How do people hear with cochlear implants

Self-determined - the report | View in the media library Spare part in the head - possibilities and limits of the cochlear implant

At the age of 16, Enno Park lost almost all of his hearing after contracting measles. He could hardly compensate for the loss with hearing aids.

The implant, which he decided on 20 years later, helped him to make out "acoustic contours" again in "this fog" that surrounded him. Half a year after the operation, he regained almost 100 percent of his speech understanding and was able to participate in life in a completely different way. Technology enables him to do a lot today: "Make phone calls, go to the pub, flirt, watch films without subtitles ..."

The most important thing about my implant is that it changes my senses, that I can perceive the world differently, that I can perceive more of the world and that's pretty great. I also have the feeling that it makes me more alert, more empathetic, it brings me closer to my environment and to my fellow human beings.

Enno Park, deaf person, computer scientist and specialist journalist

It is more difficult for people born deaf

Later deaf people like Enno Park learn to hear again, but those born deaf like Jonas Enzmann completely lack the experience of hearing and speaking. You have to reinterpret the impulses that the implant sends. A difficult path, Jonas Enzmann has it behind him. It was only revealed that he was deaf seven months after he was born. Hearing aids didn't help him. He was operated on when he was 15 months old. After that, he made rapid progress. At the age of three he was almost the level of normal hearing children. For a total of eight years, he completed intensive hearing and speech therapy. The 16-year-old goes to sports high school today. Without an implant, Jonas would not be able to fence - he has to hear the hits and commands. He feels the limits of technology, e.g. in noisy surroundings.

CI - not a panacea, but a booming market

Such restrictions make it clear that hearing prostheses are not a panacea, even if the device manufacturers sometimes give this impression.

The cochlear implant therapy is unique to this day because medical technology can replace a sensory organ.

Thomas Topp, Regional Director of Cochlear Germany

In the meantime, 50,000 people in Germany have this technology in their heads - in view of the demographic development, the trend is increasing, the market is booming and promises sales of up to 20 billion euros.

One third of those implanted are children

However, a third of those implanted are children born deaf - one in 1,000 is born with severe hearing impairment. This makes it one of the most common disabilities. For them, the cochlear implant is already part of the standard care, linked to the promise of being able to lead a "normal life" later on. The operation - after all, an operation just past the facial nerve - is carried out in the first 24 months in order not to delay learning to speak too much, which affects mental development as a whole. The first four years of life are decisive for this.

Loud vs. sign language?

But what if it turns out that the implant alone cannot help - as with Benni? The boy was operated on when he was eleven months old. At the age of four, his speech development was a year behind. The parents taught each other sign language to help him. But in this country - unlike in the USA or Scandinavia, for example - children with cochlear implants are frowned upon.

Doctors argue that their use would undermine spoken language training, even if there are now studies that show on the one hand that 50 percent of children do not hear enough despite having an implant and that they do not learn language satisfactorily, and on the other hand that sign language is the same for development can be beneficial like spoken language, the acquisition of which is not hindered by gestures. An experienced therapist like Astrid Braun from the Cochlear Implant Rehabilitation Center in Halberstadt refers to this:

Children who have mastered sign language and spoken language at the same time - such as children from their parents' homes who sign and who are in kindergartens for the hearing impaired - manage to switch quickly between the language required here and there. This is no different with bilingualism in the spoken area.

Astrid Braun, Cochlear Implant Rehabilitation Center Halberstadt

Benni's parents know that the social welfare office calculates coolly: an implant costs 30,000 euros, and the promotion of sign language also costs a multiple. In court, Benni's parents had to fight for temporary funding for learning sign language - even though the Disability Equality Act created the basis for legal recognition of sign language 15 years ago.

Patient representatives are calling for more information - and empathy

In the meantime, the patient representatives of the CI wearers warned that the doctors should better inform them that more communication is important. After all, as Barbara Gängler from the Cochlea Implant Verband Mitteldeutschland e.V. emphasizes, parents are making a lifelong decision for their child. Steffenräder, who found his way of treatment incapacitating, could certainly have saved a lot of suffering with more empathy. At the age of 12 he received his first implant. He got along well with it. But two or three years later the doctors recommended a new, more modern one. That meant: open your skull again. After the operation, his hearing was worse than before, he ignored the foreign body in his head and came to terms with his life as a deaf person again - until an accident at work in 2013. A roller shutter fell on his head and damaged the implant. Headache and tinnitus were the result. Only after long discussions was the implant removed from him in 2014.

How often there are explanations at all, for example due to defective equipment, is unclear in this country. "There are no statistics," says Barbara Gängler, because: "It's a hot topic." Professor Klaus Begall from Ameos Klinikum Halberstadt assumes five to seven percent of the implants.

One thing is certain: not everyone can or wants to be supplied with such a spare part. For Steffenräder, signing is not a crutch, but a full-fledged language, which in turn is part of an independent culture in which he lives with his deaf family. For Benni, the prosthesis is an aid. For Jonas Enzmann and Enno Park, the implant means a great plus in quality of life. The computer scientist and publicist has made "body technology", which he continuously tests on himself, his specialty. He therefore accompanies the discussion critically and comes to the conclusion:

We have to continue to accept that there will be a large number of disabled people who we cannot help with technical and medical care, and not only for a long time with deafness. And for them we still need all accessibility measures.

Enno Park, deaf person, computer scientist and specialist journalist