At St. Paul's Hospital, cochlear implants create sound where once there was silence

Erin Ellis, Vancouver Sun 



“So weird. You sound like an alien,” Justine Haines told her audiologist on Monday.

It wasn’t a flip comment, but instead the best description she could find for the first sounds she just heard through a new cochlear implant, louder and much different than the limited range of sound she’d heard since childhood through a hearing aid.

“It’s something you can’t really explain,” she said a few minutes later. “It’s like — wow.”

“It feels like a miracle ... I’m trying to take it all in .... I’m trying to calm myself.”

In a fascinating mix of technological advances and the wonder of the human brain’s ability to adapt, 25 British Columbians each year recover a semblance of hearing through the cochlear implant program at St. Paul’s Hospital in downtown Vancouver. This year marks the 30th anniversary of the first cochlear implant in Canada, performed at St. Paul’s on Lucy Philpott of Tumbler Ridge in 1982.

Click here to see a diagram of a cochlear implant

A Sun reporter and photographer followed two patients — 23-year-old Haines, of Victoria, and Gerhard Rempel, 79, of West Kelowna — from their surgeries in September to the activation of their implants about a month later, after their incisions had healed.

Haines has been deaf in her right ear since birth and had limited hearing in her left, in which she wore a hearing aid. She speaks with the rounded, less crisp pronunciation of a person with prolonged hearing loss and is fluent in sign language. Her left ear received the implant because chances of success are greater in an ear that has had some hearing. That’s because a cochlear implant doesn’t create natural hearing, rather it transmits signals to the brain, which must learn to interpret them as different sounds — human speech versus breaking glass, for instance.

Haines wanted the implant so she could hear her two-and-a-half-year-old son, Jesse.

“It never bothered me growing up,” she said before her operation in September, “(but now) I have a two-year-old and he can hear very well.

“My son has changed my life a lot and I want to hear better for him.”

For Rempel and his wife of 56 years, Kornelia, communication had been reduced to short, simple sentences; nothing like the long talks they used to have. Rempel gradually lost his hearing over a number of years and had become completely deaf in his left ear with only 15 per cent of hearing in his right. Dinner-table conversation went on around him, not with him.

“It’s isolating for him and it’s hard for me to see that, because he was always quick with the comebacks. Now he can’t do that,” said Kornelia from his bedside on the day of the surgery.

“We have become very comfortable just being silent, but I hope we will have more conversations again.”

That chance arrived on Oct. 29, just five weeks after Rempel’s operation, when his audiologist fit a battery-powered microphone and speech processor onto his ear and snugged a transmitter on a magnet to the side of his head. The device sends electronic signals to the implant which ultimately reach the brain. (Go to vancouversun.com to see a detailed diagram.)

Three days later, Rempel interrupted his wife and daughter as enthusiastically described the changes they had observed in him.

“Women are more excitable,” Rempel groused in a good-natured way, downplaying his transformation. “I’ve been deaf and dumb so long, you notice the difference.”

The retired land surveyor hadn’t jumped into a conversation in years.

Tests conducted earlier that day showed his formerly deaf ear is now three times better than his “good” ear, which still takes a hearing aid.

That’s a fairly common outcome, explained his audiologist, Cindy Gustin, coordinator of B.C.’s adult cochlear implant program who has worked with implant recipients for 14 years.

“When we see these changes, what we’re really seeing are changes in the brain,” she explained. It has to create new neural connections to make sense of the sounds created by the implant, which are far different from normal hearing.

“At some point your hearing memory kicks in.”

The Operation

In the operating room, ear, nose and throat specialist Dr. Brian Westerberg starts the surgery with an incision behind the patient’s ear, clearing tissue from the bone beneath. As he cauterizes the area, the smell of burning flesh momentarily fills the room.

A nurse readies the implant, two distinct parts are connected to each other: one is a receiver and magnet to be pushed under the skin behind the patient’s ear, the other is an electrode array in a thin flexible tube. It’s worth about $18,000 in the package and runs the health care system between $35,000 and $40,000 per person after surgery and followup care. The receiver and magnet are flat; the first not much bigger than a quarter and the second in a plastic casing the size of a loonie. The array of electrodes, which will ultimately stimulate the auditory nerve, must be threaded into the cochlea, a fluid-filled, spiral structure of the inner ear.

Westerberg begins boring through the mastoid bone behind the ear. The operation would be unthinkable without the huge microscope he uses to guide his hands while an assisting surgeon looks on through a second set of eye pieces. A view through the microscope is shown on a screen behind him.

It’s a full operating room with anesthesiologist Dr. Randy Moore, two operating room nurses, a visiting specialist, resident doctor and a University of B.C. medical student.

Westerberg tells the nurse to note the time when he pierces the cochlea. If he takes too long threading the electrodes into the structure’s snail-shell curves, the cochlea could lose the fluid it contains, rendering the implant useless.

But Westerberg makes the delicate manoeuvre look routine and is soon plugging up the tiny hole with bits of the patient’s own tissue, later leaving the younger doctors to sew the incision shut.

“Doing cochlear implants will be the last surgery that I stop doing because it’s so rewarding,” he says after the operation.

His youngest patient was an infant and his oldest just shy of 100 — although he says the latter operation was not particularly successful because the recipient had been without hearing too long, making it difficult for her brain to adapt.

“It’s like using a muscle. You have to keep it strong,” says Westerberg.

Learning to hear

While a cochlear implant presents us with the magical idea of letting the deaf hear again, it’s still a piece of complex machinery attempting to replace an even more complex part of the body. Whereas tens of thousands of microscopic hair cells pass information to the auditory nerve in people with normal hearing, implant recipients will hear only 24 channels of sound, creating what some describe as a robotic or cartoonish aural environment. But today’s implant is a great improvement from the first-generation device, with its single-channel electrode.

The results of implants are as distinct as each patient, explains audiologist Gustin.

At first, most people hear garbled noise.

“I can hear my own voice. I just can’t understand it,” Rempel said, about 15 minutes after his implant was activated. “It sounds like a foreign language.”

Like a baby hearing sounds for the first time and turning to look at the source, implant recipients must practise listening to sounds and voices, then memorize which one was a car horn and which was someone calling their name.

“People tell us it continues to improve for a long time,” says Gustin.

In the most successful cases, a recipient will be able to understand words without looking at the person who’s speaking. Others will be content with being able to hear sounds like doorbells and ringing phones.

“Do you love me?” Kornelia tested her husband about half an hour after the implant is activated.


“Do you love me?” she repeats.

“Just since you were a high-school girl.”

Go online at www.vancouversun.com to see photos of the surgery and implant activation by Vancouver Sun photojournalist Ward Perrin, see a detailed diagram of a cochlear implant and how it works, and read what makes a good candidate for an implant.


