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No longer turning a deaf ear
Lalith Gunewardena is the first patient in Sri Lanka to have had a Cochlear hearing device surgically implanted. When the device is activated in ten days time, Mr. Gunewardena is assured that he will be able to use the phone, listen to television and communicate more effectively with his family and others.

A few days after the operation, a beaming Mr. Gunewardena was eager to share his experience with The Sunday Times. "I have opened the door for others. I want them to know that it is a simple and normal operation. I will be able to advise them that it is not dangerous," he smiles.

The operation was performed by renowned ENT surgeon, Prof. Mohan Kameswaran and assisted by Dr. Devanand Jha, Consultant ENT at Apollo Hospital, Colombo, with the cooperation of J. M. Wickramarachchi and Co., and Cochlear International, suppliers of the technology to Sri Lanka.

The cochlear hearing device is an advanced technology that artificially recreates hearing pathways when a human hearing capability has previously been damaged. Dr. Jha explains further:
Who are best suited for cochlear implants?

a) Post lingual - those who have learned the language and can hear and speak but have become deaf all of a sudden or gradually; and when hearing aids do not benefit them.

b) Pre-lingual - children who are born deaf. The best time for a child to acquire language and speech skills is between ages 1-3 when their brain is the most impressionable. A cochlear implant done during that age is highly beneficial as they would develop speech and hearing as a normal person. The benefit is diminished after 5 years of age and not very effective after 10 years of age.

The Nucleas 3 cochlear implant system is an electronic device that comes in two parts - the implant measuring about 3-4 inches that is placed under the mastoid bone on the side of the head - and the speech processor, an external part that is attached to the back of the ear.

How does it work? The highly sensitive microphone in the external portion picks up sounds and the processor within the same section digitizes sound into coded signals. These codes are processed into electrical signals inside the implant. The electrodes stimulate the hearing nerve fibres that are recognized by the brain as sound.

Procedure
The mastoid bone is opened by a procedure called the 'Cortical Mastoidectomy' and a hole is made in the middle ear (Posterior Tympanotomy) from behind to put in the electrodes of the implant. Thereafter a hole is made in the cochlear (Cochleostomy) through which electrodes are put inside the cochlear. The receiver of the implant is sited on a bed behind where the Cortical Mastoidectomy has been done. The receiver has a magnet in it which couples across the skin to the microphone and speech processor which is worn as an external device. The magnet holds the external device in place.

Ten days after the operation the stitches are removed. Mapping is done three weeks later when the wounds are healed, and the device is switched on. Volume is fine tuned by mapping and the patient hears sounds for the first time. Mapping is normally adjusted over a period of two months. Thereafter it has to be attended to only when the patient is uncomfortable with his hearing level. The device can be switched on or off as the patient desires. Batteries have to be changed every week to two weeks depending on usage.

Hearing will depend on many factors including the length of time a person has been deaf. A post lingual or pre-lingual person in normal cases can obtain an average sentence understanding of 80% after three months and 90% after six months.

Dr. Jha stresses that surgery is only a small part of the process. While rehabilitation for post lingual patients it is relatively short, for pre-lingual patients is long and may involve attention from speech therapists, audio visual therapists and audiologists.

In very rare cases the body may reject the implant which is a foreign body and the patient may suffer an infection. The doctor however assures that the implant being a highly sophisticated/advanced hearing device is bio-compatible and usually accepted by the body.

The procedure has apparently been done around the world during the past 20 years on over 58,000 patients. The patient should be fit for general anesthesia during the routine surgery that lasts about 3-4 hours, requiring a short stay in hospital.

The operation costs Rs 23 lakhs which includes the surgical device. Mr. Gunewardena received support from his family, friends, colleagues, Mr. Mihira Wickramarachchi and the President's Fund.

MAN OF GRIT
Speaking of his childhood, Lalith Gunewardena recalls that his parents did not know of his hearing disability until he was around six years old. From hearing very faintly, he gradually lost all sense of hearing. There were no medical facilities in the rural area where he lived. Nevertheless his parents ensured that he went to school.

Being in a normal school, he admits was rather difficult. "I did not learn sign language or use hearing aids." However, he soon learnt to lip read and once he could read from books, there was no stopping him. "I worked very hard and took my chances with normal children. Those who marked my board/university exam papers did not know I had a hearing problem."

While at school Mr. Gunewardena also showed a keen interest in sports. "I tried very hard and wanted to beat all those who could hear." He soon topped his class in both sports and studies. Soon after graduating from the Kelaniya University he went to India for Archival Studies and later to Indonesia to learn the Dutch language. Subsequently he joined the Colombo University for a Masters programme in the History of Sports, his thesis entitled Sports and Politics in Sri Lanka.

Having also completed a mass communication degree Mr. Gunewardena today has a fair knowledge of Pali, Sanskrit, Portuguese, Dutch, Sinhala and English. "I need those languages to do my job," he says. Mr. Gunewardena is currently Assistant Director of the National Archaeological Society of Sri Lanka. He continues to serve in many sports associations and has authored 22 books on the subject. He was awarded the Sports and Education Trophy by the International Olympic Committee in acknowledgment of his work.

When asked how he hopes his hearing would improve his productivity, he says "I am capable of much more and I want to improve myself further." What he perhaps looks forward to most when his hearing is restored is to do a course in law. "I told myself, I have to do it,” Mr. Gunewardena said revealing the amazing will power that has kept him going all along!

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