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July 4, 2003

Teen one of first to get two cochlear implants

From: The Birmingham News, AL - Jul 4, 2003

Mountain Brook boy triumphs in insurance error

News staff writer

A 13-year-old Mountain Brook boy became one of the first children in the nation Thursday to get a dual cochlear implant, an operation that will allow him to hear for the first time in both ears.

Dr. Audie Lee Woolley and a team of medical experts performed the surgery at Children's Hospital on Jim Hammontree, who was born deaf. Jim got a cochlear implant in his left ear 10 years ago, when he was 3. Woolley placed the second implant in Jim's right ear during a two-hour operation that started at noon Thursday.

A cochlear implant works with a tiny radio transmitter that relays electric signals to a deaf person's auditory nerve. It often provides dramatic improvements in hearing. Former Miss America Heather Love and radio personality Rush Limbaugh have cochlear implants.

Normally, a profoundly deaf person gets only one of these high-tech devices, since that's what insurance usually covers.

But researchers, doctors and patients have started pushing for dual implants that provide stereo hearing. The concept is being studied by the Food and Drug Administration in patient trials.

Jim got his second implant because of an insurance error.

His mother, Anita Hammontree of Mountain Brook, said Viva Health Inc. approved Jim's second implant and then realized it was a mistake.

"I kept saying, 'Now they've got to do it. He's psyched up for it,'" she said.

After hesitation, Viva agreed.

The operation can cost up to $50,000, which includes an implant and months of evaluation and care.

A spokesman for Viva declined comment, citing privacy safeguards, but acknowledged that the insurer normally does not cover a second cochlear implant.

Woolley said about 70 adults in the nation have received dual implants in studies, but the expanded technology has been used on few children.

"He's one of the first in the United States," Woolley said.

Jim now will be part of a medical study to see how well dual implants work with pediatric patients, he said.

The second implant is expected to substantially improve Jim's hearing, said Woolley, who has implanted about 150 of the sophisticated devices at Children's Hospital since 1995.

"We're starting to realize the benefits of hearing with two ears," Woolley said.

The dual implants will allow Jim to determine which direction sound is coming from and will help him sort out and make sense of sounds in a noisy environment. The technology also is expected to help his speech.

Other than the normal risks of major surgery, the only potential problem with having two implants is that they may prevent Jim from taking advantage of future medical breakthroughs, Woolley said.

''We've committed him to the implants," Woolley said. ''If something else comes along, both his ears are used."

Improving technology:

"I think I will hear better," Jim said before his operation.

Talking to Jim with one implant was difficult because it was necessary to speak into the implant in his left ear.

Jim, who will be in seventh grade at Mountain Brook Junior High this fall, has had difficulty hearing voices on the telephone and hopes to hold normal telephone conversations.

Doctors said it probably will be more than a month before Jim actually starts hearing in stereo.

Cochlear implants have been around for about 20 years, but the technology has steadily improved. On Thursday, an implant called a Nucleus 24 Contour was placed under Jim's right ear. It's the smallest implant made, Woolley said.

Woolley peeled back skin and drilled a small hole behind Jim's right ear and into his cochlea, a bony structure in the inner ear shaped like a snail. Woolley uncoiled a barely visible wire with 22 electrodes into the cochlea, which contains Jim's auditory nerve. The wire is attached to an implant that contains a tiny FM receiver.

Jim will wear a microphone behind his ear. It is attached to a tiny transmitter that sends signals through his skin to the receiver, which will stimulate the auditory nerve with the electrodes. The electrodes have the ability to stimulate 22 sites along the auditory nerve, and each of them must be fine-tuned with a computer.

Jim's father, Dr. Lee Hammontree, a urologist at the University of Alabama at Birmingham, said his son loves baseball, basketball, football, water skiing and snow boarding.

"Having a cochlear implant hasn't slowed him down," he said.

Having a second implant will just make more things possible for Jim, his parents said.

"I just can't wait," his mother said. ''It's going to be amazing."

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