The Cochlear Implant

By Amanda Stinebaugh Caleb Puckett Research Techniques and Technology 10 April 2014

The Cochlear Implant: Abstract The following essay is a detailed description of the overall process of cochlear implantation with emphasis on the positive effects versus the negative effects. While every individual source is different, each is addressed in relation to the overall topic of the implantation process and affects. The majority of the sources remain unbiased and very credible with very few exceptions. This essay would be helpful to any researcher on the search for helpful references for a dissertation or simple report over the subject of cochlear implants and would be equally helpful for a prospective recipient (or parent of one) of the surgery looking to find out more about the process and possible outcomes, good or bad. The first section focuses on the overall process and the basic workings of the implant as well as the preliminary tests and evaluations that take place before the actual surgery. Each of the sources emphasizes these topics and were very educational and credible sources that would be helpful for anyone needing sources on the topic. The second section is all about the positive effects of cochlear implantation is the past and provided the reader with three separate references that individually demonstrate a specific benefit of the surgery. They all remain credible and useful throughout their contents and would be valuable sources for anyone looking to become more knowledgeable about the benefits and past successes of the process. The third section is similar to the second as it focuses on three related, yet individual sources, only this time outlining specific downfalls of cochlear implantation. Each describes an unsuccessful implantation or surgery that led to a future complication and provides a good view form the negative side of the subject. Any of the three would be helpful and reliable sources.

The fourth and final section wraps up the essay and leaves the reader with two final sources that discuss the future of cochlear implantation surgery and resource. Either would be helpful and reliable sources for a paper over the process or basic search for information on where the research is heading to.

The Cochlear Implant: A Bibliographic Essay Introduction The cochlear implant, originally introduced more than 50 years ago, has had a lasting and significant impact on the world and is continuously being developed and advanced today. More than just a simple hearing aide, the cochlear implant can either be worn externally or be surgically implanted into the inner ear. The implant is best described as an electronic device that helps to take over the function of the inner ear, enabling individuals with hearing loss to better hear speech, music, and environmental sounds (The Cochlear, 205). The seventh chapter of Schwartzs book describes not only the specific procedure of the implantation process, but also every preliminary test and potential post-surgical issue or effect that would be helpful to an individual considering implantation. With specific sections for each main idea, Schwartz outlines the process in a clear, and non-biased fashion, making the book an extremely useful and informational source for anyone interested in the overall process of cochlear implantation. Despite the many easy-to-understand descriptions of the procedure that have been written, there are many individual aspects of any candidates background, anatomy, and health, no matter how miniscule that can have a big impact on the results of the surgery. In Morphometry of the Human Cochlear Wall and Implications for Cochlear Surgery, Cervera-Paz puts together an analysis of how the length and density of an individuals temporal bones could affect the way a surgeon would operate on a patient during implantation. While this particular article is extremely specific and focuses exclusively on this one, tiny detail, the findings suggest that this could still have a major and lasting effect on the patient. The article demonstrates the fragility of the procedure and the importance of each and every part of the process, no matter how tedious or seemingly unimportant.

In addition to the health and anatomical aspects of the preparation for the procedure, one must also be aware of the financial aspects of the surgery. In Crathornes A Systematic Review of the Effectiveness and Cost-Effectiveness of Bilateral Multichannel Cochlear Implants in Adults with Severe-To-Profound Hearing Loss, a study was done to prove that a bilateral cochlear surgery (meaning an implant in both ears at once), as opposed to a unilateral surgery would not only be more effective for the patient (in regard to hearing), but more cost effective as well. The theory seemed to be logical but turned out to be only partially proven. Those patients that experienced a bilateral implantation did indeed develop their hearing and comprehension better and faster than those that experienced the unilateral surgery, supporting that aspect of the given hypothesis. However, the second idea, that bilateral surgery would be more cost effective could not be proven. A potential recipient of cochlear surgery would definitely want to find an additional source to help him decide whether the theory of bilateral surgery being more cost effective is indeed true or not. Despite this drawback, the article provides a clear and effective argument to support the case of the bilateral surgery being more beneficial than the unilateral procedure and should not be discredited entirely. Perhaps the most significant factor that effects the response and benefits of the process is the age at which the surgery takes place. In Enduring Advantages of Early Cochlear Implantation for Spoken Language Development, a strong argument is given to support the idea that the younger the patient, the more beneficial the surgery will turn out to be. A child with impaired hearing is not only unable to hear and comprehend sounds, but is also unable to properly read and speak. If that child were to receive a cochlear implant during the early stages of speech development, however, it is proven in this article that that child would be able to develop not only his hearing skills, but also his reading, writing, and speaking skills at an almost

(if not fully) normal rate. The age at which a cochlear surgery takes place is another major factor to be considered by potential patients (or parents of potential patients) and this article is a genuine source of credible information for such individuals. References: Cervera-Paz, Francisco Javier, et al. "Morphometry of the Human Cochlear Wall and Implications for Cochlear Surgery." Acta Oto-Laryngologica 124.10 (2004): 1124-1130. Academic Search Premier. Web. 20 Mar. 2014. "The Cochlear Implant." Choices in Deafness: A Parents' Guide to Communication Options. Ed. Sue Schwartz. 3rd ed. Bethesda, MD: Woodbine House, 2007. 105-18. Print. Crathorne, L., et al. "A Systematic Review of the Effectiveness and Cost-Effectiveness of Bilateral Multichannel Cochlear Implants in Adults with Severe-To-Profound Hearing Loss." Clinical Otolaryngology 37.5 (2012): 342-354. Academic Search Premier. Web. 21 Mar. 2014. Geersa, Ann E., et al. "Enduring Advantages of Early Cochlear Implantation for Spoken Language Development." Journal of Speech, Language & Hearing Research 56.2 (2013): 643-653. Academic Search Premier. Web. 20 Mar. 2014. The Positive Side Cochlear implants have been taking place around the world for half a century and have brought clearer hearing and comprehension to thousands of individuals. In Acoustic and Semantic Enhancements for Children with Cochlear Implants, Smiljanica and his colleagues demonstrate a very detailed and complex analysis of the results of a certain experiment. They were looking to prove that cochlear implants are continuously improving in their success among patients and they succeeded in backing up their theory. The only real issue that could arise with

the article is the fact that an advanced expertise in the subject would most likely be required for one to successfully understand and comprehend the plentiful amounts of information included. While the article would be a very credible and useful resource in perhaps a dissertation on the subject of cochlear implants, the average individual would most likely want to find a separate and more simplistic resource to refer to. An even more radical idea than the surprisingly quick advancement of the cochlear technology is that of those with cochlear implants having clearer hearing than those with normal hearing. In Beginning to Talk Like an Adult: Increases in Speech-Like Utterances in Young Cochlear Implant Recipients and Typically Developing Children, this idea becomes more than just a theory. In certain studies addressed in the article, the authors found that children with cochlear implants began developing speech after only twelve months with their implants as opposed to the eighteen weeks the average normal hearing child required. While the development became equal once the children reached twelve months, these findings are still a major advancement in the area of study and demonstrate just how advanced the research has become and the importance of its future. The article itself laid out the experiments and findings in a very efficient way that would enable any reader to not only understand the statistics and percentages, but to also be confident that the information presented is viable and accurate. Anyone should be able to easily utilize this article. An important aspect of the cochlear implantation process is the more advanced stages of the implant. Rather than another source focused on the beginning steps of the procedure and adolescent patients, The Effects of Behavioral Speech Therapy on Speech Sound Production with Adults Who Have Cochlear Implants shifts the focus onto adults that have had a cochlear implant and their use of it over the years. The authors concluded that the majority of the adults tested and

surveyed had continued to benefit from their cochlear implant years after their surgery. They also concluded that continuous therapy was very helpful in maintaining proper function and use of the device, just as any electronic device would. The article provided a very convincing argument defending the lasting benefits of the cochlear implant process and would be very educational and reassuring to anyone looking to undergo the surgery. References: Ertmer, David J., Jung Jongmin, and Diana True Kloiber. "Beginning to Talk Like an Adult: Increases in Speech-Like Utterances in Young Cochlear Implant Recipients and Typically Developing Children." American Journal of Speech-Language Pathology 22.4 (2013): 591-603. Academic Search Premier. Web. 10 Mar. 2014. Pomaville, Frances M., et al. "The Effects of Behavioral Speech Therapy on Speech Sound Production with Adults Who Have Cochlear Implants." Journal of Speech, Language & Hearing Research 56.2 (2013): 531-541. Academic Search Premier. Web. 21 Mar. 2014. Smiljanica, Rajka, et al. "Acoustic and Semantic Enhancements for Children with Cochlear Implants." Journal of Speech, Language & Hearing Research 56.4 (2013): 1085-1096. Academic Search Premier. Web. 10 Mar. 2014. The Negative Side While the benefits of cochlear implantation surgery and procedures are extensive, one cannot ignore the fact that there have been many unforeseen complications and drawback. In every source previously covered in this essay has been at least a small section emphasizing the importance of full-fledged and thorough pre-tests and analyses before any type of cochlear surgery. In Auditory Brainstem Implantation after Unsuccessful Cochlear Implantation of Children with Clinical Diagnosis of Cochlear Nerve Deficiency, the author is presented a clear

example of the catastrophe that can occur if such warnings are ignored. The authors studies showed the patients who received unsuccessful implants because of their deficiency could have prevented the problem if proper measures and tests were done prior to the surgeries. If the deficiency would have been detected, the patient would have been given a different, more effective implant, or wouldnt have had to waste thousands of dollars on a surgery that had virtually no chance of working. While the article could scare off potential recipients of cochlear implantation, it could also reinforce the importance of each and every pre-test and evaluation, no matter how tedious or lengthy. The structure and credibility of the source make it a very valuable and important one in any context of the process of cochlear implantation. With any field of scientific study, there are bound to be minor setbacks. One example of such an issue is diagnosed and described in Guillots Perceptual Development of Nasal Consonants in Children with Normal Hearing and in Children Who Use Cochlear Implants. Within the article, the results of an experiment show that cochlear implants dont always live up to the great expectations that have been surrounding them since their invention. A series of different sounds were issued to a group of children, some with normal hearing and some with cochlear implants. While those with cochlear implants were expected to be a bit behind those without in speech perception and comprehension, the results sometimes showed a vast difference in the skill level, with the children with cochlear implants sadly lacking behind those with normal hearing. The article was well laid out and provides a different perspective on the subject of the process. As it is important to research and become knowledgeable about both sides of a subject, especially if one is to possibly undergo the practice, this article would be a very reliable source to turn to in order to see the underside of the cochlear implant story.

As previously stated, it is extremely important for a potential patient of the surgery to understand the importance of the extensive tests and evaluations that take place before any talk of potential operations can begin. What sometimes fails to be considered is the upkeep and check-ups that should frequently occur after surgery. In Subcutaneous Emphysema and Pneumolabyrinth plus Pneumocephalus as Complications of Middle Ear Implant and Cochlear Implant Surgery. (Cover Story), a prime example of the aftereffects of improper care and maintenance of the individual implants is presented. From the experiment, the authors concluded that two out of 76 patients (one a cochlear implant patient, one a middle ear surgery patient) contracted a disease the damaged the ear even further and rendered the once-useful implant useless. If these patients would have been more diligent and responsible in regard to frequent and thorough post-operational examinations of their implants, the problems could have been identified and dealt with much sooner, and in turn, could have been infinitely less harmful. Though the article was rather extensive and graphic at times, it was very effective in its purpose: demonstrating the importance and significance of check-ups and tune-ups after surgery by demonstrating examples of neglect and their consequences. Any patient of cochlear surgery would benefit from the article and it would be a valuable asset for any research on the subject. References: Colletti, Liliana, Eric P. Wilkinson, and Vittorio Colletti. "Auditory Brainstem Implantation after Unsuccessful Cochlear Implantation of Children with Clinical Diagnosis of Cochlear Nerve Deficiency." Annals of Otology, Rhinology & Laryngology 122.10 (2013): 605612. Academic Search Premier. Web. 21 Mar. 2014. Guillot, Kathryn M., et al. "Perceptual Development of Nasal Consonants in Children with Normal Hearing and in Children Who Use Cochlear Implants." Journal of Speech,

Language & Hearing Research 56.4 (2013): 1133-1143. Academic Search Premier. Web. 20 Mar. 2014. McKinnon, Brian J., and Tamara Watts. "Subcutaneous Emphysema and Pneumolabyrinth plus Pneumocephalus as Complications of Middle Ear Implant and Cochlear Implant Surgery. (Cover Story)." ENT: Ear, Nose & Throat Journal 92.7 (2013): 298-300. Academic Search Premier. Web. 21 Mar. 2014. Conclusion? Just as with any discovery or theory, the cochlear implant is continuously being altered, advanced and improved upon. While there is some debate over various aspects of the process, there can be no denying the fact that cochlear implants have been affecting and will continue to affect the lives of thousands from all around the world. In Cochlear Implant in an Ambulatory Surgery Center, the authors discuss this very subject. With, prebycusis, or sensorineural hearing loss affecting approximately 40% to 50% of people over the age of 75, there has been an increased interest in and demand for cochlear implant surgery and research (Joseph). Combining that statistic with the thousands of children, adolescents, and adults playing some part in the process, it is easy to get overwhelmed by the number of individuals that are affected by the subject. The article describes the recent advancements and discoveries over the subject in a very clear way. While its clear purpose is to persuade the reader to help support the building of new Ambulatory Surgery Centers (making it pretty biased), it remains a good source of credible information in regard to the expanding subject of cochlear implant surgery. While it may be easy to assume that cochlear implantation takes place only here in the United States, it actually is a world-wide phenomenon. In Libyan Cochlear Implant Programme: Achievements, Difficulties, and Future Goals, the authors discuss the various aspects of cochlear

implantation in Libya, as well as the future of the practice all around the world. The specific statistics in the article (numbers of patients to receive implants in Libya, ages, types, genders, success rates) are laid out to display the ever-widening effects that cochlear implantation surgery and research in one specific country, but also that of countries all over. The article leaves the reader with quite a few questions but does in fact lead them to a great sense of expectation and hope for the science. Cochlear implantation has a bright and significant future, and the world can only wait to see what it will bring. References: Joseph, Aimee M., and L. Frederick Lassen. "Cochlear Implant in an Ambulatory Surgery Center." AANA Journal 81.1 (2013): 55-59. Academic Search Premier. Web. 26 Mar. 2014. Salamat, Ali, et al. "Libyan Cochlear Implant Programme: Achievements, Difficulties, and Future Goals." Libyan Journal of Medicine 6. (2011): 1-6. Academic Search Premier. Web. 1 Apr. 2014.

Peer Edit #1 Walker Davies Research Techniques and Technology Peer Review for Amanda Stinebaugh 1. Amanda did an excellent job of explaining the significance of her topic. Her introduction did a wonderful job of introducing the topic. So far what Amanda has the paper is sufficient in the amount of context. Her introduction was great but needs work under the positive and negative headlines. 2. Amanda did a good job explaining what sources she used and explaining in detail what the source said within its text. Going into a bit more detail with each source might be helpful. I did not notice any bias in the paper as she provided straight forward facts about her topic. 3. I thought that the transitions were pretty smooth for the most part. I thought she did a good job of connecting her sources. Once she adds to her positive and negative headlines, I think that she will have a very good essay. 4. Citations that were in the rough draft were correct.

Peer Edit #2 From Alex Paul *used comment feature on word, see attached document*