On a chilly morning in March, Sandra Lynghamer got in the car with her boyfriend, Ted Emery, to drive to Gundersen Lutheran Medical Center. The trip was short, just five minutes from their house in La Crosse, Wisconsin. But the journey to this point was far longer: Lynghamer had been contemplating this day for nearly 10 years.
Lynghamer wore a pair of black leggings and one of Emery’s blue flannel button down shirts. She didn’t need anything else. She would be home that afternoon if the surgery went smoothly. As she sat in the passenger seat, she felt the emotions bubbling over her: anxiety, excitement, apprehension.
“She’s been waiting for this day for so long,” Emery said. “It’s like being in your eighth month of pregnancy: you’re just ready for it to be over.”
Lynghamer, who was severely hard of hearing, relied on hearing aids and lip reading to communicate with those around her. But on this day, Lynghamer, 58, was embarking on a path that could transform her life. She was having cochlear implant surgery, an outpatient procedure that might allow her to hear clearly for the first time in decades.
The surgery offers both enormous possibility and uncertainty. A cochlear implant is a small electronic device that can offer partial hearing ability for people with severe to profound hearing loss. According to the National Institute on Deafness and Other Communication Disorders, about 118,000 adults and 65,000 children have received cochlear implants in the US since their approval in the 1980s. But the benefits of the implant vary considerably from one patient to the next. Some achieve a much greater level of hearing clarity than others. Lynghamer knew that she would have to endure months of rehabilitation to yield results. And there was no guarantee that her hearing would be restored.
As they pulled up at the hospital, Lynghamer worried about what lay ahead. After the surgery, she would have to wait a month before her implants were turned on. That meant a month without hearing aids, a month without sound. “How am I going to be able to communicate with my family?” she wondered.
Regina Presley, an audiologist at Greater Baltimore Medical Center who has been working with cochlear implant patients for over 20 years, said that no one should view cochlear implants as a quick fix for hearing loss.
A cochlear implant does not cure deafness. The device provides electric signals in place of normal hearing. It takes time for the brain to learn how to interpret this electrical information. Some patients wait months to experience the full benefits from their implants. Generally, more severe and longer duration of hearing loss means a lengthier period of adapting to the implant.
“What this patient is about to embark on is tremendous; she is just at the beginning stages of a journey to improve her hearing health,” Presley said. “But it’s also not something that just happens overnight. It’s going to take time to see that improvement.”
At 8:30am, Emery kissed Lynghamer goodbye in the hospital waiting area.
The operation would last about four hours. During the procedure, the surgeon would make a small incision behind Lynghamer’s ear and insert a tiny electrode into her cochlea, the inner ear nerve that converts sound vibrations into neural messages for the brain. The surgeon would then secure an internal receiver to Lynghamer’s skull underneath the skin. This same process would be repeated for the other ear. The external device, which would sit behind Lynghamer’s ear, would serve as a microphone that picks up sound, processes it, and sends it to the internal device.
Lynghamer changed into a surgery gown and felt peace wash over her as a nurse wheeled her into the operating room.
“I want to hear the leaves rustling in the wind, the birds chirping in the yard,” she had said, envisioning her new life. “I want to go stand in a McDonalds playhouse and just listen to the noise. I want to hear the happy, laughing children.”
The time was 10:30am. Lynghamer was ready. She inhaled the anesthesia.
Lynghamer began to lose her hearing more than 20 years ago. She was in her late 30s when she and her family began to notice that she wasn’t hearing the sounds around her. “It’s a hard thing to explain, the feeling of not hearing,” she said. “But I would go outside, and I’d be watching the birds chirp and I’d realize, I don’t hear them.”
She had worked in a loud electronics manufacturing factory for nearly a decade and suspected that may have damaged her hearing. Doctors said genetics may have also played a role since her younger sister suffers from mild hearing loss.
As sounds and conversations faded, Lynghamer began wearing hearing aids and relying on lip reading. But her hearing continued to deteriorate.
“I’ve got the highest quality of hearing aids available, but they don’t really work anymore,” she said. Communicating became harder. She had to stand face-to-face with people so she could read their lips. Misunderstandings became common, leaving her feeling anxious and unsettled.
The pandemic – and the proliferation of face masks – made things worse. She could no longer read lips in public places. She stopped going shopping alone.
“I don’t want to look dumb,” said Lynghamer, who began to feel increasingly isolated and frustrated that her hearing aids no longer seemed to help. “I also don’t want to look like I don’t care what someone is saying.”
Lynghamer worked as a housekeeper in a senior living apartment complex, and her hearing loss began to affect her work life. She often felt like she was missing out on what was happening around her.
“I’m not the one that people at work come to for help,” she said. “I think that’s because I can’t hear well. People don’t want to repeat things. So I get excluded.”
Her hearing loss also affected her family life.
“I pretty much have to yell at her when I talk to her,” said Donovan Lynghamer, her 26-year-old son. He recalled moments from his childhood – parent-teacher conferences and his high school graduation ceremony – when his mother couldn’t hear what was going on. “It was really hard for both of us,” he said.
Lynghamer’s younger sister, Kelly Wooden, described family gatherings when Lynghamer had trouble following the conversation and would often stop participating altogether.
“She withdraws,” Wooden said. “She gets frustrated, and then she’ll just kind of give up.”
Despite these challenges, Lynghamer felt skeptical when her doctor told her that she was a candidate for cochlear implants. The surgery required multiple follow-up visits, and the closest facility was hours away. It also meant taking months off work to recover. All of this for a procedure that had no guaranteed results. Why couldn’t she just get a better hearing aid?
Fan-Gang Zeng, a hearing loss researcher and the founder of the Hearing and Speech Center at University of California, Irvine, explained that hearing aids and cochlear implants do two very different things.
“We have two major components of our inner ear: outer hair cells and inner hair cells,” he said. “Most hearing problems are related to a loss of outer hair cells, which amplify sound. When those amplifiers stop working effectively, hearing aids can provide electronic amplification.”
But in the case of inner hair cell loss, hearing aids don’t work. “If a person has lost inner hair cells, you don’t have any microphones that can convert the sound into electric pulses,” Zeng explained. “It doesn’t matter how much you amplify the sound – it cannot be transmitted. In that case, cochlear implants are the only game in town.”
In fall 2020, Lynghamer learned that a local clinic in La Crosse had recently started performing cochlear implant surgeries. The procedure would be covered by insurance. She knew then it was time.
“I feel like my loss of hearing is holding me back from a lot of experiences,” said Lynghamer, describing why she finally decided to move ahead. “I want a better quality of life.”
Nearly one month after the surgery, Lynghamer and Emery returned to Gundersen medical center. The implant surgery had gone smoothly, but the weeks of recovery had been challenging. Lynghamer heard next to nothing without her hearing aids and relied on lip reading and a live transcription app to communicate. But the incisions over her ear had mostly healed, and she had started to get used to the feel of the implanted devices on her head.
Now it was finally time for the doctors to turn on – “activate” – the implants for the first time.
Lynghamer reminded herself to keep her expectations low. There was a good chance she would not be able to hear anything distinguishable when they were turned on, since it can take weeks or months before cochlear implant patients start to understand and interpret sounds. And even with time, she had no idea how much hearing ability she could expect.
Brian Kaplan, a surgeon with 18 years of experience performing cochlear implant surgery, explained that the patient’s age and the length of time that a patient has been living with hearing loss are critical factors in determining the success of implants. “Shorter duration of deafness is key,” he said. This is because when one of your senses isn’t being used, that part of your brain actually rewires itself over time to do a different job. This means it may no longer be available for hearing restoration.
“The age of the patient is also a factor, but it’s more related to cognitive status,” Kaplan said. “I’ve implanted many people in their 90s who do wonderfully. I’ve also implanted decades younger who don’t do as well. It’s a function, often, of how well their brain is working. Because the brain has to be able to put together and interpret these new electronic signals coming in.”
Would the implants work? Would she finally be able to hear more clearly? Lynghamer and Emery headed into a small office along with Lynghamer’s audiologist, Lindsey Hoffman, and an assisting medical student, to find out.
Lynghamer tried to stay calm. Keep your expectations low, she told herself.
The audiologist hooked up Lynghamer’s cochlear implants to a series of machines. They started easy, playing a series of beeps directly into her implants that gradually grew softer and softer. Lynghamer passed the test: she could hear even the quietest beeps. A good sign.
Next, it was time for the real test: human voices.
From their machines, the medical team could control the volume of sound that Lynghamer’s implant processors picked up. They started with the volume very low and turned it up slowly.
“I want you to tell me when the sound of my voice is loud, but comfortable,” Hoffman said. “That is what we are aiming for: loud, but comfortable.”
Lynghamer sat silently, concentrating hard. The room was quiet. Everyone waited.
“Tell me when my voice is loud, but comfortable,” Hoffman repeated.
Lynghamer’s eyes widened.
“I can hear that,” she said, shocked. She sat straight up in the chair. “I can hear that!” she repeated more loudly, the excitement in her voice palpable.
She described Hoffman’s voice as robotic, like a computerized version of a human voice. This is normal for cochlear implant patients, whose brains are learning how to understand electrical sound signals.
“This is day one,” Hoffman told Emery. “I am impressed she’s able to hear speech at all. Ninety-five percent of my patients, I would say, just hear beeping.”
Lynghamer was thrilled. She hadn’t expected to hear speech so immediately. And in the weeks after activation, the robotic sounds became more recognizable.
“I’m hearing things that I haven’t heard in years,” she said. “I heard my cat snore for the first time ever. When you pull a Kleenex out of the box, it makes a noise. When you flip the light switch, it makes a noise. When you take a step on the grass, it actually has a sound.”
The experience has been overwhelming. “Certain places are just so loud,” she said. “We went out to eat last week, and I could hear the table next to us, behind us, across the room from us.”
The sudden ability to hear so many new sounds is a sensory overload for the brain, and Lynghamer goes to bed each night with a headache. The sensations are so overwhelming that when she finally turns the implants off at night, she finds comfort in the familiar silence. And certain sounds, like music, are still heavily distorted.
Despite these challenges, Lynghamer knows that she made the right decision.
“It’s just amazing,’’ she said. “I feel alive.”
She now handles tasks she previously passed off to her boyfriend, like making phone calls and dealing with receptionists. She is back at work and said things have changed already. “I feel happier being there,” she said. “It’s so much easier to talk to people at work now, so much easier to connect with people.”
Her son, Donovan Lynghamer, marvels at the transformation.
“It’s bizarre how normal it is now, after 20 years of struggling to communicate,” he said. “This is basically the first time in my life I feel like I’ve been able to properly talk with my mom.”
The road ahead may still be rocky. Lynghamer still struggles with sensory overload sometimes and she may never hear music clearly again. But for now, she savors every moment that she steps outside her front door.
“My favorite thing is when I leave for work in the morning,” she said. “I walk out the front door and I stop, and I just stand there in the yard, listening to the birds chirping.”