Clifford Hume and Henry Ou are clinicians. Ou is a pediatric otolaryngologist at Seattle Children’s Hospital. Both split their time between clinical work and research. As Ou said, “I help families understand hearing loss, try to diagnose the cause of the hearing loss in their child. And I try to figure out the etiology of hearing loss in general—in both kids who develop it and kids who are born with it.”
The team’s approach is multidisciplinary, involving not only research scientists and clinicians but also psychologists, genetic counselors, audiologists, and special education specialists. In adult hearing loss, they are also looking at the role of prescription medications in age-related hearing loss. Many are life-saving medications, but sometimes less toxic substitutes may be available.
The UW group moved on to a lively discussion about how they would advise the parents of a young child getting implants. Should the child get implants in both ears? Cochlear implants cause the destruction of the so-called support cells that might give rise to new hair cells. Hence, should the parents “save” one ear in the hope that cell regeneration technology will eventually enable the child to hear normally out of that ear? Henry Ou said that parents often ask him about a second implant. “Sometimes they ask, ‘Do you think there’s hope that this is going to be fixed?’ I say, ‘Yeah.’ But at the same time, if I don’t think there’s hope, I shouldn’t be doing research on it. I’m a conflicted person to ask.”
Simon added: “Parents don’t want to find out when their kid is eighteen that there is something better.” He cited the substantial evidence that children do better in school when they’re implanted earlier, and bilaterally. Rubel agreed with the basic premise that early intervention is enormously important and that cochlear implants in children have become an essential therapeutic option, but expressed skepticism about the value of always doing bilateral cochlear implant surgery. Referring to one study in particular, he said, “The little known fact about this work is that it includes only the top 20 percent of single implant users.” Another study found different results. “So I think it’s still up in the air,” Rubel said.
We just don’t have enough information yet to know the impact that implants make at that critical learning period for language and speech comprehension. But, as Jenny Stone said, the same question could be asked about regenerated hair cells. “The big elephant in the room, I think,” she said, “is that we don’t know whether regenerated hair cells will result in better hearing—appreciation of music, noise, speech—than a cochlear implant can. And I think it’s a huge jump to assume that in twenty years we’ll be there.”
“Well but in fifty years?” Rubel interjected.
“Maybe in fifty years,” Stone replied.
“I keep going back to the bird,” Rubel said, “and we absolutely know that the bird gets great hearing back. They can recognize their own songs, they can learn new songs, not only speech but song recognition!”
“He loves birds,” Jenny Stone said. “I’m not trying to be pessimistic. But it’s going to take a lot of time to really get concrete evidence for what the best type of repair is going to look like.”
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