Baby Jonathan is hearing for the first time thanks to his cochlear implant.

A two year old video has recently been gaining popularity around web - in it a baby hears for the first time thanks to a cochlear implant. The boy in the video lights up, smiling widely as he hears the voice of his mother for the first time. It's a touching scene. It's also a sign of things to come. These implants are one of the most common ways people are becoming cyborgs, augmenting their bodies with technology. The device uses a microphone, processor, and transceiver to directly stimulate the auditory nerve via an electrode array. This, for many who are implanted, provides a close facsimile of natural hearing. For now they seek to provide sensory input close to an average human level, but one day they could far exceed the limits of human hearing. Something to think about when you watch the baby smiling in the video below.

There are more than 400,000 deaf people in the United States, and millions more around the world. According to the National Institute of Health, less than 200,000 people worldwide have cochlear implants, but the rate of adoption is increasing. In the US, the FDA has approved implants in children as early as one year old. In some cases (such as the one shown in the video) some doctors have fitted even younger infants with devices  regardless of FDA guidelines. A new generation of children born with deafness is poised to be raised with implants. The young boy in the video, eight month old Jonathan, is a prime example of the trend:

Cochlear implants work by directly stimulating the auditory nerve. A microphone picks up sound, a processor interprets that sound into manageable data, and a transceiver sends that data as electric pulses to an electrode array wired into the nerve. As you can imagine, the use of such a device requires surgery. The apparatus is generally counter-sunk into the skull, and a line is drilled down into the inner ear to connect the electrodes. Michael Chorost, who received an implant as an adult, described his experience with the implantation (and its subsequent use) in a video we discussed two years ago.

A typical cochlear implant is embedded in the skull and connected to the auditory nerve via a drilled tube.

There are three major producers of cochlear implants (for the US): Cochlear Limited, MED-EL, and Advanced Bionics. Each use basically the same approach as outlined above, and cost around $60k (with some large variation). Modern implants will have more than a dozen channels (some with up to 24 electrodes or so). While this is a large improvement over past models, it doesn't really come close to the 10,000+ 'hairs' in the cochlea. Many hearing people who have become deaf and then received the implant characterize the sounds as tinny or coming from a long hallway. There is also a wide range of results from getting the implant - some people will develop a very high level of oral communication, and some will receive little to no benefit at all.

Clearly though, it doesn't take much to imagine a time when these implants will improve. Already competition from these three companies (and others) have driven them to develop more channels, better processing, etc. If we look at similar sense-based implants for the eye (such as the Argus III artificial retina) we can see that as computer processing increases in a steady upward trend so will the capabilities of these devices. The growth is even likely to be exponential. One day these implants could match average human hearing. A few years later, they may even surpass it. What happens then? How will our attitudes about these implants change when they go from aid to augmentation?

Well, let's take a brief detour into the controversy surrounding modern cochlear implants. The reaction to implants in the Deaf community has been historically negative, but there's quite a bit of variation, and attitudes may be changing. To clarify, there's been an ongoing debate between hearing educators and the Deaf community. The hearing world largely sees deafness as a disability, while the Deaf community is very proud of its language (ASL in the US), and its culture. Deaf educators have fought for deaf children to be raised with ASL as their primary language, while still training them to have some oral communication skills (effectively making them partially bilingual). It's been a successful approach that has allowed the Deaf community to maintain its identify while achieving success in the hearing world.

Cochlear implants sort of throw that entire approach into question. Many proponents of cochlear implants think children should be implanted very young and trained exclusively in oral communication. Their argument is that the plasticity of the young brain should be taken advantage of, giving a child the best chance to adapt and integrate the device into their thinking. But this 'oralism' approach effectively limits deaf children from engaging with the "manualism" Deaf culture. Or it could. There's been a lot of debate about whether implants are 'eradicating' the Deaf community or merely transforming it. The Academy Award nominated documentary Sound and Fury covers these issues, as does its follow up Sound and Fury: Six Years Later. Fair warning, the documentaries have been characterized by detractors as pro-oralism (though others have claimed they are pro-manualism).

There is a statistical force that is more than likely going to push deaf children into gaining implants: most have hearing parents (90% or more). For most new parents choosing whether or not to give their child a cochlear implant isn't an issue of culture or education style, it's about helping their child 'get well'. Many will view it no differently than getting their child a wheelchair or prosthetic limb. Certainly Jonathan's parents seem very happy and touched by his ability to hear for the first time. Even the National Institute for Health's discussion for cochlear implants compares costs for the implant versus long term costs for being deaf - this isn't a discussion about cultural identity, it's an economic cost-benefit analysis! While not every person born deaf, nor everyone one who becomes deaf, is a good candidate for cochlear implants, the vast majority will be (~80%). Which, to me, means that it is likely that a majority of new deaf children will receive the devices in the years ahead.

What can we learn from this complex cultural controversy surrounding cochlear implants that may help us understand how future 'augmentation' implants could be received? Well, first let me acknowledge that conflating the two situations is a rather gross miscarriage of analysis - there are many factors in each scenario which will simply not have analogues in the other. Yet I'm going to make the comparison anyway. I think that the debate about modern cochlear implants shows that the eventual adoption of augmenting implants (for hearing, vision, etc) is going to be fiercely opposed at first, but that it will become almost inevitable. For now cochlear implants are about ability vs. culture, identity vs. integration. When they can augment beyond normal human hearing we'll face these same debates...probably with the same outcomes.

Why? Well there's an overwhelming force again, but it's not parental preference for normalcy, it's about competition. Safe augmentation will provide a range of sensory input beyond the normal, and this will be desirable. Most of us would like to run faster, jump higher, look sexier - the same will probably extend into 'see farther' and 'hear better'. Once we start to view the situation in terms of advantage vs. disadvantage, the adoption of augmentation seems very likely. We should keep in mind that some forms of these augmenting devices may not require surgery and implantation - we've seen hearing devices that use bone conduction, for instance. Yet no matter what form they take it seems likely that they will gain acceptance.

Doubt me? Take a look at Jonathan's happy smiling face. He's experiencing a sense he never had before and he obviously loves it. Imagine the same when you get an augmenting implant, able to hear whale song or ultra sonic music that no one else has ever heard. And look at Jonathan's mother's face. She's happy that her child has a new ability, an augmentation over what he was born with. Look at that Madonna-esque scene - mother and cyborg. This is a poster for what the future could hold.

[screen capture and video credit: BeanCounterBB]
[image credit: National Institute for Health]
[source: National Institute for Health
, Wikipedia, Sound and Fury]