What is the Controversy about Cochlear Implants?


This report was written by a twelve year-old girl who wears hearing aids herself, and whose brother is my patient and received a cochlear implant in 1998. She wrote this report as a school project and won a prize. No wonder; the report is clearly and accurately written and represents a mature view on the subject. She gave me a copy of the report, and after reading it, I asked her if I could put it up on my website. She, of course, has graciously consented. What you will read below is entirely in her words, i.e., I have not added or changed anything in the report except for some minor formatting. Enjoy the read. Dr. Bhansali.

WHAT IS THE CONTROVERSY ABOUT COCHLEAR IMPLANTS?

6th grade
Evansdale Elementary School
Teacher:  Ms. Burnham
Methodology: This is my timeline on how I worked on my Social-Science Fair project.
September 7th  September 12th  I chose a topic I wanted to research on.
September 13th  I turned in my topic.
September 13th  I started researching for my topic.
October 1st  My title page and purpose page was due.
October 4th  October 10th  I wrote my Rough Draft.
October 11th  My Rough Draft was due.
October 16th 24th  I had interviews with people for my Project.
October 11th  October 26th  I had a Conference with Ms. Burnham about my project.
November 12th  I turned in my Final Draft.
November 26th  December 7th  I worked on my backboard.
December 10th  I turned in my finished project.

Methodology

1. I created a research outline to find out the pros and cons of the cochlear Implant.

  1. Risks involved with surgery and recovery
  2. Costs
  3. Likelihood of success in improved hearing
  4. How the implant changes your lifestyle

2. Find resources to answer my questions.

  1. Brochures from manufactures of the implant
  2. Internet research
  3. Interviews with experts

3. Organize and analyze the information

4. Write my report with my conclusion about the benefits of a cochlear implant reviewing:

  1. Who needs an implant?
  2. Costs
  3. Risks

5. Prepare visual display to inform others.

  1. Include hearing charts and diagrams
  2. Include photos and personal story
  3. Include major sections of report

Background: I remember three and a half years ago when my brother, Jonathan, was in kindergarten, it was very difficult to communicate with him. My brother and I were born deaf and we have always worn hearing aids to help us hear. After awhile, hearing aids didn’t help my brother anymore. I remember my mom saying it took five months to make the decision to get the Cochlear Implant for my brother. After a lot of research, Mom finally decided to get the Cochlear Implant for Jonathan in March of 1998.

After the implant was turned on, Jonathan had to relearn some new sounds. For example, he couldn’t understand his name. After a few months, he was able to recognize sounds that he could never hear before, like the dishwasher turning on, the sound of crickets at night, and the music coming from the car next to us in traffic. About a year ago, I started noticing that the T.V. did not have to be as loud for Jonathan as it did for me. I also noticed that Jonathan did not say “what” as often as I did, and that he could hear sounds that I could not hear.

Purpose: The purpose for my project is to find out more about the Cochlear Implant. I want to know what the negative things are about the Cochlear Implant that made my mom take five months to make the decision to go ahead with the operation. I also want to know how the Cochlear Implant works and how it is implanted in the head. I know how successful the Cochlear Implant can be because my brother can hear better than I can. Because of all this, I also want to know why more people don’t have the Cochlear Implant. Is it because of the dangers of the surgery, or the cost of the surgery, or because the deaf culture doesn’t believe in it?
Through my report I am going to explore the negative and positive aspects of the Cochlear Implant. I will review all the things you need to consider in making the choice between hearing aids and the Cochlear Implant and the costs involved.

The Report: When most people think of hearing loss they think of old people. It used to be that the senior citizens were the only people to wear hearing aids. As technology has improved and early detection of hearing loss is now done at birth, we are finding more and more children with hearing impairments. In the past if you had a hearing loss, a person only had two choices: to wear hearing aids or not. Hearing aids are great; they amplify sound in order for the deaf person to hear. If a person has a severe to profound hearing loss, however, hearing aids would not be a benefit, and he would live in the silent world. Technology today as made it possible for the severe to profound hearing impaired person to have a third choice, the cochlear implant. The cochlea is a part of the ear. As with anything new, there are controversial issues involved. I will first explain what and how the cochlear implant works. I will also go into the negative aspects of the cochlear implant. Then I will conclude with my opinion as to whether the cochlear implant is a good choice. In order to understand the cochlear implant it is important to understand how the normal ear works, and about hearing loss.

Your ears consist of three parts:

Outer Ear: the visible outer portion of the ear and ear canal,Middle Ear: the eardrum and three tiny bones, Inner Ear: the fluid-filled cochlea, which contains thousands of tiny sound receptors called hair cells.

For people with normal functioning hearing, sound passes through all three parts of the ear. The outer ear collects the sound and directs it to the eardrum causing it to vibrate. This creates a chain reaction in the three tiny bones of the middle ear. The motion of these bones causes fluid to move throughout the inner ear, or cochlea. As the fluid moves, thousands of tiny receptors (called hair cells) that line the cochlea, bend back and forth. When the hair cells move, they send electrical signals to the hearing nerve, which carries them to the brain where they are interpreted as sound.

When hair cells are damaged, they are unable to send sound information to the hearing nerve and the person experiences hearing loss. The degree of hearing loss depends on the number of hair cells that are damaged. If only a small percentage of hair cells are damaged, a person will experience a mild to moderate hearing loss and may benefit from the use of hearing aids. If a significant number of hair cells are damaged, a person will experience severe or profound hearing loss, and even loud sounds may be difficult to understand. Hearing aids make sounds louder by amplification to compensate for relatively minor loss or damage to hearing hair cells. For many individuals with a severe-to-profound hearing loss, hair cells are damaged to such degree that even the most sophisticated hearing aids don’t help.
New technology has brought the cochlear implant. The cochlear implant does not amplify sound. It bypasses the missing or damaged hair cells altogether, and delivers more sound information directly to the hearing nerve. The cochlear implant has two parts: 1) the implant, which is surgically placed into the Mastoid bone, and 2) the outer device of a headpiece and processor. The actual surgery generally takes two or three hours and is carried out under general anesthesia. During this time, the surgeon makes a space on the surface of the bone behind the ear to hold the implant and carefully inserts the electrode array into the inner ear. After allowing one month for the healing process of the surgery, you are fitted with the sound processor and headpiece that enables you to hear.

This is how the cochlear implant works:

1. A microphone captures the full sound signal in the environment. The advanced electronics in the processor convert the sound signal into high-resolution digital signals. Once sound in the environment is captured and processed into digital signals, the signals are sent to the headpiece, which is held in place by a small magnet.

2. The headpiece sends the sound information through the skin to the cochlear implant using a radio signal.

3. The cochlear implant delivers the full sound signal to the hearing nerve through the electrode system, which is surgically implanted into the cochlea. Once stimulated, the hearing nerve fibers carry the sound signals in a few milliseconds and the sound is heard in real-time.
The cochlear implant is the next best thing to having normal hearing. So why don’t more people have the implant done?
The cochlear implant is a relatively new technology. It was first developed twenty-five years ago. The cochlear implant has been improved over the years and has only become more popular during the past six years. Public awareness is very important.
Once a person decides to live in the hearing community or to raise their child in the hearing community, there are some things they must know, along with the possible side effects before they make the decision to get the cochlear implant. There are six things that you need to remember once you have been implanted and they are:

1. Placement of the implant electrode into the cochlea will destroy any residual hearing in the implanted ear. You will never be able to hear anything in the implanted ear without the use of the cochlear implant.

2. You will never be able to undergo Magnetic Resonance Imaging (MRI), which is a special diagnostic test similar to an X-ray.

3. If you have surgery in the future, the surgeons will need to know that they can only use the Monopolar Electrocautery device in areas below the shoulder blades and the Bipolar cautery instrument needs to maintain a 2 cm margin around the implant device. An Electrocautery is a device used by surgeons to control blood loss during an operation.

4. It is recommended that one does not play any contact sports (football, wrestling, karate, etc.). A helmet should ALWAYS be worn during activities that may result in a fall or inadvertent injury to the implant site. Each user and his/her family must decide the level of risk that is acceptable in terms of activities that are permitted.

5. The implant will activate metal detectors, which may be a nuisance to you at airports and other security checkpoints. Cell phones and other electronic devices may rarely interfere with the implant performance.

6. You should avoid activities in which static electricity is commonly created (plastic slides on playgrounds, removing a wool sweater, etc.).

7. Don?t forget that during some activities you will still be deaf. Due to the fact That the processor is not waterproof or submersible, you will be deaf when bathing, showering or swimming.

The above considerations do not seem so bad when you realize how well you will hear once you get the cochlear implant. As with any surgery or procedure, there is a risk of surgical complications. So what are the possible side affects that should be considered? Every patient must realize that the cochlear implant is a major operation and some of the more common risks are:

1. The normal risk of general anesthesia.
2. Major ear surgery often results in numbness and discomfort around the ear.
3. Patients may experience a change in taste after implantation. This is due to manipulation and possible sacrifice of the nerve to the taste buds on the side of the operation.
4. There is an extremely small chance of fluid leaking from the ear or brain after surgery. This can lead to meningitis.
5. The most feared complication of a cochlear implant is damage to the facial nerve, which is the nerve that moves the face muscles.

As you can see there is a lot to think about when getting the cochlear implant. Another thing people take into consideration is the cost. Like most medical devices, a cochlear implant is a significant investment. According to Donna Wallis an audiologist with Ear Consultants of Georgia, the cost of the cochlear implant is about $30,000.00, but the hospital charges and the surgeon?s fee is also about $30,000.00. So the total cost including the first year of follow-up care is about $60,000.00. However, most medical insurance carriers, including Medicare and other government health programs, provide full or partial coverage for the cost of the implant. According to Dr. Bhansali, a renowned Otology doctor with Ear Consultants of Georgia, the insurance only pays for the cochlear implant because very few people become completely deaf and the cochlear implant is necessary to return to normal life. Insurance companies feel that hearing aids are like eyeglasses, and they are not necessary.

Various studies worldwide have weighed the benefit provided by a cochlear implant against the cost. These studies have concluded that they are highly cost-effective for children and result in better educational performance and standard of living. The biggest cost for parents of children getting the implant is not one of money, but of time. It takes a lot of time to help a child develop strong language skills and to make the most of the implant.

Besides all the things I have mentioned above, there is one big consideration everyone has to deal with, and that is your emotions. You must decide if you want to live in the world of the hearing or in the deaf community. The deaf culture is a politically active movement and believes that people should not be deprived of their natural birthrights to live in a silent world. The deaf community is very much against the cochlear implant. If you should choose to get the implant, you must also choose to learn auditory-verbal language, which means you will use your new ear to hear and not depend on sign language or lip reading as a means of communication. If you are not willing to depend on auditory-verbal, then there is no reason to go through the expense or risk of surgery for the cochlear implant. Hearing aids are great for those who benefit from them, however, there are negative aspects to them, for example:

1.) A person with a severe to profound loss will get feedback from the hearing aids.
2.) Hearing aids can only amplify sounds by so much.
3.) There is a higher risk of ear canal infections because of always having something in the ear.

Conclusion: The cochlear implant is a personal choice, and when a person is faced with a hearing loss, there are a lot of choices and options. When a profound loss is diagnosed, however, then a person is limited in choices. He/she has three choices: to live in a silent world, struggle with hearing aids or get the cochlear implant and live within the hearing community. There are a lot of things to consider when making a decision to go through major surgery to receive the implant and there are also some risks involved. I have watched how well my brother does with the implant. For example, he can hear when someone whispers, the TV does not have to be as loud as it is for me, and he can hear higher pitched sounds that I cannot hear. With these observations, and after researching everything about the cochlear implant I have come to the conclusion that if a person wants to be active in the hearing community, then the cochlear implant far outweighs the risks and special considerations that are involved. I have also decided that if my hearing ever gets any worse and I could no longer hear with my hearing aids, I would get the cochlear implant.
Interviews With Dr. Sanjay A. Bhansali M.D. Otology/Neurotology and Donna Lynn Wallis Audiologist


Dr. Sanjay A. Bhansali M.D. Otology/Neurotology Interview October 26, 2001

1. Do you believe the cochlear implant is for everyone who has a hearing loss? No
2. Are there times when a person should not get the cochlear implant? Yes
3. How is the cochlear implant different from hearing aids? It is implanted and bypasses the eardrum & ossicles (hearing bones).
4. What are the negative aspects of hearing aids? Ear canal infections, feedback, occlusion effect.  Sound unclear when volume is turned up too loud.
5. What are the negative aspects of the cochlear implant? Having to have surgery and wear something on your head to hear.
6. How deaf must a person be in order to get the implant? When hearing aids don’t help enough then they can get a cochlear implant.
7. What is the success rate of the implant? 95% overall, but individual success rates vary.
8. Does the implant give a person normal hearing? Pretty close, but not exactly like natural hearing.
9. Can a person with the implant hear everything? Mostly, yes.
10. Have you ever implanted someone and the implant not work? Fortunately, not.
11. How long will the implant last? Should last as long as you last.
12. Will a person have to go through surgery again after so many years to get a new implant? For example when a baby is implanted and then as their head gets bigger will they have to get a new one? No and No
13. Will my brother have to get a new implant when he is an adult? No
14. After the implant is turned on how often does a person need to come back and get reprogrammed? Everyone is different.
15. How much does the implant cost? About $ 30,000.00 just for the implant.
16. Does insurance pay for the implant? Yes
17. Why will insurance pay for the cochlear implant but not hearing aids? Because very few people become completely deaf and the implant is necessary to return to a normal life. Hearing aids are like eyeglasses.
18. What is the biggest controversy with the cochlear implant? Implanting deaf people who were born deaf and never acquired language. They cannot use the implant.
19. Overall do you like the implant or hearing aids for a person with a hearing loss? It depends on the extent of the hearing loss.


Donna Lynn Wallis Audiologist Interview October 26, 2001

1. Do you believe the cochlear implant is for everyone who has a hearing loss? No
2. Are there times when a person should not get the cochlear implant? Yes
3. How is the cochlear implant different from hearing aids? The implant provides electrical stimulation directly to the hearing nerve. Hearing aids provide amplified sound through the eardrum and middle ear bones into the inner ear.
4. What are the negative aspects of hearing aids? If a person has a severe or profound hearing loss feedback can occur.
5. What are the negative aspects of the cochlear implant? The patient has to have surgery to get one and patients can?t swim with the implant on.
6. How deaf must a person be in order to get the implant? Adults: 50% or less discrimination in the implant ear using sentence test. Children: 30% discrimination on age appropriate test material.  Babies/toddlers: little to no benefit from hearing aids.
7. Does the implant give a person normal hearing? No
8. Can a person with the implant hear everything? No, patients can detect sound at a comfortable level, but will test in the sound booth at a mild hearing loss level.
9. Have you ever implanted someone and the implant not work? There have been older children who used sign language exclusively who refused to wear the implant over time. I have seen one child who had an internal device failure.
10. How long will the implant last? It is meant to last a lifetime but no one knows for sure because they have been used less then 25 years in young children. There is a known 1-2% failure rate.
11. Will a person have to go through surgery again after so many years to get a new implant? For example when a baby is implanted and then as their head gets bigger will they have to get a new one? No-the cochlea is adult size at birth so unless there is a device failure or technology is so good that a new implant would be better.
12. Will my brother have to get a new implant when he is an adult? No, not unless his malfunctions or technology is vastly improved.
13. After the implant is turned on how often does a person need to come back and get reprogrammed? It varies by patient but usually about 10 times the first year and 3-5 times the second year and 2 times per year after that.
14. How much does the implant cost? About $30,000 for the product. The surgeon’s fee and hospital charges can be over $30,000.
15. Does insurance pay for the implant? Yes, most insurance companies pay for the implant.
16. Why will insurance pay for the cochlear implant but not hearing aids? I don?t know ? it doesn’t make sense.
17. What is the biggest controversy with the cochlear implant? Many people think deaf children should not be implanted and should be taught sign language.
18. Overall, do you like the implant or hearing aids for a person with a hearing loss? I think if a person can do well with a hearing aid then that is best, but if not the cochlear implant will provide access to sound and allow a person to hear and speak.

Bibliography: Blythe M.D., William R. Things you must know before undergoing a Cochlear Implant.
Bhansali, M.D, Sanjay. Ear Consultants of Georgia Otology/ Neurotology, 993-C Johnson Ferry Rd, Suite 240-C, Atlanta, GA 30342
Cost-Utility Analysis of the Cochlear Implant in Children? American Medical Association, USA 2000.
More Sound. Better Hearing. Imagine the possibilities? Advanced Bionics Corporation, USA 2001.
Stiles, M.D, Warren A. and William R. Blythe, M.D. Possible Adverse Effects from Cochlear Implantation
Wallis, Donna Lynn. Ear Consultants of Georgia Audiology, 993-C Johnson Ferry Rd., Suite 240-C, Atlanta, GA 30342