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IEET > Rights > Disability > Interns > V.R.Manoj

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Cochlear Cyborgs : Human Issues with Cochlear Implants


V.R. Manoj
By V.R. Manoj
Cyborg Fantasies

Posted: Aug 6, 2007

Some deaf way wish to revolt against the hearing world and defend the autonomy of deaf culture. But not everyone has the luxury to revolt. For the unwilling deaf, there are now cochlear implants.

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The five elements (earth, air, fire, water and sky or cosmos) make up this known world. The world in turn is perceived by us with our five senses (sight, sound, touch, taste and smell). This interaction between us and these elements demand a constant functioning of all the five senses. Each of these senses is unique and has it’s own importance in the overall sensory experience. In the orchestra of the world attended by the body, the removal of just one sense is enough to throw the experience out of sync. The loss of synchronicity with the beauty of this world because of sensory deprivation causes a tremendous sorrow which cannot be expressed. Such is the agony of an artist who can no longer see or that of a musician who can no longer hear. Beethoven, a legend then and now in the world of mortals left us with immortal musical compositions, some of which were composed even when he was completely deaf. He was in indescribable agony for having been denied the pleasures of hearing his own compositions. His life was dwelt in constant pain over this sensory deprivation from the passion which he most embraced, music. In the now famous letter which he sent his brothers named Heiligenstadt Testament, he writes:

O how harshly was I repulsed by the doubly sad experience of my bad hearing,...but what a humiliation when one stood beside me and heard a flute in the distance and I heard nothing, or someone heard the shepherd singing and again I heard nothing, such incidents brought me to the verge of despair, but little more and I would have put an end to my life - only art it was that withheld me, ah it seemed impossible to leave the world until I had produced all that I felt called upon me to produce, and so I endured this wretched existence - truly wretched, an excitable body which a sudden change can throw from the best into the worst state ... O men, when some day you read these words, reflect that you did me wrong and let the unfortunate one comfort himself and find one of his kind who despite all obstacles of nature yet did all that was in his power to be accepted among worthy artists and men”.

The above notes of personal grief were written in 1802, a time when the biological body had no choice but to accept what was bestowed unto it by random replications of genetic material and the quality of society. Now, in the year 2007, two hundred and five years later, the modern Beethoven has a ray of hope.

Human hearing is perhaps not comparable to certain other members of the fauna of our planet. However, within our species and for routine interaction with the world around us, our hearing is as adequate as can be. We can normally hear frequencies of sound between 20 Hz and 20 kHz. However, this range of hearing ability deteriorates with age, exposure to sounds during one’s lifetime and a variety of other factors. The biological ear is not as immortal as the sounds that resonate through it. The functioning of the ear is like a sophisticated receiver sending the vibrations from across the air to the brain. The ear functions much like a relayed computer in carrying the sound to the brain. The outer ear which we see outside collects and concentrates the sound waves sent to it. This then gets transferred to the middle ear which processes the different noises and translates them over to the Inner ear. The Inner ear is a fluid filled chamber, also known as the Cochlea, where these sound messages are translated from waves in the fluid, into nerve impulses, which are then received by the brain. The brain, thanks to a sophisticated network of auditory nerves, receives this information which it then interprets into coherent sounds. So, we either scream in agony over loud music or smile with content at the sweetest melody.

But, what about people with extremely limited or no hearing ability? Technology has the answer in the form of what is known as the cochlear implant. It is usually recommended only for people for whom other forms of therapy to restore or improve hearing is unfruitful. While the conventional hearing aid amplifies the sound received by it into the ear, the cochlear implant directly stimulates the auditory nerves of the cochlea. This electronic device is surgically inserted into the skin just behind the person’s ear. Externally, the device consists of a microphone that picks up sound from the environment which is then filtered by a sound processor to cancel out non-essential noises that are not required before sending to a magnetic pad transmitter placed behind the external ear. A receiver and a stimulator surgically placed inside the person’s bone just beneath the skin, converts the sound signals sent to it by electromagnetic induction into electrical signals which are relayed to extensive array of electrodes (16-24 electrodes in a regular model) wound around the cochlea of the natural ear. The electrodes are programmed to strobe on and off to mimic the activities of the auditory nerves, thus sending this information directly to the brain. The patient trains himself/herself over time to decipher the noise as coherent human speech.

I recently came across a post in the World Transhumanist Association’s mailing list, wta-talk. In it was posted a popular member’s account, or rather chronicle of his experiences with a cochlear implant. I was very interested and asked him for more details. He sent me a 272 page document detailing his everyday events with a cochlear implant. Frank Forman is his name and he terms himself as the “cochlear cyborg” in his chronicles. While too huge to include here, here are some of the highlights of his chronicle that thoroughly interested me. Frank is a lover of music and of the many dynamic human relationships in the world around him. In his chronicles, he painstakingly details how his perceived philosophical world is shrouded in a blanket of sounds which he hears and understands sometimes, but not all the time. However, with training his hearing is steadily improving. Much of the cochlear implant’s ability to decipher sounds can be improved by software or by increasing the hardware efficiency, especially the number of electrodes stimulating the cochlea. However, the most striking requirement of the cochlear implant is the amount of time and effort required for rehabilitation after the surgical procedure. Any amount of residual hearing left is completely lost after the implantation procedure. What one hears initially is something akin to noise which the user then trains themselves to decipher as human speech or even music. In Frank’s case, he had a cochlear implant and it did seem to work fine for him during conversations. However, he like many other implant receivers found it rather difficult to listen and enjoy music in the same way that a person with a “meat ear” would hear. The number of channels offered by the cochlear implant is usually eight compared to a little more than 3,000 channels perceived by a functioning biological ear with it’s fine hair arrangement. However, this is enough for a person who wishes to restore their ability to hear human speech in conversations. The latest models can accommodate up to 121 channels and it is only a matter of time and technology before the cochlear implant is able to completely substitute for all the channels available to the biological ear and perhaps more! Within Frank’s chronicle, I found him referring the reader to the struggling experience of yet another implant recipient’s relentless pursuit to make himself hear a rendition of the famous classical musical piece “Bolero” by Ravel.

Cochlear implant technology has come a long way and can now be implanted into people as young as five months. Bilateral cochlear implants (implants for both ears) are increasingly becoming popular. Children with extreme difficulties in hearing can have cochlear implants implanted so that they learn to adapt much better than getting implanted in later stages of their lives. However, as with other technologies, cochlear implants have a host of social, philosophical and technological problems and issues. The first and foremost of these is the opposition to cochlear implants by the “deaf culture”. Deaf culture was created among people who were “deaf” and learned to live their lives with dignity in their own unique ways. The members of such a community prefer to remain deaf for their own reasons. But, what I find disturbing is some of their rigid opposition to technology that can remove deafness or other hearing problems completely. Though still in it’s infancy, cochlear implants are sure to someday substitute for a disabled biological ear completely. In essence, I would not crusade to “convert” members of the deaf culture to change their views on their condition. As progressive human beings, we must learn to co-exist, if not appreciate the diversity in culture. The advocates of deaf culture have learned to link themselves to the world with their unique mannerisms, sign languages and rights. This is to be respected at it’s most fundamental level; the members of such communities do not consider their condition as a disability; but rather, as a defining quality. If we respect the reservations of the members of deaf culture, would it also be possible for deaf culture to not interfere with or oppose promising technologies such as cochlear implants? The ultimate decision should rest on the individual in whose head the implant is going. Informed consent in this matter is also not very easy especially if the implant is for a young child.

Perhaps the formation of cultures is an adaptive measure to enable survival of certain communities with different abilities. Right now, opposition to technologies such as the cochlear implant may find success owing to the implant’s own technological inconsistencies. While Michael may have found “Bolero” at long last, Frank is yet to find audio reception of such fidelity with his own implant. This is the tale with every new technology. Cochlear implant technology is less than a 100 years old. It is important to receive extensive feedback from the millions of patients who are given these cochlear implants every day. Opposition will reduce such useful feedback. Even more challenging is minimizing the loss of any residual hearing ability left after the implant. We are still far from technology that allows to switch between cochlear implant and the biological ear at the turn of a dial. Nanotechnology and stem cell research offers such promises and soon it may completely possible to rebuild the neural connections that were previously absent or deficient. Current research into contour cochlear implants strive to preserve residual hearing.

The polar opposite of Deaf Culture’s reluctance to embrace cochlear implants is that new breed of philosophy, Transhumanism. Transhumanism by itself can be seen as a cultural movement where people would like to utilize advanced technology to radically normalize, enhance or substitute their biological bodies in an ethical manner. If you had the ability to uplift the human condition via technology, then why not? Bionic ears, eyes, nose, all the five senses and perhaps even more disabled senses could be awakened through technology. People should have the right to modify their bodies to interact with society in the manner they choose. Transhumanism goes several steps further, sometimes in ways that are too political. However, this is inevitable in the pursuit of any method to improve the way which we live. Fore example, transhumanists could advocate the right to re-modify the genetic makeup of children before they are born to suit the requirements of say, a particular community. On the favorable side, we could say that the child’s genetic modification is to protect the child from a lifetime struggle against disease or disability. However, since the yet unborn child is not consulted and a host of other inconsistencies exist regarding the issues of informed consent, these genetic therapies still lie on the border between hardcore transhumanism and more established bioethics. We require radical philosophies such as transhumanism to actually address the ethical issues that creep up on us as new technologies emerge. Cochlear implant technologies are becoming commonplace and the recipients of this technology are facing challenges in a society that has been so far designed without reservations for such issues. Counseling is a time honored technique to acquire informed consent. Most societies do not have the money to do this sort of commitment. Sweden has a well established system to monitor pre- and post-operative procedures for recipients of Cochlear technologies. However, unlike a large portion of the world, Sweden can afford to spend on such resources.

Many of us know a close friend who’s abilities are different in some way. Or the person reading this may themselves be differently abled in some way. I still remember my friend who was much older than me and yet “deaf”. We used to communicate so well and I saw nothing different about him except that I had to make elaborate gestures to make him understand. As a good friend, I also saw the sadness in his eyes which could not be concealed in his brave smiles when he communicated. He was also “mute”. He was severely challenged in society and found it very difficult to get a job. The real world is very cruel in it’s discrimination. Noble ideas very rarely exist outside of books. This means that it is absolutely essential for every person to come to a level playing field. I understand the dignity of people who wish to remain “deaf” and engage the world on their own terms. But, not everybody has the luxury to revolt, especially if a disabled person is extremely poor and has a family to support in a social system which offers little or no welfare. Technology shall come to the rescue of such people. Cochlear implant technology is a way by which a person can participate in a society dominated by people who can “hear” and converse without sign language. The opposition to such implants should be practical. A person who cannot hear cannot expect that everybody in the world knows sign language. Such a person has to become self-sustaining. Why should they depend on another person to engage the world. Cochlear implants are not an enhancement where the person wishes to have superhuman abilities to hear extreme frequencies of sound. These are people who struggle everyday in a world where their dignity is challenged continuously either consciously or unconsciously. Let them become independent. Only when the technology grows rapidly can it also become cheaper. Let the technologies evolve to a stage where we each may desire to have a cochlear implant to enable us to understand the diverse languages that enter our ears, thus not just addressing disabilities. It is not at all immoral to transform into “cochlear cyborgs” to hear the sweet sounds of life again. It is only human to do so. Beethoven would approve.

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V.R. Manoj has a Ph.D in Environmental Biotechnology/Sciences from Anna University, Chennai, India. He has worked in the Renewable energy industry and currently teaches Environmental Sciences and Engineering to Engineering grad students in India. Dr. Manoj was an IEET Affiliate Scholar for 2010-2012.
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COMMENTS


My questions:  Once I have had the implant installed, and it fails to do me any good, and I remove it (is that a surgical procedure?) will the hearing that I had before the implant be affected?
    If the removal is a surgical procedure, will there be a large charge?
    Need I remove the connections before I go to bed?

            Thank you. William White





William,
When surgically implanted, a cochlear implant destroys any residual hearing you may have had before implantation. The people who are candidates for cochlear implants have a profound sensorineural hearing loss, and technically have none, if any, residual hearing prior to implantation.
If you decide the cochlear implant is not for you after surgery, all you do is not wear the external component of the implant, which is the microphone and processor unit. You can have the internal portion of the implant removed, but this rarely occurs, and only will happen if the internal portion malfunctions or needs to be replaced (also very rare).
And yes, you will have to remove the external component of the implant before you go to bed or participate in any activities that involve water (swimming, showering, etc.).
If you make an appointment with an Audiologist, they can go over all of the details about cochlear implants with you and can see if you are a good match for an implant.
Best of luck!





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