Dr. Daniela Carvalho is trying to spread the word about the dangers of frequent noise exposure to children and the possible permanent hearing loss it can cause.
Carvalho, a pediatric otolaryngologist and the chief of the otolaryngology section at Rady Children’s Hospital, said the increase in children with hearing loss is “alarming”—a recent study found that 20 percent of teens have some degree of permanent hearing loss.
Teens are exposed to a lot of noise every day through listening to devices such as iPods, playing video games and through the use of ear buds which Carvalho said is an ear, noise and throat doctor’s worst enemy.
While noise-induced hearing loss is usually gradual and painless, it is permanent.
“It’s a silent problem,” Carvalho said, noting that teenagers often don’t even realize they are having trouble hearing and it presents first as having problems in school. “We need to be careful about it and it’s so easy to prevent.”
Carvalho is the director of the hearing and Cochlear Implant Program at Rady and is a professor in the department of surgery at UC San Diego School of Medicine. She is an expert in pediatric ear surgeries, such as cochlear implants and bone-anchored hearing aids, and was the first surgeon in San Diego to do bone-anchored hearing aid surgery in pediatric patients.
Carvalho is originally from Brazil and has been in San Diego since 2003. A resident of Carmel Valley for 10 years, Carvalho has a son at Ocean Air Elementary School and a daughter at Carmel Valley Middle School.
“Being an ENT (ear, nose and throat doctor) is just very fascinating. As a surgeon I can do very delicate procedures, such as ear surgeries, to large surgeries in the head and neck,” Carvalho said.
Hearing has always been a huge passion for Carvalho. Having family members with hearing loss helped pique her interest in the field as one of her cousins was born without an inner ear canal. She has also always had a love of music and languages—she can speak five (Portuguese, English, Spanish, German and French).
“I grew up in a world where hearing was very important for communication and enjoyment and socializing,” Carvalho said. “It was definitely always something I had on my radar screen.”
Carvalho’s expertise in pediatric ear surgeries has changed the lives of many children in San Diego through the use of bone-anchored hearing aids and through cochlear implants.
The bone-anchored hearing aid is a titanium implant inserted in the skull behind the ear, allowing time for the bone to grow around it. Once it has bonded, a hearing aid is attached. The bone acts as a pathway for sound to travel through the cochlea, the inner ear, through vibrations.
Carvalho said the bone-anchored hearing aid can be used for kids with profound unilateral hearing loss (impaired hearing in one ear) or kids who were born without ear canals or born without ears, which she said is not that uncommon. Carvalho said the outer attachment is made in colors that resemble skin colors and often you can’t see it on girls whose long hair covers it.
“It’s easy to use and the results are pretty amazing,” she said.
Carvalho is the only pediatric surgeon certified in San Diego County to perform cochlear implants. She has installed cochlear implants on more than 400 kids in San Diego.
Patients who are candidates for the cochlear implant are born completely deaf. It is a complex surgery in which an electrode is placed inside the ear that communicates directly with the auditory nerve.
Carvalho aims to perform the surgery on children within nine to 12 months of when they are born deaf, as well as on children who have progressive hearing loss.
The Rady Children’s cochlear implant program includes a very comprehensive team to help guide patients, including Carvalho, audiologists, a speech pathologist, a developmental psychologist and an education liaison.
The cochlear implant takes a lot more rehabilitation than the bone-anchored hearing aid and it’s a long process with extensive speech therapy, programming and mapping of the devices over the course of a year. It takes a lot of commitment but Carvalho said it’s amazing seeing patients learn how to speak or play an instrument and hear music for the first time—every year Rady celebrates its young cochlear implant patients with a heartwarming “Joy of Sound” picnic and gathering.
Carvalho said what is most frightening about hearing loss in adolescents is that it can often go undetected.
Kids with hearing loss may struggle socially because they cannot hear and in school they may be incorrectly diagnosed as having ADHD (attention-deficit/hyperactivity disorder) or being lazy. In reality they are not responding because they cannot hear and aren’t able to understand. With any degree of hearing loss, it can be very confusing when in a room with lots of people talking, like a classroom.
“It really is a big issue because with high frequency hearing loss it’s hard to listen to the teacher and it’s tiring because they’re using more energy to understand,” Carvalho said. As most kids don’t like sitting in the front of the classroom, they are less likely to move closer if they are having trouble hearing. “It’s something that we need to monitor.”
To combat hearing loss now and in the future, Carvalho said there are several “healthy listening habits” that parents can encourage in their children.
Ear buds are her number one targets.
Carvalho said the problem with ear buds is that they often don’t fit inside kids’ ears properly so kids have a tendency to “crank up the volume.”
“Headphones are better because they go around the ear and can muffle the sound around them so they don’t need to increase the volume as much,” Carvalho said.
She said often parents limit the amount of screen time their children have and they should also limit sound time as well.
“We use the rule of 60-60,” Carvalho said. “Kids should not be listening to electronic devices with headphones for longer than 60 minutes at a time, ideally not more than 60 minutes a day, and at less than 60 percent of the maximum output of the device.”
Carvalho said teens usually hate her when she shows parents that there is a way to lock the volume of devices so it cannot exceed 60 percent output.
At any loud events, such as concerts, Carvalho advises the use of ear plugs.
Taking on healthy listening habits now, both children and parents alike, can help limit the damage in the future. As Carvalho’s patients can attest, the ability to hear is a joy and one that shouldn’t be taken for granted.