September 10, 2007
A 5-year-old child once completely deaf is now easing into a world of new sensation.
Born 10 weeks prematurely and weighing less than 3 pounds, Jorden had no ear canals or auditory nerves, leaving him completely deaf. Small skin flaps appeared where his ears should have been.
Flowers is now one of the youngest patients to receive prosthetic ears anchored by implant posts after a Sept. 5 procedure at the University of Florida College of Dentistry. Medical artists at the university fashioned the prosthetic ears from silicone and cast them from his twin brother’s ears and colored them to match Jorden’s skin tone.
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Jorden is delighted with his new look.
"He treats them like a new pair of shoes. He thinks that the only time he should wear them is when he’s going out and he wants to take them off as soon as he gets home," Flowers said. "I think he’s trying to protect them from getting dirty or from getting damaged by playing too rough with his brother."
The new ears are an exhilarating end to Jorden’s long journey from silence to sound, his parents say. Two years ago, they took him to Italy, where he became the only child in the U.S. and one of a handful of children worldwide to undergo auditory brain stem implant surgery. He’s since gone from being 100 percent deaf to being able to hear and is learning to speak.
Jorden’s condition, bilateral microtia, is characterized by only partial formation of or the absence of the outer ear on both sides of the head. The National Craniofacial Association estimates it occurs in 1 in every 25,000 births. Jorden’s twin, Jaden, was born with normal ears and can hear.
"We didn’t know until he was born that there were some problems, and the doctors said we would have to run tests to determine what the problems were," Flowers said. "The doctors tried different hearing aids, and we thought they might be working and that he was getting some sound from us as a baby. It wasn’t until Jorden was about a year and a half when we finally understood, ‘OK, he’s not getting anything.’ "
Determined for Jorden to have every opportunity to hear, his parents scheduled him for the auditory brain stem implant procedure. During the surgery, electrodes were placed on the area of the brain responsible for processing sound. An external processor, designed to tuck behind an ear like a hearing aid, picks up sound and transmits it electronically to the brain, essentially acting as proxy for Jorden’s missing auditory nerves. Because of the implant, Jorden now can hear, and his parents are thrilled that he responds to their voices and is learning to speak.
"Jorden hears us, and he wants to hear us," said Johnny Flowers, Jorden’s dad. "He has a large vocabulary from signing. He’s trying to speak now, instead of signing he’s trying to say the words he has in his mind."
The prosthetic ears fashioned at UF will support the processor for Jorden’s auditory brain stem implant and will provide him with a more natural appearance. They are embedded with magnets that help affix the ears to metal posts surgically placed in his skull at Children’s Hospital of Alabama, located in his hometown of Birmingham.
"We do a lot of bone-anchored hearing aids in children. This is very similar to that type of procedure," said J. Scott Hill, M.D., a staff surgeon at Children’s Hospital and an assistant clinical professor of surgery at the University of Alabama at Birmingham. Hill has been Jorden and Jaden’s ear-nose-and-throat specialist since birth. "It’s really remarkable, particularly for children who are not candidates for conventional ear reconstruction."
Hill and his team at Children’s Hospital of Alabama estimated they see 90 percent of the children in Alabama born with microtia and said the combination of Jorden’s auditory abnormalities is very rare.
Last week, UF anaplastologist Robert Mann, a medical artist who specializes in the preparation and fitting of prosthetic devices, made casts of Jorden’s brother Jaden’s ears. From those he made wax models, which he shaped and customized to Jorden’s anatomy and to the abutments placed to support the ears. Mann next made plaster casts of them, which were used to form the permanent silicone ears. He then matched the color of the silicone ears to Jorden’s skin tone by custom painting each prosthesis.
About 80 patients a year benefit from the artistry and surgical expertise of dentistry’s Maxillofacial Prosthetic Services, a division of the college’s department of prosthodontics directed by Glenn Turner, D.M.D., one of the few maxillofacial prosthetic specialists nationwide.
The division creates lifelike prostheses for patients missing eyes, noses, ears, cheeks, chins even fingers because of cancer surgery, traumatic injury or congenital birth defects.
"The psychological advantage for Jorden of having ears like other children, even at an age as young as 5 years, is tremendous," said Turner. "He’s starting school, and the prosthetic ears will help Jorden feel and be treated just like any other child."
Jorden started kindergarten this week at Jacksonville’s Clark School, which specializes in speech training for hearing-impaired children. His parents say their hope for the future is that he will be able to graduate from the school’s oral program after second grade and be mainstreamed into a regular classroom.
"We’ve been extremely blessed to have so many wonderful supporters like Allianz, Faith Chapel Christian Center and many others that have helped us throughout our journey. Because of their efforts our son’s life will be changed forever," said Johnny Flowers. "A couple of weeks ago, Jorden spontaneously said, ‘I love you’ to his mom. That, to us, is worth any of the effort that we’ve put forth, and any of the effort that anybody else has put forth.
"We know that when we tell him we love him, he can hear us," Flowers said.