Big decision

By now most of us will have seen at least one video of the moment a person with hearing loss or deafness has a cochlear implant (CI) activated for the first time – one of the most famous clips has over 27 million views and counting.

 

 

 

These videos capture a hugely significant and emotional time in their subjects’ lives, so it’s hardly surprising to see them go viral. But how accurate is the picture of cochlear implant use that they project?

One thing we can be sure of, from stories like Sloan Churman’s, is that getting a cochlear implant is a life-changing event. Unlike, say, hearing aids, which act as a kind of amplifier to make sounds louder, cochlear implants actually send those sound signals to the brain. This means they are effectively functioning instead of the parts of the inner ear, or cochlea, that don't function fully in people with hearing loss or deafness. A user might have them inserted in one ear or both, depending on their needs. Either way, getting a cochlear implant involves surgery, since the device consists of not just the sound processor, which is usually worn behind the ear or on the body, but electrodes too, which are placed into the cochlea itself.

It’s clear, then, that the decision to have an implant is a big one. But that’s not the only reason they’re controversial. Let’s weigh up some of the pros and cons on both sides of the argument.

Pros

First, the pros. Cochlear implant use is most common among people with moderate to severe hearing loss. The pay-off for undergoing the implant process – the operation lasts about three hours and requires a short stay in hospital – is that users often report dramatic improvements compared to hearing aids. For those people, who may otherwise have had little or no chance to access sound, cochlear implants might represent a huge opportunity. They can also be especially good for adults who have recently acquired hearing loss, and who might mourn the hearing world they’d left behind.

But the benefits can be social or emotional as well as perceptual. It does take some time to adjust to life with a cochlear implant, and recipients will often need ‘training’ with an audiology team in order to become comfortable with the range of sounds they’ll experience in everyday life, and particularly the direction those sounds are coming from. But over time many individuals report a feeling of much greater independence as a result of the surgery, as well as being able to experience smaller joys like being able to hear their relatives’ voices.

Considerations

However, it’s important to point out that there are risks to having an implant. Getting a cochlear implant can be expensive, and like any surgery, it’s invasive too. It can destroy residual hearing, and learning to process sound can be an intense and exhausting journey, at least in the short-term. Some cochlear implant users might find that a shock, however well they’ve been helped by their audiologist to that point.

What’s more, although the technology involved is impressive – as one of our Ai-Live clients has said, it can be like getting ‘a bionic ear’ – as they also point out, it’s equally true that everyone’s experience is different. The sounds heard by a cochlear implant user may occasionally be distorted by the device as it struggles to process information. More generally, its effectiveness will depend on a number of other factors, including the extent of the user’s hearing loss, the length of time they’ve had it, and their age and overall health. These are all completely unique to the individual, whereas CI devices are relatively generic, so some people will find that CIs don’t suit them as well as they would hope.

Cons

Aside from these risks, there are some downright cons to weigh against the pros. The biggest potential downside of cochlear implant use has to be that they absolutely do not ‘cure’ deafness or hearing loss, despite the perception in wider society that it’s a kind of magic bullet. This might not be so much of a problem for adults with hearing loss who are weighing up whether to have an implant. But it’s a much more complicated matter for parents who are making the decision on behalf of their children. There’s an argument that, on learning that their child has deafness, some people are too eager to have them undergo the cochlear implant process, thinking it will ‘fix’ the ‘problem’. Of course, it’s completely understandable that a parent would want their children to have the best possible access to sound, not least because of the social disadvantages still faced by a large number of people with disabilities. The point is that they may not be getting the solution they think they are.

As we’ve mentioned, there’s so much variation in the effectiveness of the technology. Many parents will sensibly do lots of research around cochlear implants beforehand, but it’s still important to remember that, as Rikki Poynter puts it, ‘it’s not a cure and their child is not gonna be hearing.’

 

 

 

Parents need to be aware that it's beneficial for them to introduce their child to Deaf culture and sign language – they should have access to Deaf role models and know that they are part of a community. Meanwhile adult cochlear implant users have been sad to notice that friends and relatives sometimes make less effort with them in communication, assuming they’re now able to hear everything exactly as a person without hearing loss would.

There are cultural and societal implications of cochlear implant use too, which are every bit as important to consider when weighing up whether to get one. Amanda McDonough is a cochlear implant user who had 21 years of hearing loss before getting an implant. That’s a significant chunk of time, and it will have influenced her personality and identity in profound ways. The identity that comes from being someone with hearing loss isn’t erased overnight once a cochlear implant is inserted.

Cochlear implant users may also have to choose between abandoning hobbies or removing their implant, leaving them deaf while it is removed. Certain activities, such as contact sports, motorsports and swimming are not compatible with all CIs and may require the user to remove the device in order to participate. If the CI user wants to continue enjoying their pastimes, they'll need other ways to communicate (for example with sign language) while their implant is removed.

Importance of context

Ultimately, a cochlear implant is a tool. Like any tool, they’re really useful – maybe even essential – in some contexts, but far less effective in others. It just depends on the potential user, and what they want them for. Making that decision might not always be the stuff of viral video legend, but it’s still an important process for the individual to go through.

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