After nearly a decade of enduring chronic ear infections from a perforated eardrum, Delia Binette almost had to give up the sport she loves most: swimming. Now, she’s back in the pool thanks to a collaboration between pediatric specialists at Mass Eye and Ear and Massachusetts General Hospital.
Delia Binette stands at the edge of her grandparents’ pool. As the 13-year-old from Saco, Maine leans forward to jump in, a tingling sensation erupts from her stomach. The feeling catches her by surprise.
Delia loves to swim. Diagnosed with a rare mitochondrial disorder, she tires easily whenever she puts too much pressure on her joints. Her condition, coupled with epilepsy and autism diagnoses, makes team sports like soccer and basketball seem impossible. Swimming, however, makes her feel like a rock star, she says; her joints weightless and the doctor’s office out of sight.
However, on this June afternoon, Delia is nervous. The year prior, she had been warned not to set foot in a pool again due to chronic ear infections. Delia had been diagnosed with a rare pediatric cancer called Ewing’s sarcoma at age six. Subsequent radiation treatments had perforated her eardrum, which had never healed and increased her risk for infections.
“Cancer had taken so many things away from Delia — her hair, her eardrum, parts of her skull — but I think this crushed her the most,” Delia’s mom, Kristine Binette, told Focus. “It was like telling her she shouldn’t walk anymore.” Determined to see her daughter swim again, Kristine called David Sweetser, MD, PhD, Delia’s pediatric oncologist at Massachusetts General Hospital, who immediately referred the family to Michael Cohen, MD, director of the Multidisciplinary Pediatric Hearing Loss Clinic at Mass Eye and Ear. In a matter of weeks, Dr. Cohen collaborated with his Mass General colleagues to repair Delia’s eardrum and return her to the pool.
Collateral damage from cancer treatment
The eardrum is a tight, thin membrane that separates the outer ear from the inner ear. While very strong, the eardrum can be punctured by infections, extreme changes in atmospheric pressure, injuries and violent noises. When a tear occurs, the eardrum often heals on its own—but not in Delia’s case.
After her Ewing’s sarcoma diagnosis, Delia underwent 30 rounds of radiation to eliminate any last traces of cancer that had not been removed during a craniotomy. The tumor sat above Delia’s right ear, which meant the radiation would also destroy healthy tissue. Sure enough, the radiation tore a hole through Delia’s eardrum, preventing it from healing.
Significant hearing loss ensued. Delia needed to wear a hearing aid over her right ear and keep it protected from foreign substances at all times. Chronic ear infections occurred whenever water entered her ear, especially after a day at the pool. As time went on, doctors feared Delia would develop a bacterial resistance if she kept taking the same antibiotics for the infections, which occurred more frequently. Finally, after years of managing symptoms, Delia and her mom visited a local ear specialist who believed the radiation had damaged her eardrum beyond repair. The specialist recommended that she completely avoid the swimming pool or risk further damage.
“Swimming was the one thing Delia knew she could be just like her peers in,” Kristine said. “To hear the words, ‘No, you can’t,’ killed her spirit. It was another reminder of how different she was from the other kids at school.”
When Dr. Sweetser heard the news, he picked up the phone and called his Mass General Brigham colleague Dr. Cohen for a second opinion.
Fixing an eardrum with the help of a team
Surgically repairing a perforated eardrum is a common outpatient procedure. The procedure, called a tympanoplasty, involves harvesting healthy tissue from nearby areas and crafting it into a new eardrum. According to Dr. Cohen, the procedure, while common, is by no means perfect. He estimates that it fails to completely heal 10-to-20 percent of the time. That percentage increases for patients like Delia, who have pre-existing damage to the ear.
Upon receiving a phone call from Dr. Sweetser, Dr. Cohen agreed to meet with Delia and examine her ear.
“This family came to Mass Eye and Ear because they were told their problem couldn’t be solved,” Dr. Cohen said. “We often see patients whose prior treatments have failed or have not been attempted due to the complexity of the case. That doesn’t mean we always succeed, but we will certainly do our best to help everyone who walks through the door, no matter how challenging the problem.”
In collaboration with Torunn Yock, MD, director of Pediatric Radiation Oncology at Mass General, Dr. Cohen investigated the extent of the radiation damage to Delia’s eardrum. Her record revealed she had undergone proton beam radiation, which is a more precise way of targeting cancer cells than traditional radiation therapy. After carefully reviewing her treatment plan, the doctors felt that the proton beams had spared enough healthy tissue around the eardrum to create a graft; a surgical repair could be performed. Although there was no guarantee the procedure would restore Delia’s hearing back to its normal threshold, Dr. Cohen performed the reconstructive surgery in June of 2020.
“The two goals of this operation were to make the ear safe for Delia to swim again and to improve her hearing in that ear.” Dr. Cohen said. “By analyzing and optimizing all the factors related to her surgery in collaboration with the Mass General Brigham team of doctors, I was hopeful that we would be able to get her back in the pool and cautiously optimistic that we might improve her hearing as well.”
A picture worth a thousand words
Back at her grandparents’ pool, Delia inches closer and closer to the water, trying to convince herself to jump in. She pauses and steps back after a few more minutes of deliberation. Thinking back to her post-op appointment with Dr. Cohen, she tries to remember the image he showed her on the monitor: A healthy eardrum. Her healthy eardrum.
Finally, with a giant exhale, she leaps off the patio and splashes into the water beneath her. As she rises to the surface, she immediately grabs her ear, as if by instinct. The ear feels fine and a wide smile spreads across her face. Her smile widens further when she hears her mom clapping her hands from the patio. The surgery was a complete success in repairing her eardrum and, despite Dr. Cohen’s reserved expectations, her hearing had been restored to the point she no longer needs a hearing aid.
Now, Delia is finally back in her happy place. She’s also excited for the start of a new school year, during which she plans to compete on the middle school swim team.
“As a mom, you’re constantly fighting to get what you need for your child,” said Kristine. “At Mass Eye and Ear and Mass General, I didn’t need to worry. They listened to what my daughter wanted most and made it a reality.”