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March 18, 2007

The bionic ear

From: New Haven Register, CT - Mar 18, 2007

Abram Katz , Register Science Editor

With a miniature computer behind her ear broadcasting signals to an electrode in her ear, Lisa Oliveri felt like there were golf balls bouncing around in her head.
It was an unpleasant feeling and a moment of despair.

A surgeon at Yale-New Haven Hospital had cut a small window in the mastoid bone, behind her ear, and inserted a tiny implant into a snail-shaped structure that translates vibrating air into sound.

Oliveri had excelled at Andover, attended Middlebury College, and received a law degree from Boston College — while hardly hearing. She had practiced law in the Connecticut Attorney General’s office with two minimally effective hearing aids.

Now it was 1999 and the cochlear implant was supposed to let her enter an alien world of sound. Other implant users had told her to be patient and practice.

"Everyone with a cochlear implant says the first day will be the worst because everything sounds strange. I knew that for me that would be squared a million times," she said.

But after sensing vibrations rattling the inside of her skull she felt miserable.

"I felt like it was a huge mistake for about five hours. Then it started to get better. My husband put a Beatles song on the radio, ‘When I’m 64.’ At first it was just bumps in my head. Then I heard a little of the beat," she said.

"I got home and turned on the water, rang the doorbell" and created other everyday sounds to see if she could hear.

Her dog’s bark sounded like a gunshot. A toilet flushing felt like a truck had hit the house. Then she took off the external pieces of the implant apparatus and went to sleep.

The next morning she put the sound processor behind her ear, connected the magnetic headpiece to the implant under the skin of her cranium and went for a walk in the woods.

"I stepped on a twig and it cracked. Leaves rustled. It blew me away. Things went up from there," said Oliveri, of Glastonbury.

Oliveri continues to rely on lip-reading and other skills she learned to compensate for profound hearing loss when she was an infant. And she has picked up some American Sign Language.

Still, she may be seen as a threat by some deaf people who want to preserve a culture of silence that developed decades before the advent of hearing aids and cochlear transplants.

Or as the National Association of the Deaf puts it in response to questions, "The NAD supports the right of deaf and hard of hearing children to have early and full exposure to (American Sign Language) as a primary language along with English and they ought to be educated as bilingual and multilingual persons, with regard to reading and writing skills. Deaf and hard of hearing children need to acquire American Sign Language early and with full fluency in order to develop their fullest potential as educated and independent citizens."

"I know a lot of people who prefer signing," Oliveri said. "I understand. A shared language is a strong bond. That culture is very strong. They see that cochlear implants will reduce their numbers. I understand why people who went to deaf schools want to protect that culture," she said.

"But now hearing parents want deaf children to be in the hearing world. There are going to be more children getting cochlear implants. It’s a golden rule on this planet. You respect what other people do," she said.

Cochlear implants seem to be getting more popular.

About 100,000 people worldwide have cochlear implants, 45,000 of which live in the U.S. The demand for cochlear implants is increasing annually by 12 to 14 percent, according to the American Speech Language and Hearing Association.

Moreover, each cochlear implant in a child saves taxpayers about $53,198, and up to $420,000 can be saved in special education costs if a deaf children receives early intervention, based on statistics from the National Institute on Deafness and Other Communications Disorders.

"If I had a baby born deaf today I would get him cochlear implants," said Oliveri, who raised four sons, ages 13, 15, 17, and 20, while deaf.

Oliveri believes her hearing was destroyed when she was a baby. She was hospitalized with a "strep throat." Between a high fever and antibiotics, her cochlea were damaged.

"The basic way we hear is that sound vibrates our ear drums, and the small hearing bones transfer the vibrations to the inner ear," said her surgeon, Dr. John F. Kveton, clinical assistant professor of otolaryngology at the Yale School of Medicine.

The stapes bone, in turn, sends vibrations into the cochlea. The cochlea, from the Greek word for "snail," is a small curved organ filled with endolymph fluid. Sound waves cause the fluid to vibrate. The cochlea is lined with about 16,000 hair-like nerve receptors that wave as the fluid moves back and forth.

The receptor signals feed into the auditory nerve and to the brain.

Oliveri felt vibration through the floor and the draft from opening doors and little else. Children were not screened for deafness then and her condition did not become apparent until she was 2.

"I wasn’t talking and my brother, who is 14 months younger, was."

Her parents did not take doctors’ advice to send her to a deaf school where she could learn to sign.

Instead she got two hearing aids. They amplified the 2 percent of hearing she had left, mostly in the low frequencies.

Oliveri said she is grateful to her mother and father, who taught her to use the combination of lip reading and hearing aids to communicate. "Lip reading is a gift. You have to re-wire your brain to be visual. Auditory is turned into visual," she said.

Friendly teachers sat her in the front row so she could see their lips. She loved to read and did well in all subjects except French. Lip reading does not convey an accent very well.

In college she was on the tennis team, taught skiing and was an avid hiker. She did not do much drinking. "If you’re seeing double it’s hard to lip-read," she said.

College professors in Vermont were sometimes difficult to understand under prolific facial hair. It’s also difficult to lip-read and take notes simultaneously.

"I grew up wanting to be a veterinarian, but I wasn’t good at math or science. They’re more abstract, not like English. Girls weren’t encouraged to go into the sciences, either," she said.

After graduating in 1978, she bummed around in Utah, teaching skiing to special needs children using sign language. She met her future husband there, who suggested that the couple "move east and get real jobs."

"Law school seemed like a good choice. There are many different ways of practicing," she said.

After obtaining her degree in 1984, she took the bar exam in New Haven. Construction near the test room distracted others. All she felt were vibrations.

Oliveri then practiced tax, health and environmental law in an administrative capacity in then-Attorney General Joseph I. Lieberman’s office.

Her children quickly discovered that she could only "hear" them if she was looking at their faces. Tiny hands would gently grab the sides of her head and direct her vision.

She started to think seriously about a cochlear implant after her youngest son started school.

"I had qualms. Most people with implants had normal hearing most of their lives. Auditory pathways in their brains were well developed," she said.

Oliveri understood that she would need to build these pathways as an adult. "It wouldn’t be a hearing issue, it would be a brain issue," she said.

After she turned 40 and started to become farsighted she decided it was time for a cochlear implant.

"A cochlear implant bypasses the damaged sensory cells to restore hearing to the patient," said Patricia Trautwein, director of education with Advanced Bionics of Boston, a manufacturer of implant components.

"It’s a very tiny, sophisticated, computer. A microphone picks up sound and processes it into digital code and then broadcasts it to the implant," she said.

Like any computer, the cochlear implant’s software can be updated, she said. Cochlear devices are designed to accommodate new hardware and software.

The current generation of implants has 120 channels, or bands, or resolution, Trautwein said.

The actual implant is about 1 inch long and one-twenty-fifth of an inch thick. Babies are born with full-sized cochlea, so a child’s implant does not need to replaced as the skull grows.

The processor, which fits behind the ear, powers the inner workings by inducing electricity magnetically, Trautwein said.

Kveton said that after openings are made in the mastoid bone and cochlea, the curved electrode is gently inserted until it lies over the appropriate receptors. Signals emerge from the implant at points in the cochlea that normally would respond. For example, high-pitched signals are emitted at the high-pitch region of the cochlea.

Since some of the cochlear receptors are still active, and some more so than others, the output of the implant must be adjusted accordingly. This "mapping" is performed about a month after the implant.

The earlier a profoundly deaf child receives implants, the more easily the child will learn to speak. If implants are installed by 12 months of age, talking and language are very close to normal, he said.

The device, surgery and the hospital stay generally costs about $60,000 to $70,000, Kveton said.

Medicare reimbursements barely cover the cost of the implant, meaning that hospitals lose money.

"This will probably become a big issue. There will be more demand as the population ages and hospitals won’t do them anymore," he said.

Oliveri felt lopsided with one implant, and she could not localize sounds. So in 2004 she received another implant.

"I really missed having two ears and sound on both sides of my head. A few people are getting two," she said.

Insurance paid for the surgeries. "With two implants the sum of the whole is greater than the parts," she said.

"I love hearing the birds sing, and the wind in the trees," Oliveri said. "I can hear emotions in people’s voices."

Abram Katz can be reached at or 789-5719.

©New Haven Register 2007