Deaf Patient Hear The Slightest Sound example essay topic

Introduction: I decided to do a researched-based project. Since I was a young child I have been fascinated by the Hearing Impaired. Recently there has been much controversy in the Deaf community over the use of Cochlear Implants in pre-lingual deaf children. I took this assignment as an opportunity to take a closer look into the world of hearing aids and Cochlear Implants.

Since I was in high school I have known what I wanted to do with my life: Work with the hearing impaired to better their communication skills. In order for me to fulfill my goals, it is important for me to fully understand the devices out there that may or may not help a deaf patient hear the slightest sound. There has been much controversy, as noted before, because of the advanced use of the Cochlear Implant, in fact many members of the Deaf community view it as an effort of the hearing world to fix the deaf world. Many Deaf people do not wish to be fixed, nor do they feel anything is wrong with them. I wanted to research this so I would be better equipped to make an educated opinion of my own about the intentions of the Cochlear Implants being used in pre-lingual children. Findings: I feel it important to start with the basic anatomy of the normal working ear.

Without knowledge of the basic concepts and terms of hearing the rest of the findings will be rather confusing. First lets cover some key terms. An Audiologist is a person with a degree and / or certification in the areas of identification and measurement of hearing impairments and rehabilitation of those with hearing problems (Turkington). The oval window is the tiney opening at the entrance of the ear.

There are three basic parts of the ear that will be covered in detail shortly: the outer ear, the middle ear, and th inner ear. The middle ear is the small cavity between the eardrum and the oval window that is home to the three tiney bones of hearing. The eardrum is a paper thin covering that stretches across the ear canal, separating the middle ear from the outer ear. The inner ear is the inside section of the ear where sound vibrations are formed into messages that are sent to the brain. Hair cells facilitate this because they are the tiney sensory receptors that transform the messages to the brain. (Turkington) The ear as a whole is pictured below in figure 1, and the three sections of the ear are explained in more detail: Figure 1: The human ear is divided into three anatomical divisions; the outer ear which includes the pinna e or auricle and the external auditory canal; the middle ear which includes the tympanic membrane (the ear drum), the middle ear ossicles (bones) named the malleus (hammer), the incus (anvil) and the stapes (stirrup), as well as the cavity in which they are situated (otic capsule); and the inner ear which includes the cochlea and the semicircular canals.

(Anatomy... ) Hearing aids are the age old remedy to hearing loss in varying degrees. A hearing aid is a device that amplifies sound waves to help sounds be processed more clearly. Hearing aides amplify sounds, helping a person hear better, but cannot restore normal hearing abilities. Hearing aids will amplify ALL sounds, not just those that the person wishes to hear. This results in much interference, which can take some getting used to.

(Turkington) There are many types of hearing aids available, more than 1,000 different models are available in the United States alone! Each type will include a microphone to pick up the sounds, an amplifier to boost the sound level, a receiver or a speaker to deliver the sound to the ear, and all are powered by some sort of battery. Some people wear them in just one ear (monaural) or can wear them in both ears (binaural). Hearing aids are divided into five different types: digital, in-the-ear, in-the-canal, behind-the-ear, and on-the-body. The two most common are in-the-ear and behind-the-ear models, shown in figure 2. (Turkington) Figure 2 In-the-ear aids are lightweight devices whose custom-made housings contain all the components; this device fits into the ear canal with no visible wires or tubes.

It is possible to control the tone but not the volume with these aids, so they are helpful only for people with mild hearing loss... Because they are custom-fit to a person's ear, it is not possible to try on before ordering. Behind-the-ear aids include a microphone, amplifier and receiver inside a small curved care worn behind the ear; the case is connected to the earmold by a short plastic tube. The earmold extends into the ear canal. Some models have both tone and volume control... some people who wear glasses find that the glasses interfere with the aid's fit. Others do not have space behind the ear for the mold to fit comfortably.

(Turkington) The First step in preparing for a hearing aid is to have a medical exam and a hearing evaluation. Through this exam, and audiologist can determine whether or not a hearing aid will help, and which model will be the most beneficial. Hearing aids can be very expensive, anywhere between $500 and $4,000, and are usually not covered by most insurance plans. There is no known medical risk to hearing aids, although some people choose not to wear them sometimes, complaining that everything seems entirely too loud. (This is often due to the fact that the person has forgotten how loud normal sound can be.) (Turkington) Cochlear Implants are beneficial in restoring hearing in a profoundly deaf patient whom cannot be helped by a conventional hearing aid.

According to a report of surgical results... the device is capable of restoring speech discrimination to the extent that patients can once again carry on a conversation (Parkin) The Cochlear Implant acts as an artificial human cochlea in the ear, aiding sound travel from the ear to the brain. It is different from a hearing aid in that it does not amplify the sound, it merely helps it to travel. Cochlear Implants are electronic prostheses that transducer sound energy into coded electrical signals that bypass the nonfunctioning or absent Cochlear hair cells and deliver them directly to the spinal ganglion cells or axons of the Cochlear nerve. Proximal neural elements conduct these impulses to the auditory cortex, thereby restoring the sensation of hearing.

(Callanan) The Food and Drug Administration (FDA) has placed limits on those people eligible for the Cochlear Implants. They have done this because they are highly controversial, very expensive, and sometimes have uncertain results. (The cost of surgery ranges from $7,000 to $10,000, and the price of the device is about $10,000. - Parkin) Only those people who receive no significant benefit from hearing aids, are atleast two years old, and have severe to profound hearing loss are eligible. A typical Cochlear implant is pictured in figure 3. Figure 3 All Cochlear implants consist of a microphone worn behind the ear that picks up sound and sends it along a wore to a speech processor, which is worn in a small shoulder pouch, pocket, or belt.

The processor boosts the sound, filters out background noise, and turns sound into digital signals before sending it to a transmitter worn behind the ear. A magnet holds the transmitter in place through its attraction to the receiver-stimulator, a part of the device that is surgically attached beneath the skin in the skull. The receiver picks up digital signs forwarded by the transmitter, and converts them into electrical impulses. These flow through electrodes contained in a narrow, flexible tube that had been threaded into the cochlea.

As many as 24 electrodes (depending on the type of implant) carry the impulses that stimulate the hearing nerve. The brain then interprets the signals as specific sounds. (Turkington) Despite all the possible benefits of this procedure, many members of the Deaf community argue that the benefits do not outweigh the risks and limitations of the device. They are also concerned that this Implant will have the potential to make their language, American Sign Language, obsolete. Because it is a surgical procedure, medical risks are possible, such as dizziness, facial paralysis, or infection. During the procedure, the surgeon will make an incision behind the ear to open the mastoid bone that leads to the inner ear.

The receiver-stimulator is placed in the bone, and the electrodes are threaded into the cochlea. The operation can take anywhere from one hour to five. It is impossible to guarantee a significant change in hearing abilities. Many people describe the sounds they are able to hear as being robot-like or artificial. This of course is a result of no medical breakthrough being able to match the ability of a persons natural hair cells to transport sound to the brain.

(Turkington) Most people whom receive the implant report being able to distinguish medium to loud sounds, especially speech. Vincent Callanan reports that Postoperative speech perception varies widely, although patients can be simply classified as good or poor responders. Factors predictive of better performance, irrespective of the device implanted, include younger age at the time of implantation, a higher IQ, a normal cochlea on computed tomographic scan, and better ability to lip-read. The problem arises when Cochlear implants are used in children that are prelingually deaf: those children that have not yet developed any meaningful acquisition of oral language.

Robert Crouch argues that the Cochlear implant is intended to help the deaf child ultimately learn an oral language and, in doing so, to facilitate the assimilation of the implant - using the child into the mainstream hearing culture. When the child receives a Cochlear implant, he or she is put on a lifelong course of education and habilitation, the focus of which is the acquisition of an oral language, and ultimately, a meaningful engagement with the hearing world. He does not argue that this is a horrible thing, however if the parents make the decision to fix the child's deafness before he really understands it, the child is separated from a part of their lives, their DEAFNESS. It is important that the child be able to experience their true identity, and later in life, when the child is mature enough and comfortable with themselves, it is then that the decision should be made to receive the implants. Crouch sums up his argument against Cochlear implants, saying While the post lingually deafened person, once fitted with a Cochlear implant, can maintain his or her present speech production capabilities and relearn to hear, the prelingually deaf child using a Cochlear implant must be intensively taught and trained to recognize and produce each vowel and consonant sound and each word from the ground up.

For the implant using prelingually deaf child, then, the path to oral language development is a long and arduous one beset with many pitfalls, where there seems to be no guarantee that the destination will be reached. Why put a child through this with no real guarantees Would it not be better to wait until the child has developed enough to be emotionally stable and secure with themselves A child that is permitted to remain deaf can look forward to learning a language as unique as their condition: ASL. Through this the child will have a building block to learning and recognizing spoken language. They will share a culture with people similar to themselves, and will be able to make a choice between hearing and remaining deaf. I firmly believe that the battle of going from deaf to hearing is a long and trying one, and the person should be old enough to understand that before making the decision. Conclusion: I can understand how the prospect of the Cochlear Implants can appear to be a light at the end of the tunnel for those parents who foster deaf offspring.

However, I do feel it to be very important to allow the child to first experience their own culture before forcing the hearing world on them. The world of the deaf person is rich with culture and history, believe it or not, and I believe that it would be easy for a pre lingual child to feel stuck between two worlds: the hearing and the deaf. The child could very easily feel as if they belong to neither group. The decision to use any type of hearing device, whether it be a hearing aid or a Cochlear implant, should be the decision of the individual, when they are mature enough to understand all the benefits, risks, and complications.

Bibliography

Anatomy of the Ear April 20, 2001.
also source of Figure 1) Callanan, Vincent. Cochlear Implantation for Children and Adults. Lancet. 2000;
356 (8999): 412-414. February 17, 1996.
Crouch, Robert A. Letting the deaf be deaf: reconsidering the use of Cochlear implants in prelingually deaf children. The Hastings Center Report, July- August. 1997.
vs. 27. n 4. p 14 (18). Larkin, Marilynn. Can lost hearing be restored Lancet. 2000;
356 (9231): 744. August 26, 2000.
Parkin, M.D., James L. Multichannel Cochlear Implant Restores Hearing. Am Fam Physician 1984;
30 (5): 249. November, 1984.
Turkington, Carol A. Cochlear Implants. Gale Encyclopedia of Medicine. Edition 1.1999.
p 740. (also the source of figure 3) Turkington, Carol A. Hearing Aids. Edition 1.1999.