Dr. Lisa Esposito
Chair of Philosophy & Religion Department
Associate Professor of Philosophy & Religion
Phone: (417) 873-7229
Fax: (417) 873-7435
lesposit@drury.edu
The Cochlear Implant Controversy
Shelli Delost and Sarah Lashley, MacMurray College, 2000
The field of Deaf Education has been riddled with controversy for hundreds of years. Sign language, Oralism, Cued Speech, and Inclusion are just a few issues which have, and will continue to, cause controversy in this field. The most recent controversy is literally being sparked by a tiny bundle of electrodes better known as a cochlear implant. In 1980, the first child was implanted with a single-channel cochlear implant at the House Ear Institute in Los Angeles, California (Osberger 28). This "technological breakthrough" suddenly divided two very important groups of people, the hearing parents and those associated with the Deaf community, leaving the child in the middle. As a result of this division, one group supports the use of cochlear implants to medically "repair" deafness in children with a sensorineural hearing loss while the other believes the children's natural condition should be emphasized. Those who support cochlear implants believe that normalization is the key to success for deaf children. On the other side, the Deaf community and others opposed to cochlear implants feel that deafness should be looked at as a cultural identity, not a disability. After describing the cochlear implant procedure, this paper explores the underlying values of these two competing views in an attempt to better understand and perhaps resolve the controversy.The cochlea is located in the inner ear and is devoted to hearing ("Location"). It is a spiraling, fluid-filled tunnel which is lined with tiny hair cells. Signals travel through the fluid and hair cells to the auditory nerve and then to the brain where it is interpreted as meaningful information ("Location"). A sensorineural hearing loss occurs when the tiny hair cells have been damaged or are absent preventing the electrical impulses from reaching the other nerve fibers (Cochlear Corporation 5). A cochlear implant is an electronic device that provides the function of the damaged or absent hair cells by providing electrical stimulation to the remaining nerve fibers.
The implant is inserted into a small depression in the mastoid bone behind the ear in order to hold it in place (Cochlear Corporation 24). An array of electrodes is inserted into the cochlea through an opening in the round window. The incision is then closed and bandaged. Typically it takes three to five weeks to heal leaving a scar and slight bump behind the ear (24). Once the incision is healed, the implant must be activated or "mapped" and the person must receive the external components (25).
The external components consist of a microphone worn behind the ear similar to a hearing aid, a magnetic transmitter which is attached to the ear piece by a wire, and a speech processor which is also connected to the ear piece via a wire (Cochlear Corporation 7). The magnetic transmitter adheres to the metal implant previously inserted under the skin. The audiologist then uses special computer software to set the speech processor to the appropriate levels of stimulation for each electrode (25). Once the implant has been activated, it begins to pick up external sounds. The sounds are picked up by the microphone located in the ear piece (7). The cord carries the sound from the microphone to the speech processor. The speech processor, a powerful miniaturized computer, filters, analyzes and digitizes the sound into coded signals. These signals are then sent to the magnetic transmitter attached behind the ear. The transmitter sends the coded signals as FM radio signals to the implant under the skin which delivers the appropriate electrical energy to the electrode array that has been inserted into the cochlea. Finally, these electrodes stimulate the auditory nerve fibers which send the information to the brain for processing (7).
The conflict concerning cochlear implants is centered around the definition of disability. If deafness is defined as a disability, in the eyes of many, it is something to be altered and repaired. According to the medical view, deafness is a disability. On the other hand, if deafness is a cultural identity, it should be allowed to thrive and, given the emphasis on diversity in today's society, should be readily accepted and supported. This opinion is based on the cultural view of deafness. Therefore, although the controversy over cochlear implantation seems simple, it is based on the very complicated and often unstated implications of the true meaning of deafness.
Those who support the use of cochlear implants believe the decision to get a cochlear implant should be no harder than deciding to buy glasses to correct a vision problem ("Who Is Normal" 14). The American Medical Association and the American Academy of Otolaryngology-Head and Neck Surgery recognize it as a standard treatment for profound deafness for children ("Cochlear Implantation"). The main concern of the cochlear implant supporters is for the deaf child to have access to the mainstream, or "normal", hearing world (Osberger 28). Although medical professionals prefer to show their most successful cases, most openly admit to parents that the success levels vary from child to child ("Cochlear Implantation for Children"). In their fact sheet, the cochlear implant team at Children's Memorial Hospital states that "benefits range from the detection of sounds to the understanding of speech without lip reading." However, Dr. Nancy Young from Children's Memorial Hospital, recently spoke at a cochlear implant forum held in Chicago where she specifically stated, "Each child receiving a cochlear implant will gain benefit from the device"(Young). Even a promise of only a minimal success level may be exactly what parents are looking for ("Who is Normal" 15). Therefore, medical professionals and many parents believe that the possible benefits the child could receive far outweigh any negative consequences.
In addition to the support of cochlear implants by medical professionals, authors of the past held beliefs that shed positive light on this subject. For example, Karl Marx and Friedrich Engels wanted an equal chance for everyone. They believed that every person in society should be geared toward the norm in order to accomplish equality (Marx and Engels 381). Deafness, to Marx and Engels, would be a deviation from the norm which would need to be repaired (379). In addition to Marx and Engels, Machiavelli also would have supported the use of cochlear implants. Machiavelli believed in the greater good of society by any means necessary (Machiavelli 285). For this reason, it would be easier to alter deaf people than to provide special services in order to allow them to live effectively with deafness. Altering a deaf child with surgery at an early age would only cost money once. In contrast, providing interpreting, note taking, and assistive technology would not only continually cost society money; these practices would also create inconveniences for others because of the language barrier. Moreover, Machiavelli would support the expertise of the medical professionals. He stated, "In the actions of individuals, especially princes, when there is no judge to appeal to, people look at the results" (288). Parents often look to many professionals seeking someone to tell them the right answer ("Who is Normal" 14). In most cases, parents are presented the information and then told that the final decision is theirs, therefore, there is "no judge to appeal to". Parents then look at the results the implant has shown in other children and the possible results they could see in their own child.
Those who oppose the use of cochlear implants do so for several reasons. These people challenge the supporters of cochlear implants by asking questions such as, "What is normal?" and "Do the quality and quantity of the benefits outweigh the risks involved?". Parents, confronting a new diagnosis of deafness, react with a wide spectrum of emotions including denial, guilt, the need to blame someone, and the need to find a miracle (Bienenstock 126). Doctors and parents tend to see the child as missing something and view the deafness as a disability that must be fixed to make the child "normal" or whole again. This attitude can have serious social and emotional implications (Stewart-Muirhead). A child who is told she is "broken" and needs to be fixed will forever see herself as less of a person because of her deafness. Critics of cochlear implant literature point out the lack of studies investigating the implant's impact on the child's family, peer relationships, self-esteem, and sense of identity (Stewart-Muirhead). These opponents maintain that positive self-image may be better promoted by participation in the Deaf community. For example, several deaf individuals have written about their love of the culture to which they belong. Saul Kessler wrote the following poem explaining how he feels about being deaf:
They Say I'm Deaf
They say I'm deaf,
These folks who call me friend.
They do not comprehend.
They say I'm deaf,
And look on me as queer,
Because I cannot hear.
They say I'm deaf,
I, who hear all day
My throbbing heart at play,
The song the sunset sings,
The joy of pretty things.
The smiles that greet my eye,
Two lovers passing by,
A brook, a tree, a bird;
Who says I have not heard?
Aye, tho' it must seem odd,
At night I oft hear God.
So many kinds, I get,
Of happy songs, and yet
They say I'm deaf! (Carver 1)
This poem describes the enjoyable alternative to being hearing. This poet obviously has no problem with being deaf. In fact, he implies that it is other people who have a problem with deafness because they do not fully understand it. Deaf people are often proud of being deaf. A deaf couple is very unlikely to want a cochlear implant for their child. The reason for this is that they do not view their deafness as a disability. They see deafness as a subculture that should be allowed to thrive. Deaf parents are often very happy if their child is born into the same subculture that they have so long enjoyed. In sum, those who oppose cochlear implantation support deafness as being an acceptable alternative to hearing.
Opponents of cochlear implants are also concerned with the quantity and quality of the benefits received in relation to the risks involved. The surgery itself incurs the normal risks of any surgery with the use of general anesthesia (Hoppe). Additional complications can include meningitis due to inner ear fluid leaks or other complications which can result in medical treatment, surgery, and/or removal of the device. One consistent complication of the surgery is the complete loss of all residual, natural, hearing in the implanted ear. As a result of the implant, certain precautions must be taken to avoid damaging the device. For example, a child with an implant is not able to receive an MRI (Magnetic Resonance Imaging) because the implant contains a magnet. Electrostatic discharge is also of concern to implanted children, as it will erase the program mapped in the speech processor. In order to avoid electrostatic discharge, implanted children cannot play in pits of plastic balls, slide down plastic slides, or play with balloons. Kathleen Hoppe, a mother of a deaf child writes, "Some may argue that the benefit of possible speech perception and use outweighs the disappointment in a child having to avoid these play situations. However, I find it ironic that in an attempt to make the child be more like the rest of the 'hearing world' that the child must be identified as 'different' on playgrounds and at birthday parties" (Hoppe). Significant language delays can also occur while the child is waiting to begin receiving any form of benefit from the implant (Byrd 19). Once the implant is programmed, it can take anywhere from two weeks to two years before the child receives auditory input. If the only interaction is through oral communication, a currently inaccessible mode for the child, delays in language development can occur (Byrd 19). Finally, there is no way to know the extent of the benefits the child will receive (Carver). Critics of cochlear implant research continue to point out the failure of researchers to distinguish between the success rates of children who were born deaf (prelingually deaf) and those who lost their hearing at a later age (Bonn 1836). Medical specialists misrepresent the facts to parents of prelingually deaf children in order to convince them that their child will be successful (Carver). Rarely do doctors tell parents that "success" does not always mean the ability to hear and speak. "Success" with implanted prelingually deaf children commonly means simply the ability to detect environmental sounds (Carver).
As future educators of the deaf, we believe opposition to cochlear implantation is the only logical action. We view deafness as a cultural identity and exceptionality instead of a disability. Therefore, we believe that cochlear implants are unnecessary, oppressive, and potentially harmful, particularly when forced upon minor children. First, cochlear implants are unnecessary. Deaf children learn to be successful everyday without hearing. The problem is that 90% of deaf children are born to hearing parents. In many cases, these hearing parents may have never met a deaf adult. It is common for parents to be introduced to a number of audiologists and speech therapists when their child is first diagnosed with a hearing loss but to never be taken to meet a deaf adult so that they may receive the other perspective. They are told that something is wrong with their child. It may never be mentioned that deafness is considered to be a cultural identity for some people and that implants are seen as unnecessary. The parents of the deaf child, wanting only what is best for their child, will want to make sure that the child has the opportunity to succeed. If all they have been told is that the child will need to speak to function and that there is a procedure that can provide this, of course they would want the implant. To the parents, it is seen as the instrument of success. They may not understand that it is possible for a deaf child to function and thrive in a hearing word without the ability to hear or speak. By only giving the parents half the information, the parents have been cheated out of the option to decide what is best for their child. Perhaps they still would have made the decision to implant their child; however, their decision will never be known if all the options are not presented. The parents may have decided not to do the surgery because the child still has an excellent opportunity to succeed and be happy in the world without the implant. As Lao Tsu stated "A great tailor cuts little"(28). He believed that things should be left in their original state as much as possible. Lao Tsu would have thought that deafness was not a mistake made by nature, it was an intended exception. Therefore, he would have believed that the implant is not needed to succeed or enjoy life.
In addition to cochlear implants being unnecessary, the idea of the implant is oppressive. Cochlear implants are used when the medical view of deafness is taken: something is wrong with the child's ears...this must be fixed. Parents are obsessed over the loss of hearing instead of focused on the fact that their child is just a bit different from the parents. This child may have a different natural language than the parents. The child is not broken or impaired, he or she is different in only one area. In the age of educating to accept diversity, one would think that the American attitude would be turning more towards embracing this exceptionality rather than trying to alter it. Overcoming the oppression experienced by many deaf individuals needs to start with the parents of the next generation. They need to learn to accept deafness and teach their children to be proud of who they are. Being content with oneself is the only true way to happiness as described by Alice Walker in The Color Purple. The main character, Celie, was miserable while she lived under oppression and tried to conform to make life easier. The light at the end of the tunnel appeared when she was shown how to accept herself and be proud of everything that made her who she was (Walker 118). She found happiness and led a much better life from that point on. Overcoming oppression instead of trying to adapt to fit another's ideals is the way to find self-worth.
Finally, we believe that cochlear implants are potentially harmful both physically and emotionally. The surgery itself involves cutting into the head, through the skull, and inserting a wire with electrodes directly into the cochlea. In the surgery, there is a risk of damaging the facial nerve (Young). This would result in the decreased control in movement of certain areas of the face. Also, cochlear implants destroy all residual hearing. If the implant does not work, the child can no longer rely on what little hearing he or she had. On the side of emotional harm, many different avenues could be effected. First, the child may feel strange and out of place in front of their peers. Hearing children will look at them as different. They may still have noticeably different speech and rely on speechreading. This may put up a communication barrier between children. Also, deaf children will see them as different. If they are raised oral (with speech and speech reading), they will not share the language of the signing deaf children. Children with cochlear implants are likely to feel stuck in the middle of two categories of people while not fully being accepted into either group. According to Cara Hammond, a speech/language pathologist at the Illinois School for the Deaf, a third problem that has appeared with cochlear implants is that the child begins to resent the parents for having the implant done. One teenager expressed great anger towards his parents for having him implanted at a young age. He explained that it made him different from his deaf friends in a way that made it hard for him to become accepted. Mary Shelley warned of this kind of problem in her book Frankenstein. She spoke of the scientist's own creation ruining him emotionally because it was wrong for him to alter nature's course (Shelley 168). Harm is a very possible consequence of cochlear implantation.
The advocates of cochlear implantation believe that these devices are beneficial to the children that receive them. The problem is that they may not have fully considered everything involved in the controversy. For example, medical professionals involved believe that nearly all children are candidates for receiving an implant and all have equal opportunity to achieve the same levels of success (Children's Memorial Hospital). One of the main criteria required by Children's Memorial Hospital is that the child be able to understand speech at normal conversational levels without the use of speechreading. Opponents of cochlear implants point out that once the procedure is done, all residual or natural hearing is lost (Stewart-Muirhead). If a child is able to perform that well with or without hearing aids, why are the doctors willing to destroy residual hearing in order to implant? Although this figure has increased somewhat in the last 6 years, as of 1993 only about 20 percent of implant recipients ever are able to understand spoken language without the use of some visual supplement ("Who is Normal" 16). The common reason for the success late-deafened children and adults have from cochlear implants is that they had good speech skills prior to their deafness. However, children with no auditory memory to reestablish have a much more difficult time acquiring adequate speech skills (Bienenstock 126).
A second issue often overlooked by doctors and parents is the social and emotional implications of the implant (Stewart-Muirhead). This is mainly due to the focus placed on the word "normal." Understandably, parents want a child who is like themselves ("Who is Normal" 14). No parents dream of having a child they cannot communicate with. Upon learning of their child's diagnosis of deafness, parents are very confused and upset and are willing to do anything to help their child. Therefore, doctors and parents are tempted to view the child's deafness as a condition that needs to be fixed to make the child "normal" again (14). In his writing On Education, Jean Jacques Rousseau addresses the topic of children who must overcome hardships (144). He writes, "This is nature's law; why contradict it? Do you not see that in your efforts to improve upon her handiwork you are destroying it"(144). Although he obviously never addresses deafness or the use of cochlear implants, Rousseau directly addresses an integral issue in the cochlear implant debate, the idea of what is "normal". By trying to change what has occurred naturally we are altering the nature of that child (144). In other words, by trying to fix the deafness we are altering the children's natural state. We are changing the children's identity and forcing them to continuously struggle to be something that they cannot become.
Parents who agree to this procedure often think that it means that their child will be able to hear. The fact is that the child will be receiving auditory signals but will not hear actual sound. They will receive a series of signals that they will need training and practice to decode. Parents may believe that in order to succeed, their child will have to be able to hear and speak. This is simply not true. With greater exposure to successful deaf adults these parents could be taught that people with severe hearing loss do succeed. In this way, the parents would not be as desperate to find a "cure" for their child's "ailment". While parents are only trying to do what is right for their child, they may in fact be doing more harm because of the ignorance they have about other options.
Overall, the sad fact is that the main reason for implanting a deaf child is that a medical view of deafness defines the child. Hearing parents of deaf children may have very little knowledge of deafness and, therefore, may see their child as being broken. Instead of fostering the child's natural abilities and allowing them to acquire the language that is natural to him/her, the parent may want to surgically alter the child to bring a sense of "normal" into the child's life. The parent is looking at what would be best for the family and society in the way of interaction instead of acknowledging the fact that the child may have individual needs and desires that are separate from societies ideals. When a parent starts seeing a child as an anomaly instead of a person, the child ultimately suffers.
The debate over the use of cochlear implants may never be solved. The medical professionals feel that, by healing or repairing the problem, they have found the answer for the deaf child. On the other side, the deaf community feels as if their culture, and the culture of the individual deaf child, is being exterminated by ignorance. To truly see the solution, society as a whole must learn acceptance and understanding of differences. Children should be proud of who they are, not ashamed of what they were born with. Unfortunately, the futures of deaf children are being decided every day by people other than the children themselves, by well-meaning medical professionals and loving parents on the one hand and the cultural family the children may one day find in the Deaf community on the other. Only a clear understanding of the underlying values on each side of this controversy will enable everyone to work together for what is truly in the best interest of each child.
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