Who Turned Down the Volume? Chronicles of a Bionic Man
By Bennett L. Pugh

Hearing loss is occurring at a younger age and becoming more prevalent throughout society. Research shows that three in 10 people ages 60 and older and one in six baby boomers have hearing loss. Meanwhile, at least 1.4 million children, ages 18 or younger, have hearing problems and it is estimated that three in 1,000 infants are born with serious or profound hearing loss. Here's a first-person account of how one ASB member underwent a surgical procedure to restore his hearing.

Who can forget the memorable statement from the most famous cyborg of all time, the Terminator. After being denied entry to a police station, he declared, "I'll be back." With shaking hands, I repeated the same phrase as I sat in the pre-surgical waiting area at Methodist Hospital Germantown (Memphis).I had not experienced a worse case of the "yips" since my daughter arrived, as a very light package, two months before her due date. Life would be forever changed at the end of this day and I would become a bionic man, part human and part machine.

An unlikely trio
Rush Limbaugh, Foxy Brown and I seem like a very unlikely trio. The common thread that weaves us into one piece of fabric is that we all lost, and then regained, our hearing. Limbaugh and I experienced Autoimmune Inner Ear Disease (AIED), where the body's immunity system runs so high that it attacks the inner ear with micro-organisms, destroying the tiny hair cells of the cochlea (a spiral-shaped cavity of the inner ear that resembles a snail shell) that enable hearing. Mine was probably due to a childhood illness. It operates in very methodical way, attacking one ear and then the other in a very relentless manner. It can be treated with steroids if it's caught in time, but in my case, it was too late.

Sound travels along the ear canal to the tiny hair cells inside the cochlea, then to the auditory nerve and finally the brain, working like a field of grass blowing in the wind to process the sound. These hair cells can die or become damaged by noise, disease, age or trauma. When that happens, sound travels unevenly, distorting both volume and clarity. Hearing aids are helpful, but amplify the sound along the same pathway over the damaged hair cells. Sometimes, they can overcome these deficits with the built-in microphone, but they enhance all noises, too. For me, they worked, but I knew it was just a matter of time. The answer? A cochlear implant.

A sputnik anchored to the skull
Before the procedure, the surgeon showed me what the implant looked like. I actually held it in my hands and appeared to be a cross between an eel and a tiara. "You're going to put that in my head?" I asked the doctor. Great—a little sputnik anchored to the skull. These devices operate by receiving sounds directly in the cochlea which sends it to the auditory nerve and the brain, bypassing the damaged hair cells. The surgery would be followed by two to three weeks of recovery. Then, a daylong "mapping" session with an audiologist would allow me to be turned on and the device activated.

Cochlear implant surgery involves shaving part of the head and then having a jagged incision made above the ear. The surgeon inserts the implant device and carefully wraps it around the cochlea so that it becomes part of the inner ear system.

The implant has electrodes that process sounds up and down the pitch scale. It's designed to work as instantaneously as normal hearing, as close as technology can come to the natural method. A device called a Digital Signal Processor involves four computers built on a single microchip and is designed to accommodate future upgrades without additional surgery (it can be done by computer).

Creating a "hearing fingerprint"
The mapping was done by a trained cochlear audiologist. Imagine being hooked up to a computer for a full day listening to beeps, tones and eventually voices. It's a tedious process but necessary to set the proper sound reception with the electrode array and to establish a "hearing fingerprint."

Fortunately, I had immediate speech recognition at the first mapping without static or other variant sounds. Initially, voices sounded like Minnie Mouse but then became more mechanical before sounding normal. This occurs as the brain learns to adapt to the new sounds and hearing method.

Is this different than other prosthetic mechanisms? Is it really bionic? The answer to both is yes. With products such as a hip or knee prosthesis or even a pacemaker, the device allows the body part to function as it normally would. The brain still commands the knee to bend or the heart to beat, although with assistance. Here, the cochlear implant, in essence, decodes the sound waves and dictates how and what should be heard. My hearing is the direct result of the work done by engineers and is programmed by their determination of how sound should be processed. Ethical issues abound regarding restoration versus enhancement, but that is a debate for another day. The amazing point of all this is that one of the five senses can actually be replaced and restored.

It's good to be back, back in the routine, back to normal function and back in the hearing world.

—Bennett L. Pugh is a founding member and senior partner in Carr, Allison. He specializes in workers' compensation and Medicare law. He is a member of the National College of Workers' Compensation Lawyers. Pugh has written and lectured on Medicare law for many years. He can be reached at bpugh@carrallison.com.

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