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Thursday April 19 2018

The Cochlear Implant: Genocide or Medical Miracle?

Genocide.

A word reserved for the worst of human rights atrocities—the deliberate extermination of a particular demographic.

The fact that this word has been used by some to describe cochlear implants (CI) for the deaf is a testament to the deep-rooted controversy that surrounds the technology, especially with its implantation in young children. When it was first approved for adults in 1984 and children six years later, the cochlear implant was the first device to restore—even if partially—a missing sense. For a person with sensorineural deafness whose damaged cochlea prevents them from using traditional hearing aids, this device converts sound into electrical impulses and feeds them directly into the auditory nerve (1). The CI, over thirty years after its inception, is still a medical marvel by any measure.

For many of the 38,000 deaf U.S. children who’ve received the operation, the cochlear implant has given them both the gift of sound and greater integration into the hearing mainstream (2). The controversy, then, is largely one of identity. Members of the Deaf — capital “D” — community have long fought the notion that deaf people are in need of “fixing.” To them, deafness is not a medical condition but a culture, one that, just like any other culture, has rich language, traditions and values. Because less than 25% of implanted children are taught American Sign Language (ASL), the native tongue of the Deaf, each child that receives an implant is seen by some as another child removed from Deaf culture (3). The notion that cochlear implants are a form of cultural genocide is by no means representative of all opinions within the community, but it’s not hard to see how widespread advocacy of the technology by medical corporations and professionals can be taken as an invasion of identity.

Although cochlear implants are far from a simple “cure”—due to the actual level of hearing improvement being highly variable between individuals—the life-changing potential of the device is hard to deny. Since receiving approval from the Food and Drug Administration in 1990, almost 100 000 deaf children have successfully developed spoken language with the help of CIs (4). For parents caught in the crossfire between medical benefit and social self-determination, there is one very practical question to answer: Should my deaf child should receive a CI?

The way a parent views their child’s deafness is shaped heavily by their own hearing status. For deaf parents, the decision to forgo implantation may be driven by the need to pass on their language and culture to their child. However, over 95% of deaf children are born to hearing parents. For many of these families where their child is the first deaf person they’ve ever encountered, CIs may seem like an attractive option that offers the promise of easier communication. According to research conducted by the Washington University School of Medicine, most children who receive a CI and oral training before the age of two can be expected to exhibit levels of spoken language that are on par with their hearing peers before they enter kindergarten (5). Further considering how learning ASL—an entirely new mode of communication—may simply be unrealistic for certain parents, some would argue that the ability to ensure smooth parent-child communication is more than enough to justify the surgery.

Still, others might fire back: if deafness is an identity, children should have the freedom to make their own decision regarding CIs. The prevailing Deaf view is that adult CI recipients are old enough to understand their choice, but implanted children, on the other hand, are having an identity imposed upon them. However, the reality is despite being at the optimal age for CI surgery, children would not have the cognitive capacities or social experience to identify with either the deaf or hearing community. As opposed to completely denying a deaf child the possibility of a hearing future by forgoing implantation, some parents maintain their child’s right to self-determination by opting for the implant and allowing the child to “turn it off” later on. Even still, it can be argued that as much as rejecting surgery prevents a mainstream hearing lifestyle, neglecting ASL in favor of a purely oral approach through a CI equally robs the deaf child of deaf integration (4). The arguments are endless.

With all sides of the debate solidly entrenched after decades of controversy, the disagreement will no doubt persist. The cochlear implant will always remain a divisive choice. What is non-negotiable, however, is a child’s right to a first language—the very ability to communicate. For parents faced with this difficult decision, the priority ought to be making sure that the deaf child receives rigorous language training, regardless of whether the chosen approach is sign language or speech. In both cases, timing of intervention is crucial. There is a “biologically expensive” time window in an infant’s development where neural circuits are still highly malleable. Sign language cues must be introduced in infancy; cochlear implantation must be done within the first 18 months of development and followed by intensive auditory-oral training (6). If implemented in a timely and meticulous manner, both a visual and oral approach can fulfill a deaf child’s developmental needs. With a device that has been deemed everything from “genocide” to “medical miracle,” parents, now more than ever, must critically consider the conflicting voices and make decisions that place their child’s language acquisition at the utmost priority.


Written by Edward Cui

Edited by Angela Dong


References:

  1. NICDC (2017). Cochlear Implants. [online] National Institute on Deafness and Other Communication Disorders. Available at: https://www.nidcd.nih.gov/health/cochlear-implants [Accessed 23 Dec. 2017].
  2. NIDCD (2017). Quick Statistics About Hearing. [online] National Institute on Deafness and Other Communication Disorders. Available at: https://www.nidcd.nih.gov/health/statistics/quick-statistics-hearing#10 [Accessed 23 Dec. 2017].
  3. Kasulis, K. (2017). The strange reason deaf children aren’t taught sign language. [online] Mic. Available at: https://mic.com/articles/185597/deaf-children-language-deprivation-alexander-graham-bell#.P4uA5659B [Accessed 23 Dec. 2017].
  4. Mellon, N., Niparko, J. and Rathmann, C. (2015). Should All Deaf Children Learn Sign Language?. PEDIATRICS, [online] 136(4), pp.781-781. Available at: http://pediatrics.aappublications.org/content/136/1/170.
  5. Nicholas, J. and Geers, A. (2007). Will They Catch Up? The Role of Age at Cochlear Implantation in the Spoken Language Development of Children With Severe to Profound Hearing Loss. Journal of Speech Language and Hearing Research, [online] 50(4), p.1048. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2882067/.
  6. Niparko, J. (2010). Spoken Language Development in Children Following Cochlear Implantation. JAMA, [online] 303(15), p.1498. Available at: https://jamanetwork.com/journals/jama/fullarticle/185710.

 

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The Meducator is McMaster University’s undergraduate Health Sciences Journal. It publishes pieces that critically address current issues with a high degree of scientific rigor, but in a way that is accessible to a broad audience.

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