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September 25, 2003

Sounds of science, Sept. 24, 2003

From: Zionsville Times Sentinel, IN - Sep 25, 2003

By Matt Hendrix

For the Times Sentinel

Brenna Voils occasionally wishes she couldn't hear as well as she does. The rumble of a nearby train or the hum of her refrigerator are sounds that often irritate her. Then the 26-year-old Lebanon native remembers her life just two years ago.

Until a 2001 surgery improved her ability to hear, Voils relied on lip-reading to maintain conversations with those only feet away from her. A case of meningitis when she was an infant left her with profound hearing loss in one ear and deaf in the other. A hearing aid allowed her to faintly hear some noises, but Voils couldn't even distinguish between the voices of her own family members and could only hear traces of their words.

Her surgery, a procedure to install a cochlear implant, changed everything, she said.

A cochlear implant is an electronic device that provides enhanced sound detection and potential for greater speech understanding to people who have suffered hearing loss so severe that hearing aids would provide little or no benefit. It electrically stimulates the auditory nerve to produce hearing perceptions by using an internal implant and an exterior device, often resembling a hearing aid, that has a microphone, speech processor and transmitter.

"The whole world is so loud," Voils said. "Sometimes it's almost too much to take in, but I love learning the sounds of new things. I am always hearing things I haven't heard before and asking, 'What's that sound?' to whomever is around me."

Only about 50,000 people worldwide have had the surgery, but it's a concept that's been around for years, said Dr. Mario Svirsky, professor of otolaryngology for the Indiana University School of Medicine. French scientists began developing cochlear implants in the 1950s and they were used experimentally in the 1970s. The implants didn't become popular for clinical use, though, until the late 1980s, he said. Now, about 100 cochlear implant surgeries are performed by Riley Hospital for Children and Indiana University Hospital annually.

On Sept. 10, surgeons at Riley Hospital attempted to perform the surgery on Yeahsen John, 1, of Zionsville. They stopped the surgery early because of excessive bleeding, a complication probably related to John's small size. His family will have to wait six months to a year before they can try again, but they still believe the surgery can help their son.

"We're not going to stop until we're satisfied that we've done what's right for him," said mother Lisa John. "Though there were complications, there's still no reason why he can't be implanted." She said the implant will give her son "the opportunity to live a normal life in a hearing world."

The implant alone does not work miracles, though. Its success will hinge on the abilities of the John family and speech and hearing therapists to coach the toddler through his development. After a successful surgery, doctors will wait six weeks for swelling to go down before he can wear the exterior part of his implant. Then he will begin a regimen of twice-weekly speech therapy sessions and monthly "mapping" -- a process similar to tuning an instrument, where doctors adjust an implant so that it digests tones correctly and does not cause discomfort.

"We're very happy to be able to do this while he's so young," said Lisa John. "It should only take a few months for him to catch up verbally with other children his age."

She said parents who take the route she and husband Jimmy have chosen for their son often receive criticism from other deaf children and families, who view cochlear implants as "genocide to the deaf culture." Some critics of the procedure have said it poses a threat to American Sign Language. But some experts who have worked with both children who primarily use sign language and those in more verbal environments said children with cochlear implants usually have less limitations in their everyday lives than those who rely solely on signing.

"Every child learns differently, and some children need sign language," said Cara Kaiser, speech and language pathologist at St. Joseph's Institute for the Deaf in Indianapolis. "But cochlear implants are becoming more mainstream and help people become part of the hearing world. There is no right or wrong decision, but I have seen the success these kids with implants can have."

Svirsky agreed. Studies he and his colleagues have conducted show that cochlear implants enhance English language development in prelingually deaf children, he said. "For children who have the surgery, their speech perception is more intelligible and they develop language faster than their non-implanted peers. Complications are rare and they are almost always treatable. The rate of failure is also very low."

For Voils, the results are already evident. "Her speech is crisper now and she's far exceeded everyone's expectations," said step-mother Vicki Voils. Brenna Voils currently attends the University of Indianapolis and has a new job at a Zionsville daycare center. She said the implant helped make that possible.

For the Johns, it's only the beginning, but it's a challenge they embrace. "You never know when something like this is going to happen to you," said Lisa John, who didn't know for sure her child was deaf until several months after his birth. "But we want him to have as normal of a life as possible, and it's wonderful that we have this option. Not all deaf children qualify physically for this surgery, but we were blessed." Her son's complications may turn out to be a blessing in disguise, if implant technology improves within the next year, as is expected, she said. "We may even participate in a clinical trial if it's something we believe doesn't pose a risk to Yeahsen."

In coming decades, cochlear implants will probably become even more common, Svirsky said. He expects bilateral cochlear implants (implants for both ears) to receive Federal Drug Administration approval within the next few years. Also, the three companies that produce and distribute implants in the United States, and one in France, are all working to develop implants that would be completely internal, he said.

Voils said she's content with the independence one implant has already given her, but she looks forward to such breakthroughs. "If bilateral implants were approved, I'd get a second one right now."

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