Illustration of the internal parts of a cochlear implant.
A cochlear implant (CI) is a surgically implanted electronic device that provides a sense of sound to a person who is
profoundly deaf or severely hard of hearing. The cochlear implant is often referred
to as a bionic ear. Unlike hearing aids, the
cochlear implant does not amplify sound, but works by directly stimulating any functioning auditory nerves inside the cochlea with electrical impulses.
External components of the cochlear implant include a microphone, speech processor and transmitter.
Under the appropriate conditions, an implant can give a deaf person a useful auditory understanding of the environment and/or
hearing and help them to understand speech, although post-implantation therapy is usually required. According to researchers at
the University of Michigan [1],
approximately 100,000 people worldwide have received cochlear implants; roughly half are children and half are adults. The vast
majority are in developed countries due to the prohibitive cost of the device, surgery
and post-implantation therapy — Mexico had performed only 55 cochlear implant operations by the
year 2000 (Berruecos 2000). China will
be having 15,000 cochlear implant surgeries on children, which are being paid for by a Taiwanese philanthropist. The concern is
that the follow-up services in China are not adequate to meet the needs of cochlear implanted children [1]. A small percentage of those now have bilateral implants, or one on each cochlea.
Bilateral cochlear implants are a growing trend globally, Cochlear Americas reported that 15% of their 2006 sales in the United
States were for bilateral implants. [2]
Individuals who have acquired deafblindness (loss of hearing and vision combined) may find
cochlear implants a radical improvement in their daily life. It may provide them with more information for safety, communication,
balance, orientation and mobility and promote interaction within their environment and with other people, reducing isolation.
Having more auditory information that they may be familiar with may provide them independent gathering of information to become
more independent.
The introduction of cochlear implants has seen the renewal of a century-old debate about models of deafness that often has the hearing parents of deaf children on one side and the
deaf community on the other. University of
Pittsburgh science affiliation, led by prominent bio-molecular audiologist Michael
Kraemer, has crafted the basic audiological structure for the cohesion to operate properly. On the one hand, modern
medical ethics law dictates that the decision of whether to get a cochlear implant is up to the patient or the legal guardian of
the patient. Therefore, political debate about whether deafness is a disability or not is irrelevant to the current medical
profession. On the other hand, whether society treats deafness as a disability has direct bearing on government policy. Many
governments in the world have disability legislation which includes people who are deaf. Some developed countries provide cochlear implantation as a part of state healthcare.[3] The debate is also
economic. Many state-funded medical interventions for a disability (such as free genetic screening for Down Syndrome) are justified on the ground that, in the long run, they will prove cheaper for the state.
Sweden is the only country that has legislation that when a deaf child is born to a hearing parent, they are, by law, consulted
by the deaf community as well as the medical community so they can make an informed decision.
History
The discovery that electrical stimulation to the auditory system can create a perception of sound occurred around
1790, when Alessandro Volta (the developer of the
electric battery) placed metal rods in his own ears and connected them to a
50-volt circuit, experiencing a jolt and hearing a noise "like a thick boiling soup". Other experiments occurred sporadically,
until electrical (sound amplifying) hearing aids began to be developed in earnest in the 20th century.
The first direct stimulation of an acoustic nerve with an electrode was performed in the 1950s by the French-Algerian surgeons
André Djourno and Charles Eyriès. They placed wires on nerves
exposed during an operation, and reported that the patient heard sounds like "a roulette wheel" and "a cricket" when a current
was applied.
In 1961, American doctor William F. House of
House Ear Institute [4] and House ear clinic[5] had Djourno's paper translated and had devices made which he implanted into three
patients. In 1969, with the help of Jack Urban, House created the first wearable cochlear implant. House's technology used a
single electrode and was designed to aid lip-reading. Throughout the 1970s, University
Of Melbourne researcher Graeme Clark, initially inspired to develop an artificial
hearing device through his deaf father[6], developed implants which stimulated the cochlea at multiple points, and on the
1st of August, 1978, Melbourne resident Rod Saunders became the first person in the world to
receive a multi-channel cochlear implant.
In December 1984, the Australian cochlear implant was approved by the United States
Food and Drug Administration to be implanted into adults in the
United States. In 1990 the FDA lowered the approved age for implantation to 2 years, then
18 months in 1998, and finally 12 months in 2002, although off label use has occurred in babies as young as 6 months in the
United States and 4 months internationally.
Throughout the 1990s, the large external components which had been worn strapped to the body grew smaller and smaller thanks
to developments in miniature electronics. By 2006, most school-age children and adults used a small behind-the-ear (BTE) speech
processor about the size of a power hearing aid. Younger children have small ears and might mishandle behind-the-ear speech
processors, therefore, they often wear the speech processor on their hip in a pack or small harness, or wear the BTE's pinned to
their collar, barrette or elsewhere.
Since hearing in two ears allows people to localize sounds and to hear better in noisy environments, bilateral (both ear)
implants are currently being investigated and utilized. Users generally report better hearing with two implants, and tests show
that bilateral implant users are better at localizing sounds and hearing in noise. Nearly 3000 people worldwide are bilateral
cochlear implant users, including 1600 children. As of 2006, the world's youngest recipient of a
bilateral implant was just over 5 months old (163 days) in Germany (2004).
Parts of the cochlear implant
The implant is surgically placed under the skin behind the ear. The basic parts of the device include:
- External:
- a microphone which picks up sound from the environment
- a speech processor which selectively filters sound to prioritise
audible speech and sends the electrical sound signals through a thin cable to the
transmitter,
- a transmitter, which is a magnetic pad placed behind the external ear, and
transmits the processed sound signals to the internal device by electromagnetic
induction,
- Internal:
- a receiver and stimulator secured in bone beneath the skin, which converts the signals into electric impulses and
sends them through an internal cable to electrodes,
- an array of up to 24 electrodes wound through the cochlea, which send the impulses directly into the brain.
Candidates
There are a number of factors that determine the degree of success to expect from the operation and the device itself.
Cochlear implant centers determine implant candidacy on an individual basis and take into account a person's hearing history,
cause of hearing loss, amount of residual hearing, speech recognition ability, health status, and family commitment to aural
habilitation/rehabilitation.
A prime candidate is described as:
- having severe to profound sensorineural hearing impairment in both
ears
- having a functioning auditory nerve
- having lived a short amount of time without hearing (approximately 70+ decibel loss, on average)
- having good speech, language, and communication skills, or in the case of infants and young children, having a family willing
to work toward speech and language skills with therapy
- not benefitting enough from other kinds of hearing aids
- having no medical reason to avoid surgery
- living in or desiring to live in the "hearing world"
- having realistic expectations about results
- having the support of family and friends
- having appropriate services set up for post-cochlear implant aural rehabilitation (through a speech language pathologist,
deaf educator, or auditory verbal therapist).
Type of hearing impairment
People with mild or moderate sensorineural hearing loss are generally not
candidates for cochlear implantation. After the implant is put into place, sound no longer travels via the ear canal and middle
ear but will be picked up by a microphone and sent through the device's speech processor to the implant's electrodes inside the
cochlea. Thus, most candidates have been diagnosed with profound sensorineural hearing loss.
The presence of auditory nerve fibres is essential to the functioning of the device: if these are damaged to such an extent
that they cannot receive electrical stimuli, the implant will not work. A small number of individuals with severe
auditory neuropathy may also benefit from cochlear implants.
Age of recipient
Post-lingually deaf adults and pre-lingually deaf children form two distinct groups of potential users of cochlear implants with
different needs and outcomes. Those who have lost their hearing as adults were the first group to find cochlear implants useful,
in regaining some comprehension of speech and other sounds. If an individual has been deaf for a long period of time, the brain
may begin using the area of the brain normally used for hearing for other functions. If such a person receives a cochlear
implant, the sounds can be very disorienting, and the brain often will struggle to readapt to sound.
The risk of surgery in the older patient must be weighed against the improvement in quality of life. As the devices improve,
particularly the sound processor hardware and software, the benefit is often judged to be worth the surgical risk, particularly
for the newly deaf elderly patient. [7]
The other group of customers are parents of children born deaf who want to ensure that their children grow up with good spoken
language skills. Research shows that congenitally deaf children who receive cochlear implants at a young age (less than 2 years)
have better success with them than congenitally deaf children who first receive the implants at a later age, though the
critical period for utilizing auditory information does not close completely until
adolescence.
Number of users
It has been estimated in 2002 that around 10,000 children in the US and an additional 49,000 people worldwide have received
Cochlear implants.[2]
The operation, post-implantation therapy and ongoing effects
Cochlear implant as worn by user
The device is surgically implanted under a general anaesthetic, and the operation
usually takes from 1½ to 5 hours. First a small area of the scalp directly behind the ear is shaved and cleaned. Then a small
incision is made in the skin just behind the ear and the surgeon drills into the mastoid bone and the inner ear where the
electrode array is inserted into the cochlea. The patient normally goes home the same day as the surgery, although some cochlear
implant recipients stay in the hospital for 1 to 2 days. It is considered outpatient surgery. As with every medical procedure,
the surgery involves a certain amount of risk; in this case, the risks include skin infection, onset of tinnitus, damage to the vestibular system, and damage to facial
nerves that can cause muscle weakness, or, in worst cases, disfiguring paralysis. There is also the risk of device failure,
usually where the incision does not heal properly. This occurs in 2% of cases and the device must be removed. The operation also
may destroy any residual hearing the patient may have; as a result, some doctors advise single-ear implantation, saving the other
ear in case a biological treatment becomes available in future.
After 1-4 weeks of healing (the wait is usually longer for children than adults), the implant is turned on or activated.
Results are typically not immediate, and post-implantation therapy is required as well as time for the brain to adapt to hearing
new sounds. In the case of congenitally deaf children, audiological training and speech therapy typically continue for years, though infants can become age appropriate in
a matter of months. The participation of the child's family in working on spoken language development is considered to be even
more important than therapy. The family can aid development by participating actively in the child's therapy, making hearing and
listening interesting, talking about objects and actions, and encouraging the child to make sounds and form words.
In 2003, the CDC and FDA announced that children with
cochlear implants are at a slightly increased risk of bacterial meningitis (Reefhuis 2003).
Though this risk is small, it is still 30 times higher than children in the general population, without proper immunizations.
Many users, audiologists, and surgeons also report that when there is an ear infection causing fluid in the middle ear, it can
affect the cochlear implant, leading to temporarily reduced hearing.
The implant has a few effects unrelated to hearing. Manufacturers have cautioned against scuba
diving due to the pressures involved, but the depths found in normal recreational
diving appear to be safe. The external components must be turned off and removed prior to swimming or showering. Some
brands of cochlear implant are unsafe in areas with strong magnetic fields, and thus cannot be used with certain diagnostic tests
such as magnetic resonance imaging (MRI), but some are now FDA approved for
use with certain strengths of MRI machine. Large amounts of static electricity can cause the device's memory to reset. For this
reason, children with cochlear implants are also advised to avoid plastic playground slides. [8] The electronic
stimulation the implant creates appears to have a positive effect on the nerve tissue that surrounds it.[citation needed]
Cost
In the United States, medical costs run from USD$45,000 to $105,000; this includes
evaluation, the surgery itself, hardware (device), hospitalization and rehabilitation. Some or all of this may be covered by
health insurance. In the United Kingdom, the NHS covers cochlear implants in full.
Efficiency
A cochlear implant will not cure deafness or hearing impairment, but is a prosthetic substitute for hearing. Some recipients
find them very effective, others somewhat effective and some feel overall worse off with the implant than without. [9] For people
already functional in spoken language who lose their hearing, cochlear implants can be a great help in restoring functional
comprehension of speech, especially if they have only lost their hearing for a short time.
British Member of Parliament Jack Ashley received a cochlear implant in 1994 at age 70 after 25 years of deafness,
and reported that he has no trouble speaking to people he knows one on one, even on the telephone, although he might have
difficulty with a new voice or with a busy conversation, and still had to rely to some extent on lipreading. He described the robotic sound of human voices perceived through the cochlear implant as "a
croaking dalek with laryngitis". Even modern cochlear implants
have at most 24 electrodes to replace the 16,000 delicate hair cells that are used for normal
hearing. However, the sound quality delivered by a cochlear implant is often good enough that many users do not have to rely on
lipreading. Rush Limbaugh, U.S. talk radio show host, says that everything sounds normal
except that he cannot pick out the melody of new music that he had not heard prior to becoming deaf.
Adults who have grown up deaf can find the implants ineffective or irritating. This relates to the specific pathology of
deafness and the time frame. Adults who are born with normal hearing and who have had normal hearing for their early years and
who have then progressively lost their hearing tend to have better outcomes than adults who were born deaf. This is due to the
neural patterns laid down in the early years of life - which are crucially important to speech perception. Cochlear implants
cannot overcome such a problem. Some who were orally educated and used amplifying hearing aids have been more successful with
cochlear implants, as the perception of sound was maintained through use of the hearing aid.
Many individuals who use sign language believe they have no use for sound, with the obvious exception of the detection of
emergency situations (onrushing vehicles, law enforcement officials calling to them or attackers) located outside the range of
vision. Individuals who are deaf use sign language and an interpreter to communicate with those who use spoken languages, in the
same way that an individual who only speaks English but wants to meet with an individual who only speaks French, would utilize an
interpreter.
For small children, amazing results have been achieved with the use of cochlear implants[3]. Almost all children hear quite well with a cochlear implant, save for a rare
few. Those children without a working auditory nerve may be helped with a cochlear implant, although the results they experience
may not be as spectacular. Patients without a viable auditory nerve are usually identified during the candidacy process. Fewer
than 1% of deaf individuals have a missing or damaged auditory nerve, which today can be treated with an auditory brainstem implant. Recent research has suggested that children and adults can benefit from bilateral cochlear implants in order to aid in sound
localization and speech understanding. (See Offeciers et al. 2005)
Risks and disadvantages
The FDA reports that cochlear implant recipients may be at higher risk
for meningitis.[10] A study of 4,265 American children who received implants between 1997 and 2002
concluded that recipient children had a risk of pneumococcal meningitis more than 30 times greater than that for children in the
general population.[11] A later, UK-based, study found that while the incidence of meningitis in implanted adults was
significantly higher than the general population, the incidence in children was no different than the general population.[12]
There are strict protocols in choosing candidates to avoid risks and disadvantages. A battery of tests are performed to make
the decision of candidacy easier. For example, some patients suffer from deafness medial to the cochlea - typically acoustic
neuromas. Implantation into the cochlea has a low success rate with these people as the artificial signal doesn't have a healthy
nerve to travel along.
With careful selection of candidates, the risks of implantation are minimized.
Ethical issues
Discussions within the deaf community continue to fuel controversy and emotional personal debates about health, rights of the
individual citizen, language, ethics, deaf culture, and the death of deaf culture. Part of
the controversy concerns also the basic right for an individual to choose a language versus an individual as a young child having
a mode of communication and language chosen for them. In the past, many adults whose first language is sign language endured policies created by medical and educational governing bodies that enforced the use
of spoken language and use of hearing aids on them. One argument made by those in the deaf community opposed to cochlear implants
is that implantation of CI's in young children is just another form of abuse. In the past, individuals who were deaf have
advocated change successfully to improve human rights for individuals and continue to work to advocate for change, to help
children who are born with loss of hearing.
Cochlear implants for congenitally deaf children are often considered to be most effective when implanted at a young age,
during the critical period in which the brain is still learning to interpret sound;
hence they are implanted before the recipients can decide for themselves. Critics question the ethics of such invasive elective
surgery on otherwise healthy children. They point out that manufacturers and specialists have exaggerated the efficacy and
downplayed the risks of a procedure that they stand to gain from. On the other hand, Andrew Solomon of the New York Times states that "Much National Association of the Deaf propaganda about the danger of
implants is alarmist; some of it is positively inaccurate."[4]
Much of the strongest objection to cochlear implants has come from the deaf community,
which consists largely of pre-lingually deaf people whose first language is a
signed language. Regardless of the fact that to be deaf is to lack the ability to hear,
many individuals who are deaf and the deaf community do not share the view of deafness held by the hearing parents of deaf
children, which obviously regards deafness as a disability to be "fixed." Individuals who are deaf celebrate their diverse
culture (see deaf culture). On the other hand, many people feel that refusing to implant
deaf children is unethical, comparable to refusal to treat any other handicap or disease that can be effectively alleviated. Many
individuals who can hear, or who have experienced the wonder of hearing before going deaf, are not comfortable with the thought
of a child that lacks the sense most commonly associated with human language. Individuals who are deaf may feel that implants are
just another form of mental and physical abuse in the long history of punishments, abuse and pain they have had to endure.
The conflict over these opposing models of deafness has raged since the 18th
century, and cochlear implants are the latest in a history of medical interventions promising to turn a deaf child into a hearing
child — or, more accurately, into a child with a mild or moderate hearing
impairment.
Critics argue that the cochlear implant and the subsequent therapy often become the focus of the child's identity, at the
expense of a deaf identity and ease of communication in sign language. Measuring the child's success by their success in hearing
and speech will lead to a poor self-image as "disabled" (because the implants do not produce normal hearing) rather than having
the healthy self-concept of a proud deaf person.[5]
Some writers have noted that children with cochlear implants are more likely to be educated orally and without access to sign language (Spencer et al
2003). Children with implants are also often isolated from other deaf children and from sign language (Spencer 2003), and instead
are 'married' to a team of hearing experts who will monitor his cochlear implant and adjust the speech processor, at great
expense. Children do not always receive support in the educational system to support their needs as they may require special
education environments and EA's Educational Assistants. According to Johnston (Johnston 2004), cochlear implants have been one of
the technological and social factors implicated in the decline of sign languages in the
developed world. Some of the more extreme responses from deaf activists have labelled the widespread implantation of children as
"cultural genocide". As cochlear implants began to be implanted into deaf children in
the mid to late 1980s, the deaf community responded with protests in the US,
UK, Germany, Finland,
France and Australia.
Opposition continues today but is softening. As the trend for cochlear implants in children grows, deaf-community advocates
have tried to counter the "either or" formulation of oralism vs manualism with a
"both and" approach; some schools now are successfully integrating cochlear implants with sign language in their educational
programs. However, some opponents of sign language education argue that the most successfully implanted children are those who
are encouraged to listen and speak rather than overemphasize their visual sense. Significantly, deaf individuals have a high rate
of illiteracy due to the phonetic nature of the western writing systems; it is thought that cultivating the auditory senses will
help a hearing impaired child to avoid this problem. However, others (mainly deaf people who have been through education in
decades past) feel that the high levels of relative illiteracy is mainly due to profoundly deaf children being taught orally,
despite being sign language users and not being able to fully understand speech. Oral education in the past, though, was vastly
different from the approaches today, which have the benefit of hearing with cochlear implants. Previous generations relied
heavily on lipreading; today's implanted person can often hear well with no lipreading whatsoever.
A recent study[6] about attitudes of young, implanted
people shows, that their feelings about the implantation are overhelmingly positive; although they are aware of the negative
effects, too. None of the teenagers participating in the study criticised their parents for making the decision. They developed a
positive identity, felt that they belonged to both the hearing and deaf worlds; although only some of them use both spoken and
sign language.
Functionality
The implant works by using the tonotopic organization of the basilar membrane of the
inner ear. "Tonotopic organization", also referred to as a
"frequency-to-place" mapping, is the way the ear sorts out different frequencies so that our brain can process that information. In a normal ear,
sound vibrations in the air lead to resonant vibrations of the
basilar membrane inside the cochlea. High-frequency
sounds (i.e. high pitched sounds) do not pass very far along the membrane, but low frequency sounds pass farther in. The movement
of hair cells, located all along the basilar membrane, creates an electrical disturbance that
can be picked up by the surrounding nerve cells. The brain is able to interpret the nerve
activity to determine which area of the basilar membrane is resonating, and therefore what sound frequency is being heard.
In individuals with sensorineural hearing loss, hair cells are often fewer
in number and damaged. Hair cell loss or absence may be caused by a genetic mutation or
an illness such as meningitis. Hair cells may also be destroyed chemically by an
ototoxic medication, or simply damaged over time by excessively loud noises. The cochlear
implant bypasses the hair cells and stimulates the cochlear nerves directly using electrical impulses. This allows the brain to
interpret the frequency of sound as it would if the hair cells of the basilar membrane were functioning properly (see above).
Processing
Sound received by the microphone must next be processed to determine how the
electrodes should be activated. The simplest way of processing would be to divide the acoustic
signal by the number of electrodes in the device and apply the resulting voltage to the appropriate electrode. More sophisticated
processing algorithms are used in practice because applying voltage to each of the electrodes simultaneously could cause non-charge-balanced currents to flow between the
electrodes. This could stimulate the nerves in undesirable ways and lead to both tissue and electrode damage by essentially
electrocuting individual nerve cells.
Fourier strategies use bandpass filters to divide
the signal into different frequency bands. The algorithm chooses a number of the strongest outputs from the filters, the exact
number depending on the number of implanted electrodes and other factors. These strategies emphasize transmission of the temporal
aspects of speech.
Feature extraction strategies use features which are common to all
vowels. Each vowel has a fundamental frequency (the lowest frequency peak) and formants (peaks with higher frequencies). The pattern of the fundamental and formant frequencies is specific for
different vowel sounds. These algorithms try to recognize the vowel and then emphasize its features. These strategies emphasize
the transmission of spectral aspects of speech. Feature extraction strategies are no longer widely used.
Transmitter
This is used to transmit the processed sound information over a radio frequency link
to the internal portion of the device. Radio frequency is used so that no physical connection is needed, which reduces the chance
of infection. The transmitter attaches to the receiver using a magnet that holds through the
skin.
Receiver
This component receives directions from the speech processor by way of radio waves sent from the transmitter. (The receiver also receives its
power through the transmission.) The receiver is also a sophisticated computer that translates
the processed sound information and controls the electrical current sent to the
electrodes in the cochlea. It is embedded in the skull behind the
ear.
Electrode array
The electrode array is made from a type of silicone rubber, while the electrodes are
platinum or a similarly highly conductive
material. It is connected to the internal receiver on one end and inserted into the cochlea
deeper in the skull. (The cochlea winds its way around the auditory nerve, which is tonotopically organized just as the
basilar membrane is). When an electrical
current is routed to an intracochlear electrode, an electrical field is generated
and auditory nerve fibers are stimulated.
In the devices manufactured by Cochlear Ltd, two electrodes sit outside the cochlea and acting as grounds-- one is a ball
electrode that sits beneath the skin, while the other is a plate on the device. This equates to 24 electrodes in the
Cochlear-brand 'nucleus' device, 22 array electrodes within the cochlea and 2 extra-cochlear electrodes.
Speech Processors
Speech Processors are the component of the cochlear implant that transforms the sounds picked up by the microphone into
electronic signals capable of being transmitted to the internal receiver. The coding strategies programmed by the user's
audiologist are stored in the processor, where it codes the sound accordingly. The signal produced by the speech processor is
sent through the coil to the internal receiver, where it is picked up by radio signal and sent along the electrode array in the
cochlea.
There are primarily two forms of speech processors available. The most common kind is called the "behind-the-ear" processor,
or BTE. It is a small processor that is kept worn on the ear, typically together with the microphone. This is the kind of
processor used by most adults and older children.
The other form is called a body-worn-processor. This is the kind used typically by younger children, whose ears are too small
to properly fit the bulky BTE processor (though it is gradually being phased out, with baby and child friendly BTEs on the
market). The body worn processor is kept on the user's body, and a long wire extends up to the microphone earpiece to connect it
with the processor. Users of the body worn processor have to find some creative way where to place the body worn processor. Some
mothers place the processor on the child's back in a pocket sewn onto a T-shirt or onesie, others
use a harness that clips across the child's chest. In July 2007, Cochlear Corp., the maker of the Nucleus brand of cochlear
implants, announced that they will be making an accessory called "Babyworn", that will allows the BTE processor to be worn with a
small battery pack that will clip onto the babies clothing[7]. This will possibly diminish demand for the Bodyworn style processor. Advanced Bionics will likely
come out with a similar accessory for their processor in the near future. Med-el has had a baby-friendly BTE which pins on the
collar on the U.S. market since the fall of 2001; 70% of their market is to children.
Programming the speech processor
The cochlear implant must be programmed individually for each user. The programming is performed by an audiologist trained to work with cochlear implants. The audiologist sets the minimum and maximum current
level outputs for each electrode in the array based on the user's reports of loudness. The audiologist also selects the appropriate speech
processing strategy and program parameters for the user.
Manufacturers
Currently (as of 2007), the four cochlear implant devices are manufactured by Cochlear Limited, Australia, MED-EL, Austria, Advanced Bionics, US, and Neurelec,
France. Each manufacturer has adapted some of the successful innovations of the other companies to their own devices. There
is no clear-cut consensus that any one of these implants is superior to the others. Users of all four devices display a wide
range of performance after implantation.
Since the devices have a similar range of outcomes, other criteria are often considered when choosing a cochlear implant:
usability of external components, cosmetic factors, battery life, reliability of
the internal and external components, MRI compatibility, mapping strategies, customer service from the manufacturer, the
familiarity of the user's surgeon and audiologist with the particular device, and anatomical concerns.
Cochlear Americas, the Americas subsidiary for the largest cochlear implant manufacturer, Cochlear Limited, acknowledged to
shareholders in March 2004 that it is under investigation by the U.S. Department of Justice for offering inducements to
physicians in exchange for prescribing devices made by Cochlear. See Australian Stock Exchange Release. In its Annual Report of September
2007 Cochlear indicated that DOJ had passed the investigation to the Office of the Inspector General for administrative
processing. Cochlear's Australian Stock Exchange filings in August 2007 also reported a record profit of A$100 million (or just
over US$85 million) and a 70 percent market share.
Cochlear implant in popular culture
In 2000, an Academy Award nominated documentary film Sound and Fury depicted
the cultural divide between the deaf community and children with cochlear implants. The Artinian family themselves are a
"microcosm" of the deaf culture war and two children – Peter (11 months old) and Heather (7
yrs old) – are caught in the middle. Many of the family members who opposed cochlear implants later went on to receive implants
or allow their children to be implanted, and have become strong advocates for cochlear implants.
Famous recipients of cochlear implants include British MP Jack
Ashley, conservative U.S. talk-show host Rush Limbaugh, British designer and
typographer Tony Malone, and Heather
Whitestone, Miss America 1995. Sigrid Cerf, wife of the creator of TCP/IP and Chief Internet Evangelist Vint Cerf, has two
cochlear implants. Vint Cerf has a hearing impairment himself, and has spoken in support of
the Hear and Say Centre, a cochlear implant and speech training organisation based in Brisbane, Australia.
On the television show ER, Reese Benton, the son of Dr. Peter Benton, is born deaf and his father briefly considers giving his son a cochlear implant.
On the television show Scrubs, the son of Mr. Francis is a child born deaf
that ends up receiving a cochlear implant.
On the long running soap opera The Young and The Restless, Neil and
Drusilla Winters adoptive son Devon lost his hearing due to meningitis and got a Cochlear Implant so he could hear again.
On the long running soap opera "Guiding Light", former actress Amy Ecklund received the cochlear implant in 1999. It was written into the show weeks later.
A Cochlear Implant is present in the video game series Splinter Cell as a
means of communication without obvious microphones and the risk of being overheard and is used by the protagonist
Sam Fisher.
On the television show, "What About Brian", the daughter of Dave and Deena, Carrie,
gets a cochlear implant.
The Michael Moore film Sicko documents one families' process in fighting against
CIGNA to receive a sequential bilateral cochlear implant for their daughter. That child was a
client of the Let Them Hear Foundation Insurance Advocacy Program. After several other appeals and an investigation opened by the
Florida Attorney General, CIGNA finally changed their policy to include bilateral cochlear implants as a standard benefit in all
traditionally insured plans in May of 2007.
See also
References
- ^ Cochlear Corp. News
- ^ van der Heijden, Dennis (2006-03-01). What are Cochlear Implants?.
Axistive. Retrieved on 2007-03-01.
- ^ http://www.medicalnewstoday.com/articles/46327.php
- ^ Defiantly Deaf.
- ^ Cochlear Implants.
- ^ Wheeler, A., Archbold, S., Gregory, S.: "Cochlear implants: young people's view",
The National Deaf Children's Society & The Ear Foundation, 2007
- ^ http://hearingpocket.wordpress.com/2007/07/27/babyworn-is-here/
- Berruecos, Pedro. (2000). Cochlear implants: An international perspective - Latin American countries and Spain.
Audiology. Hamilton: Jul/Aug 2000. Vol. 39, 4:221-225
- Chorost, Michael. (2005). Rebuilt: How Becoming Part Computer Made Me More Human. Boston: Houghton Mifflin.
- Djourno A, Eyriès C. (1957). 'Prothèse auditive par excitation électrique à distance du nerf sensoriel à l'aide d'un bobinage
inclus à demeure.' In: La Presse Médicale 65 no.63. 1957.
- Djourno A, Eyriès C, (1957) 'Vallencien B. De l'excitation électrique du nerf cochléaire chez l'homme, par induction à
distance, à l'aide d'un micro-bobinage inclus à demeure.' CR de la société.de biologie. 423-4. March 9, 1957.
- Eisen MD (2003), 'Djourno, Eyries, and the first implanted electrical neural stimulator to restore hearing.' in: Otology
and Neurotology. 2003 May;24(3):500-6.
- Grodin, M. (1997). Ethical Issues in Cochlear Implant Surgery: An Exploration into Disease, Disability, and the Best
Interests of the Child. Kennedy Institute of Ethics Journal 7:231-251.
- Johnston, Trevor. (2004). W(h)ither the Deaf Community? In 'American Annals of the Deaf' (volume 148 no. 5),
- Lane, H. and Bahan, B. (1998). Effects of Cochlear Implantation in Young Children: A Review and a Reply from a DEAF-WORLD
Perspective. Otolaryngology: Head and Neck Surgery 119:297-308.
- Lane, Harlan (1993), Cochlear Implants:Their Cultural and Historical Meaning. In
'Deaf History Unveiled', ed. J.Van Cleve, 272-291. Washington, D.C. Gallaudet University Press.
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Deaf News 2 (3):22-28.
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Angle." Ear & Hearing, 2006; 27; 43-59.
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Multichannel Cochlear Implants or Hearing Aids. Annals of Otology, Rhinology and Laryngology 105 (Suppl.):334-337
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External links
- Cochlear Implants
Information from the National Institutes of Health (NIH).
- Brightsurf Science News - Cochlear Implant Restores Hearing To Patient With Rare Genetic
Disorder
- Increased use in
the elderly.
- NPR Story about
improvements to improve the processing of music. Includes simulations of what someone with implants might hear.
- Tuning In
PBS article about advances in cochlear implant technology with simulations
of what someone with each type of implant would hear.
- My Bionic
Quest for Boléro (Wired, November 2005): Author writes about his own implant and trying the latest software from researchers
in a quest to hear music better.
- Rebuilt: How Becoming Part Computer Made Me
More Human A memoir of getting a cochlear implant, published in 2005.
- Rationale for bilateral cochlear implantation (PDF)
- The Let Them Hear Foundation assists
individuals with appealing health insurer denials for cochlear implants
- Cochlear implant case
study
- Cochlear Implant Info
- "For Some
Who Lost Their Hearing, Implants Help", Jane E. Brody, New York Times, October 3, 2006.
- Hear Again,
by Arlene Romoff The compelling, true story of how a late deafened adult regained communication with the "hearing" world
- [13]Cochlear
Implants, Cochlear Implant Surgery, Benefits of Cochlear Implants, Information for Patients
- "What Does Health Insurance Pay for Cochlear
Implants?" A non-commercial information resource presented by Otologic Reimbursement Management
- Hear Again - an Implantees BlogA blog by an
implantee, that gives a vivid, descriptive picture of what it is like to have a Cochlear Implant
- Cochlear Implants
and Their Effects on the Deaf Community
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