The Sounds, The Silence

New London Day, CT - Jul 6, 2003

Technological Improvements In Cochlear Implants Bring Life's Little Noises Into Ledyard Woman's World

By DAVID COLLINS Day Staff Columnist

Liz Cote has been profoundly deaf since the age of 2, the result of a near-deadly bout with meningitis and a life-saving dose of heavy antibiotics.

She kept talking anyway, a lot, and it took some time before her parents, relieved that their daughter survived, realized she had lost her hearing. She was fitted for hearing aids but hated them and eventually just put them in a drawer.

And then she coped, finishing high school by honing her reading and writing skills. She went to college, learned sign language, moved out on her own, started programs for deaf children, married, received a bachelor's degree and raised a family.

She lived in a world of silence, unaware of the sounds most people take for granted - a telephone ringing, a dog barking, rain on the roof - until 2 p.m. on March 3. That's when the sound processor for Cote's new cochlear implant was hooked up for the first time, an event she later described to friends as a "brain blast."

One of the first things she heard was the voice of her mother, who was with her at the time. She heard voices in the office, background music, the dialing of a cell phone and then, the click of the handle opening the car door, the engine, and then later, at home, the dog's collar clicking on its bowl, her sons calling her mom.

"Needless to say, I was exhausted by the time I got to bed that night," Cote later wrote to friends in the first of a series of e-mails she has sent to keep them posted on her progress learning to hear again.

Cote, 38, says the decision to have the implant was one she deliberated for a long while. She knew it would involve a lot of work. She knew it would be a life-changing experience, one that would affect her relations with other people.

"I had 36 years of total deafness. I thought it would be too overwhelming to hear sound again," she says. "My children were nervous about it. All their lives they had a deaf mom."

Cote and her husband Brian live in a rural section of Ledyard and have two boys, 17-year-old Josh and 14-year-old Tyler.

Ultimately, it was a friend's implant that convinced Cote to give it a try. Implants have been available since the mid '80s, and Cote says, when she went with her friend for an appointment, she was impressed at how far technology has progressed since the early systems.

"In October 2002, I decided I had nothing to lose. I'm going for it. And nothing could stop me," she says.

Cote's father, who got involved in programs for the deaf when his daughter was first diagnosed, died in his 40s, in a scuba diving accident. Cote's mother, who always left the implant decision to her daughter, was ecstatic over Cote's choice.

"She said the best days of her life were when I was born," Cote says of her mother, "and when I got the implant."

The cochlear implant restores hearing by directing electrical impulses to the auditory nerve. The implant itself is a small device with a wire tail that is wound inside the cochlea during surgery. The processor, usually a very small device worn behind the ear, picks up sounds and turns them into electrical impulses that it sends through the skin to the implant. Three manufacturers make versions of the system.

Patients respond differently, depending in part on their age, how long they've had a hearing loss and how well they remember sounds and speech. Before an implant is recommended, an assessment is made, in part to insure traditional hearing aids won't work.

While simple sounds can be learned and understood relatively quickly for implant patients, the complexities of speech are much harder to master for those who don't have a memory of them.

It also takes time for people with implants to become more accustomed to the sound of their own speech and improve the way they speak.

For Cote, who can read lips but has little or no recollection of the sound of speech, this has resulted in an aggressive therapy program, with visits twice a week to a speech therapist. Every few weeks, depending on how well she's doing, her program is "mapped" by an audiologist who tries to find just the right balance of frequencies in the 12 channels of the processor.

At the end of the mapping, Cote can select from one of three programs set in the processor and experiment with which works the best.

"I'm like a puppet," she says during a recent mapping session with audiologist Kathy Lessler at the New England Center for Hearing Rehabilitation in Hampton. Her processor was linked at the time to Lessler's desktop computer, and each tweaking of the frequencies could produce changes in Cote's voice, as she adjusted her speech to way she heard herself.

"This is kind of detective work," says Diane Brackett, Cote's speech therapist at the center. "The nice thing about implants is that you can make changes. It's a dynamic thing for people with profound hearing loss.

Brackett says the center is the only one of its kind in the area. Patients come from as far as New York, Rhode Island and Massachusetts. They currently serve 55 patients, 14 with implants.

Cote had her implant surgery at Yale-New Haven Hospital. Her therapists predict she eventually will need far fewer mappings, but will continue, at least weekly, with speech therapy. The surgery and therapy, more than $80,000 so far, have been covered by Cote's health insurance.

Cote predicts it might be a year or more before she can handle telephone conversations routinely. She says her friends already comment on the improvement in her speech.

"I'm learning to hear again," she says. "It takes a lot of motivation."

While her conversation skills improve slowly, she says routine background sounds are now a part of her life. She can recognize the telephone, the ding of the microwave and her husband calling her name. She says she no longer has to watch the teller at the drive-up bank window to determine when it's her turn.

It's not all good. She hates the rap music her kids sometimes play. The background music in stores drives her crazy. She's also discovered how annoying the sound of the shuffling of her slippers can be, so now she picks up her feet.

And she can hear her husband snore.

Sometimes she just turns off the processor and enjoys the silence.

Liz Cote Documented Her Progress In E-mails To Friends After Her Cochlear Implant Was Turned On In March:

. I hear the birds every day outside. I hear the pitter-patter of a steady, light rain as I stand outside with my umbrella. I hear the car engine running. I hear the dog barking down the street. I hear the slam of the car door. I hear the noises of my son's baseball game. The crack of the bat. The "plunk" of the ball into the baseball glove. The umpire declaring "Strike One ...!" The ball which flies past the catcher's mitt and crashes into the wire fence. The cheering of the parents. The birds tweetering in the background. The wind blowing slightly.

. One major turning point occurred last week when I made a comment that I liked my voice on one program over another. Diane, my therapist, was absolutely thrilled because she said that was a HUGE step forward for me. The fact that I can monitor my voice and recognize whether I like the quality of my voice is definitely a good thing! Sometimes I feel like I have multiple personalities when I switch from one program to another.

. I turned on the radio and scanned through the different stations ... just to listen to the different kinds of music. Along with feeling the music, I was able to hear the variety in the music and distinguish between rock, country and perhaps soft rock. I am not hearing music in the true sense of enjoyment yet . . . that will take time.

. The brain is very much like a muscle . . . If I do too much, my brain just goes "pffffffffflllllllt." In that case, I take off the processor and regress into my quiet world for a while! That helps enormously!

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