Cochlear implants: one man’s experience
Recently, I was lucky enough to meet Tom Rice. Tom received a cochlear implant in October of 2013 and is open to sharing his nearly life-long experience with hearing loss. I am indebted to Tom for his willingness to talk about his experience and I stand in complete admiration for his generosity. I also want to thank Marlon Aguilar for producing the video shown below.
I will make a few comments and then let Tom speak for himself. In the first segment, Tom talks about realizing that he was losing his hearing. The changes that he experienced in his late teens and twenties were slow and symmetrical. Hearing loss did not interfere with his life until his late twenties when he first got hearing aids. Tom’s story reminds me of how hard it can be to realize hearing loss even when it is more sudden. David Wright was a South African poet who contracted scarlet fever when he was 7 years old. He wrote a book, Deafness (Harper Perennial, 1994), which I highly recommend. In the first portion of this book, which is an autobiography, he writes, “One would think that deafness must have been self-evident from the first. On the contrary it took me some time to find out what happened….One day I was talking with my cousin and he, in a moment of inspiration, covered his mouth with his hand as he spoke. Silence! Once and for all I understood that when I could not see I could not hear.” In Tom’s case, if someone was talking right to him, he could make out what was said by using all available cues – auditory, lip movements, facial expression and context.
As Tom got into his forties, his hearing continued to decline. And Tom’s hearing loss became a problem whenever he was not in one-on-one situations or in very small groups. In other words, if Tom could not use lip reading, understanding was going to be a challenge. Tom’s hearing loss has been a progressive loss starting from the highest frequencies. Losing the ability to hear high frequencies is common. In fact we all hear higher frequencies at birth than we do by the time we reach our mid-twenties.
The age-related hearing loss of the very highest frequencies has been used both to teenagers’ advantage and disadvantage. To their advantage, teenagers can set their cell phones to use high frequency rings. Teachers, even those in their twenties, cannot hear these frequencies and so the teenagers can get calls without teachers’ knowing it. On the other side, shop owners who want to discourage teenagers from hanging around their stores, can play high frequency sounds that will drive younger people away. The owners as well as the older preferred customers cannot hear the high frequency sounds and therefore are not bothered.
What led to Tom’s hearing loss? Probably a loss of outer hair cells. Remarkably these hair cells are not the sensory cells that connect to the auditory nerve. Instead outer hair cells move the cochlea, increasing the stimulus that inner hair cells are exposed to. Without the mechanical amplification provided by the outer hair cells, inner hair cells do not respond to sounds at reasonable intensities (meaning they could respond to a jet engine 10 feet away but not to sounds of less than about 120 decibels).
Tom received a hybrid cochlear implant, an exciting device pioneered by his physician Dr Bruce Gantz. This device allowed Tom to keep intact the apex of his cochlea, where low frequency sounds are processed. Dr Gantz could thread a wire into the base of the cochlea and then push it only part of the way into the cochlea.
The cochlea has a tonotopic arrangement, meaning that tones are represented in topographic progression from the highest frequencies at the base to the lowest frequencies at the apex.
One of the truly remarkable features of Tom’s story is how quickly he regained his hearing after his implant was turned on (a month after surgery to allow for inflammation to resolve). Tom regained hearing quickly because he had so much previous experience with hearing – 17 years or so before there was any problem. I am sure that this metaphor is hyperbole but I get the sense that Tom’s ability to use his cochlear implant was akin to a person using a knee replacement. Plug it in and go. In contrast, Michael Chorost, an author who lost his hearing as an infant and never heard normally, had a much harder time learning to use his cochlear implant. In his memoir (Rebuilt: My Journey Back to the Hearing World, Houghton Mifflin, 2005), Chorost describes having to be a perceptual Olympian to be able to understand the electrical signals from his implant.
One of the reasons I find Tom’s story is so fascinating is that he speaks a hearing person’s language. He can tell us that the cochlear implant sounded like wind chimes at first. Someone who was profoundly deaf from birth or even from an early age would not be able to translate the electrical signals into perceptions that hearing people are familiar with. Because of Tom’s long experience with normal hearing, he quickly gained great benefit from his cochlear implant. And he can tell us that the hearing provided by his implant is still not normal. For example, Tom realizes that that sound at the end of “boat” is a t, a sound he had not heard for a long time before his implant. At first the sound at the end of boat did not sound like a t, but after some time, Tom’s brain has re-assigned that sound to be a t.
Tom’s hearing is not normal. He still has problems in environments with background noise. The telephone (the gold standard for hearing because it depends only on auditory cues) is challenging. Heavy accents are hard work. Music is enjoyable but it’s not as he remembers it.
Overall, receiving a cochlear implant has been a “game-changer” for Tom. He tells the story of hearing but not understanding whispering when he was young, one of the early signs that his hearing loss was becoming a problem. Now after receiving a cochlear implant, he no longer has to be facing someone to hear them. He can now overhear. That is a big deal. Barbara Stenross writes in Missed Connections: Hard of Hearing in a Hearing World (Temple University Press, 1999) that one of the most impactful problems of hearing loss is the inability to overhear. A great deal of important social information is garnered from overhearing.
[Note added: As I was responding to Dan below, I just came across this perfectly put quote from Michael Chorost’s book: “Social norms are not taught, they are overheard, but the one thing even the most skilled deaf people cannot do is overhear.”]
Hearing Tom say that the walk to get the paper is now “filled with sound” is just priceless. How wonderful.
Enjoy Tom’s story in his own voice: