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Emotional Impact

Posted By Naama Tsach, PhD, Wednesday, June 15, 2016
Updated: Monday, June 13, 2016


 

Emotional Impact of Cochlear Implantation

How does cochlear implantation impact people on an emotional level? Though it is difficult to find empirical data documenting the emotional effect of cochlear implants on adult recipients, this is an extremely important issue. How can one find information about emotional effects? One source is the abundance of online videos documenting the first moments of hearing after CI activation. In addition, there are published studies that assess quality of life benefits for adult CI users.

Most CI candidates and their families view videos posted on the Internet documenting the first sounds and words heard by adults and children at activation. Watching these videos, one can witness the tremendous excitement of the recipients and their families—often expressed with tears of joy and relief. Studies examining the effect of CI on adult quality of life document that there is general improvement and satisfaction over time.

But what happens in between? Relying on these two sources of information (i.e., videos and quality of life studies) might lead to the impression that the timeframe following CI is characterized mainly by a great happiness and that once a cochlear implant is activated, individuals experience a continuous increase in your quality of life. However, many CI recipients know from their personal experience that the reality is much more complicated. My experience with many adult CI users, has taught me that not everyone experiences the same level of joy when the implant is activated. Importantly, for some people, the first period of CI use is characterized by significant emotional challenges.

Let's start by stating the obvious; severe to profound hearing loss is not a life threatening condition. Adults' motives are not linked to health conditions in the same way that many other surgeries are but rather are driven by a desire for a better quality of life. This includes improved communication with family members and in the as well as better environmental orientation. These hopes may be dashed in light of difficulties that arise initially. The challenge of adapting to the CI and the gradual—not immediate—acquisition of auditory skills can cause intense emotional distress and disappointment. Emotional difficulties may be experienced by adults with wide-ranging hearing histories. In this post, I would like to share some experiences that I have witnessed.

Recipients Who Experienced Progressive Hearing Loss

People who lost their hearing progressively later in life might experience the sound provided by a CI as unpleasant (not "natural") and their speech perception via CI might not meet their expectations. They might not accept the time required to adjust to the CI. Their wish is to experience normal hearing again. It will take them some time to acquire improved hearing skills and to accept that their CI cannot provide normal hearing. Someone who lost their hearing later in life may be disappointed when their auditory progress does not occur as quickly as they had anticipated.
It may appear that people who had progressive hearing loss have the least need for auditory rehabilitation given their prior auditory perception. On the other hand, such recipients may experience high levels of stress. They may derive special benefits from an auditory therapist who can help them to recognize their achievements rather than dwelling on their difficulties. A therapist can also help the new recipient understand the gradual nature of the rehabilitation process, provide answers to questions and help them remain positive about the process.

Recipients with Usable Residual Hearing in One Ear

People who have usable residual hearing in their non-implanted ear may feel that the hearing aid continues to provide the dominant hearing information during the initial timeframe after activation while the implanted ear provides less usable information, even to the extent that information from the implanted ear interferes with speech understanding. Auditory training improves the implanted ear auditory abilities as well as contributes to the CI users' faith in the potential auditory benefits of the implanted ear. The concern is that people with functional hearing in their non-implanted ear do not continuously use their implant and may not give their implanted ear sufficient opportunity. An auditory therapist can help such recipients to maximize the benefit from the sound from cochlear implant and merge the two sources of sound.

Prelingually Deaf Recipients

This group includes people who never experienced normal hearing and must learn to adjust to entirely new auditory stimulation. During the first period after implantation, the auditory information they receive may be incomprehensible and may be perceived as disturbing noise. The silence that engulfed them before cochlear implantation is gone and they are exposed to many sounds without the ability to distinguish or choose which sounds are worthwhile to focus on. These recipients may struggle to acquire basic auditory skills such as identifying environmental sounds, speech sounds, and words and phrases. They may also need to learn about the impact of various acoustic environments on speech perception.
Prelingually deaf recipients who come to CI may also need to learn a good bit more about spoken language communication. During the rehabilitation process, CI recipients are gradually exposed to new sounds and they expand use auditory information in their daily life. This is a fascinating journey in which CI users' experience auditory learning and growth, however they also become more aware of their past and present limitations. This rehabilitation process requires emotional strength and support.

Concluding Thoughts

It is important to remember that the course of adjustment and rehabilitation is very personal and there are various possible scenarios relative to one’s emotional adjustment. Every scenario is legitimate and should be accepted sensitively and patiently by the CI recipient’s family, their CI team, and by the CI user himself. One’s emotional reaction is not predictable. It is affected by a variety of personality factors and by the course of the auditory learning as well as the support from the recipient’s family, social environment, and his or her CI team.

Recommendations

If you are experiencing emotional difficulties arising from cochlear implantation, know that you're not alone. Like many other starts in life, the beginning of the path can be difficult but it does not necessarily imply the future and there is no reason for despair. Remember how brave you were choosing to go through the surgery. Continue to have faith that your dreams for a better quality of life will eventually come true. As explained in this and earlier posts, CI rehabilitation is hard work.
In addition, CI rehabilitation is a very dynamic process that requires emotional adjustment skills, flexibility, positive thinking and faith in yourself and your CI team. If you feel that the process of adaptation to the cochlear implant is an overwhelming emotional burden, please seek professional support. You can contact your CI team and seek the appropriate assistance.

 

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Mary Beth Napoli says...
Posted Wednesday, June 15, 2016
Great blog Naama! The emotional journey of adult CI users is often overlooked. Working with a CI team, especially a CI audiologist, who supports both the audiological and emotional journey is a blessing. My wish is that every adult CI user has a close, understanding ally to accompany them on this journey. Having someone who is ready to listen, understand, support and encourage you along the way is so much help. This journey has its ups and downs and being able to share the wow moments and the frustrating moments makes the experience so much easier.
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Felicity Bleckly says...
Posted Friday, June 17, 2016
There are so many issues with a CI apart from the obvious of hearing again. Emotional, identity, technology, expectations.
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Rochelle Dennis Twining says...
Posted Friday, June 17, 2016
Really appreciate this post, was euphoric when first activated, then hearing started to fade and I had anxiety, not understanding that I needed a new mapping. Has been back & forth for about nine months. Others don't recognize how emotional this experience is. In a room full of ppl, I've laughed, because I realized I was hearing - they thought I was weird. When having a bad hearing day, get angry when ppl say , but I thought you could hear? Thank you for validating the emotions if this powerful experience!
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