I said I’d put together a post on cochlear implants earlier this month. First a disclaimer: I don’t have one, nor do I have plans to get one. I’m fairly neutral about them although I do find it annoying many hearing people assume I’d get one at the drop of a hat.
So, what exactly ARE cochlear implants? I had thought they were entirely internal somehow (without really giving this much thought, obviously — for example what about the power source?). Well first of all they do not amplify sound as hearing aids do. They bypass the ear to directly stimulate the auditory nerve. This approximates sound, this does not recreate it. It consists of three components: an implant which consists of a flat disk implanted under the skin behind the ear with a wire reaching down to an array of electrodes that feeds into the cochlea; a removable microphone and transmitter which sits on top of the flat disk (via magnetic adhesion) which picks up acoustics and transmits the processed signal to the electrodes; and the final component is the sound processor which converts analog sound input into digital output. The last component can be worn behind the ear, rather resembling a hearing aid, although there is no earmold in the ear. It can also be worn on a body harness or clipped to a belt.
Cochlear implants are typically performed on adults, particularly late deafened adults, and on young children, when there are no benefits obtained from the use of hearing aids. All recipients require extensive training to make effective use of the cochlear implant, including adjusting of the processor, learning to associate the new sound with remembered sounds (for late deafened recipients), and intensive speech therapy and other exercises for children. I will note here that of the sites I visited and read, not one of them discussed ASL in terms of making sure childrens’ abilities to communicate are not delayed. Instead there was generally a good deal of information discussing the committment and amount of work and the need for intensive therapy to catch up; it really illustrates the blindness the hearing have toward non-verbal communication. I have said again and again on this blog that deaf children should be learning ASL from the start, regardless of level of deafness, to eliminate the issues with the window for language and communication acquisition. Especially if they’re already worried about language delays.
There are often questions about how young children can be to get them. In general, the FDA has approved specific types of cochlear implants (I’m not sure how they differ) for ages two and up; a particular one was approved for one year and older, and in the news recently there was a 10 month old baby featured as having received the implant. For the moment, without getting into the sociological and political considerations, there are medical reasons for pushing the envelope early: children recover much more quickly from medical procedures than adults do. For example children tolerate much more toxic levels of chemotherapy than adults do because they regenerate so much more quickly (I fully realize deafness is in no way shape or form comparable to say ALL). I do not know what happens with the implanted portion of the CI in a growing child, though, if the wire will always have enough length to reach from the implanted disk to the electrode array. I do not know what the lifespan of the array within the ear is, if it requires replacement or repair of some sort. These questions are not addressed in the online information available (if you know where I can find this, please let me know). Additionally, and this is true for other senses, development of that sense occurs before three to four years of age. For example a child with vision in only one eye who gains vision in the other later will not have depth perception because that is a learned ability. The same is true for understanding sound, especially in distinguishing different varieties, distance, and direction. Even if full hearing could be restored to an adult, that adult may not have the brain centers necessary to use that information. Research suggests the results to be very good in very young children.
Now of course this leads directly into the debate around Deaf culture, the use of ASL, the best interests of the child, whether deafness is truely a disability, whether speech and so on are really the only valid ways to communicate and so on. While a CI child may never be exposed to deaf culture when he’s younger, I would not point the finger at CI in this case; plenty of deaf children are kept isolated from deaf culture that never had CI’s (I am but one of many, many examples). The real issue is that 90% of deaf children have hearing parents. Such parents probably have no idea of deafness at all, have never dealt with anyone deaf until their own child. Parents do want the best for their children, but out of ignorance and well meaning determinations for their child to be as “normal” as possible (I guarantee you, every single parent of a deaf child who is mainstreamed, who is not failing classes, is extremely proud of the fact that their deaf child is in regular schools and so on. How can you possibly blame them when this is all they know?) they will not generally have their child taught ASL. CI’s are not culpable here, they are merely yet another symptom, just as mainstreaming is, of the notion that hearing is the only way there is.
However, the controversy is considerable, with some saying this is a direct attack on Deaf culture. In other cases, deaf children with CI are ostracized by other deaf for having the CI. I can state that this is unequivocally wrong, having been the recipient of such ostracization for having been mainstreamed and thus being deaf without ASL. That will weaken Deaf culture faster than the existence of the CI itself ever would.
I honestly don’t know what I would do if I had a child that I knew would not be able to use hearing aids. I would want to know quite a bit more than I do now, that’s for sure. For most hearing parents, it’s probably not even up for a debate, it will be grasped at eagerly. (This points back toward my other favorite refrain, that of a deaf parent outreach program, that begins literally the moment they find out their child is deaf…)
But in the end, I think the best thing to do is what we ourselves demand: LISTEN TO US. To that end, I suggest that we all go out and see exactly what people with CI have to say. There are a number of good blogs to start off with:
Bionic Ear Blog
My Son Tom
Bionic Sound Project