Intro: Welcome to Pediatric Insights: Advances and Innovations with Children's Health, where we explore the latest in pediatric care and research. Today's episode is a special edition featuring our In The Know series, a new addition to our podcast lineup that brings you insightful conversations with our chief medical executive, Dr. Dai Chung, and expert physicians from across Children's Health. We'll be sharing these special episodes regularly to keep you informed on emerging trends and advancements in pediatric care straight from the leaders who are shaping it.

In this episode, Dr. Chung is joined by Dr. Kenneth Lee, Director of the Cochlear Implant Program at Children's Health and professor at UT Southwestern. Together, they'll discuss the multidisciplinary Cochlear Implant Program and how it's improving outcomes for children who are deaf or hard of hearing.

Dr. Dai Chung (Host): I'm Dae Chang. Welcome to the In the Know video series.

This afternoon, we have a guest, Dr. Ken Lee, who's a Professor of Otolaryngology at UT Southwestern Medical Center and Children's Health, and also the Director of Pediatric Cochlear Implant Program. Welcome.

Dr. Kenneth Lee: Thanks, Dai. Pleasure to be here.

Host: Oh, so glad you're here. I was looking very much forward to having a chat with you. There's lots and lots of areas that you oversee, but we're going to delve right into cochlear implants.

Dr. Kenneth Lee: You know, I feel really privileged to be a part of the Pediatric Cochlear Implant Program here. A lot of people don't know, but hearing loss is actually the most common chronic disorder in the world. There's more people affected with hearing loss than heart disease, cancer, and blindness combined.

Host: Combined?

Dr. Kenneth Lee: Combined. So, that's a pretty astronomical, you know, thing to kind of wrap your head around. Specifically for pediatric population, six out of every thousand children born have some degree of hearing loss, and up to two of these have profound hearing loss, which means that they're deaf and they have no other option than a cochlear implant to get any meaningful sound.

Host: I wonder if you can give us a little basic educations on how even the hearing functionality even gets, like, processed by the brain.

Dr. Kenneth Lee: The ear basically has three parts. There's the external ear, there's the middle ear, and then there's the inner ear. The external ear captures a sound, brings it through the middle ear, which has three bones.

The three bones connect the ear drum to the inner ear, and those bones function like levers, so they amplify the sound themselves so they can make, you know, quiet sounds kind of normalized to a louder sound once it gets into the cochlea. The cochlea has cells that can change the mechanical energy of sound to an electrical signal that is then carried by the nerve going from the ear to the brain. And so, that's how we normally hear.

A hearing aid, basically what that does is it amplifies that sound or makes it louder for someone who has hearing loss. But you get to a certain point with hearing loss that it's so severe that you can make it as loud as you can, and then when you get what's called distortion. Just like if you're listening to your stereo too loud, it gets loud. But then, the sound quality starts to diminish. And that's where a cochlear implant comes into play. Someone who's got such severe hearing loss that you can bypass the entire normal mechanism of hearing and electrically stimulate that nerve.

Host: So in our patient population, what are some causes that result in, you know, kids losing their hearing or never having even to start with?

Dr. Kenneth Lee: The most common causes of hearing loss in children are abnormalities or malformations of parts of the inner ear, including the cochlea. There's also genetic mutations that can be syndromic or non-syndromic. Most are non-syndromic, so just have isolated hearing loss, but there are certain syndromes that also have associated hearing loss. And then, there are other reasons such as CMV or infectious cause that has really become on the forefront of research in identifying causes of hearing loss in children.

Host: So, implants are actually planted. And I wonder if you can describe this as sort of a surgical maneuvering.

Dr. Kenneth Lee: We do make an incision behind the ear. It's kind of about three centimeters in length typically. And then, we go through the soft tissue. We then access a bone called the mastoid, and that gives us access to the middle ear space. And then, we secure what's called the receiver stimulator. That's kind of the brains of the implant itself. And then, that's connected to an electrode array that goes into the cochlea itself

Host: After a patient receives cochlear implant, is it just like any other kids without having had hearing loss?

Dr. Kenneth Lee: Some people have described it as somewhat as mechanical, like a machine sound. In terms of speech perception, it works really well, but the quality of the sound is somewhat lacking. And so, that's one of the big areas of research. How do we get sound quality to improve?

The cochlear implants have gotten better over time. There have been different aspects of the hardware itself, but a lot of the advances come through the software, the speech coding strategies, different ways that the electrical impulses are delivered to the auditory nerve. From my perspective as a surgeon, we also have learned techniques that make the surgery less traumatic, and that's really important because more trauma during surgery creates fibrosis and scarring, and that scarring kind of impedes the electrical signal. So, we focus on doing soft surgery, as it's called, atraumatic surgery. There's also companies that are developing robots for robotic insertion for slow constant velocity insertion.

Host: That was great. Tell us about the entirety of the team.

Dr. Kenneth Lee: We have a very cohesive cochlear implant team, and most of the large centers across the country have a multidisciplinary approach. So, this always includes a surgeon. Other key players of the team are include the audiologists who do the initial and subsequent hearing evaluation. And then, a speech pathologist needs to assess how well they will potentially do with an implant in terms of gaining speech. Afterwards, the speech pathologist works with the patient so that they can kind of learn and develop speech.

In addition to that, we also have a team called the FFC or the Family Focus Center for Hearing. So, this team kind of coordinates all of the medical aspects of hearing loss kind of beyond the surgery. An extremely important member of our team is Margot Schird, our cochlear implant coordinator. The unique fact about Margot is that she is bilaterally deaf and has a cochlear implant. When talking with families, she shows them that she is using an implant. That speaks volumes as most people have no idea she is deaf. Parents are delighted to see her communicate as if she has normal hearing.

Host: That's got to be incredibly special, you know? What's more down the sort of near future as well as what's anticipated in your hospital in five years? What does that mean to the cochlear implant program?

Dr. Kenneth Lee: I've been here for almost 19 years.

Host: Wow.

Dr. Kenneth Lee: And I've really seen an acceleration in terms of this collaborative kind of joint effort. And so, in addition to just the new campus, the expansion into satellite facilities like in the northern market, we're taking that clinical expertise out to the community, bringing those services to people close to their home.

The surgeons and physicians are all from UT Southwestern. They're employed by the university. Our audiologists and speech pathologists are at Callier Center, which is part of UT Dallas. And then, Children's houses the facility where we all take care of the patients, and they also provide the psychologists and social workers. It's a very unique and collaborative relationship that works well.

Host: Well, I really enjoyed having this conversation, Ken. And thank you and your team for all that you do. It's an incredible work, so we appreciate you.

Dr. Kenneth Lee: Thank you, Dan. It was a pleasure.

Outro: Thanks for listening to Pediatric Insights: Advances and Innovations with Children's Health, where we explore the latest in pediatric care and research. We'll be back soon with another special edition featuring our In The Know Series with Chief Medical Executive Dr. Dai Chung, where he interviews expert physicians from across Children's Health.

You can find out more at childrens.com. And if you found this podcast helpful, please rate and review or share this episode and please follow Children's Health on your social channels.