In Search of a Cochlear Implant and Beyond

I had my cochlear implant (CI) on the right ear exactly 15 years ago last month. It has been a very productive and gratifying journey, restoring, I would say, more than 75% of hearing in my right ear; much more than I expected.

I first learned about CI in 1984 through an article in the New York Times on March 27th. That morning my associate and research mentor, Jag Gulati, spotted the NYTimes article and passed it to me. By noon, excited by the prospect of the new procedure, our senior mentor and the famous cardiologist, Ed Sonnenblick called the CI surgeon at the NYU Bellevue Hospital who apparently performed the first surgery there to enquire the suitability of me having the CI. As the CI surgeon explained, the procedure was still in its infancy, and told my mentor that if I can respond to a “hello” then I was not a candidate. This was the scenario in mid-1980s. During the next quarter-century, CI hardware evolved from a body-worn crude device to a most sophisticated programmable multi-channel miniature behind-the-ear unit. By the turn of the millennium, CI procedure became mainstream with many hospitals worldwide offering CI surgeries and insurance carriers covering the costs of the procedure and the device.

During the early 2000s, while working in a non-profit science publishing organization, I had access to published research in the Acoustic Society of America journals, which included topics on CI ranging from device mechanics to language perception in implanted users. The society also used to publish distilled information as "layman papers”. I could spend a good part of my lunch hours poring over this material gathering sufficient knowledge on the current status of CI and its future prospects. I also joined a couple of online CI support groups to read first-hand accounts and to ask questions to satisfy my curiosity.

Human brain is like plastic. As one experienced audiologist explained to me, “if you lose a thumb, the tiny part of the brain that used to process the signals from that thumb is taken over by something else and if you ever get a thumb replacement it takes a while for the new thumb to recapture that part of the brain.” Speech processing in the brain is very similar. By the time I was considering the CI, my hearing was gone for well over four decades due to an antibiotic overdose in childhood; and it seemed there was no guarantee that the sense will come back. Nevertheless, I persisted in my search for the CI. 

The next question was which ear, the left one or the right one. Having moved to a digital set of behind-the-ear hearing aids seven years earlier, I could rate my left ear as the best of the two. I had been using hearing aids in that left ear alone since childhood until I switched to dual aids. As it happens, in undergoing the CI, the ear that gets operated on completely loses the sound perception without the external audio device. So, opting the left ear for CI would mean a huge sacrifice because if the CI doesn’t work then I would end up with the one bad ear that has only marginal hearing; a scary scenario. The right ear, the less optimal ear, appeared to be the more optimal candidate for CI.

With sufficient knowledge about CI and enough bravado, I communicated my thoughts to my family, my wife, and two kids. By then, my first son was a college freshman and the second was a high-school freshman, both still requiring my continued support, financially, socially, and academically. I explained to them I was going to make the most important decision and if the CI doesn’t restore a good amount of hearing, I would simply have to go on disability. But, if it works, that would restore a good amount of hearing. I also told them I see my family expanding as they acquire their own families in their adulthood and I do need to improve my hearing capabilities not just for me but for the sake of everyone around me. My wife and kids, at first thought the idea was crazy but once they saw how determined I was, they extended their full support.

I was operated on my right year in New York’s Long Island Jewish Medical Center. I was first tested for my potential candidacy, in which, unlike most other tests, you are supposed to fail to be eligible. The surgery itself was under general anesthesia with an overnight stay in the hospital. As the surgeon explained, the operation involved “drilling a quarter-size hole in the skull to position the receiver part of the device and placing a set of electrodes on the cochlea". I still remember the words the surgeon whispered in my ear before she took away my hearing-aid on the operating table just before the anesthesia took its effect: “You start dreaming now.” A month later, when the incision was cured, I was fitted with the external transmitter, the small electronic device that sits behind the ear with a computational capacity comparable to the chips in the old Pentium computers. Once fitted, the internal device was ready to get activated by the default programs loaded on the transmitter. Finally, the long-awaited moment had arrived.  

At first, I heard nothing, nada. For several minutes I agonized: Is this what I have been preparing for. As the audiologist was trying to explain, I started recollecting what I learned from the online forums: The brain requires retraining. Immediately, I thought up a strategy to attempt to retrain my brain and discussed it with the audiologist. For the next several weeks, I would dedicate three hours each evening to listen to children’s sing-along songs, starting with the Old McDonald series, on the computer, and slowly progress to nursery rhymes. The therapy sessions also included story readings by my wife. Two months into the training, I heard crickets and birds, for the first time. I slowly progressed continuing my three-hour sessions to include read-along audiobooks and finally perfected my hearing, I would say to my satisfaction, a year later. That was an arduous journey, but definitely worth pursuing. A couple of years later, as I was able get along without the extra hearing aid in the other ear, I could claim the bad ear I gave to the CI surgeon was now the good ear. I involuntarily stopped lip-reading completely. 

Have I achieved normal hearing? Hell, no. I neither claim it nor did I anticipate it. CI is not a replacement for normal hearing but helps me get along very nicely. Sometimes I get asked if I am considering a second implant because the lone implant is working significantly well and the second one can add to it. My answer has been, “No, I am waiting for advances in gene therapy in restoring hearing.”