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October 24, 2002

Cochlear implant system brings voices and music to the profoundly deaf

From: Daily Press, CA
Oct. 24, 2002

Daily Press

The dining-room clock struck eight, a deep, satisfying bong.

“Hear that?” Robert Surek cried. “I heard it!”

Surek and Judy Wagner were sitting with Debra Hollingsworth in Hollingsworth’s Apple Valley living room.

As the clock continued to sound, all three turned to face it, smiling broadly.

And listening.

Surek was born three months premature — and deaf. Until recently, his hearing level was so poor, he couldn’t hear a noise of 105 decibels (dB), that is, a noise equal to the racket made by a power lawn mower.

Now he responds to a noise of 35 dB, “the noise level of a quiet basement.”

Wagner, who lost her hearing at age 5, and Hollingsworth, deaf since 17, had been even worse off than Surek: unable to hear noises of 110 dB, the same roar heard by a gardener operating a leaf blower.

Now the two women can hear sounds of 20 dB, comparable to “the Grand Canyon at night."

The secret of their new-found hearing: cochlear implants, described by some as bionic ears, by others as a miracle.

In a person with normal hearing, the visible outer ear collects sound waves and directs them to the eardrum. As the eardrum vibrates, it causes three tiny bones (the malleus, incus and stapes) to vibrate. The vibrating stapes makes waves in the cochlea, the fluid-filled inner ear.

The cochlea is lined with thousands of minute hair cells. As these slosh back and forth, they send electrical signals to the cochlear nerve, and thence to the temporal lobe — the hearing center of the brain.

This beautiful chain-reaction breaks down if the hair cells are damaged.

When only a few are injured, a hearing aid can help by amplifying sounds. But if a significant percentage of the hair cells have been damaged, even the loudest amplification does no good, and the person experiences severe or profound hearing loss.

Then it may be time for a cochlear implant system, which bypasses the hair cells and delivers information directly to the cochlear nerve.

Wagner, Surek and Hollingsworth have all been fitted with the same brand, the Clarion CII Bionic Ear System. Here’s how it works:

• A surgeon implants a “bionic ear” in the patient’s head, a little bit higher than his or her outer ear. (The patient is knocked out for the surgery, which lasts about three hours.)

• After the incision has healed — typically four weeks later — the patient is “hooked up” (Wagner calls it being “turned on”). This involves hanging a microphone and headpiece behind the patient’s outer ear.

The microphone captures sound and converts it to digital signals. These are forwarded to the headpiece, which sends the signals, by radio, to the implanted bionic ear.

From there, an electrode carries the signals directly to the cochlear nerve, which then sends the signals to the brain to be interpreted as sound.

“On my ‘hookup day,’ ” Hollingsworth said, “the audiologist, Ki-Young Portillo, asked if I could hear her, and I said, ‘Yes. It sounds like a duck quacking.’

“But over the next few months, my hearing improved as my brain developed auditory neural pathways.”

Hollingsworth’s daughter, Tara, bought her mother a Sony Walkman.
“When I put on ‘Are You Lonesome Tonight?’ ” Hollingsworth said, “I started crying. I had music back! For one month I did nothing but listen to Elvis and the Beatles.

“Then I bought an audiocassette of Snow White. Reading along with the tape taught me to listen. After a while I could make out words without reading the book.”

Hollingsworth continues to practice on an English as a Second Language Web site. But she begins each day by listening to Yannis, followed by the Temptations and Creedence Clearwater Revival.

After his hookup day, the first words Surek heard distinctly were the best words imaginable. “I was in the laundry room,” he said, “and I heard, ‘Daddy’s home.’ ”

When Wagner was first “turned on,” she heard nothing.

“I’d expected to hear with my ears,” Wagner said. “Then my head started shaking as I began to hear with my brain.

“After that I went to the bathroom and heard a lady pee. I’d never known you could hear someone pee!”

Indeed, all three friends had to adjust to a new and noisy world.

Surek, who works as an illustrator for Johnson Control at Fort Irwin, found the noise of fluorescent lights “overwhelming.” For Wagner it was her car’s left and right blinkers, and crickets.

An avid golfer, Hollingsworth is bothered by the sound of cars driving by the 18th hole at the Apple Valley Country Club. And she has learned that her husband, John, snores.

Surek cannot yet talk on the phone, but Wagner and Hollingsworth can.

“I practiced by calling John’s office answering-machine,” Hollingsworth said. “After about 15 times, my brain clicked in and I could hear words!”

Remarking that, even though implants allow them to hear, they “respect the deaf who wish to stay deaf,” Wagner said that for many in the deaf culture cochlear implants are unacceptable:

“Deaf people still come up to me and say, ‘I hear you can’t wash your hair or go swimming.’ Not true. I simply take the microphone and headpiece off.
“We must educate the deaf.”

And while they’re at it, educate doctors and insurance companies.

In order to get prescriptions for implants, and then to have the brand they preferred, both Surek and Hollingsworth fought hard.

In August 2001, a friend of Wagner’s sent her information on the Clarion CII Bionic Ear System (“the brand Rush Limbaugh has”).

“I thought, ‘It’s not for me,’ ” Wagner said, “but I showed the info to Debra, and she sent away for a video tape.

“We watched it together.”

Hollingsworth was persuaded by Clarion’s claims of speech discrimination — not “discrimination” in the civil-rights sense, but the ability to distinguish words.

“I’d had an implant before,” she said, “in 1985. But it was a big failure. Because there was an exposed wire, every time I heard a sound, I felt a shock.

“The shock hurt. And although I could tell the difference between male and female voices, I couldn’t understand what they were saying.

“I used that system for only five months. But I had a taste of what the future would bring.”

Hollingsworth’s initial implant cost $24,000 and wasn’t covered by her insurance. But Wagner’s insurance did cover cochlear implants, “so I was on her case to get one,” Hollingsworth said.

“After someone spilled water on Judy’s hearing aid and ruined it, her doctor said, ‘You might as well have a cochlear implant.”

Wagner was the first of the three to have the operation: on Feb. 12 of this year, when Dr. Dennis Maceri of USC University Hospital implanted a Clarion.

Surek was next.

“Four years ago,” he said, “my insurance company turned me down for an implant. I didn’t know that you had to fight.”

With help from his wife, Cindy, he did fight, but his doctor referred him to Loma Linda University Medical Center, which, at the time, only implanted one brand, Nucleus (“the brand that the first deaf Miss America, Heather Whitestone, has”).

The Sureks persisted, and on June 25 Dr. Maceri gave Robert Surek a Clarion CII implant. Hollingsworth was also referred to Loma Linda, but by now she was a tiger. Maceri implanted her Clarion CII on July 18.

“High Desert doctors need to learn not to play God with people’s lives,” she said.
The three friends had all wanted the Clarion system, Hollingsworth said, “because it uses just 10 percent of its total capacity.

“But as of January 2003, an audiologist can download new software that greatly increases Clarion’s effectiveness — and without the patient’s having to have new surgery, as is necessary with a Nucleus.”

Surek stressed that cochlear implants are not for everyone: “You must have motivation and patience.”

What’s more, the Food and Drug Administration requires that a candidate for implants 1) have severe to profound hearing loss in both ears and 2) be getting little or no benefit from conventional hearing aids.

Because inserting the electrode sacrifices the cochlea, Surek said, only one ear is operated on. This preserves the other cochlea for future miracles such as hair-cell regeneration.

Besides, he said, insurance companies are reluctant to pay for both ears when there’s no proof that two implants are better than one.

Hollingsworth warned that because today’s implants cost between $50,000 and $90,000, “insurance companies invariably turn you down the first time around.”

Surek was proud and delighted that he can watch and listen to the Apple Valley High School Sun Devils Marching Band. His daughter Jenna is one of the band’s two drum majors.

And Hollingsworth could hardly wait for the upcoming Paul McCartney concert.

“My daughter and Craig, her fiancé, bought me fifth-row center seats,” she said.

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