Biomedical engineering technologies such as brain–machine interfaces and neuroprosthetics are advancements which assist human beings in varied ways. There are exciting yet speculative visions of how the neurosciences and bioengineering may influence human nature. However, these could be preparing a possible pathway towards an enhanced and even posthuman future. This article seeks to investigate several ethical themes and wider questions of enhancement, transhumanism and posthumanism. Four themes of interest are: autonomy, identity, futures, and community. Three larger questions can be asked: (...) will everyone be enhanced? Will we be “human” if we are not, one day, transhuman? Should we be enhanced or not? The article proceeds by concentrating on a widespread and sometimes controversial application: the cochlear implant, an auditory prosthesis implanted into Deaf patients. Cochlear implantation and its reception in both the deaf and hearing communities have a distinctive moral discourse, which can offer surprising insights. The paper begins with several points about the enhancement of human beings, transhumanism’s reach beyond the human, and posthuman aspirations. Next it focuses on cochlear implants on two sides. Firstly, a shorter consideration of what technologies may do to humans in a transhumanist world. Secondly, a deeper analysis of cochlear implantation’s unique socio-political movement, its ethical explanations and cultural experiences linked with pediatric cochlear implantation—and how those wary of being thrust towards posthumanism could marshal such ideas by analogy. As transhumanism approaches, the issues and questions merit continuing intense analysis. (shrink)

I distinguish and assess three separate arguments utilized by the opponents of cochlear implants: that treating deafness as a medical condition is inappropriate since it is not a disability; that so treating it sends a message to the Deaf that they are of lesser worth; and that the use of such implants would signal the end of Deaf culture. I give some qualified support to the first and second claim, but find that the principal weight of the argument must (...) be borne by the third argument: that use of the cochlear implants is impermissible because Deaf culture is intrinsically valuable. I show that this claim is, in practice, incompatible with the claim that deafness is not a disability: that the significant disadvantages suffered by the hearing impaired can only be corrected by measures that would end Deaf culture. Since the potential recipients of cochlear implants are, in the main, the prelingually deaf children of hearing parents, the burden of banning the implants would be borne by people who are not members of Deaf culture, and who owe that culture nothing over and above what we all owe cultures in general. I conclude that we cannot ask the parents of these children to sacrifice the interests of their children for the sake of Deaf culture. (shrink)

The use of cochlear implants in born-deaf infants addresses the issues of disability, proxy consent, and potential ethnocide of the Deaf culture. The ethical issues explored in this paper are: 1) the disability versus trait argument of deafness, 2) parents versus Deaf community in proxy consent, 3) justification for surgical intervention in a non-life threatening condition, and 4) justification for ethnocide. Decisions for non-competent individuals should be made to assure the child of an open future, with rights that need (...) to be protected now, so that the child can exercise them later as an adult. Cochlear implants provide the potential of an open future and are morally justified on that basis. (shrink)

: Because I reject the notion that physical characteristics constitute cultural membership, I argue that, even if the claim were persuasive that deafness is a culture rather than a disability, there is no reason to fault hearing parents who choose cochlear implants for their deaf children.

This article ethnographically considers the experiences of Australian young people who were born deaf and who hear and listen through cochlear implants to explore the intersection between the sensory body, lived experience and technology. The article draws on phenomenology to examine how experiences of deafness are productive in analysing articulations of embodiment and the meanings embedded in a body that is valued as both deaf and hearing. Leaving aside binary conceptions of deaf versus hearing, and understandings of the (...) class='Hi'>cochlear implant as a remedy for sensory deficits, we instead make a case for nuanced understandings of the device and embodied experiences through technology. This analysis identifies how a cochlear implanted body navigates connections to the world and to others in turning on and off engagement. We contend that the device has an intrinsic value for recipients through enabling their access to hearing while not removing their experiences of deafness. (shrink)

In congenitally or prelingually deaf childrencochlear implantation is open to seriousethical challenge. The ethical dimension ofthis technology is closely related to both asocial standard of quality of life and to theuncertainty of the overall results of cochlearimplantation. Uncertainty with regards theacquisition of oral communicative skills.However, in the western world, available datasuggest that deafness is associated with thelowest educational level and the lowest familyincome. Notwithstanding the existence of aDeaf-World, deafness should be considered as ahandicap. Therefore, society should provide themeans for (...) the fulfilment of a deaf child'sspecific needs.For the time being there is no definitiveanswer with regard the best way to rehabilitatea particular deaf child. Therefore,communitarian values may be acceptable. If thedeaf child parents' decide not to implant,their decision should be respected. Guardiansare entitled to determine which standard ofbest interest to use in a specificcircumstance. They are the proper judges ofwhat (re)habilitation process is best for theirdeaf child. However, most deaf children areborn to two hearing parents. Probably, theywill not be acculturated in the Deaf-World. Itfollows that cochlear implantation is awelcomed (re)habilitation technology.If auditory (re)habilitation will in the futureprovide the necessary communicative skills, inparticular oral language acquisition, customs,values and attitudes of the hearing worldshould be regarded as necessary to accomplish adeaf child's right to an open future. Ifcochlear implantation technology will provideall deaf children with the capacity to developacceptable oral communicative skills –whatever the hearing status of the family andthe cultural environment – then auditory(re)habilitation will be an ethical imperative. (shrink)

: This paper examines ethical issues related to medical practices with children and adults who are members of a linguistic and cultural minority known as the DEAF-WORLD. Members of that culture characteristically have hearing parents and are treated by hearing professionals whose values, particularly concerning language, speech, and hearing, are typically quite different from their own. That disparity has long fueled a debate on several ethical issues, most recently the merits of cochlear implant surgery for DEAF children. We explore (...) whether that surgery would be ethical if implants could deliver close to normal hearing for most implanted children, thereby diminishing the ranks of the DEAF-WORLD. The ethical implications of eugenic practices with the DEAF are explored, as are ethical quandaries in parental surrogacy for DEAF children, and their parallels in transracial adoption. (shrink)

The use of cochlear implants, especially for prelingually deafened children, has aroused heated debate. Members and proponents of Deaf culture vigorously oppose implants both as a seriously invasive treatment of dubious efficacy and as a threat to Deaf culture. Some find these arguments persuasive; others do not. And in this context arise questions about the extent to which individuals with disabilities may decline treatments to ameliorate disabling conditions. When they do so, to what extent may they call upon society (...) to provide supportive services and accommodations? (shrink)

This article provides an ethnographic account of pediatric cochlear implantation, revealing an important shift in the definition of deafness from a sensory loss to a neurological processing problem. In clinical and long-term therapeutic practices involved in pediatric implantation, the cochlear implant is recast as a device that merely provides access to the brain. The “real” treatment emerges as long-term therapeutic endeavors focused on neurological training. This redefinition then ushers in an ensuing responsibility to “train the brain,” (...) subsequently displacing failure from the device onto the individual’s ability to train his or her brain. New caregiving techniques that accompany implantation are understood through neuropolitics, showing how parents are encouraged to engage in neuro-self-governance, and how the concept of neuroplasticity is used to cultural ends. (shrink)

The paper focuses on processes of normalization through which dis/ability is simultaneously produced in specific collectives, networks, and socio-technological systems that enable the construction of such demarcations. Our point of departure is the cochlear implant, a neuroprosthetic device intended to replace and/or augment the function of the damaged inner ear. Unlike hearing aids, which amplify sounds, the CI does the work of damaged hair cells in the inner ear by providing sound signals to the brain. We examine the processes (...) of the CI’s genesis as well as its specific uses by and interrelations to the different and divergent actors that the CI assembles. We argue that the technological device and the implicated normalization process mobilize complex effects in varying socio-technical arrangements. The CI is conceived as a “boundary object” [89] or a “quasi-object” [49, 83], i.e., a metastabilized medium of translation that coordinates social, cultural, and technological action. Although intended to transform non-hearing or hard of hearing people into competent and “normal” hearing subjects, the CI system reproduces the asymmetrical structures of the disability discourse [14] through its function of “developing and maintaining coherence between intersecting social worlds” [89, 393]. Additionally, it initiates controversial discourses that have resulted in new forms of biosocial collectivities ranging from cochlear implantees with normal human hearing to human configurations who have passed through human enhancement. Our approach is thus situated at the intersection of disability and media studies and tackles the particular conditions technological media configurations impose upon the production of dis/ability. (shrink)

While cochlear implantation has benefitted many patients with single-sided deafness (SSD), there is great variability in cochlear implant (CI) outcomes and binaural performance remains poorer than that of normal-hearing (NH) listeners. Differences in sound quality across ears – temporal fine structure (TFS) information with acoustic hearing versus coarse spectro-temporal envelope information with electric hearing – may limit integration of acoustic and electric patterns. Binaural performance may also be limited by inter-aural mismatch between the acoustic input frequency and (...) the place of stimulation in the cochlea. SSD CI patients must learn to accommodate these differences between acoustic and electric stimulation to maximize binaural performance. It is possible that training may increase and/or accelerate accommodation and further improve binaural performance. In this study, we evaluated lateralization training in NH subjects listening to broad simulations of SSD CI signal processing. A 16-channel vocoder was used to simulate the coarse spectro-temporal cues available with electric hearing; the degree of inter-aural mismatch was varied by adjusting the simulated insertion depth (SID) to be 25 mm (SID25), 22 mm (SID22), and 19 mm (SID19) from the base of the cochlea. Lateralization was measured using headphones and head-related transfer functions (HRTFs). Baseline lateralization was measured for unprocessed speech (UN) delivered to the left ear to simulate SSD and for binaural performance with the acoustic ear combined with the 16-channel vocoders (UN+SID25, UN+SID22, and UN+SID19). After completing baseline measurements, subjects completed 6 lateralization training exercises with the UN+SID22 condition, after which performance was re-measured for all baseline conditions. Post-training performance was significantly better than baseline for all conditions (p<0.05 in all cases), with no significant difference in training benefits among conditions. Given that there was no significant difference between the SSD and the SSD CI conditions before or after training, the results suggest that NH listeners were unable to integrate TFS and coarse spectro-temporal cues across ears for lateralization, and that inter-aural mismatch played a secondary role at best. While lateralization training may benefit SSD CI patients, the training may largely improve spectral analysis with the acoustic ear alone, rather than improve integration of acoustic and electric hearing. (shrink)

In theory, cochlear implants hold out the possibility of enabling profoundly prelingually deaf children to hear. For these children's parents, who are usually hearing, this possibility is a great relief. Yet the decision to have this prosthetic device implanted ought not to be viewed as an easy or obvious one. Implant efficacy is modest and the burdens associated with them can be great. Moreover, the decision to forgo cochlear implantation for one's child, far from condemning her to (...) a world of meaningless silence, opens the child up to membership in the Deaf community, which has a rich history, language, and value system of its own. (shrink)

Studies have shown that children vary in the trajectories of their language development after cochlear implant (CI) activation. The aim of the present study is to assess the preverbal and lexical development of a group of 20 Italian-speaking children observed longitudinally before CI activation and at three, 6 and 12 months after CI surgery (mean age at the first session: 17.5 months; SD: 8.3; and range: 10–35). The group of children with CIs (G-CI) was compared with two groups of (...) normally-hearing (NH) children, one age-matched (G-NHA; mean age at the first session: 17.4 months; SD: 8.0; and range: 10–34) and one language-matched (G-NHL;n= 20; mean age at the first session: 11.2 months; SD: 0.4; and range: 11–12). The spontaneous interactions between children and their mothers during free-play were transcribed. Preverbal babbling production and first words were considered for each child. Data analysis showed significant differences in babbling and word production between groups, with a lower production of words in children with CIs compared to the G-NHA group and a higher production of babbling compared to the G-NHL children. Word production 1 year after activation was significantly lower for the children with CIs than for language-matched children only when maternal education was controlled for. Furthermore, latent class growth analysis showed that children with CIs belonged mainly to classes that exhibited a low level of initial production but also progressive increases over time. Babbling production had a statistically significant effect on lexical growth but not on class membership, and only for groups showing slower and constant increases. Results highlight the importance of preverbal vocal patterns for later lexical development and may support families and speech therapists in the early identification of risk and protective factors for language delay in children with CIs. (shrink)

The cochlear implant controversy involves questions about the nature of disability and the definition of “normal” bodies; it also raises arguments about the nature and significance of culture and the rights of minority cultures. I defend the claim that there might be such a thing as “Deaf culture” and then examine how two different understandings of the role of culture in the lives of individuals can lead to different conclusions about the rights of Deaf parents in relation to their (...) children, and about the ethics of public funding for research on cochlear implants. An argument asserting the rights of minority cultures to equal respect and consideration within a multicultural society, informed by communitarian political philosophy, offers the best prospect for the defence of the unique culture(s) of the Deaf. (shrink)

Background Speech understanding may rely not only on auditory, but also on visual information. Non-invasive functional neuroimaging techniques can expose the neural processes underlying the integration of multisensory processes required for speech understanding in humans. Nevertheless, noise (from fMRI) limits the usefulness in auditory experiments, and electromagnetic artefacts caused by electronic implants worn by subjects can severely distort the scans (EEG, fMRI). Therefore, we assessed audio-visual activation of temporal cortex with a silent, optical neuroimaging technique: functional near-infrared spectroscopy (fNIRS). Methods (...) We studied temporal cortical activation as represented by concentration changes of oxy- and deoxy-hemoglobin in four, easy-to-apply fNIRS optical channels of 33 normal-hearing adult subjects and 5 post-lingually deaf cochlear implant (CI) users in response to supra-threshold unisensory auditory and visual, as well as to congruent auditory-visual speech stimuli. Results Activation effects were not visible from single fNIRS channels. However, by discounting physiological noise through reference channel subtraction, auditory, visual and audiovisual speech stimuli evoked concentration changes for all sensory modalities in both cohorts (p<0.001). Auditory stimulation evoked larger concentration changes than visual stimuli (p<0.001). A saturation effect was observed for the audiovisual condition. Conclusions Physiological, systemic noise can be removed from fNIRS signals by reference channel subtraction. The observed multisensory enhancement of an auditory cortical channel can be plausibly described by a simple addition of the auditory and visual signals with saturation. (shrink)

Interactive technology assessment is a novel approach to evaluating (health) technology, which philosophically draws from the works of Rawls and Habermas. That is, it seeks to organise a practical setting for discursive ethics in order to find a legitimate basis for policy to be pursued when the technology under scrutiny features a moral controversy. Interactive technology assessment involves a cycle of interviews with all stakeholders, who are explicitly asked to respond (anonymously) to the concerns and issues raised by other participants. (...) This cycle is completed repeatedly, so that a process of vicarious learning develops. This process aims at identifying issues agreed and disagreed upon, on the basis of which widely endorsed policy recommendations can be formulated. This chapter involves an interactive technology assessment of paediatric cochlear implantation. The rationale, the design, and the results are explained, as well as the main ethical aspects of the procedure. (shrink)

Cochlear implants (CI) support the development of oral language in hearing-impaired children. However, even with CI, speech recognition in noise (SRiN) is limited. This raised the question, whether these restrictions are related to the quality of life (QoL) of children and adolescents with CI and how SRiN and QoL are related to each other. As a result of a systematic literature research only three studies were found, indicating positive moderating effects between SRiN and QoL of young CI users. Thirty (...) studies addressed the quality of life of children and adolescents with CI. Following the criteria of the World Health Organization (WHO) for pediatric HRQoL (1994) only a minority used validated child centered and age appropriate QoL instruments. Moreover, despite the consensus that usually children and adolescents are the most prominent informants of their own QoL (parent- reports complement the information of the children) only a minority of investigators used self-reports. Restricted SRiN may be a burden for the QoL of children and adolescents with CI. Up to now the CI community does not seem to be aware of a possible impairment of QoL in young CI users. Further studies addressing this topic are urgently needed, which is also relevant for parents, clinicians, therapists, teachers, and politicians. Additionally investigators should use valid pediatric QoL instruments. They should be aware, that most of the young CI users are able to inform about their quality of life also themselves (additionally to parents). (shrink)

It has been forty years since the first multi-channel cochlear implant was used in Australia. While heralded in the hearing world as one of the greatest inventions in modern medicine, not everyone reflects on this achievement with enthusiasm. For many people in the Deaf community, they see the cochlear implant as a tool that reinforces a social construct that pathologizes deafness and removes Deaf identity. In this paper, I set out the main arguments for and against cochlear (...) implantation. While I conclude that, on balance, cochlear implants improve the well-being and broaden the open futures of deaf children, this does not justify mandating implants in circumstances where parents refuse them because this may compound unintended harms when society interferes in the parent-child relationship. For this reason, I argue that parental refusal of cochlear implantation falls within Gillam’s concept of the zone of parental discretion. (shrink)

This paper uses the fictional case of the ‘Babel fish’ to explore and illustrate the issues involved in the controversy about the use of cochlear implants in prelinguistically deaf children. Analysis of this controversy suggests that the development of genetic tests for deafness poses a serious threat to the continued flourishing of Deaf culture. I argue that the relationships between Deaf and hearing cultures that are revealed and constructed in debates about genetic testing are themselves deserving of ethical evaluation. (...) Making good policy about genetic testing for deafness will require addressing questions in political philosophy and anthropology about the value of culture and also thinking hard about what sorts of experiences and achievements make a human life worthwhile. (shrink)

IntroductionThe present study aimed to evaluate the effects of the Active Communication Education program on the social/emotional impacts of hearing loss in a group of older adults with a cochlear implant.DesignProspective cohort study design, with a “within-subject” control procedure.Study SampleTwenty adults over-65 post-lingually deafened CI users. All subjects were required to be native Italian speakers, to have normal cognitive level, have no significant psychiatric conditions and/or diagnosed incident dementia, and used CI for at least 9 months.Materials and MethodsTwenty participants (...) were assessed using the Hearing Handicap Inventory for the Elderly, the Geriatric Depression Scale, and the Speech, Spatial, and Qualities of Hearing Scale before, during, and after ACE program, with a one and 6-month follow up. The cognitive and audiological evaluation was carried out before commencing the ACE program.ResultsThe ACE program had a positive impact by reducing HL’s social/emotional effects. Participants benefited from a rehabilitative approach by improving multilevel skills: comprehension of audiological and hearing dimensions, acquisition of communicative, pragmatic and problem-solving strategies, and interaction and sharing of experiences with peers.ConclusionAlthough targeting the older adults with moderate HL, the ACE program also seemed to benefit older adult CI users. An improvement in social and emotional adaptation to hearing difficulties can, in turn, significantly promote optimal use of CI in the older adults, thereby possibly reducing the risk of losing motivation and engagement in device use and in rehabilitation protocols. (shrink)

Cochlear implants electrically stimulate surviving auditory neurons in the cochlea to provide severely or profoundly deaf people with access to hearing. Signal processing strategies derive frequency-specific information from the acoustic signal and code amplitude changes in frequency bands onto amplitude changes of current pulses emitted by the tonotopically arranged intracochlear electrodes. This article first describes how parameters of the electrical stimulation influence the loudness evoked and then summarizes two different phenomenological models developed by McKay and colleagues that have been (...) used to explain psychophysical effects of stimulus parameters on loudness, detection, and modulation detection. The Temporal Model is applied to single-electrode stimuli and integrates cochlear neural excitation using a central temporal integration window analogous to that used in models of normal hearing. Perceptual decisions are made using decision criteria applied to the output of the integrator. By fitting the model parameters to a variety of psychophysical data, inferences can be made about how electrical stimulus parameters influence neural excitation in the cochlea. The Detailed Model is applied to multi-electrode stimuli, and includes effects of electrode interaction at a cochlear level and a transform between integrated excitation and specific loudness. The Practical Method of loudness estimation is a simplification of the Detailed Model and can be used to estimate the relative loudness of any multi-electrode pulsatile stimuli without the need to model excitation at the cochlear level. Clinical applications of these models to novel sound processing strategies are described. (shrink)

Voluntary stream segregation was investigated in cochlear implant users and normal-hearing listeners using a segregation-promoting objective approach which evaluated the role of spectral and amplitude-modulation rate separations on stream segregation and its build-up. Sequences of 9 or 3 pairs of A and B narrowband noise bursts were presented which differed in either center frequency of the noise band, the AM-rate, or both. In some sequences, the last B burst was delayed by 35 ms from their otherwise-steady temporal position. In (...) the other sequences, the last B bursts were temporally advanced from 0 to 10 ms. A single interval yes/no procedure was utilized to measure participants’ sensitivity in identifying delayed vs. no-delay sequences. A higher d′ value showed the higher ability to segregate the A and B subsequences. For NH listeners, performance improved with each spectral separation. However, for CI users, performance was only significantly better for the condition with the largest spectral separation. Additionally, performance was significantly poorer for the largest AM-rate separation than for the condition with no AM-rate separation for both groups. The significant effect of sequence duration in both groups indicated that listeners made more improvement with lengthening the duration of stimulus sequences, supporting the build-up effect. The results of this study suggest that CI users are less able than NH listeners to segregate NBN bursts into different auditory streams when they are moderately separated in the spectral domain. Contrary to our hypothesis, our results indicate that AM-rate separation may interfere with the segregation of streams of NBN. Additionally, our results add evidence to the literature that CI users build up stream segregation at a rate comparable to NH listeners, when the inter-stream spectral separations are adequately large. (shrink)

While cochlear implantation is now considered routine in many parts of the world, the debate over how to ethically implement this technology continues. One’s stance on implantation often hinges on one’s understanding of deafness. On one end of the spectrum are those who see cochlear implants as a much needed cure for an otherwise intractable disability. On the other end of the spectrum are those who view the Deaf as members of a thriving culture and see (...) the cochlear implant as an attempt to eliminate this culture. Rather than take a stance in this debate, we will argue that the informed consent process for cochlear implantation must include access to Deaf perspectives. Deaf individuals know best what it is like to be a member of the Deaf community; the reasonable person would put significant weight on the testimony of Deaf individuals when considering whether to undergo cochlear implantation. The reasonable person standard determines what information careproviders must present as part of the informed consent process; thus, informed consent for cochlear implantation requires access to the testimony of Deaf individuals. (shrink)

After 50 years of being profoundly deaf, Patricia finds her world ‘transformed’—literally and metaphorically—when she receives a cochlear implant. Her sense of self and the taken-for-granted, comfortable world she knew before surgery disappear and she is thrown into an alien, surreal existence full of hyper-noise. Entry into this new world of sounds proves a mixed blessing as Pat struggles to come to terms with her changing relationships, not only with others but also with herself. On good days, she is (...) exhilarated by all her sensory gains and her feeling of being more connected with and to the world. On bad days she is distracted and overwhelmed by the intrusive noise and she is forcibly confronted with the painful reality of her own disability. The challenge she confronts is not simply the cognitive-perceptual one of learning to discriminate between sounds. Pat must also re-orientate herself and learn to cope with her transformed self and world. She must undertake a journey to come to terms with her past, present and future being. Pat shared her story with me and together we undertook collaborative existential phenomenological research, co-creating a narrative of her journey over the year and a half following her implant. This paper presents this narrative followed by an existential analysis of Pat’s disrupted, changing lifeworld. (shrink)

A previous study demonstrated that consonant recognition improved significantly in normal hearing listeners when useful frequency and time ranges were intensified by 6 dB. The goal of this study was to determine whether bilateral cochlear implant and bilateral hearing aid users experienced similar enhancement on consonant recognition with these intensified spectral and temporal cues in noise. In total, 10 BCI and 10 BHA users participated in a recognition test using 14 consonants. For each consonant, we used the frequency and (...) time ranges that are critical for its recognition, identified from normal hearing listeners. Then, a signal processing tool called the articulation-index gram was utilized to add a 6 dB gain to target frequency and time ranges. Consonant recognition was monaurally and binaurally measured under two signal processing conditions, unprocessed and intensified target frequency and time ranges at +5 and +10 dB signal-to-noise ratio and in quiet conditions. We focused on three comparisons between the BCI and BHA groups: AI-Gram benefits, enhancement in binaural benefits via the AI-Gram processing, and reduction in binaural interferences via the AI-Gram processing. The results showed that the mean AI-Gram benefit was significantly improved for the BCI and BHA groups. However, the mean binaural benefit was not improved after AI-Gram processing. Individual data showed wide ranges of the AI-Gram benefit and binaural benefit for both groups. Individual data also showed a decrease in binaural interference in both groups after AI-Gram processing. These results suggest that the frequency and time ranges, intensified by the AI-Gram processing, contribute to consonant enhancement for monaural and binaural listening and both BCI and BHA technologies. The intensified frequency and time ranges helped to reduce binaural interference but contributed less to the synergistic binaural benefit in consonant recognition for both groups. (shrink)

Patients fit with cochlear implants commonly indicate at the time of device fitting and for some time after, that the speech signal sounds abnormal. A high pitch or timbre is one component of the abnormal percept. In this project, our aim was to determine whether a number of years of CI use reduced perceived upshifts in frequency spectrum and/or voice fundamental frequency. The participants were five individuals who were deaf in one ear and who had normal hearing in the (...) other ear. The deafened ears had been implanted with a 18.5 mm electrode array which resulted in signal input frequencies being directed to locations in the spiral ganglion that were between one and two octaves higher than the input frequencies. The patients judged the similarity of a clean signal presented to their implanted ear and candidate, implant-like, signals presented to their normal-hearing ear. Matches to implant sound quality were obtained, on average, at 8 months after device activation and at 35 months after activation. At Time 1, the matches to CI sound quality were characterized, most generally, by upshifts in the frequency spectrum and in voice pitch. At Time 2, for four of the five patients, frequency spectrum values remained elevated. For all five patients F0 values remained elevated. Overall, the data offer little support for the proposition that, for patients fit with shorter electrode arrays, cortical plasticity nudges the cortical representation of the CI voice toward more normal, or less upshifted, frequency values between 8 and 35 months after device activation. Cortical plasticity may be limited when there are large differences between frequencies in the input signal and the locations in the SG stimulated by those frequencies. (shrink)

PurposePrevious studies examining the relationship between health-related quality of life and speech perception ability in cochlear implant users have yielded variable results, due to a range of factors, such as a variety of different HRQoL questionnaires and CI speech testing materials in addition to CI configuration. In order to decrease inherent variability and better understand the relationship between these measures in CI users, we administered a commonly used clinical CI speech testing battery as well as two popular HRQoL questionnaires (...) in bimodal and bilateral CI users.MethodsThe Glasgow Benefit Inventory, a modified five-factor version of the GBI, and the Nijmegen Cochlear Implant Questionnaire were administered to 25 CI users. Speech perception abilities were measured with the AzBio sentence test in several conditions.ResultsHigher performance scores on the GBI general subscore were related to greater binaural speech perception ability in noise. There were no other relationships between the GBI or NCIQ and speech perception ability under any condition. Scores on many of the GBI-5F factors were substantially skewed and asymmetrical; therefore, correlational analyses could not be applied. Across all participants, binaural speech perception scores were greater than first-ear CI only scores.ConclusionThe GBI general subscore was related to binaural speech perception, which is considered the everyday listening condition of bimodal and bilateral CI users, in noise; while the more CI-specific NCIQ did not relate to speech perception ability in any listening condition. Future research exploring the relationships between the GBI, GBI-5F, and NCIQ considering bimodal and bilateral CI configurations separately is warranted. (shrink)

This text presents an overview of the bioethical debate on pediatric cochlear implants and pays particular attention to the analysis of the Deaf critique of implantation. It dismisses the idea that Deaf concerns are primarily about the upholding of Deaf culture and sign language. Instead it is argued that Deaf skepticism about child rehabilitation after cochlear surgery is well founded. Many Deaf people have lived experiences as subjects undergoing rehabilitation. It is not the cochlear technology in (...) itself they view as problematic, but rather the subsequent rehabilitation process. Because they themselves have experienced what they describe as harmful effects which relate above all to the idea of normalization, they have articulated worries for the new generations of deaf children in need of rehabilitation following cochlear implant surgery. These insights have attracted little attention, but could represent relevant ethical questions of which both practitioners and researchers in the field of implantation might be aware. (shrink)

ObjectiveCochlear explantation for purely elective (e.g. psychological and emotional) reasons is not well studied. Herein, we aim to provide data and expert commentary about elective cochlear implant (CI) removal that may help to guide clinical decision-making and formulate guidelines related to CI explantation.Data sourcesWe address these objectives via three approaches: case report of a patient who desired elective CI removal; review of literature and expert discussion by surgeon, audiologist, bioethicist, CI user and member of Deaf community.Review methodsA systematic review (...) using three scientific online databases was performed. Included articles addressed the benefits and/or complications of cochlear implantation in young children, CI explantation with or without revision surgery and the ethical debate between the medical and Deaf communities on cochlear implantation and explantation.ConclusionsThe medical and audiological perspectives identify a host of risks related to implant removal without reimplantation, including risk from surgery, general anaesthesia, cochlear ossification and poor audiometric outcomes. The member of the deaf community and bioethicist argue that physicians need to guide the principles of beneficence, non-maleficence and patient autonomy. Taken together, patient desires should be seen as paramount, if the patient is otherwise fit for surgery and well informed.Implications for practiceSimilar to the case of device implantation, device explantation should be a multidisciplinary and collaborative decision with the patient and the family’s desires at the centre. While every case is different, we offer a CI explantation discussion to assist in clinical decision-making, patient counselling and education. (shrink)

This article investigates differences in pragmatic abilities between children who have cochlear implants and their hearing peers. Recordings of 10-minute conversations between 10 children with cochlear implants and a hearing peer were transcribed. Conversation analysis provides insights into interactional troubles not evident in broader measures of number of turns, requests for clarification, topic initiation and so on used in earlier studies. How the children go about repair proves of particular interest; other-initiated repair that prompts the speaker to repeat (...) the prior utterance is, not surprisingly, more commonly produced by the children who have cochlear implants. The key contribution of this article, however, is to detail examples where children with cochlear implants choose not to initiate repair of an error made by their hearing friend. The discussion not only highlights the interactional cost of initiating repair, but also demonstrates that not doing repair can cause a breakdown in conversation. (shrink)

Hearing loss has been identified as a major modifiable risk factors for dementia. Adult candidates for cochlear implantation represent a population at risk of hearing loss-associated cognitive decline. This study investigated the effect of demographics, habits, and medical and psychological risk factors on cognition within such a cohort. Data from 34 consecutive adults with post-lingual deafness scheduled for CI were analyzed. Pure tone audiometry and Speech Discrimination Score were recorded. The Repeatable Battery for Assessment of Neuropsychological Status for (...) Hearing impaired individuals was used to measure cognition. Demographics, habits, and medical factors were evaluated. Depression was measured using the Hospital Anxiety and Depression Scale, and social inhibition with the Type D questionnaire. All participants suffered from severe to profound hearing loss. The mean RBANS-H total score was 83 ± 16. Participants reported a mean of years of formal education of 12 ± 5 years. The prevalence of habits and medical risk factors was: physical inactivity, body mass index >30, traumatic brain injury, hypertension, heavy alcohol consumption, smoking, and diabetes. Regarding psychological factors, the mean scores of social inhibition and depression were 10 ± 6 and 6 ± 5, respectively. The number of years of education was significantly correlated with the RBANS-H total score, and with the domains “Immediate memory”, “Visuospatial/constructional”, and “Attention”. The mean RBANS-H total score in participants who had university studies or higher level was 97 ± 9, with the remaining participants reporting a mean score of 75 ± 15. Men performed better in the “Visuospatial/constructional”. Physical inactivity was associated with lower scores in the “Delayed memory” ; hypertension correlated with lower RBANS-H total scores and “Attention”. Depression and social inhibition were negatively correlated with RBANS-H total score and with the “Immediate memory,” “Visuospatial/constructional,” and “Attention”. In adults with late-onset deafness scheduled to CI, educational level has a significant effect. Additionally, sex, physical inactivity, hypertension, and psychological traits of social inhibition and depression may also influence cognitive status. Long-term studies with more participants would enable us better understand the effects different risk factors on cognitive status. (shrink)

Recent contributions to discussions on paediatric cochlear implantation in Norway indicate two mutually exclusive doctrines prescribing the best course of post-operative support for a child with cochlear implants; bilingually with sign language and spoken language simultaneously or primarily monolingually with speech only. This conflict constitutes an ethical problem for parents responsible for choosing between one of the two alternatives. This article puts forth the precautionary principle as a possible solution to this problem. Although scientific uncertainty exists in (...) the case of both doctrines, there exists a scenario of possible irreversible harm to some of the children habilitated monolingually. An application of the precautionary principle may hence suggest that it is rational to agree on the bilingual approach, at least for the time-being. (shrink)

This article deals with the author’s experiences in studying cochlear implantation over a period of some years. While no overt controversy surrounded the device or the practices associated with it in the Netherlands when this work started, studying its introduction became complex. Following others, the research strategy that was evolved might be termed one of mediation and intervention. It entailed treating the views and aspirations of research subjects, clinical and lay, with equal regard. It entailed promotion of dialogue. (...) For reasons that are discussed in the article, the attempt was made to translate this dialogue to the political level. The challenge confronting the author was simultaneously methodological and political. (shrink)