While they can be priceless for some, cochlear implants do require extensive training to function well. They are also seen by some in the Deaf community as ableist.

Hearing is one of the five critical senses that people use to experience, interpret, and interact with the world around them. But hearing loss, whether present at birth or developed throughout life, affects a significant number of people.

According to the Centers for Disease Control and Prevention (CDC), roughly 2 to 3 out of every 1,000 children in the United States are born with some form of hearing loss in at least one ear. Meanwhile, the Journal of American Medical Association (JAMA) estimates that roughly 1 in 8 Americans — or 13% of the population — ages 12 and older have hearing loss in both ears.

So, understandably, protecting hearing health is important. However, while hearing loss or complete deafness is a concern, treating the condition can be viewed as controversial depending on the method used. In particular, the process of receiving cochlear implants is a topic that splits both the Deaf and medical communities.

Understanding how cochlear implants work, the adjustment process, and how they can be considered ableist is important for both hearing-impaired individuals and hearing parents of a child with hearing loss to make an informed decision.

How do cochlear implants work?

Cochlear implants aren’t the same as hearing aids, as these devices are designed to bypass damaged parts of the inner ear to stimulate your auditory nerve directly. By contrast, hearing aids amplify external sounds.

The cochlear implant directly stimulates the auditory nerve, which in turn sends the auditory signals to the brain, which are then recognized as sounds. However, learning to live with cochlear implants takes time, as the recipient must learn how to interpret the signals being received as specific words.

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One of the biggest disadvantages of opting to undergo cochlear implant surgery is that the process doesn’t immediately restore hearing in the traditional sense. People who opt for the surgery must learn how to interpret the signals that the implant sends to the brain.

Note that the ability to adjust to the implants can vary widely by age. Adults tend to experience more immediate improvement than children.

And for people with partial hearing loss, the implants can cause any residual hearing to be lost or difficult to discern. Likewise, a small percentage of recipients may experience device failure. However, this tends to occur in less than 5% of participants.

Also, while rare, some people that get cochlear implants may be at risk for meningitis, an inflammation that attacks the membranes that surround the brain and spinal cord. However, to prevent this from happening, surgery patients are usually given preventive vaccines against meningitis before undergoing the procedure.

Note that the statistical risk of contracting meningitis from a cochlear implant is low and can be prevented.

Who can’t benefit from cochlear implants?

Just because a person has partial or complete hearing loss doesn’t mean that they’re automatically a good candidate for this surgery. Specifically, people with inner ear hearing loss, or who have trouble hearing even when using hearing aids that fit properly, tend to be better candidates.

Additionally, experts usually recommend cochlear implants for young children with severe hearing loss that have difficulty with traditional hearing aids.

While cochlear implants can help people better interact with the audible world around them, they’re not without controversy. The hearing world often doesn’t realize the learning curve that comes with the implant.

Social media is partly to blame for sensationalizing the treatment. It often showcases videos of young children undergoing the surgery and then “hearing” their parents for the first time.

The truth — which many people feel is downplayed — is that adjusting to life with cochlear implants can be difficult and can take years in some cases.

Because the device isn’t like a traditional hearing aid, people must learn how to interpret audio signals into words. In some cases, this can translate to sensory overload for individuals that were born with complete hearing loss when they begin to receive audio signals for the first time.

Likewise, many cochlear implant recipients still rely on lip reading, sign language, and other visual cues to fully interpret audible noise into intelligible sounds. Because this reality often isn’t highlighted in pop culture, hearing parents of a child with hearing loss may falsely assume that learning American Sign Language, or making other adjustments to ease the activation process for their child’s cochlear implants, is unnecessary because the child can now “hear like them.”

Additionally, many members of the Deaf community feel that cochlear implants play into “audism,” a specific form of ableism aimed at people with hearing loss. Many people with hearing loss feel that it implies that there’s something inherently wrong with them that needs to be cured or corrected.

Often, members of the Deaf community opt not to use hearing devices and instead prefer to leverage sign language, lip reading, and other techniques to communicate with each other.

In short, for some members of the Deaf community, the implant represents a major ableist insult that signals the dominant society’s unwillingness to make necessary accommodations to interact with Deaf individuals.

For people with hearing loss that opt for cochlear implants, benefits can range widely. While the adjustment period can take time, most people will be able to perceive soft, medium, and loud sounds ranging from the rustling of leaves to a barking dog to the sound of fireworks.

Additionally, many people do go on to understand speech without needing supportive solutions like lip reading or sign language. Others can make phone calls without assistive devices or watch television without having to rely on closed captions. Depending on how well the implants work for an individual, listening to music can also be possible.

Individual results can vary widely in terms of cochlear implant success. So, it’s important to maintain perspective before considering the procedure.

A 2020 case paper review investigated published studies between 2000 to 2018 for adults who underwent cochlear implant surgery. Of the 102 studies with at least 10 participants, the ability to recognize words improved from 8.2% to 53.9% after implantation.

Most results were self-reported by the patient, with an average improvement of 21.5%. However, the type of hearing loss recorded pre-surgery impacted the perceived improvement.

Specifically, roughly 82% of adults with postlingual hearing loss (loss after learning to speak) felt their speech perception had improved by at least 15%. Conversely, only 53.4% of the adult group with prelingual hearing loss (born with hearing loss) felt their speech perception improved by at least 15%.

How long does it take to get used to cochlear implants?

Individual results will vary because the process of getting used to cochlear implants can be different from person to person. On average, it can take three to six months to get used to the implants.

Activation requires working with an audiologist to help calibrate the implant and ensure that it works properly. Likewise, a variety of training techniques and support during rehabilitation are used to help someone adjust to accurately interpreting the audio signals their brain is receiving from the implant.

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Cochlear implants can help people with hearing loss better interact with the audible portion of their world.

Before getting them, you need to understand that cochlear implants require significantly more effort than traditional hearing aids on the part of the recipient to enhance their lives rather than detract from them. Likewise, reliance on hearing-supportive techniques such as lip-reading or sign language may still be necessary.

It’s also important to be aware of the ethical controversy surrounding these devices. Some members of the Deaf community feel they represent a larger problem of ableism and are an attempt to improve the lives of hearing people rather than their own.