A journey into sound

When Andrea Lepore started having trouble hearing her teachers in grade four, she thought it may have been because they were soft-spoken. When her grades began to spiral downwards, her parents assumed she was having problems adjusting to her new school. It wasn’t until the following year that Andrea’s parents and doctors identified the real source of Andrea’s problem – she was losing her hearing.

Doctors at the Montreal Children’s Hospital conducted numerous tests to make sure Andrea was not suffering from a brain tumor, or some other medical affliction that would cause a loss of hearing. Unable to find another explanation, they finally decided it must have been a genetic component that caused her to lose her hearing as a child.

Andrea first got her hearing aids when she was in grade five. Her situation was categorized as “moderate to severe”. Her hearing, she said, was basically stable from the time she started using the hearing aids until she reached the age of 22.

“For a while my hearing was okay, but my discrimination was worse. It was like, the sounds… I knew that they were there but it was more distorted, or unclear, like a kind of static-y radio,” she said.

According to Andrea, hearing can be divided into two separate issues: sound and discrimination.

“It’s not just hearing the loudness of things, but how you are able to discriminate what it is people are saying; how clear it is,” Andrea said.

The hearing aids amplified every sound, Andrea said, which was only helpful to a certain degree. While they helped Andrea to hear basic sounds, the hearing aids could not help her to distinguish one sound from another properly.

Andrea said she found it difficult, with the hearing aids, to distinguish background noise from the sounds in closer proximity. She could hear the sound of people’s voices when they spoke to her, but was unclear about the actual words they were saying.

“One-on-one was okay ’cause I’m a really good lip reader,” Andrea said. “But it was always hard in groups.”

To explain her difficulty with the different levels of sound, Andrea used the example of listening to a car radio.

“If you turn[ed] the music up in the car, the motor of the car, or whatever noises outside the car that the car was making- the rain, or whatever- [were] completely overpowering the music. So it would be very meshed,” she said.

It was because of her dissatisfaction with the hearing aids, and their inability to help her distinguish different sounds, that Andrea decided to go through with the operation to get a hearing implant.

The implant, she said, is a relatively new medical advancement in treatment for the hearing impaired. The procedure involves a micro chip that is implanted into the patient’s head.

“The implant is totally artificial,” Andrea said. “It has nothing to do with my ear.”

Whatever hearing Andrea had left in her ear before the operation had to be destroyed before the microchip could be inserted. The chip, itself, was placed in her head, just behind her ear.

The microchip is connected to a processor Andrea wears on the outside that “looks kind of like a hearing aid,” she said. The processor has a built in microphone and another microphone is magnetically attached to Andrea’s head.

“What they implanted inside is magnetic also, so it’s like these two things are attracted; so that’s how it stays,” Andrea said, pointing to the microphone that stays hidden underneath her hair.

The microphones pick up the sound waves and transmit messages, through the processor, to Andrea’s brain.

“It’s not going through my ear,” it’s going through this implant,” Andrea said. “It goes directly to the brain, without having to pass through the ear canal.”

The processor has approximately 14 electrodes that represent the different frequencies of sound Andrea could be exposed to. At first, Andrea said, she could only hear sounds in terms of their frequencies and she had trouble distinguishing one type of sound from another.

“Like with music,” she said. “The sounds would just be jumping all over the place. I could tell it was music, like the flow and everything, but I couldn’t tell what kind of music it was, what instruments were playing. it was just these random things going up and down.”

Simple sounds would sometimes be confusing because the frequencies would be too similar for Andrea to be able to distinguish what the source of the sound was.

“With water, if it was water [running], or the toilet flushing, [I couldn’t] tell the difference! It would just be like a sprinkle of sounds,” she said.

With her audiologist, Andrea was able to modify the way the frequencies were transmitted to her microchip. She created programs that were specific to her way of hearing.

The programs are saved inside Andrea’s processor and they regulate the way the sound messages are transmitted to her brain.

“We’re constantly fine-tuning.” Andrea said. “I’ve finished now, but I still go for a check-up once in a while.”

There are two different base programs available for people with implants to modify to their own needs: Sequential and Paired. Andrea tried the Sequential program first, but found everything sounded too robotic and computerized.

“Everyone sounded the same when they talked,” she said. “It was like a computer was talking to me. It sounded like a Mickey Mouse voice.”

Although she found it easier to distinguish what people were saying with the Sequential program, Andrea was bothered by the computerized aspect of it.

With the Paired program she found it more difficult to distinguish sounds. After hours of work with her audiologist, Andrea was able to distinguish the sounds using the Paired program, and she found it to be a far more natural sound.

The carefully-designed programs are saved on a computer as a back-up.

“If something were to happen to my implant, and we didn’t have a back-up, I’d have to go through this whole process again,” Andrea said.

Because the programs are transferable from Andrea’s processor to a computer, any changes she makes to her program can be archived and easily accessed at any time.

Andrea said her ability to adapt to the implant programs has to do with the fact she had her hearing as a child. She already had memories of the way certain things were supposed to sound, and she thinks this memory helped her to distinguish sounds more quickly than other people with new hearing implants.

“Sometimes I think, if I didn’t (have that memory), would a person’s voice really sound like that, like how the implant is picking it up. But it does, it is the same.” Andrea said.

Andrea only has the implant in her right side, and she still has only partial hearing in her left ear. Most patients, she said, only get the implant in one side for a number of reasons.

Andrea said most people who decide to have the implant done want to save at least one ear incase another method for hearing restoration is eventually discovered.

“If something comes up in the future, you still have one ear that they can actually (work on).”Andrea said.

“This ear” she said, pointing to her right ear with the implant, “the hearing’s destroyed now, so I don’t know if they’d be able to anything with that (.) I’m reluctant myself,” she said, “to give up two ears.”

The Quebec Government, Andrea said, gives money every year for 80 implant operations to be done. Doing one ear per patient is one way of assuring that the maximum number of patients are able to benefit from the government funding.

“They could only do 40 patients if they were doing two ears per patient.” Andrea said.

Overall, Andrea has found her experience with the implant to be a positive one and she’s thrilled with the hearing ability she’s been able to develop. She is, however, something of a success story as far as the implants go.

“I’m even talking on the phone.” she said. Other patients, Andrea said, have become severely depressed when they found they weren’t able to talk on a cell phone after the operation.

“The phone .,”she said, “you can’t expect that that’s going to happen, even with a regular phone. The fact that maybe it’s a bit better, okay; but you can’t be expecting that it’s going to be all perfect.”

Andrea had to meet with a psychologist at the hospital before having the operation to discuss what her expectations of the implant were. She had to be emotionally prepared to deal with the outcome of the operation, whether her hearing ended up being drastically better or only a minorly improved.

“Some people think it’s just going to fix everything,” Andrea said, “and then they get really depressed. And obviously that affects how well they’re going to adapt to it, and how well it’s going to work for them.”

Andrea, who is now working as a pre-school teacher, says she manages to function very well with her implant. With a class of 19 four-year olds, and only one co-teacher, Andrea said she’s not sure she would have been up to the job when she didn’t have her implant.

“If I was still wearing a hearing aid I would probably feel stress, with respect to the noise and everything.” she said. “I feel like I have less headaches at the end of the day (.) I don’t strain as much, it comes more naturally.”

Andrea credits her parents for having instilled her with such a positive attitude towards her hearing condition.

“When I was getting my hearing aids and everything,” she said, “I don’t think I was upset. You know, I didn’t view it negatively.”

Andrea’s parents, she said, taught her that nothing had changed because of her hearing impairment. They didn’t put limits on her in anyway, she said.

“They show(ed) me that I could do whatever it is I wanted to do, and still continue doing what I wanted to do. (..) that indirectly, directly, I was still the same person . it was viewed very positively.”


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