Family

The world went silent 50 years ago and took away the melody that makes up the rhythm of a child's life:

Mama's voice.

A dog barking to greet the neighbor.

A blue jay kicking up a fuss in a bush outside the kitchen window.

When Teressa Gross was 2, she was given medicine to cure an ear infection. Instead, it attacked her body and left her in silence. She lost all the things, the words and phrases and music, that accompany children as they grow up.

It would take 50 years — and a major shift in the way insurers and society regard treating deafness — for her to rediscover what it means to hear.

"This is just the beginning," Gross said, about an hour after an audiologist turned on the cochlear implant that could help repair what was ruined by the medicine from two generations ago. "It will be hard just getting used to it."

Indeed, her task of relearning how to hear will take months, according to experts who've been studying the success of cochlear implants since they hit the U.S. market in the early 1980s. The longer someone is deaf, the longer the journey toward understanding the sounds the rest of the world takes for granted.

A toilet flush.

A newspaper rustling.

The wail of a train whistle on the 4 o'clock Amtrak run.

"Imagine being able to finally hear all the things we hear and just don't even notice," said her husband, Anniston Star photographer Steve Gross. "Actually, I guess you can't imagine that, really."

He paused. "I mean, what about hearing a bird? She asks, 'What is that?' Well, it's a bird, but what kind of bird? She'll have to learn that they all sound different, that everything has to have its own sound.

"And she's never heard any of it."

When the pair met, he was just starting out at The Star, and she was still living at home with her parents and sisters. They married in 1982, about the time the technology came on board for cochlear implants. They looked into the surgery, but it was $35,000. The cost put it out of their range and practically everyone else's, too.

Time passed, as did the insurance industry's stance on not paying for the implants. The treatment went from being labeled "experimental" to becoming an "elective" procedure. It's only been recently that insurers considered them "medically necessary" and standard care for treating deafness. Its cost today: $85,000.

As insurers and Medicaid and Medicare wrestled with finances, controversy germinated about the implants and whether deafness should be considered a fixable defect or whether it should be accepted, embraced as part of society.

"There was a question of what this would mean to the deaf culture," says Dr. Dennis Pappas Jr., who added the implant to Gross's head. "Nobody's out to destroy the deaf culture, but our job as doctors is to conquer disease and illness.

"This has become a mainstay treatment, and interest is definitely growing."

As of 2006, more than 112,000 people worldwide have received implants, according to the Food and Drug Administration. In the United States, that's about 23,000 adults and 15,500 children, a number expected to skyrocket with the FDA's decision to approve the implants for children as young as a year old.

Medical personnel are identifying children who are deaf and hard of hearing earlier, which gives children a chance to grow up with a sense of hearing, says Paul Millard, principal at the Alabama School for the Deaf in Talladega. School officials have been tracking their students with implants for about six years, and the growing numbers of children who come to school with the devices is increasing interest among other students, he says.

Millard and Pappas have seen a sea change in the way the implants are perceived by advocates for the deaf. Whereas once the implants were considered unethical — a way of diminishing the deaf culture — they are now largely seen as an option.

"What child 20 or 30 years down the road would not have wanted this procedure, if it could have allowed them to hear, to grow up speaking?" Pappas asked. "Who would not want their child to hear?"

Our sense of hearing gets turned on before we're born. Unlike sight, which is the least-developed sense at birth, the ears immediately begin gathering information that, in normal cases, builds an intricate database that stays with us throughout our lives.

The stimuli come in through the outer ear and enter the cochlea, the auditory part of the inner ear. It's the part that looks like a snail's shell, and it sends the signals to the auditory nerves, which pass them on to the brain.

About a month ago, Pappas implanted an electrode on Teressa Gross's cochlea and put a receiver just inside her skull, hugging her right ear. A few weeks after that, she went back to see audiologist Lynn Carmichael, who gave her the external part of the implant: a transmitter that attaches to her head and, with the help of a magnet, the receiver in her head. There's also a microphone and speech processor that drapes over her ear and attaches with a wire to the transmitter.

When Carmichael pushed the button to activate it, Gross's eyes widened to the size of half-dollars. Her husband, who'd been chatting away in the waiting room nonstop for the previous hour, was speechless.

"Steve, talk. Talk," Teressa said, looking up at him. "Say something."

She hadn't heard him speak in their 27 years together. She'd have to wait a few minutes more.

"Is it working?" he asked, standing behind Carmichael and her computer. His wife smiled. Nodded. And listened.

Carmichael calibrated the speech processor and microphone to absorb different levels of sound. For example, one setting is best for music, and the Grosses tried it out the first weekend listening to an ABBA-inspired concert at Music at McClellan. Their list of things to hear seemed as long as the years of silence.

There's always a fear that an implant won't work when Carmichael flips the switch. She said it's never happened to her, but the patients have such hope, such expectations. It's always a relief to see their eyes widen when they get that first burst of sound in her office, which seems quiet to a hearing person but is really teeming with the subtle rhythm of office noise.

The buzz of fluorescent lights.

The tick of a plastic wall clock.

The drone of a central air-conditioning system trying to fight off a 92-degree day.

All are things Teressa Gross had never heard, and all those sounds jockeyed with others to get to the parts of her brain that govern hearing. Known as the Herschel's gyrus, they'd been dormant for 50 years, and it will take some time for them to wake up. It may take even longer for her to learn what all those sounds are and what they mean.

It can be an exhausting bombardment. Doorbells and telephones and thunderstorms. She was amazed at how loud the waves are as they slap against the white sands at the Gulf Coast.

They wind together and form a skein of sounds that had been shut out to her in the same manner as her husband's voice, her sisters' laughs.

"It's going to be a long road," she said, pausing occasionally to ask for help identifying a noise.

A fax machine.

A robin.

The grinding click of a doorknob turning.

Life's sound and fury still surprises her occasionally. Light switches click? "It's going good, not bothering me at all."

Her husband says it was nice to be able to holler down the hall and have her come help change the faucet in the bathroom. That's something people take for granted — being able to ask a spouse in another room for help — but it was a first in the Gross household.

And while those everyday elements come steadily, she wonders about the moments that cannot be recaptured.

Her late mother's voice.

The piano playing at her wedding.

Her son's first cry, as well as every other sound he made on his way to becoming a man and leaving childhood behind.