1. WHAT ARE THEY AND WHY ARE THEY CONTROVERSIAL?
COCHLEAR IMPLANTS
WHAT ARE THEY AND WHY ARE THEY CONTROVERSIAL?

2. WHAT IS A COCHLEAR IMPLANT?
A cochlear implant is a small, complex electronic device that can potentially help to provide a sense of sound to a person who is profoundly deaf or severely hard-of-hearing. The implant consists of an external portion that sits behind the ear and a second portion that is surgically placed under the skin (see figure).

3. A COCHLEAR IMPLANT HAS THE FOLLOWING PARTS:
* A microphone, which picks up sound from the environment.
* A speech processor, which selects and arranges sounds picked up by the microphone.
* A transmitter and receiver/stimulator, which receive signals from the speech processor and convert them into electric impulses.
* An electrode array, which is a group of electrodes that collects the impulses from the stimulator and sends them to different regions of the auditory nerve.

4. HOW DOES A COCHLEAR IMPLANT WORK?
A cochlear implant is very different from a hearing aid. Hearing aids amplify sounds so they may be detected by damaged ears. Cochlear implants bypass damaged portions of the ear and directly stimulate the auditory nerve.
Signals generated by the implant are sent by way of the auditory nerve to the brain, which recognizes the signals as sound.
Hearing through a cochlear implant is different from normal hearing and takes time to learn or relearn. However, it allows many people to recognize warning signals, understand other sounds in the environment, and sometimes even enjoy a conversation better in person or by telephone.
An implant does not restore normal hearing. Instead, it can potentially give a deaf person a useful representation of sounds in the environment and help him or her to understand speech.

5. WHO GETS COCHLEAR IMPLANTS?
Children and adults who are deaf or severely hard-of-hearing can be tested for eligibility and fitted for cochlear implants. According to the Food and Drug Administration (FDA), as of December 2012, approximately 324,200 people worldwide have received implants. In the United States, roughly 58,000 adults and 38,000 children have received them.
Since 2000, cochlear implants have been FDA-approved for use in eligible children beginning at 12 months of age.
Some adults who have lost all or most of their hearing later in life can also be fitted for cochlear implants. They learn to associate the signal provided by an implant with sounds they remember. This sometimes provides these individuals with the ability to understand speech solely by listening through the implant, without requiring any visual cues such as those provided by lipreading or sign language.

6. HOW DOES SOMEONE RECEIVE A COCHLEAR IMPLANT?
Use of a cochlear implant requires both a surgical procedure and extensive, significant therapy to learn or relearn the sense of hearing. Not everyone performs at the same level with this device.
The decision to receive an implant should involve discussions with medical specialists, including an experienced cochlear-implant surgeon.
The process can be expensive. For example, a person’s health insurance may cover the expense, but not always.
Surgical implantations are almost always safe, although complications are a risk factor, just as with any kind of surgery.
An additional consideration is learning to interpret the sounds created by an implant. This process takes time and practice. Speech-language pathologists and audiologists are frequently involved in this learning process. Prior to implantation, all of these factors need to be considered.

7. THE CONTROVERSY
Since it was first approved for testing in 1985, the cochlear implant has been engulfed in a storm of controversy for years.
Many questions have been asked:
*Does the cochlear implant pose a serious threat to deaf culture?
*Is it fair for parents to decide on implantation for their deaf kids?
*Can people with the implant function effectively as members of the hearing world?
*Is there really a way to know if it will be successful before implantation?
*Do the results justify the risk and expense of surgery and years of therapy?
*Will it make implanted children part of the hearing world or stuck somewhere in between?
*Will the implant always work or will it fail?

8. THE ARGUMENT - PROS
Hearing ranges from near normal ability to understand speech to no hearing benefit at all.
Adults often benefit immediately and continue to improve for about 3 months after the initial tuning sessions. Then, although performance continues to improve, improvements are slower. Cochlear implant users' performances may continue to improve for several years.
Children may improve at a slower pace. A lot of training is needed after implantation to help the child use the new 'hearing' he or she now experiences.
Most perceive loud, medium and soft sounds. People report that they can perceive different types of sounds, such as footsteps, slamming of doors, sounds of engines, ringing of the telephone, barking of dogs, whistling of the tea kettle, rustling of leaves, the sound of a light switch being switched on and off, and so on.

9. THE ARGUMENT - PROS
Many understand speech without lip-reading. However, even if this is not possible, using the implant helps lip-reading.
Many can make telephone calls and understand familiar voices over the telephone. Some good performers can make normal telephone calls and even understand an unfamiliar speaker. However, not all people who have implants are able to use the phone.
Many can watch TV more easily, especially when they can also see the speaker's face. However, listening to the radio is often more difficult as there are no visual cues available.
Some can enjoy music. Some enjoy the sound of certain instruments (piano or guitar, for example) and certain voices. Others do not hear well enough to enjoy music.

10. THE ARGUMENT - CONS
*General Anesthesia Risks, Infection (like Meningitis), Dizziness, or Numbness after surgery
*Injury to the facial nerve --this nerve goes through the middle ear to give movement to the muscles of the face. It lies close to where the surgeon needs to place the implant, and thus it can be injured during the surgery.
*Cerebrospinal fluid leakage --the brain is surrounded by fluid that may leak from a hole created in the inner ear or elsewhere from a hole in the covering of the brain as a result of the surgical procedure.
*Perilymph fluid leak --the inner ear or cochlea contains fluid. This fluid can leak through the hole that was created to place the implant.
*Tinnitus, which is a ringing or buzzing sound in the ear and is permanent.
*Taste disturbances --the nerve that gives taste sensation to the tongue also goes through the middle ear and might be injured during the surgery.
*Reparative granuloma --this is the result of localized inflammation that can occur if the body rejects the implant.
*May have to have it removed temporarily or permanently if an infection develops after surgery.

11. THE ARGUMENT - CONS
May hear sounds differently. Some users describe the sound as "mechanical“ or "technical"
May lose residual hearing. The implant may destroy any remaining hearing in the implanted ear.
May have their implant fail or not hear as well as others who have had successful outcomes with their implants.
May not be able to understand language well. There is no test a person can take before surgery that will predict how well he or she will understand language after surgery.
May not be able to upgrade their implant when new external components become available.
May not be able to have some medical examinations and treatments, such as an MRI.
Will depend on batteries for hearing. For some devices new or recharged batteries are needed daily.
May damage their implant. Contact sports, automobile accidents, slips and falls, or other impacts near the ear can damage the implant permanently.
May hear strange sounds because their implant will interact with the electronic environment. An implant may be affected by things such as metal detectors, cell phones, and radios.
May have lifestyle changes  because of cultural differences between the Deaf and Hearing