Running header: REVIEW OF LITERATURE

Review of Literature: The Controversy on the Cochlear Implant

Briana Martinez
The University of Texas at El Paso












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Introduction
Deafness is something that had been seen as untreatable for many years until
scientists created and perfected the cochlear implant, a prosthetic device that is implanted
on deaf people in order for them to have gain some hearing. The implant sends electrical
signals to the brain through the auditory nerve allowing the brain to identify those signals
as sounds. It takes time to adjust to the implant and it is suggested to get it at a young age
since at this time the brain is developing and can pick up adjustments quicker. The cochlear
implant may seem like the cure for deafness and it can be assumed that deaf people are
dying to get it, but in all reality a majority of deaf people are against it. The Deaf culture,
capitalized to distinguish the cultural label from the condition, is very exclusive and brings
together deaf people with a strong sense of their deaf identity. They believe that their
deafness is a way of life rather than a disability; therefore they do not find the need to be
cured by getting the cochlear implant. This causes frequent controversy due to the lack of
understanding of mutual sides.
The purpose of this paper is to answer the following questions about the cochlear
implant while being open to the ideas and opinions of the multiple sides of the argument.:
What is a cochlear implant and how does it work?
Can anyone receive a cochlear implant?
What are the effects of receiving a cochlear implant?
Who decides if a child receives a cochlear implant?
The purpose of this paper is to answer these questions about the cochlear implant while
being open to the ideas and opinions of the multiple sides of the argument. This will be
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addressed by using a wide-range of sources to gather information from various
perspectives.
Review of Literature
What is a cochlear implant and how does it work?
The cochlear implant is a device implanted on a deaf or severely hard-of-hearing
person. According to Loizou (1999), all devices have four parts: a microphone, a signal
processor, a transmission system, and an electrode or electrode array. The microphone
gathers the sound from the atmosphere that is then taken to the signal processor that
chooses the sounds and organizes them into electrical signals. The transmission system
then takes those signals and translates them into electrical impulses that are taken by the
electrodes to be sent to the auditory nerve causing the identification of sound. The amount
of nerve fibers that are activated during this process indicate the loudness of the sound. In
the following diagram from the Med-El Company International one is able to see how the
cochlear implant works in the ear.

As stated in the article by Loizou (1999), cochlear implants differ when it comes to the
electrode design, the type of stimulation, the transmission link, and the signal processing.
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These can differ depending on the person being implanted and their status of deafness.
Lane and Godin (1997) discuss the surgical process and highlight the implantation in
children in a negative manner. They state that the children are put under anesthesia for
three to four hours in order to connect the receiver coil to the wire that is sealed on the
skull with skin sewn over it. Experts at the Houston Ear Research Foundation say that the
surgery is done in an outpatient procedure that causes little discomfort afterwards
(personal communication, March 24, 2014). But most deaf people see the surgery as very
invasive and make that one of their points as to why they do not want to receive it.
According to Lane and Godin (1997), the microphone is on an earpiece, the speech
processor is worn on a belt or in a pocket, and the transmitter is attached behind the ear.
James and Papsin (2004) mention that since 2002, a small incision of less than 25 mm is
done on small infants and the placement of the coil is at an advantage for the child because
it will not become dislocated during the growth and activity of the infant. These sources
have done a great job providing information on the cochlear implant, specifically its
components and the process of implantation.
Can anyone receive a cochlear implant?
According to Loizou (1999), not all people who have a hearing impairment can
receive a cochlear implant. Certain audiological criteria need to be met (Loizou p. 37).
This criterion includes severe or profound hearing loss and it needs to be bilateral. Another
criterion is that the candidate has to obtain a sentence-recognition score of 30% or less
under best aided conditions (Loizou p.37). Experts at the Houston Ear Research
Foundation said, in order to receive the cochlear implant, a person must meet certain
qualifications - both for FDA approval and insurance requirements (personal
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communication, March 24, 2014). It is important that the criteria is met in order to receive
the cochlear implant because it is not something that can be taken so lightly, the surgery
must be done extremely carefully, especially when working on a child.
Dettman, Pinder, Briggs, Dowell, and Leigh (2007) state in their article that with the
hearing screening on newborns it has helped diagnose hearing loss at a very early stage in
life. This allows the option of a cochlear implants to be given to the parents of the child.
Studies have proven that it is better to implant children as early as possible because of the
better adaptation to the implant and the best results in communication. According to the
studies done by James and Papsin (2004) the implantation is safer when done on infants
over 6 months old. This is because there are certain factors that cannot be proven at this
early age. For example, James and Papsin (2004) mention that sometimes parents do not
accept the fact that their child has a hearing impediment until they start showing delay in
their speech. Some parents who have a child that is born with hearing loss and are familiar
with the cochlear implant are more likely to want to implant their children as early as
possible. Deaf parents with deaf children are less likely to implant their children because
they do not see deafness as a disability. For example, in the documentary Sound and Fury
directed by Josh Aronson (2000), the deaf parents saw that deafness in their children was a
blessing whereas the hearing parents wanted to implant their child as soon as they could.
As long as the person is a candidate of the cochlear implant the time to do the implantation
is personal preference.
What are the effects of receiving a cochlear implant?
The timing of the may be a factor of the effects, both positive and negative, the
implant may have on the recipient. As mentioned before, the studies performed by
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Dettman, Pinder, Briggs, Dowell, & Leigh (2007) show that when the surgery is performed
safely, children younger than a year old show very positive response to the cochlear
implant. The age a person is implanted is very important because of the way a person
adapts. The implications of a successful implant in a young child are far greater than those
of an adult (Loizou p. 38). Loizou (1999) says that because children are at a stage where
they develop their language and cognitive skills. In the documentary Sound and Fury
directed by Josh Aronson (2000) a deaf woman goes to a cochlear implant center to see if
she would be a good recipient of a cochlear implant in order to decide if she should let her
deaf daughter get it as well. The audiologist tells the woman that the results of a person
who has been deaf for many years are not as good as a child. This is because a child is still
developing his or her language skills. The cochlear implant usually has a more positive
effect in a younger person compared to an adult.
One effect that a cochlear implant causes is that the recipient must go to a lot of
therapy to become verbal and also to take full advantage of the cochlear implant. Fryauf-
Bertschy, Tyler, Kelsay, Gantz, & Woodworth (1997) conducted a study where they
analyzed 34 prelingually deafened children who received a cochlear implant. Experts say
that about 3-4 weeks after the implant is placed on the patient it is activated and has
normal levels of sound detection, but the ability to understand speech depends on each
patient but can improve over time (personal communication, March 24, 2014).
In the study by Fryauf-Bertschy, Tyler, Kelsay, Gantz, & Woodworth (1997), two
children were discounted because their cochlear implantation failed after a year. This is
one of the effects of a cochlear implant: its failure. The failure rates are generally low but
when it occurs the patient runs the risk of going under surgery once more. Specialists say
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that there are less than 1% failure in the cochlear implant and the usual causes are related
to device manufacturer (personal communication, March 24, 2014). According to Tucker
(1998) people in the Deaf community see the surgery as invasive and a threat to Deaf
culture. Another criticism of this argument is that no individual should be required to have
surgery or any other invasive bodily procedure (Tucker p. 11). The effects are both are
positive and negative depending on each individual and their condition and age.
Who decides if a child receives a cochlear implant?
The issue that brings up a lot of controversy is who should decide if a child should
receive a cochlear implant. The studies have shown that an implant works best when the
recipient is still an infant, and many parents who are not familiar with the Deaf culture fail
to investigate on the Deaf community and implant their child as soon as possible. This is
something that was shown in the documentary Sound and Fury (2000), hearing parents of a
deaf child got her the implant at a very young age therefore she saw herself as hearing. The
deaf woman asked her if she ever researched anything on the Deaf culture beforehand and
she said no because she wanted what was best for her daughter and for her that was having
her daughter hear. This is something that most people who are for the cochlear implant
see, that their quality of life is better if they can hear. But people from the Deaf community
believe that their condition is not a disability so they do not see how they cannot do
something a hearing person can do. It is a given that parents should decide what s best for
their child but in these cases, how does a parent know what is best? Many people also say
that the child should be given the choice since they are the ones undergoing the surgery but
the issue seen here is that by the time a child is old enough and aware of the decision they
are making, it might be too late to get the best results with the implant. This decision is all
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depended on personal parenting preference but it does cause a lot of controversy between
hearing people and deaf people.





















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References
Aronson, J. (Director). (2000) Sound and Fury [Documentary]. United States: Docurama.

Dettman, S. J., Pinder, D., Briggs, R. J., Dowell, R. C., & Leigh, J. R. (2007). Communication
development in children who receive the cochlear implant younger than 12
months: Risks versus benefits. Ear and Hearing, 28(2), 11S-18S.

Fryauf-Bertschy, H., Tyler, R. S., Kelsay, D. M., Gantz, B. J., & Woodworth, G. G. (1997).
Cochlear implant use by prelingually deafened children: The influences of age at
implant and length of device use. Journal of Speech, Language, and Hearing
Research, 40(1), 183.

James, A. L., & Papsin, B. C. (2004). Cochlear implant surgery at 12 months of age or
younger. The Laryngoscope, 114(12), 2191-2195.

Lane, H. L., & Grodin, M. A. (1997). Ethical issues in cochlear implant surgery: An
exploration into disease, disability, and the best interests of the child. Kennedy
Institute of Ethics Journal, 7(3), 231-251.

Loizou, P. C. (1999). Introduction to cochlear implants. Engineering in Medicine and
Biology Magazine, IEEE, 18(1), 32-42.

Tucker, B. P. (1998). Deaf culture, cochlear implants, and elective disability. Hastings
Center Report, 28(4), 6-14

Wilson, B. S., Finley, C. C., Lawson, D. T., Wolford, R. D., Eddington, D. K., & Rabinowitz, W. M.
(1991). Better speech recognition with cochlear implants. Nature, 352(6332), 236
238.