Title of the case study: MLJ

1. General data on the case:

Biographical and case identification data

ML is the first daughter of a young couple, both with a degree in Physiotherapy. The household comprises the parents and the maternal grandmother. They live in a house with ample space, in a region in the north of the country (Guimarães), surrounded by nature. There is no history of hearing loss in the immediate family.

Case history (Anamnesis):

  • Significant medical data

ML was conceived through artificial insemination, after several attempts at getting pregnant. Her mother says it was a troubled pregnancy, and lived with great anxiety, amplified by the death of her grandparents shortly before birth. She was properly followed in all stages of her pregnancy and was born at 38 weeks of gestation.

After birth (14-06-2018) and before leaving the maternity ward, she underwent the Universal Neonatal Hearing Screening, with the REFER result. After a month, she returned to repeat the OAE and again the result indicated REFER. She was referred for evaluation by automatic ABR’s and at 3 months confirmation of the diagnosis of bilateral profound hearing loss. She was soon referred to a specialist consultation in ENT, Developmental Pediatrics, Ophthalmology and Genetics.

At 5 months she was already referred to our team at the Center for Deafness, Vertigo and Tinnitus at Hospital Lusíadas Porto.

In the first year of life, there was no change in his motor development. Currently she is 33 months old chronological and her health, in general, does not show any type of change.

At the time, there’s no etiology known but eventually is genetically inherited.

  • Significant psychological data

All ML development milestones are at the same level of children with their chronological age, with the exception of comprehensive and expressive language and speech production. There is no additional needs identified to date. She uses hearing to receive information from the environment and spoken language as its main means of communication. She doesn’t know or use any other means of communication, namely sign language. The parents’ option, from the first moment, was to choose a path based on their own means of expression, spoken language, which is the language used by the most significant adults.

  • Educational setting:

She is attending in a private kindergarten, with hearing peers and the same chronological age, since September 2020.

  • Significant social data

The family is middle class, monolingual, with both parents licensed and employed. They have family support in the home context, staying in the care of the maternal grandmother with whom they live, who is currently retired.

  • Age of fitting the first hearing aids and cochlear implants

She started using hearing aids at 6 months of age, with no functional gains until the moment parents decided to proceed with bilateral cochlear implantation, which took place in July 2019. She was activated on August 23th, 2019 and currently has 19 months of hearing age. She uses her cochlear implants every hour she is awake, an average of 9 hours of systematic use.

  • How often and what kind of support/rehabilitation does the child/family receive?

The family started supporting the Auditory-Verbal approach, from the moment they were referred to us at 5 months of age. Up to 12 months he received 2 weekly sessions and currently has one session per week.

3. The implantation

  • age of undergoing first cochlear implantation (left or right side): 14 months of age (simultaneous)
  • type of implant: Cochlear Kanso 1
  • number of implants (CI and hearing aids): bilateral
  • current average duration of the CI use (information from the audiologists): 9 hours for both sides
  • other relevant information: difficult periods during early-stage development. No problem using both CI’s since she was activated.

4. What is the procedure to start the speech therapy after CI?

Parents/caregivers are present and active participants in Speech Therapy sessions after CI’s implantation and activation.

5. The Speech Therapy used in the rehabilitation

After being duly informed about the various communicative modalities and expected results according to the literature, the family continued to intervene in our Center because it is the only one in Portugal with a certified therapist in Auditory-Verbal Therapy in the country. The preferred means of communication is the language spoken through hearing.

  • frequency and duration of therapy: up to 12 months, ML had 2 sessions per week and following that period 1 session per week; the duration of each session is around 1 hour-1 hour and 30 minutes maximum, in one-to-one therapy and in presence mode; after march 2020, sessions began with telepractice until now (1 hour per session), and every 6 months we have one session in presence for evaluation.
  • listening development: currently, she can locate sounds in all relative positions in space; clearly identifies all 6 Ling sounds; features a 3-item auditory memory.
  • speech production development: currently, ML is capable of producing words with 3 syllables and, occasionally, with 4 syllables; in terms of phoneme production, it manages to produce all voiced and voiced stops, nasal consonants and fricatives /s/ and /sh/.
  • spoken language development: she is currently able to produce phrases with 2-3 words as a standard (ex. Mum, come here; look at the paper; the cake is mine) and occasionally simple phrases (e.g., Mummy’s car is big!)
  • spoken language supported by signs or other visual cues: She does not use any support in gestures, she only uses spoken language as a means of communication.
  • monitoring of the progress in auditory, speech and spoken language development: Currently, ML is followed in audiology every 6 months, and the last schedule review was carried out in January 2021, with mean thresholds of 35dB in both ears. It makes periodic assessments of your language development every 6 months, in person.

6. Results

Parents are truly involved in therapy sessions and improving their strategies and techniques during the journey so far
The collaboration among the actors involved.
ML had access to the most up-to-date hearing technology (first hearing aids and second cochlear implants)
Parents were able to choose the brand and model of CI’s
Parents are systematic participants in all therapy sessions
Poor services