The joy of cochlear implants

I read Professor Ibrahim’s article on hearing loss and cochlear implantation with great enjoyment. As someone in a similar line of work who also lost their hearing in adulthood and is now a cochlear implant recipient, it was wonderful to read such an articulate account in which so much was recognisable to me. Whilst I suspect that a formal study along the lines of “The Epidemiology of Epidemiologists with Cochlear Implants” would ultimately founder under sample size considerations, I find it interesting to consider one aspect where our experience diverged.

It seems to me that if you lose your hearing in adulthood and don’t fancy the idea of hiding away from other people forever, sooner or later you’ll be compelled to choose between one of two strategies. Will you be a nodder-and-smiler or a collar-grabber?

The nodder-and-smiler is hoping to “pass” as a hearing person: if they can’t follow the conversation, they just keep quiet and hope no-one will notice. The collar-grabber, on the other hand, will tell any passing stranger about their hearing loss and is forthright about expressing their communication needs. Professor Ibrahim, I deduce, is a nodder-and-smiler; I on the other hand am a confirmed collar-grabber and will explain interesting facts about lip reading to anyone who stands still for long enough.

Choosing a strategy is necessary because oddly, given that hearing loss is such a common problem, people won’t guess that you’re deaf until you tell them. Highly-trained experts such as one’s spouse can see through the nodding-and-smiling facade at fifty paces, but new acquaintances are extraordinarily slow to cotton on. When people detect that you’re not responding completely appropriately to what they’ve said, almost the last explanation that will occur to them is “Hang on, I don’t think this person can hear me very well”. Instead they are quite ready to believe that you are bored, sceptical, eccentric (but not in a good way), shy, or just plain rude.

I find it very distressing that anyone might think me rude or uncaring, and that’s been a primary driver of my career as a collar-grabber. Besides, people do genuinely want to help but don’t always know how. So I believe there are strong arguments for telling people straight away; but nothing about deafness is simple, and I’ve found that disclosing hearing loss has risks as well as benefits.

Even the opportunity to tell people about your communication needs is a bit of a double-edged sword. You can ask people to speak more slowly and generally they do, but almost everyone will alter their natural speech rhythm as they slow down and this is disastrous for lip reading because you then lose essential contextual clues. It’s surprisingly hard to get this right. Try speaking very clearly at about two-thirds of your normal speed without losing rhythm or natural emphasis; of course while standing in a good light and keeping your face always turned to your listener. If you can do all this and still remember what it was you meant to say, I salute you!

The consequences for lip-reading of asking people to slow down are easy to understand even if hard to address, but there’s a more subtle adjustment going on with slower speech that’s all the more powerful because people are clearly quite unaware that they’re doing it. What I’ve found is that people have a strong tendency to bundle together a need for slow, clear speech with a need for simple concepts. Speaking to a deaf person is not like speaking to a new language learner; or a person with an intellectual disability; or a small child. All of these conversations have their own unique communication needs and it takes conscious effort not to blur the lines. We all know not to shout at a foreigner but it’s equally inappropriate to assume that if someone can’t hear, they can’t manage complexity.

It is deeply uncomfortable to be spoken to as if you have cognitive difficulties, if you don’t; and the resulting conversations are actually more isolating than no conversation at all.

The idea of diminished competence can be tenaciously entwined with deafness even amongst people who’ve had disability training. For example, when flying on your own it seems sensible to let the cabin crew know that you can’t hear announcements. This can be enormously helpful if the flight is delayed, as the crew will keep you updated about what’s going on; and the extra attentiveness is also nice when you need someone to come and take your dinner tray away so that you can work. But it can be a little disconcerting when they try to help you off the plane at the other end, having extrapolated a specific communication need into a generalised, boundless lack of capacity.

I had my first cochlear implant in 2006 and a second-side implant in July 2013. It’s been truly life-transforming, not least because after all these years I can finally let go of people’s collars and “pass” as a hearing person. For me, it’s been a wonderful, but rather bittersweet experience to rediscover how it feels to chat to someone without first having to climb out of the box that they built for me the moment I told them that I couldn’t hear.