Bionic Ear
Caroline Nassour
Daniel Yazbek
Vatsla Nagpaul
Amanda Bolzan
Susannah Ng

Executive Summary

The Bionic Ear is a biotechnological device that is designed to be implanted into deaf people, to facilitate hearing. The report gives an introduction on how the Bionic Ear operates, and presents an analyses and discussion of the social and ethical implications connected to the Bionic Ear.

The Bionic Ear is quite advantages for the post-lingually deaf as it increases self-esteem, independence and social integration. However for the pre-lingually deaf, long-term emotional and social affects are experienced due to the patient having an inferiority complex about themselves, and feeling that technology is required to improve the quality of life.

Two prime ethical issues surrounding Bionic Ear technology include firstly the implications that exist when parents make the decision to implant a Bionic Ear in their deaf infant child. There is no right or wrong decision. Parents make decisions for their children based on the information they are provided and their own morals, beliefs and ethics. Secondly the future of bionic body parts, and their impact on society if their development continues. Biotechnological development needs to be controlled or moderated to avoid social identity conflicts.

Introduction

Advancements in Information Technology have now made it possible to restore hearing to the profoundly deaf by inserting a prosthetic device called the Bionic Ear (also known as the Cochlear Implant) in an individual’s inner ear. The Bionic Ear technology is an example of design and innovation combined with information processing, software design and development. Since it was first devised, technology advancements proceeded on a parallel track in terms of miniaturisation and increasing sophistication of this Bionic Ear technology. This particular technology operates by delivering electrical stimuli to the auditory nerve which then triggers auditory sensations to progressively become closer to sounding like normal speech.

What is the Bionic Ear?

The Bionic Ear, which is an artificial hearing device intended to directly stimulate the implant recipient’s auditory nerve. It is implanted surgically into the ear, and is activated by a device that is worn outside of the user’s body. The purpose of the Bionic Ear is to bypass the normal hearing mechanism within the human ear and convert speech and sounds into signals that are sent to the hearing centres of the brain. This technology was first researched and devised by Professor Graham Clark in the 1960s to 1970s and since then, a range of implants have been devised by the Nucleus® Cochlear division. As opposed to the traditional hearing aid which makes use of sound vibrations, the Bionic Ear converts these vibrations into electrical stimuli that are picked up by the auditory nerve and transmit them to the implant recipient’s brain. (http://www.entnet.org/healthinfo/ears/cochlear-implant.cfm)

Who is it catered for?

Many people with hearing loss utilise hearing aids to intensify and amplify sounds as well as to assist them in hearing. However, for people with severe or profound deafness, these aids do not provide any assistance. Hence, these individuals require the use of the Bionic Ear. This technology is designed especially for these people who receive little or no assistance from the normal hearing aids. The device can be implanted to aid two types of individuals:
- The Post-Lingually Deaf: individuals who have learnt a spoken language before going deaf.
- The Profoundly Deaf: individuals who have lost their hearing before they acquired language.

How does the technology work?

The Bionic Ear consists of two main components:
1. An electronic device, which is surgically implanted under the skin behind the ear.
2. An external speech processor that is worn on a belt or placed in a pocket. A microphone is also worn outside of the body as a headpiece behind the ear to obtain sounds.

Sounds and speech are captured by a microphone and sent to the external speech processor. The processor then translates the sounds into electrical signals, which are then sent to the transmitting coil. These codes travel up a cable to the headpiece and are transmitted across the skin through radio waves to the implanted cochlea electrodes. The electrodes’ signals then stimulate the auditory nerve fibres to send information to the brain where it is interpreted as meaningful sound. (http://www.entnet.org/healthinfo
/ears/cochlear-implant.cfm).

Social Aspects

Advantages

The Bionic Ear has revolutionised the lives of deaf individuals all over the world, it is not only a great scientific achievement, but also a great progression in a socio-cultural context within the lives and communities of the deaf and hearing-impaired individuals. The Bionic Ear with the aid of IT has provided new capabilities and in turn gives individuals new choices of action. This statement is supported by James Moor (T. Bynum, 2000). He believes that the IT is the nearest thing we have, to a universal tool, so its utilisation in cases such as the Bionic Ear can only prove to be advantageous.

According to Knutson JF -1998 (Advanced Bionics, 2005) within 54 months of the implant, recipients go over a large psychological change. In addition to an improved hearing performance, the Bionic Ear users report that they do not feel as lonely, have less social anxiety, and experience greater independence than before they received their implant. Interpersonal communication skills and social confidence are also found to be enhanced, and after long-term use, marital satisfaction and assertiveness have also been shown to improve between adult users. Hence showing that recipients are able to actively associate with members in society.

Furthermore the Bionic Ear aids individuals by allowing them to hear, which in turn prevents them from being labelled, teased and isolated as a disabled person. It generally enables post lingually deaf adult and child users to become more aware of sounds in the surroundings around them. The utilisation of this technology can help in alleviating some of the barriers being faced by the deaf, and aids in social acceptance. This has been found by 90-100 percent of post-lingually deaf recipients demonstrating significantly enhanced speech reading capabilities (M.Greco, 2005).

The Bionic Ear therefore is quite advantageous, especially for the post-lingually deaf, as recipients can benefit by an increase in self-esteem, independence, social integration, and vocational prospects. Furthermore, it provides a renewed curiosity about the experience of hearing and the phenomena of sound. In some cases the experience of implantation becomes an integral part of the individual's identity, leading implant users to even participate and share experiences in self-interest and advocacy groups.

Disadvantages

The detriments of the bionic ear must be known to the implant recipient prior to receiving the technology.

Firstly it is found that the Bionic Ear works better for the Post-Lingually deaf individuals as they have previously acquired a language before becoming deaf (Omer Zak, 1996). So the profoundly deaf may not benefit as much from the surgery, making them feel like social outcasts as they have yet to acquire a language prior to becoming deaf.

Secondly, according to a ‘Sound Decision’ paper by Dr. Susan Williamson (S.Williamson, 1999) in the first few years of life, the human brain is highly plastic, this gives it the potential to grow and form many complex neural connections. The reason why an implant done on children is more successful is due to the easy manipulation of the neural connectivity in nerves. However if a neural connection is not used it will degenerate as time goes by hence making it difficult for a deaf adult. An adult’s brain is no longer as plastic and the auditory nerve often degenerates as a result of disuse, which also leads to major surgical complications. Therefore the longer a person has been deaf, the less likely it is for them to gain meaningful information from a cochlear implant. So even if the surgery is successful, full social activity may not be experienced, which could lead to social anxiety and frustration by the recipient.

Additionally the surgical procedure of the implant itself could cause social hesitance for the recipient as major complications may occur. For instance those requiring revision surgery, include flap problems, device migration or extrusion, and device failure. Facial palsy is also considered a major complication that can lead to patient suffering from damaged facial tissues and nerves, as well as various abnormalities such as drooping cheeks. According to results of the in-depth Questionnaire by a number of various Bionic Ear recipients, at the Congressional Hearing Health Caucus these negative effects can lead to the recipient gaining a complex and feeling like a social outcast, (M. Greco, 2005).

These negative social impacts of the Bionic Ear can have a large effect on both children and adults. As a result of the implant, children may get teased and isolated due to the additional signal processor accessories that need to be utilised in order for the technology to function. This can be used as a basis for a child suffering from long-term emotional and social affects (C.Splona, 2003) due to the child having an unhealthy self-belief that there is something wrong with his/her body. Common social insecurities, for children and adults, may result from the difficulty of hearing amidst background noise, and from unreasonable expectations of aural-only benefit on the part of the implant user or his/her family and friends. These negative aspects of the Bionic Ear technology support the theory of Donald Gotterban that failure to see one’s responsibility has significant consequences (D. Gotterban, 2004). Showing that though IT has advanced in the form of the Bionic Ear it has not proven to be problem free, resulting in problems and consequences impacting implant recipients on a social level.

Ethical Aspects

There are numerous ethical implications related to the cochlear implant technology. This section will discuss two prime ethical issues surrounding the technology:
3. Is it ethical for parents to make the decision on behalf of their child to receive the Bionic Ear implant?
4. The ethics regarding the social and future developments of the technology.

Parents making the decision

The largest ethical implication that exists is whether or not the parents of a deaf child have the right to make a major life changing decision for their child (in this case, to receive the implant), who is incapable of making his or her own decisions (Zak, 1996). There is a fairly large amount of controversy surrounding this ethical dilemma as parents are making a major life-altering decision on behalf of their deaf child before the child is too old to successfully receive the implant.

This decision may seem trivial as cochlear implants are most of the time successful and being able to hear is a sense that is vital for quality living according to those who are not deaf. However, the result of this ethical dilemma can have serious repercussions for the child. The key dilemma being that as the child grows, they will begin to analyse the differences in living life with and without the implant. They may blame their parents for making a wrong, ill-informed decision (Hyde & Power, 2002). Forcing a human being into something as life-altering as this is a violation of human rights at any age, although it is legal to make this decision. (Refer to Section 4.3 The decision to receive the Bionic Ear technology).

Since the Bionic Ear is a relatively new technology, the long-term impacts of the IT are still quite unknown. Parents making the decision on behalf of their children always fail to consider this issue, hence possibly sentencing their child to a future of uncertainty. (Hyde et al. 2002) Ethically, it is inappropriate to make a decision for others where the outcomes are not clearly defined. On the contrary, parents are also concerned about the quality of life their child will experience, and believe that the best decision is that their child should be able to hear just like the majority of the population can.

What gives parents the right to make a major life changing decision on behalf of the child? Some parents believe that they are only trying to provide the best opportunities possible for their child; others believe that deafness is a disability and their child cannot live life being “disabled”. Parents making this decision for their deaf child fail to consider the quality of life the child would have if it were to remain deaf. Parents are often not informed of the culture and heritage of members of the deaf community, so fail to consider the alternative which is allowing the child to live their life deaf. Removing a deaf child from their culture is a sign of intolerance and aggression.

Most children who have received implants are mainstreamed into society. After receiving the implant, children are sent to normal schools after some brief post-implant therapy. Unfortunately, most implanted children attending normal schools do not perform at “grade level” and fall behind the majority of the class. It is proven that people with a disability in one of their senses tend to develop superior quality in their other senses. Thus, the child can be considered to be unfairly disadvantaged by receiving the cochlear implant because the superior development of the other senses would not take place (Christiansen, Leigh & Clerc, 2002).

Personal religious beliefs of parents can also influence decisions related to acquiring such technologies. People with a strong Catholic faith believe that the body should not be altered, and the way you are is the way God intended. Religious parents contemplating cochlear implants for their children often face moral and ethical dilemmas in this domain (House, 1995). Should they allow the technology to be used on their child in an attempt to improve their child’s quality of life, or should the follow their firm religious beliefs which potentially results in the child not having the opportunity to hear.

Children of parents that made the decision to proceed with the implant surgery cannot have the cochlear implant removed (Hyde et al., 2002). The surgery is irreversible; hence they are forced to live the rest of their lives with an implant that was forced onto them, even if they disagree with the decision their parents made for them.

As discussed, parents are faced with many ethical issues when contemplating the decision to give the implant to their deaf child. The deaf child is unable to make a decision so the parents ultimately make this life altering decision for them. Receiving the technology is a life altering decision and unfortunately, there is no right or wrong decision; parents will ultimately make their own decision based on their morals, beliefs and ethics.

Ethics and Technology

Additional to the ethical implications faced by parents when contemplating to perform cochlear implant surgery on their child, the technology itself poses many ethical implications on society, culture and future biotechnological developments.

The only way to test the quality and development of the cochlear implant is to insert it into a deaf child and monitor how he or she reacts (Zak, 1996). Continual development must be trialled on human patients, as testing on animals will not provide accurate results as they will not be able to respond to humans like children will. This issue poses many ethical implications. It is not acceptable to test such technology on children when the long-term impacts are still not known. However, if the technology is not tested, continual development and improvement could not be possible and the quality of technology that current patients receive would not be as state of the art, as it is today.

If scientists, IT professionals and engineers can work together to create such remarkable technology as the Bionic Ear, what else can these professionals create? Further research and development into biotechnology can lead to other “bionic” body parts, such as a bionic eye. Research and development has already gone into the bionic eye, which operates by feeding video signals coming from a tiny camera mounted on reading glasses into the nerves behind the retina (Sandhana, 2003). If more and more of these “bionic” technologies are developed, it could lead to social chaos. Wealthier people would be able to afford such bionic devices to enhance their quality of life to an ultimate goal of living longer. However poorer people of society will not be able to afford medical treatment and thus be unfairly disadvantaged. Further development into bionic body parts will lead to social divides and clashes. Rules and regulations must be put into place to prevent such events from occurring.

Conclusion

While the Bionic Ear technology offers the deaf community many advantages in all areas of their lives, it raises many social, legal and ethical issues. On a social level, the provision of the Bionic Ear technology can be advantageous; however the surgery can also lead to negative impacts for an individual if it fails. Current laws also exist to state that the IT manufacturer and surgeon are professionally responsible for the technology and its installation. On an ethical level, there are many implications related to the Bionic Ear technology as the majority of patients receiving implants are profoundly deaf children. Hence, they are not able to voice their opinions, leaving the parents in control of a large, life altering decision for their child. Moreover, the Bionic Ear technology itself poses many ethical implications on society, culture and future biotechnological developments, including the affects of testing and trialling the technology on human patients.

While parents realise that their implanted children are still children who are deaf, they see the implant as enhancing their child's quality of life. A lot of parents are making decisions for their children when they are often poorly informed about the culture and quality of life of a deaf person, so they fail to consider the possibility of leaving their child to live the rest of their live being deaf. Children should therefore not be forced to undergo the implant surgery and parents should consider accepting their child as being deaf. They should also consider that the great amount of money that goes towards the financing of their child’s cochlear implant could be used in other ways, such as improving the education and literacy amongst the deaf and hearing-impaired.

From our research, we can also conclude that with the use of this technology to further society and the wellbeing of people from all around the world, the motivation of IT professionals is not only for money in this growing and dynamic industry. What also motivates them is their underlying interest and passion in finding ways to apply IT to the current and changing needs of society and make meaningful contributions to the way we live. In considering whether it is easy to make a difference in society through the use of IT, it can be concluded that the Bionic Ear should not be viewed as a threat to society, but rather a choice that is available for those who wish to experience the effects of the technology in their lives. We should be aware that there will always be challenges that will arise due to the conflicting interests of the stakeholders affected by the technology.

In future, the Bionic Ear will lower power consumption, biocompatibility, miniaturization as well as manufacturing automation. These Bionic Ear technology advancements will continue to make an impact on society as IT professionals continue to work for the betterment of humanity. The Bionic Ear will continue to provide many great advantages to the deaf and if implanted and used correctly, become one of the greatest beneficiaries to humanity.

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