Learning to Crawl
By Don Mayhew
It's a common misconception that when a cochlear implant is activated, the patient immediately will hear everything crystal-clear.
Birds will sing. Bells will chime. The heavens will open to the accompaniment of harps and violins.
Sorry. Nope. Like most deaf people who choose to have the surgery, Jimmy Bronson won't have a eureka moment.
Instead, the Fresno teacher will spend the first couple of hours after activation trying to decipher a steady stream of beeps running through his head. Are they the audiologist talking? His wife, Michelle? Are the beeps cool air whistling through ceiling vents?
A cochlear implant simulates sound by converting it to electrical impulses that stimulate the cochlea, allowing most users to more easily understand others' speech. But it rarely happens effortlessly.
In July 2002, a little more than a month after the device was implanted in Jimmy's skull, the Bronsons return to Stanford to flip the switch. Their mood is light and excited. A beautiful blue sky heralds a day that's supposed to bring record high temperatures.
Outside audiologist Cache Pitt's office, construction on a nearby building is in full view through the second-floor windows. A dull roar wafts over as trucks come and go, tools pound and heavy equipment beeps as it moves slowly in reverse.
No one notices the hubbub. Neither Jimmy nor Michelle can hear it, and Pitt is busy trying to find a processor with a magnet strong enough to stay attached behind Jimmy's right ear.
Michelle says to Jimmy, "See, I told you, you had a thick skull."
Jimmy says he tried to get a refrigerator magnet to stick to his head.
Michelle says, "I'm going to get Post-It notes that he can attach to his head. So many times, I ask him to pick up some stuff, and he forgets."
Pitt smiles and says they can do whatever they want. The implant will be unaffected.
He turns to his computer and checks to see that the electrodes inside Jimmy's head are working. The next step is to set the lowest level of volume Jimmy can hear, electrode by electrode. Next, Pitt sets the volume as loud as Jimmy can tolerate.
When Pitt reaches an uncomfortable volume, Jimmy blinks hard and pops his eyes wide. He flutters his eyelids in mock pain. Pitt asks if it's too loud. Jimmy says it's hard to tell.
"It's in my head," he says. "It's beeps. It's not speech."
Point and click, point and click, Pitt balances the electrodes. The goal is to make them sound equally loud across the spectrum.
That done, Pitt is ready to activate the implant. Before he does, he turns everything off and asks Jimmy to put his hearing aid in his left ear.
Nobody knows what speech sounds like when a processor is activated. The most accurate description probably comes from people who lost hearing late in life.
"Their answers typically are that it sounds robotic and electrical, very much like a computer would sound," Pitt says. "Some say at first we sound like cartoon characters."
Pitt explains this to Jimmy and says, "Chances are, you won't like it."
Jimmy removes his hearing aid, and Pitt activates the implant. He starts talking to Jimmy, who looks pensive.
"Oh, you're talking," Jimmy says after a moment. "It's a little loud."
Pitt counts to three. Jimmy hears beeps. After a few minutes, he removes the earpiece and puts his hearing aid back in.
"Boy, that's the worst I've ever heard," Jimmy says. "It's almost like there's no soft, no loud. It's very intense. It's right in my ear."
Pitt gives him the bad news: "It's loud? OK. It's barely on."
Jimmy puts the earpiece back on, and within a few minutes, his brain and right ear adjust. The voices of Pitt and Michelle sound alike but are distinctly speech.
Pitt, idly tapping a pen on his desk, wants to make it louder.
Jimmy winces and says, "That's one loud pen rap."
Pitt tests different speech sounds, to see whether Jimmy can differentiate between them.
Jimmy: "That sounds like a beep."
Jimmy: "That sounds like a beep."
Pitt picks up a black screen about the size of a dinner plate and puts it in front of his mouth: "Aaaaaaaaa."
Pitt: "Good. Eeeeeeee."
Pitt shakes his head no, then: "Oooooooooo."
Pitt compares the first hours of activation to leaving a darkened theater on a bright summer afternoon: "You come out afterwards, and you go, 'Owww.' But you get used to it. After a while, it's normal."
Pitt reaches into a drawer and rustles his keys around. Jimmy closes his eyes and winces, as if he ate something sour. Pitt taps his fingernails on the counter. Jimmy says half the time, it sounds like beeps.
Pitt presses on, trying to get the volume as loud as possible. The biggest strides are made early. The more sound implant users can tolerate right away, the better off they are in the long run.
But it's a balancing act. Audiologists don't want patients so uncomfortable that they become discouraged or drained.
Within an hour, women's voices sound like they should to Jimmy. Men's still sound a little hollow. When Pitt calls out "Jimmy" as he's looking the other way, he snaps his head around.
"You heard me call your name," Pitt says. "Good."
He tells Jimmy to push the volume as much as possible and leaves him with a caveat: A headache is a common side effect of the implant early on.
During the next few weeks, it takes time each morning for Jimmy to adjust to how loud the device makes sounds. A squeaking door first thing is murder.
But right away, his life changes in subtle but significant ways. He usually keeps the device on until bedtime.
"I have it on all day, far more than I used to wear my hearing aids," Jimmy says. "I used to arrive home, and I'd take the hearing aids off. I'd only put them back in if friends were coming over."
It wasn't long before Jimmy stopped wearing the hearing aid in his left ear.
"I didn't like the imbalance in volume between ears," Jimmy says. "I was playing with the hearing aid one time, and I accidentally left it off. I didn't notice it for half an hour."
Jimmy can't always separate sounds. But he's learning.
"I can block out some sounds," Jimmy says. "Before, when I was driving and turning, I could hear the clicker, and if I had the music on, the music would overpower it."
Now he hears both.
His progress is slow, sometimes leaving him frustrated.
But within a month or two, Michelle watched her husband become more confident when dealing with hearing people at church, the mall or the neighborhood park. Once he might have merely said hello. Now he's more relaxed, not leaning for- ward and furrowing his brow as he strains to catch every syllable.
"I don't think he understands how much easier it's getting for him," Michelle says. It's better for her, too. She doesn't have to repeat herself as often.
That's important when you have children.
"There are times when everything moves faster," Michelle says. "And I want him to understand me right away. . . . If I have my hands full, I can't sign. I can just speak to him, and he understands."
It's not high on their list of advantages, but the implant helps when they argue.
During a brief disagreement over dinner one night, they didn't sign at all. Neither remembers what the argument was about -- just end-of-the-day, garden-variety bickering.
"Talking is faster than signing," Michelle says. "It was rapid-fire, neither of us signing.
"Before the implant, we would not have been able to do that.
"This was the first disagreement we had where we did not sign or that I had to stop what I was doing to repeat myself by signing.
"Jimmy didn't realize any of it. I went to him afterwards and asked him, 'Did you realize we weren't signing?' He said, 'Are you sure?' "
The first year after a coch- lear device is activated, the patient returns to the audiologist several times to fine-tune the programming and boost the volume.
When Jimmy returns to Stan- ford in October, Pitt first checks the electrodes to make sure they're working. Jimmy blinks rapidly a few times, then rolls his eyes upward, as if being electrocuted. The corners of his mouth tighten, barely concealing a smile.
Pitt laughs and says, "Don't do that. I was going to say, if you're doing that, I'm going home."
They get down to business. Jimmy reports that it's a struggle to get his brain up to speed with what his ears are telling him. But he's noticed steady improvement.
"I'm putting the pieces together," Jimmy says. "I'm figuring out how sound works. Some sound sounds prettier through the hearing aid. But speech was muffled through the hearing aid."
Later, he says, "The implant does 10 times what the hearing aid could do. It does help to have it in my other ear, but I don't want to be bothered."
Pitt completes the adjustment, then takes Jimmy into an auditory studio for a speech perception test. Pitt sits at a control panel outside the room and plays a recording containing sentences spoken by a man in a soothing baritone.
The disembodied voice spouts two-syllable nouns: "baseball . . . toothbrush . . . ice cream . . . cowboy . . . hot dog." Jimmy has trouble identifying them.
It becomes clear how much he relies on lip-reading and conversational context to understand speech. Anyone who thinks an implant is an easy cure should witness this.
Sentences are next.
"They finished dinner on time."
Jimmy shakes his head, unable to decipher the words.
"He got mud on his shoes."
"The police cleared the room."
Jimmy: "The police . . . something."
"The little girl is happy."
Jimmy repeats it verbatim.
Pitt goes into the studio, sits near Jimmy and has him turn the other way. He reads some of the sentences, and Jimmy generally understands more. The longer the test goes, the more practice Jimmy has at this, the better he does.
"It's like my brain can't think fast enough auditorily," Jimmy says.
But Pitt is encouraged. He says it's like building a house: "You don't build the top first. You have a foundation. Keep reading to yourself, listening to things over and over. Take away visual cues and train."
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