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IntroductionScience has come a long way since the beginning of time. The evolution of science has given us cars, planes, phones, light, and so many other things, like the ability to hear. Some people believe it has gone too far while others believe we should continue forward. This disagreement has created much controversy over the Cochlear Implant. There are two types of deaf. There is “Deaf” with the uppercase D, which symbolizes the culture and the acceptance of who you are, these people tend to be against the Cochlear Implant. Then  there is the “deaf” with the lowercase d, which signifies deafness is just a medical condition, this group is more for the surgery.  Some believe the Cochlear Implant is the optimal solution for those who are deaf, while the Deaf community believes it is an unnecessary change to the way they are. The Cochlear implant is a controversial, yet revolutionary, scientific advancement. The Cochlear Implant has advanced a tremendous amount through the last five centuries and will only continue to improve to help those in need of it. The Cochlear Implant is an invasive surgery where a device is inserted into your cochlea which is behind your ear to transmit sound into those who have severe hearing loss. The Cochlear Implant has five parts. These five parts are the Transmitter, the Speech Processor, the Microphone, the Stimulator, and the Electrode array. (NIH, 2017).  All these parts work together to produce sound. The way the Cochlear implant works is sound waves are picked up from the microphone, which is place right at ear level. The microphone is connected to the speech processor. The processor orchestrates sounds into “spectral bands” with the help of numerous band-pass filters, then the spectral bands are reconstructed into digital signals. These digital signals are then shaped and controlled in amplitude, pulse-width and rates, then transferred to the to the primary Transmitter. The Transmitter is located on the side of the head, behind the ear, held up by a magnet. The transmitter sends the modified digital signals through the skin, via the magnet to the cochlea through the electrodes which are located in the cochlea. (Kissiah, 2007) The Cochlear Implant is very different from a hearing aid, and it is important to know that the implant does not restore full, normal hearing. Rather gives a hearing impaired person a digital type of sound to help understand speech. (NIH, 2017). History to the Cochlear Implant Throughout history, there have been many discoveries and developments in the Deaf community. In the First Century A.D, the first deaf person was recorded. (World Health Organization, 2017) In 1620 sign language was invented by Juan Pablo de Bonet. (Ryan, 2002). The first hearing aid was invented in 1898 by Miller Reese Hutchison. (Hear-it, n.d.). And in the mid 1970’s the first Cochlear Implant was created by Adam Kissiah Jr. (Kissiah, 2007). The Cochlear Implant has gone through many changes since it’s beginning. Before Kissiah patented the Cochlear Implant, there were many people before him who attempted to “cure” deafness and there have been many after Kissiah to modify his creation. Although the first working Cochlear Implant device was not created until the mid 1970’s, the first idea of artificial hearing loss correction was in 1957. It was done by the French group, of whom included Drs. Djourno and Eyries. The two implanted a patient with a single electrode into the middle ear cavity near the auditory nerve. An electrode is a conductor through which electricity enters or leaves an object, substance, or region. The patient was able to understand noise without pain. (Kissiah, 2007). The implantation only lasted a few weeks and then failed. The Doctors tried on another patient, but it resulted in failure as well. After that, Eyeries refused to go forward with any other experiments. (Eshraghi et al., 2012). This was the start to something revolutionary. Dr. House is also someone who contributed to the making of the Cochlear Implant. Dr. House was a part of the House Ear Institute (HEI). In the 1960’s, Dr. House had been doing many experimental insertions of either single electrodes or multi-electrode implants into many patients. (Kissiah, 2007). His first permanent surgical approach seemed to work; Dr. House’s patient was able to pick up on different noises but the devices had to be taken out because of complications with the failed compatibility of the electrodes. House ended up delaying any further work from fear of more infection or more electrode rejection. House returned to his work six years later, in 1967, with a partnership with an electrical engineer, Jack Urban. (Eshraghi et al., 2012). Another highly recognized person is Simmons. Simmons placed a single-wire electrode into the auditory nerve of a deaf and blind volunteer patient. His approach was different than what had been done before. His patient was able to perceive speech, but was not able to understand what was being said. After this experiment, Simmons decided to stop testing on humans and began to experiment on animals. He did this for safety reasons and to study the physiological response to electrical stimuli. (Eshraghi et al., 2012). A neurophysiologist, named Michael Merzenich, also conducted experiments with a single electrode implants. His results were very similar to those of Dr. House, the patients were not able to recognize speech. He also did multiple experiments on animals, where he discovered different frequencies, with a single electrode can create a response in the auditory pathway. (Eshraghi et al., 2012). There were other doctors who contributed to the path to the first, working Cochlear Implant, such as Drs. Michaelson, Merzenich, Schindler, Henri-Chouard, Eddington, and Balkany. Dr. Eddington is known for his creation of the Inneraid Implant. (Kissiah, 2007). It is important to know that these devices were only able to give their patients the ability to hear background noises and did not get to experience the communication of spoken word, although it was a help to those who could lip-read. (Kissiah, 2007). This was until Adam Kissiah made the first, working Cochlear implant. Adam Kissiah is credited with the breakthrough of the Cochlear Implant. Kissiah worked at NASA- Kennedy Space Center (KSC) located in Florida. Kissiah suffered from hearing problems and after three failed, corrective surgeries, he became motivated to fix this problem. (Lockney, n.d.)  He later designed the first electronic simulation of the the operation of the human cochlea, his design included 22 electrodes. He was also the first to apply for a patent through the Kennedy Space Center Technology Commercialization Program. The patent was granted by James Harrell. Kissiah was granted Patent 4,063,043. (Kissiah, 2007). Kissiah started something monumental with his design. It was about twenty five years later that Kissiah received the right recognition for his life altering discovery. It is estimated that over 66,000 patients have received an implant. (Lockney, n.d.). The Cochlear Implant has gone through many changes since its birth but has only gotten better. Today’s version is known as the Naida CI Q70 system. This version has three types of electrodes arrays and 16 active electrodes. You can also add a second sound processor which is also waterproof.  (Hainarosie, Zainea, & Hainarosie, 2014)Benefits of the Cochlear Implant When considering if the Cochlear Implant is right for you, or in many cases, your child, it is important to completely understand all the facts about the Cochlear Implant and how it could help you and your baby. The Cochlear Implant is very effective in a person’s life by giving them the ability to comprehend sound. In the year 2012, there have been 324,200 people around the world who received an implant. In the United States, 58,000 adults and 38,000 children received the implant. Eligibility for the Cochlear Implant starts as early as 12 months. (NIH, 2017). To be a candidate as an adult, eighteen years or older, you must have moderate to profound hearing loss in both ears and you must have minimal benefits from amplification. This is determined by a test which you must score less than, or equal to 50% in the prospect, operative ear, and in the opposite ear you must score less than, or equal to 60%. For children aged 2 to 17, you must have severe to profound hearing loss, you also must have limited benefits from binaural amplification, or simply, wearing two hearing aids. Another requirement for kids is they must score less than, or equal to 30% on Multisyllabic Lexical Neighborhood Test (MLNT) or Lexical Neighborhood Test (LNT). (Shapiro & Roland, 2010). Both tests examine word and sentence recognition. (Krull, Choi, Kirk, Prusick, & French, 2010). For infants between the age of 12 and 24 months, they must have profound hearing loss with no benefit from wearing two hearing aids.  (Shapiro & Roland, 2010). It is recommended to get the implant as early as possible in your baby’s life so they can develop quicker and catch up to the normal growth rate. There are so many benefits to the Cochlear Implant, although you do not receive normal hearing, you are still able to hear and enjoy the ability to be able to have conversations with people everyday. Adults are the quickest to benefit from the implant, kids usually take more time to full benefit from the surgery, for they have to learn and adjust to this new world. From birth to the age of five is so crucial in child skill development, and when a child is profoundly deaf, they are unable to develop adequate. They are unable to develop auditory speech perception, speech production, and english language skills. Being deaf can affect everything in your child’s life. It can take away the social aspect of their lives because they will not be able to have oral conversations, there will be fewer educational and job opportunities because of lack of communication, and there is a chance for low self-esteem. (Department of Health & Human Services, 2012). This makes it very important to do the surgery as young as possible. Kids with the Cochlear Implant will have to go through many sessions of speech therapy and learn how to talk, but the end result is worth it. There have been many studies to prove that kids with the Cochlear Implant develop at a good rate and are able to catch up to their peers who did not undergo the implantation. Geers and Tobey conducted a study  in the year 1995 which assessed speech perception of children with the Cochlear Implant versus children with hearing aids. After twelve months of analyzing and assessing both sets of kids, the children with the Cochlear Implant scored higher than the kids who just have hearing aids. (Mckinley & Warren, 2000). Kids younger than 18 months who received the cochlear implant develop language skills close to those who were born hearing. They also are seen to be very successful in the classroom. (NIDCD, 2017). Young children who were implanted at a young age also show much more improvement in speech production and recognition and sound detection than the children who use a hearing aid. (American Academy of Audiology, n.d.). Although it is true everyone develops at different rates, it is a fact that the Cochlear Implant helps you develop at a faster rate to catch up to where “normal” development is for a certain age level. How fast you develop with the Cochlear Implant also depends on the age you became deaf, and when the Cochlear was implanted, the amount of experience you have with the Implant and your educational training. Even if everyone increases their development at a different rate, they are still developing. Choosing the Cochlear Implant will restore some hearing in your child, keep them up to pace in schools, keep them safe, for they can not hear danger, and give them a normal life. Risks of the Cochlear Implant With all surgeries, there are always risks and side effects that need to be considered; especially when you are making this decision for your child. It is very important to know and understand all the possible risks and side effects to this surgery. For children around the age of one, there are many concerns going into the surgery. There is a concern with blood volume, the risk for infection, issues with the scalp flap, a chance of device migration, it could affect the shape and thickness of the skull and possibly cause facial nerve issues. Kids can lose 10% of blood volume, but without careful surveillance during the surgery, kids can lose up to 35 ml. (Shapiro & Roland, 2010). Kids are also much more prone to infection, the input of the Cochlear Implant can cause a greater risk to Meningitis. The issue with the scalp flap is that it may not heal as it should, creating infections and problems for the child. (Shapiro & Roland, 2010). The chance the device moves is because the child is still growing which means the chance for plates shifting is higher. The surgery could also affect how the skull grows and its thickness, because it is a foreign object in the head and ear. There is also a threat to the facial nerve because if the surgeons are not careful while heating nerves through the facial recess, they could hit the facial nerve. (Shapiro & Roland, 2010). This nerve controls movement in your face, so if obstructed it can cause paralysis to the side of the face that is being operated on. (Center for Devices and Radiological Health, 2014). These are risks for everyone who undergoes the procedure, but babies are more susceptible. Other possible risks from the procedure include, cerebrospinal fluid leakage. This is possible because your brain is filled with fluids, and when you create the hole in the inner ear, it is possible for the fluid to leak. (Center for Devices and Radiological Health, 2014). There is also the risk of a perilymph fluid leak. The inner ear and cochlea contain fluid and that fluid can leak through the new hole that was produced during the surgery. (Center for Devices and Radiological Health, 2014). Another clear risk that comes with any surgery is, infection around the skin. This could also lead to a blood and fluid build up where the surgery was performed. There is also a risk of random attacks of dizziness. (Center for Devices and Radiological Health, 2014). Tinnitus and taste disturbance can also occur. Tinnitus is the ringing or buzzing noise in your ear. Taste disturbance can occur because the nerve that gives you the ability to taste is also located in the middle of your ear could be damaged during the implantation. (Center for Devices and Radiological Health, 2014). The surgery also runs a risk of a numbness sensation around the ear. The surgery also risks receiving a reparative granuloma. This is a benign lesion that appears when your body rejects the Cochlear Implant. Those are all the surgical risks, people with the cochlear implant may also experience other side effects that are not as serious. Other risks include hearing sounds differently, or losing your residual hearing. Residual hearing is the little ability to hear that you had, with the surgery you may lose that and only be able to hear what the Cochlear Implant allows. There is also a chance you will not hear as well as expected or hear strange noises, and in turn have trouble understanding english. There is also a risk for constant irritation at the site of surgery. The Cochlear Implant also takes away the opportunity to have neurostimulation and electrical surgery as well as electroconvulsive therapy. A great risk is failure or damage to the Implant and cause it to be removed. (Center for Devices and Radiological Health, 2014). Another chance you take when you are implanted is being criticized from the Deaf Community. They feel as if the Implant is taking away from who they are and that there is nothing to be fixed. It is also important to note that the Cochlear Implant is not the end of the problem. It is a long term commitment to years of speech therapy, rehabilitation, must learn oral and visual language skills, and lastly, there is a possibility of additional surgeries. (National Association of the Deaf, 2015).Ethical Issue; Quality of Life The Ethics of Quality of Life is defined as, “Quality of life as a state of satisfaction expresses a value judgment: the experience of living, as a whole or in some aspect, is judged to be good or bad, better or worse.” (Siegler & Winslade, n.d.). The issue at hand is medical intervention to correct or change non life threatening conditions in patients. (Admin, 2009). The two sides in this issue are Medical Professionals and members of the Deaf Community; their different perspectives are the fuel to this issue. The Deaf Community believes that they are not disabled. They treat their deafness as a trait, not a disability. There are more than 700,000 people in the Deaf Community and they thrive together as one. (Admin, 2009). People who are deaf, do not feel as if there is something to be fixed with them because they are able to live a long, healthy life without the ability to hear. Children who are born deaf, are also born into a culture. About 90% of babies who are born deaf, are born to hearing parents. This means when parents consider the Cochlear Implant, they are making an ill-informed decision because they do not, truly know what they are taking away from their child. (Admin, 2009). This also leads to the ethical issue of Proxy decisions. A Proxy decision is a decision maker for patients who are incompetent. The problem with this is, the parents do not know the severity of their decision. The Deaf Community also feels like the Cochlear Implant has started Ethnocide on them. Ethnocide is the deliberate and systematic destruction of the culture of an ethnic group. But the issue at hand is the ethical decisions of the Quality of Life a person. It is believed by the Deaf Community, that others who are not deaf, should not try to fix them. (Admin, 2009). Who is anyone else to decide what the perfect life is and how to live? Deaf people can get jobs, have a family, and live a normal life. The only difference in quality of life is, they can not hear. But members in the Deaf Community see nothing wrong with their life, it is who they are. The medical community has a flipped viewed on this issue. Society and the medical field view deafness as a disability and the Cochlear Implant is the best solution. The “normal” human- being has the ability to hear and they believe everyone should at least consider it to give you the best life possible. The Cochlear Implant gives you the ability to hear, which will bring you many more opportunities than you would receive if you were deaf. With the Cochlear implant you are able to learn at a better pace, talk with people, and have better employment opportunities. Although, there are Equal Opportunity Acts that give people an equal chance to be employed, there are still jobs where the ability to hear and have a conversation are necessary skills. The medical field feels the quality of life with the ability to hear is a much higher quality of life than of those without the ability. Discussion The controversy over the Cochlear Implant has been prevalent issue in the Deaf Community for years on end. They feel like the Cochlear Implant is Ethnocide and the Medical Community feels like they are giving the deaf a better life. This is what started the debate over the Quality of Life Ethics. After careful examination of both sides and opinions, I agree with the medical field. The Cochlear Implant is able to give you the ability to hear, and to pass up the opportunity to restore a sense. Although it is no one’s right to tell you how to live, you would have a much more fulfilling life with the ability to hear. The issue over the Proxy Decision Maker is another problem the deaf have with the Cochlear Implant. The Proxies are parents for deaf-born babies who are making the decision to give their child the ability to hear. The Deaf Community feels that this is taking away from their culture, but it is the smart decision for the child. The earlier the surgery is done and the Cochlear Implant is inserted, the faster the child will develop because they will still be in their crucial developmental years. With being able to hear, you will receive a better education, be able to have any job you can dream of, lead a normal life and so much more. Being deaf, you can still work and lead a normal life, but it denies you the opportunity to have an oral conversation with someone which can also be a component to the lack of opportunity. To deny yourself or anyone else, the opportunity to have crucial sense would be cruel. Conclusion The Cochlear Implant is a surgical procedure that not only restores hearing, but has the potential to give the deaf more opportunities in life.. This revolutionary tool has brought much controversy to the Deaf Community through the Quality of Life Ethics. Some believe that there is no need for the Cochlear Implant because the Deaf believe there is nothing wrong with how they were born and do not need to be fixed. But the Cochlear Implant is a life changing device that has changed the world by giving the deaf the ability to hear. The Cochlear Implant has advanced a tremendous amount through the last five centuries and will only continue to improve to help those in need of it. The Cochlear Implant is open to most people and has remarkable results for the patients. Although there are side effects, the pros weigh out the cons. The Cochlear Implant is able to restore hearing and give patients a “normal” life.

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