Stefania Darya

Age 11 years

General data on the case:

  • Biographical and case identification data personal data, address, important events in the subject’s biography, significant data on family composition, parents’ hearing status, etc.

Stefania is the only child of a hearing family. There is no history of hearing problems in her family.

  • Case history (Anamnesis):
– Significant medical data –
  • Medical counseling could find a cause for the impairment: premature birth at 32 weeks through caesarian section; her APGAR score was 7; at birth, she needed CPR for about 10 minutes; she remained in the neonatal intensive care (incubator treatment) for 2 weeks; also, during that time Gentamicin antibiotics therapy was administrated.
    • When Stefania was 1 and a half years old her mother noticed some difficulties in her speech acquisition. She tried speech therapy but with no significant results.
    • Bilateral hearing loss was detected by our audiologist at the age of 3 (in 2012) when an ASSR was done, which recorded a bilateral auditory threshold between 65 and 70 dB and conventional hearing aids were recommended. At first, the hearing aids were helping, but after 5 years Stefania and her parents noticed that the efficacy of said aids was starting to fade. Further objective measurements (audiogram with hearing aids and BERA repeated from 2015 to 2018) indeed showed a progressive bilateral hearing loss on both sides. That is why in 2018 we decided to recommend cochlear implantation with the consent of Stefania’s parents.
  • At the age of 9, Stefania received her first cochlear implant on her left ear and 2 years later, at the age of 11, she received her second implant on her right side.
  • Significant psychological data – Stefania is a creative and artistic child, she uses drawing, music, and dancing to express herself. With the help of conventional hearing aids and later, with the CI Stefania managed to lead an ordinary life, make friends, and go to a regular school. Her parents treated her like any other child.
    • After implantation Stefania immediately started to have better results at school and at home, her speech production improving noticeably. Her speech and language developed naturally. Sign language was not needed anymore, although her parents used it to communicate for a short period of time when conventional hearing aids didn’t help her anymore.

She is a quiet young girl, with good social skills and very good attention span and auditory memory skills.

  • Educational setting: The SLP suggested continuing the logopedic therapy because her speech is not yet at the same level as that of hearing abled children. That is why Stefania has had two sessions a week for the last five years.

Significant social data: The mother works as a nurse at a hospital and the father is a manager at a firm.

– Age of fitting the first hearing aids and cochlear implants:
  • When she was 9 years old, Stefania received her first CI, which was fitted after 2 months. She used the CI on her left ear and her conventional hearing aids on the right ear, for another 2 years, until she got her second CI. Stefania was able to adapt to her devices quite well; all the fittings went smoothly, without problems.
– How often and what kind of support/rehabilitation does the child/family receive?

Stefania started speech therapy at a very young age, even before her cochlear implants. The first results were not satisfying, because in our country there aren’t a lot of speech therapists qualified to work with cochlear implanted kids. After many years of searching and changing therapists, her parents finally found the right one for Stefania and they have been working together for 5 years now.

The implantation

  • age of undergoing first cochlear implantation (left or right side): 9 years/ left ear
    • type of implant: Med-El SYNCHRONY
    • number of implants (CI and hearing aids): CI1 at 9 years; CI2 at 11 years
    • current average duration of the CI use (information from the audiologists): 12 hours/day
– other relevant information: difficult periods during early-stage development. If yes, why?

She had no problem using the devices, she was actually excited to use them.

What is the procedure for starting speech therapy after CI?

We discussed with the parents about the importance of rehabilitation after implantation. The lack of speech therapists that have the necessary qualification to work with cochlear implanted children in our country was

a problem for the family, but we found one that could help Stefania and her parents agreed. They work together now, quite successfully.

Children go to this kind of speech therapy after audiological tests, which include the audiogram and a short report signed by an ENT doctor.

The Speech Therapy used in rehabilitation

  • describe the kind of therapy done (communication options, approach, environments, average timing). The speech therapist was integrated into our teamwork. That’s why Stefania can receive multidisciplinary therapy: speech therapy + physical therapy if needed + audiological support.
    • Stefania saw a speech therapist twice a week and each time she received individual speech and language therapy. Also, our audiologists of the fitting team work closely together.
    • listening development: it was clear that Stefania started reacting better to speech sounds a few weeks after her first fitting.
    • speech production development: Stefania was a fast learner. Speech and spoken language developed very quickly and naturally. She is able to pick up information from the environment, even from a distance and in difficult listening situations. She’s come really close to binaural hearing. Also,  her voice sounds almost natural.
    • spoken language development: The parents were coached on how to support the child’s spoken language development at home. They don’t use signs anymore.
    • monitoring the progress in auditory, speech, and spoken language development. How? Audition, speech, spoken language development, cognitive development, and social-emotional development are very well monitored by our fitting team’s audiologist and speech therapist. Every 6 months there is a multidisciplinary meeting with the parents on the development of their child.

Audition is monitored by: tonal audiogram, Auditory Speech Sound Evaluation (ASSE)-test, and LittlEARS parent questionnaire.

Results

SWOT analysis by Stefania’s parents

  Strengths:

The fact that Stefania’s parents noticed her atypical language development and decided to investigate the matter was an important step that lead to the early diagnosis of her disability. Because of her progressive hearing loss, Stefania managed to lead a normal life with the help of conventional hearing aids and speech therapy until she actually needed the CIs. Her hearing was monitored her entire life by our audiologist, so we were able to recommend the cochlear implantation at the right age for her.

The diagnosis of bilateral sensorineural hearing loss was difficult for the parents to accept, but they were able to face it and search for the right solution for Stefania. After discussing with our audiologist and interventionist, they felt that they had all the information they needed.

Weaknesses:

Having the first cochlear implant surgery at 9 years old, a late age for rehabilitation could be considered a weakness, but Stefania’s case was special. Her sensorineural hearing loss was progressive, she was diagnosed at a young age, used hearing aids and went to speech therapy therefore auditory depravation effects were minimal.

Opportunities:

Stefania’s diagnosis brought her family close together and her parents benefited from the full support of our team. Two sessions a week of speech therapy wasn’t enough, she needed to practice at home for better results. Each member of her family spent several hours a day doing all kinds of activities with the girl – reading, drawing, playing, listening to stories. Spending quality time with the family helped her in coping with challenges, instilled a feeling of security and filled Stefania with confidence. Her mother feels that family time is an important factor that creates strong bonds, love, and connections between the members.

Threats:

Stefania’s family seems content with the help and support they received during the child’s audiological rehabilitation, with little to no negative experiences. “I feel lucky to have met such an amazing team of professionals with a lot of experience working with hearing-impaired children. Thanks to them our child was able to go to a regular school, she was able to make friends and mingle with normal hearing kids without problems. She is now in 6th grade and her achievements match those of her colleagues.”