The pro and con of cochlear implants

We’ve all seen the heartwarming videos on YouTube of people with cochlear implants experiencing the joy of sound for the first time: the 8-month-old baby hearing his mother’s voice, pacifier falling out of his mouth in wonder, or the 29-year-old woman hearing her own voice for the first time and dissolving into happy tears.

These are just two examples of how life-altering the ability to hear can be.

Recently, a study in Nature reported that researchers were able to restore hearing in an animal model using stem cells, an advance that puts science perhaps a step closer to curing deafness. However, many people in the deaf community don’t necessarily embrace such achievements with unabashed enthusiasm. For example, actress Marlee Matlin, who is deaf and an activist on the issue, took to her Twitter account to decry the stem cell research, stating that deafness “is not a disease to cure.”

Is deafness a disease? Should people pursue every opportunity available to restore one of the basic senses? We’ve asked Dr. Jeffrey Harris, division chief of otolaryngology at UC San Diego Health System, for his thoughts.

Q: What are cochlear implants and how do they work? Can anyone with hearing deficits use them?
A: Cochlear implants are devices that pick up sound and convert them into electrical impulses that travel down along a very thin electrode array that is surgically implanted into the inner ear (cochlea). If there are sufficient numbers of remaining nerve endings that can be stimulated, then hearing sound, words, speech, and even music, can be perceived by the deaf individual. Only people who no longer have benefit from hearing aids and meet the established hearing loss criteria are candidates for this surgery.
Q: Do you often meet resistance from patients with deafness when implants are suggested?
A: Interestingly enough, the vast majority of patients that I now implant were originally hearing individuals. These individuals have lost their hearing for a number of different reasons and they greatly desire to have their hearing restored with a cochlear implant. Back in the 1980s, when these devices were first introduced, there were a great number of adults who were born deaf and learned sign language who had great hesitancy to undergoing this surgery for social and cultural reasons. And the results on late implantation were not good because the unstimulated cochlear nerves had degenerated long before they could have undergone the operation.
Today, most centers implant deaf children early in order to prevent nerve degeneration from occurring and, as a result, they can be mainstreamed in school and can develop excellent speech and language skills.
Q: Marlee Matlin, who is an advocate for deaf people, stated that deafness is not a handicap and “there are millions of Americans who sign, who are deaf, and who are not a ‘disease’ to cure.” Should deafness be approached as just another trait, like being born with blue eyes or having red hair?
A: I firmly believe the options for implantation in a child born deaf need to be presented in a fair and balanced, nonemotional way to the parents, who can then make that decision. Included in this presentation should be a consideration of educational levels, average income, speech and language acquisition and quality of life assessments (to name a few) that can be achieved in hearing restored versus deaf children. One striking fact is that a child who is implanted early on, say at the age of 2, can achieve the same or nearly close to the level of speech and education as that of a hearing child. If the implant is delayed, say to the age of 6, the level of speech and education is significantly reduced. The dilemma, then, is that there is a window of opportunity that exists for the deaf child to be implanted, and, if it is delayed for too long, the child may never achieve the same hearing result because neural degeneration begins to occur in the unstimulated ear.