Cochlear Implants: My Perspective

By William F. House, D.D.S., M.D. (Edited by David House)

The reasonable man adapts himself to the world;
the unreasonable one persists in trying to adapt the world to himself.
Therefore, all progress depends on the unreasonable man.

~George Bernard Shaw

Introduction

This monograph

Not long ago a prominent otologist and medical school faculty member asked me when it was that I became interested in cochlear implants. I explained that my interest in cochlear implants actually started in 1957 (my second year of practice) when a patient brought me an newspaper article about a totally deaf patient in France who could hear because of an electrical device implanted by Dijourno and Eyries. [1] His reply was: "Wow, that was the year I was born!"

The incident made me realize that there is a growing need for a clear presentation of information about cochlear implants, including some information about: their history; some of the current controversies or questions, as well as some of the misconceptions regarding implants; and the metrics of fitting them. As well, I have decided to offer some information about the AllHear implant, since it came into being as a result of this same information.

The audience

Beyond the fact that such a presentation does not, currently, exist in vernacular language in one place, it is also true that the number of people who are interested in implants is growing. It is not only the professionals — the otologists, audiologists, speech pathologists and teachers of the deaf — who need information about this medical technology, but as well the patients themselves, and the families of these patients, are increasingly interested in having a full and understandable presentation of some of these facts and issues. They want to be fully informed.

I therefore expect that you are from one of these groups, and thus, primarily for the reasons presented above, this monograph.

Truth, bias, and acceptance

Every such document has a viewpoint, and obviously if I am writing the monograph it will be my viewpoint.

There are many who will disagree with my viewpoint, or think of it as being mere bias. That's fine: its their right to have such a viewpoint (or mere bias).

Indeed, alternative points of view are most welcome: one of the most important purposes of this monograph and subsequent is to stimulate critical thinking and discussion about cochlear implants within the professional community, and to help you, if you are a professional, to further refine your approach to advising implant candidates. On the other hand, if you or a member of your family is an implant candidate, then this monograph will offer you some information about the issues being discussed among professionals, and the evidence which exists one way or another. As such, it will help you choose or develop your own position.

I mention this particularly because the saga of cochlear implants has long been dominated by the conflict between clinical observation and theory. As you read this monograph, it will become clear that my viewpoint is strongly shaped by clinical observation. To put it another way, I admit to considerable distrust regarding unsupported statements which disagree with what I can see unfolding in my patient's lives.

However, the last thing that I want is to be dogmatic and not carefully listen to alternative positions. If I expect others to listen and be persuaded, then I also have to be willing to change my ideas when presented with convincing arguments and clear proofs.

The whole process of change, in fact, has much to do with the advance of science and society as a whole, and it figures prominently in any history such as that regarding the development of implants. General acceptance of what is new does not happen by one sudden turning on of the light. It is a gradual process, as it has been with cochlear implants.

After all, much of what is presented as new, or which is outside of the mainstream of thought at one time or another, turns out to be wrong. Skepticism is healthy and necessary, but at the end of every argument the beholder must make a decision for rejection or for the more difficult act: acceptance of the new thought, previously foreign. It is never easy when we have become comfortable with the present status quo — and particularly if we have loudly espoused it-- to accept a new way of thinking. For whatever reason, healthy skepticism can at times regress into mere obstructionism. Perhaps the difference is found in the line between defending the truth and defending one's self.

I write, therefore, in hopes that we would all recognize the difference, and in preservation of our honor and dignity yield, not to each other, but to the truth, to the degree that we can currently understand it.