The Healing Power Of Laughter Essay, Research Paper

The reasonable man adapts himself to the world;

the unreasonable one persists in trying to adapt the world to himself.

Therefore, all progress depends on the unreasonable man.”

George Bernard Shaw

What is a Cochlear Implant and Why Does the Deaf Community Oppose It?

A cochlear implant is an electronic device designed to provide useful hearing and improved communication ability to individuals who are profoundly deaf. For those with profound hearing loss, hearing aids provide little, if any, benefit. The cochlear implant will not cure deafness. It, in my opinion, has much to offer to those deaf people who can be implanted.

The Deaf culture believes that this technology will have a significant impact on their culture. They are vehemently opposed to any deaf person, children especially, being “Cut open” to put something foreign into their body. Some deaf people look down on those deaf people who have had the implants, and consider them outsiders even traitors to their own culture.

What is the Cochlear Implant Comprised of and How Does it Work?

The cochlear implant consists of both internal and external components. The internal components are those that are implanted surgically under the skin behind the ear. The external parts include a battery-powered speech processor, worn on a belt, a pocket or a harness, a thin cable, and a headpiece (Dallas Otolaryngology 2-3).

The cochlear implant converts speech and sounds into electrical signals and sends these signals to the hearing nerve. The sound is sent from the microphone to the speech processor. The speech processor converts the sound into the most effective code for sound and speech understanding. The sound is processed and the electrically coded signal is sent back to the headpiece and that signal is then transmitted across the skin via radio waves to the implant. The implant receives the signal and delivers it to the array of electrodes positioned within the cochlea. Those electrodes stimulate the hearing nerve fibers within the cochlea causing electrical impulses to be delivered by the auditory nerve to the brain, which then interprets them as sound (MED-EL 1-2).

How Does the Ear Work?

There are four main parts of the ear that are involved in hearing. However, for this topic the only parts we are interested in are the inner ear and the central auditory system. The inner ear contains the balance system, the cochlea and the auditory nerve. The cochlea is filled with fluid and lined with thousands of tiny nerve cells, which convert sound vibrations into nerve signals. The central auditory system consists of the nerves, which carry the nerve signals to the brain where they are deciphered. In normal hearing sound waves enter the ear and move to the eardrum. Vibrations pass, from the eardrum, along the chain of bones in the middle ear to the fluid in the inner ear. The vibrating fluid moves the nerve cells, located in the cochlea, which convert the vibrations into nerve signals which then send the message to the auditory nerve and to the brain (Elaine 25).

Different Kinds of Hearing Loss.

There are three different types of hearing loss. There is the conductive hearing loss, the sensori-neural loss and the mixed. The conductive hearing loss is caused by a problem in the outer or middle ear. Most conductive hearing losses are medically or surgically treatable. However, these are not treatable with the cochlear implant. The sensori-neural hearing loss is caused by a problem in the inner ear or the auditory nerve. When damage occurs to the cochlea, sound may be distorted. In addition, the degree of hearing loss depends on how much damage there is and where, in the cochlea, it is located (N I D C D 3). Mixed hearing loss is a combination of both conductive and sensori-neural loss. When speaking about profound deafness we are usually talking about sensori-neural hearing loss, but sometimes this also applies to mixed hearing loss.

What is “Profoundly Deaf”?

A person is profoundly deaf when the sensory receptors of the inner ear, called hair cells, are damaged or diminished. Increasing the amplification of sounds does not enable the profoundly deaf ear to process sound. The cochlear implant bypasses damaged hair cells and directly stimulates the hearing nerves with electrical current, allowing individuals who are profoundly or totally deaf to receive sound (MED-EL 2).

A Brief History of the Cochlear Implant

The FDA approved the 3M/House cochlear implant for marketing in November of 1984. It was hailed as the first device ever approved to replace a human sense. This was done with lots of excitement and fanfare. The first implants that were made public were by Dijourno and Eyries in France in 1957. I remember a commercial that had a boy running out of his house and saying, “I can hear the wind!” and it seemed so wonderful. Now deaf people need only get an implant and they would be able to hear.

Progress

In the area of implants, technological progress has been slow. Moreover, this was not the only area that was slow to accept implants. It appears that those who were prominent in the research of speech coding and auditory psychophysics were also unwilling to experiment with the implants. In addition, it appears the general feeling was that implant research, on any level, should not be done. Many of these prominent doctors insisted that no benefit was possible with a cochlear implant because the theories all indicated that the implant could not produce any sound that would be worth hearing. Yet there were patients with implants who were hearing sounds they considered useful ((NIH Consens Statement 1-25). If accomplishment were based on theory, then bumblebees would not fly, because according to aerodynamic theory, they cannot fly.

There were theories that had to be reconsidered and some that needed to be abandoned. Whatever the theory, there were important questions that needed answering. Will the implants cause meningitis or an increase in otitis media (middle-ear infection)? The answer to date is no (N I D C D 10-12). In addition, will the implant cause damage to the cochlea after long term use? Although the FDA approved the implant for marketing in 1984, the development and widespread use of implants has only recently come to fruition.

Residual Hearing

There is proof that in individuals implanted with a cochlear implant that had a long electrode (approximately 7mm in depth), there was damage to the spiral ligament, the basilar membrane, and in some cases the fragile bones of the cochlea had fractures (NIH Consens Statement 1-25). By using this type of implant, the cochlear structures which are essential to residual hearing, are damaged or in some cases destroyed. In short, the implant destroyed the residual hearing the deaf person already had.

Who Qualifies for a Cochlear Implant?

There are fifteen million people in the United States with significant hearing impairment. However, less than one percent of them are potential candidates for the cochlear implant. Favorable indications for implantation are a profound sensori-neural hearing loss bilaterally (in both ears). In other words, the deaf person would remain deaf even with the help of a hearing aid. The sensori-neural connection to the brain where sound is processed must still be viable. Traditionally it appears that the usual candidate is a healthy, postlingually deafened adult. Medical history and lab tests are used in planning a total program. Numerous physical limitations may be found later that would exclude a candidate from implantation (N I D C D 10-12). Further complications are that there is no way to preoperatively predict how successful the cochlear implant will be in a specific person.

How Effective are Cochlear Implants?

The cochlear implant does not restore hearing. About five percent can carry on a normal conversation without the aid of lip-reading. The most common effect of the implant is its improvement in the ability to read speech in postlingually (after learning speech) deafened adults. Some can distinguish between the sounds of speech and that of a car horn. For some, however, the results have been less than desirable.

The variability is partly because of the differences between the implant candidates. All have profound hearing difficulties. They meet the other criteria though there were significant variances among them (N I D C D 10-12).

Risks

There are always risks associated with surgery. Increased tinnitus and stimulation of the facial nerve are also risks. Of course, with any mechanical device, there is the possibility of mechanical failure. Also, there is the possibility that psychological problems might develop because of unrealistic expectations of the improvements related to implant use (NIH Consensus Statement 14-15).

Special Considerations for Children

The information with reference to children varies depending on when it was published and who published it. The most recent information indicates there have been approximately three thousand seven hundred children implanted to date in the United States (Valley Children s Hospital 4). In addition, the minimum age for implantation recently went from two years to eighteen months of age. Not every child is a candidate for a cochlear implant. Only 1% of severe and profoundly deaf children will be candidates for this procedure (Valley Children s Hospital 4). The cochlear implant is just the beginning of many hours of hard work and therapy. There is also the question of who should decide if a child gets an implant. Ninety percent of deaf children are born to hearing parents and most hearing parents want their children to be hearing like them. The Deaf Culture says that if a child is born deaf then that child is deaf and should be part of the Deaf Culture (those who are deaf whose language is American Sign Language). We need more information on the Deaf community in order to understand the position they have taken.

The Deaf Culture

Culture is a shared set of learned behaviors of a group of people who have their own language, values, rules of behavior, and traditions. It results from a group of people coming together to form a community around shared experience, common interests, and shared norms of behavior (Deaf Culture 2). To you and me, hearing is the norm. However, to the deaf, deafness is the norm, and hearing is only another form of communication. To the Deaf community, the fact that the dominant hearing culture considers deafness as the lack of a sensory function, and therefore a disability, is an insult. To the Deaf community, being deaf is just a form of existence that is different from that experienced by the hearing. There exists, in the Deaf community, a rich heritage and pride in the ability to overcome adversity as individuals and as a group (De Vera 1-4).

The essential link among the American Deaf community is American Sign Language. Mastery of American Sign Language and skillful storytelling are highly valued in Deaf culture (Deaf Culture 2). This community shares a common sense of pride in their culture and language.

Another aspect of the Deaf culture pertains to the role of marriage. It is estimated that nine out of ten members of the American Deaf community marry other members of their cultural group. Many of those couples also wish for a deaf child so that they may pass on their heritage and culture. This preference is not just because of the language, but the values-the same things that hearing parents want to instill in their children.

Deaf Identity

Deaf identity is highly valued. Most of the members of the Deaf community agree that hearing individuals can never fully acquire that identity and become a full-fledged member of the Deaf community, just as a white person can not fully acquire and become a full-fledged member of any other race. Even with deaf parents and a native command of ASL, the hearing person will have missed the experience of growing up deaf. They would have missed the experience of a residential school. These schools provide a vital link in the transmission of Deaf culture and language. For many members of the Deaf community, speech and thinking like a hearing person are negatively valued. There is a fierce group loyalty (How is Your Feeling about Cochlear Implants?). This may also be the reason why they withhold information about the community s language and culture.

Furthermore, it is important that deaf children be encouraged to further their education and not to think that deafness will keep them from growing up to be successful and happy (of course success and happiness being measured by their own perspective). Though a deaf child can be mainstreamed, mainstream education will not provide the socialization that is essential to a deaf child s growth (Deaf Culture 2-4). This is one reason the Deaf community opposes the cochlear implant. They do not feel that theirs is a disability as much as it is a different culture, and that by implanting the device into a child who can not make the decision for themselves they have taken away that child s culture, the Deaf culture.

The Purpose

The main purpose of the cochlear implant is to enable the deaf adult the ability to communicate with speech and detect sounds. In some cases, the adult might even have the ability to enjoy music. The biggest role of the implant that is being explored is in the implantation of children, which bears the crux of the debate. Postlingually deaf children would need to be implanted as soon as possible to benefit from that language they already know. Prelingually deaf children need to be implanted as soon as possible so that they may be trained to listen and learn language in order to communicate. I am unable to comment on the success of early implantation as there is insufficient data, and it was not until recently that the minimum age was lowered to eighteen months of age.

The Facts

It is essential that the deaf child have a proper language at an early age. The child needs to have a language by the time he or she starts kindergarten instruction. If the child does not have a language by then he or she will have to learn not only the basics but also a language. ASL provides deaf babies with an internal language, which will allow the child to interpret the world around them. Also, according to Betty Shaw M. A. Deaf and Special Needs Educator, “The acquisition of American Sign Language is much faster than learning most languages because ASL uses signed concepts” (Shaw). Language for the deaf child without ASL, even with the advent of the cochlear implant, will be a lifelong, twenty-four-hour a day struggle. As for the adult, it depends on numerous factors. There have been many notable successes, but there have also been failures.

The Controversy

Clearly, the cochlear implant is not for everyone. Those who can be implanted are few. So, why does the Deaf community think this an assault on their culture? Do they feel we are stealing away a piece of their community? Yes, according to information I obtained from several chat sessions posted on the web by those who belong to this community (How is Your Feeling about Cochlear Implants? 175). Would their community be lessened in its value by the absence of so few? Again, yes. Should a deaf child be given a cochlear implant? If you ask a deaf person from the Deaf community the answer is NO! Definitely Not! (How is Your Feeling about Cochlear Implants? 173) The decision of implanting a child is made by the parents of the child. Most parents of deaf children are hearing; are they aware of the Deaf community? Have they been told about all the alternative options available? The information is out there, but they as parents must decide what is best for their deaf child just as parents everywhere decide everyday what is best for their hearing child.

When all is Said and Done

The cochlear implant was designed to provide “useful” hearing, and in some deaf people, it does. Will a successful implant mean the deaf will hear like hearing people? No. Will it automatically allow the deaf person to communicate with hearing people or in the same way as hearing people without obstacles or barriers and without being dependent on some type of assistance? No. Will the effectiveness of the implants improve? They already have. The first cochlear implant was only a single channel implant (like the channels on your cordless phone), but now multi-channel implants are the ones that are used for implanting, and the newer ones are digital. In addition, they are working on making the implant more reliable and less likely to have mechanical failure. The controversy concerning the implantation of deaf children is not one that will soon go away. I don t see the opposition from the Deaf community lessening anytime soon either. Should deaf people be implanted with the cochlear implant? I believe that those few who can be implanted should be implanted.

The cochlear implant will not cure deafness. However, I feel this device has much to offer to those who can benefit from it. The impact of the cochlear implant on the Deaf culture is significant, but their culture will not cease to exist because of it. The cochlear implant technology is still a very young technology that has many researchers improving on it daily. I do not believe the Deaf community has anything to fear from this technology as it exists now, but will the future of this technology endanger this culture? Only time will tell.