NEWTON - Nelda Balding likes the fact that at age 74, she was the second U.S. Citizen (by one week) to have a research device surgically implanted into her inner ear. Only 10 other people in the country, nearly 25 in the world, have participated in the same research study of an upgraded cochlear implant system.

While she boasts of the novelty, she said her truest appreciation was hearing her 4-year-old granddaughter's voice for the first time.

From her kitchen in Newton last month, the 76-year-old laughed while recalling her confusion at the sound coming from the kitchen. It was sizzling bacon. She beamed when she said she heard familiar lyrics of her favorite artist, Willie Nelson.

But she cried when she said the only thing missing from her newfound ability to hear is her longtime interpreter, her husband of 54 years, Neil Balding.

Her world fell one level quieter when he died nearly two-and-a-half years ago from cancer.

During her progressive hearing loss since the 1970s, Neil Balding was her ears.

"He heard the phone," she said. "He heard the door. I was almost completely deaf after he was gone because he did everything for me."

Her oldest daughter, Kathy Hanneken, said Balding often hesitated.

"If she wasn't going someplace with Dad, she wouldn't want to go," Hanneken said. "You shut yourself out because you don't put yourself into situations where you can't hear."

After reminders from her five children, Nelda Balding eventually learned to ask people to speak up.

Still, every other word became, "Huh? Huh? Huh?" even though she pieced together sentences a few seconds later.

"I think I got in the habit of it," she said.

Tears formed in her eyes when she recalled the frustration that plagued conversations with her husband.

Then, at his visitation, she couldn't hear consoling comments from friends. Her son Bruce translated for her. She couldn't hear the sermon during her husband's funeral, but the pastor prepared a transcript so she could read along.

"You just don't realize how helpless you are," she said.

Although Balding had lost her companion and her translator, she said her husband still influences her progress by keeping her busy in the research program.

"This has taken away that frustration," she said. "It's just opened up a whole new life for me."

"Everything just fell into place," she continued in a soft voice. "He planned it. There's no doubt."

Opening a new door

Balding had been accompanying her husband to Barnes-Jewish Hospital in St. Louis during his final stages of cancer. Meanwhile, daughter Kathy Hanneken became her translator at all appointments with audiologists.

One month after Neil Balding's death, Hanneken persuaded her to get tested at Barnes' affiliate, Washington University School of Medicine in St. Louis.

Dr. Gail Neely, a surgeon at the Department of Otolaryngology, told her she was a candidate for a cochlear implant.

Balding had no idea what that was, other than recalling radio host Rush Limbaugh had received one.

She said she initially thought it was only for rich people, until she realized the $50,000 to $70,000 was covered by her Blue Cross Blue Shield and Medicaid insurance.

"I did not hesitate one minute," she said. "What did I have to lose?'"

But cochlear implants are not for everyone.

"The people eligible have profound hearing loss and very limited benefit from a hearing aid," said Laura Holden, audiologist at Washington School of Medicine. "(Balding) had very little speech recognition, so she wouldn't have been able to use a hearing aid at all."

People with nerve damage have often been told nothing could help them, but Balding learned cochlear implants could still work for certain types of nerve damage.

Cochlear implants have been around since the 1970s, but Holden said a lot of people who have become severely to profoundly hearing impaired are not aware something beyond a hearing aid is available.

"We want people to know the cochlear implant can help those people who are no longer helped by hearing aids," she said.

Not all cochlear implants are experimental. Holden said the upgrades and modifications that Balding is participating in are considered investigational.

A new world

After a month of appointments for medical exams, communication screenings, CT scans, balance tests and psychological evaluations, Balding was approved for the implant.

She received a Nucleus cochlear implant system, a trademark of Australian-based Cochlear Ltd. There are two parts: an internal system under the skin and an external system worn outside of the ear.

The surgery implanted a microchip diagonally above her left ear. A small tube stretched down into her cochlea (the part that looks like a snail), where coded signals stimulate nerve fibers. The signals are then sent to the brain, producing the hearing sensation.

Another part of the system consists of the microphone that picks up sound and the speech processor that codes the signals. It is not connected for the first month so the patient can heal.

During that month, Balding was completely deaf. She only heard slight sounds with a strong hearing aid.

In March 2003, Balding became the first U.S. citizen to have the external system hooked up to her internal system.

A small microphone rests above her ear, and the sound is processed by a device hanging behind her ear. A transmitting coil also attaches to the outside of her head and sends the coded signals as FM radio signals to the cochlear implant under the skin, according to Cochlear Ltd.

The first time the physicians activated her speech processor, Balding said the doctor's voice sounded like Mickey Mouse.

It took four minutes for her brain to adapt to the sounds.

Walking outside with her daughter, Balding heard the traffic.

"We pulled up to a stop sign," Hanneken said, "and there were a whole bunch of birds in a bush. I rolled down the windows. She said, 'What's that?' I said, 'Mom, that's birds.' She hadn't heard birds for so long. I went into the mall, and she stayed in the car and wanted to listen to the car run."

Opening the door

Just as receiving the implant wasn't automatic, neither was being able to fully speak or hear. She regularly returned to St. Louis for training until her brain could remember sounds of words and music, of course, with the help of Willie Nelson.

With each new processor, she compared the clarity of sounds and noted the shortfalls of each, such as not translating dialogue in live theater or not allowing her to hear people talk behind her back.

Returning to St. Louis, she voiced those complaints so Cochlear Ltd. could consider her suggestions and make practical changes. For instance, the battery life increased from 28 hours to 45 hours. The number of microphones increased from three to four.

But there are still problems.

She took off the processor one afternoon and laid it on the kitchen table.

"I'm deaf now," she said in a loud, sharp and more forceful manner as if she were trying to hear herself.

When putting it back on, the batteries nudged out of alignment. She fumbled with them, trying to realign them.

"I'll be bringing that up next week," she said loudly.

She finally reattached the processor, and her voice dropped to a softer tone and consistent volume as she said the work-in-progress has been worth the 32,000 miles driven to and from St. Louis.

"I'm very, very proud to have been part of the research," she said. "Everything that we come up with will improve the ones down the line."

Her newfound independence has given her the confidence and the urge to spread the word. Any time she sees someone who is hearing impaired, she approaches them and tells them about cochlear implants.

"There is so much left out there to do and to hear," she said with conviction.

Bethany Carson can be reached at bcarson@;herald-review.com or 421-6968.