When they stopped to gaze at the mammoth Renaissance Fountain in the center of the gardens, Joyce Atchison couldn't hear the splashing water.

Now, less than a year later, she can hear the fountain because of a cochlear implant.

"(I feel) joy," she said, smiling. "I can hear water again."

After more than 40 years of severe to profound hearing loss, the Clear Lake woman decided in May to get a cochlear implant. The device is surgically implanted under the skin behind the ear.

Cochlear implants are not similar to hearing aids. Hearing aids amplify sound, while implants make up for nonworking parts of the inner ear by sending sounds to the brain. When cochlear implants are taken off, people are completely deaf.

Atchison could hear when she was born, but at 5 a battle with the measles and a high fever left her hard of hearing. In third grade, Atchison started wearing hearing aids, devices that would accompany her everywhere for the next four decades.

As a freshman at Moorhead State University in 1978, an audiologist told Atchison her hearing loss could be progressive. She left the office determined to learn sign language in case she became deaf.

History

The idea of cochlear implants first circulated through the medical field in the late 1960s, said Frank Rimell, otolaryngologist at the University of Minnesota Medical School.

The first successful implants began in the late 1970s but were much less complex than they are now. The U of M Medical School — where Atchison received her cochlear implant — was a pioneer in bringing cochlear implant technology to patients, Rimell said.

Now, cochlear implants are more common. As of May, there were more than 96,000 registered cochlear implant users worldwide, and more than 36,000 in the United States, according to the Food and Drug Administration.

Cochlear implants have been controversial in deaf communities for years, said Diane Leonard, consultant for Deaf & Hard of Hearing Services in St. Cloud. Deaf people were concerned people would get cochlear implants, give up on sign language and abandon the deaf community. Butattitudes are changing, she said.

"Most recently, it seems people are accepting that it's people's personal opinions," said Leonard, who is deaf.

Rich Diedrichsen, regional manager for Deaf & Hard of Hearing Services in St. Cloud, decided to get a cochlear implant more than two years ago. He said the St. Cloud-area deaf community — which is the second-largest in Minnesota, behind the Twin Cities — accepts that cochlear implants are an individual choice. Diedrichsen's choice has not affected his association with the deaf community, he said.

"They're respectful of the fact it's an individual's decision and they don't judge the individual positively or negatively about that decision," he said.

Big decision

The decision to get a cochlear implant was not easy for Atchison. She seriously considered implants last year when her hearing began deteriorating to the point where it was difficult to hear people speaking next to her. Atchison decided she had nothing to lose.

"She very clearly made an informed decision," said Mick Mayhew, associate professor of marriage and family therapy at St. Cloud State University, where Atchison is continuing her education. The two spent time talking about her decision.

"She was informed by science, other people, her faith. It was a real test of courage," he said.

Only days after her cochlear implant surgery May 23, Atchison spotted a woman, Carolyn Gropp, walking into Wal-Mart wearing a cochlear implant device. Gropp, who got her implant three years ago, can now talk on a regular phone and converse with her family. For Atchison, Gropp is an inspiration.

Gropp, a Foreston resident, was hard of hearing since she was young, but she was stunned to wake up at 42 with no hearing. Two years after going deaf, Gropp had cochlear implant surgery.

The first sound Gropp heard with her new implant was the clicking of her car's turn signals. Gradually, she could hear birds chirping, Christmas carols, songs from her high school years and, best of all, her family.

"My world is so open now," she said. "I have so many things I can reach out for."

Gropp said it took almost a year of implant programming sessions and speech practice to adjust to her cochlear implant.

Implants for kids

JP Wilson, 13, is rooting for Atchison.

Wilson got a cochlear implant when he was 4 and now speaks about his implant at the American Sign Language classes Atchison teaches for St. Cloud State students.

Wilson, a Clear Lake resident, was born deaf and started learning sign language at 12 months. After he got the implant, Wilson had to learn how to move his lips to speak during therapy sessions. Now Wilson can lip-read, sign and speak.

"I can't live without (my cochlear implant) now," he said.

Increasingly, more young children who were born deaf are getting cochlear implants. Research shows children who have the surgery by 12 months of age are most likely to develop good speech skills and mainstream in the school system, said Rimell, who specializes in pediatric cochlear implants. Twelve months is the standard age for hospitals to do pediatric cochlear implants, he said, although in the future, six months might be the ideal age.

Rimell said almost all hearing parents who have a deaf child choose cochlear implants. Sometimes, if one or both parents are deaf, they elect to not have their child undergo the surgery, he said.

But if parents do choose cochlear implants for their child, speech and oral therapy should take priority, he said. Children with implants who learn speech and sign language simultaneously do not attain speech skills as well as children with implants who focus on oral learning, he said.

"I'm a very strong proponent if they're going to get implanted — if that's what the parents want — (children) need to get an oral education," he said. Once children solidify speech skills they can choose to learn sign language, but most recipients don't, Rimell said.

But because infants with implants are being taught mostly oral skills, some worry these children won't learn other ways to communicate, such as sign language. When they take off their implants, children are deaf. Atchison believes they must be taught sign language and lip-reading so they can communicate without the device, if needed.

Atchison considers her three forms of communication necessary for her future career as a therapist for deaf and hard of hearing people and their families.

As she's finishing classes, Atchison is thankful for the technology that lets her hear the tapping of her computer keyboard, Velcro ripping on her sandal strap and, most recently, the rain.

"I'm making a leap of faith," Atchison said. "To me, it's almost a modern-day healing."

What is a cochlearimplant?

It's a small, electronic device that can provide a sense of sound to someone who is profoundly deaf or severely hard of hearing. The implant must be surgically placed under the skin behind the ear.

How are cochlear implants different from hearing aids?

Hearing aids make sounds louder, but a cochlear implant bypasses the outer and middle ear to bring auditory signals straight to the inner ear.

People who get implants can no longer benefit from a hearing aid in that ear. When a person takes off the external part of their cochlear implant, he or she is profoundly deaf.

Who can get a cochlear implant?

Cochlear implants

Children and adults can get cochlear implants.

Adults who have lost all or almost all of their hearing later in life are good candidates for cochlear implants because they can often associate sounds they hear through the cochlear implant with sounds they remember. Also, adults who became deaf after age 4 or 5 are usually good candidates because they experienced sound and speech before losing their hearing.

Young children who were born deaf also can get cochlear implants. Research shows that the earlier the child gets an implant, the more likely he or she is to acquire speech and language similar to hearing children.

How much does a cochlear implant cost?

The cost is usually $40,000 to $60,000. Many health insurance plans cover the cost.

Do cochlear implants help people understand speech?

People's ability to understand speech varies. After receiving an implant, some people can use the telephone while others also rely on lip-reading and sign language to fully understand what people say. Many people who receive cochlear implants can hear environmental sounds, such as water or birds chirping, before they hear speech. These sounds are more consistent than listening to speech, which differs with each person.

Sources: National Association of the Deaf, National Institute on Deafness and Other Communication Disorders

By Michelle Ma