Talk:Cochlear implant

Why does it process sound?

Why should the cohlear implant need a system for processing speech or other sounds? If it's converting the sound waves into impulses for the auditory nerves then wouldn't the brain itself do all the processing? I thought the reason it's called a cochlear implant is that it's a replacement for the cochlea. The cochlea doesn't analyze sound; it simply translates sound waves into electrical waves. —Preceding unsigned comment added by 24.190.148.116 (talk) 20:37, 16 June 2008 (UTC)

The cochlea doesn't merely "translate sound waves into electrical waves". (I'm not even sure what an "electrical wave" is.)

Please go read the Functionality section again, lest folks think you're merely spreading FUD about CI's.

First off, the cochlear implant doesn't replace the cochlea. It really mostly replaces damaged or missing hair cells within the cochlea. If the cochlea is missing or damaged to a certain degree, a CI will be far less effective.

Now, the trick behind how the cochlea works is the way it separates sound waves of different frequencies using tonotopic organization. In other words, different pitches of sound end up resonating in different parts of the cochlea. The implant accomplishes this by using many small electrodes placed along a strip of plastic down the length of the cochlea. In either case, nerves at different places in the cochlea get stimulated differently, and thus we discern one sound from another.

Therefore, the speech processor's primary task is to generate electrical signals that make sense to the auditory nerves within the cochlea. A vital part of this is to break the sound into different "chunks" based on their frequency. If you've ever played with an equalizer on a stereo set, this is pretty much the same concept. Think of each knob on the equalizer as responsible for the signal that stimulates a specific part of the cochlea.

The equalizer analogy goes a bit further. Say you have set all the knobs on an equalizer to precisely the way you like it, but to your friend it sounds terrible. This is because each of us have different ears, different cochleae, different neural pathways, etc. In order to get maximum efficiency from a speech processor, you need to program it differently for each person. (This is a gross oversimplification, naturally, but significantly more on the mark than the comment I'm responding to.)

There's much more that a processor can do to the signal before it hits the implant, of course. You can selectively amplify at frequencies common to voice and thus eliminate a lot of non-speech "noise", for example. Also, differences in each electrode's timing, strength, and various other attributes can provide different aural experiences for the recipient.

Plus, some of them come with little flashing lights, which anyone with even half a heart has to admit is pretty freaking awesome.

Sproaticus (talk) 20:08, 25 June 2008 (UTC)

Article should be tagged not NPOV

• This article requires some serious editing*. It reads like it was written by a deaf person who thinks that Cochlear implants are some kind of abomination. Half of the introduction is dedicated to how evil it is to the deaf culture, how it is vigorously opposed by the deaf community (is it?), how it harms the deaf community, etc.... The same ramblings are reiterated, sometimes word for word, in the middle of the article (ethical issues section). Scare tactics are used throughout the article, describing various dangers and illness caused by the device - these belong to the *risks* section only, and have no place in ethics section or post-implantation section. 89.0.123.43 01:14, 22 March 2007 (UTC)

• I agree, it's been heavily edited in recent weeks by the looks of things. 121.44.226.24 22:14, 21 April 2007 (UTC)

• Agreed. The ethical issues are important, but should be restricted to the Ethical Issues section. The current articles spends most of the introductory section discussing the ethical issues, which is inappropriae.Goweftus 13:17, 15 September 2007 (UTC)

• I do also agree. The ethical discussion in the introductory section should be moved to "Ethical issues". --Svensta 07:26, 31 October 2007 (UTC)

• I have a profound hearing impairment and going in for my cochlear implant in about two days from now. After reading over the "ethical argument," I was bothered and didn't appreciate the fact that this was there. I feel very strongly about the fact that the deaf community/culture is a sham and an excuse to exclude people out of their group. However, because this is my personal opinion, I will not state this in the actual article itself but I would recommend removing the "ethical issue" part of the article. Where can I do this? Yoryx 08:32, 30 October 2007 (UTC)

Judging by all the the improvements hat have been made since December, is this article still needing the NPOV tag?

Lot49a (talk) 05:33, 15 April 2008 (UTC)

If someone could take the ethical arguments and put them in a debate section, that would be good. If the section is totally removed you would be discriminating against the Deaf point of view. —Preceding unsigned comment added by Pilipinoman (talk • contribs) 00:39, 6 May 2008 (UTC)

Issues

We should mention that many deaf people consider the use of implants, particularly if the aim is to completely replace signing with speaking, as "normalization"; and as such are opposed to it. -- Tarquin 16:34 7 Jun 2003 (UTC)

To my fellow contributors: There are some serious, but inadequately described issues that should be addressed in this article's "Objections" sections. "Normalization" is not the core of the deaf community's objections. It is "technologies of normalization" and not "normalization" that are contentious. Still, there are several major positions to be considered of which the technologies of normalization are but a minor (though important) aspect of. The collision occurs on the level of the deaf view of "wellness" and how views of disability and pathology conflict with it. I'll be posting an update to the Objections section very soon. Ray Foster 00:59, 31 Dec 2004 (UTC)

Free cochlear implants

There stands a citation is needed. I don't know how to add it, and am ready for bed, so I'll quickly give a link ;-)

In Belgium cochlear implants are provided for free by the government. The following link is in Dutch, and is about a parliamentary discussion concerning this. [1] On a personal note, I do not understand how a rich country can call itself "developed" if it's social system does not provide such basic help to it's citizens. --Spiri82 01:44, 28 September 2006 (UTC)

REF: "I do not understand how a rich country can call itself "developed" if its social system does not provide such basic help to its citizens."

Actually, Spiri82, I live in the United States and was born with high-frequency hearing loss and did receive a hearing aid ABSOLUTELY FREE OF CHARGE through the Dept. of Vocational Rehabilitative Services.

More to the point, I received the device back when I used to live in Mississippi, which is one of the relatively poorer states in the US.

Even more to the point, my hearing loss, while of course a personal source of frustration, is not necessarily debilitating (i.e. I can hear most people fine; it is only when talking to someone who mumbles or otherwise has a soft voice or perhaps when I am in an especially noisy environment that it becomes a problem.). Thus, it's not as if I was someone who desperately needed the device in order to function normally in society. But nonetheless, DVRS still helped me out -- even though my hearing problem wasn't necessarily terribly severe.

So in other words: Yes, we have government aid over here too, and you don't have to be all that extraordinary in order to receive it -- you just have to find out where to go to get it. If your hearing loss affects you on the job you can go to DVRS and they will help you.

At netherlands I have recieved free Cochlear implant.but I am not glad because my new hearing aids are not free and costs 875 euro. Edwtie (talk) 13:10, 31 May 2008 (UTC)

Origins & Availability

• A NASA engineer, Adam Kissiah, also researched and developed cochlear implants beginning in the 1970s, but I am not sure how it connects to the Australian or British research. NASA has an article on it, so I added an external link to it but I did not add any content. I just don't know how it all relates. (talk) 14:48, 24 July 2008 (UTC)

As with all articles about technology, it would be nice to have some reference to who makes these things and where they came from/when they were developed. Someone should get right on that.

i've read somewhere else that the real person who developed the 'bionic ear' was professor graeme clark, an australian scientist. fact or fiction??????

• This is not my area of expertise, but I agree that such information should be added to the article. The Bearded One 05:46, 5 December 2005 (UTC)

Here in Australia, Graeme Clark is taken to be the inventor of the cochlear implant. It was his research at Melbourne University that led directly to the establishment of Cochlear Limted, which makes what I believe is the market leading implant. I can't confirm the exact date of his first human implant, but it was around about the same time as the American device mentioned in the article.

Update - I believe the distinction is that Graeme Clark developed the multi-channel implant necessary to inerpret speech. The earlier single channel implant was unable to do this.

I agree that Graeme Clark deserves a great amount of credit and could be called the "inventor" of the multi-channel implant. I would suggest checking out his book (http://www.amazon.com/gp/product/0387955836/104-1012816-9392724?v=glance&n=283155). He provides an excellent history in Chapter 1. You will find that he is more than willing to share the credit (and rightly so) with a number of different researchers around the world who provided essential contributions.--mcrema

I am in the UK and have just received a free implant under the National Health Service but have to stress that it took around 6 years from my original application. There is a waiting list and, although I am 76, provision does not depend upon age but on suitability but also the limited funds available to each health authority. It is therefore one more Postcode lottery. As my operation was undertaken in a different area from my Health Authority it took place in a private hospital (not the main hospital which normally undertakes the work) though the surgeon was the same one. —Preceding unsigned comment added by Suffolk Silver (talk • contribs) 17:07, 28 April 2008 (UTC)

Updating the article

While on the whole this page is good and getting better, there are some errors that need to be amended with better and more recent information. First, it is no longer the case that cochlear implantation always destroys residual hearing. It is now fairly common for patients to experience little or no loss of residual hearing, due to better electrode arrays and better surgical techniques. This is a crucial aspect in the development of hybrid cochlear implants, where a short electrode array provides high frequencies and a hearing aid provides low ones. These devices are likely to come to market in the next year or two, and they'll be for people with moderate to severe high-frequency hearing losses: e.g. older people experiencing natural age-related and noise-related hearing loss.

That said, no surgeon can presently guarantee that residual hearing will be preserved with traditional cochlear implants, and patients do need to know that. Instead of saying "residual hearing is destroyed," a better phrasing would be "there is no guarantee that residual hearing will be preserved, although it often is."

The other main issue is that it's claimed that users are still "severely to profoundly hearing impaired" -- and the citations for this claim are 11 years old! It's still true that cochlear implants don't restore hearing to normal levels, and it's also true that results can vary widely between patients. However, in 2006 it would be more accurate to say that most users are "mildly to moderately hearing-impaired." As for myself, I can hear sounds down to 15dB in testing booths with my Clarion CII device, which corresponds to a mild hearing loss, and I use telephones frequently and easily.

The NIDCD's estimate of 59,000 users as of 2002 is now badly out of date, though I don't know of a more recent authoritative number. Cochlear Corporation alone has implanted 70,300 devices. Recent estimates of total implant users I've heard are around 100,000.

The claim that cochlear implants are "cultural genocide" was originally made in the National Association for the Deaf's position statement on cochlear implants in 1991. It was removed in an entirely rewritten version of the statement released in 2000.

Finally, the cost figures I hear most often for CI implantation are $40-$50,000, though the lower figures might be accurate outside of the USA.

With some digging through the literature, I could amend the article to make these updates.

I'm knowledgeable on this because (a) I'm an implant user, and (b) I've written a book on the subject.

-- Mike Chorost

Thanks for your thoughts Mike. Your experience and knowledge are really valuable and I look forward to your additions. Please be bold in updating pages! I hope you don't mind, but I moved your comments to the bottom of the talk page (following wikipedia convention), where people are more likely to see them. If you like, you can sign your comments with an automatic username and date and time stamp by typing four tildes like this: ~~~~. I've been around on wikipedia for a while so please don't hesitate to ask me any questions about how to do stuff like this. Cheers! ntennis 09:29, 5 March 2006 (UTC)

On his note, is there anybody here that would care to browse through other pages that refference cochlear implants and update their numbers?... I at very least have noticed that the Neuroprosthetics article, as well as the Brain-computer interface articles still feature old numbers (different sets of old numbers in this case). I'll likely change them by the time this is read, but I'm sure that there's further articles that refference old numbers if I'm able to stumble across 2 by accident. -Tiak 05:33, 16 October 2006 (UTC)

Controversy

I have a problem with the following statement:

"While cochlear implants have been welcomed by late-deafened adults, hearing parents of deaf children, audiologists, speech pathologists, and surgeons, the implantation of deaf children has been vigorously opposed by many from the signing Deaf community."

In relation to deaf children, the views of their hearing parents, audiologists, speech pathologists, surgeons, and the signing Deaf community are secondary behind the views of those who were implanted as children. There are now plenty of young adults able to express their views. Some support the implanting of deaf children, others oppose it. If there is any research into these vital opinions, we should see it here. My guess is (and it is just a guess, so not worthy of inclusion) that most adults who were implanted as children are supportive of their parents' decision.

As it is, I come away with the feeling that the document is slightly POV against implanting children. --Mralph72 00:41, 16 March 2006 (UTC)

It is an important view but IMHO not the end all. The trouble is, you can never get a fair view. Children who have been implanted are not going to be part of the deaf community and so will have different views etc, largely influence by the views they were brought up around i.e. the hearing community. If you were to ask a person who didn't get implants, they will very likely have the opposite views of the person who did. The only way to get a proper picture would be if we duplicate the earth exactly, implant one version of a child and leave the other be and then somehow recombine these two people 20 years later (or whatever). Of course, this is not possible. For starters, the combined person will just be schizoprenic and probably commit suicide since he/she can't reconcile his/her different views. N.B. I actually support implanting and although I don't believe it should be compulsory. But it's important to understand a person with implants can only offer his/her POV which is not anymore an internal NPOV then others. Nil Einne 12:33, 24 November 2006 (UTC)

Ethical issues

"The older child goes for a "checkup" to tune up their map once or twice a year" -- Tune up their map? Someone please define this map thingy. I guess it's tuning the implant for equal perception of the spectrum of pitch and maybe some timbre adjustment, but I dunno. I'll leave that to an expert. Thanks!! Lemme know!!! --basilwhite 15:21, 15 May 2006 (UTC)

Citations needed

(...)

The problem with wording like "some of X" is that it's a bit weasely and can be used to introduce bias. Do the majority of developed countries do this? Or just a few? For example, Canada, well known for its socialized universal health care, does not provide implants for free, to my knowledge. And the U.S. certainly does not. So the North American trend, for what it's worth, is to not provide them. Perhaps the European or Asian developed model is to provide them, so this could be clarified (with cites) rather than just saying "some". Even if it's a lot of work for us, the articles we make must provide verifiability above all else. Here's one small source: [2] --Ds13 17:59, 21 September 2006 (UTC)

(...) Mralph72 09:11, 29 January 2007 (UTC)

As far as I know, and as a Canadian citizen from Québec, and as a guy married to a wife who received an implant on March 5, 2008, I confirm that cochlear implants are indeed provided for free in the Québec province. This is a fact. While I have no absolute proof of this, I surmise that the same is true for all provinces in Canada, in accordance with federal healthcare regulations.

The reference given above is very old (1993) and should be discounted as far as Canada is concerned. The CHUQ hospital in Québec city has a vast research program on cochlear implants headed by Dr. Ferron. The team of surgeons there does cochlear implants routinely every day. All costs are covered by the healthcare system.

Roger Gauthier, Québec, Canada Roger The Photographer (talk) 22:22, 10 March 2008 (UTC)

Children have died

This should not be added back until a citation is included:

In the worst cases, children have died as a result of the implants.

—Preceding unsigned comment added by Dblantau9001 (talk • contribs)

Medical Model

Say, someone is dying of illness which has an easy cure. It is up to the patient to chose the treatment. S/he can refuse the treatment and die if so wish. The idea that doctor got some personal vendetta against deaf community is entirely due to paranoia. The real conflict are between the deaf community and the hearing parents of deaf children. Vapour

Children have died (Cont.)

Apologies if I'm not using the correct wiki markup, but anyway...

“ The FDA reports that cochlear implant recipients may be at risk for meningitis and that a minority of these cases, worldwide, have resulted in death.[3] ”

This is correct, if you refer to the link. But I did a bit of looking and found the original source - http://www.fda.gov/cdrh/safety/cochlear.html. (This is the same paper referred - if you look at the "Original Publication" and title, they match.) In that FDA paper, no deaths are mentioned.

NOW, I am NOT sure how independent the FDA is (I am aware that occasionally public orgs in USA are suspectible to lobbying and may have retracted statemeents) and I'm NOT sure why the "deaths" bit was removed. I did a bit of googling, and cannot find a more verifiable source (i.e. apparently deaths HAVE occured but no details).

Comments please? Thanks!

Mrdini

From a quick look I would say it's misleading to say children have died. The source appears to be saying they're appear to be at greater risk of developing bacterial meningitis and that is what we should say. Perhaps mention that bacterial meningitis is a rather nasty disease. Nil Einne 12:26, 24 November 2006 (UTC)

Specifically, the source says recipients MAY be at higher risk of developing meningitis.

Have taken the liberty of redirecting the FDA link & removing the "deaths" line in absence of any medical papers citing a direct link between CIs & deaths. Mrdini 19:13, 28 January 2007 (UTC)

May not be strictly true

On the other hand, the modern medical ethics/law dictate that it is up to the patient or the legal guardian of the patients to decide whether one have the implant or not. 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.

I feel this might be misleading. Many developed, progressive countries have various restrictions on what a parent may do. They may do anything which is considered resonably harmful to the child in the long run generraly they can't withhold essential treatment. For example look at Jehovah's Witnesses and blood transfusions. I would assume there are similar issues with HIV treatment. Obvioulsy issues raised with FGM also have some bearing. I'm not suggesting that cochlear implants are comparable, this is not for me to decide. I'm simply pointing out that in many societies, it's accepted by many that there should be limits on what a parent can and can't do and in some cases. In otherwords, the current standards are not that such issues are universally up to the guardian, it could be considered compulsary or it could be forbidden depending on your view of cochlear implants. N.B. I hope I haven't offended anyone. I actually believe at the current time it should be up to the parents. However I do feel the need to raise this issue because the reality is even tho some people like to deny it, restricting what a parent can and can't do is accepted in many countries. Nil Einne 12:20, 24 November 2006 (UTC)

This is not fact

(Though this expense is probably less than what a signing deaf individual costs society in terms of social services.)[citation needed]

That line is grossly untrue given that the majority of deaf individuals don't receive government services. I think it should be taken out completely due to its lack of citation. If someone can find a reliable citation, then put it back in.

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.

As a Swedish citizen and with recent personal experience of the subject, I'm quite sure this line is untrue. I've neither heard of such a law, nor of any "consulting by the deaf community". I think it should be taken out completely due to its lack of citation. If someone can find a reliable citation, then put it back in. --Svensta 12:30, 29 October 2007 (UTC)

I believe the Sweden thing was from Journey into DEAF-WORLD book. However, it has been a while since I've read that book. If anybody has the book and knows for sure, please do so and add in the removed statement. —Preceding unsigned comment added by 69.208.151.159 (talk) 01:44, 29 December 2007 (UTC)

I've added tags to the article

This article, in several sections, is trying to push an anti-implant POV. In addition, there is a significant amount of OR, especially in the Cultural and Social Impacts and the Ethical issues sections. Jtrainor (talk) 01:47, 25 December 2007 (UTC)

Cochlear implants as an evil device

People who think that Cochlear implants are evil are very small minority, as the vast majority of people see this as a great leap forward. Remember that Wikipedia does NOT need to equally represent the side of a case that doesnt have equal support in reality. For clarification on that rule, see the NPOV article. —Preceding unsigned comment added by 137.28.228.112 (talk) 22:53, 1 April 2008 (UTC)

What a mess

Boy, this article is a bit of a mess, isn't it? Look at the lede. Those (ostensible) facts about the Chinese implants (provider, follow up) are absurdly detailed for the intro. This needs an overall rework. I mean, it'll help someone who's never heard of the term and is just trying to figure out what it is, but this needs a lot. Unschool (talk) 20:52, 20 April 2008 (UTC)

Ethical Issues section should include NAD's shifting stance

The National Association for the Deaf issued a statement in 1991 that they "deplored" the FDA's decision to authorize implantation in children below a certain age. A few years later, they issued a retraction (of sorts), with the statement's language toned down and more reasonable content added.

I believe that this event should be at least mentioned in the Ethical Issues section, probably in the next-to-last paragraph ("Opposition continues today but is softening"), to help illustrate the fact that the collective attitude of the Deaf community towards cochlear implants is neither static nor is it firmly antagonistic.

I wish I could find the text of the 1991 statement to cite. Please give us a link if you find one.

Sproaticus (talk) 20:29, 25 June 2008 (UTC)

Testimonial from article

The following was added to article space, so I am moving it here:

I am s.Cartledge and i am a cochlear implant patient Aged:14 Born Profoundly deaf. I had my surgical operation when i was 2 and was officially switched on a month later. I had to go to the sheapered centre to learn how to hear. (help cochlear ear patients for kids) i con tinued to have lessons 3 days a week until i was 3.5 years old. So far i have 4 different modles and attend a normal school. without the cochlear i would of had a life in the dark. The cochlear for me and many other patients is a lifesaver! And i wuld like to thank proffessor Graham Clark who invented the implant.

- Eldereft (cont.) 11:29, 28 July 2008 (UTC)

State of the article

After making a few edits to clarify the writing in a few areas, I switched the template to put the stress on the need for complete inline referencing. In my view the article is fairly well balanced and informative but much more work is needed to improve clarity and referencing. Nesbit (talk) 19:36, 22 December 2008 (UTC)

Remove myth\misconceptions and other changes to make this more readable

I put the remove section tag on the myths and misconceptions because little or none of it actually seems to address actual myths or misconceptions (or at least have been addressed earlier in the article. Instead, it's mostly a continuation of the arguments from the ethics section above. I would say the two sections could be merged, but the ethics section is already far too long. In general, the entire article is much longer than it needs to be, and I feel that the position of the "Deaf community" is stated repetitively. For example, the statement: "because many in the deaf community believe that their deafness is a gift" is a repitition of earlier statements and is unnecessary. --Thud495 (talk) 15:28, 18 March 2009 (UTC)