In this three-part series, I want to explore the medical devices called Cochlear Implants. These devices help so many, but they are mysterious to many including some who could maybe use them. Cochlear Implants are devices that are used to bypass the ear and deliver sound vibrations to the auditory nerve. A CI, as they are called for short, can bring sound to a profoundly deaf person. Sounds wonderful, right? Well, think again. CIs are actually very controversial in certain populations. How can that be? Well, let’s take a look at the good, the bad, and even a little ugly . . .
First, let’s look at hearing loss in general and the usual solution.
People with mild, moderate, and upper ranges of severe hearing loss often function well with hearing aids that merely amplify the sound vibrations to improve the brain’s ability to interpret the signals correctly. It is sort of like using large print when the eyes can’t focus and/or transfer light waves to electrical signals well enough for the brain to process visual information. When hearing aids aren’t enough, there are FM systems that work with the hearing aids to receive and process sounds even more by amplifying, reducing distortion, dampening background noise, and more. Modern digital hearing aids can only do some of this with limited degree. Both of these methods can bring sound to the hard of hearing, clearer and with better clarity. Neither of these require any medical procedure including surgery. They are just devices worn on the ear or on the body. Neither of these are a cure, of course.
Now let’s look at Cochlear Implants or CIs.
To do that we will need to discuss what happens in the ear through the surgical procedure to place the implant. This will be just a cursory look not intended for an audience of doctors for sure, but it will give you an idea of the invasiveness of surgery involved. A CI is an implant that places electrodes (electrode array) into the inner ear along the cochlear which is the fluid-filled organ of the inner ear that helps control balance and transfer mechanical sound vibrations into electrical signals through the hair cells that touch the auditory nerve. The auditory nerve takes these electrical signals to the brain areas that process or interpret sounds. If any part of the ear doesn’t work correctly, sound signals won’t be sent to the brain or will be sent in ways the brain will be unable to interpret properly.
For those people who have very severe to profound hearing losses, hearing aids and FM systems amplified to the maximum do not help. The more you amplify sound the more it becomes distorted and the less understandable it is. For these individuals, a cochlear implant can be helpful. The main difference of a CI and hearing aids/FMs is that the CI has a transmitter and receiver that actually does the function of the inner ear and converts the sound vibrations to electrical signals.
Once implanted, the CI receives the sound by the microphone worn over the ear and sent through the processor that is located in the microphone housing that looks similar to a hearing aid, but doesn’t have tubing and a mold entering the ear canal. This processor can dampen background noise, clarifying the sound by strengthening certain frequencies. After processing, the sound vibrations are sent to the transmitter behind the ear through a tubing to the transmitter which is worn on the outside of the skin behind the ear and converts the sounds into electrical signals and sends them to the receiver/stimulator attached to the skull underneath the skin. The transmitter on the outside is secured on the skin over the receiver/stimulator using a magnet. The receiver also has a magnet that holds the transmitter in place. It works like holding a door wreath to a glass door using a magnet on each side of the glass to hold the wreath where you want it to be placed. You take the transmitter and over the ear microphone and processor off to sleep, shower, swim, and other activities that might damage the transmitter or the microphone.
The receiver/stimulator then stimulates the auditory nerve by sending the electric signals through a wire that is passed through one small hole in the skull at the receiver/stimulator down through the brain cavity to the lower skull over the middle ear and passed through another small hole into the skull into the middle ear. The wire then crosses the internal part of the ear to the cochlear in the inner ear, and its ending has electrodes that are implanted into the cochlear where the signals are then sent to the auditory nerve which sends the signals to the brain for interpretation. Sounds complicated, right? Well, it is simple in theory, but a bit more complex in the implementation with the wonder of modern technology. If you want to learn more, you can start with the National Institutes of Health’s web site.
The good is that a cochlear implant can provide understandable sound to a severe to profoundly deaf person. The earlier the implant is provided to the person after loss or birth (usually around age one) the better chance the person has of being able to receive a good benefit of the CI. A person’s brain must learn to interpret the signals that a CI brings to the person, and that takes time. It can be a beautiful thing to bring usable sound to a person when that person can make functional use of that sound. Many of you have probably seen the video clips over the internet of a child or adult hearing sound for the first time. You can watch these clips now if you wish.
While there are many other advantages of CIs, these are mostly differences over hearing aids and FM system use. These are less of a consideration by a person who is profoundly deaf when hearing aids and FM do little, if anything to help. At this point, the decision to get a CI is a bit easier if the person needs and wants to hear to function, so I won’t go into these specifically due to space limitations. What is important is that a CI can provide greater hearing ability and reduce or eliminate the few issues found with hearing aids. For many, there is hope of a new life within those sounds.
CIs are not all good. Like most things in life, there are pros and cons, advantages and disadvantages, good and bad.The bad for CIs is that even with initial screening tests and evaluations, it is not possible to say conclusively that a CI will provide substantial benefit or even any benefit to a person before the major, invasive surgery. Those videos that make you want to cry only show the joy of hearing initial sound. Whether the person can understand that sound immediately or even after time varies from person to person and can be affected by how long, if ever, the person had heard and understood sound before implantation.
Though safe for the most part, the surgery, itself, is still major surgery with the possibility of complications including infection and the usual reactions to anesthesia and complications to any major surgery that one must consider when making the decision to choose a CI. As with most major surgeries now performed for decades, this is relatively minor, but it still needs some consideration.
The bigger concern is that the procedure permanently destroys whatever hearing is left before the procedure and makes the organ most likely unable to accept any other type of future development in implants and genetic developments. There is also a significant chance that the implant will not give great benefit or even possibly will give no benefit at all to the user, but the device is there for life unless user pays for another surgery/device.
In addition, even if the device proves to be of great benefit, the surgery is very expensive with the additional high cost of the processor. Ongoing maintenance, batteries, etc. are there like with hearing aids and FM systems, but these ongoing expenses are much more expensive than those required for hearing aids and FM systems. Medical insurance may pay for the initial surgery and possibly the implant itself, but most do not cover additional surgeries for maintenance and upgrades and certainly not for batteries and other accessories required. The cost alone can prevent some from even considering the implant for help.
Some users experience vertigo or extreme dizziness after surgery. This typically goes away, but not always, and the change is greater if the person also has Meniere’s Disease which has the dominant symptom of vertigo which can be increased with cochlear implantation.
Finally, there are the usual annoyances that many hearing aid users deal with like interference and loud noise sensitivity which can be worse with a CI. CIs also have activity restrictions even with the ability to remove the outer portions of the device such as pressure activities (scuba diving), possible trauma activities (football), MRIs (restrictions from magnetic resonance imaging), and more.
The user must also consider the fact that sound is not like sound a hearing person hears or even sound heard with hearing aids and FM systems. The signals received are vastly different, and it takes considerable therapy to teach the brain to properly match the sound to familiar sounds heard before the surgery. The actual benefit varies greatly from individual to individual.
One must also understand that the inability to hear anything without the CI being turned on or later failing is total because any residual hearing is totally destroyed and can become dramatic for many and traumatic for some.
CIs are not a cure for deafness in any way and even with dramatic success, CIs can’t bring total access to the hearing world. In many cases, FM systems are still needed to help with certain situations, especially with loud background noise. There will still be situations where complete understanding cannot be achieved. These are all issues that need to be considered before actual surgery, but many of the negatives can be reduced or simply lived with when the joys of sound are desired to improve life.
Now for those who have enjoyed access to the Deaf community, and now for whatever reason may want to consider a CI, there is another area to consider. That is the attitudes toward CI use in Deaf Culture. To some in the Deaf community, being deaf is not something broken needing to be fixed. They are accepting of being deaf and proud of being Deaf. They have a culture and a language that unifies them in their own community where they are happy and safe being who they are and how they want to be. They signify this mindset with the capitalization of the word deaf as in Deaf. All people who can’t hear are medically deaf, but only some are part of the culture and community of the Deaf. American Sign Language is the key to that unity. It is a visual language that does not require or even include sound input or output. They are self-sufficient, especially in their world where people understand their culture and speak their language. It is only with those who can hear and can’t sign and in a world dominated by speech that they are at a disadvantage. Instead of the world being accepting of them as they are and finding a way to merge the Deaf language into the hearing world where the Deaf could contribute on an equal standing, the world chooses to force the Deaf to accommodate to the world of speech and sound where they can never contribute on an equal standing. That fact alone causes friction between the two cultures: hearing and Deaf. Add to that, the medical world which seeks solutions to cure deafness or at least, develop devices to help bring “sound” to the Deaf people and pressure them to use these options when they aren’t asking for that help, and you can find that friction can turn to animosity, if not outright rebellion. That is how many received the invention of the CI initially. Over time, that resistance to the CI in the Deaf community has lessened considerably, but you will still find the pockets of resistance everywhere. CI users can feel alienated and sometimes ostracized totally. Life can be somewhat lonely for these CI users when they feel they do not fit in either the Deaf or the Hearing world.
That is the good, the bad, and maybe some ugly that must be considered when a person with hearing loss considers a CI. There are many reasons why a deaf or Deaf person might consider a CI and probably includes better access to the hearing world even if it is just for economic reasons (to get and hold a job). DeafBlind people will often consider a CI when their vision is lessened to the point that tactile ASL is needed or will soon be needed. The reasons for getting a CI are good, understandable, and certainly valid. The reasons for not getting one are just as valid. The important thing for all, whether hearing and sighted or hard of hearing/deaf/Deaf/DeafBlind, to understand is that every person with a hearing loss has their own unique situations in life and how they access that life. The decision has to be made by the individual. There is no one right or wrong decision. Everyone must try to accept that the decision has to be made individually and withhold judgement. If we remove the judgement, the decision can be easier made and lived with from day to day.
Well, this has been all about explaining what a CI is, how it works, and some of the many things needed to be considered before deciding. A place to go to begin to research if you are interested in a CI for yourself or a loved one is Buzzle.com and Auditoryverbaltraining.com and National Association for the Deaf where lots more things are discussed than could be discussed in this space. Also, it is for those hearing and sighted who are curious and want to know more.
The decision to get a CI is very involved, difficult, and individual with no right or wrong way, so we all need to think carefully before passing judgement on others when we can’t understand their decisions or situation. I hope I have been helpful to you in some way and achieved my goals.