The miraculous gift of hearing

From: Malaysia Star, Malaysia - Jul 17, 2005

Universiti Kebangsaan Malaysia celebrates the 10th anniversary of its cochlear implant programme this year. StarEducation learns how the implant works and what a difference it has made to those with hearing loss. KAREN CHAPMAN reports.

IT WAS the most terrifying experience of young Ang Boon Su's life. In just six dramatic days, he lost his hearing and became profoundly deaf.

The 15-year-old had succumbed to a fever and as the days went by, he realised he was finding it more and more difficult to hear what people were saying.

The silence was overpowering. But it wasn't to be permanent as Ang became Universiti Kebangsaan Malaysia's (UKM) first recipient of a cochlear implant under a special programme started in 1995.

Thanks to the cochlear implant, which comprised an electronic device surgically implanted in his inner ear, Ang was able to recover his hearing.

UKM medical faculty dean Prof Dr Lokman Saim, who was part of the pioneer team, explains that the device consists of a signal processor (usually worn on a belt or in the pocket), a microphone (worn as a headpiece behind the ear), an internal coil (surgically implanted in the skull) and electrodes (implanted in the cochlear).

The microphone captures the incoming sound which is transformed by the processor into electrical signals and transmitted to the electrodes.

The signals from the electrodes then stimulate the hearing nerve which sends information about the sound to the brain.

Being able to hear again is something Ang is very appreciative of.

"Life is very quiet when you can't hear. That is why I'm so grateful for this implant.

"The thing I missed most when I lost my hearing was the sound of people speaking. My hearing is more precious to me now," he says.

He had the implant when he was studying in Form Five. During the period that he lost his sense of hearing, he continued attending normal school even though he could not hear a thing.

Ang obtained his degree in Bioscience from Universiti Putra Malaysia in 2002 and started working in the private sector.

"But I felt that something was missing and decided to take up teaching instead. After completing my training, I began teaching Biology, Science and English at a secondary school in Sekinchan, Selangor," he says.

The times when he can't hear are when he removes the microphone (which captures incoming sound) when he sleeps, swims or takes a bath.

Adapting well

Since UKM started its cochlear implant programme, 140 children and adults have had the operation.

Prof Lokman says children who receive cochlear implants at a young age adapt well to the implants. Most learn to comprehend sounds and speech and speak intelligibly.

He adds that it is important for a child to get an implant as soon as possible as studies show that if the inner ear has not received sound for more than four years, the part of the brain used to interpret sound shrinks.

Assoc Prof Dr Kartini Ahmad from UKM's Audiology and Speech Science Department explains that an individual's sense of hearing is critical for speech and language development.

"The earlier the child's brain is stimulated, the faster and better his ability to acquire speech. The early years are the critical period," she explains.

However, there is no time limit for those who become deaf after acquiring speech as some sounds have already registered in their memory.

It is also very important that parents and family members are committed to helping their child after the implant.

"Speech therapy is an important part of the rehabilitation process. Parents must be committed to sending their child for the sessions each week.

"They must also have realistic expectations and know that a tremendous amount of hard work is involved before the child can be taught to speak.

"We have seen parents, usually mothers, who give up their jobs so they can work with the child at home," adds Dr Kartini.

Valene Low's son Tee Le Peng was born deaf. He had the cochlear implant when he was two years and nine months old.

Besides sending Le Peng for speech therapy at UKM after the surgery, Low also took a one-year correspondence course from the John Tracy Clinic in the United States which teaches parents how to impart speech, language and auditory skills to children with hearing loss.

Her commitment and efforts have paid off as Le Peng, who is now 10 and in Year Four, attends normal school and has no problems following what is taught in class.

Le Peng is very articulate and enthusiastically told StarEducation that he enjoys going to school and speaks three languages – Chinese to his father, English to his mother and Bahasa Malaysia to the maid.

He even plays the piano at his mother's encouragement although he is not fond of the instrument.

"Playing the piano helps enhance his hearing. His favourite tune is the theme from the movie Titanic," shares Low who also has a daughter aged 13.

Like Low, Rosnani Mat Kasa is just as committed to her daughter Nur Syafiqah Mohd Nazeri, 8.

"She had the implant when she was four and continues with speech therapy once a week," she says.

Nur Syafiqah was too shy to speak but her mother explains that she likes playing computer games.

Prof Lokman also stresses the importance of undergoing rehabilitative therapy after the surgery.

"Many people think getting an implant means you can hear straight away but that is just the first step.

"To help a child understand what he is hearing, he needs training from the audiologists and speech language pathologists," he explains. "Without that, the sounds would not be meaningful."

Rehabilitation therapy

The right therapy plays a critical role in contributing to the success of cochlear implants.

Dr Kartini, who was also part of the pioneer team, says surgery alone will not guarantee that the implant recipient can hear again.

"It is important to have systematic management as sound has to be taught to the implant recipient," she says.

The cochlear implant device must be programmed individually for the user, explains Assoc Prof Dr Siti Zamratol-Mai Sarah Mukari from UKM's Audiology and Speech Science Department.

This is done once the implant recipient has recovered from the surgery, a process which usually takes three weeks to a month.

"This is called 'mapping' and is performed by an audiologist," she says.

The audiologist sets threshold and comfort levels for the softest and loudest sounds based on information given by the user.

For children, mapping sessions are carried out more frequently during the first three months after surgery.

"The child may have one mapping session a week in the first month followed by once every two weeks in subsequent months. The rate depends on the individual," she says.

Intensive auditory and communication training as well as speech therapy are held each week on a long-term basis.

This is why it is important that parents and caregivers are committed, she adds.

"Parents will be coached on how to maximise their child's hearing via techniques such as speaking to the child without using visual cues.

"This is because if the child continues looking at body language to understand what is said, he will not use his hearing ability," adds Dr Kartini.

According to research carried out by the university's Audiology and Speech Science Department in 2003, 24 children who received cochlear implants are in school.

A total of 83% of the children are in normal school while 11% are in special schools for the deaf.

Education Minister Datuk Seri Hishammuddin Tun Hussein says that there are currently 2,121 students with hearing problems in schools.

Of this number, 1,589 are primary school pupils while the rest are secondary school students.

"These students are being taught by 585 special education teachers in both special education schools and schools which have special education programmes," he said when attending the university's anniversary celebration recently.

Prof Lokman says he still receives SMS (short message service) from Ang now and then.

"It is nice to know he is doing well," he says.

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