Friday, December 3, 2010

Hear and Now

Silence is golden. Silence is beautiful. Our frenetic world assaults us with sound, and it's just nice to hear nothing sometimes. It used to be that silence made me nervous. I kept expecting something to ignite, some explosion to shatter the idyll. Paul and Sally Taylor have spent decades appreciating the silence; they've known nothing else. Both were born deaf. Their daughter, Irene, who has the ability to hear, felt that it would valuable to document the life-changing decision her parents made, at age 65, to undergo cochlear implant surgery.

This, of course, is not a light decision. No surgery is. A cochlear implant is an electronic device that artifically stimulates an impaired inner ear system via electrical impulses. The surgery is performed by an ENT or neuro-otologist who drills through the mastoid bone (which houses the inner ear) and places fiber optic-like cables/electrodes into the cochlea (recall that snail-shell looking structure from anatomy or science class). In other words, an invasive procedure with an implantable receiver that attempts to mimic the electrical processes that occur to allow the perception of hearing.

As an audiologist, I have had several occasions to speak with CI recipients. After the surgery, these patients follow up with someone like me who will first activate, then program or "map" each electrode as the journey begins. The initial visit, where a patient "hears" either again or perhaps for the first time, is indescribable, I am told. I have not had the privilege of performing such, but colleagues have relayed heartwarming stories that get me all misty, especially when the stories involve children who are getting a taste of auditory world for the first time.

The Taylors have spent their lives in silence, but have had productive lives, despite the difficult childhood years of having to learn to communicate through American Sign Language and perhaps other methods such as lipreading. Each began in special schools and were later mainstreamed. Tough road, but later each would find success in their careers, particularly Paul, who would go on to help develop telecommunications devices for the deaf(TDD/TDI).

The couple decide to be implanted after 65 years. 2007's HEAR AND NOW follows their journey after the surgery and their very different rates of success. For one, it is a revelation, a new chapter of discovery. For the other, it's noise, interference. What this documentary does not distinguish is pre-lingual and post-lingual implantation. Meaning, some receive CIs early enough (usually before age 2) so that the development of speech sounds necessary for vocabulary building can progress (admittedly slower than that of a child with a normally functioning ear). A post-lingual implant conversely would involve someone who once heard, had normal language evelopment and perhaps now has the benefit of auditory memory. For example, an adult who loses his hearing has an arsenal of speech he recalls and the process of discerning vowels and fricatives ("s", "t", "th") is, while not easy, certainly less problematic than the other pre-lingual group, folks like the Taylors, who've never "heard" anything, speech or otherwise.

That is a big part of the problem, the other noises. For Sally, it proves to be too much. Her beautiful silent world shatters with this influx of stimuli. Never mind using the telephone or listening to television, even live speech understanding is difficult. For Paul, too, though he adapts a bit better. For both, it's tough sledding. This film does not show all of the (hopefully) sessions of mapping with the audiologist and aural rehabilitation with same or others. This is a shortcoming. If Irene had given us more scenes of the rehab, we might've gotten a clearer picture of such a struggle. Hearing is not a passive skill; it takes work if you suffer any degree of impairment. I could preach for hours about this, and have. While comparing hearing aids and CIs are apples and oranges, both require their users to work. One does not get a surgery, slap on a processor and just hear.

Think about six plus decades of no sound. Your entire existence absent of this precious sense; you have no such reference point. I wonder if the Taylors were counseled extensively prior to the surgery to this effect. That is essential. Still, the magnitude of receiving such new, foreign information after years in the auditory void cannot be overestimated. Some will adapt, some will not.

Despite my minor misgivings, HEAR AND NOW is a fine doc. There are many telling moments, especially the recollections of family and friends. Some relay how cruel people were to Paul and/or Sally as they were growing up. Despite the difficulties, though, they were part of a proud sub-culture. Many individuals who are born without hearing have no desire to attempt to correct it. In fact, they see CIs as an intrusion of their being, an erosion of their culture.

For a pointed look at this conflict, pick up SOUND AND FURY. That doc follows two adult brothers, one deaf, the other with hearing, who both have deaf children. One brother wants his child to be part of the Deaf culture, the other has his child implanted. The film raises questions of whether it is cruel to leave a child deaf if the option to potentially provide hearing exists. You'd be surprised of the differing (and strong) opinions on both sides. I would be interested to hear what Paul and Sally Taylor have to say on the subject at this late date.

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