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Tag: Cochlear Implants

Hearing Beyond Silence

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This image shows a person with a fitted cochlear implant.

“Blindness separates us from things, but deafness separates us from people.”

– Helen keller

Hearing loss currently affects approximately 9 million individuals in England. Projections indicate that by 2035, this number is expected to rise to around 13 million.

A Journey into the World of Cochlear Implants

Attending Nicci Campbell’s workshop on cochlear implants was eye-opening. With a father who battles deafness and relies on hearing aids, I was intrigued to find out more about the candidacy for cochlear implants. Before the workshop, I had a limited understanding of cochlear implants. I mistakenly viewed them as upgraded hearing aids. However, the workshop shattered this misconception. This got me thinking about the gap in public awareness.

The Mechanics of Hearing with a Cochlear Implant

Cochlear implants consist of an external sound processor and an internal implant. The sound processor captures environmental sounds, processes them, and transmits the signal to the implant. Surgically placed under the skin, the implant’s electrodes stimulate the auditory nerve directly, bypassing damaged sensory hair cells in the cochlea. Through auditory training, users learn to interpret the electrical signals.

Are You a Candidate for Cochlear Implants?

Cochlear implants are considered for candidates with severe/profound hearing loss.

  • hearing only sounds that are lounder than 80dB HL at two or move frequencies (500Hz, 1,000Hz, 2,000Hz, 3,000Hz and 4,000Hz) bilaterally
  • AB words test < 50% (for adults)

The day after attending the workshop, my father had a hearing test, eager to delve deeper, I asked him for his audiology reports to review.

This shows my father’s audiograms from 23/02/2024 compared to 20/11/2023 (shown in grey). I compared his audiology report to the degree of hearing loss (displayed on the left). Seeing this made me feel a lot of sympathy for him, despite not qualifying for cochlear implants, his hearing challenges are significant. Specifically:

  • Right Ear: He falls into the severely deaf category for frequencies 3,000Hz and above, and 4,000Hz and above in the profoundly deaf category.
  • Left Ear: Although his overall hearing levels are better, he still experiences severe hearing loss for frequencies 4,000Hz and above.

Clip From a Cochlear Implant User

The workshop featured this video clip of Asgar explaining his experiences. I found that it deeply resonated with me. Asgar’s heartfelt account of his children avoiding conversation with him to evade repeating themselves reminded me of my own childhood -my sister and I would employ the same tactic. I think it’s crucial to recognise that hearing loss not only has a physical impact, but it also effects relationships.

“If I were offered a cochlear implant today, I would prefer not to have one. But that’s not a statement about hearing aids or cochlear implants. It’s about who you are.”

–Anonymous

Embracing Silence

Discovering that cochlear implants are not universally embraced initially surprised me. Yet, as I delved deeper, I recognised the profound impact of individual differences. What proves effective for one person may not necessarily be the optimal solution for another.

  • Complex Adjustment Process

Cochlear implants don’t immediately restore hearing, users must learn to interpret the signals. This adjustment takes time and practice.

  • Loss of Residual Hearing

For people with partial hearing loss, cochlear implants can sometimes cause any remaining hearing to be lost.

  • Health Risks

There is a small risk of infection with the surgery.

  • Lifestyle Considerations

Some people may have other strategies for coping, such as sign language and lip reading.

  • Music

While cochlear implants can significantly improve speech, they are not suitable for transmitting the structural features of music.

Pop song:

cochlear implant simulation:

“The cochlear implant is not just a device; it’s a key to a new world of sound and communication”

–Dr. Graeme Clark

Awareness

Public awareness of cochlear implants varies widely. Generally, there’s a growing awareness due to increased media coverage and education initiatives. However, misconceptions and stigmas still exist, such as the belief that they “cure” deafness or that they are appropriate for all individuals with hearing loss. Organisations like RNID work on research and public awareness.

Comparing Behind-the-ear and Off-the-ear Cochlear Implants of UK Brands

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Cochlear implants have been an approved method of treatment for the profoundly, and more recently severely, deaf since the late 20th century. Their continued technological improvements since have provided those patients with the ability to hear through a processor (Hainarosie, 2014). The audio is not a perfect replication of natural hearing, but allows for interpretation of speech and sound in a way the brain can understand. Modern technology around cochlear implants provides patients with the option to have the external processor of their implant either behind their ear or off of their ear. Both designs allow for bluetooth connection between phone and processor, and each option has its own positives and negatives for users to consider.

Behind-the-ear (BTE) Cochlear Implants

BTE cochlear implants are the originals – this design for the external processor has been used since implantation in the cochlear began. The processor (containing the microphone) sits on the ear of the user and a short cable connects this to the magnet that transfers the audio information to the electrodes implanted in the cochlear. The location of the microphone on these processors differs between companies. For example, Advanced Bionics’ Naida Cl M sound processor has the microphone dipping down into the outer ear region whereas Cochlear’s Nucleus 8 sound processor has dual microphones. Each company has taken a slightly different approach to the goal of reducing background noise and making the sound as close to natural hearing as possible.

BTE – Naida Cl M sound processor – Advanced Bionics

OTE – Kanso 2 sound processor – Cochlear

Off-the-ear (OTE) Cochlear Implants

OTE cochlear implants are a more recent development in cochlear implant technology with Cochlear’s Kanso 1 sound processor being released in 2016. These processors contain only one piece that sits on the side of the head connecting directly to the magnet inside the head. There is no part that rests on the ear. Because of this, some users find it more comfortable because their ear can have a break from holding the processor. However, it is often found that the magnet needs to be stronger to ensure that the processor does not fall off because it is a less secure connection. This is a problem for some people as they feel more comfortable with a processor on their ear when they are playing sport or in other situations where the processor could get dislodged. The single piece design of the OTE processor means that the microphone is placed on the side of the head. This can have some impact on the audio that the user receives as it is not being collected from the natural location – the outer ear.

Conclusion

Some cochlear implant users opt to obtain both a BTE and OTE sound processor after surgery so that they can use each to their strengths. Throughout reading for this blog I found that my preferred design is the Naida Cl M sound processor by Advanced Bionics because of its microphone location and BTE design. A BTE design allows for better microphone placement and a more secure feeling whilst an OTE design allows for a more discrete processor with fewer pieces attached to the head – perhaps making glasses or hat wearing slightly easier. To improve comfort around OTE sound processors, there are clips and headbands available. I think that it is important for each user to be able to weigh up the pros and cons of each processor type to make an informed decision about which would work best with their lifestyle. Perhaps the difference in age between two patients would be enough to result in different choices. Access to both processor types appears to be a great solution for those who find that OTE and BTE processors are each useful in different parts of their life.

Further reading suggestions:

A Reddit thread discussing personal experiences with OTE and BTE processors:

https://www.reddit.com/r/Cochlearimplants/comments/wtdkvd/ote_kanso_2_vs_traditional_bte_processors/?rdt=42393

A list of current cochlear implant processors available in the UK:

https://www.bcig.org.uk/ci_manufacturers.aspx

Cochlear’s comparison of their current sound processors:

https://www.cochlear.com/us/en/home/products-and-accessories/cochlear-nucleus-system/nucleus-sound-processors/compare-nucleus-sound-processors

References:

Hainarosie, M., Zainea , V. and Hainarosie , R. (2014) ‘The evolution of cochlear implant technology and its clinical relevance’. Journal of Medicine and Life. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4391344/ (Accessed: 8 March 2024).

Where do cochlear implants fit in Deaf culture? 

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After watching the film ‘The Sound of Metal’, I realised that my previous perceptions of hearing loss didn’t consider the personal nuances and complexities that are integral to the Deaf community. The film follows a drummer who suddenly loses hearing in both ears. It is a highly personal portrayal of the different perspectives on hearing loss and the difficulties of adjusting to cochlear implants. What struck me the most (spoiler alert!) was the main character’s initial disappointment when getting fitted with a CI and the reaction of the deaf community he lived with to his decision. Following a fascinating lecture from Nicci Campbell, I decided to explore the perceptions of cochlear implants within Deaf culture further. 

What Are Cochlear Implants? 

Diagram of an in-situ cochlear implant. (NIDCD, Cochlear Implants).

Cochlear implants are small electronic devices that aid hearing acquisition and sense of sound in profoundly deaf or hard of hearing individuals (NIDCD). The instrument picks up sound through the microphone. Sound is then arranged by a speech processor and transmitted as an electrical signal to the electrode array, which sends the electrical impulses to various regions of the auditory nerve (NIDCD).

Concerningly socioeconomic status can influence outcomes of cochlear implant surgery, particularly in children (Sharma et al., 2020). I was unpleasantly surprised to learn that adults are only entitled to one CI on the NHS. It seems that whilst just one CI may provide sufficient access to auditory stimulation, this could intensify the socioeconomic divide in treatment for hearing loss and may prevent a significant increase in quality of life of individuals who can’t afford a second implant. One reality star, Daisy Kent, spoke about her hearing loss and stated that since she had the implant she doesn’t have ringing in her left ear, but “in my right ear, I have a ton of ringing”. I think this helps illustrate how only having one CI can prevent a much more desirable outcome for those who can’t afford two. 

Deaf Culture 

Prior to watching ‘The sound of metal’, I perhaps wouldn’t have considered that cochlear implants could be such a controversial topic. However it is clear that individual perspectives, particularly within the Deaf community, vary quite dramatically (Li et al., 2024). In the film, the main character joins a deaf school, and is told to leave once he secretly pays for cochlear implant surgery.

Some members of the deaf community see CI as a threat to Deaf culture. I think this highlights the rich history of communication and adaptations of people with hearing loss. To understand this further I have included a brilliant Ted Talk by Glenna Cooper.

I particularly enjoyed her statement that deaf people tend to have a much greater appreciation for the exchange of information, and I think this enhances her point that deaf people should not be considered as disabled, rather that they “have a different language”.  

You can read more about Deaf culture here.  

A Middle Ground

Sign language is perhaps the most obvious facet of Deaf culture. However, I was horrified to learn that not too long-ago many doctors told parents to discourage their deaf children from signing – and this is just one of the reasons why I can appreciate the sensitivity of assuming all deaf people may benefit from auditory aids, which may lead to a decline in the use of sign language. However, it is important to appreciate experiences where cochlear implants have created a unique path between both ways of life – Heather Artinian, a lawyer who was born deaf and to deaf parents, decided to get a cochlear implant surgery at age 10, against her parents initial wishes. She describes how she operates in the ‘Heather world’ where her upbringing amongst a deaf community, and her implant, allows her to enjoy aspects of both the hearing and the deaf world. I would highly encourage listening to her engaging and positive perspective on being in ‘not the hearing or deaf world.’ https://youtu.be/jhm5OaXJVMQ?si=TU_DSGcD-m-fEeqq

In an ideal world, we would all be more accommodating of Deaf culture, and more people would aim to learn sign language.  

You can follow this link to find out how to start learning sign language. You can also learn how to sign your own name, and other words here.

 

Celebrating diversity and appreciating different ways of experiencing the world enhances new perspectives and solutions of healthcare. Following utilitarian beliefs that aim to serve the majority threatens minority cultures, such as Deaf culture, which could be excluded when attempting to ‘fix’ what many people consider a significant part of their identity. I believe that whilst the development of CI has provided many people with access to a better quality of life, reduced social isolation and discomfort, we shouldn’t immediately assume that anatomical differences need to be universally ‘fixed’, rather than accommodated and respected, whether that be through learning BSL or providing equitable access to assisted hearing technology.

Links

NIDCD https://www.nidcd.nih.gov/health/cochlear-implants#:~:text=A%20cochlear%20implant%20is%20a,the%20skin%20(see%20figure).

Sharma et al (2020) https://doi.org/10.1016/j.ijporl.2020.109984

Li et al (2024) https://doi.org/10.1038/s41598-024-55006-8