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January 23, 2004

The Cochlear Implant - Rejection of Culture, or Aid to Improve Hearing?

From: Reporter Magazine On-Line, RIT, NY - Jan 23, 2004

by John-Michael Stern
January 23, 2004

Rejection of Culture, or Aid to Improve Hearing?

Housed in a sound-proof vault, like I was on a game show that one would never watch, I sat in a chair buzzing in on all the annoying beeps I could hear. At times during this hearing test, the beeping became so faint that I was afraid I kept buzzing in on the ringing in my ear from last night's dance. After I won or lost that game, I moved on to a speech recognition test. A recording read off a list of 25 common words like "bat, ocean, wall," which I then had to write down. When all was done, I found out that I, who am hard-of-hearing, had a 43 dB (dB stands for decibel, a measurement of the volume of sound) hearing loss and an 80 percent accuracy of speech recognition in my better ear. Qualifying candidates must have less than 50 percent speech recognition and a hearing loss of at least 50 dB in each ear.

But, even had I met all the requirements, NTID Audiologist Linda Gottermeier at the Ear and Eye Clinic told me that she usually discourages people from getting cochlear implants under a 90 dB loss. With my moderate hearing loss, I benefit from hearing-aids and can make use of my remaining, damaged hair cells. Unlike the cochlear implant, which replaces damaged or missing hair cells with an electrode, hearing-aids simply amplify sound to assist those hair cells in stimulating the nerves to the brain. Had the audiologist determined that I could benefit from a cochlear implant and met all the FDA requirements, I would be faced with the decision as to whether or not to continue with the surgery.

For those with good hearing, sound travels into the ear and hits the eardrum, causing vibrations to pass onto three tiny bones. These bones push against the snail-shaped, fluid-filled cochlea. Inside the cochlea, hair cells excite nerve fibers, which the brain takes in as sound. For many with hearing loss, however, damaged or missing hair cells prevent the stimulation of the nerves to the brain. The cochlear implant solves this problem by sidestepping damaged or missing hair cells in the cochlea, and directly stimulating healthy nerve endings with an electrode.

For those who are eligible and desire one, the cochlear implant is a viable option, turning hair cells on end and restoring hearing. The root of conception for the cochlear implant stems back to Graeme Clark, who spent 18 years inventing and marketing the device. Since its inception for commercial use in 1985, the cochlear implant has been fit into the ears of over 23,000 in the US and 65,000 worldwide. NTID's cochlear implant program, founded 16 years ago by Catherine Clark, currently serves 111 of these students. Interestingly, the cochlear implant population at RIT is like a world within a world within a world, as students with cochlear implants (111) constitute about a tenth of all the deaf students (1,270), who in turn constitute about a tenth of all RIT students (15,312).

The average NTID student has a 90 dB hearing loss. With a cochlear implant, these students' 90 dB hearing losses can scale down to that of 30 dB. However, since they may never have had access to sound information to make auditory connections in the brain, they may actually feel rather than hear the foreign sounds that the implant creates. People with cochlear implants often feel overwhelmed while first trying to add meaning to new sounds. With continued use of the cochlear implant, their brains begin to recognize the new stimuli as auditory information. Headaches and fatigue, as well as doubting whether implantation was the right decision, are typical initial reactions.

As NTID audiologist Josara Wallber said, "We really can't predict how much a deaf person, who may not have developed neural pathways for sound in the brain, will be able to hear with an implant. Now, compare that to Rush Limbaugh [who experienced sudden hearing loss]. Because he was hearing and developed an auditory system in the brain, all they had to do is 'restart it', and he hears well enough to work on the radio again. Remember, cochlear implants started out just for post-lingually deafened adults like Mr. Limbaugh. The controversy began when doctors started implanting children and pre-lingually deafened adults."

Imagine that the hearing and the Deaf represent two separate land masses, and ask if the cochlear implant could bridge the two lands, or become a river between them, flowing on its own. One major barrier between these two lands is that the hearing view deafness as a disability that must be cured.

However, the Deaf do not see themselves this way. Rather, they pride themselves with their distinct cultural identity. Many Deaf will argue that the cochlear implant is not a perfect fix, and, therefore, trying to mold into the hearing world is a waste of time. In addition, many Deaf fear that the cochlear implant will bring about the cultural genocide of the Deaf way of life. Third-year student Justin Drezner said, "Implanting is like making black people white or white people black."

On the other hand, Wallber said, "A cochlear implant is not a cure. It does not transform Deaf people into hearing people. It is simply a sophisticated hearing device. I hope the Deaf community will eventually accept persons using cochlear implants as part of their diverse culture, just as they have done with hearing aid users." Or, perhaps people with cochlear implants, as second-year student Adam Drake said, "belong to neither the hearing nor the Deaf, but constitute their own world."

Regardless that its use has created a storm of controversy between the Deaf and medical communities, one thing holds true--the cochlear implant has come and is here to stay, as manufacturers predict a 25 percent increase in cochlear implant recipients annually. According to Dr. Gerald Buckley, the Associate Dean for Student Affairs at NTID, NTID expects to have between 300-500 students with implants over the next 3-5 years.

Along with the controversy revolving around cultural identity comes the issue of parenting children with cochlear implants. Because the effectiveness of the cochlear implant depends largely on persistent use to make the auditory connections in the brain, many doctors advocate solely for oral communication. First-year student Jamie Perlman stated, "Cochlear implants are only successful for those who use them everyday. Parents must force their children to be oral and go through speech training for years and years." In spite of evidence favoring this method, the cochlear implant cannot equate to perfect hearing. Therefore, total communication (oral and sign combined) would allow the child access into both hearing and Deaf worlds.

"I believe parents should teach their deaf babies total communication. You ought to be giving a child everything you can towards language development. Even if you plan to get a cochlear implant, the FDA requires children be a minimum of 12 months old. Think of the language learning that occurs in the first year of life!" Wallber said.

People get cochlear implants for a variety of reasons. Some advantages of the cochlear implant include distance hearing, enhanced lip-reading, the ability to hear soft sounds such as s, sh, h, f, and more distinct rhythm and loudness of speech. As first-year student David Raim remarked of his experience with an implant, "I hear so much more detail in music. My favorite example is Puff Daddy's song 'What You Gonna Do?' I remember I could only hear the rapping and his voice. But with the cochlear implant, I could hear the sirens in the background." On the other hand, the effectiveness of the cochlear implant may vary dramatically between individuals, based on his or her brain's ability to process sound.

In addition, while a pair of hearing-aids cost $500-$4000, a cochlear implant can easily run over $50,000. The low risks--8 percent major and 4 percent minor--include infection, tinnitus, meningitis, and despondent auditory nerves. The installation of the cochlear implant may also destroy remaining hair cells. If the candidate later wishes to surgically remove the cochlear implant, his or her hearing may have been damaged. Moreover, cell phones and metal detectors may interfere and distort sound from the cochlear implant.

Cochlear implantation is a noticeably exciting, albeit anxious, process, as friends and family peel their eyes into the operating room wondering what to expect. During the two to three hours of surgery, doctors thread an electrode (whose function is like artificial hair cells) into the patient's ear, and anchor a receiver coil to the skull. To do so, the surgeon must drill a hole into both the cochlear wall and temporal bone respectively, which creates a wound that takes three to five weeks to heal. Though the patient is under general anesthesia, he or she can usually go home the same day and resume normal activity within 24 hours.

After the wound has healed, the initial hook up with an audiologist includes "fitting" the external components--the microphone, speech processor and battery, transmitting cable and coil--behind the ear. The audiologist then uses a computer program for MAPing, which means fine-tuning the speech processor for best access to the speech spectrum. When the cochlear implant is activated, the microphone collects and transmits sound to the speech processor, which converts the sound into electrical signals. Radio waves then transmit this signal across the skin to the receiver-coil. Finally, sound travels through an electrode, which directly stimulates the hearing nerve, sending sound information to the brain.

In a sample survey of 63 RIT students, 25 deaf, 25 hearing, and 13 hard-of-hearing, Reporter posed questions to see how each student felt about cochlear implants on a scale from 0 (strongly disagree/not at all) to 10 (strongly agree/a lot). The first question asked them to identify how much emphasis should there be on a person with a cochlear implant to develop sign, oral, or total communication. The survey found that the perceived best communication approach is total communication (8.2), followed by oral (7.4) and sign (6.8). The groups themselves showed relatively insignificant differences between each other.

In regards to how likely they would choose to cochlear implant their children, however, the groups varied considerably. The average for all the groups showed a slight unlikelihood (4.0) to implant their children. While hearing students reported a slight desire to implant their children (5.7), Deaf students firmly opposed (1.9), and hard-of hearing students formed middle-ground between the two groups with a slight unlikelihood (4.2) to implant their children.

As more and more people get cochlear implants, the question of whether the cochlear implant will bridge the barrier between the lands of the Deaf and hearing or become a river flowing on its own remains to be seen. Controversy aside, the cochlear implant simply provides a door for the deaf to hear more. The cochlear implant does not cure deafness, nor does it try to ruin Deaf culture. It is simply a device that fits onto the ear of whoever wants one.

© 2004 Reporter Magazine On-Line