"It was so noisy and gave me such a headache," Nanthaporn Kulpiyavaja, 19, said using sign language translated to words by her younger sister.

Nanthaporn referred to the world she entered after receiving cochlea implants three years ago.

Born profoundly deaf, Nanthaporn lived in a world with no voices until she was 16 when a public hospital doctor agreed to implant her with an artificial cochlea. Unfortunately, she didn't believe she belonged to the new world of noise introduced to her which cost her parents almost Bt1 million. "I heard all the voices but did not know their meaning," she reasoned as to why she prefers not to use an electronic device that assists her hearing.

Cochlea implantation is regarded as a safe and effective treatment for the profoundly deaf. Besides an artificial cochlea that is implanted inside the patient's ear, there is an external electronic device that sends sound-generated impulses directly to the brain and bypasses the flawed part of the inner ear.

Nanthaporn, a second-year accountancy student at Rajabhat Institute Bansomdej Chao Phraya, could not remember how long she used the electronic device but is sure that the world of voices is not for her.

Her father Preecha said he could never have imagined that his daughter would find her new world so noisy and disturbing.

"I never thought that hearing voices would be my daughter's problem. The doctor never informed us that she would not be able to understand the voices she heard. I believed that once my daughter could hear she would be automatically be able to communicate normally," he said.

Before Nanthaporn had the cochlear implants, the family had to undertake a gruelling schedule of checks and tests for almost a year to make sure she was suitable for the treatment.

"The doctor told us that she would hear everything and would have to train to improve her hearing skills and learn how to talk. What he didn't mentioned was how difficult it would be for a 16-year-old girl who was born deaf to learn such skills," he said.

Preecha now understands that her daughter is not happy in a world of unintelligible voices and has allowed Nanthaporn to discard the device and abandon the hearing and speaking lessons.

The case of Nanthaporn demonstrates the improper use of medical technology, said Dr Yot Teerawattananon, a senior researcher and programme leader of the Public Health Ministry's Health Intervention and Technology Assessment Programme (HITAP). Yot said a doctor must first study carefully the implications for each individual before introducing any technology.

"It doesn't mean that one health technology can be applied to all patients that have the same problem or illness. A doctor must be ethical and use his judgement to introduce the right technology to the right patient," he said.

Yot said cochlear implantation was not the only health technology that was reported as being used improperly, which is why the country needs health-technology assessment.

HITAP was set up last year to appraise a wide range of health technologies, including pharmaceutical and medical devices. Besides cochlea implants, HITAP is now conducting research into the practice of Caesarean sections.

Preferring not to criticise the doctors who treated Nanthaporn, Dr Kiertiyos Komin, head of the Centre of Excellence in Otolaryngology at Rajavithi Hospital, said for children born deaf the cochlea implants would be beneficial only if they were implanted before the age of five and before they had learned to communicate with sign language. Adult or aged people could benefit from cochlea implants only if they were not born deaf but lost their hearing later.

"It is very difficult for those who never heard a single voice in their life to enter into a world filled with voices. Having no hearing or speaking skills, they cannot understand the voices they hear and are unable to correctly pronounce words," said Kiertiyos.

In addition to age and hearing condition, Kiertiyos said the background and circumstances of a patient are part of his criteria when considering whether they would benefit from the device.

Though Preecha spent almost Bt1 million for a device that is now useless, he does not cry over spilt milk.

"At least she has a new life now as she is able to step out of the deaf community and live with normal people who don't have a hearing problem," he said.

Preecha said that, after the implants, the doctor recommended he encourage Nanthaporn to study and spend time with normal people instead of studying in a deaf school. The doctor reasoned that living with normal people would drive her to improve her speech skills. With strong support from her family, Nanthaporn now lives a happy life as a deaf person in a world of voices.

"If she hadn't received an implant, no one would have recommended us to bring her out of the deaf community," Preecha said optimistically.

Pennapa Hongthong

The Nation Published on February 4, 2008