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October 26, 2004

Implant gives a teen's world another dimension

From: The Record - Hackensack,NJ,USA - Oct 26, 2004


For the first 13 years of her life, Claudia DeRocco could not hear birds chirping, clocks ticking or the sound of the letter "s."

Born with a severe hearing loss, Claudia got by with hearing aids, sign language and lip reading. But by the end of June, she was ready to turn the volume up with a cochlear implant.

This device consists of a computer chip and a magnet surgically implanted under the scalp, attached to an electrode threaded into one ear's cochlea (the spiral-shaped nerve center of the inner ear). A speech processor worn behind the ear transmits sounds via the internal electrode to the auditory nerve and brain, bypassing non-functioning parts of the ear. Pioneered about 25 years ago, CIs have gotten progressively smaller and more sophisticated.

The best implant candidates are people for whom hearing aids are not effective and whose auditory nerve is functional. Claudia fit the bill.

Yet surgery was not an easy decision for Carolyn and Ed DeRocco, who adopted Claudia when she was 3 months old. They did not know the extent of her hearing loss until she was nearly 1.

"I was very apprehensive at the beginning because [the implant] will destroy her residual hearing" in the implanted ear, said Ed DeRocco as he, his wife, and son Michael, 15, waited with Claudia at NYU Medical Center shortly before the procedure on Aug. 17. "But I started to realize where she was and where she could be. And she was completely, utterly convinced. The decision was hers."

Claudia, cradling her favorite stuffed dog, was smiling but shaky as she waited for the surgeon, Dr. Anil Lalwani, to come and mark her right ear with his pen and answer last-minute questions.

"There are a lot of things that are difficult with hearing aids," Claudia wrote via e-mail earlier that month. "For example, listening in a group conversation or watching a movie with no closed captions or understanding on the phone. I can't wait to find out what I can hear with my CI."

About three of every 1,000 American infants are born deaf, and others lose hearing to illness or injury. Many such children are candidates for cochlear implants, as are some adults. An estimated 23,000 people nationwide have a CI, including some 10,000 children as young as 1.

"You don't suddenly hear well with a CI; it's a process that takes a lot of fine-tuning and at least a few months for hearing to reach its fully improved level," said Arlene Romoff of Saddle River, author of "Hear Again - Back to Life With a Cochlear Implant," a chronicle of her first year after surgery in 1997. Still, Romoff said her CI has been "a miracle of biblical proportions."

Fifteen-year-old Rebecca Herman of Englewood said her CI, implanted six years ago, changed her life dramatically.

"Now I'm fortunate enough to be able to overhear conversations, communicate on the cellphone and not have ear infections [caused by irritation from hearing aids] anymore," she said. "Also, I can understand the teacher better in the classroom and I was able to improve academically, whereas with the hearing aids, I was going down the curve."

Claudia is an eighth-grader at Lake Drive School in Mountain Lakes, in a program for deaf children that's housed at a middle school to facilitate mainstreaming when possible. It didn't look like that would happen for Claudia. "She's missing an awful lot with hearing aids, and her language keeps her at a disadvantage," her mother said before the surgery.

Now, however, there are more options. Carolyn and Ed are evaluating which of several programs can provide Claudia with the best mix of support services and mainstreaming in academics and extracurricular activities so that she can enter college on an equal footing with her hearing peers.

Over the summer, Carolyn drove Claudia from their Chatham home to NYU's implant center several times for evaluations and to choose among various CI models. Claudia opted for the same kind implanted two years ago into former Miss America Heather Whitestone. The processor (dark brown to match her hair) weighs less than half an ounce and uses disposable hearing-aid batteries.

Claudia emerged from the two-hour surgery dizzy and in pain from the tight bandage around her head. But she was perky on the way home the next day. "I feel like I'm already beginning my new life," she told her parents.

The surgical wound needs to heal for about four weeks before the CI is activated, and then regular "mapping" sessions begin with an audiologist to fine-tune the speech processor.

"Mapping takes place over the child's lifetime," said Carol Zara, coordinator of the children's cochlear implant program at Manhattan's League for the Hard of Hearing. "At the beginning, it's weekly or biweekly for six months. An older child may come three times a year. If you start with a child who's 1, the visits are more frequent because it's so hard to get feedback from such a young child; you're looking for reaction to sound."

That reaction is often quite noticeable. Everyday noises such as the garbage disposal, toilet flushing and thunder startled Rebecca Herman so much at first, she said, that for a long time she turned off her speech processor before flushing the toilet.

Claudia was told she might not start hearing clearly for several weeks, but she understood her audiologist at the very first session.

"She heard words right away. She said we all sounded like Minnie Mouse, including her dad," Carolyn said with a laugh.

That soon improved. And only a week after activation, she was able to understand her mother perfectly over the phone.

"It was cool to hear many things I never heard before," said Claudia, "like in school when my speech teacher and I were doing a listening program, I heard the man cutting the grass outside."

The CI does have limitations. Claudia got an ear mold to more firmly anchor the processor because it fell off during active play. The batteries wear out in just three days, more quickly than with hearing aids. Like Rebecca, Claudia still lip-reads to augment her imperfect hearing, and she cannot wear her processor in or near water, just as with hearing aids.

If her parents had any remaining doubts, however, they've been dispelled by the smile on Claudia's face every time she hears a new sound. "She likes the hearing world," Carolyn said. "She wants it all, and we want her to have it all."


In the near future, more improvements

There are many advances on the horizon for cochlear implants, said Dr. Anil Lalwani, chairman of New York University Medical Center's department of otolaryngology and professor of physiology and neuroscience at NYU School of Medicine. In the coming years, improvements will include:

* Fully implantable devices with no external components.

* Smaller internal devices, which would be especially helpful in young children.

* A less traumatic way to introduce the electrode component into the cochlea, reducing the risk of injury to the auditory nerve cells.

* Design changes that will allow the electrode to "hug" the auditory nerve better.

* The ability to implant children at younger and younger ages.

* Bilateral implants for better sound localization and better hearing in background noise.

* Genetic predictors to help determine who the best or worst implant candidates are.

* A shorter electrode that could be implanted in people whose hearing loss is only in the high-frequency range without impairing their existing low-frequency hearing.

* A way to code sound (speech or music) and present it to the inner ear for greater clarity and better appreciation of speech and music after implantation.

Copyright © 2004 North Jersey Media Group Inc.