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January 29, 2005

Cochlear implant helps woman enjoy the sounds of life

From: USA Today - USA - Jan 29, 2005

By Vicki Cheng, The News & Observer of Raleigh

CHAPEL HILL, N.C. — By the time Ruth B. Miller learned what a sigh sounded like, or how to whisper, she had raised two girls, earned a master's degree and celebrated her 38th wedding anniversary. She worked daily to help young children with disabilities. She was happy, successful and confident, though mostly deaf. She was 59 years old.

The last time she heard well, she was 17 months old. After a high fever, she stopped making sounds. When she cried for her parents, they would call out that they were coming, but the baby no longer responded.

Nearly six decades later, Miller became one of 25,000 Americans to receive a cochlear implant. A tiny microphone and computer processor worn outside her ear deliver electric signals through a magnetic coil to an implant under her scalp. That implant, attached to electrodes inserted into her inner ear, stimulates her auditory nerve. The nerve sends signals her brain interprets as sound. As baby boomers like Miller age, demand for the devices is increasing at 20% a year, according to Self Help for Hard of Hearing People, or SHHH.

In the journal she kept about what it was like to discover a completely new sense after a lifetime of dull, blurry hearing, Miller jotted down nearly 100 sounds that were novel and fascinating to her: The "ting" of silverware clicking together. The way a bottle sounds when you uncap it. The many different sounds water can make.

That was in the fall and winter of 2002. Two years later, she has implants in both ears. She owns a cell phone and an iPod. She listens to National Public Radio. She reminds her husband he no longer needs to flap his hand in front of her face to get her attention.

The sense of hearing has changed her life in more profound ways. There has been a shift in her inner self, said husband Perry Miller, a pastor and psychotherapist. Although his wife has always been comfortable with who she is, "the heart wants to be connected to people via sound," he said.

Ruth Miller said she feels more like a participant in the world.

"At different times in your life, there are different things to come to terms with," she said. "When I was a young child and a teenager, those are the times I'd say, 'I like myself.' But if I had a choice, I'd rather not be deaf.'"

Straddling the world between the deaf and the hearing are the people who have profound hearing loss. SHHH estimates that one in every 10 Americans, or about 28 million, suffer from significant hearing loss, a number expected to double by 2030.

About half of those with cochlear implants are children, whose brains adapt more easily to the electrical stimulation, according to SHHH, a Maryland-based consumer organization representing people with hearing loss. Implants help children who are born deaf develop speech and language, said Molly Ann Justus, the Duke audiologist who treated Miller.

But adults — even in their 80s — can benefit from implants, too. Those who spent a lifetime completely deaf are often poor candidates for the devices because the auditory nerve has never passed sound information to the brain, and it may never do so. But people like Miller, whose auditory nerves were stimulated with hearing aids, can be good candidates.

Miller got her first hearing aid at age 6. She could hear loud sounds — a baby crying, a dog barking, or maybe a nearby truck. Without the hearing aid, she couldn't hear much at all.

Growing up in Minneapolis, Miller attended mainstream classes and learned to read lips and to modulate her nasal, monotonous voice with speech therapy training. She did well academically.

By the time she met Perry in college, she was accomplished, and intriguing, he said. "She just did so well, moving around in the world," he said. "Here was a deaf woman who was so gifted." That night, she beat him at pingpong. He was smitten.

Every seven to 10 years, Miller had to upgrade her hearing aids. She always needed the strongest ones on the market. Over time, her doctors believe, the amplified sound damaged what little hearing she had left.

In recent years, Miller got worse at hearing on the phone. At parties, the conversation would jump from one person's lips to another, and background noise made everything confusing. Ruth would fade in those social situations, or fake it, Perry Miller said.

The last time Miller needed another hearing aid upgrade, her audiologist suggested that she look into getting a cochlear implant. After doing her own research, Miller decided to have the operation. She wanted to hear music, to sing, to use the cell phone.

Her husband told her the decision was a "no-brainer." Still, he had anxieties of his own.

"All through our marriage, I've always been so proud of her," Perry Miller said. Her deafness was what made her unique, he thought. "If she becomes a hearing person, am I going to lose some of this specialness I have with Ruth?"

On Oct. 16, 2002, Ruth Miller went to Duke University Medical Center for the surgery. Dr. Debara L. Tucci shaved a little strip of hair behind her right ear. She made an incision that followed the curve of the ear; halfway down the curve, another incision went up toward the scalp. She used a small drill to make the holes she needed to feed the electrodes into the cochlea. She stabilized the implant on the skull and packed tissue around it.

Twelve days later, Tucci removed the stitches and staples. In four to six weeks, after the incision had healed, the computer processor would be turned on.

Tucci said that although doctors can't predict exactly how much someone will be able to hear with an implant, about 90% of patients do extremely well.

Patients who become frustrated and withdrawn because they can't hear become "just ecstatic," Tucci said. "They've forgotten what birds sound like or that you make a noise when you walk. Just the simplest little things. It's a whole big revelation to them."

Miller rarely turns her processors off, except when she's sleeping. The world of sound is a smorgasbord; she devours all she can.

On the first day Miller's processor was turned on and adjusted, her first reaction was, "Oh, my God ... this does not sound like sound as I know it to be," she wrote. "It all sounds so different. I could not distinguish anything that I was hearing. Beeps, squawks and other indistinguishable, indescribable sounds."

Justus said that it's impossible to know exactly what someone with a cochlear implant is hearing. Some of her patients report that voices sound robotic, or like Donald Duck, at first. Then they start to sound normal. Over time, the brain translates buzzes and beeps into speech.

"I don't know how that magic happens," Justus said. "Truly, the brain is plastic."

It took Miller a few seconds to distinguish her husband's male voice from Justus' female voice. In the car, she heard a radio announcer listing the time and temperature. She noticed the different sounds the motor made as it shifted or accelerated. She heard the rumble as Perry drove over a bridge.

"As we approach the house after getting out of the car, the dogs are barking — wow, I don't know if I can stand it," Miller wrote. "It is so loud — what a racket they make. Another sound I hear the dogs make — really heavy breathing — and they are not even panting."

"Water — I didn't know there were so many sounds to water," she wrote. She listened to water splashing in the fountain in their living room, water dripping in the kitchen sink and trickling down the drain, the swishing of the toilet. "It is hard to describe, but it is so rich — before, there was just this dull blurb."

She noticed the different sounds that heels, flats and tennis shoes make on the floor. At the grocery store, she heard a shopping cart's wheels squeak for the first time.

"Such a mixture of emotions," she wrote. "There are tears of joy but also tears of sadness for what has been missed all these years."

Perry helped Ruth practice understanding speech, hiding his mouth while he read to her, so that she couldn't read his lips. Before long, they held their first conversation without using any visual cues. They found they could talk to each other in the car at night — something that had been impossible before.

Ruth got a cell phone. The first songs she heard on Perry's iPod were Bette Midler's "Wind Beneath My Wings" and "The Rose." The tears flowed.

In September 2003, after three denials from her insurance company, Miller convinced a review panel that she should receive coverage for a second implant for her left ear. Insurance companies often pay for one implant but rarely for two, arguing that patients can function with hearing in one ear, Tucci said. The device and the surgery are expensive — the total bill runs about $76,000 per implant, including at least $27,000 for the device itself, Justus said.

That November, Miller received her second implant. Med-El donated the device in return for her participation in a hearing study, and her insurance company agreed to pay the rest of the bill. She can now hear in "surround sound," she said.

Perry Miller's worries about losing the part of his wife that was unique have evaporated.

"To the contrary — it's almost like living with a new woman," he said. "I've always found her a beautiful and exciting woman. There's been this added fresh dimension to who she is."

Ruth Miller has much to practice. She's trying to appreciate music, and to learn to talk socially on the phone, rather than being curt and businesslike.

She still gets teary when she tries to name her favorite sounds.

"So many sounds to hear," she wrote in her journal. "Frogs and tree frogs. Crickets. Birds — I didn't know that they talked to each other, fussed at each other. Rain on our metal roof. Roll of thunder."

© Copyright 2005 USA TODAY, a division of Gannett Co. Inc.