. If you have a question, it simply means that we didn't explain ourselves fully and, chances are, other readers will have the same question. Please feel free to ask any questions in the comments section at the bottom of each post. Below you'll find a FAQ section that we'll update regularly.

Please feel free to leave comments if you feel so moved-we read them all and truly appreciate them even if we can't respond to each individually!

Enjoy and check back often as our journey continues...

FAQ's

  • We will answer any questions that our blog readers come up with! Please leave your questions in the Comments section of the related post or email Kelli at kelliagnich"at"gmail"dot"com.

What does it sound like to hear through Cochlear Implants?

Click each of the links below to hear the example
Normal hearing...

With hearing aids... Landry hears even LESS than this, even with her hearing aids on (which is why she "babbles" rather than making strings of individual consonant-vowel combinations such as "ba," "ma," "ga,")

The first few days after activating the Cochlear Implants...

A few days later...

A few weeks later...

How does a Cochlear Implant work, anyway?

Sounds are picked up by a microphone and turned into an electrical signal.

This signal goes to the speech processor where it is "coded" (turned into a special pattern of electrical pulses).

These pulses are sent to the coil and are then transmitted across the intact skin (by radio waves) to the implant.

The implant sends a pattern of electrical pulses to the electrodes in the cochlea.

The auditory nerve picks up these tiny electrical pulses and sends them to the brain.

The brain recognizes these signals as sound.

Ref

How many degrees of hearing loss are there?

Hearing loss is generally divided into five categories. These include mild hearing loss (20-40dB); moderate hearing loss (41-55 dB); moderately severe hearing loss (56-70 dB); severe hearing loss (71-90 dB); Landry has profound hearing loss (91 dB or greater).

What is an audiogram?

An audiogram is a graph with red O’s and blue X’s connected with little lines. The O’s represent the right ear and the X’s indicate the left. Marks near the top of the graph are an indication of better hearing while marks further down the graph denote worse hearing. Located across the top or bottom of the audiogram are frequency numbers ranging from 125 Hz, a very low tone, to 8000 Hz, a very high tone.

Along the side the graph a series of decibel (dB) numbers indicate loudness. Very soft sounds are at the top (-10 or 0 dB) and loud sounds (110 db) are located at the bottom. Zero dB does not mean that there is no sound. This level is merely the softest sound a person with normal hearing ability can perceive 50% of the time. A normal conversation usually occurs at about 45 dB on the decibel scale.

An example of Landry's audiogram can be seen here.

What is sensorineural hearing loss?

A sensorineural hearing loss indicates that there is a problem in the inner ear or the auditory nerve which leads to the brain. This type of hearing loss is usually permanent as damage to the inner ear (cochlea) and nerve endings cannot be repaired. The degree of hearing loss in a child with a sensorineural hearing loss can vary from a mild loss to a profound hearing loss.
The cause of a sensorineural hearing loss that occurs before birth is often unknown. However, some of the potential causes may include infections in the mother such as rubella, toxoplasmosis, and cytomegalovirus, low birth weight in the child, or lack of oxygen to the infant during birthing. The hearing loss may also be hereditary. Some children become deafened in the later years of childhood. Possible causes may include physical trauma to the head or ear area, chronic ear infections left untreated, meningitis, or exposure to excessive noise and loud sounds.

If Landry will learn to listen and speak, why are you teaching her sign language?

Landry was born deaf and will always be deaf.

The cochlear implants will allow her to hear sound such that with a tremendous amount of Auditory Verbal therapy, she will learn to listen and speak normally; however, there will often be times when she will not be wearing the external part of her CI (when sleeping, in the bath, swimming, at the lake, etc.) and we will need to communicate with her. We also believe that Landry is extremely lucky to be a candidate for CIs and want her (and us) to honor the deaf culture of which she will always be a part; ASL is the deaf community's manual language.

We hope that friends and family will have fun learning ASL with us and will use the links to online resources on the left sidebar of our blog.

What does a cochlear implant look like?

Drew's dad posted a great video on YouTube showing his device. Click here to see it

Where can I buy my own name in black and white fingerspelling (like "Agnich" in our blog title)?

email Kelli (kelliagnich"at"gmail"dot"com) to have a custom name or phrase designed especially for you!

Monday, March 9, 2009

The Sound of Sound

I read this article in a magazine before Landry's implantation and it gave me a wonderful perspective of what was to come. It was recently posted on cicircle, a Yahoo group for parents of deaf children and wanted to pass it along to our blog readers.

I have been terrible about updating this blog, but will do so in the next few days. Landry is doing wonderfully with her listening and speaking skills and is a sight to behold! We often have to remind ourselves that she is deaf...

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What it's like to be a little girl with a cochlear implant. What it's like to be her mom.

For my 4-year-old daughter Juliet, hearing is optional. She was born profoundly deaf. Juliet has a cochlear implant, which brings her access to sound, so long as she wears her external processor — a behind-the-ear device that looks like a hearing aid with a small magnetic disk that attaches to the implant in her head. Throughout each preschool day, Juliet wears her processor, and with it she hears. And she talks. She hums. She sings. Juliet's language and music are wonders to behold. But when she arrives home from school exhausted, she often wants to take her processor off.

"I don't want my sound," she says, and she piles the mound of earmold, wire, and magnet into my open palm.

If a restaurant is too loud and Juliet is tired — yank — I have to rush to catch this several-thousand-dollar "ear" before she sets it down on a table smeared with ketchup or blue cheese dressing. Just as quickly, I race to settle Juliet into a comfortable position because, with the blessing of quiet and the shut of her eyes, she falls asleep in seconds. On weekend mornings, Juliet asks to wait before putting on her processor. She enjoys puttering around the house in silence, tuning us out, ignoring our demands. When she wants us, she just stands in place and yells (she has no idea how loudly) until we show ourselves in her visual field. Juliet signs, and we sign back, yet she often chooses not to reason with us when her sound is out. Sometimes she won't even look our way, disabling our speaking voices and our signing hands. To be sure, Juliet can be ornery with or without her sound. But without it, her face takes on so much expression that her glower can send us packing.

Juliet rips her processor off at the sight of the blender or the vacuum cleaner. She puts it back on when she spies a book I could read to her or a video she wants to watch. Like a baseball cap: off for the bath, on for the playdate, off to run through the sprinkler, then back on for the cupcakes. I wonder sometimes whether to encourage this. But why should she hear the babies crying at the pediatrician's office if she doesn't have to? Why not miss the jackhammer blast when the car is stuck in traffic? Juliet senses everything that's happening through vibrations anyway. Whether her sound is on or off, she knows when someone walks into the room, and she can read a face like a book. As she reminds me with a scowl when I repeat in sign what I've said aloud: "I know what you just said."

It's impossible for me to know what Juliet's experiences are like, with sound or without it. When I first heard a simulation of how a voice sounds through a cochlear implant, I was horrified. It sounded like Darth Vader speaking through Demi Moore as she imitated the Wicked Witch of the West. "We're going to drill into her tiny skull for this?" I asked the Boston Children's Hospital cochlear implant team. Can I never expect her to hear the timbre of my voice, or to distinguish between voices? And what will her voice sound like? I was placated, ultimately, by the sight (and sound!) of other implanted children at the playground of a nearby school for the deaf.

Juliet's cochlear implant surgery took place on her first birthday, and it lasted five hours. A few weeks after, her sound was "turned on" — the external processor was programmed and activated. It was set at a low volume, so as not to scare her, and it came with extra settings that grew gradually louder.

We were warned that most implanted babies cry when they hear sound for the first time. I wrapped my arms around Juliet as the audiologist attached the processor — glop — and the external magnet glommed onto Juliet's head like a magnet onto a refrigerator. Instructing us to be quiet, the audiologist handed Juliet a drum and a stick. Juliet whacked the drum, then jumped back like a startled animal at the sound of the boom. She searched our faces with wide questioning eyes. She beat the drum again. And then Juliet thrust back her head and laughed.

For the next hour, she used the drumstick to beat other things: the audiologist's pant leg made almost no sound, the metal file cabinet made a loud clanging boom, the tone of the wood chair was different than the thicker wood table. Juliet had become a scientist, studying and experimenting with sound.

According to the audiologist, all sounds would come in as beeps and blips at first. It would be months before the neural pathways between Juliet's auditory nerve and her brain would be forged and able to translate the input into meaningful sound. That is, it would be months before "moo" could be distinguished from "quack" and pinned on its rightful farm speaker. And months before Juliet would turn at my calling of her name. In the meantime, we would put in a lot of "moos" and "quacks." We would point out and comment on nearly every sound that could be heard in our home: the sizzling of an egg in the skillet, the full rush then drip drip of water from the faucet, the stray cock-a-doodle-doo of a neighbor's rooster, the metallic scritch of a zipper running up a coat. "I hear it," I'd say, pointing to my ear, as the phone rang, or the heat kicked in.

The flop of a pancake. The shake of the milk bottle. The sound of the birds as we walked outside. The click of the car seat buckle before we drove. The clank of carts and the thunk of grapefruits as we shopped. Every sound: listened for, acknowledged, remarked upon.

Each morning, I'd put on Juliet's implant processor. I'd also stick a hearing aid into her nonimplanted ear. I was used to hearing aids. Juliet's older sister, Sophia, has a lesser hearing impairment, and hearing aids enable Sophia to hear and speak. Juliet objected to her aid, but I persisted. Set at its highest volume, it might give her access to new sounds.

Then, to keep things cheery, I'd chase her around the house. One snowy day in February, when Juliet was 1 1/2, we were running round and round. "I'm going to get you, Juliet," I yelled, offering her the lead, then trailing in the sea of squeals and laughter that floated in from the room ahead. At one point the tea kettle whistled and I broke the chase for a quick hearing lesson. I stood still in the kitchen until Juliet knocked into me, and as she caught her breath I pointed out the high-pitched whistle, thick steam shooting up at the kitchen cabinets. "I hear it," I said, pointing to my ears. Then I switched off the stove and resumed the chase.

Time out had to be called several times because Juliet's processor magnet slipped off, dragged down by the weight of her controller, which flapped in a pocket I had hastily sewn onto her T-shirt. Juliet took the time-outs like a puppy halted mid-nip to scratch an itch. Her hair came loose from her topknot. Her eyes sparkled. At one point, as I gained on her, sock-skating into the dining room, I called out, "Juliet!" and she turned her head to look at me.

I stopped in my tracks like Road Runner.

"Juliet?" I ventured again. By now she was smiling a huge smile — she had heard and recognized her name.

"Juliet," I choked, and I scooped her into my arms, "I got you, Juliet. I got you. I've gotten you."

About Juliet and Sophia

Juliet, 4, and her sister Sophia, 7, have genetic hearing impairments — the result of recessive genes that Jennifer and her husband Bill both carry. Jennifer has looked into her family tree and found, since 1871, six ancestors who were deaf, including two great-great-aunts who, like Sophia and Juliet, were sisters. On a scale of mild, moderate, severe, and profound, Sophia's deafness is severe; she can hear with hearing aids. Juliet's deafness, though, is profound, which made her a candidate for a cochlear implant. When she was 3, Juliet got a second implant, in her other ear, which has enhanced her ability to locate sound.

About the Author: Jennifer Rosner is currently writing a memoir about the history of deafness in her family. She reports that Juliet and Sophia often hear more than hearing people, because they have learned how to listen. Of course, sometimes they opt not to listen, like when Jennifer calls out that it's time for bed.

Sunday, November 16, 2008

1 Month Update

Landry has been hearing for exactly one month today and we are astounded by her progress!

In true Landry fashion, she has taken her new "hearing" in complete stride. Though the last year has been quite an ordeal for us, it must seem perfectly normal to her to begin hearing at 10 months!

Some milestones to note during the first month:
*startles to sounds
*localizes and turns to noises with great accuracy including sounds coming from distances of 5 feet+
*mimicks sounds
*matches intonation with surprising reliability
*tunes us out when she doesn't want to listen anymore (is she 13 already???)
*LOVES music and dances with great enthusiasm! (We were told that many CI wearers do NOT like music, so this is a tremendous relief!)

Speech progression:
"Mmmmmmmm"-one week post-activation
"eh-eh-eh"-2 weeks post-activation
"mamamama"-3 weeks post-activation (just babbling, not as in, "Mama!")
"dadadada"-3 weeks post-activation (again, not as in, "Dada!")
"bbbbbbbb"-3 weeks post-activation (mimicked sound when I asked if she wanted a, "B-b-b-b-b-b-anana"
"Uh-uh!"-3 weeks post-activation ("Uh-oh!" when she drops something)
"M-m-moe!"-3.5 weeks post-activation ("More"...food/Daddy/Loofah/Mommy/music/books/etc. She usually signs "more," too as she's saying it for extra measure!)

Her favorite noise is still "AAAAAAAAAAAAAAAAAAAAAAAAAAAHHHHHHHHHHHHHHHHHHHHH!" with a huge grin! Landry is constantly making sounds that we've never before heard her make and is absolutely loving her new listening ability. She pats on her head whenever her CIs are off now and the only times she pulls off her CIs are when she gets bored in her carseat and when she wants us to know that she's ready to go to bed.

We scrapped the baby-worn configuration that Cochlear sent us and are now using wig tape to stick the pink processors behind her ear (with the wig tape on the flat part that sits against her head). This reduces the number of wires and simplifies the entire process which is a relief given that we put them on and take them off an average of 10 times per day.

We are in the process of putting together a video of her speech clips so we can keep a great record for her to enjoy when she's older and will post as soon as it's finished...

Wonderful Progress!

We have not been great about updating everyone on Landry's hearing/speech progress, but now have documentation to share!
The other day, I caught Landry playing with Loofah's dog food bowls and snuck up on her. Watch the video below and notice how quickly her head spins around when she hears me call her...she knew that she had been caught red-handed!

Most parents would probably drop the camera and stop their child from snacking on kibble, but I was savoring the moment. Before her CI activation, I could sneak up and shout her name 1 foot from her head and she wouldn't even realize that anyone else was in the room with her. Some remarkable points to notice in this clip:

1. Not only did Landry turn to my voice, but she figured out pretty quickly from which direction the sound was coming!
2. She has become very reliable in saying, "Mmmmmmmmmmmmmmmmmmmmmm" when she eats-this is something that her teachers have been working with her on at school in order to give her sound/word/action association.
3. She now understands that, "Uh-uh-uh!" means that she's in trouble. She turned to me and ditched the evidence...being 11 months old though, knowing that she was in trouble didn't stop her from doing it again!
4. She has only been hearing for 1 month!

Wednesday, October 29, 2008

Smooth Sailing So Far...

Landry's activation went wonderfully! (see her blog for more info) Over the last few weeks, we have been teaching her how to identify, localize and discriminate sounds as well as attach meaning to them. For example, when Landry hears a knock on the door, we show her that the sound she heard was someone knocking at the door, show her where the sound is coming from, teach her the difference between the sound of a knock at the sound of a door closing, and teach her to expect that someone will soon be coming through the door. It's a bit like having a 10 month old newborn since absolutely everything is brand new to her.

I read an article the other day which explained Landry's situation perfectly:
I’ll try to make a visual picture that relates to the way sound is heard by a child with a cochlear implant. Suppose that you have to identify a four-legged animal, and you’ve not seen that animal before but you have to figure out what it is. Maybe you have to draw it. Maybe you have to learn the name for it. Now that animal is standing in back of a bunch of trees. To see that animal, you have to look through tree trunks that are hiding big parts of that animal. Now, if you were looking through those trees with the equivalent of a hearing aid, you could probably only see the tail end of that animal because you could only hear the low frequencies with that hearing aid. With a cochlear implant, though, you can see pieces of that animal’s head, pieces of its neck, its legs, its body, pieces of its tail end, but you still are missing pieces in between each of those that you see. The reason I’m bringing this up for you to think about is because it’s important for us to realize that children who are using cochlear implants still don’t see the whole animal. They see more of a range of that animal but they have to use their brains. They have to use what they already know about the world. They have to use their cognitive abilities to fill in those gaps to be able to put together a picture of that whole animal. That’s the kind of task that a child is facing using a cochlear implant. -Dr. Patricia Spencer, Professor, Department of Social Work, Gallaudet University

Wednesday, October 15, 2008

Landry's Activation is Tomorrow!

Because her ears have healed so well, Landry's doctor feels comfortable giving her Audiologist the green light for activating her cochlear implants tomorrow (Thursday)!

For those of you who are totally confused by this process so far (and you're not alone, I promise-we still get questions from friends and family whom we thought understood it all!), here are a few quick FAQ's that we've gotten recently:

"Hooray! The surgery's over and was a success...so she can hear now, right?"

Wrong. The surgery implanted the internal device into her cochlea and secured the "receiver" to the inside of her skull. For the last week, she has heard absolutely nothing. Nada. Zip. Zero.

Here's what the internal part looks like:

1. Sound processor: External sound processor captures sound and converts it into digital signals.

2. Digital signals: Processor sends digital signals to internal implant.

3. Electrode array: Internal implant converts signals into electrical energy, sending it to an electrode array inside the cochlea.

4. Hearing nerve: Electrodes stimulate hearing nerve, bypassing damaged hair cells, and the brain perceives signals as sound.
"What will the external part look like?"

Landry will have two external processors for each ear, one to wear on each ear and one set as a backup. We have ordered one set in a skin tone and the other in hot pink!






"What is the "activation"? I thought everything was finished now..."
After the incision has healed, the external components (which look like a hearing aid) of the device can be programmed and activated. The activation includes:
Fitting the headset
After the incision has healed and swelling has subsided, an audiologist attaches a headset. The headset contains an external magnet that is aligned with a magnet implanted inside the head during surgery. Adequate magnetic attraction is necessary to hold the headset over the internal receiver/stimulator so that information can be transmitted across the skin via radio frequency.
Cochlear implant check
The device is checked through a computer system, by communicating information between the cochlear implant and the external speech processor. Every component, including each electrode, is checked to make sure it is working properly.
Programming the speech processor
The speech processor is programmed with a special computer system by an audiologist. Each electrode is fine-tuned for threshold (first hearing) and for comfortable listening levels. As each electrode is turned on, very small increases of electrical current are delivered to the hearing nerve until the patient hears a soft beep or tone. Once the softest hearing level is set, the patient listens for an increase in loudness until these beeps or tones become comfortable to hear. These steps are repeated until all electrodes are set for soft and comfortable levels. From these loudness judgments, a "hearing map" is created. The map is a specially designed set of instructions that tells each electrode how to stimulate the nerve endings in the cochlea.

Once a map is created and downloaded into the speech processor, the speech processor is turned on, and the patient hears through the cochlear implant for the first time. On this first day, speech usually sounds garbled or high-pitched. Environmental sounds may be difficult to identify. Over time, speech and environmental sounds become clearer and more natural. The audiologist will verify that the cochlear-implant recipient is able to tolerate a range of sounds, such as conversational speech, loud speech, hand clapping, coughing or doors shutting.
from: The Mayo Clinic

The reactions from babies range from:

to:

...and everything in between! Given Landry's curious personality and the timing of the activation (hooray for pre-nap scheduling!), we don't expect her to cry or be upset, but we're prepared for anything! Our prediction is that she'll respond something like this:

Check back tomorrow night to see if we were right!:)


"What brand of implant did you decide to go with?"
Cochlear brand Nucleus Freedom model


"But after tomorrow, Landry will be "done" with all of this, right? No more doctor visits?"
Several programming sessions are required to obtain and maintain optimal performance from the device. We will go back to her Audiologist on Monday for a recheck — and again after two weeks, one month, three months, six months, nine months and one year. After the first year, we will only have to schedule annual appointments.


"Once those visits are all over, she'll be able to listen and speak normally?"
Not exactly.
Rehabilitation involves training the brain to understand sounds heard through the cochlear implant. Since the cochlear implant restores awareness for all sounds, Landry might be overwhelmed initially. Her hearing loss was so profound that she never heard normally to start with, so it will take time for her brain to recognize what these sounds mean. We are told that the more she wears the auditory processors, the faster she'll learn to interpret new sounds.

Tuesday, October 7, 2008

What Exactly Did Landry's Surgery Involve?







This FLASH video was put together by The California Ear Institute and is an outstanding explanation of the implantation process! Be sure to click the arrows to advance to the next slide...

Monday, October 6, 2008

Surgery is complete!!!



Landry just made it out of surgery and, according to the doctors, everything went smoothly. Kelli and Michael will be staying at the hospital with Landry overnight, so all of you will have to wait a little while longer for more details... Thank you for all the thoughts and prayers!!!

Landry surgery update


Just a brief update - Kelli and Michael just took Landry in for surgery. Landry was in good spirits despite not having eaten since 2am. Now the waiting begins.....

Sunday, October 5, 2008

Prayers for Tomorrow

For those of you who like to pray / meditate with specifics, here they are! :)

Landry's surgery has been moved up and will now likely begin at 7:15 am (PST)
Her anesthesiologist will be Dr. Bryan Bohman.

Her surgeon will be Dr. Joseph Roberson

She will be staying overnight at LPCH

Please check this blog (or sign up for email updates using the button on to the left) for updates throughout the day-we'll keep you posted as soon as we have information!

To those that we know well and those we have yet to meet, we appreciate you.

So that Landry can know how much she was uplifted on the toughest day of her little life, would you (friends, family, blog-stalkers and friends we haven't yet met) please leave a quick note as a comment to this post? People have told us that they are nervous about posting because they can't think of the "perfect" thing to say; if you feel inspired to wax poetic, feel free, but know that even simply leaving your name will let Landry know that she was in your thoughts today. We would love to share them all with her in a book that we are in the process of creating for her to read once she is older...

Much love to you all,
Kelli & Michael

Tuesday, September 30, 2008

Prayer Request: Monday Morning...Landry's Surgery

Landry's bilateral CI date is rapidly approaching! We can't believe that it is on Monday and are both excited and nervous about the outcome. Fortunately, we have quite a few balls in the air right now which are doing a great job of keeping our minds occupied in the meantime.

Her actual surgery time is 8:30am (PST) and the procedure should take between 2 and 3 hours. We would greatly appreciate your prayers (and your friends', and THEIR friends'...) during these hours as we sit on pins and needles waiting for Landry to re-appear with her bionic ears.

They will keep her overnight just to monitor her and will allow one of us to stay overnight with her. It's hard to believe that it will be 10 months to the week that we were last in the hospital having her!! Even more symbolic is that 10 months will also mark the date when we were first alerted to the possibility that something was not right with her hearing...
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For those alert readers who realized that tomorrow was to be Landry's sedated ASSR test, please know that we have cancelled it. We have prayed that she would either show a significant improvement or a significant decline in her hearing so that we could avoid sedating her twice in one week; (un?)fortunately, our prayers were answered as Landry's speech has changed noticeably from babble to "sing-songy" tones which she seems to feel more than she hears. She has also, in the last week, started to mimic the motion of our mouth when we tell her, "Hi," but when she does it, she doesn't make any sound. It is both heartwarming to know that she is so eager to speak and heartwrenching since she has no idea that she's supposed to be making a sound when she says, "Hi!" We are hoping that it will be a different case after her activation on the 24th. Both of these observations as well as Landry's newly-developed consistency in the sound booth when being tested give us the confidence to move forward with the surgery knowing that we are doing the best thing possible for our little girl (hopefully she'll agree with us 15 years from now!).
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Thank you to everyone for your cards, phone calls, emails, comments on our blog and Landry's. Many of you have generously offered to bring meals over; we will gladly accept if you promise not to go to too much trouble! The easiest way to keep track of this is if you can simply leave a comment in response to this post "claiming" a day...that way, we can keep it straight! We are so blessed to have such considerate friends and will gladly return the favor in the future.

We will keep you abreast of any updates, but please check in often on Monday as we will be calling a friend with updates from the hospital and she will update this blog with new news.