The author notes that there are many ways of being deaf and that the ultimate decision on how to provide language to a deaf child rests with the parents. She then expresses her opinion on the best way for a child to be deaf.
Fortunately parents do have choices about how to approach their child’s deafness, choices that will have long-lasting consequences. Over 90% of children with hearing loss are born to two typically hearing parents who do not know sign language. Unlike children born to deaf parents who already know and use sign language, deaf children in households in which the parents are learning ASL, are often language delayed.
In a multi-site study of 100 deaf children with cochlear implants (Geers 2017), researchers found that children who had limited exposure to sign language developed better listening, speech, and reading. Studies that find an ASL advantage typically involve small samples or children whose parents already knew ASL. The reality is that the “years of vigorous auditory-verbal training” noted by the author is really just good parenting—lots of talking, asking questions, reading, and limited screen time—doing things that parents can be mentored about so that they and others who interact with their child spend a lot of time doing what all parents should do. The organization where I work, the American Cochlear Implant Alliance, encourages and shares research based findings on cochlear implants. For more details, visit www.acialliance.org.
42
I know just enough about language learning (mainly thanks to Stephen Pinker's "The Language Instinct") to appreciate many of the points in this piece....and its a really good piece. It certainly won't take ignorant people all the way to understanding; what people who have no personal engagement with deafness need to know is, be respectful, and its a complicated issue. The people who need a deep understanding of are deaf adults and especially, the parents of deaf children. I hope all possible efforts are being made to educate them.
5
As a mother of a deaf daughter whom I chose to implant at age 11 months, I am happy to see my now teenage daughter thriving as a mainstreamed high school honor student.
My husband and I researched choices and outcomes, and we ultimately made a decision that would allow our daughter to communicate with us in our primary language as well as become an independent member of our family and society.
I have heard criticism from the Deaf community stating we should have let our daughter decide whether to implant once she turned 18, but waiting that long would have lessened her chances of successful hearing and spoken language.
My daughter now wears her bilateral cochlear implants at school where she needs them to hear and learn. At home, she is increasingly choosing to take them off and retreat into her silent world. I am envious of her ability to tune out the rest
36
I'm weighing in, not because I'm deaf, but because I have questions.
First of all, I understand that an implant is not for everyone, that it is not a solution, that it has downsides as well as upsides, and I would never presume to say or even think that every eligible deaf person should get one for themselves or their children.
I also understand that deaf people live rich, full lives with a distinct culture, and that they don't think of themselves as handicapped.
At the same time, I have known and worked with deaf people. I recently took a Lyft ride with a deaf driver who couldn't hear a loud horn honking behind her - a honk that was completely justified, and we nearly got into an accident. Hearing is not just some nice thing that some folks happen to possess - it's a vital sense, and learning ASL does not completely make up for it in terms of how one negotiates one's life.
I don't hear blind people denigrating those that have sight or passing up any technology that exists to improve how they function in the world - but I have witnessed deaf people disparaging "hearing culture" and attempting to raise their hearing children as if they were deaf. I realize there are extremists everywhere, and I'm not saying they represent all deaf people. But, while I'm sure being deaf is extremely frustrating, and it's good to be empowered, I don't understand why there's a level of insularity and hostility that you don't find in those with much more severe disabilities.
Let me have it.
47
@James Jacobs Thank you! I could not have said it better myself! CIs have changed my life and have taken me out of isolation. I can now line and tap dance and interact with others and hear horns and birds and crickets and sirens. I still don't understand everything I hear, as I was born with severe hearing loss and became at 17 and received my first implant at 32 (29 years ago). But I understand a lot and my ability to hear some things still brings tears to those who have known me all my life. Hearing is a gift. The CI is a miracle.
28
@James Jacobs I'm gratified that this has gotten only positive reactions so far; I'm sure the negative ones are coming, and I welcome them, because my questions were sincere; I'm sure there are aspects of this I'm not thinking of from my place of privilege. It's possible, for example, that the problem isn't that deaf people are angry but that blind people aren't angry enough at the lack of accommodations society has provided for them. In any case, I mean it: let me have it.
12
@James Jacobs. The implant delivers sound but not communication which are two different ideas. It is offered as a alternative to ASL just one more part of a long chain of efforts to break the Deaf community of their natural language. Read any of the histories of the Deaf Community and you will understand.
7
Does it actually take kids who are implanted very young more work and time to learn spoken language than it does kids with normal hearing? It makes sense that older people would have to work hard when implanted, but my guess would be that babies just learn speech like any other kid.
11
Being severely aurally challenged is no fun, but I have kept gainfully employed for some four decades as a foreign language translator. (As Ms. Novic points out, a quiet environment is indeed conducive to concentration.) There are people who like me in spite of my handicap, and as for the others, I can rationalize that they don't have much to say that's worth listening to in any event.
4
As the parent of two DHH children, I had to make the decision about whether or not to implant my children. My older son has had bilateral implants since he was a year old. My younger son is not implanted because hearing aids serve him well enough. Ms. Novic is correct that it is a lot of work, but don't gloss over the amount of work involved in learning to speak for someone with regular hearing. For many babies, including my older son, it's essentially the same experience.
Both my sons use ASL and spoken English, because they're effectively deaf when not wearing a device. There doesn't need to be a choice between languages, it's a good point you make, and one that many educators get wrong.
I think the article you present would resonate more if you truly understood both deafness and hearing - that is, if you had this perspective after being implanted as a baby. My sons choose each day whether or not to wear a device - nearly every day it is to wear it. As the copious comments attest - plenty of people are completely successful with implants.
28
Our son was born deaf and a short while later we concluded that we work to help him to listen and to speak. That decision and the journey that followed, was all consuming. The CI comes with work. The benefits reaped exceed anything we could have imagined.
It was a journey made with love, best intentions and a commitment to our son that he have access to a future of wide choices (where to live, languages to speak, work to do) even if this first choice (to implant or not) was made for him.
These decisions were made with the chaotic hub of Southeast Asia as a backdrop. Living here, it seemed apparent to us that our adult son would benefit from having the widest choices available to him. In the past decade the only School for the Deaf has closed. There are now at least 4 programs running out of the public hospitals to assist children to hear and talk and numerous private service providers.
A hard person might condemn a new parent’s desire for a ‘normal’, ‘passing’ child and the uncomplicated joy of “normal” childhood without early intervention. An ignorant person might assume that a decision to implant a child with a CI is a decision based solely on appearances and “passing”. I think the only assumption that can be made is that a decision to implant a child with a CI is a hard one.
19
I understand that there are many individuals that have had a cochlear Implant. In the past a cochlear Implant may have been the first answer, but now a cochlear implant is not today the first answer.
The first answer today is the amazing hearing aids that are now available.
Every doctor today should tell a patient to try working with the new hearing aids before suggesting a cochlear Implant.
With the today amazing hearing aids that are now available, a cochlear implant should only be suggested when a doctor clinically knows that a patient has lost all of the ability to hear.
2
Thank you for this article. Having been a bi-lateral CI recipient since February 2009, I was in my 40’s and had lost hearing in both ears to Menieres Disease.
When you get “programmed” about a month after your surgery, your initial hearing will sound very mechanical. Verbal exercises such as talking out loud to get used to your own voice (yes, it is quite different to hear compared with natural hearing), to getting used to all those familiar background sounds we block out of our busy day, or more likely, your hearing was slowly dying, takes a lot of practice. The airplanes overhead, birds chirping, even a dishwasher running may either make you jump out of your chair, or think, “Wow. What else did I miss hearing?”
I’ve been through three or four upgrades with my CI’s and with each upgrade there are improvements for better hearing. However, the ability to articulate depends on the extent of your vocabulary. The older you get, the more words you’ve heard and understand. You can imagine a person at my age (now 54), who still can’t understand people over the phone after dozens of attempts, switching to different programs on my CI, adjusting nervously the volume and surrounding perimeter, and trying to hear people in noisy areas is futile.
My recommendation if you have children who were born deaf is to teach them ASL, but also start their reading ASAP. Also, if they are less profoundly deaf in one ear rather than the other, keep the natural hearing in the less affected ear.
11
@Nancy Chovancek
Also, if they are less profoundly deaf in one ear rather than the other, keep the natural hearing in the less affected ear.
With the amazing hearing aids that are now available it makes sense to keep the natural hearing for young children instead of cochlear implants.
1
I'm in that group some call "prime candidate" for cochlear implants. I had normal hearing for over 40 years, and then it slowly began to diminish. I did hearing aids for years, and did ok with the combination of hearing aids and lip reading. Ironically, my undergrad degree is in deaf ed, so I could sign some (I'm not fluent). I went to deaf meet ups and silent dinners...all looking to find "my people." Guess what? You can't change cultures. As a late-deafened adult, I could no more join the deaf culture than I could decide to join the Hispanic culture. Both are cultures defined by a language--just not my language. My language is spoken English. After my surgery, I waited 3 weeks for activation. I teach English in a general ed (hearing) school. If this didn't work, I'd have to find a new job. At activation I was hopeful. School started in less than a week and I was counting on this. In hindsight, that was really silly, but I assumed I'd hear from day one. Fortunately , I heard immediately. The next day, my son had his Eagle board of review and I heard them congratulate him on his achievement. My other son is in the army. I can hear him when he calls me. I can take care of all of my own business on the phone. I can hear my students across the room...and if there's noise, I have tools to hear in that, too. There are some people the CI may not be for...but for me, well, I like to say, "I got my life back." Thanks to all the "borgs" out there who helped me in the journey!
37
I can’t speak to the language training needed by deaf-from-birth cochlear implant recipients, because I began losing my hearing at around age 35 and ultimately received a cochlear implant at age 60.
However, I’m surprised that this article ignores the value of cochlear implantation for purposes other than speech: The songs of birds, the purr of a cat, the sound of the ocean, the rhythm of music, and (this can’t be emphasized enough) the sound of an approaching car when crossing the street on foot.
The surgery itself was the most difficult part of my cochlear implant experience. There were no training sessions. Interacting out in the world provided the experiences my brain needed to adjust to the new sounds. Regular “mapping” appointments took place over the years to adjust the programs based upon my perceptions; e.g. “vowels are too loud”.
With a cochlear implant, the sound experience isn’t perfect but it’s a major improvement, and my quality of life would certainly be worse without it.
25
Hmmm ... so, there would be controversy, as well, if you had refused a hip implant because you thought limping was a suitable option?
Seriously?
What defensive silliness.
26
@George
I had a brother that had two failed hip implants that had to be removed. He died years later with no hip. Limping would have been a suitable option.
3
@George
I know people who have had hip surgery and it is not the cure all you are implying here. It can not work or work for a while and then begin to fail. Some people will be told they are better off limping than replacing a hip. Seriously--don't jump into body altering surgery in the expectation you are getting an instant, life-long cure. If you are so silly, you may live to regret it.
5
This is an incredibly important story and one that rings true for many assisted technologies.
They don't work for everyone.
They require a lot of effort.
They're not a cure, but rather one part of a total treatment plan.
15
It's fascinating how other people think they have a right to tell you what to do with YOUR BODY. If deaf people like their bodies that way, that's their privilege and no outsider should question it. In the same way as if a woman desires not to be pregnant, no outsider should question it.
And the answer to people who make intrusive remarks is "Kindly mind your own business. I am completely capable of managing my own body". No further explanations needed.
15
I'm 68 years old and received my cochlear implant 16.5 years ago. At that time, my natural hearing had degraded to the point where hearing aids were no longer useful. I retreated from most social settings, fearing that I would be seen as a fool because I did not understand what was being said and that I had often said inappropriate things in those settings.
Because I had fully developed speech prior to my deafness, the effect of my implant was truly miraculous. I knew what English words and most environmental sounds were supposed to sound like. Yes, it took several months to get my mind wrapped around the "sounds" that were coming from my implant -- along with numerous equipment adjustments at the audiologist' office -- but when my mind finally made the connection it was amazing.
I heard things that I hadn't heard in decades. The voices of birds and small children, the sound of wind moving through the leafed trees, and much more. I'm glad I made the "commitment" to getting a cochlear implant. For me, the rewards were huge.
48
@LynnBob
I had problems hearing when I was ten years old and I have lived with that for over sixty years. I now have hearing aids that allow me to hear again and I am amazed.
By the way from being ten years old I did not hear the "voices of birds and small children, the sound of wind moving through the leafed trees, and much more" until I had hearing aids in 2010.
By the way the hearing aids I received in 2015 were even more amazing than the 2010 hearing aids.
Now it is better for elderly individuals to switch to the amazing new hearing aids instead of having a cochlear implant.
3
@Bob S: The utility of hearing aids depends on the nature and severity of hearing loss. Improvements in hearing aid technology are always beneficial, but that doesn’t mean that hearing aids work for everyone. Cochlear implants may help those for whom hearing aids don’t or no longer work.
15
The author's thoughts would be authoritative had she tried the implant and then decided to go back to life without it. Without that actual experience, she's only speculating on how it might affect her life.
29
I have had a cochlear implant for 8 years. I lost my hearing in my 50s. I would say it took me about a month to get used to it. In part it was my cochlear implant audiologist at Kaiser Oakland making adjustments and partly my brain getting used to it. I am very happy with it. Granted we no longer have dinner parties of more than six because competing and overlapping voices are difficult. I think the biggest problem with it is it getting knocked off by low hanging trees. But my Advanced Bionics implant is very sturdy and I just put it back on. I have to say it changed the trajectory of my life.
30
Your experience mirrors mine. Deaf since birth. Cochlear at 45. Took to it like a duck to water.
I don’t doubt every recipient is different or many face major challenges. Some however do not.
Never regretted the decision for a moment.
17
Cochlear implants are 40 years old and I wounder why there needs to be these implants.
Hearing aids are now amazing from 40 years ago and electronic wires are now amazing.
Why not wire(s) through the ears and not implanted in the head? The idea of cutting into the head is not a happy thought.
I see no reason why this can not be done. Tests can be used on animals. There is no real need for everything of the device to be implanted to the head. Wires could be connected to the hears and areas below the ears that have batteries.
Medical companies want to keep the same thing for years and not have to change. Research and tests means larger costs and lower profits so medical companies keep with as things were done 40 years ago.
Of course wires though the hear instead of cochlear implants would reduce the cost of medical companies by at least by 50 percent.
By the way a powerful hearing aid with a large battery on the body might be able to do the job.
1
Deaf people continue to be an oppressed cultural and linguistic minority. Reading most of these comments proves it. Thank you for sharing the perspective on a Deaf professional to the readers of The NY Times. Hopefully some will be interested in taking the next steps to learn more about the value and richness of the Deaf community and ASL.
11
My mother taught deaf children and one of my children's friends is deaf and has a cochlear implant. This article does not really clarify the author's position an I am left confused by generalities.
What examples are there of cochlear implants that have not benefited the users? How are these compared with deaf people who never attempted cochlear implants? OK, so the success depends on many factors, but is partial success so bad? And were are any statistics and data? Also, doesn't waiting until someone is older to have cochlear implants also have disadvantages in terms of training the brain to understand the sounds?
26
I know many Deaf adults who no longer use their implants at all. It’s not a research study but there are many examples of the CI not being helpful for people. Just ask around the Deaf community.
4
@Justin and yet we have thousands and thousands in USA that still wear their CI.
I know many who love it.
I know many culturally deaf who uses their CI and loves it.
14
I lived in St Louis for many years. St Louis is home to the world-famous Central Institute for the Deaf. This marvelous school has always believed in teaching deaf children how to TALK. They do NOT teach signing at all! Long before cochlear implants, their deaf students could lip read and talk and function in a talking world. My late husband taught a girl who had been trained at CID - one would not have known she was deaf. She was able to completely function in the hearing world.
Before I lived in St Louis, I lived in KS. I had a wonderful ballet teacher whose first child was born deaf. Her husband quit his job to move with the family to St Louis so this child could be trained at CID. I know another family that did the same.
The Opinion piece does not mention that the oral method of deaf education has been around for a very long time and has taught millions of deaf children how to speak and lip read. There are schools all over the country teaching this instead of "manualism", ie using ASL.
This entire idea of a "deaf culture" is limiting and frankly, rather ridiculous. Why on earth would any parent want his child limited to a culture that excludes most of the rest of the world? That even may exclude him from some family members who find ASL difficult to learn?
Now, with cochlear implants and oral speech training, a child can be a part of the entire world. Who wouldn't want that for a child?
39
Would you call any other cultural group ridiculous? Harsh and oppressive terminology.
8
@Justin I don't believe that deafness must mean being a member of a "cultural group" anymore than it would be if one wore glasses (I do!). If someone wants to make it that, then I think that is a BIG mistake. It is limiting the deaf person being a part of our ENTIRE culture!
10
I'd say that parent's deciding that their children should be permanently disabled is not an acceptable outcome. We don't have this discussion when it comes to walking, seeing, or any other potential source of permanent disability in children. Replace "hearing" with "walking" in this essay and you can see how ludicrous the proposition is. Nothing in life is 100% and that is also true in medicine. Not having a perfect cure is not a reason to allow parents to cause permanent damage to their children. And yes, the data does show that if you don't get these early you are impacting a child's ability to speak later in life.
42
I know many brilliant Deaf professionals who would never view themselves as “permanently disabled” who work in medical research, academia, human services, and the medical field.
Try and learn more about the Deaf community before you label them as such.
7
@Justin Do they lack an "ability" to hear? That is the definition of a dis"ability" if you're wondering. One of the most brilliant people and mentors of mine was deaf so I am very much aware of deaf individual's ability to thrive in our society. However, this is certainly a disability, and I'm not seeing an argument against the ethical obligation to reduce a child's disability.
13
Using the argument that families in low socioeconomic situations are more likely to have language delays with CIs is such a terrible argument because they are just more likely to have language delays regardless of which path was chosen. It’s true that deaf kids in low socioeconomic families have more delays but if a single mother is working multiple jobs then her child isn’t getting the best language model regardless of methodology. Assuming that parents with beginner ASL skills can offer better language model in ASL than spoken language is also a bit reckless. It takes 7 years of constant education and social exposure to ASL to become fluent in ASL. Learning the vocabulary is only the tip of the iceberg.
I could not raise my child as a primary Spanish speaking language while only learning the vocabulary as I go. It don’t work that way.
27
People who plan to discuss the merits of cochlear implants would benefit from bringing data.
Many major measures of achieving life goals: educational achievement, salary and expectation of not being sexually abused, to name just three, are significantly better for CI wearers compared to deaf people. Unfortunately I can't cite the source, and its 18 years since I saw the data, but its real and dramatic.
Yes, they are not perfect for all, but the data shows they are more likely to give significant benefit than not.
I used to work for Cochlear Ltd, and it was life affirming to see how much benefit they provided.
14
Ms. Novic: The people who portray cochlear implants as a "miracle" are mainly those who use them - and there are half a million of us out there. It is not for you to tell us how we should portray them. If we think of them as miracles, then that is how we truly feel. For you, as a non cochlear implant user, to dictate how we should speak about a technology that many of us find incredible and life changing, is not fair. You are more than entitled to publish this opinion piece stating that you love your life of silence. Mazel tov to you. It's your life and we're glad you're loving it. You do not have the right to say that we who wear cochlear implants should not call them miraculous. We're the users - you are not. It's not for you to speak for us.
67
What about music? Birds singing? Traffic noise as a warning? Cat steps on the floor? Coming from a person who has never heard I find it rich for her to say in essence "don't get it". It may not be a miracle cure (wearing a hearing aid is not the same as "normal" hearing either), but it will help a person acclimate to the world in a way that just knowing ASL will never do.
26
There is nothing stopping people who get CIs from learning ASL as well... in fact many hearing parents with hearing children teach their babies some sign simply to communicate with them before they are physically capable of speech, but mentally capable of comprehension... It doesn't have to be an either or choice...
19
I worked for a cochlear implant manufacturer before going into retirement. I‘m familiar with the medical and ethical issues and am aware that rehabilitation is essential for positive outcomes.
I don’t think I would choose an implant if I had a severe hearing impairment. It would have been a very difficult choice to make if one of my children had hearing loss: among other reasons, because I don’t like the idea of having an active implant in one’s skull.
What I don‘t undertand is why the author has tattoos if she was „happy with the way“ she was.
14
I have had a CI since 1995, at age 40 after losing most of my hearing by age 11. This is the first time I have read that CI results may vary by surgeon.
I am glad I got the implant but it was hardly the "miracle" portrayed in some promotional literature.
It took about 6 months for it to work well for me and I was an extremely motivated science PhD candidate in an oral environment with classes to teach. I knew almost no other hearing impaired people.
But there seemed a certain idiocy at the time, just after getting "hooked up" for the first time, the audiologist sent me out on the street in mid town Manhattan which was hardly the way to ease into the device,
Having been born oral and with strong language skills, it just took my brain awhile to adapt to the implant , I am not convinced more "effort" and a rehabilitative program would have helped much.
As part of the trials on the device I had a number of tests after which I was told that I was in the top 5% in how well I responded, I viewed this as amusing, I may have done well enough in a sound proof room for the standard tests but out in the real world with background noise I was a bit worse off.
12
But the truth is that we absolutely have data that shows that children who use spoken language with a CI do better than those who do both (Geers 2017). We also have 40 years of data that says that children who use spoken language (with or without a CI) do better in academic, vocational, and linguistic achievement than those who use ASL.
Sorry.
30
Thank you for this article, it clarified a lot of things for me.
5
Brava Sara! I am a hearing person, but I do know the deaf have a culture of value to us. Your article brought to mind a movie I saw starring a pair of deaf actors. When they staged a fight they settled it quickly without raising their voices.
7
Hearing, hearing, hearing.
People, please take a moment to think about language outside the bias of hearing.
Then take a moment to think about being a three year old on a beach and your parent is restricting you so you don’t hurt your CI. Yes, I saw this and yes I wept. There was no way to communicate with this child.
I’ve seen Deaf people whose children are using sign language at age 10 months.
The parents on the beach were restricting the right of their child to language and normal human development.
To develop sovereignty in body and being one must have language.
Language, language, language.
7
@Rebecca Sharad The CI can totally go in the water. There are waterproof boxes for it or a version of it made expressly for water (like the Neptune by Advanced Bionics). And as I've said in other comments, hearing is more than language, it's about sound. I would weep at the thought of a child never hearing the sound of the ocean.
28
I know a man who went deaf at age 10. He says it "just happened." He got a cochlear implant, probably an early model, and described it as a very hard operation and recovery. And guess what-- he wears it but it doesn't seem to help him at all.
2
@Trilby You are describing one story. There are over 200,000 people implanted in the world. I can share with you the story of the over 100 that I have worked with or known over the past 15 years and exactly two have not received benefit from their CIs and both of them used ASL heavily.
15
Both the opinion piece and the comments illustrate the dichotomy that exist, pro-C.I. and anti-CI. I had natural hearing for over 30 years, hearing aids for 25+ years, and have been a bilateral user of CIs for 8 years. There is truth in that children have the best brain plasticity under the age of 6, however, if your brain has auditory stimulus for any number of years, the C.I. can be successful. Patience, practice, and perseverance are the three Ps, a supportive environment whether it be family and friends, a good audiologist, regular mappings (reprogramming the external processor as your hearing evolves), and good Auditory Verbal Therapist, (AVT, specializing in cochlear implants), and reasonable expectations upon activations are good indicators for success. Unreasonable expectations, failure to do your homework, no post activation therapy are prime factors for a checkered outcome.
Surgeon skill and human anatomy are also very important. Your success or failure can be helped or hindered by the effort you, as the end user, put in.
I am involved in various C.I. research projects and what I have learned allows me to be a more effective advocate for CIs.
My CIs saved my marriage, career, relationships with all and my ability to feel like a normal, productive member of society.
36
thanks.
3
“The value of the tool lies only in the skill of its user”= well said, and also true of hearing aids, as some users expect ‘normal hearing’ right off the bat. But hearing aids are not eyeglasses. They aren’t an instant fix. Good article.
4
I agree that hearing aids often require an adjustment period by the wearer.
Many of those who wear hearing aids also may experience problems similar to the problems experienced by those who have had cochlear implants, such as sounds being experienced as harsh or strange, difficulties in understanding speech and difficulty hearing in crowded or noisy environments.
1
I worked as an engineer on the cochlear implant project in the 1970's at UCSF. As I learned more about the auditory system I became convinced that the cochlea played a role in decoding speech. Otherwise, you are putting too much faith in the brain to extract the useful information from the auditory waveform. Extracting the useful information is a very complex process and it just makes sense to me that the cochlea is playing a role. I wrote a memo expressing my concern that if we don't take this into account the implants we were designing would not work as well as everyone was hoping. I was fired for writing that memo so I never heard how things went, but I've always wondered if I was right.
9
Fascinating and extremely well written article - as someone who hasn't known a person with a cochlear implant (at least that I know of), I learned a lot and appreciate the author's clear explanations of how complicated this choice and learning process must be for both parents and the children now receiving implants.
7
C.I. is a transitional technology. We can reasonably expect the future will offer improved prevention of conditions causing hearing loss, better medical therapies (possibly including cochlear regeneration as other writers have mentioned) as well as improved C.I. technology. In short, the number of people who require ASL for communication will diminish.
Therein lies the problem. There is a culture built around the shared language of ASL and the prospect of losing an entire culture is bound to be resisted. Technology may eventually drive that very outcome, but in the meantime I don't think we should calling C.I. skeptics religious extremists.
5
I am an adult who got a cochlear implant at 66, after losing hearing at 60 (I had to wait for Medicare to afford it.) The implant is never as good for hearing defects as glasses are for vision defects, but it helps a lot, and I'm glad I have it. I understand that adults who were deaf all their lives have trouble adjusting, just as a lifelong blind person suddenly given sight has trouble interpreting what they see, but for those children it works for, it's fantastic. I know many deaf people say they're fine. but it's hard to bicycle while deaf.
21
More work has to be done for children that have a hearing problem but are not totally Deaf. There are children that can not hear high sounds because of illness. These children do not need a Cochlear Implants.
Children can be given exercises with mirrors of the movement of the tongue and lips. Pictures and drawing of the movement of the tongue and lips can also be made available to children. This will aid children in pronunciation and also in reading lips.
Children should also be given hearing tests when there are children with speech problems since there are now test that can indicate when there are hearing problems.
Many children that have problems with hearing are in many cases ignored.
2
As Ms. Novic does not have a cochlear implant and has expressly rejected the opportunity to have one, she is completely unqualified to talk about their benefits or costs. I expect the NY Times will publish an impartial piece, by someone with no skin in the issue. There is no possibility this article is not colored by personal preferences and misconceptions.
26
@drollere her piece strikes me as reasonable; she's neither for nor against. She's making people aware of the nuances and the importance of language fluency during the critical period.
14
@drollere
It's an essay in the Opinion section, not a feature story in the News section.
Also, as a Deaf person and educator she DOES have skin in the game. In fact, EVERYONE, whether Deaf or hearing, has skin in the game. That's the point of the essay.
9
@drollere I find Ms. Novic uniquely qualified to respond to an article that lauded the benefits of CI implantation while not speaking to the lengths families must go to to ensure success post implantation. I am quite sure that she looked into the benefits AND costs, both financial and emotional before coming to a very personal decision. My son was implanted in 1999 after much research on my part and I am convinced that the biggest reason (other than the large amount of work from incredible professionals, my son and his family) he is an unqualified success story with the CI is because he had a full and robust language system already in place. I had to fight for him to continue to receive interpreting services in school as the school felt I had "chosen" oralism because of the CI and I had to remind them that the CI was a tool, not a miracle. He graduated college with honors with a degree in English. And he is unique. No other Deaf or deaf person will ever have the same journey that he had. Getting a CI for him was a huge leap of faith. Thankfully it paid off.
10
I know nothing of the deaf experience. But I do remember walking down a busy city street once playing music through my headphones. I immediately felt less safe -- the normal traffic sounds I usually processed almost subconsciously had disappeared, and crossing the road and navigating pedestrian traffic had become much more difficult. I removed the headphones after a couple of blocks and have never tried that again. I have come to understand that my ears are constantly feeding me vital information about the world around me whether I consciously notice it or not -- information that could make difference between life and death. Even if CI does nothing for speech recognition, wouldn't it help with everything else hearing does for us?
14
As hearing people we will never know what it means to see as a Deaf person sees. I can only watch my Deaf son and I know that he sees differently than me.
3
I thought I knew what Cochlear Implants are. I was wrong and now I know what they really are and aren't. Any day you learn something new about little discussed medical technology is a good day.
15
It is important to remember that the sellers of ANY technology are in it for the money. They will, therefore, present all the benefits, while trying to minimize any problems or concerns. It's called "capitalism."
7
C.I. appears to be effective with very young children that are totally Deaf and have parents that will work hard to have their child overcome the time lost in hearing sounds and understanding the meaning of sounds. C.I. is not very effective with poor children.
C.I. can be effective with adults that were not totally Deaf but have recently become totally Deaf. These adults in the past could hear sounds and would understand the meaning of the sounds of the C.I. device.
C.I. would be a problem with adults that were always totally Deaf since these adults would have a very large problem in understanding the meaning of the sounds of the C.I. device.
3
While this article is not incorrect, there is a lot of missing information. The resources used are subpar and it leans toward a negative view of cochlear implants rather than providing a neutral lens. The one major source missing is the perspective of an audiologist. Audiologists are the ones that are directly involved in the counseling, fitting, and after care of a cochlear implant. They are the ones that are walking these patient's through the entire cochlear implant experience. Without their perspective you are unable to draw well rounded conclusions and/or opinions. The cochlear implant processes is different for every individual and the decision is very personal, therefore it is impossible to draw overarching conclusions about the process. When you write about a topic such as this make sure you provide more sources and a wealth of perspectives.
22
That’s because it’s not an article, it’s an opinion piece. And opinions are not fact. I hope readers are astute enough to see through the bias in this piece.
7
thank you for an interesting perspective; both my parents are partially deaf (in their 80s) and their adaptation to the world with less sound has made using their hearing aids difficult. things now are "too loud" for them, or distracting. they can no longer filter out background noises when they have them in. we (their children) are frustrated and annoyed that they don't hear the way they used to, making communication more of a chore. i see now that hearing aids, and CI are tools, like hearing aids, or eyeglasses (i wear very strong ones)... i may encourage my parents (and siblings) in learning some ASL as well as speaking slowly and clearly!
1
Am I wrong in believing that modern technology beginning with simple things like email and instant messaging have already resulted in huge improvements in the lives of deaf people?
4
"Huge" and "improvement" is in the metaphorical eye of the beholder. As I see young parents today shopping with their young children in the cart, the parents never looking at their young children because the parents are too busy texting, I don't see a "huge improvement" down the line in the development of these young childre.
4
@A. Stanton
Yes. You're wrong... though texting does make it easier for us to sit home and avoid the people.
Can you email at the movies, the market, in a work meeting, or in the car? Can you text while walking in the park with a friend, ordering takeout food, or chatting at a wedding?
If I'm at party and I meet a soft-spoken, tall man with a huge mustache and thin lips, can I tell him to stop talking and text me instead? Cause I will never be able to read his lips. He doesn't move them, they're camouflaged, and they're twelve inches above my head.
I wish.
6
Texting and emailing have certainly helped the deaf and others with significant hearing difficulties, but they are no substitute for normal hearing. As someone who is dependent on hearing aids, I can attest to this from first hand experience.
2
Beautifully written, very clear. If I met Rush Limbaugh the only thing I would want to talk to him about is his cochlear implant.
I'm a low brass player and occasionally practice with earplugs, because it gives a different sensation, "feeling" the music vibrating instead of hearing it. I have wondered if, had Beethoven been a brass player instead of a pianist, he might have been able to continue performing in public much longer, or even permanently, as his deafness got worse (he was never totally deaf -- in later years, he had a stick that he'd hold against the piano soundboard so he could hear a complex harmony, in his later works). I have a mostly-deaf friend who explained the subtleties of why she chose not to try cochlear implants -- these things never occur to a "normie."
4
Fantastic article, thank you! As a hearing person with Deaf family members, I appreciate this clear information on a subject that is so widely misunderstood. I will be sure to save and share this most helpful article!
8
This is a beautifully balanced and thoughtful essay that I found illuminating. Kudos to Sara Novic.
In dealing with elders with hearing loss and troubled relationships with hearing aids, I have come to realize that technology is not a solution to hearing loss or lack of hearing. It’s just an imperfect workaround. And sometimes silence is better than low-fi sounds and intermittent squawks.
4
@Pangolin My husband's hearing aids were a just short of miraculous. He didn't believe he had significant hearing loss, although the VA had marked it on his retirement exam. He turned everything way up because 'something was wrong with the channel' and he couldn't converse with us at the dinner table anymore. He began to stop going out because everyone mumbled and the sound in the theaters was bad. I made a bet with him, I said he had to get his hearing checked and if nothing was wrong I would never bring it up again, but if he had hearing loss he had to get help. He had (of course!) significant hearing loss. He was quite surprised, but he got the hearing aids and what a difference it has been. He has come back to us and can converse again and go out to dinner without problems. He was slowing sinking into silence and it wasn't a good silence.
19
@Moira Rogow
I'm happy for him. But it's not true for everyone. Mine help me hear, but they bring me so much pain. It's like I spend life looking straight at the sun. I've got a good audiologist. There's nothing I can do. Hearing is, quite literally, painful for me.
2
@Pangolin: but for SOME elderly with hearing loss...cochlear implants WOULD WORK, But they are not covered by insurance for the elderly -- just as they do not get coverage for any hearing devices!!! -- and until recently, no coverage for prescription drugs. Without insurance, almost nobody could afford cochlear implants.
I think to dismiss cochlear implants as "low fi sounds and intermittent squawks" is extremely unfair and dishonest.
NOTE: there was a time when people with cataracts had nothing done and went blind. When my mother developed cataracts in her mid-50s -- in the early 1980s -- they removed the cataract, but did NOT give her implanted lenses. They were "too experimental and costly" back then. She got horrible, awful glasses that grossly distorted her appearance and gave her very poor vision results.
2
Communication with each other is a vital aspect of leading a healthy life. I don't want to be stuck in any culture, whether it's deaf, gay, straight, or of any race. I am grateful my cochlear implant has been key to opening the door to better communication. I'm a lousy student and not the sharpest tack in any drawer - but in my experience, my CL surgery was simple, easy and painless. The outcome of CL takes patience, the brain discovers a new way of hearing. I tried to learn sign language but that was much more of a difficult task than being open to a new way of hearing. I will hopefully attempt to learn sign language again but to be honest I don't know anyone to sign with.
23
@Bruce Savin - Exactly - sign language is a two way street and useless if you have no one to sign with. But hearing is about a lot more than communication - it's about sounds that keep us safe, like alarms, and those that make our lives richer, like music, the ocean, the sound of crunching leaves, and laughter.
18
@Bruce Savin
You are so right. I was hearing impaired for 17 years and deaf for 15 before getting the implant. It was definitely a miracle for me, albeit not one I wanted for the first week or so. But it did take patience for the first week. After that, I learned my first curse words and I could understand much more than hearing aids ever allowed me to. When I received the 2nd one, I heard the radio for the first time. This has been a wonderful adventure and allows me to communicate with the hearing. As I know sign language also, I can communicate with the deaf too. I just wish I had received this when I was a child. It would have been even more helpful, but as I received the first multi channel implant 30 years ago, it was not an option for me.
17
@C I remember hearing the ocean for the first time in my life at the age of 38. It was an amazing experience. And I heard birds for the first time with my first implant 30 years ago. I'd never heard them either. I love my Cochlear Implants. They have enriched my life beyond measure.
19
I have a friend in his seventies who just got a cochlear implant. He told me from the start that the confusing jumble of sounds he perceives will need to be sorted out by training, which he is doing with the discipline that characterizes all of his efforts in life. He knew that going in.
It’s hard work for his wife and him, as she helps him with his drills and repeats what she says to help him correlate the sounds he is perceiving with the words she is saying. But I have already noticed the positive difference in his speech recognition, although I know he is and will remain frustrated. He tells me what this article said - it’s like learning a new language. But the good news is that he already knew the language. It must be terribly hard for those who never heard.
I guess, based on this article and other letter writers, that cochlear implants have proponents and detractors. I know there are other tools and techniques to facilitate communication, if not hearing. I suspect that “all of the above” is the right answer to helping people to cope with deafness. And I hope that these devices and ones not yet invented provide assistance.
9
This article raises great points, and it is difficult for anyone who isn't deaf to understand what being deaf is like, or how a cochlear implant is different than regular hearing. I think it is important to make the distinctions made here, that C.I. is not a miracle cure, and that using it requires the good fortune to have a condition it can work with, and a ton of hard work.
Hopefully, it won't be too long before we surpass the C.I. and become able to cure deafness directly. I would imagine that using increased proficiency with stem cells will allow us to rebuild nerves, cochleae, and so on, and when we can accomplish that we should be able to completely cure most deafness, blindness, and other neural and physical problems. But it's important to keep in mind, we're not there yet, and A.S.L. is still vital.
6
@Dan Stackhouse ASL is of course vital to those who need it. It's just that it is not needed by every child or adult who is deaf.
9
I am a post lingually deafened adult and have bilateral cochlear implants. It took about 3 months to make sense of CI input such that communicaton was easier with than without.
1. Hearing preservation techniques are well known and the the standard of care, and if you are told otherwise I would seek another implant center that is dedicated to preserving residual hearing. Studies are clear that speech recognition is better in CI recipients with a component of acoustic hearing. Even a few decibels are valuable. EVERY decibel is valuable.
2. Outcomes vary dramatically by surgeon, these are not published but are known to the CI companies, who track outcomes of their devices. If your implant electrode is not well placed, then no programming or speech language therapy in the world will overcome that. I believe that the wide range of outcomes observed is in part due to surgical technique. Ask about outcomes.
3. Programming varies dramatically by audiologist. You need a center dedicated to a systematic programming approach with frequent adjustments the first year and long term follow up. Fortunately, poor programming can be corrected.
4. CIs have been a life changing technology for me. Miraculous and magical apply. I had a great surgeon and great programming. I don’t use or know sign language and function as a leader in a high demand job. Granted I was born hearing and I had that all important language cortex well developed before living 35 years with hearing loss.
38
There seems to be aspects of a cult to the Deaf. Not people who are deaf, who can't hear, but who are Deaf. These people who have embraced a 'deaf identity' and reject anyone who doesn't. I remember some of the anti-cochlear propaganda when the device was first invented. Its wasn't pretty.
22
@sjs
The Deaf are proud like other groups that have to overcome problems.
C.I. in many cases is not effective to adult Deaf since the many of these individuals have never could hear sound. Imagine an adult that never heard and was aware of any sound, now trying to learn and understand the meaning of sound.
C.I. is being used on adults who have recently become completely Deaf. This can be effective since the adults previously heard and were aware of sound.
6
@sjs
It's not a cult. It's a culture, with a history and language and community of heroes/villains just like any other.
5
@sjs
Wow! I watch them talk with their hands and find it so beautiful and expressive. I'm sad that I can't do that. I'm losing my hearing and suspect that, just as it is hard for them to learn sound at a late age, it will be extremely hard for me to learn to talk as they do. Given how impatient hearing people are with me, I don't hold out hope they they will be any kinder to me.
But I envy them. I wish I had learned it young just in case deafness ever came. Because it here it comes.
3
Ms Novic, thank you very much for this very informative article and opinion. As a person, facing severe hearing loss, I found the information here very helpful. Thanks!
6
@Theni If you have heard in the past, then learning to hear with a CI should be easier for you than for others. Hearing is important and so is communication. Otherwise, you may find yourself isolated and with health issues. When you do get the green light for a CI, please talk to a Mentor Volunteer. It will help you sort things out. I love hearing with my CIs!
8
I have a CI and its a hearing aid period! Its does not change the fact that I am still 100% DEAF! CI only work when you wear it! Yes there are downsides and challenges but the best thing is you can be in both worlds DEAF and Hearing! Is it for everyone, NO! Depends on the kind of DEAF that you are, ex. I have Bilateral Meniere's Disease, my CI no longer works because of the disease, but I got about 3 more years of sound, music etc. So there are upsides too! It's just a hearing aid!
10
@Kala Plante Yes, it only works if you have it on, but it is more than a hearing aid. It allows me to hear birds, crickets, music, and speech, unless of course, for some reason or disease, it can no longer help you. I am really sorry you have lost that ability.
6
Hearing aids, when effective, allow the user to hear birds, crickets, footsteps and all of the sounds mentioned here. If hearing aids are no longer effective a cochlear implant can be investigated.
I fail to see how "deaf rights" advocates who protest against things like this implant technology can be thought of as anything by religious extremists.
What the bloody heck gives you the right to decide whether another deaf person wants to treat themselves or not??
27
@Mtnman1963
Because they see the CI as a technology of assimilation to hearing standards of what is "normal."
Think of all of the native Hawaiians who were told, after annexation, that English was now the only approved language and that their own language (used at home, in ceremonies, etc) was now illegal.
It's an imperfect parallel but it gives you a sense of what's at stake for Deaf people and why they see CI as a tool used to oppress them, not "free" them--which is a perspective only a hearing person would claim.
4
@David S. Society is not ethnic cleansing deaf people, and it is such an imperfect parallel as to be in a different hemisphere
5
Ms. Novic, you are an adult and so you can make decisions for yourself with full authority and responsibility.
It's far more difficult for a parent who must choose for a minor child, who can't make those decisions for themselves.
I am not deaf and there is no deafness in my family beyond some very elderly relatives with age-related hearing loss.
But there are plenty of people who are near sighted, far sighted, with astigmatism, amblyopia, cataracts.
Would anyone EVER tell the parents of a very near-sighted child to NOT correct the child's vision with glasses -- but to send them to a school for the blind, to learn Braille or get a seeing eye dog? because it is more "politically correct" than eye glasses?
Would you tell an older person with cataracts NOT to have them removed, and an intra-occular lens put in their eye -- giving them near-perfect 20/20 vision for the rest of their lives -- because they should just ACCEPT cataracts and eventual blindness? because surgery or an artificial lens are "not politically correct"?
I understand there is a deaf culture, and how much it means to the deaf population -- and that there is much richness in ASL as a language -- but opposing this kind of technological advance is a losing game.
Sorry.
84
@Concerned Citizen AMEN! They are religious extremists, as the commenter above you said.
18
@Concerned Citizen, from my perspective, you write with such anger even though you're not part of the deaf community. Reread the article again and really take it in this time what Ms. Novic was trying to explain. Hearing loss is not the same as the loss of your eyesight. I thought her article was trying to lay it out rather objectively. I actually don't understand some of the angry posts from this article.
14
@Concerned Citizen I wear glasses. When I put them on, my vision goes from blurry to clear. It is amazing. Unfortunately, CI's do not work like that. The human ear is very complex. The cochlea has approximately 20K cilia which transport sound, arranged tonotopically (think of it as a curved piano keyboard). The high frequencies are on the outside edge, reducing to the lowest frequencies as you travel into the cochlea. The CI has 22 electrodes. These are placed into the cochlea, and because of biology, the cover the same area as the top 2/3 of frequencies. 22 electrodes have to do the work of 20k cilia. There is no way that a CI can ever replicate the sophistication of the human ear. It is set to pick up sounds from approx 50Htz to 8K Htz, whereas at birth, we can hear from 0 - 20K Htz (we lose our high frequencies as we age). Whether or not to get a CI, whether for an adult OR a child is an intensely personal decision, a decision that should require lots of research and input, hopefully, from doctors, surgeons, speech therapists, audiologists, and yes, from the deaf community..
15
This article and the comments are insightful and interesting, but they all ignore another tool that can be very successfully combined with CIs to provide access to spoken language: Cued Speech. This system is easy to learn - a determined individual could learn it in a weekend, though it would take longer to build up speed and accuracy. By providing a visual representation of the phonemes of spoken language in conjunction with oral speech, it helps the deaf/HOH individual acquire language in that same way as a hearing child, which allows the individual to make sense of the sounds they are hearing through their CI (though it works even without a CI). I learned Cued Speech in college after watching a transliterator providing services to a fellow student, and as I learned CS and met others who use different a combination of CIs and Cued Speech, I noticed that they all spoke and understood English with native fluency - which has not always been the case with the people I have met who rely primarily on ASL (granted, I am speaking based on my own experiences, so please note I am not claiming that these experiences are universally true). At the same time, many of the people I know who primarily use CIs and CS also have learned ASL, and switch back and forth, or use a mixture of oral speech, CS and ASL simultaneously, depending on who they are communicating with and which option best conveys their meaning.
7
As I understand it, cochlear implants work infinitely better when installed at a very young age, while the brain has maximal plasticity. What would deaf parents say to blind parents with a infant whose vision could be restored with surgery (say, born with cataracts) who wanted to wait until the child was old enough to make the decision themselves, given that at a later age the degree of vision restored would be much, much less? The possibilities in children's lives should be maximized. Certainly, if there are deaf people in a child's family, learning ASL should be part of the package. Indeed, I wish I has been taught it back at an age when learning languages is easy. There are no deaf people in my family, but I do have friends losing their hearing. Beyond that, I find ASL beautiful and fascinating. But limiting a child to that seems like a family from another country, say France, living in the U.S. with a child and preventing the child from learning English as well as French for fear of them losing their connection with French culture.
42
I received two cochlear implants at the age of 38 and 40 after three decades wearing hearing aids. I'm 44 now. My hearing aids were no longer strong enough once my hearing loss dipped from moderate severe to severe-profound. I certainly think my cochlear implants are miraculous and life changing. I can hear on the phone again. I can hear my doorbell ring or my cell phone on the street. I can hear myself typing right now. I can sit in the front seat of our car and carry a conversation with my kids in the back without turning my head to lipread. I can attend parties and work functions. I absolutely adore them. Regarding sign language: communications is a two way street. How many people actually know sign language? Will you be able to use it with your taxi driver? You doctor? Your pharmacist? Your banker? Your children's teachers? The police? And never hear Beethoven or the Beatles? If you plan to live you life in an insular Deaf Culture community that is one thing. But that's pretty limited and cuts you off from the rest of humanity - really no different than living in an ultra-religious community. Also: I am quite involved with several organizations for the deaf and hard of hearing, including the Clarke Schools, the Center for Hearing and Communication, the Cochlear Implant Center, the Children's Hearing Institute, and the Hearing Loss Association of America. I've witnessed hundreds of young children and adults with CIs. All are living wonderfully with them.
108
Same for me. A miracle!
23
I'm glad your implants worked out for you wonderfully.
I became deaf at the age of three. My parents were ready to implant me, but it was discovered that I was not a candidate as my cochleas were totally ossified (this was in the 80s).
How do I communicate with the taxi driver? My doctor? My pharmacist? My banker? The police?
I write. Yes, communication is a two-way street. Me writing to people who don't know ASL is "meeting them halfway". I don't live in an Insular Deaf Culture community. I'm a deaf Anglophone thriving in Montréal, Canada where the primary language is French. I have a full-time job I love (in the "hearing world") that allows me to live independently and even affords me the luxury of being able to travel the world.
I understand that the CI has benefitted many people immensely, but let's not paint those like myself as SOL.
22
@C Totally agree. I grew up hard of hearing and wearing hearing aids, with a progressive hearing loss that worsened significantly in my 30s. I got my CIs in my 40s. They gave me back the ability to use the phone, to hear speech without lipreading, to return to my professional career, and to communicate in my everyday life where people do not know ASL. I also think this article is misleading in saying that even "those who are good candidates still have a long road to success" and "must spend years in vigorous auditory-verbal training." That may be true for those who are post-lingually deaf, especially those who are implanted later in life (which is why parents are faced with the CI decision during the five-year speech window the author mentions). But it is not true for many post-lingually deaf or hard-of-hearing people I know. I was hearing better than with my hearing aids within a few weeks of the surgery and talking on the phone to pretty much everyone within a few months. Is it a cure for deafness? No. Life-changing. Absolutely.
21
It's fantastic to see this perspective appear in the New York Times. The success of cochlear implants are far more variable than often portrayed in news media; it's not that they're never successful, but they are frequently unsuccessful or only partially successful. For example, someone's audiogram may be impressive - sound is being sensed - while the usefulness of that sound is negligible, and doesn't translate into being able to have a conversation or enjoy music.
When cochlear implants are portrayed as a miracle cure for all, that has real-life implications. These include, but are not limited to:
- Real concerns about the efficacy of cochlear implants are dismissed as irrational
- Damaging and inaccurate assumptions are made that exacerbate divisions between the Deaf and hearing communities.
- And worst of all, the real risk of Deaf children missing out entirely on language during the critical window because everyone in their lives are working on the assumption that cochlear implants make them hearing - when that is simply not always the case.
19
@Jenna - please don't spell Deaf with a capital D when by and large, children born without hearing are not part of the capital D Deaf Community. They just happen to be born without hearing and most likely have parents who hear. These children, if implanted very early, do nearly as well as their fully hearing peers and are in no need of learning sign language because they are interacting mainly with the hearing world (the Deaf Community wouldn't want anything to do with them anyway). Visit the Clarke Schools or the Center for Hearing and Communication if you think this is a false statement, and you will see for yourself.
32
@Bob there are many style variants, but when I use capital D I mean anyone within that general group, which includes culture but also means DeafBlind, hard of hearing, audiologically but not culturally deaf, etc. etc.
The idea that the Deaf community doesn't want anything to do with them is really untrue. I'm Deaf. I know a LOT of awesome people with cochlear implants. (Notably, many of them do sign and are part of the Deaf community.)
It's a damaging and outdated idea that the Deaf community shuns people with cochlear implants.
The key here, the thing to take away, is VARIABILITY. Nobody is saying that cochlear implants are never successful. Too many people are saying that cochlear implants are always successful. And they're simply not.
13
I heard reasonably well as a child and am fully lingual.
Over a period of decades I developed moderate to severe hearing loss and am now dependent on— and grateful for— hearing aids. Should my hearing decline further, I imagine that I will consider a cochlear implant.
I understand that you mean well, but I do not consider myself Deaf in the sense of belonging to a culture. I am, however, deaf in the sense that I have a physical disability that requires me to wear hearing aids.
The decision of whether or not to identify with Deaf culture should be made by the individual. It is a very personal decision that is driven by individual circumstances.
3
First, with all of the text-to-speech conversion technology available, signers might want to be looking for new places to be helpful, rather than keeping others from technology that could be helpful...
Every time I see a politician speaking from a teleprompter, and neither the teleprompter feed nor a speech/text conversion caption is avaiIable, it looks as luddite as compassionate…
Sort of like librarians making their case – in a time where every book across every library can be accessed in about fifteen seconds, and deeply searched at the same time – for manual search that might take several days, using conventional library methods...
…..
Second, with hearing aids, it’s both heartbreaking and reprehensible that smartphones – just as a byproduct of being competitive – did, till recently, a far better job of restoring wanted sounds and cancelling unwanted ones...
While costing about a fifth of what the (clinically regulated) hearing aids did...
Finally gotten to the point where the hearing-aid incumbents had to up their game...
Does the same situation exist for implants - i.e. how much has the signal-processing capability of implants improved since their introduction date...
Or has it improved at all...
4
Having worked in the field of Deaf education for over 20 years, I have seen how this controversy impacts children and families first hand. I really appreciate this article because it shows an open and honest discussion about CI’s.
Here are a few things to also consider:
1. The surgery destroys any residual hearing the person has so when the CIs come off the person is now profoundly deaf. Without another method of communication - the child cannot learn while the C.I. is broken, lost, or battery is dead. Or even in some cases where internal components are recalled or need to be replaced.
2. It is a device implanted close to the brain which means there are risks of stroke, tics, etc. I have seen kids with both and other side effects.
3. Much like a pacemaker or other medical device after implanted there are things the patient can never do (like dive, get an MRI) and the processor cannot get wet so you can’t wear it and sweat a lot, shower, or swim. See number 1 regarding once it is off - the child is now deaf.
4. Your auditory nerve plasticity is set in the very early years. Best chance for success is doing surgery before the age of 4 or 5.
5. In the early years, many hearing parents (90% of deaf children are born to hearing parents) felt it was abuse NOT to implant. So they did it and the doctor got paid. But they didn’t have the transportation or money for the replacements (can only get new parts every year or more), speech therapy, audiology and mapping appts,
15
@Elizabeth S
Lots of untruths, here.
1. You are always given a spare. Always.
2. No risks of stroke - that is completely false
3. You can totally swim with them - there is a waterproof box you can put them in or one made for water (the one by Advanced Bionics is called The Neptune).
4. The earlier the better for fully deaf children, sure. But adults whose hearing loss becomes profound can thrive with them as well. I am thriving as someone implanted as an adult.
5. Most insurance will cover replacements AND therapy in full. Mine certainly did. And if something break, they Overnight Fedex you a replacement.
24
@xt every thing I have said I have seen. Kids stick their magnets to the side of the bus or the slide. They flush them down the toilet. I have seen parts melted, torn, chewed, etc. You only get so many “free” replacements and if a family is on Medicaid or is low income without private insurance - it means no education without another method to learn (like sign or captions if they are old enough to read) while you are trying to get new ones. Schools do not always provide loaners like for hearing aids. Especially of the processor (if it gets fried somehow).
I have seen children with tics, or eye blinking due to faulty or C.I. issues that forced parents to take it out. It’s a device - it can have problems like any other medical or electronic device. Not trying to scare people. It’s the truth... it can happen - I ‘ve seen it.
Was not aware they had waterproof options. Every student I have worked with takes them off to run Cross Country, play soccer, or compete in general because of sweating. Again going by what I see coming to the school...
We get paperwork from the C.I. doctors saying not to get them wet and also cautions for static charge (take them off before going down a metal slide)...
Again... I am only sharing what I have personally seen in the schools. Not talking about adults.
And I am not saying don’t do it. I think children should be given every advantage. Just appreciated the article reminding everyone it isn’t just a surgery and done...
14
@xt I can testify in support of the points made by Elizabeth S. Having to retire early from a college teaching position because of poor hearing, I was subsequently socially isolated for many years due to increasing loss of hearing. Then I received a CI in my right ear and continue to wear a hearing aid in my left ear, which contributes a little to the sense of "naturalism" in the resulting hearing experience.
Within two weeks of wearing the implant, I was able to carry on conversations in most situations. Noisy environments are still a problem, but my new CI and hearing aid now "communicate" with one another to allow some greater degree of localization of sound in noisy environments.
My life has completely changed. I don't have any direct information about implants in young children but find it hard to believe that their adaptation would be a problem for most of them.
Like other authors I have read, Novic seems to romanticize disability.
14
I wonder if a parallel discussion is going on in regard to bionic replacements for the blind.
7
Would the same reasoning prevent one from obtaining prosthetic legs? Prosthetics are imperfect and have to be fitted. Training is required. Time invested. The end result is a person who has lost their legs can resume walking, playing sports, and generally live a more normal life. Give life a chance!
36
I as the child of a deaf person have always felt that something is lost with the addition of hearing. My mom couldn’t stand aids.
5
My son is deaf. He has chosen NOT to have a cochlear implant for the reasons you have described. He benefits as much from the hearing aids that he wears. He also benefits from some of the modern conveniences, captioned TV, text messaging.
Yes he still misses much of what is said, especially in large family group settings. He still needs a interpreter for significant events. He clearly understands the lengthy training it takes to learn how to translate the sounds from a cochlear implant. And he has a large group of other deaf friends, none of whom have cochlear implants.
9
The real question is whether there is a great deal of follow up after the surgery. From the article it appears that there is not a great deal of follow up, and after the surgery the doctors and experts walk away.
Just doing the surgery is not enough and there should be professional experts to aid is a great deal of follow up.
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@Bob S. Definitely correct. When young children receive a cochlear implant (and I mean under two-three years and often these days under a year), and they receive high quality auditory-oral training at a Center like ours (the Center for Hearing and Communication), they do not experience a language delay and the CI is a "miracle". You are correct, without the follow-up it is a device. It would be the same as putting a prosthetic leg on an amputee, providing no therapy and saying prostheses don't work.
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@Bob S correct. The follow up is left to the parent to schedule and navigate much like any other procedure. While children with hearing loss do get follow up at an early age from a teacher or parent advisor, we cannot make them put the implants or hearing aids on when we aren’t there.
It is interesting that there are ALL kinds of programs to teach your baby to sign and yet still there are professionals that tell parents of Deaf children not to use it. The best scenario is that the child gets everything. Technology (C.I. or hearing aids), lip reading training, AV and speech therapy, AND sign language instruction for the whole family. Other countries require parents of Deaf children to learn.
On the flip side of this discussion:
as an educator it still saddens me that parents will choose to enroll their child in a school that uses sign and yet they never learn themselves. No matter what choice you make - follow up and follow through should be happening or none of the strategies or interventions will work.
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@Laurie Hanin, Executive Director
With experts and doctors doing follow up information might be found that would make the surgery and devise more effective. There might be many differences for individuals.
Prostheses are different for individuals and CI devices for different individuals might be more effective based upon the individual.
1
Can modern medical technology ameliorate perceived disabilities and inequities?
Deaf communities are rather cohesive with their shared language, methods and mechanisms of communication.
Cochlear implants suggest that this is a weakness to be repaired, but the issue of a majority quashing the uniqueness of a minority persists.
There is little argument that restoring a compromised sense may be a good thing. Certainly restoring sight would allow blind individuals to be able to navigate their environs and computers more easily.
However, where does it stop? Does having a darker skin tone predispose people to hardships? Being taller has been shown in studies to advantage individuals. Poor teeth, noses and even eye shape are "corrected" in the pursuit of a perceived "ideal".
I am thrilled with my titanium knee, but I am concerned when our brave new world seeks to efface the individuation provided by nature.
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@Mooretep
But were they cohesive because they didn't have a choice? When the device was first invented, people who showed an interest were treated almost like traitors.
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@sjs, not being hearing impaired, I don't think I can answer this question.
I am aware of how people who opted for Cochlear Implants were treated as "traitors".
I believe that there are also parallels to people with darker skin tones attempting to "pass" as "white".
Are they considered traitors?
These are questions that I pose hoping for some epiphany that I do not expect to be provided easily.
Just questions that I pose for people to be aware of when we discuss "fixing" what is considered to be undesirable in ourselves and others.
Sorry for all of the "quotation marks", but I don't intend to offend.
2
As someone who gradually developed hearing loss and who is now dependent on hearing aids, I am not sympathetic to the perspective that one must accept a disability so as not to exacerbate any stigma associated with that disability.
Yes, those who are deaf (or Deaf) should be treated with respect, provided a robust array of affordable supportive programs and services, and not be required to enter the hearing world.
That does not mean, however, that others should be impeded or discouraged from treating hearing problems.
2
I am 93 years old and legally deaf with a profound war connected noise injury. I have been eligible for an implant for a decade or more but feel the travel and other hassle to learn using it would negate its value to me. So I use hearing aids with microphones adaptable to the noise background environment.This has mostly worked for me, even as a TV interview host. My greatest frustration is the unawareness of the medical profession to the degree they reject the needs of hearing impaired patients and actually increase the likelihood of creating or worsening a hearing loss. Yesterday, I had to call a halt to a needed ten minute MRA test at Southampton Hospital on a blocked carotid artery because the noise resembled the loudness on the tarmac at Kennedy Airport and thereby threatened what little residual hearing I have. The ear plugs I was given did not fit and were useless. If I had been warned of this, I could have obtained my own ear plugs and gone through the procedure. But no one thought of that. The lesson: Be wary of technological "progress" and think for yourself.
25
As a cochlear implant user for the past 20 years, I can tell you firsthand the difference between hearing with a CI, and being unable to hear at all. I'm actively involved with the world around me - can "work a room" when networking, and can socialize in mainstream settings without any interpreters required. To choose not to implant a child, and forgo any chance of the above happening, is not to understand the impact of being able to navigate our world without undue barriers. A parent who waits for the child to decide, will have missed the window of language acquisition for optimal success. My definition of cochlear implants? Miracles.
www.listeningclosely.com
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@Arlene Romoff you'll note that this article doesn't claim that cochlear implants are never helpful. Merely that their success is extremely variable.
And when a cochlear implant is unsuccessful - which most definitely happens - a child who has acquired language via ASL still has language. A child who is relying on aural paths exclusively will have missed out, with serious consequences.
(A cochlear implant is also not the only path for a Deaf person being able to "work a room." I'm Deaf, don't have cochlear implants, and share this ability - including in all-ASL environments.)
11
No, Jenna - it's not "extremely variable", especially not in children implanted early in life. These kids do very, very well and live life very much like typical hearing children. It's also not "extremely variable" for thousands of adults like Arlene (whose two books I have read) whose lives have been transformed by the technology. The author of this opinion piece is writing exactly that - an opinion. Her point of view is not fact. She has no cochlear implant so she cannot possibly know what life is like with one.
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@OC, it is extremely variable. I base this on my extensive reading on this subject - I am someone who became Deaf as a teenager, was advised not to get one right then by my ENT, and have remained very interested in the subject since. If I thought it was likely enough that my quality of life would improve to justify the (very real) risks, I'd get one in a second. I have not been convinced, yet. (My mind is open.)
A quick google search for "Cochlear Implants variable" yields many results, many of which seem to be in medical journals and unavailable. This is a sample, though:
"However, cochlear implantation results are variable; are likely to be
significantly better with earlier versus later cochlear implantation, shorter versus longer duration of deafness, and oral
versus total communication before cochlear implantation; but also may be influenced by other factors such as preimplant residual hearing, learning style, family structure/support, or cochlear implantation coding strategy."
https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/cochlear-implants.pdf
I also base "extremely variable" on the large number of people with cochlear implants I've spoken to in person.
If you are saying merely that cochlear implants are very helpful for many people, I'm entirely on board. But claiming that they helpful for absolutely everyone is both false and problematic. That there is not such universal benefit is in fact a major point of this article.
3
Thank you for this essay. I knew little about CI - as someone who is severely hearing impaired I rely on lip reading and technology to interact with the world. I have learned so much about my brain and how we interpret sound through my experience and you have added another dimension, especially as it pertains to children. The impact of poverty on children crosses all aspects of life, but none more significant, I think, than health care. That is where the gap shows up most of all.
5
Finally! A nuanced perspective, importantly from a user of an implant. In the old days when hearing aids were the only technology, it was well known that a deaf or hearing impaired child's ultimate level of auditory and language functioning could not be predicted by how well that hearing aid provided access to sound. And it has never been clear what other individual factors played a role. And lo and behold, the same holds true for CIs. They are a brilliant technology but we can't forget that the technology interacts with a human being.
10
@it wasn't me The author does not have a CI.
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@it wasn't me You are incorrect: The author does NOT have a CI. Therefore, she cannot possibly know what a miracle they are. Those of us who wear them by and large think they are incredible and life changing.
11
@wgrohv this comment doesn't say that the author has a CI, merely that the article contains the perspective from a user of a cochlear implant - which it does.
3
I recommend the documentary HEAR AND NOW, which tells the story of a 65-year-old deaf couple, with hearing children, who choose to have cochlear implants. Provides exceptional insight into the issues involved with these implants. Extraordinarily poignant.
14
An important essay that shines much needed light on the controversy. This should change policy everywhere.
9
@Robert - the "controversy" is by and large generated by and among Deaf Culturalists who are threatened by the rapid loss of their way of life. Most children born deaf have hearing parents who thankfully do not hesitate to implant their children very early in life, which pretty much ensures that they will hear and function nearly as well as those with typical hearing. I am not sure what "policy" you are referring to that needs changing. Parents do whatever they want with their kids. If they don't want to implant, no one can force them. And if they do, no one can or should stop them. No policy is needed.
11
Our daughter got two C.I.s when she was 10 months old. With the implants, a totally new world of sound opened up for her. Sure, it was hard work for her (and her parents), but 3 years later we see that it was worth it. She also learned lip reading and (to a degree) signing (as did we). However, the C.I.s are her favorite choice of communication. She totally embraced them. To us as (hearing) parents, it wasn't a binary choice. We just wanted to enable our daughter to be part of a larger community. And since the best time for implanting is at a fairly young age, parents necessarily have to decide for their children. Waiting just for the sake of letting the child decide is also some kind of avoidance.
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I would be fascinated to interview a very rare individual with both deafness and synesthesia, if one could be found, to gain a better understanding of the way our brains interpret the world around us.
Ms. Novic's op-ed gives us a better understanding of deafness for which we should all be appreciative.
6
American Sign Language users have been opposed to any kind of technology that allows people to hear. It's really the old against the new. Yes, it takes time to learn how to use a cochlear implant but with small children, everything is new and takes time--walking, talking, reading, etc. So why not give them every chance you can to fully experience a world of sound?
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@AV The broad statement that "American Sign Language users have been opposed to any kind of technology that allows people to hear" is a straw man. When implants first appeared on the scene, the community was fearful for the loss of their language and culture. And if you read the history of deaf education and sign language in this country you would understand that it has been attacked and marginalized for over a century. Signers have had to fight for their right to their native language in a way that most of us cannot understand. But now that the first wave of kids who were implanted has reached young adulthood, the community can see that implants are neither a savior nor a curse. Outcomes after implantation are far more variable than anyone thought they might be, and far more individuals with CIs end up using sign language in one capacity or another. And that is the point to be taken from this article. Maybe you should read it again?
20
@it wasn't me
I get the fact that they want to preserve their culture and language but, if the technology improves, why would you deny children the joy of sounds from their parents' voices to the miracle of music. That's something ASL cannot provide these children. The technology may not be perfect but it is a step in the right direction and will no doubt continue to get better. If I had a deaf child, I'd want to do everything possible to help that child hear what I hear.
6
I wonder if the resistance is about monetary interests such as jobs that come with boundaries.
1
Thanks for this article. It was illuminating, and I learned a lot. The one thing that gave me pause, though, was your statement that “It would be a big commitment — learning to use a cochlear implant takes a lot of work.”
Graduating from college takes a lot of work. So does becoming an athlete or a competent musician. Maintaining one's health by going to the gym every morning is a lot of work. Should having to work hard at something be a reason for not doing it if the end result is growth and the broadening of one's horizons?
I have a better understanding now of why a cochlear implant may not be seen by some as real growth or the broadening of one's horizons, but it seems to me that always ending with the fact that learning to use cochlear implants takes a lot of work weakens your case.
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@Elizabeth Fuller The idea is that the deaf individual is required (often as a child) to do a lot of work so as to not make the hearing world have to accept deafness and accept that a deaf person can live a full happy life without hearing. The deaf child is told to work harder than the hearing children lest the adults in the world have to accept those that are different. It's like telling a person of color or immigrant group in America that if they wouldn't be or wouldn't speak x,y, or z if they just acted more white then they could succeed. I'm sure I'm not saying this very well, and I'm not sure if the author was seeing it from this perspective, but other articles and books I've read frame it this way. - from a hearing ally
13
@ Briana - enough already with the identity politics. You think a non-implanted deaf child will NOT have work even harder than an implanted child to be understood? Most of the world does not know ASL. I'm deaf with two CIs and I don't know sign. I "accept* all deaf people and all disabilities, but I fully understand that it's on ME to navigate the world the best I can instead of expecting the world to serve me.
40
@Elizabeth Fuller the point is - who is making sure the family is up for it. Why do it on a child of a family with no means to then support it? Other articles, tv specials, the news...give the false impression that the implantation surgery is all that is needed for people to both speak and listen/make sense of spoken language.
This article explains that it isn’t just one and done. And that IS very important for people considering C.I. surgery to have.
9
The author says that Cochlear Implants vs. ASL should not be a binary choice and yet, she presents her case that they are. While I am not deaf nor the parent of a deaf child, I do personally know people who have opted for implants for their deaf children. In every case their children, since they learn to lip read very early, also learn to sign. What I have seen is that these parents are so delighted to have their children hear sounds in the world, even imperfectly.
50
@Alice S: With respect, what delights non-deaf parents may not always be in the best interests of the child who is deaf. Deafness, at bottom, is about communication and one's linguistic community and one's ability to develop and maintain a psychologically and emotionally meaningful social "place" from which to conduct one's life. Parents should consider carefully how and with whom their child's future is likely to be carried out, and close off as few avenues toward all possible futures as possible during the developmental years.
12
@Jane Hunt
If parents are concerned with "how and with whom" the child's future will be, note that it is overwhelming likely it will be in the hearing world. There are not going to be interpreters in the vast majority of settings. Few will know ASL. You present a false dichotomy - the hearing or the deaf community.
20
@Jane Hunt I just wanted to point out that Alice S said that the deaf children she knows with the implants also learn to sign.
6
Humans adapting to the senses they have is the human condition. This article provides a perspective to reflect upon.
I wear ear plugs to tune out the auditory acoustics. There is a comfort to be found in silence. It heightens other senses as well. Appreciative that in this, it is by choice.
At Cabrillo College in Aptos, California many students enroll in A.S.L. Class because they wish to learn a new language. Bravo!
2
@Tabula Rasa
The crazy thing about losing my hearing is that I never, ever get to hear silence. There is always a loud buzzing in my head. I might feel better if it were just a little quieter in there.
3