With special ear implant, man awakened to sound

From: Bridgewater Courier News - NJ - Nov 28, 2004

By STEFANIE MATTESON
Staff Writer

Published in the Courier News on November 28, 2004

SOUTH PLAINFIELD -- When William Spisso, 55, sat down to Thanksgiving dinner with his family Thursday, he had a lot to be thankful for. Deaf since birth, Spisso is the recipient of a cochlear implant -- in essence, an artificial ear -- that allows him to hear well for the first time in his life.

Though he still is getting used to the device -- with no frame of reference, he has to learn the meaning of each new sound -- it promises to bring him out of the silent shell of isolation he has lived in all his life, increase his independence, build his self-esteem and brighten his career prospects.

The quiet, shy man has been married for 21 years to a extroverted woman who has served as his translator, guide and champion. Now he faces the prospect of independence for the first time in his life.

"It's scary," said Spisso, who earns his living as an architectural woodworker, making custom cabinetry for corporate clients.

Though the device was surgically implanted at the NYU Cochlear Implant Center on Sept. 17, Spisso wasn't "turned on" -- his term for the activation of the device -- until Oct. 13. The day is one of the most memorable of his life. He walked out of the implant center into the cacophony of midtown Manhattan's First Avenue at rush hour.

His wife, Theresa, said he clapped his ears over his hands at the shock of the noise. "It was too much for him," she said.

The trip home was a confusing barrage of unfamiliar sounds, for which Theresa Spisso sometimes served as interpreter.

The most mundane sounds were a wonderment: the crinkle of the shrink wrap of his new device, the tap of the plastic coffee-cup lid on the Formica tabletop at Starbucks, the clicking of a car's turn signal.

He is also able to hear himself speak for the first time, and his wife no longer has to stand in front of him to talk to him so that he can read her lips. He can even hear her when she's in the laundry room, she said with amazement.

Spisso suffers from sensorineural hearing loss, which was caused by German measles contracted by his mother during pregnancy. Unlike more common conductive hearing loss, which is caused by the dysfunction of the apparatus that transmits sound energy from the outer to the inner ear, his type of hearing loss, sometimes called nerve deafness, is caused by damage to the hearing mechanism itself.

While conductive hearing loss, in which sounds become fainter, can be helped by a hearing aid, sensorineural hearing loss is harder to treat, involving damage to the snail-shaped cochlea in the inner ear and in particular the "hair cells" that convert sound waves into electrical impulses that stimulate the auditory nerve. The cochlear implant bypasses the hair cells by converting sound waves into electrical impulses.

Spisso has worn a hearing aid since he was 8 -- he still keeps his first hearing aid out of nostalgia for the world of sound it opened up for him -- but it never allowed him to hear well, and in the months before his operation, the hearing aid in his right ear stopped giving him any benefit, a result of the deterioration of the hearing in that ear.

Theresa Spisso had watched her husband become more withdrawn, but she had no idea it was because he had lost the little hearing he had left. The revelation of the cause of his withdrawal, however, had a silver lining: it made him a candidate for the implant, one criterion for which is total hearing loss since it eliminates any residual hearing ability, she said.

"He was withdrawing. He wasn't contributing to the conversation," she said. "I knew something had changed, but I couldn't put my finger on it. It was almost a grieving process."

About 70,000 people worldwide have benefited from cochlear implant technology, which was developed about 20 years ago. The NYU center where Spisso received his implant is one of the largest in the world. In Spisso's case, the $100,000 cost was largely paid for by his health insurance policy, though Theresa Spisso had to go to bat for her husband before the insurance company would approve the expenditure.

"This little thing is like this little miracle," she said, displaying the external speech processor that communicates with the surgically implanted device. Unlike a hearing aid, which because it amplifies sound is of limited use to someone who cannot process the information, a cochlear implant provides useful sound information by directly stimulating the surviving auditory nerve fibers in the cochlea. According to the manufacturer of Spisso's device, Cochlear Americas, almost a third of the recipients achieve 80 percent or higher sentence recognition within two weeks, with performance improving over time.

The device promises to revolutionize Spisso's life. Though he is of normal intelligence, he was forced to attend special education classes because his school system had no accommodations for deaf students. He could never play sports, and though he wanted to join the military, he was classified as 4F.

"From day one, there's been nothing but adversity," Theresa Spisso said.

Fortunately, he has developed his love of woodworking into a successful career, but his chances for promotion have been hindered by his inability to use the telephone.

All that is soon to change, with Theresa Spisso now facing the loss of her primary occupation -- that of caring for her husband -- to an electronic device. But, she said, speaking of the Christmas season, there is no more welcome prospect.

"There is nothing in the store that could be bought that could make me happier than receiving the gift that he can hear," she said.

But before she loses her job completely, there is a lot of work to be done, including daily exercises designed to help her husband recognize fine sound distinctions -- such as the difference between "sheep" and "cheap" -- and break his dependence on lip-reading.

The process is a slow one, and implant recipients need time to adjust to the auditory input. Music is still far in the future: during an interview, William Spisso found even the ticking of a clock to be too loud.

"His brain would be scrambled," Theresa Spisso said of taking it too fast.

In addition to the auditory training with his wife, William Spisso also goes to an audiologist for "mapping" sessions, in which the 22 electrodes in the speech processor, which convert sound into electrical signals, are programmed to provide maximum clarity according to the individual's personal hearing needs.

A speech and language pathologist is also helping him make the most of the new device, Theresa Spisso said.

The biggest hurdle will be the telephone. Though William Spisso now talks on the phone, his wife acts as his translator: as she repeats what the caller is saying over the speaker phone, and he reads her lips. Often callers who have known the couple for some time are unaware of their little deception, she said.

Though some cochlear implant recipients are never able to manage the telephone, Spisso is excited at the new horizons offered by the prospect, including the possibility of advancement at work and talking to his grandchildren.

But for now, he is taking it one step at a time.

"Right now, I'm just like a baby," he said.

Stefanie Matteson can be reached at (908) 707-3136 or smatteson@c-n.com.

AT A GLANCE:

Normally, sound is transmitted along the ear canal to the cochlea, which converts sound waves into electrical impulses. The impulses are then sent along the auditory nerve to the brain. If the cochlea is damaged, a cochlear implant can be used by bypass the usual hearing pathway. Sound is picked up by a microphone, converted into electrical signals by a speech processor and sent to a transmitter on the scalp. The transmitter relays the signals through the skin to a receiver-stimulator implanted in the skull. The stimulator then relays the signal to electrodes, which stimulate the nerve fibers of the cochlea.

Source: The NYU Cochlear Implant Center

from the Courier News website www.c-n.com

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