Diverse Concerns

Scientists, however, aren't the only ones debating the issues surrounding the cochlear implant. Some deaf and hard of hearing people—as well as some hearing educators and family members— take issue with the increasingly widespread use of the cochlear implant, particularly in young children. Their concerns are as diverse as the 28 million Americans who are deaf or hard of hearing.

		Cochlear implantation requires invasive surgery

First, the procedure itself is an invasive surgery and implanting the device destroys any residual hearing, committing the patient to the implant and forever removing the option of using a hearing aid. Most doctors schedule the procedure as soon as possible in young children to increase their odds of acquiring oral language skills. But some deaf advocates worry that hearing parents may wind up making a choice their deaf children would not have made for themselves.

"It is easier for the general public to imagine what it is like to be blind ranther than deaf," says Nancy J. Bloch, executive director of the National Association of the Deaf (NAD) in Silver Spring, Maryland. "Not until recently has the media been more balanced in their portrayal of the deaf and hard of hearing, countering the traditional view of deafness as pathological. "

That view of hearing loss as pathological is at the heart of the cochlear controversy. On the extreme end, some deaf advocates who communicate only via sign language and shun any attempt to learn oral language, view the device as a threat to their unique, sign-language-based culture. But even to those with far more moderate views, the cochlear implant is a symbol of the hearing world's desire to "fix" deaf people. "We don't take a position on the cochlear implant," says Bloch of the NAD's inclusive policies.

"We simply ask parents to take all factors into consideration, and we encourage the acquisition and use of sign—which doesn't necessarily exclude the acquisition of hearing and speech skills."

		People with and without the cochlear implant benefit from using American Sign Language

And deaf and hard of hearing groups also worry that the image of them as broken or sick erodes their civil rights and complicates deaf children's education by appearing to be the easy solution to the "problem" of being deaf.

"Often parents will go the speech/hearing route to the exclusion of sign," says Bloch. "We feel this is a mistake. Deaf and hard of hearing children need to be afforded with all the tools available for lifelong development and success, including the use of sign language."

Given the variation in results of the cochlear implant, Shannon couldn't agree more.

"Language—oral or manual—is a precursor for cognitive development," he says. "Some kids are surely being poorly served. We can't predict which kid will do well and which won't, so we have to watch them and make sure they have alternatives."

Both Shannon and Bloch worry hearing parents will see implantation as a way to avoid the time-consuming process of learning a second language—sign language. As with any second language, sign language is harder to acquire as an adult, and parents of children who sign often quickly lag behind their child's signing abilities. It is not surprising that hearing parents might feel more comfortable using oral language to communicate with their children. But forcing a child down the speech route could cause the child a number of problems.

Some implanted children still don't hear well enough to be able to speak and understand oral language. Even children who do well with cochlear implants probably need extra help with speech and language development. These issues are often not made clear to enough parents.

"It's important that parents be told that sign language is an option and that even if they select an implant they must be vigilant to ensure that their child is making good progress on language development," says Shannon. "Parents should know the implant isn't the end of the problem, but just the beginning of a long process, just as learning sign language is a long process."

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Photo: Rebecca Smith, University of Virginia.