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November 23, 2002

Cochlear Implant Provides Sense of Sound to Deaf

From the Daily Nonpareil, Council Bluffs, Iowa, November 23, 2002

Part one of a two part series

By Staff writer Brien T. Boyce

With modern advances in technology, some in the deaf community are gaining a foothold in the hearing world through a cochlear implant.

But is the surgery, the therapy, and the rehabilitation worth the risks - and ridicule?

Nic Upchurch and Lauren Wellman are two of many students at the Iowa School for the Deaf who underwent the surgery for a cochlear implant.

The difference: Wellman, a fourth-grader, still uses hers, while Upchurch, a senior at the school, no longer wears the cochlear implant.

Upchurch said he was 5 or 6 years old when he got his cochlear implant but stopped using it when he was 13 and arrived at ISD from a Des Moines public school.

"I just felt like, ?Why should I use the cochlear implant here?' I've got communication with people who know how to sign," he signed through his interpreter.

Upchurch said his parents initially decided to get their son the cochlear implant but now leave the decision to use it up to him.

Like Upchurch's parents, Wellman's mother, Beth, wanted her daughter to have the ability to hear and got her the implant when she was 3 years old.

"I wanted her to hear," she said. "Why would you not want your child to hear? You give them what they need. If they need glasses, you give them glasses. If I thought it would affect the hearing that she had, then I would have given it more thought. But in her case, it was about her hearing that she didn't have."

A cochlear implant is a surgically implantable device that resembles a hearing aid and serves as a substitute for the middle ear, cochlear mechanical motion and sensory cells by providing hearing sensation to individuals with severe-to-profound hearing loss.

In a normal ear, the middle ear converts sound energy to mechanical energy, which is then converted to mechanical fluid motion within the cochlea, and eventually becomes electrical impulses in the auditory nerve.

The cochlear implant transforms the sound energy into electrical energy to stimulate impulses within the auditory nerve.

Ever since the late 1700s, scientists have known that electrical stimulation can produce hearing sensations; but it was not used until 1957, when two French surgeons placed an electrode on the auditory nerve of a deaf man during an operation.

The patient was able to disseminate some sounds and understand some words when a current was sent through the electrode.

At around $30,000, cochlear implants are more expensive than hearing aids, according to the American Academy of Otolaryngology - Head and Neck Surgery. The cost includes patient evaluation, surgery, the device itself and rehabilitation.

Most insurance companies provide benefits that cover the cost, whether or not the implant device has received clearance from the Food and Drug Administration is still in a trial phase.

The implant consists of two parts: the cochlear implant package and electrode array (or receiver-stimulator), and the speech processor and headset.

The implant package is placed under the skin behind the ear during surgery, and the electrodes are inserted into the cochlea and a muscle near the ear. The speech processor and headset are either worn in a pocket or attached behind the ear.

"A cochlear implant increases the ability for a person to hear," said Jennifer Bakkerud, an audiologist with Loess Hills Area Education Agency 13. "It's not making the hearing normal - the hearing will always be impaired. But it makes access to sound much better."

There is a difference between a cochlear implant and a hearing aid, Bakkerud said. The cochlear implant is an internal/external device and uses the eighth cranial nerve in the ear.

On the other hand, a hearing aid is used outside of the ear, never touches any part of the inner ear and amplifies sound before it is sent into the ear.

Individuals who want a cochlear implant go to an audiologist to determine if they have enough of a hearing loss to warrant a cochlear implant.

"One of the things that they look at before is if the individual benefited from a hearing aid," Bakkerud explained. "If you did benefit from a hearing aid, then you're probably not going to benefit from a cochlear implant."

Both Upchurch and Wellman are profoundly deaf. Upchurch has no hearing in his left year and has minimal hearing in his right ear. Beth said without the cochlear implant, her daughter can only hear very loud noises - such as a car horn - at close range.

The cochlear implant does not prohibit its user from abstaining from physical activities, such as sports. While Upchurch cannot wear the implant for extremely physical sports, such as boxing or wrestling, he is able to participate in football and basketball, and was named an All-American basketball player.

"I thought the cochlear implant would prevent that," he said, "but it didn't."

Lauren also is active in sports, such as softball and volleyball. Beth said her daughter is just as good as many of the hearing students, and the only area of difficulty is communicating with her coaches.

There is a downside, Bakkerud said, associated with the implant. As the surgeon inserts the electrode through the cochlea, the minute hairs in the cochlea, known as cilia, are destroyed.

In a deaf person's ear, the number of hairs that work determine how much residual hearing they have. Once the hairs are destroyed, all residual hearing is lost permanently.

Beth said the risks associated with the implant were worth it.

"It's not as though she (Lauren) would lose a large amount of hearing, because she doesn't have it," she said. "She won't be like you and I, being able to hear every single word; but she does so well with it that I'm starting to lose my (ability to) sign."

- Editor's note: This is the first of a two-part series.