Fifteen years ago, about to turn 60, I began to lose my hearing — gradually, then precipitously. Within a decade I was functionally deaf, increasingly isolated and edging toward depression. Today I hear surprisingly well, thanks to a cochlear implant (CI) — a surgically embedded bionic ear and a technological miracle, which is not a word I use lightly. My CI restarted my stalled life. It could do the same for so many people like me. Yet only an estimated 5 to 7 percent of eligible adults in the U.S. who could benefit from a cochlear implant have the device in one or both ears. And as of December 2019, only about 736,000 registered devices had been implanted worldwide.
Hearing aids help many people but are less useful when hearing loss becomes too severe. That’s when cochlear implants could be a remedy. Yet they are still a bit mysterious and are misunderstood, especially by older people wary of surgery. As we live longer, late-onset hearing loss is a serious health problem for our aging population, one that may even contribute to cognitive decline.
Our brains need stimulation, and we need communication. Cochlear implants provide both. Infants as young as 6 months and adults of advanced age can be candidates for the surgery if they have no underlying disease and a healthy auditory nerve. The decisive factor that makes you a candidate: Your hearing loss is so severe that you struggle to communicate even with hearing aids. “Hearing is a major mode of communication,” observes J. Thomas Roland Jr., my surgeon and chairman of the Department of Otolaryngology — Head and Neck Surgery at NYU Langone Health. “If you give that back to someone, the brain is rocking again. It is doing what it is supposed to do.”
Realizing I had hearing loss
It began one night when I was watching Mad Men, the go-to TV series of the mid-2000s. I could barely make out the dialogue. Why would AMC tolerate such bad sound, I wondered? Then I could not follow the eulogies at a friend’s memorial service, began to struggle at the movies and on phone calls, and despaired about not being able to hear my young grandchildren. I was going deaf, and AMC had nothing to do with it. I consulted with doctors, took test after test, bought increasingly powerful hearing aids. Both ears tested below par, the left worse than the right — a serious hearing loss attributed to an antibiotic overprescribed in my childhood, and aging.
Hearing loss, a challenge at any age, throws a sharp curve at those who lose hearing later in life. We have no coping mechanisms — no sign language, no lipreading, and our friends and family relate to us as if we could still hear.
A recently retired journalist, I had always been outspoken. But hearing only an occasional word, I routinely withdrew. I learned the neutral smile, the noncommittal “hmmm,” the agreeable nod. Weary of asking people to repeat things, I often faked it — pretending to hear what I did not — or lapsed into silence.I had to find another way. Like most people, I knew little about cochlear implants. They were not approved by the U.S. Food and Drug Administration until 1984, then permitted only for the profoundly deaf.
“Awareness is poor,” I learned from William Shapiro, the codirector of NYU Langone’s Cochlear Implant Center. He cited studies showing that only 18 percent of the general public is somewhat familiar with implants, and only two-thirds of audiologists — the very people who fit and sell hearing aids. None of the three audiologists I saw when my hearing was tanking mentioned implants; they just pushed for expensive new bells and whistles that would have been as helpful to me as sunglasses at night.
Exploring cochlear implants
I didn’t need an audiologist to tell me that hearing aids could no longer help me. Yet I hesitated. I hated the idea of clunky hardware hanging from my ear, feared surgery so close to my brain (even if peripheral), worried about reports of post-op vertigo or infections. I was particularly adamant about keeping whatever hearing remained in my weaker ear. Surgeons can preserve the residual hearing of some patients, but what about mine? What if my surgery failed and I had forfeited my lingering decibels?
Nobody could reliably predict what sounds my implant would produce — near normal or annoyingly mechanical, as I had read. Would my husband, my friends, my grandkids sound like Donald Duck? There is no sure answer. Each implant patient adjusts differently and hears uniquely.
I delayed surgery, until the residual hearing I so valued had plummeted to near zero. My husband and I concluded I had little to lose and a lot to gain. I would go for it.
Relearning how to hear
In the spring of 2019, I learned from an evaluation at NYU Langone’s implant center why I was a good candidate for the surgery: The key predictor of success is a healthy, active auditory nerve. I had started to lose my hearing only about a dozen years earlier, and because I had worn hearing aids, my auditory nerve was still working. If the auditory nerve is dysfunctional, as it usually is in those long deaf, it cannot send sound signals to the brain. (Many private insurers and Medicare cover implant surgery if hearing aids are inadequate, so candidates must first undergo tests to assess their hearing and speech comprehension, and the condition of their middle ear and cochlea.)
In September 2019, at age 73, I underwent surgery. My worse (left) ear would get the implant, and I would continue to wear a hearing aid in my right.
The procedure went smoothly. Roland, using less risky local rather than general anesthesia, made a small incision behind my left ear, inserted a magnet and a receiver-stimulator into my head, and threaded my implant’s 22 electrodes into my cochlea. The cochlea is a snail-like bone lined with thousands and thousands of hair cells (cilia), which are damaged in deaf people. I was home in a few hours, the post-op pain was minor, the incision healed quickly and is barely visible today. No vertigo, no infection.
My NYU Langone audiologist, Nathalie Chouery, gave me the external parts of the implant system: a sound-receiving gizmo that curls around my ear like a large hearing aid; it contains a microphone, sound processor and battery. A thin wire connects the processor to a disc-shaped magnet that attaches to the magnet inside my head, to complete the circuit. The external parts are easily removed when I sleep, shower or swim.
How does it work? In a healthy ear, the cochlea’s hair cells transmit sound to the auditory nerve, but that’s impossible when the hair cells are injured. With a CI, the sound processor and microphone on my ear collect sound and send it to the implant’s electrodes. They convey signals to the auditory nerve, which relays the message to my brain. The brain interprets the message as sound — eventually.
Two weeks after surgery, Chouery activated and programmed my implant. The moment of truth. She hit the equivalent of the “power on” button, and I heard my first new sounds. Oh my. What sounds they were: roaring air, clangs, whistles and a mumble of unintelligible speech. My brain had to adjust — not my ear but my brain.
We hear with our brains. The ear converts sound to a signal that the brain interprets and understands. Would my brain accept the mechanical intruder? I had my doubts. My implant replaced all those thousands of hair cells with just 22 electrodes, after all.
In those early post-op days, I heard mostly noise. How could my brain do its job with so little information? Then, magically, it did. About two weeks after activation, I was listening to a newscast. Until that night, the anchor, Lester Holt, sounded as he always had, because I heard him through my hearing aid, while my implanted ear whooshed away like annoying background noise. That night, though, Holt’s voice began to sound odd, sort of tinny. I was hearing him through the implant as well as through my hearing aid! My brain was adapting, translating the implant’s weird sounds into familiar language. The beginning of my new life!
I was progressing, hearing more, but not quite normally. It takes time and training to help the brain interpret the implant’s signals. I continued to work with Chouery on comprehension — focusing on distinguishing between words that sound alike, repeating simple sentences, taking multiple-choice tests on what I had heard as I worked my way through online exercises.
My hearing improved rapidly. Over the next several months, tests showed that my understanding of sentences in my implanted left ear went from 6 percent before surgery to more than 70 percent — and on one test, to over 90 percent. Adjusting to the implant can take patients up to a year, sometimes longer. Every experience is different.
My new reality? Conversations are back — no faking or withdrawing. I hear well in small gatherings but not so great in crowded settings with a lot of ambient noise. Amplified sound remains difficult. But the sound of speech is now close to what it was before my hearing loss — somewhat more robotic, but the voices of friends and family (yes, even Lester Holt) are fully recognizable.
A new hearing aid in my better ear syncs with my implant. That improves my general hearing and streams sound directly into both ears, which lets me converse by cellphone and enjoy videos, podcasts and audiobooks. All that was impossible before surgery.
Music, a more sophisticated sound than speech, is distorted for me. While intensive training helps some CI users with music, implants are designed for language and speech comprehension, not for Beethoven.
I miss Beethoven. I miss hearing as I did when I was young. But as we all learn as we age, life is a matter of trade-offs. I was cut off from the world around me. Now I am back in the game. I’ll take it.
Joyce Purnick is an award-winning journalist and former columnist for The New York Times.