Team effort to create new ‘ears’ for six-year-old Elijah
Innovative intervention paves the way for life-enhancing prosthetic ears
A team of experts from various medical disciplines and organisations came together on 24 July 2018, to assist a child born with underdeveloped ears and sealed ear canals, an unusual congenital medical condition known as microtia with bilateral congenital aural atresia. Six-year-old Elijah Cloete has undergone surgical preparation for a pair of custom-made prosthetic pinna, or external ears, and received a hearing aid as part of the efforts to enhance his quality of life.
“Elijah was born with his ear canals sealed, while the visible, external part of the ears were tiny and malformed,” explained Elijah’s mother, Shirene Cloete, shortly after the procedure undertaken at Medicross Kalahari Cataract, Eye and Day Hospital in Upington.
Last year, Shirene read in the media about another young man with microtia who had been assisted through an intervention involving maxillofacial prosthodontist Professor Cules van den Heever, the Centre for Rapid Prototyping and Manufacturing (CRPM) at the Central University of Technology (CUT) in the Free State and the Carl & Emily Fuchs Foundation, a private grant-making organisation. Shirene contacted the boy’s parents, Nehemia and Deidre Doolabh, who put her in touch with the team, and this set the wheels in motion for Elijah to receive the gift of realistic-looking prosthetic ears, as well as a bone-anchored hearing aid.
Soon preparations were underway to assist Elijah, thanks to funding provided through the Carl & Emily Fuchs Foundation and Wohlers Associates, a rapid product development consulting firm. The CRPM CUT team and medical professionals provided their expertise and services pro bono, while the Medicross Kalahari Cataract, Eye and Day Hospital, operated by Medicross and ophthalmologist Dr Erhardt Kidson, donated theatre time.
“I am so grateful for everything that these organisations and individuals are doing to help my son. I thank God for bringing them all together to make this possible. To the family who helped me connect with the experts, the organisations that provided funding, Gerrie Booysen of the CRPM, Professor Van den Heever, maxillofacial surgeon Dr Charles van Niekerk, the friendly, caring staff of Medicross, and audiologists Julia Jensen and Andra Bester – as a mother, I want to thank you all for helping Elijah to live a normal life,” Shirene said.
Professor Van den Heever, the CUT team and Dr Van Niekerk had to work closely together to meticulously plan how the implants, which will hold the prosthetic ears, would be placed.
Dr Van Niekerk explains, “To hold the prosthetic ears, the implants need to be attached with small screws into the skull at just the right position. The bone to which we anchor the implants is only between 3mm and 4mm thick, therefore it is essential to plan precisely where the bone surface is adequate to hold the screws and to make sure that they are exactly the right length.”
Working with Professor Van den Heever, the CRPM of CUT produced a 3D-printed positioning device, known as a patient-specific surgical stent, after taking a CT scan of Elijah’s head. This stent is placed over the patient’s face in theatre and is essential in guiding the surgeon to accurately position the screws for the implants, to which the prosthetic ears will attach.
In mid-June, Dr Van Niekerk performed the procedure at the state-of-the-art Medicross Kalahari Cataract, Eye and Day Hospital. Elijah’s malformed external ears were surgically removed, and the implants were carefully positioned using the patient-specific surgical stent.
“After the initial surgery, we must wait three to four months for the bone to grow around and attach to the titanium implants. Once we are satisfied that the implants are securely integrated with the bone, we will undertake the second phase of the surgery, where we will place small metal structures that will form the pillars to which the prosthetic ears will attach with magnets,” Dr Van Niekerk elaborates.
The CRPM CUT team will then use 3D printing to create the moulds that Professor Van den Heever and a Master’s engineering student will use to make the medical grade silicone prosthetic ears for Elijah as part of the Changing Faces, Changing Lives programme sponsored by the Carl & Emily Fuchs Foundation, which aims to enhance quality of life and reaffirm the sense of dignity of those with facial disfigurement.
“Ears are fairly noticeable structures, and even though Elijah’s braids have helped to disguise the malformation of his external ears, the prosthetic ears will assist to enhance the aesthetics of his face,” Professor Van den Heever notes.
“The presence of ‘normal’-looking prosthetic ears is more than merely aesthetic, however, as it positively contributes to social aspects of a child’s development. We are able to match the skin tone and texture almost exactly, and do everything possible to make the prosthetic ears look as realistic as possible.
“As Elijah is only six years old, his features are still growing and in the future we will need to replace the prostheses to remain in proportion with the rest of his face,” Professor Van Den Heever adds.
While the surgeries and prosthetic ears will address the cosmetic aspects of Elijah’s microtia and aid in some developmental aspects, he also required assistance for his impaired sense of hearing. The head of the speech therapy and audiology department at Pelonomi Hospital, Julia Jensen, came to learn of Elijah’s situation through the CUT team and arranged for him to have a hearing test with private audiologist, Andra Bester who practices in Upington, which is nearer to the Cloete family’s home.
“The hearing tests indicated that Elijah had partial hearing in one ear. Due to his condition, his ear canals are sealed and we believe that this contributes significantly to his hearing impairment. We performed a bone conduction hearing test and found that Elijah’s cochleas, the part of the inner ear integral to hearing, are functional on both sides,” Bester says.
Elijah was fitted with a special hearing aid. “The bone-anchored hearing aid converts sound into vibrations through the skull and temporal bone, which stimulates the hair cells in the cochlea. Sound is then transferred normally through the acoustic nerve to the brain,” Jensen explains.
Bester added that Elijah would need to have a follow-up consultation with her in a few months, after he has had time to get used to the hearing aid and has learned how to process the new stimuli. She will then be able to determine the extent to which his hearing has been improved.
Dr Billyy van der Merwe, managing director of Netcare’s Primary Care Division, says he was most pleased that the Medicross Kalahari Cataract, Eye and Day Hospital and its staff were able to play a role in the interventions to assist Elijah.
“This young boy has shown great courage at such a tender age, and we are pleased and privileged to be doing our part in improving his quality of life. In the coming months we look forward to the successful culmination of the efforts of all the expert healthcare professionals involved and seeing the meaningful difference these interventions make for Elijah,” he concluded.
1: Six-year-old Elijah Cloete, who was born with underdeveloped ears, is pictured with his grandmother, Maralise Cloete, at the Medicross Kalahari Cataract, Eye and Day Hospital, shortly before undergoing surgery in preparation for receiving a pair of custom-made prosthetic pinna, or external ears.
2: Prosthodontist, Professor Cules Van den Heever; maxillofacial and oral surgeon, Dr Charles Van Niekerk; dentist, Dr Johan van der Merwe who assisted in theatre; and Medicross Kalahari Cataract, Eye and Day Hospital operations manager, Rina de Vries were amongst those who reached out to assist Elijah Cloete.
3: Staff members of the Medicross Kalahari Cataract, Eye and Day Hospital came to wish Elijah Cloete and his family well shortly before the surgery. Back, left to right: Elijah’s mother, Shirene Cloete; ward cleaner, Liezle Jood; Elijah’s grandmother, Maralise Cloete; theatre cleaner, Anna Thomas; theatre scrub nurse, Sr Mari van Niekerk; operations manager, Rina de Vries; administrator, Anika Venter; ward nurse, Sr Soekie Pienaar. Front, left to right: Enrolled nurse, Denise Chiefer; patient, Elijah Cloete; recovery ward nurse, Sr Marlaine Swartz; and central sterile services department staff member, Thembeka Bizo.
Issued by: Martina Nicholson Associates (MNA) on behalf of Medicross and Central University of Technology, Free State
Uploaded: 25 July 2018