Sound treatment.

Byline: Tim Christie The Register-Guard

As Daisy and Andy Monticelli sit in a waiting area at Doernbecher Children's Hospital in Portland, Daisy looks wistfully at her daughter, Maren, not quite 1 year old, playing on the floor.

The Monticellis are about to turn their baby over to a surgeon who would insert a cochlear implant, an electronic device that will allow Maren - born profoundly deaf - to be a part of the hearing world.

"I just keep looking at her and thinking she's just pure baby," Daisy says. "She'll always have an implant after today."

She pauses, then adds, "But I have no doubt we're doing the right thing."

The Monticellis know the sooner Maren gets an implant, the easier it will be for her brain to adapt to the device, and the sooner she'll catch up to her hearing peers. The longer a child goes without being able to hear, the harder it is to adapt to cochlear implants.

"They don't work particularly well in teenagers or adults who have never heard," said Dr. Bob Shannon, who directs the department of auditory implants and perception at the House Ear Institute in Los Angeles. "Their brains have never developed the pattern processing necessary to understand what sound is."

The use of cochlear implants has grown rapidly in recent years, as Oregon and other states have passed laws requiring hearing screenings for newborns.

About 40,000 people in North America have the implants - of those, about half are children. The number of devices implanted has increased about 20 percent a year in recent years, manufacturers say.

At Doernbecher Children's Hospital in Portland, which does about 95 percent of the implants in Oregon, surgeons did 50 implants last year - a 100 percent increase over 1999 - and are on a pace to exceed that number this year, hospital spokeswoman Tamara Hargens said.

Better screening driving implants

As more infants with hearing loss are identified, doctors and audiologists are advising parents to get implants for their children at younger ages so they can more easily learn to process sound.

Since July 2000, Oregon's 39 largest hospitals have been required to screen newborns for hearing problems and report the statistics to state health officials. But the children themselves weren't identified, leading many infants to go without follow-up care, said Amy Rosenthal, who coordinates the early hearing detection and intervention program in the state Office of Family Health.

The law was revised in January requiring hospitals to list the names of the children, so that state health officials can contact parents and health providers. The goal is to get more testing for children who fail the hearing screenings by 3 months of age, and to enroll those with permanent hearing loss in early intervention programs before they are 6 months.

"Since the law took effect, we're definitely seeing more children with mild to moderate hearing losses, who probably wouldn't have been identified until they were age 5 or older," said Susan Detels, a pediatric audiologist at Eugene Hearing and Speech Center in Eugene.

Before screening, children with profound hearing loss often weren't caught until they were about 2, Detels said. By that age they already have experienced significant delays in speech and language development and never really catch up with their hearing peers, she said.

Hearing loss affects about three of every 1,000 children.

`A big shock'

Maren Monticelli's hearing loss was detected the day she was born, April 22, 2003, at Sacred Heart Medical Center in Eugene.

She failed four hearing screenings before she went home, but her mother didn't believe there was a problem.

"I thought, she was still very young," Daisy said. "So we went home; we really weren't concerned."

On June 2, Daisy took Maren to Eugene Hearing and Speech for more conclusive hearing tests. It became apparent after a few minutes of testing that Maren was profoundly deaf.

Daisy hung her head and cried. She was sad and angry. She wondered, if Maren can't hear, how will we teach her to read? How will she learn anything?

"It was a big shock," Daisy said. "We knew something was up, but I honestly didn't believe Maren was deaf. This was the last thing we expected."

But when the news sunk in, the Monticellis decided their daughter would get a cochlear implant.

"For us there was no question," Andy said.

Talking with signs

That decision is not so simple for every family.

JulieAnn Sutton, 6, is a happy, healthy kindergartner at Washington Elementary School in Eugene.

Her parents, Fred and Natalie Sutton, learned she was deaf when she was 2. They took her to House Ear Institute in Los Angeles for a second opinion when she was 4. When the Suttons asked about a cochlear implant, doctors and audiologists said her chances of success with the device were slim, given her age and reluctance to use conventional hearing aids.

JulieAnn simply prefers to communicate with sign language, her father said. She wears her hearing aids only about 5 percent of the time, and only to be socially acceptable, he said.

"I don't think she likes the noise," Fred said. "Noise is annoying to her. I don't think she can process it."

JulieAnn has become very competent with American Sign Language, a rich language with its own grammar and syntax, slang and colloquialisms, that relies heavily on body language and facial expressions.

The Suttons have taken signing classes, purchased more than 15 signing books and practice all the time. Still, Sutton said he has to ask his daughter what different signs mean, and he finds it difficult to explain complex concepts to her.

"Sometimes you don't have conversations because you don't have the words," he said.

The Suttons have no regrets that JulieAnn did not get a cochlear implant.

"I don't think it's an opportunity missed," Sutton said. "I think we did the right thing for us. She's happy. I'm not going to second-guess myself."

Surgery goes `perfect'

On March 31, the Monticellis arrive at Doernbecher, part of the Oregon Health & Science University complex in Portland, about two hours before surgery.

Andy, a radiation oncologist, says the physician in him thinks Maren will be just fine, but the parent in him is nervous and thinking about what can go wrong.

Maren, meanwhile, hasn't a care in the world as nurses and the anesthesiologist get her ready for surgery. Finally, Dr. Sean McMenomey, the burly, bearded surgeon, stops by for a quick chat before the operation.

In the operating room, just before 3 p.m., McMenomey makes an S-shaped incision behind Maren's right ear to begin the surgery.

The doctor scrapes soft tissue to expose the skull, then uses a high-speed drill to cut a small hole. He looks for key landmarks as he exposes the middle ear, taking care to avoid the facial nerve.

McMenomey exposes the cochlea and drills a hole the size of a pen tip into the snail shell-shaped organ, which holds the hearing nerves. He carves out a recess in her skull about the size of a dime, into which he places a transmitter coil. Then he painstakingly threads an electrode with 22 listening points into her cochlea.

After an audiologist confirms the electrodes are stimulating Maren's hearing nerves, the surgery ends just before 5 p.m. McMenomey comes out to the waiting area.

"The implant went in perfect," he says.

The Monticellis go back to the post-op area to see Maren. She's awake but groggy. They bend down to hold her and give her her binky.

"She looks better than I thought she would," Daisy says.

`Hello, Maren'

Five weeks after surgery, on May 5, the Monticellis show up at Eugene Hearing and Speech to get Maren's cochlear implant activated. The anxiety they felt before Maren's surgery has been replaced by excitement.

"It's almost like starting over with a brand new baby," Daisy says.

They go into a conference room, where pediatric audiologist Kim Niday plugs the processor of Maren's cochlear implant into a computer.

Maren fusses on her father's lap as Niday begins testing the device, setting maximum and minimum levels on the 22 electrodes inside Maren's cochlea. As Niday tests different tones at different frequencies and volumes, Maren blinks her eyes at the sounds, looks around and smiles.

Now comes the moment of truth: Niday turns on all 22 electrodes, and Maren's father utters the first words that she will ever hear. "Hello, Maren."

"What's going on?" Daisy asks.

Maren looks around. She cries briefly, stops, then calms down.

"What is all that noise?" her mother asks. "Where is that coming from?"

It is the start of what will be a long journey for Maren as she learns to make sense of the sounds coming into her head. She'll get intensive follow-up care from audiologists and pathologists, as well as her teachers and parents. But for now, she's enjoying her new sense.

Maren beats on a bongo drum, then smiles and laughs as the sound waves make their way from a microphone to a processor to the series of electrodes inside her cochlea.

"The next toy she gets," Andy says, "is a drum."

CAPTION(S):

Maren awakens after the two-hour surgery on March 31. About five weeks later, her implant was activated.