Hearing with the Heart

She hadn’t seen him since seventh grade, when her family moved from Oregon to California, but the minute Lindsey Higgins started researching a college paper on Deaf culture, Richard McMahan was the first person she thought of.

Even in grade school she’d understood him despite his distorted speech, the result of learning to talk without being able to hear one’s own voice. They’d developed a bit of a mutual crush, passed a few notes in class. But of course when their little brothers got hold of one and broadcast the contents, they’d both denied everything.

“I suppose somewhere in the background [Richard] had something to do with my getting into this field,” Lindsey acknowledges now as she heads into the fourth and final year of California’s only doctorate of audiology (Au.D.) program, a joint curriculum offered by SDSU and the University of California, San Diego (UCSD).

Lindsey’s senior project at Biola University in La Mirada focused on a controversy triggered by the advent of cochlear implants—bionic devices that mimic a healthy cochlea, or inner ear, by converting sound waves into electrical signals the auditory nerve then transmits to the brain.

Children as young as 14 months have received cochlear implants and the potential exists for successful implantation at younger ages. Proponents of the technology hail it as a revolutionary advancement that essentially eliminates deafness. But many in the Deaf community view the implants as unnecessary, risky and a threat to their unique culture. Lindsey knew Richard could provide insight into the subject. He’d spent his life caught between the deaf and hearing worlds.

"What's wrong with me?"

After meningitis destroyed his hearing as a toddler, Richard was accepted into a test group of 10 children surgically fitted with cochlear implants. The 1985 experiment would later merit mention in Lindsey’s audiology textbooks as a watershed event, paving the way to widespread use of the technology in children as young as one year and allowing many to develop nearly normal speech communication skills.

Richard went on to attend a school for the Deaf before being mainstreamed into Lindsey’s fifth-grade class. But even with the implant, he really couldn’t hear accurately enough to understand others or to speak normally himself. Hardly surprising, considering the technology at that point processed only one narrow frequency range, or channel, among the thousands of frequency ranges that contribute to normal hearing.

Bottom line, Richard’s bionic ear never worked well enough for him to fully participate in the hearing community. And because his first school had focused on teaching him to speak rather than sign, he couldn’t communicate with other Deaf people, who didn’t accept him anyway because of his implant.

“What’s wrong with me?” he wondered. “I don’t fit anywhere.”

No wonder Richard was delighted to receive an “out of the blue” message from Lindsey, the girl who’d always made him feel normal. It was great rekindling their friendship and helping with her project. Eventually he began to think they might even have a future together. So in December 2005, the same month Lindsey graduated from Biola, Richard took the next step. “I’ll be driving through California at Christmas,” he messaged her. “Can I stop at your house?”

An unimagined life

Lindsey, at home for the holidays with her family in Santa Rosa, consented, but she found the request a little disconcerting. Would she and Richard still get along in person after so many years? Would she even be able to understand his thick deaf speech?

As it turned out, “I could understand him right away,” she remembers. “My family couldn’t very well, but for some reason I could.” Richard’s visit turned into a two-day stay, and the relationship shifted into high gear. By the following September, when Lindsey arrived at SDSU to begin her graduate studies, Richard had found a job in San Diego and moved there himself.

Suddenly, it seemed, Lindsey found herself living a totally unimagined life. She certainly hadn’t expected to fall in love with her seventh-grade crush, and she hadn’t expected to be pursuing a doctoral degree, either. She’d applied to the competitive SDSU/UCSD audiology program, not ever imagining she’d actually be one of the 10 applicants admitted.

In the past, audiologists needed only a master’s degree. But over the last 25 years, in large part because of rapid technological advances, the profession has evolved dramatically. In 2007, its entry-level requirements were upgraded accordingly. Of the numerous master’s-level audiology programs in California, only SDSU’s School of Speech, Language and Hearing Sciences proved able to accommodate the new standards, by pairing its nationally ranked audiology program with UCSD’s expertise in neuroscience and medicine, along with its authority to confer doctoral degrees.

The resulting four-year, year-round program combines coursework, labs and clinical hours, plus a unique medical rotation enabling audiology students to work with physicians and observe surgeries. A working internship, augmented by online coursework, caps the curriculum.

Her husband's advocate

Aside from holidays, Lindsey would have only one real break in her schedule, a month before the start of her second year, squeezed between summer classes at SDSU and the fall-quarter medical rotation at UCSD. So that’s when Lindsey and Richard got married.

For some time before their wedding, Richard had begun encountering glitches—screeching, shooting pains down his neck—caused by the upgraded 16-channel implant he’d received during high school. No one could figure out what was wrong or how to fix it. He finally got so frustrated he just quit wearing the implant’s external processor. For nine months, Richard couldn’t hear at all, and his speech deteriorated.

Although she had studied cochlear implants with SDSU alumna Sara Mattson, Au.D., Lindsey wasn’t particularly drawn to it as a career emphasis. All that changed when Richard’s implants began malfunctioning.

Lindsey became his advocate, rallying the full resources of SDSU and UCSD hearing and speech specialists. Jacque Georgeson, Au.D., director of SDSU’s audiology clinic, referred them to UCSD Medical Center in Hillcrest. Midway through the ensuing gauntlet of medical tests and insurance tangles, they were referred to Lindsey’s instructor Sara Mattson, who’d established the cochlear implant programming center at UCSD’s Thornton Hospital in La Jolla.

“Sara Mattson, she has been amazing,” Lindsey says. “She took over and started making things happen.”

When it was finally determined that Richard needed a new cochlear implant, Mattson ran tests during the surgery to be sure the new equipment was working correctly and then met with Lindsey outside the operating room to share the reassuring results.

Hearing the sea

Nothing you’ve seen about cochlear implants in popular television shows like “House” is accurate. The entire process is slow and deliberate, allowing time for careful evaluation and decision-making. The surgery is performed by highly talented and experienced specialists. The rehabilitation is thorough and gradual, including multiple clinic sessions to tune and customize the implant.

And then the patient must learn to understand and replicate what he or she is hearing. Previously Deaf toddlers don’t wake up from anesthesia singing nursery rhymes. But the outcomes can be dramatic.

After his surgery, Richard took two semesters of speech and listening therapy at the SDSU Speech and Language Clinic, a community service staffed by SDSU graduate students under the direction of Charlotte Lopes. As a result, Lindsey—and her classmates, too—noticed “a huge improvement” in his speech.

Now a year later, Richard confirms that his new 22-channel implant has given him expanded communicative abilities. For the first time, he’s talking on the telephone and hearing sounds he could never pick up before—water dripping, pizza sizzling, skateboards on concrete, waves on the beach.

Home again in Santa Rosa, Lindsey is fulfilling her fourth-year working internship at a Kaiser facility where she hopes to stay as a full-fledged Au.D. and help establish an implant clinic, much as Sara Mattson did at Thornton Hospital in La Jolla.

“I didn’t think I’d ever want to work with cochlear implants,” she says, “but now I really like working with them. Because I’ve been on the family-member side of things, I know things beyond the clinic. And that’s important. Any audiologist, no matter what they’re going to do, has to know the personal daily-life issues to be able to relate to patients and counsel them. It’s not just about programming their equipment.”

And Richard, who predicts his wife will be a personable and empathetic clinician “like Sara,” certainly knows he can count on her expertise and support as he moves toward a long-deferred career goal of his own. After years of warehouse and production jobs, Richard is looking forward to studying architecture in San Francisco.

“I couldn’t do it before because you have to talk a lot,” he says. “But now what’s stopping me?”

(Read about an alumna whose gift enables students to study at SDSU's School of Speech, Language and Hearing Sciences).