Thinking About Cochlear Implants
I recently received a request to be interviewed from a student at the Graduate School of Journalism at Columbia University for an article about cochlear implants. Included below (edited for length) is the request and my response, which I think might be useful to share with others.
The Request
Dear Mr. Creemer,
... I am interested in writing a story about cochlear implants and in my research ran into your very interesting website. I thought it would be great to have a parents perspective on the implants and since you also seem to be very instructed in the theme I would like to include your remarks in my story.
What I want to do is write about the technology, the pros and cons and the debate over the surgery with the Deaf Community. I would also like to know if there is something like a bank or library of sounds recorded through cochlear implants. (Is it even possible to do that and tell the difference between how a human ear records sound and how the implants do it?) ...
My Response
One of the reasons I write the blog is to facilitate discussion and learning, so I am more than happy to talk / email about the topic. ...
From my perspective, the technology is nothing short of stunningly amazing. My son is completely deaf, yet talks on the phone to his grandmother without difficulty. It's worth pausing for a moment to consider the achievement and implications of the previous sentence. Brendan is six, and has had an implant since age one, and two implants since age 5 (the standard of care is only just now shifting from a single one side only implant to bi-lateral or stereo implants). Brendan can converse pretty much equally well with either implant, but does noticeably better with two. (You can try that experiment on yourself -- see how well you hear in a noisy room when plugging one ear). His speech quality is indistinguishable from his hearing peers. He attends our neighborhood elementary school, in a regular old first grade class (and is generally at the top of his class academically :-) ). He is now just about one month into piano lessons, and is singing on key (doubly amazing as neither of his parents can do that). If I sound like a typical Dad crowing about the achievements of his son, then, well -- great! It's probably worth pausing once again to consider the previous sentence -- he's not "doing well for a Deaf kid," -- he's doing well for any kid!
I used to worry more about the ethical issues of implanting a child -- I fully understand and respect that the Deaf community does not consider themselves "broken" in any way -- quite the contrary actually, as some see deafness as a gift. I can understand that. I also understand math and basic genetics pretty well, and when about 90+% of deaf kids are born to two hearing parents, that doesn't bode well for the continued growth and vitality of the Deaf community and it's unique culture. Believe me -- I understand serious threats to a culture -- there are big chunks of my family tree that did not survive the Holocaust. These circumstances can sometimes bring out the worst in people, and I have been called a "child abuser" and worse by one or two especially bitter members of the Deaf community. But I consider that sort of behavior to be the exception. I certainly understand that our society has not always treated Deaf people with the kindness and respect that all of us deserve.
Thankfully, it appears that much of the misinformation about this debate seems to be largely a thing of the past. The safety and efficacy of cochlear implants are now pretty well understood -- if implanted at a young age, my sons results are more typical than extraordinary. (And the "young age" part is critical -- result drop off a lot with age). What is left is a "should you or shouldn't you" question. I can't see how either side will make much progress on that debate. From the perspective of a parent, a cochlear implant "fixes" deafness; and as best as I can understand it, from the perspective of many in the Deaf community, there is nothing to fix, and cochlear implant is like getting cosmetic surgery on your kid, only far worse.
Like many ethical debates, it may be instructive to try to "poke at the edges" of each argument. What if a child is born blind and deaf, for example, or with a condition that causes vision loss over time? Would a cochlear implant still be "wrong" in that circumstance? What about a child who can hear in one ear (and therefore is not deaf), but who risks losing his hearing in the one good ear? What about an autistic child who generally doesn't look at faces, but responds to sound? Is sign language the right thing for her? (These scenarios are more common that one might imagine).
I'm rambling, and haven't reached your last question -- sorry. I'm not sure that you can accurately "listen" to what someone with a cochlear implant is hearing in some cases. For the sake of argument, divide the population into two classes -- adults who had hearing and lost it, who now use a cochlear implant, and children born deaf who have only known artificial hearing. From what I understand, adults report that they hear "like AM radio" -- i.e. a smaller dynamic range, etc. But these adults have spent hours with an audiologist fine-tuning how their implant sounds to achieve the best results.
For kids implanted pre-verbally, the audiologists seem to take their best (educated) guess at the settings, and tweak as we go along using both telemtry from the device as well as sound production and hearing tests with the child. Who know what the kid is hearing? It must be something like what adults hear, but regardless, the auditory information is sufficient to understand and produce speech, appreciate some music, etc. In some sense, this is like the old philosophical debate of "how do we know that we both see the same thing for the color we call blue?" :-)
Hopefully this perspective is useful.
Categories: cochlear_implants
