The Hindu Business Line : From silence to the world of sound

WHEN 17-year-old Durai Murugan, a Plus Two student of a school near Chennai, lost his hearing, following an attack of mumps and a desperate round of visits to medical experts proved in vain, he and his parents attempted suicide by consuming poison. Luckily, they were rushed to a hospital and saved.

Later, when the doctor attending on them found out the reason for the desperate act, he referred the family to Dr Mohan Kameswaran, the Chennai-based ENT (ear-nose-throat) surgeon and Managing Director of the Madras ENT Research Foundation.

The year was 1997 and Dr Kameswaran was just getting ready to do his first cochlear implant procedure, a cure for total deafness. It could be done on Durai Murugan, but the hitch was the huge cost of the implant — Rs 6 lakh then — which his parents could not afford; the father was a clerk and the mother a teacher. Says the surgeon: "I had a frank chat with the parents and told them we don't have any experience and this would be our first case, so would they want to go through with it? He was their only child and the mother said we're willing to die for this chance."

But they had no money, and so the doctor went shopping for a bank loan, which of course was not available. "The boy was very bright and when I asked bank mangers, `why don't you give him a loan and he can repay after completing his education?', they said we have no such provision. We can give loans for a car or a house; if it's not paid we can seize the car, but we cannot take the implant back. This was their logic," recalls Dr Kameswaran.

But one Deputy General Manager of a public sector bank, sensing his immense frustration, offered the doctor a personal loan "without a guarantee." After a dialogue with his wife, the ENT surgeon decided that the Trust would pick up the tab. "She was hesitant as the amount was large and the technology untested, and what if doesn't work."

But she was finally convinced and the surgery was performed. "Three weeks later when we switched on the implant, we were in a room fitted with an AC unit, advertised as `The sound of silence', and the boy said: `Ah, the AC is on'. Then the phone rang in the next room and he said, `Doctor the phone is ringing'."

The boy never looked back, completed his education and is today a software engineer trying to go the US. "He tells me, `Doctor, the first Rs 6 lakh I make, I'll send to you'," says Dr Kameswaran with a smile.

Six years later, Dr Kameswaran's Foundation centre has done 50 cochlear implants, the largest number in India. Explaining how the device works, he says a cochlear implant is called a bionic ear. It brings sound back into the world of the profoundly deaf; those who cannot hear even with a hearing aid.

This is an artificial hearing device, comprising two parts: One that goes in the inner ear and the other that is held in place behind the outer ear. The external device picks up the sound and routés it to a small computer that processes the sound. The device produces hearing sensation by electrically stimulating nerves inside the inner ear.

The speech processor does not just enhance sound levels, as a hearing aid does. Instead, it selects out some of the important information in the speech signal and then produces a pattern of electrical pulses in the patient's ear. (The device gets its name from the inner unit being implanted surgically into the shell-like structure in the inner ear known as the cochlea.)

Its biggest advantage is that the person is able to go back to normal life, though a team has to work with the patient for some time during the "rehabilitation" phase.

In the last six years, hardly 100 cochlear implant procedures have been done in India though it is estimated that over one million Indians require this procedure. "We have a large number of children who are either born deaf or become deaf due to such infections as mumps or measles and this includes adults too," says Dr Kameswaran.

The huge cost of the implant, which he imports from Australia at Rs 5 lakh, is a deterrent to more numbers being done. "In India the patient pays for the device, whereas in the Western countries, either the medical insurance or the government pays for it. In these countries, schools for the deaf have become anachronisms. Children who are fitted with cochlear implants undergo rehabilitation in special audio units for a short period before joining normal schools," says Dr Kameswaran.

Asked why the device should be so costly, he says: "Because of the technology. Ideally we like to implant it in a child who is one year old. So you are looking at a device that has a life span of 100 years. So, it needs matching technology."

The surgery takes about a couple of hours and the child has to be in hospital for two days. The whole package, which includes rehabilitation training and therapy for a year, costs Rs 5.5 lakh.

Stressing the importance of rehabilitation, Dr Kameswaran says that when the implant is switched on, three weeks after the surgery, it is an intensely emotional moment. "If the child is 5 years old, it is his first experience of sound. And for a child it can be a frightening experience... From a world of silence he is moving into a world of sound, and the first reaction is to panic. For the parents it is a very unique and emotional moment as it is for us, the team attending on the child. The parents have waited for this moment for years, and unless you are very hard hearted, it is very difficult for us doctors to keep our eyes dry. Invariably, you also become emotional when the child hears sound for the first time, because this is going to change his life totally," he says.

WhileDurai Murugan could immediately hear the AC, and could say so, for those who are born deaf, it is very different. "For example a child who has lived in the world of silence for five years, cannot talk either. We can give them some lip movement training but they are not hearing and talking. So these children have to go through a proper rehabilitation process and their conditioning starts before the surgery. The team — the ENT surgeon, a speech therapist, an audiologist, and others — works with the child to give him a feeling of confidence and security so the when he panics on hearing the first sound, he knows he is with people he can trust. It is a lot of hard work and not like your work is over after the surgery," says Dr. Kameswaran.

Once the device is switched on, it is as the child is a new born. Just as a new born is not expected to talk till he is one year old, these children too take a year to talk. But after that, they catch up rapidly and integrate very well in schools for ordinary children.

Apart from such infections as mumps and measles, the commonest cause for congenital deafness is consanguineous marriages and "unfortunately in Tamil Nadu we have too many people marrying their cousins. Maybe they keep the money in the family but they also keep the negative genes," says the ENT surgeon wryly.

Stressing the need to implant this device in children around their first birthday, Dr Kameswaran says by the time is child is two, "you won't know the difference. You asked me if the patients have to take it out at night. I have a one-year-old patient who gets up in the night for a feeding bottle. His mother says he first wants to put the device behind his ear, before he takes the bottle. Obviously, he needs the comfort of the familiar sounds around him, before he takes the bottle."

Having done half the total number of cochlear implants in India, this Chennai centre gets patients from Sri Lanka and other neighbouring countries and even as far as Africa. A year ago, he placed an implant for six-year-old Tarshika from Sri Lanka. "Again it was a question of marriage between cousins. She was born deaf and her younger sister too has the same problem. Their grandparents sold their property and family jewels to give her the gift of sound. Next we will be placing a cochlear implant in her sister's ear too," Dr Kameswaran adds.

Though he feels sad he cannot help larger numbers because of the prohibitive cost for most people, he is happy that those who do get the implant do very well in life. He recalls how Durai Murugan had major problems in getting a seat in college five years ago "because he was considered handicapped. Luckily around that time the local MLA, who had lost his speech following a problem with his vocal chords, came to me. After he regained his speech following surgery, he was so grateful he did not know how to repay us. So I promptly sought his intervention in the boy's admission in college. At first the principal resented me for having used `influence'. But after a year, he wrote us a letter saying Durai Murugan was consistently topping the class!"

Response can be sent to rasheeda@thehindu.co.in

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