Cochlear Implants COCHLEAR IMPLANTS

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Cochlear Implants and Their Effects on the Deaf Population Neal W. Jarnagin American Sign Language I, Des Moines Area Community College

Cochlear Implants The cochlear implant controversy and its many facets have caused great unrest amongst both

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medical personnel and the Deaf community since the first cochlear implant was installed. While opinions vary greatly as to the reasoning behind their argument, the impact on the Deaf community cannot be denied. Specifically speaking, the problems that exist between the two communities are that of choice and overall benefit. These problems are significant to both communities because the medical community is attempting to “fix” the Deaf community while the Deaf community as a whole feels they are better off in a deaf world then a hearing one. The following pages will review articles from both the medical and Deaf communities in an attempt to better educate both parties as well as those of us that are either misinformed or uninformed. Ultimately, the indifference or lack of information regarding the use of cochlear implants is caustic in nature to our society and will result in more separatist viewpoints and an even greater separation of the hearing and Deaf worlds. The National Institute on Deafness and Other Communication Disorders (NIDCD) (2006) defined a cochlear implant as “a small, complex electronic device that can help to provide a sense of sound to a person who is profoundly deaf or severely hard-of-hearing.” The NIDCD continued to state that “an implant does not restore normal hearing. Instead, it can give a deaf person a useful representation of sounds in the environment and help him or her to understand speech.” While a much generalized, layman language, the above quote has implications of its own which will be discussed further, later on. As you will discover, even defining such an intricate device will be difficult in itself. Before we continue to the medical aspect of the cochlear implant it is important to understand to a certain degree, the history of the implant. According to the Powerhouse Museum (2007), the

Cochlear Implants first direct stimulation to the auditory nerve, the nerve used to hear, was in 1950 by a scientist

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named Lundberg. Seven years later, two scientists named Djourno and Eyries implanted a single electrode which was attached to an induction coil into the head of a deaf individual. That individual was able to hear sounds similar to that of a grasshopper or cricket but was also able to recognize very simple words such as mama and papa. This particular experiment inspired scientists and medical professionals to continue working on a “cure” for deafness. In 1964, Dr. Blair Simmons successfully implanted the first multi-electrode device consisting of six electrodes and resulted in a patient able to recognize simple tunes. The quest for a cure continued throughout the rest of the 20th century and in turn resulted in the state-of-the-art cochlear implants we have today. According to the U.S. Food and Drug Administration (2006), many risks and benefits have been reported in regards to both surgery and post-surgical effects. While both communities may disagree on what may be beneficial to their particular community, they are reported, nonetheless by this particular advocate of cochlear implant usage. They have stated that while some individuals may exhibit near normal hearing, others may have no benefit whatsoever. They continued to state that adults often begin to benefit immediately from the use of their cochlear implant and will continue to do so for about 3 months after the initial tuning sessions. After 3 months, improvements begin to slow down but in some cases, improvements may occur for several years after implantation. Children, on the other hand, improve at a much slower rate and will require “a lot of training to help the child use the new ‘hearing’ he or she now experiences.” The FDA (2006) reported that many individuals may understand speech without lip-reading, may be able to make telephone calls, enjoy music, and can even watch television more easily.

Cochlear Implants As with all general anesthesia, there are always risks associated with this type of surgery which in some cases, could be fatal. Keeping with what was reported by the FDA; other risks associated with the surgery include injury to the facial nerve, meningitis, cerebrospinal fluid

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leakage, perilymph fluid leak, infection, blood or fluid collection, dizziness, tinnitus or a ringing in the ears, taste disturbances, and numbness around the ear. They did not stop by recognizing only the physical risks that are involved with the implantation of a cochlear implant. They continued with the social and emotional effects it may have on patients as well. To include some of these “risks” as they have dubbed them, they include having to depend on batteries, having the implant for life, damaging the implant and not being able to replace the old one, and quite bluntly stating that the implant may actually damage what hearing individuals have left. To a hearing individual the benefits may outweigh the risks but more importantly the multitude and seriousness of those risks cannot be overlooked. Before an individual can be implanted there are several tests and exams that must occur. According to Sargent (2005), individuals who made the best candidates for implantation were those that could respond reliably, using standard pure-tone and speech audiometry tests. For children between the ages of 12 and 23 months, the pure-tone average for both ears should not exceed 90 dB. Those older then 24 months, the pure-tone average should not exceed 70 dB. Speech recognition tests should also be utilized. In addition, a preimplantation CT or MRI scan must be taken in order to find any deformities of the internal auditory canal. Lastly, standardized lab tests to include a complete blood count, electrolyte values and clotting time studies are required. Certain abnormalities are not necessarily contraindicated however all facets of the mechanics of the ear must be known prior to surgery.

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No lesions to the eighth cranial nerve or the brain stem can exist. Now that you understand, to a certain degree, the benefits, risks, and indications for a cochlear implant we will briefly move on to the actual procedure. Megerian (2006) stated that the procedure as we have discussed before is done under general anesthesia. While the procedure has been done under a local anesthetic in the past, it is no longer recommended.

Figure 1: Postauricular incision for cochlear implant from Megerian

Figure 2: Mastoidectomy has been performed, as well as facial recess approach. Attention is now turned to marking the site for implant-well drilling from Megerian

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Figure 3: Tie-down holes have been created and 2-0 nonabsorbable sutures have been placed through 1-mm holes drilled into the ledge of bony well from Megerian

Figure 4: Cochleostomy is performed (upper left hand corner) prior to placing implant into receiver well (main photo) from Megerian

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Figure 5: Once electrodes are placed into cochleostomy and extracochlear electrode lead is placed under temporalis muscle, closure of periosteal tissue can begin from Megerian

Figure 6: A water-tight periosteal closure is performed and skin closure begins with a subcutaneous absorbable suture line from Megerian

While the procedure is invasive, it is a relatively simple and can take between 60 to 120 minutes but it is the procedure in general and the idea of “fixing” something that those with this particular abnormality do not wish to have fixed that lies in bitter controversy. CBS News (1998) reported in an article in 1998 that “cochlear implants are an affront to their (the Deaf community) culture, which as they view it, is a minority threatened by the hearing majority.” It

Cochlear Implants continued by stating “the deaf community feels that its way of life is fully functional, and that using American Sign Language instead of oral English gives them no disadvantage in society.”

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Furthermore, because most deaf individuals are born to hearing parents, they are not afforded the opportunity to educate themselves or be educated on every aspect of their child’s options regarding their deafness. When the Food and Drug Administration announced that they were dropping the age of implantation to twelve months, the Deaf community escalated their fight against cochlear implants. Their battle was on two different fronts; that of choice and that of education. Returning to the CBS News report, they quoted Mary Koch from the Johns Hopkins’ Listening Center as saying “the (deaf community’s) perception is that there’s nothing wrong. There’s nothing that needs to be fixed. Our perception is, there is something that needs to be fixed. So from the very foundation, we’re diverging in our perspectives.” Sigrid Cerf, a cochlear implant recipient and Deaf community sympathizer stated that “The deaf community is a culture. They’re much like the culture of the Hispanic community, for example, where parents who are Hispanic, or shall we say deaf, would naturally want to retain their family ties by their common language, their primary language, which is either Spanish or in our case its American Sign Language. It’s difficult to accept something that would take someone’s entire culture into question.” Another viewpoint is that of the National Association of the Deaf (NAD) (2000) who in 2000 released a position statement solely on the use of cochlear implants for medical professionals, parents of deaf children, deaf individuals, and the media. Their rationale behind the position statement was to preserve and promote the psychosocial integrity of deaf and hard of hearing children and adults. Specifically speaking, they stated that the cochlear implant does not cure

Cochlear Implants deafness. A deaf individual that receives an implant is still deaf. They continue in their statement by making recommendations to all individuals involved and request that medical professionals, being the first point of contact for parents of deaf children, to seek specific

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training regarding the psychological, social, educational, cultural, and communication aspects of deafness and request that they become part of the medical school curriculum. They ask parents to become very familiar with the potential benefits, the risks, and all the issues that they entail. They urge parents to receive unbiased information about the pros and cons of cochlear implants and to interact with successful deaf and hard of hearing adults, as well as parents of deaf and hard of hearing children. According to the Clerc Center at Gallaudet University, considered the Harvard of the Deaf community, there came two viewpoints from two different sources. Clerc (2003) stated that it agrees with the National Association of the Deaf position statement but according to CBS (1998), “the university doesn’t have a stand on cochlear implants.” They continued by quoting Mercy Coogan when she said “we try to be a forum where people can look at it objectively. A university is where you debate issues, then make judgments based on that debate.” The next point of view comes from individuals in the Deaf community rather then the Deaf community as a whole. Alldeaf.com is advertised as a “popular online community of thousands of deaf and hard of hearing people from around the world.” While the site welcome’s those from the hearing community and the validity of the opinions can certainly be questioned as coming from those that are actually deaf or hard-of-hearing, you can only hope that there are enough honest people in the world to make truthful statements regarding their own community. Seattle.guy (Alldeaf 2006) in 2006 asked the question “do you feel or think that cochlear

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implants ruin the Deaf culture?” A total of 55 people voted on the poll with 29% saying that they believed cochlear implants ruin the deaf community. Another 49% voted no. 16% voted neutral, and 5% voted no opinion. The poll was supposed to be unanimous however many people posted their replies quite openly. One individual, Nesmuth (2007) who considers himself to be “Deaf Activist Emeritus” wrote a very interesting opinion that must be quoted in it’s entirety to fully understand his point of view. Deaf Culture means booting out a person who represents the future of deaf society from running a university. Deaf Culture also means either your deaf or not deaf enough. Deaf Culture also means screw the hearing people. Deaf Culture also means refusing to caption vlogs to make them accessible to the hearing people. Just what good has Deaf Culture been to the rest of the society? Hearing society spent a lot of money to help us and we’ve basically been flipping them off in return. That’s why come up with these things like the CI and other hearing loss mitigations to get rid of Deaf Culure. Richard. (p. 1) While this particular point of view I’m quite sure is rare, it is an interesting point of view to say the least. Another interesting point on the opposite side of the spectrum comes from Franz K (Alldeaf 2007) Once again, quoted in it’s entirety will give you a better understanding of this particular point of view. I think yes I think that cochlear implants and other related technology will eventually destroy Deaf culture. Interesting that I'm saying this as I'm a mainstreamed deaf adult, and I'm both trying to get my ASL completely fluent and also seriously considering getting an implant this summer. Why do I think it will destroy our culture? The centerpiece of Deaf culture is ASL, and with the improving technology, fewer and fewer people will speak ASL. 90% of us are

Cochlear Implants born to hearing parents. So I think ASL will mostly die out in the next hundred years or so. There will remain some strong Deaf families but most of the 90% will get these new technologies, especially as they become less invasive. In the best of all possible worlds there would be some way to overcome the "disability"

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aspect of deafness while retaining the cultural and pride aspects of being Deaf. And for those of you who argue that deafness is not a disability, in the paradigm we live in more than 99% of people communicate in a way that is at the very least challenging and sometimes impossible for us. For the disability aspect of deafness to be done away with, we can only surround ourselves with Deaf culture, effectively shutting ourselves off from most of the world. I know that it is important for me, even as I will likely get an implant, to advocate for Deaf culture, pride and language. For a few generations we will be able to keep that. And then, sadly, I think it will fade away, especially as implants are replaced by invisible, more effective technologies that may at the very least give the illusion of reversing deafness. Think of all the great human societies that have died out and lost their languages-- the Romans, the Etruscans, the original Aryans of India, the Mayans and Incas, indigenous tribes the world over, including many Native American societies... and that's only the tip of the iceberg. I'll do what I can to keep the culture alive, but I think we're seeing the beginning of the end, unless some kind of advocacy can sustain ASL awareness even among those of us who do not need to use it to communicate. Ironically enough, it will be in other parts of the world where sign language in many forms is continued, as many will be too poor to have access to medical and technological advances. Part of me hopes that ASL usage can become

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more widespread internationally, even as I also support linguistic diversity of many different sign languages. I think that's the only way it can survive. (p. 2) As previously stated, opinions vary greatly as to the reasoning behind their argument; the impact on the Deaf community cannot be denied. Some opinions are certainly better then others but these are the opinions of the society and the organizations that have the power to change how laws are formed. The future is uncertain regarding the use of cochlear implants. Certainly, according to the Sargent (2005), advances are being made in the actual device, making them smaller, clearer sounding, and safer. The medical community will continue to make advances as long as individuals are purchasing cochlear implants and ultimately, through education both communities will become better attuned to what the other needs and wants.

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References Benefits and Risks of Cochlear Implants. U.S. Food and Drug Administration. (2006, February 15). Retrieved February 10, 2007 from http://www.fda.gov/cdrh/cochlear/riskbenefit.html Cochlear Implants NAD Position Statement. (2000, October 6). Retrieved February 10, 2007, from http://www.nad.org/ciposition Cochlear Implants. National Institute on Deafness and Other Communication Disorders. (2006, October 5). Retrieved February 10, 2007, from http://www.nidcd.nih.gov/health/hearing/ Coch.htm Franz K. (2007, February 10). Do you feel or think that CI ruin…? [Msg.32]. Message posted to Cochlear Implant Discussion Group at http://www.alldeaf.com/hearing-aids-cochlearimplants/38612-do-you-feel-think-ci-ruin-2.html History: Who Developed the Cochlear Implant and Why? Powerhouse Museum. (n.d.) Retrieved February 7, 2007, from http://www.powerhousemuseum.com/hsc/cochlear/ History.htm Megerian, C A. (2006, May 24). Cochlear Implants, Surgical Technique. Surgery – Otolaryngology and Facial Plastic Surgery. Retrieved February 7, 2007, from http://www. Imedicine.com/printtopic.asp?bookid=4&topic=425 Nesmuth. (2007, February 5). Do you feel or think that CI ruin…? [Msg. 12]. Message posted To Cochlear Implant Discussion Group at http://www.alldeaf.com/hearing-aids-cochlearImplants/28612-do-you-feel-think-ci-ruin.html Sargent, E W. (2005, September 9). Cochlear Implants, Indications. Surgery – Otolaryngology

Cochlear Implants and Facial Plastic Surgery. Retrieved February 7, 2007, from http://www.imedicine.com/ printtopic.asp?bookid=4&topic=424 The Cochlear Implant Controversy. CBS News (2001, September 4). Retrieved February 7, 2007, from http://www.cbsnews.com/stories/1998/06/02/sunday/main10794.shtml?source =search_story Transcript: Cochlear Implants and the Deaf Community. Cochlear Implants Navigating a Forest of Information…One Tree at a Time. (2003, March). Retrieved February 7, 2007 from http://clerccenter.gallaudet.edu/kidsworlddeafnet/e-docs/CI/CI-script.pdf

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