Time for a pop quiz! ‘True,’ ‘False,’ or ‘It depends!’
Cochlear implants (CI) ….
- are a modern medical miracle
- are destroying a rich and complex Deaf culture
- are guaranteed to work
- will work the same for everybody
- will make someone ‘deaf’ into someone ‘hearing’
There are many aspects of cochlear implants that have been hotly debated over the last few decades among audiologists, doctors, surgeons, the Deaf community, medical ethicists, therapists, patients, parents, teachers, and educators. On one hand, CIs represent an incredible advancement in biomedical engineering and has provided millions of recipients with access to sound, and thus access to the wider “hearing” world. On the other hand, proponents of Deafness as a cultural trait rather than a disability may view CIs as a threat to their cultural community and identity.
As with all complex issues, there are many shades of gray and taking an individualized “case-by-case” approach is the best course of action.
No two people share identical experiences and it is up to the professionals guiding patients and their families to address their concerns, provide adequate information, and regard everyone with respect. This is why I write, and educate, and speak, and post on Instagram and continue to learn every day. As an audiologist, I feel I have a responsibility to expand my understanding and awareness of experiences surrounding hearing, communication, device selection, surgery, language development, and everything related to my chosen field.
Here are a couple of myths that some people hold about cochlear implants. I hope more people will understand the complexity and gravity when approaching this decision for themselves or their child. In addition, I want to help the general public understand and educate themselves to become supportive allies to those faced with this decision; implant recipients, those decidedly against implantation, and everyone in between.
MYTH: Cochlear implants restore hearing and cure hearing loss.
FACT: Cochlear implantation does NOT restore hearing or cure hearing loss. The cochlear implant device provides electric stimulation to the auditory nerve, thereby giving a person access to sounds in their environment. Sounds are captured by microphones on the external processor (worn on the ear, head, or clipped to clothing) and converted into electrical signals which are transferred across the skin to the internal receiver that then stimulates an electrode array within the cochlea to activate the nerve fibers of the auditory nerve. CI recipients perceive sound in a very different way than those with intact peripheral auditory function. The advancements in the design and function of CIs have been exponential and continue to improve every day, but CIs do not restore the natural structures of the cochlea, in fact any remaining inner hair cells at the site of electrode array placement are destroyed. CIs do not cure deafness, but provide an alternate, non-biological route to perceiving sounds, ie. hearing.
MYTH: Cochlear implants are instantaneously successful.
FACT: Contrary to what those adorable clips of activation day would have you believe, with their wide-eyed babies and mothers crying to see their child’s first reaction to sound, the rehabilitation process is lengthy and often very difficult. Not to mention the serious and complex surgery and subsequent recovery time needed. Once a person is implanted, the central auditory pathways up to the auditory cortex need to “learn” how to hear, how to make sense of the input provided via the implant. Much like hearing newborn babies develop auditory awareness and attention over many months and years, the CI recipient needs time to develop these pathways and skills. Often on audiological and speech-language reports, the ‘hearing age,’ or time since implantation, is reported in addition to chronological age.
A patient and their family need to have a great commitment to the MAPping schedule, follow up appointments, aural re/habilitation, and daily device usage in order to maximize the auditory potential of the recipient. The decision to undergo, or put your child through, major surgery is not one that is made on a whim. If a patient/parent does not exhibit realistic expectations or does not appear motivated to put in the work and effort for the device to help, they should be advised to carefully consider and learn more about the process ahead. Although time is of the essence and earlier implantation is associated with better outcomes, taking time to make an informed decision is every parent’s right. Success with a cochlear implant is highly variable and requires hard work, motivation, and support.
MYTH: All children who are implanted young will learn to speak.
FACT: There are so many factors that contribute to a child’s speech and language development. There are children who have co-morbidities that affect speech production, ranging from oral motor disorders to langauge disorders to cognitive disability. Many children who are implanted and receive ample supportive services do develop speech skills and are successful oral communicators, however there is no gaurantee that a CI recipient will learn to speak- there are no gaurantees that a hearing child will learn to speak!
Having access to sound is generally considered a prerequisite for developing speech, but not language! Language exists in different modalities and is independent of speech. Sign languages are rich and complex systems of communication that utilize the visual and manual modalities, and there are numerous languages around the world, just as there are hundreds of different spoken languages. Just because a child can not speak, this absolutely does not mean they can not communicate. Sign language, picture exchange communication system, AAC devices, gaze tracking devices etc. can all be used to facilitate communication. See more on this here. Conversely, as many of you can attest to, just because someone can hear, it does not mean they can comprehend what is said. Langauge, attention, and auditory processing abilities all play a role.
MYTH: A person with a cochlear implant isn’t deaf.
FACT: As stated above, the use of a CI allows for a person to have perception of sound, but once they turn off or remove the device, they are deaf. There is a layered discussion here about deaf vs. Deaf and the forming of identities that I attempt to understand and learn about by hearing the stories and personal experiences of those who claim these terms for themselves. I have met several Deaf adults who were implanted as children but choose not to use their device, or use it sporadically, as they are more comfortable communicating in ASL with their Deaf friends and family. Which brings me to the next myth:
MYTH: Using a CI is easy and effortless.
FACT: Use of a CI can be incredibly taxing for the user. Many users report great fatigue at the end of a day of “listening” and just want to shut off a barrage of sound. For others it is something they rely and depend on for communication and feel safest when they are using their device. There are many challenges associated with CI use, especially with young children, but over time people do “bond with the device” and recognize the benefits they receive when using it.
Please leave a comment or reach out to me with any thoughts on these topics. I would especially like to open the comments space for you to speak on your own experience so we can all learn from one another.
Dr. Lilach Saperstein