The Gift of Sound

Reprint of an article from Vim and Vigor, a University of Virginia Health System magazine, which describes the efforts of Bradley Kesser, MD, Associate Professor of Otolaryngology – Head and Neck Surgery at the University of Virginia, to bring hearing to a young boy, born without a developed ear structure. In addition to his treatment of patients, Dr. Kesser also conducts research into regen- eration of damaged or destroyed human hair cells.
Dr. Kesser is a conscientious and involved hearing foundation board member.

By Kelly Casey
Adapted from Vim & Vigor magazine with permission of the author

When Nicholas Papaneri was born, he was perfect in every way – except for one thing: His ears had stopped developing at three months in the womb. Born with bilateral microtia and atresia – rare disorders that left him with severe hearing loss – he had tiny skin tags where his outer ears should have been (microtia), no ear canals and underdeveloped middle ears (atresai).

As soon as Denise Papaneri got home with her newborn, she and her husband Mario Sr. began a search to find the best doctors to build ears for their youngest son.

The search would take the Papaneris from their Cherry Hill, N.J., home to Texas, Florida, California and, finally, to Virginia. At the University of Virginia Health System, Bradley Kesser, M.D., would complete the journey and give Nicholas the ability to hear on his own.

Last January, Kesser performed a delicate four-hour surgery inside Nicholas’ left ear. A few months later, he performed the same surgery in the right ear.

“Everything went great,” Denise says. “My son went from being deaf without his hearing aid to having 100 percent hearing in both ears.” For Nicholas, who by then had gone through eight surgeries, “it was really an emotional thing for him,” his mom shares. “He’s really, really happy about it.”

Kesser, a member of the hearing foundation’s board of directors, has performed nearly 200 atresia surgeries like the one Nicholas had. Few surgeons in the country do as many as he does. Kesser carefully selects his patients – ranging from 5 to 58 years old – to make sure they are good surgical candidates. Following the operation, 80 to 90 percent of his patients have normal to near-normal hearing restored. “This surgery is perhaps the most gratifying part of my job,” Kesser says.

Because few surgeons have attained his track record, he gets two or three CT scans sent to him each week for his review; they come from families every- where – all hoping to hear that their children are good candidates for surgery.

Kesser’s mentor, Robert Jahrsdoerfer, M.D., is a retired UVA professor and surgeon who 30 years ago pioneered a more effective approach to the atresia operation. Kesser trained under Jahrsdoerfer, and then had further training in California at the House Ear Institute, considered to be a premier training program for ear surgery. Kesser was in private practice, when he got a call from the soon-to-retire Jahrsdoerfer, asking him to come back to UVA to take over his atresia practice. “I’ve been extremely privileged and fortunate to be able to carry on his work,” Kesser says. “It really is an honor.”

Jahrsdoerfer adds: “Brad has fulfilled all of my expectations and more. He’s doing a wonderful job. He’s already an all-star in the specialty.” Denise Papaneri agrees. She found Kesser through California surgeon Burt Brent, M.D., who performed the six surgeries (over 18 months) that it took to build Nicholas’ outer ears using the boy’s own rib cartilage.

At age 7, Nicholas continued his journey to UVA – a six-hour drive from home – for his final two surgeries. “The goal of surgery,” Kesser explains, “is to establish the natural, sound-conducting pathway of the ear canal, eardrum and three middle-ear bones.” The operation involves removing bone to open the ear canal; finding and freeing the middle-ear bones so they can vibrate; building an eardrum; lining the new canal with a skin graft; and connecting the canal to the outer ear.

“Not everyone gets a home run like Nicholas, but almost everyone gets improvement in their hearing,” Kesser says.

Nicholas will likely be hitting another type of home run; he no longer needs what’s called a Baha system – a special type of bone-conducting hearing aid that put sound right into the inner ear. Although the device allowed Nicholas to hear, it could never get wet and required him to wear a headband that got in the way of baseball (it wouldn’t fit under his batting helmet).

For his mom, all the time away from home and all the surgeries were worth it in the end – but it was never easy: “Although you know deep down that you’ve made the best decision for your child, you have the best docs caring for your son, and you know the surgeries will change his forever for the better,” she says, “nothing prepares you to watch your soon be wheeled away in a huge hospital bed. All eight times, the urge to run after him, climb into that bed and hold him forever was overwhelming.”

Nicholas Papaneri was born with severe hearing loss in both ears from what’s known as bilateral (both sides) atresia. Most times, this birth defect only affects one ear (called unilateral atresai).

Children who have hearing loss in one ear have difficulty locating sound in space and hearing amid back-ground noise. So Kesser and his collaborator, Lincoln Gray of James Madison University, have designed a research study to figure out if these children can hear better in a noisy classroom and locate sound in space after they have surgery to gain hearing in the abnormal ear. Early results show that one month after surgery, these children can hear better amid noise but still have trouble locating sound in space. Kesser will continue to follow about 20 children over the next couple of years to see if, over time, they learn to locate sound in space.

“Another important question we hope to answer,” Kesser says, “is whether we need to be recommending for children with unilateral atresia that they wear a cone-conducting hearing aid from age 3 months until they are old enough for ear surgery by 5 or 6. We want to know if this could help improve their school performance.”