Editorial

Cochlear Implants: A Perspective

It has been less than a generation since the move in Australia and some European countries to provide cochlear implants to young deaf children. In the early stages some hailed the procedure as the equivalent of the Holy Grail. Supporters predicted that it would be the long-sought “cure” for deafness and implants would provide the gift of sound and speech to all deaf children, who would then function as “normal” hearing children. There would be no need for special schools or classes or interpreters and educational systems would save hundreds of thousands of dollars over the educational lifetime of each implanted child. In opposition, operating under the implicit assumption that the claims for implants were accurate, others expressed fears that they could threaten the very existence of deaf culture.

Neither hope nor fear came to realization. Researchers conducting many of the early studies either were affiliated with institutions providing implants or had a vested interest in the success of the procedure. There is a long history in science about how expectations can influence statements of problems, gathering of data and interpretation of results, even by careful researchers. Fortunately, there have been a large number of relatively recent studies that provide a more nuanced picture.

Before continuing, for purposes of full disclosure, I should provide my own perspective. I have had reservations about implants with deaf children, especially young deaf children, from the time of their introduction. A child born today may have a life span of 80, 90, or even 100 years and I shrink from invasive surgery that involves drilling through the skull and implanting a foreign object in the head of a six-month-old infant. For me, deafness is not a handicap. We may argue about whether it is a disability. In some circumstances I believe it may be, but not to the extent that surgery is needed. I know that improvements have been made in both the devices and procedures and that miniaturization is ongoing. We may not be far away from having a completely imbedded implant. Still, there are non-invasive means, including digital and analog hearing aids that may provide equal or greater benefit. At present, if I had a young deaf child, I would not choose a cochlear implant. However, I sympathize with parents of young children and would support whatever decision they would make.

After looking at the research literature, depending on the meaning of the word “success,” one could argue that cochlear implants have been successful. That is, if a group of children of similar characteristics were to be randomly assigned to experimental (implant) and control (non-implant) groups and receive similar training except for the implant—obviously impossible given institutional review board and informed consent constraints—it is probable that the implanted children would show higher levels of speech awareness and clarity of articulation as a group. It is also probable that children with hearing aids might also show higher levels of speech awareness and clarity of articulation as a group than children without aids.

The research that is conducted in the field does not—and cannot—meet the requirements for true scientific research, but there have been approximations. Some trends are appearing. Overall, results appear to be positive. There are reports of some children with severe to profound hearing losses being able to communicate over the telephone after implantation and training. The same thing might be said for powerful hearing aids, but it appears to be more frequent with implants. However, one consistent finding is that implants have little or no positive impact on the hearing of some deaf children. Researchers have advanced several explanations for this. One common rationale is that perhaps implants have been made too late in life and that maximum effectiveness is achieved only if the procedure is done by one year or even six months of age. This is logical given the biological bases for language acquisition and the probable existence of critical or optimal stages for learning. If so, does this imply that implants should not be made after a certain age?

Another reason posited for lack of success is the possible influence...