Beep, beep, beep.
Clinical Supervisor Carissa Moeggenberg pointed to graduate student Kati Stilwell's computer screen as Stilwell programmed electrodes and tones sounded out in the small examination room: Beep, beep, beep.
Suddenly, the 13-month-old boy at the center of everyone's attention looked up.
"Yup, he heard that!"
One small step for the
Carls Center for Clinical Care and Education audiology clinic at Central Michigan University, one giant leap for toddler Harlan Lafferty.
“It was absolutely overwhelming. It was all worth it.”
— Hillary Breiler, Harlan’s mother
Harlan was hearing those tones, and the recorded crowing of a rooster — and the voices of his mother and father — for the first time in his life. On Oct. 2, he became the clinic's youngest patient to gain the sense of hearing through bilateral cochlear implants.
"It was absolutely overwhelming," Harlan's mother, Hillary Breiler, said of the long journey to this day. "It was all worth it."
Grant helps center serve children
Carls Foundation grant paved the way for Harlan to hear. Moving into pediatrics with help from the grant was a strategic step for the audiology clinic, which since 2007 has served approximately 150 adult cochlear implant recipients.
Cochlear implants are surgically implanted electronic devices that pick up and transmit sound signals directly to the auditory nerve, bypassing the inner ear, or cochlea — unlike hearing aids, which simply make sounds louder.
"Because we're a teaching college, we wanted to give our students exposure to working with children," said Moeggenberg, a cochlear implant audiologist and 25-year veteran of audiology who has been at CMU for two years.
Until Monday, the clinic had handled implants for 10 kids, but none as young as Harlan.
"Today was our first bilateral (both sides) cochlear implant activation for a child younger than 2," Moeggenberg announced.
Hearing is crucial in developing speech and spoken language skills, and Moeggenberg said research shows the younger a child receives a cochlear implant the better. Based on federal guidelines, children as young as 12 months can receive implants.
A mother's hopes are realized
Harlan cried when he first heard sounds Monday —pretty normal for when implants are first activated, his mom said.
"Before now, I often tried to imagine what it was like for him," she said. He's been attuned to vibrations and motion, like a stomp on the floor or a wave of hands to get his attention. Harlan likes to point at things he wants, and the family also uses some American Sign Language.
"I can't wait for him to hear a dog bark for the first time, or to hear cars and motors that he could only feel before," Breiler said.
She especially looks forward to watching her twin sons interact now that they both can hear.
Family finds answers at CMU
CMU's Carls Center is the northernmost facility in the state that serves children with cochlear implants, Moeggenberg said, making it the go-to choice for a large swath of the state.
Harlan's family lives in Lake City, Michigan, and came to CMU after two weeks of inconclusive testing in Traverse City, where Harlan and his twin brother, Leeland, were born Aug. 23, 2016.
Leeland's hearing is normal, but Harlan was found to have a genetic condition that left him with no hearing in either ear.
"We finally got a referral here from Traverse City," Breiler said, "and within an hour we had the results: that he was bilaterally profoundly deaf."
Since that time, the Carls Center and Harlan's parents — mom Hillary and dad Ben Lafferty — have worked toward the day when Harlan would be able to hear.
In September, Dr. Robert Daniels, a cochlear implant surgeon in Grand Rapids, Michigan, implanted Harlan's devices in preparation for the Carls Center to activate and fine-tune them.
Kids present challenges, opportunities
Working with implants in children is labor intensive, Moeggenberg said, involving a whole support team of parents, siblings, schools, therapists and doctors.
And there's something else that sets the clinic's pediatric implant patients apart from its older adult clients, most of whom are regaining lost hearing.
"Most of these kids haven't heard before," Moeggenberg said. "They are really hearing sound for the first time."
Some adults who once heard naturally report that the sounds they hear with a cochlear implant seem mechanical or robotic at first, but there's no way to know what it's like for kids who have never heard before.
"Everyone's perception of sound is different," Moeggenberg said.
She said some infants with new implants who start crying will stop suddenly, realizing they're hearing themselves cry for the first time.
Students connect with experience, emotion
Third-year doctoral graduate students Hannah Borton of Coshocton, Ohio, and Kati Stilwell of Davison, Michigan, feel fortunate to watch all this unfold.
"Lots of other grad schools I looked at, they didn't even have a cochlear implant program," said Borton.
"It was exciting to see a different part of audiology from diagnostics and hearing aids," said Stilwell, who also likes working with veterans at the center. "CMU is a great program, with lots of opportunity for a variety of work."
Of course, it's about gaining more than clinical experience.
"I'm just so happy for Harlan and his family," Borton said. "I felt emotional watching his mom choke up.
"You realize you're really making a difference in people's lives."