Cochlear implants and hearing aids: some personal and professional reflections.

The ear, nose, and throat physician who diagnosed my hearing loss many years ago called it a “progressive hearing loss” and told me that I would eventually be going deaf. And then he went on to his next patient. It took me a long time to realize that what he meant by “deaf” was not a condition that I would ever fully experience. He apparently used the term as a medical diagnostic label and not as a functional description. I am quite sure that the potential contribution of hearing aids never figured in his diagnosis. At the time, the medical profession mainly focused on the limitations of hearing aids—when they thought of them at all (audiology as a profession was in its beginning stages). Of course, without a hearing aid, someone with a hearing loss of 60 or 70 dB was indeed functionally deaf. Fortunately for me, this diagnostic encounter happened while I was in the service. Shortly thereafter, I was transferred to Walter Reed Army Medical Center, where I participated in the aural rehabilitation program then being offered at military hospitals. There I received my first hearing aid. I still remember my reactions when I first turned it on. I could hear my footsteps echoing down the hallway at the Forest Glen section where the aural rehabilitation program was then located. It was an exciting but rather eerie experience, and I wondered if those people with perfectly normal hearing could also hear these sounds. But of course they could; for them, it was just part of the auditory background, heard but ignored. This first hearing aid was a bit larger than a pack of cigarettes and worn in one’s shirt pocket or in a special harness under the shirt. Of course, there were lots of problems with these aids, but before we dismiss them as primitive devices from the technological Stone Age we should know that they helped many people (including me) hear and function much better than we would have without them. I shudder to think what my life would have been like without them. Over the years, my hearing loss did indeed progress, but as it did, a parallel development with hearing aids also occurred. Hearing aids moved from the body-worn style to ear level, continually becoming more sophisticated and powerful. By this time I was an audiologist myself and able to keep up with all these new developments. Thus, I was able to switch to more appropriate hearing aids (thanks to the Veterans Administration) as my hearing thresholds worsened. These changes permitted me to continue to function quite adequately for many years. During this period, about 20 years ago, cochlear implants were developed and subsequently demonstrated to be a potentially significant prosthetic tool. The first generation of implants were single-channel devices whose advantages, while noteworthy for those who were candidates (little or no