SOUTH LAKE TAHOE, Calif. andamp;#8212; The sounds coming from Danielle Knowlton could have been simple baby talk.andamp;#8220;Ba ba ba ba,andamp;#8221; she said to Juan andamp;#8220;Emilioandamp;#8221; Duran-Reyes, in a sing-song voice.The 14-month-old Kings Beach boy rarely looked up, engrossed by the array of colorful toys in front of him at the Barton Audiology office in South Lake Tahoe.andamp;#8220;Ch ch ch ch ch,andamp;#8221; she said again, repeating the first sound of andamp;#8220;choo-choo.andamp;#8221;Still, the brown-eyed boy’s attention stayed on the toys.It wasn’t that the colorful blocks and dinosaur cutouts were anything special. Emilio kept his attention on the toys because he wasn’t aware of the noises Knowlton made.While Emilio played with a set of plastic toys that looked like atoms, Knowlton, a clinical audiologist at Barton Health, turned to her nearby computer to adjust the level of sound his new Cochlear implant would detect.Once more, she turned to Emilio.andamp;#8220;Ba ba ba ba,andamp;#8221; she sang.Emilio was born profoundly deaf. After a routine infant hearing screening, doctors discovered the damage in his inner ear.andamp;#8220;He is basically in the range where he can hear a jet andamp;#8212; very loud sounds like that,andamp;#8221; Knowlton said. andamp;#8220;He has no awareness of speech whatsoever or most environmental sounds unless they are extremely loud.andamp;#8221;At first he was fitted for hearing aids at Sutter Memorial Hospital in Sacramento, Calif.But they didn’t help him hear enough, and he hated wearing them.andamp;#8220;He would take them off and bite them,andamp;#8221; his mother Carmen Reyes said in Spanish. Nelson Hurtado, a Spanish Medical Interpreter and Junior Applications Analyst at Barton Health, interpreted for Reyes.When he was four months old, Emilio’s doctors gave his mother another option andamp;#8212; a device called a Cochlear implant.andamp;#8220;That’s when they first told us that there was a chance he could hear,andamp;#8221; Carmen Reyes said. andamp;#8220;I told them I wasn’t going to pay until he could hear.andamp;#8221;The Cochlear implant has two parts, one internal and one external, that work together to capture sound, turn it into digital information and then into electrical signals that simulate the hearing nerve and allow the brain to perceive the sound.Cochlear implants mimic natural hearing by bypassing damaged hair cells in the cochlea to stimulate the hearing nerve. This makes them different from hearing aids, which simply make sounds louder. About three weeks ago Emilio and his family traveled from their home in Kings Beach to Children’s Hospital and Research Center Oakland in Oakland, Calif. to have the internal part of the device implanted. .andamp;#8220;The day of the surgery I was so scared, but I knew he was going to be fine,andamp;#8221; Carmen Reyes said.Once the swelling from surgery subsided, Carmen Reyes, Emilio’s grandmother: Guadalupe Garcia Garcia and cousin Luis Manuel Salatar Castro, went to Knowlton’s office to have the external element of the device activated.andamp;#8220;It healed very fast,andamp;#8221; Knowlton said.While Knowlton continued to adjust the programming on Emilio’s implant, he worked intently with Susanne Jury, R.N., trying to figure out a classic toddler’s puzzle.Meanwhile, Knowlton was figuring out another puzzle.andamp;#8220;In his ear the electrode has 22 channels, we need to find the amount of current he requires to stimulate his nerves,andamp;#8221; Dr. Knowlton said.While Knowlton programed the device, Emilio reached up to touch the smooth plastic half-moon that wrapped around his ear and was anchored to his head by a small magnet.Knowlton steadily gave Emilio a little bit more sound, to see his reaction.Emilio began to squirm as the sound intensified. Suddenly, he reared back and threw one of the plastic toys he had been playing with at Jury.andamp;#8220;Too loud,andamp;#8221; Knowlton said, turning back to her computer quickly to adjust. andamp;#8220;It’s a little overwhelming. We give a little sound to get him used to it and then we give him a bigger range each time he comes back.andamp;#8221;Emilio will come back to Knowlton’s office regularly. First once a week, then once a month. As he gets older, he’ll come back every three months, every six months and then finally every year.Before Barton Health recruited Knowlton, Emilio and his family would have needed to travel to the Bay Area for each of those visits. Now, his device can be activated and programmed in the Lake Tahoe Basin. He is one of the first patients in the basin to have his Cochlear implant activated at Barton Audiology.andamp;#8220;It does open the door to people who may not have had the resources to travel,andamp;#8221; Knowlton said. andamp;#8220;If a family can’t travel down reliably, especially in the beginning, they won’t get the implant because it does not work without the appropriate programming and services.andamp;#8221;In infants, getting the implant at as young of an age as possible is key, Dr. Knowlton said.andamp;#8220;The critical language learning years for children are from birth to three years of age,andamp;#8221; Knowlton said. andamp;#8220;If it’s done at 12 months, language learning is much more natural. If you do it at three to four years old they have a lot of catch up to do. The auditory system is plastic to a point where we can mold it but if you wait it takes much longer.andamp;#8221;Once she adjusted the levels to Emilio’s implant again, Knowlton began to test his awareness.andamp;#8220;Ba ba ba,andamp;#8221; she said. andamp;#8220;Ch ch ch.andamp;#8221;Then she asked Carmen Reyes to talk to Emilio, who was seated on his mother lap andamp;#8212; his back facing her stomach. Carmen Reyes called his name.andamp;#8220;Emilio,andamp;#8221; she said.Her son sat relatively still, his eyes moving back and forth.andamp;#8220;Emilio,andamp;#8221; she said again.But still, Emilio didn’t react.After a few more tries, Knowlton brought a colorful dinosaur into Emilio’s eye line and tapped him on the shoulder with it. The boy giggled and so did his mother.andamp;#8220;The signs are subtle,andamp;#8221; Knowlton said. andamp;#8220;We’re looking for an awareness. It’s like a newborn being aware of sound. None of those sounds are meaningful until his brain starts making the connections and adding meaning to what he is hearing.andamp;#8221;Carmen Reyes knows that while the implant may help her son hear, he will always be deaf.andamp;#8220;The device isn’t going to fix everything,andamp;#8221; Carmen Reyes said.To help develop his language skills, Emilio’s family and Cheryl Petzold, an early intervention specialist for the deaf and hard of hearing with Placer County Office of Education, have been teaching him sign language.He knows 15 phrases, including andamp;#8220;dog,andamp;#8221; andamp;#8220;yes,andamp;#8221; andamp;#8220;mama,andamp;#8221; andamp;#8220;up,andamp;#8221; andamp;#8220;I see you,andamp;#8221; andamp;#8220;milk,andamp;#8221; andamp;#8220;birdandamp;#8221; and andamp;#8220;play.andamp;#8221;andamp;#8220;It’s an amazing family,andamp;#8221; Petzold said. andamp;#8220;They’re so motivated.andamp;#8221;Emilio will keep learning sign language, his mother said.andamp;#8220;He should learn it,andamp;#8221; she said. andamp;#8220;There’s no guarantee that he will learn how to speak.andamp;#8221;But Knowlton has high hopes for Emilio.andamp;#8220;There’s always that chance, but Emilio shows all the signs of being a success and learning to speak,andamp;#8221; she said.