Being deaf is not an illness that needs to be cured. It’s true that cochlear implants (CIs) can help some severe or profoundly deaf individuals improve their way of communicating in the hearing world. However, not everyone has positive experiences; some deaf people actively protest the use of CIs.
Many people in the deaf community resent cochlear implants for the effect it has on the hearing people in their lives. When a deaf person gets a CI, and it works to a certain degree, their friends and family assume they can stop putting in the effort to effectively communicate with them, because “you can hear now, right?” It’s important that you understand how much work and dedication goes into effectively using a CI. You don’t simply flip a switch and boom you can hear. Also, it doesn’t work for everyone.
Having said that, a hearing person who suddenly becomes deafened after decades of hearing will have a different experience from someone who was born deaf. A CI candidate with a memory of sound, knowing what things are supposed to sound like, may make those connections more easily, and is likely to be more successful, more quickly, than a person who was born deaf with no memory of sound.
Tom was a hearing person and became a CI candidate when he suddenly lost his hearing as an adult. After getting his CI, he says:
How does a cochlea work?
The ear is made up of three primary parts, the outer ear, the middle ear and the inner ear. The cochlea is the inner organ of the inner ear. It is a fluid-filled snail-like structure with tiny little hair cells which bend when the fluid is disrupted by sound waves. Each tiny hair responds to a specific frequency or pitch. The bending of these hair cells sends electrical signals to the brain for interpretation, allowing us to understand what we’re hearing.
Due to CIs being such a controversial subject, I’ll keep the focus of this article to cochlear implants for adults and the pros and cons associated with it.
What does the cochlear implant do?
Cochlear implants are surgically implanted electrical devices that allow people with a severe-to-profound hearing loss to process sound. Referred to as an auditory prosthesis it provides a sensation of hearing, and some implantees achieve near-to-“normal” speech understanding in quiet acoustic conditions.
The implant works by transforming sound into electrical stimulation. A microphone-like device, or sound processor, picks up external sounds and digitizes it. These digital signals are then sent to a tiny wire, with many electrodes, which is implanted into your cochlea. Each electrode corresponds to a different signal frequency. Your brain then receives the signal through the auditory nerve.
The problem comes in when two electrodes stimulate the same neural population or overlapping neural populations, thus confusing the sounds, reducing your understanding of what you might have “heard.”
How well does the cochlear implant work?
A cochlear implant doesn’t work for everybody, and not everyone is a candidate to receive a CI.
The audiology team try to give candidates realistic expectations of how successful they will be with a CI, and they will only offer a CI if they think a candidate will benefit from having one. Of course, they can’t predict how well someone will do. Statistically most people will do relatively well; those who have been recently deafened tend to do better than those who were profoundly deaf all their lives. Recipients can push the envelope, as I did, by practicing listening to a variety of sounds on a daily basis to get the best out of their CI.
Being born profoundly deaf, my audiologist said I should not expect to do as well as most recipients – I will always have to lip read. By focusing on Auditory Verbal Therapy, listening to music and audio books when I was working or doing housework,and asking people what I was hearing, I improved well enough that I can sometimes use the telephone or have a conversation with someone in the next room. It really depends on how they talk and it’s still difficult for me.
With my hearing aids, I had no hope of being able to understand speech. With the CI, I had some hope, and with lots of practice, determination and patience, pushed it as far as I could. It’s like training for a marathon – you tend to get out what you put in. It’s important to remember that everyone is different and can get very different results at activation. The CI won’t cure your deafness, but in my experience it sure is a heck of a lot better than a hearing aid.
There are many factors that can contribute to your CI outcome, including:
- The amount of residual hearing you have.
- How long you’ve been deaf.
- Your age, overall health and other medical information.
- If you have a functioning auditory nerve.
- The type of device implanted.
- The experience of your surgeon.
- Postoperative complications.
Increases your level of hearing, making it easier for you to communicate with your friends and family and follow conversations.
CI development has improved a lot, allowing recipients better speech perception in quiet environments.
A CI can expand your career opportunities, setting potential employers concerns at ease.
Increased opportunities to learn and participate in a learning environment without outside assistance.
Being more alert to potential dangers, for example hearing sirens and thunder.
Music and telephone
Many recipients enjoy the beautiful melodies of music and even use the phone.
Confidence & independence
Many recipients experience a boost in confidence, being able to hold their own in a conversation.
Background noises, like many people talking or environmental sounds, can affect a CI recipient’s understanding of speech. Technological advances are rapidly improving this.
All surgery carries an element of risk.
You must be careful participating in certain physical activities, including high contact sports and water related activities.
A CI does require maintenance, for example replacing wires, changing batteries or remapping of the sound processor.
It does take some time getting used to the CI device. It might irritate your skin, or you may experience muscle spasms, numbness and even facial paralysis. Fortunately this is rare.
Sounds are translated via the device and might sound unnatural at first. You need extensive training to perceive and comprehend the sounds more effectively.
There is no guarantee that the implant will work well. You could lose any remaining or residual hearing.
The cochlear controversy
If you’re a hearing person reading this article, you might be surprised to find out that many deaf people don’t like CIs and believe them to be a threat to deaf culture. The controversy about cochlear implants are primarily directed to the definition of deafness as a disability. Many deaf people argue that they should not be seen as disabled, but rather as members of a minority cultural group. They do not see deafness as an illness to be cured or a problem to be solved. For them, being deaf is part of their identity and getting a CI would destroy their identity, effectively betraying their cultural values.
I disagree with this view. I have two cochlear implants, and I am still deaf. What I mean is I still require communication support when dealing with noisy environments and multi-person conversations. I will never be able to be a fully hearing person, and that’s OK. I’ve accepted I am deaf – but now I really do have the luxury of selective hearing! I understand that deaf people against CIs believe they’re fighting for the preservation of their culture, and that’s great, but every person should have a right to their decision and not have to defend it.
How much does a cochlear implant cost?
U.K. residents wanting a CI can usually get one on the NHS if over the age of 18, and two if younger than 18. Very few people in the U.K. need to pay for a cochlear implant.
An adult might get a second CI if they are blind as well as deaf, or have another qualifying disability. In the U.K., the cost of assessments, surgery, and aftercare is around £20,000 to the NHS. The CI device costs upwards of £20,000. Paying privately for the CI will easily double the cost.
In the U.S.A., the cost of a CI, including all add-ons, is around $40,000; it may be covered by insurance.
A cochlear implant will not give you “normal” hearing, but it will, in many cases, enable you to hear better. When I say “hear better” I’m comparing CIs to the standard hearing aid. Today, cochlear implants are more sophisticated, and they help many more people with severe to profound hearing loss than ever before. Still, a CI cannot replace natural hearing. The cochlear implant pros and cons should be carefully weighed before you make your decision.
That being said, the decision to receive a cochlear implant, if you are eligible, is yours and yours alone. I encourage you to respect every adult’s decision and not judge them.
In my experience, the best impartial website to help you to make an informed decision is Cochlear Implant Help. There you will find a very useful comparison chart. You can read my personal cochlear implant story and how I went from rejecting the very idea of having a “thing” implanted into my head, to acceptance and learning to live with a new way of hearing.
Cochlear implants and hearing aids are so very different. I now understand why hearing people find it so hard to understand hearing loss, and why deaf people can’t really comprehend what it’s like to hear. It’s like night and day. I’ve lived through the shock of going from almost zero hearing to a full-on Take-Me-With-You-World rollercoaster ride at 90 miles an hour – and lived to tell the tale – and I’d do it all over again!
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Thinkstock photo by Elizabeth Hoffmann.