Latest / Becker’s Healthcare -- Pediatric Leadership Podcast / Dr. Abby Meyer, Medical Director of ENT and Facial Plastic Surgery, and Chelsea Kimlinger, Audiologist at Children's Minnesota

Transcript

Dr. Abby Meyer, Medical Director of ENT and Facial Plastic Surgery, and Chelsea Kimlinger, Audiologist at Children's Minnesota · Becker’s Healthcare -- Pediatric Leadership Podcast

• 0:00
  This is Chris Sosa with the Becker's Healthcare
• 0:02
  podcast.
• 0:03
  I am thrilled to be joined by doctor
• 0:04
  Abby Meyer, medical director of ENT and facial
• 0:07
  plastic surgery at Children's Minnesota, and Chelsea Kimlinger,
• 0:10
  an audiologist at the health system. They're with
• 0:12
  us to discuss Children's Minnesota's pediatric cochlear implant
• 0:16
  program. Doctor Meyer and Chelsea, thank you for
• 0:18
  joining us today.
• 0:20
  Thank you for having us.
• 0:21
  Thank you.
• 0:22
  Wonderful. For those of us,
• 0:25
  for those of us in the audience rather
• 0:26
  who do not are not familiar with your
• 0:29
  work, could you please introduce yourselves and tell
• 0:31
  us a bit about your backgrounds?
• 0:33
  Happy to. So my name is Abby Meyer.
• 0:35
  I'm a pediatric otolaryngologist.
• 0:37
  I did my training at the University of
• 0:39
  Minnesota and at Seattle Children's Hospital, and I've
• 0:42
  been in practice for a little over 13
• 0:44
  years now.
• 0:46
  I am the medical director at Children's Minnesota
• 0:48
  for ENT for and I've done that for
• 0:50
  2 years. And then prior to that, I
• 0:52
  was the director of audiology services at Children's.
• 0:55
  And one of the main focuses of my
• 0:57
  practice is caring for children who are deaf
• 1:00
  or hard of hearing.
• 1:02
  I am Chelsea Kimlinger, pediatric audiologist at Children's
• 1:05
  Minnesota.
• 1:07
  I work with children of all ages
• 1:10
  and their families to help,
• 1:12
  reach individualized
• 1:13
  hearing and speech and language outcomes.
• 1:17
  I am one of 2 audiologists that helped
• 1:18
  to start the cochlear implant program here a
• 1:21
  little over 10 years ago.
• 1:23
  So I have a passion for working with
• 1:25
  children and their families
• 1:27
  entering the cochlear implant process.
• 1:30
  Fantastic. Thank you both so much for filling
• 1:32
  us in, and thank you for all the
• 1:34
  wonderful work that you do in this area.
• 1:36
  As you mentioned, Chelsea, Children of Minnesota is
• 1:39
  working on 10 years of this pediatric cochlear
• 1:42
  implant program. My question is, what do you
• 1:44
  see as the biggest changes in cochlear implants
• 1:46
  over the last 10 years?
• 1:48
  Yeah. I would say that one of the
• 1:50
  biggest changes we have seen in this first
• 1:52
  decade of our program
• 1:54
  is the expansion of who is a candidate
• 1:56
  for a cochlear implant, particularly
• 1:59
  for 2 populations of children,
• 2:02
  that first group being single sided deafness.
• 2:05
  So in this population a patient has typical
• 2:07
  hearing in one ear and no functional hearing
• 2:10
  in the other ear. And until recently we
• 2:13
  didn't really understand how the brain could combine
• 2:16
  the acoustic hearing in the typical ear and
• 2:19
  the electric hearing from the cochlear implant in
• 2:22
  the other ear,
• 2:23
  together in a meaningful, useful way.
• 2:26
  And we know that one of the many
• 2:28
  factors that contribute to successful outcomes with a
• 2:31
  cochlear implant is dedicated practice with the cochlear
• 2:34
  implant.
• 2:35
  But when you're listening with a cochlear implant
• 2:37
  in one ear and you have typical hearing
• 2:39
  in the other ear, your brain is gonna
• 2:41
  crutch onto that typically hearing ear because it
• 2:45
  obviously does so well.
• 2:46
  But in order to achieve maximum benefit from
• 2:49
  your cochlear implant, you really have to exercise
• 2:52
  the device by itself.
• 2:54
  In
• 2:54
  most recent years, we've seen technology advancements
• 2:57
  where cochlear implant processors are now incorporating Bluetooth
• 3:01
  technology
• 3:02
  into their processors,
• 3:04
  and this has really opened the door for
• 3:06
  successful hearing rehabilitation in this population.
• 3:10
  Streaming through Bluetooth allows our single sided deafness
• 3:13
  patients to strengthen the auditory pathways with their
• 3:16
  cochlear implant without crutching onto the other side.
• 3:19
  And this has led to greater acceptance and
• 3:22
  success with their cochlear implant
• 3:25
  and offers the ability for these patients to
• 3:27
  take advantage of binaural hearing.
• 3:29
  And some of those examples of binaural hearing
• 3:32
  include improved listening and noise, better localization,
• 3:35
  better sound quality, and reduced listening fatigue.
• 3:39
  The other population we are serving more of
• 3:42
  now is younger infants.
• 3:44
  In 2020, the FDA actually lowered the approved
• 3:48
  age for cochlear implantation in infants with bilateral
• 3:51
  profound hearing loss from 12 months to 9
• 3:53
  months of age.
• 3:55
  However, the literature actually overwhelmingly
• 3:58
  supports implantation
• 3:59
  in these children even earlier, as young as
• 4:02
  6 months old.
• 4:04
  And implanting at 6 months old is really
• 4:06
  becoming the gold standard here in the United
• 4:08
  States at pediatric,
• 4:10
  cochlear implant centers, and it has actually already
• 4:13
  been the gold standard in Europe and many
• 4:16
  places,
• 4:16
  in Australia as well.
• 4:19
  And this is wonderful because we know that
• 4:21
  early implantation leads to a more typical trajectory
• 4:24
  of spoken language development. So the earlier that
• 4:27
  we can get these patients started with this
• 4:29
  process, the better.
• 4:31
  Thank you, Chelsea. It sounds like there have
• 4:33
  been some huge strides made, and I do
• 4:35
  wanna touch about on the future of these
• 4:38
  implants a little bit later.
• 4:40
  But before we get to that, doctor Meyer,
• 4:42
  could you do us a favor and please
• 4:44
  describe the connection between the surgeon and audiologist
• 4:46
  when it comes to these cochlear implants?
• 4:50
  Absolutely. Well, I mean, I I hope the
• 4:51
  feeling is mutual, but I just, I can't
• 4:54
  stress enough just
• 4:56
  how valuable a strong relationship between a surgeon
• 4:59
  and an audiologist is.
• 5:01
  We have to be on the same page,
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  and, you know, we need to make sure
• 5:06
  that what we're thinking also,
• 5:09
  aligns with what the family wants for their
• 5:11
  child, their goals for their child. So that
• 5:13
  communication,
• 5:15
  that open communication, frequent communication
• 5:18
  is just so critical to the success of,
• 5:21
  of any cochlear implant program, but especially for
• 5:24
  children.
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  So we, we're very fortunate. I think we
• 5:28
  have just really strong relationships between our surgeons
• 5:31
  and our audiologists.
• 5:32
  I've been working with Chelsea and,
• 5:34
  Lisa, who was another one of the original
• 5:36
  audiologists who started the program
• 5:39
  for the entire 10 years,
• 5:40
  and
• 5:41
  it's just been a joy to to work
• 5:43
  with both of them and all of the
• 5:44
  other people that have been added to our
• 5:46
  team since that time. I think what was
• 5:48
  really great is I constantly learn from our
• 5:51
  audiologists, and I think that I'm hoping, anyway,
• 5:53
  that they learn some things from us as
• 5:55
  surgeons too. And, you know, we both bring
• 5:58
  different perspectives, different experiences, different expertise,
• 6:02
  to this kind of partnership, but I think
• 6:05
  that they're complementary and we really continue to
• 6:08
  grow and I think also push each other,
• 6:11
  to stay up to date on what's, you
• 6:13
  know, the newest in the literature and and
• 6:15
  push each other to say, well, how can
• 6:16
  we make our program better? How can we
• 6:18
  take better care of our patients? So
• 6:21
  having that just open dialogue,
• 6:23
  open relationship, and also open to feedback is
• 6:25
  just so critical, and I feel very lucky
• 6:28
  that our program has all of that.
• 6:31
  Thank you, doctor Meyer. I'm glad you mentioned,
• 6:33
  commune the communication
• 6:34
  aspects
• 6:35
  of making this program work. And, Chelsea, you've
• 6:37
  already touched a little bit on on some
• 6:39
  of the different types of patients that you're
• 6:41
  dealing with at Children's Minnesota.
• 6:44
  Building onto that, what strategies have been most
• 6:47
  effective in meeting each child and and families'
• 6:49
  individual hearing goals?
• 6:51
  Yeah. I find that one of the most
• 6:54
  important things that we can do as provide
• 6:57
  providers in the cochlear implant,
• 6:59
  specialty
• 7:00
  is counseling on realistic expectations.
• 7:03
  We know that each child has their own
• 7:05
  unique circumstances
• 7:07
  and that that is going to contribute not
• 7:09
  only to their candidacy for a cochlear implant,
• 7:12
  but also what their outcomes with the cochlear
• 7:14
  implant may be. So it's really important for
• 7:16
  us to have honest and open conversations with
• 7:19
  families
• 7:20
  about the outcomes we may expect for their
• 7:23
  child so that they can make an informed
• 7:25
  decision on if a cochlear implant is the
• 7:27
  right thing for this child and their family.
• 7:30
  So, again, making sure that we are being
• 7:32
  honest and open with families,
• 7:34
  from the very beginning
• 7:36
  about what their child could potentially get from
• 7:38
  a cochlear implant so that they can make
• 7:40
  the best decision.
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  One of the reasons I really love working
• 7:44
  with cochlear implants in Audiology is that there
• 7:47
  are a lot of appointments,
• 7:49
  and you get to know patients and their
• 7:51
  families pretty well.
• 7:53
  And when we have a better idea of
• 7:56
  what a patient's day to day life is
• 7:58
  like, we are able to better help them.
• 8:00
  For example,
• 8:02
  who is spending time with the child during
• 8:04
  the day? If both parents are working outside
• 8:06
  of the home, you know, who is watching
• 8:08
  that child? Because they are spending a lot
• 8:10
  of time with that child and we are
• 8:12
  going to need their support,
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  in helping achieve the goals that we are
• 8:17
  hoping to achieve with this child.
• 8:19
  So I like to encourage families to invite
• 8:22
  these family members
• 8:24
  to some of our appointments so that they
• 8:25
  can learn more about cochlear implants and ask
• 8:29
  questions
• 8:29
  so that they feel more empowered to help
• 8:32
  support these children in their when they're in
• 8:34
  their care.
• 8:35
  Another example of this is, you know, getting
• 8:38
  to know does the patient spend time between
• 8:41
  2 different households?
• 8:42
  This is actually really helpful for me to
• 8:44
  know because when I'm ordering equipment for the
• 8:47
  child, in these cases, I like to make
• 8:49
  sure I have, you know, 2 full sets
• 8:51
  of batteries, 2 full sets of chargers
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  so that these can be split between the
• 8:55
  households and parents don't have to constantly be
• 8:58
  worrying about packing everything every time the child
• 9:00
  transitions from one home to the other.
• 9:03
  So yeah. Really getting to know the kids
• 9:06
  and the family dynamics so that we can
• 9:08
  best support them because, you know, no 2
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  child no 2 children are exactly the same,
• 9:12
  and we really need to get to know
• 9:14
  them better to help support their best outcome.
• 9:18
  This is a question for either doctor Meyer
• 9:20
  or Chelsea, but what sort of feedback have
• 9:22
  you gotten,
• 9:23
  from parents and
• 9:25
  really the children who have been receiving these
• 9:27
  implants and how it's enhanced their lives?
• 9:30
  I I mean, I think it's incredible as
• 9:32
  you see, you know, now that we've have
• 9:34
  you know, some of the kids that we
• 9:36
  implanted in the early years of our program
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  are now
• 9:39
  know, in late elementary and even, you know,
• 9:41
  thinking about middle school. And to see them
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  grow into these just, you know, really lovely
• 9:47
  people and see how far they've come. You
• 9:49
  know, when you meet a family
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  and they receive the news that their child
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  has
• 9:54
  you know, that is deaf or hard of
• 9:56
  hearing, and especially if it's a very significant
• 9:59
  hearing difference that puts them,
• 10:01
  you know, on the path towards cochlear implantation,
• 10:04
  it can it it often comes out of
• 10:06
  nowhere for these families. So you see,
• 10:09
  where they start, you know, where they start
• 10:11
  this journey. And then when you see them
• 10:14
  on the other side of the journey where
• 10:16
  their their kids are, you know, out on
• 10:17
  the soccer field, they're having sleepovers with their
• 10:20
  friends, they're, you know, they're just living their
• 10:23
  best life. It
• 10:24
  I mean, it is pretty it is a
• 10:26
  very special and remarkable thing. And I think
• 10:29
  I mean, families,
• 10:31
  for the most part, are, I I think,
• 10:33
  just incredibly grateful and and but it's kind
• 10:36
  of their normal life. You know? It just
• 10:38
  becomes, like, well, this is what we do.
• 10:40
  And
• 10:40
  and that's another special part to see how
• 10:42
  they come so far
• 10:44
  and and, you know, saying how am I
• 10:45
  going to do this? How are we gonna
• 10:47
  do this as a family?
• 10:48
  To then being, like, well, this is just
• 10:50
  what we do is is is pretty remarkable.
• 10:54
  That's certainly very heartwarming, and hopefully, more children
• 10:57
  will have
• 10:58
  access to this technology as time goes on.
• 11:00
  Another question for you, doctor Meyer, and that
• 11:02
  simply is what are you excited about or
• 11:04
  focused on when it comes to the future
• 11:06
  of pediatric cochlear implants?
• 11:09
  Yeah. I mean, it's an an incredible time
• 11:10
  to be in our field. There's just so
• 11:12
  much that's changing all the time. Some of
• 11:14
  the things that Chelsea,
• 11:16
  you know, pointed out as far as where
• 11:18
  we've come in the past 10 years. I
• 11:20
  think a couple of the things, you know,
• 11:21
  and most of what we're working on is
• 11:24
  really maximizing the benefits, knowing
• 11:27
  who could best benefit from this amazing technology
• 11:30
  and when. When is the best time to
• 11:32
  do it? How can we,
• 11:34
  put the child in the best position to
• 11:36
  meet their potential,
• 11:38
  with this implant and this technology?
• 11:40
  So, one example that we have,
• 11:43
  is, you know, unfortunately we do see children
• 11:46
  that have meningitis and meningitis,
• 11:48
  is a very,
• 11:50
  significant risk factor for developing a significant hearing
• 11:52
  loss. So,
• 11:54
  and it's
• 11:55
  a cause of hearing loss that if it's
• 11:57
  not identified early and intervened for early, it
• 12:00
  can,
• 12:02
  it may not ever be able to, have
• 12:04
  a cochlear implant, for example, that's very time
• 12:06
  sensitive. So,
• 12:08
  there really wasn't a meningitis protocol to follow
• 12:11
  that was published, and it was the standard.
• 12:14
  So we had a very small,
• 12:17
  baby that came into our hospital with meningitis.
• 12:20
  And,
• 12:22
  we actually, she was the youngest patient to
• 12:24
  receive a cochlear implant. We did it here
• 12:26
  at Children's Minnesota, and that really
• 12:29
  helped us develop a meningitis protocol.
• 12:33
  Basically,
• 12:34
  a protocol to follow when a child is
• 12:36
  admitted to the hospital for meningitis, how to
• 12:37
  follow their hearing so you don't miss that
• 12:40
  critical window, and we've since published that protocol,
• 12:43
  for other centers to use. So that's, you
• 12:45
  know, an an exciting thing that we're very
• 12:48
  proud of. I think in Minnesota, you know,
• 12:50
  we're the only state that screens all infants
• 12:52
  for congenital cytomegalovirus,
• 12:54
  and that is a virus that can cause,
• 12:57
  hearing loss later in life or it can
• 13:00
  cause a child to be born deaf or
• 13:01
  hard of hearing.
• 13:03
  And so we're in in a very exciting
• 13:04
  position in the state of Minnesota
• 13:06
  to,
• 13:07
  be able to follow these children and understand
• 13:10
  because a lot of them, are not I
• 13:11
  shouldn't say a lot, but several of these
• 13:14
  children that are born of this end up
• 13:15
  being cochlear implant candidates and and determining, okay,
• 13:18
  when when is the best time to do
• 13:19
  it? What are the other things we should
• 13:21
  be watching for?
• 13:22
  We're in a really great position that we
• 13:24
  can,
• 13:26
  you know, share this knowledge that we're learning.
• 13:28
  I think even things like,
• 13:31
  like gene therapy. So there is,
• 13:34
  there is a specific
• 13:36
  genetic cause of hearing differences that actually causes
• 13:39
  something called auditory neuropathy that
• 13:42
  there are successful gene for gene therapy for
• 13:45
  this specific gene change.
• 13:47
  And I think this is probably just the
• 13:49
  start of
• 13:50
  other
• 13:51
  genetic causes of hearing differences to potentially have
• 13:55
  that option of, gene therapy. So it's really
• 13:58
  exciting. And then figuring out, well, how does
• 14:00
  the role of cochlear implantation,
• 14:03
  you know, how do we
• 14:05
  tie that into these advancements in in medicine?
• 14:07
  And and do we learn more about, you
• 14:10
  know, again, who should have a cochlear implant?
• 14:13
  When should we do it? And is the
• 14:15
  gene therapy, how does that play a role?
• 14:17
  So it's it's really kind of exciting. There's
• 14:19
  all of these new things. And and I
• 14:21
  think the other thing is that the implants
• 14:23
  themselves
• 14:25
  continue to just get better and better all
• 14:27
  of the time. The tech the advances in
• 14:29
  technology,
• 14:31
  you know, like Chelsea mentioned, just being able
• 14:33
  to stream to practice with the implant, which
• 14:36
  is really critical for some patients.
• 14:39
  It's just crazy to think how much things
• 14:42
  have changed in the 10 years that I've
• 14:43
  been doing this surgery or actually 13 years
• 14:46
  that I've been doing this surgery, but 10
• 14:48
  years here at Children's. And then to think,
• 14:50
  well, where are we gonna go over these
• 14:51
  next 10 years is is just is pretty
• 14:54
  amazing to to think about and to be
• 14:56
  a part of.
• 14:58
  Doctor Mein, Chelsea, thank you so much for
• 15:00
  being so generous with your time and insights
• 15:02
  on this program. We cannot wait to share
• 15:04
  them with our audience, and we look forward
• 15:06
  to connecting with you guys again soon.
• 15:08
  Thank you so much. Thank you for having
• 15:10
  us.