What is the significance of ACEs?
People seem able to tolerate just one or two ACEs. Perhaps you
could say that ACEs are a fact of modern life. But when the ACE
count gets high, up to four or more, the trouble starts. In the Kaiser
study, 12.5 percent of those studied had four or more ACEs. The
more ACEs, the more likely a child is to have learning and behavior
problems. And ACEs can carry over into adulthood in very negative
ways. With more ACEs, adults are much more likely to have trouble
with chronic medical, mental, and social problems.
Can ACEs be treated?
ACEs can be treated, but it takes
effort and understanding.
Further information
What follows is a reading and research list offering more information about
ACEs and how to recognize or address them in your patient population:
Paper Tigers
(2015), is a documentary created by filmmaker James
Redford about Lincoln Alternative High School in Walla Walla, which
offers an education approach informed by ACEs.
Redford wrote blog post for ACEs Too High news titled “Can School
Heal Children in Pain,”
https://acestoohigh.com/2015/06/03/
can-school-heal-children-in-pain/#more-4293.
“The Adverse Childhood Experiences Study—the largest, most
important public health study you never heard of—began in an
obesity clinic,”
https://acestoohigh.com/2012/10/03/the-adverse-
childhood-experiences-study-the-largest-most-important-public-health-
study-you-never-heard-of-began-in-an-obesity-clinic/.
“About Adverse Childhood Experiences,”
http://www.cdc.gov/
violenceprevention/acestudy/about_ace.html.
“The impact of adverse childhood experiences on an urban
pediatric population,”
http://www.nwcphp.org/documents/training/
maternal-and-child-health/burke-article.
“Adverse Childhood Experiences and Public Health Practice”
(webinar),
http://www.nwcphp.org/training/opportunities/webinars/
adverse-childhood-experiences-and-public-health-practice.
Thanks to Karen Russell of King County Public Health for several references.
July/August 2016
7
Cochlear implants
Research on cochlear implants began in the 1960s and 1970s. They
were approved for use in adults in 1984 and for children in 1990.
16
By 2012, almost 325,000 cochlear implants had been placed
worldwide, and 38,000 U.S. children had received an implant.
17
Cochlear implants consist of an external microphone and processor
worn over and behind the pinna, with a transmitter above the pinna.
General anesthesia is required for insertion of the receptor and electrode
array. The patient first has a mastoidectomy, which creates a space for
the receptor. Then a channel is created into the middle ear, and what
looks like a wire is threaded into the cochlea. This is actually a series
of 24 electrodes at different frequencies which stimulate the existing
intact auditory nerve fibers. Placement of this electrode will perma-
nently destroy any residual hearing in the ear. The internal receptor and
external transmitter are magnetized and thus held together. Typically,
the transmitter will not be activated for three or four weeks after surgery.
Mild complications are common after the procedure, including CSF
fluid leak, tinnitus, vertigo, damage to the facial nerve, or cellulitis of the
skin flap. There is an increased risk of meningitis, and a pre-operative
pneumococcal vaccination is recommended. More serious compli-
cations tend to occur later, at a rate of 2 to 5 percent in large series.
These include flap necrosis, otitis media, cholesteatoma, nonauditory
stimulation of the facial nerve, and electrode extrusion. Device failure
rate is between three and six percent, and requires reimplantation.
18
Because of the structure of the cochlea, the cochlear implant does not
pick up low tones as well as higher tones. Background noise remains
a problem, and it is difficult to distinguish sounds well enough to
appreciate music. Inserting bilateral cochlear implants can help with
sound localization and improves hearing in noisy areas. Medicare,
Medicaid, and the VA have covered cochlear implants since 2004.
19
The future holds great promise for those affected by hearing loss.
Researchers are investigating regeneration of hair cells in guinea
pigs. Stem cells may have a useful role. For infants, early discovery
of the hearing deficit and aggressive treatment are very impor-
tant. Normal language devel-
opment and social interac-
tion depend on the sense of
hearing. The use of cochlear
implants in children has been
life-changing.
About the Author
Dr. Barbara Gehrett
is a retired MD and
feature columnist for
The Bulletin
.
16. “Cochlear Implants for Children with Severe-to-Profound Hearing Loss.”
17.
www.nidcd.nih.gov/health/hearing
, accessed May 30, 2016.
18. “Cochlear Implants for Children with Severe-to-Profound Hearing Loss.”
19.
http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/Implantsand
Prosthetics/CochlearImplants/ ucm062866.htm
, accessed June 1, 2016.
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