Suddenly, Sounds

Diagnosed As Profoundly Deaf When He Was 1 Year Old, With Cochlear Implant Surgery, A Toddler Can Now Hear And Speak

August 10, 2009|By Shari Roan | Shari Roan,Tribune Newspapers

Tyler de Lara, 2, thrashes on a gurney, tangled in a hospital gown and IV tubing. A bandage on his head, loosened by his squirming, slips and covers his eyes. His mouth is set in a pout.

Dr. Akira Ishiyama notes Tyler's grimace and says he's pleased. It means there is no facial nerve damage.

Tyler was diagnosed as deaf six months earlier. Now, on an autumn morning at UCLA, he is drifting from a cloud of anesthesia with two cochlear implants in his skull. His parents hope he can finally enter the world of those who hear.

One or two of every 1,000 U.S. children are born profoundly deaf, numbers that have not changed for decades. What is changing, fast, is the number of children under 3 who are receiving cochlear implants, devices that mimic the function of cells of the inner ear.

About 40 percent of such children now get an implant, up from 25 percent five years ago. The number is projected to rise.

Cochlear implants have long been endorsed for adults. But now studies have delivered what many experts say is ironclad evidence that the devices are safe in babies and toddlers and let most children develop spoken language without extensive speech therapy.

"It used to be ... a big, bold move," says Efrat A. Schorr, a psychologist at the University of Maryland. "It's become the standard of care for children with profound hearing loss."

Before implants, deaf children learned American Sign Language or lip reading. Most fared well, although many couldn't speak. Like the de Laras, many families whose kids get implants are discouraged from learning sign language, a trend that will affect the entire deaf community and that some experts fear is a mistake.

Tyler's generation, hearing experts say, will redefine what it means to be deaf.

Designed for people who are deaf or have little hearing, a cochlear implant consists of a removeable headset and surgically implanted pieces. A microphone-speech processor hooked over the ear processes sounds. They are sent to a transmitter that adheres to the head with a magnet.

A receiver inside the skull picks up signals and sends them to electrodes inside the inner ear - stand-ins for the tiny hair cells that, in most deaf people, are damaged. The message moves on to the brain. Tyler was to get two implants, one for each ear.

One week earlier

One day in October at the couple's home in Harbor City, Calif., the boy pounds on an electric keyboard. His mother Marieta de Lara, 39, guesses some of the racket can reach his brain.

A nationwide embrace of programs to screen newborns has meant deaf babies are identified at an average of 2 months to 3 months old, compared with 2 1/2 to 3 years in 1990. The results of Tyler's exam, which were normal, were either wrong or he lost his hearing later on.

By age 1, Tyler was still silent. His pediatrician said not to worry: Boys are late talkers.

One day, shortly after Tyler's first birthday, his father Michael de Lara, now 38, slammed two pans together a few feet from his son. Tyler didn't flinch.

An audiologist told the couple Tyler had some hearing loss and recommended hearing aids. Tyler, almost 2 when the devices arrived, hated wearing them.

Finally, an examination at John Tracy Clinic in Los Angeles, which provides free services to preschool-age children with hearing loss, showed he was profoundly deaf. He was 2 1/2 years old.

The day of surgery

At 7:30 a.m., Ishiyama, Tyler's surgeon, drops by the UCLA pre-op room. "Are you ready?" he asks. "Yes, I am. He is. We are," Marieta de Lara says. Tyler is wheeled away.

Shortly after noon, Tyler, after a four-hour operation, is in recovery, his head swathed in white. "It looks like he's wearing a helmet," Michael de Lara says.

Marieta de Lara talks about the coming weeks: Healing. Turning on the implants. Starting speech therapy. "It's going to be ... like starting over," she says.

"When I call him and he turns his head, that will be progress," her husband says.

3 weeks later

It's the day the implant on Tyler's right side is to be turned on.

Audiologists Denise Nicholson and Shannon White lead the family into a small room. Nicholson puts the microphone and speech processor over Tyler's ear and a transmitter on his head. He pulls it off. They try to distract him with toys. Tyler shakes his head.

They play an airplane video. Tyler pulls the transmitter off and swats his hand at his mother to signal "No!" The audiologist replaces the transmitter. Michael de Lara massages Tyler's scalp to distract him. Offered a new toy, Tyler stops fussing.

"OK," Nicholson says. "It's time to turn it on." She tells the De Laras to speak to Tyler, "so your voices will be the first thing he hears." Michael de Lara: "Tyler, baby." Marieta de Lara : "Tyler." A puzzled look crosses his face. He lowers the toy in his hand to the table and looks up.

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