Cochlear implants in children

I remember reading many articles awhile back debating these implants, as they infringed on the culture of deafness. At the time, I understood that argument, but now with kids, I think I'd want to do whatever I could to make their lives easier. I'd love to hear from some parents with deaf children, and their point of view.

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Oh, PUH-LEASE. Not this debate again. This kind of thing INFURIATES me and as a DEAF person, I have a right to be! Look, I grew up with hearing aids and my speech is intelligible for the most part. I turned out fine without a cochlear implant. My brother, also born deaf, does not have intelligible speech though, even with YEARS of speech therapy. If he had the cochlear implant, it would not make a difference. Speech, like dance for others, is a skill for deaf children. Not all achieve this skill.

Besides, even with a cochlear implant, the child is STILL DEAF. IMHO, it's much, much more important for parents to focus on their deaf child's reading and writing skills. All that time going to speech therapy could be used to improve deaf children's reading skills (many graduate high school on the THIRD grade level). This is far more important than speech skills. You do NOT have to have hearing to learn to read and write. There are visual aids to help deaf children learn to read.

It's also far more important for deaf children to have an identity. Most of them who grow up in hearing families who don't allow them to sign have low self-esteem and no identity of their own. They don't find this until they meet another deaf person or go to Gallaudet University or RIT where there is large majority of deaf students. I know I didn't until I went to a Deaf boarding school for high school. When they (and myself) discover American Sign Language, they begin to realize who they are as deaf individuals and accept themselves. Then they throw out the cochlear implant. I know many people who have stopped using the cochlear implant once they have discovered the Deaf World.

Heather, if I were you, I would be very careful with the wording you chose for this post. For example: However, some children are not this lucky.

For the record, I consider myself very proud to be Deaf because it has made me the person I am today, the parent I am now. I cannot imagine what my life would be like if I were not Deaf nor am I wistful about it.

Another example: It could give you and your child a head start in correcting potential problems due to deafness.

While I agree with you that early detection (hospitals do routine newborn hearing screenings nowadays) is critical but my reason is for language acquisition. The sooner the parents know their child is deaf, the sooner they can provide a language for their child: American Sign Language. AND I MUST emphasize that cochlear implants DO NOT correct deafness. They are AIDS, a tool that helps children hear SOME sounds but they will never be hearing.

We all need to remember to use sensitive language because there are thousands of readers on this site and I am quite positive many of them have varying abilities and challenges in their lives.

And the last thing I want to say is: Please, people, focus on deaf children's ABILITIES, not on what they cannot do which is hear. We wouldn't force a child with no legs to walk, would we? We would accomodate that child to be as mobile as possible with what skills the child has. Why not the same for deaf children?

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I forgot to clarify that I am strongly against cochlear implants (you couldn't tell?) for young children. However, if the child is older, like high school age, then it's their choice and I support their choice even though I don't agree with it. It's more important to me that they made the choice on their own without the pressure of their parents and the medical community.

I am a professor of ASL and Deaf Culture at a university so if anyone has questions or wants a list of resources, I'll be happy to provide one.

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I want to say that I agree with Keri. I went to college to be an interpreter for the Deaf and my 3 years of a foreign languge in HS was american sign language.

People who are deaf do not consider this to be a handicap. They are proud to be Deaf just like I am proud of my irish heritage. Until you have spent quality time with the Deaf community or are Deaf yourself, you will never understand or even comprehend why it's not unfortunate for someone to be born Deaf.

They have an extremely strong community. To be honest, I have never met people who are more accepting of others like I have in the Deaf community.

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I was going to address how many members of the deaf community feel about cochlear implants, but I see Keri beat me to it!

I have a very good (hearing) friend who was born to deaf parents. As a matter of fact, she and her two siblings are the only ones in their entire extended family who are hearing. We've had conversations about cochlear implants and I have to say that her sentiments (and her family's) match Keri's exactly.

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I could care less about the "Culture of Deafness". (I'm deaf, and pretty much decided not to partake, as the culture wars irritate me to no end.) But I'm strongly anti-cochlear implant for one reason alone: Cochlear implants are imperfect and irreversable. They rip out the nerves in your ears and replace them with wire after drilling a hole in your skull and mounting a magnet. And they don't always work.

The "rips out the nerves in your cochlea" bit disturbs me, especially with the advancements in stem cell therapy. How horrid would I feel if I were the parent of a deaf child and I put my baby through this surgery and long recovery process only to have stem cell therapy emerge down the line, and be unavailable to my child?

Cochlear implants would be fine if they had a 100% success rate. But they don't. For some people they're just as worthless as what hearing the person had to begin with. And the sound you get out of them doesn't resemble any real-life sound. To remove the possibility of future treatments/cures in favor of an imperfect technology? Bleh.

When the cochlear implant doesn't work, what is the solution? To turn it off and go from being simply deaf (usually with some amount of residual hearing) to 100% deaf. Brilliant, eh?

Ever hear the voice of a child that has had a cochlear implant since very early in life? It doesn't sound much more "natural" than the the heavy deaf accents that freak out so many sensitive souls.

Cochlear implants are NOT a cure. They're a patch. An ugly imperfect and invasive patch.

Far more important to the child's lingual development is early and full exposure to a full and natural language (ie: American Sign Language).

That said, I can fully understand why some parents would opt to go the cochlear implant route rather than learn a new language to communicate with their child. It's certainly easier. And insurance covers it, whereas it doesn't cover hearing aids or other less invasive therapies. And with doctors promising it's the best thing ever for your child? How can you say no?

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I don't want to be run out of the room by the Deaf community, but as an Audiologist, I feel the need to insert a few more facts that someone who has no previous knowledge of the debate should be aware of.

First off, the above posters are 100% correct in saying that a CI is not a cure. When a child takes off their processor, they no longer have the auditory cues that most people take for granted. This is something to remember for any time a child would not be able to wear their processor, such as while sleeping (what will you do if there's a fire in the middle of the night and your child won't hear the alarm, or your yells to get out? What kind of alarm clock will an older child use to wake up?) or when swimming (the child will not be able to hear the lifeguard blowing a whistle.)

The above posters are also correct in saying that an implant permanently destroys all residual hearing. This is why only one ear is implanted (usually the one with a greater loss, though every case is different.) The processor picks up sound through a microphone that is just above the person's ear, it is processed into an electrical signal, and the signal then stimulates the auditory nerve so that it knows which sounds to recognize.

Implants have changed drastically in the last few decades. They have gone from one or three 'channels,' which are bands of sounds that are grouped together, to as many as 22. A one channel processor would transmit all sound as a single signal, the ear would simply know that "beep" = some sound was made, but it would not designate what kind of sound it was. A three signal processor might break it into low, middle and high frequency categories. (You could think of the keyboard on a piano as having 88 channels, each key represents a frequency or pitch, and when pressed, it sends a message to the rest of the instrument that C is being played, and the brain recognizes this stimulus as being different from the notes B or D or Dflat.)

Implants today typically break sound into up to 22 channels, (mostly focusing on the speech fequencies) and a much more clear 'picture' of sound is presented to the auditory nerve (and thus, the brain.)

That is not to say that technology will stall there. Every year there are imporvements on the previous year's technology, and god willing, stem cell research will begin a whole new frontier of hearing sciences. But we are not there yet, and cochlear implants are a patch to bridge the imperfect gap of science.

While they may be a patch, they do not magically 'fix' hearing so that it is normal. Once they have been deemed a candidate for surgery, there is usually a wait to find a surgeon/hospital that will work for the family. Once the surgery is done, there is a 6 week period of healing. Then the first mapping is done, the processor that the child wears behind their ear is hooked up to a computer and one by one, the channels are turned on. Then every few weeks/months (depending) the child is seen again to further adjust and fine tune the 'map' that is set in the processor. Beyond that there is intensive speech therapy/classes, and both parents and child need to work hard to acchieve success.


But all of that work pays off. I have been witenss to children hearing sound for the very first time, and it is an astonishing thing.

My last comment is about waiting until a child is 'old enough' to make the decision for themselves. This is probably my biggest concern. The critical timeframe for language learning is birth to 18 months. From the moment we emerge we are hearing and thus learning about the world around us. We coo to our babies while we nurse, speak in high pitched tones as we change diapers, and sing songs to soothe away tears.

Babies brains are like a sponge just waiting to absorb knowlege. When babies receive auditory stimulation, their brain makes new connections and nerves literally create new pathways, preparing their brain for more knowedge. After this time period, the brain is stubborn, and has a much harder time making these connections. This is the same reason they say that high school is the wrong time to start learning a new language, our brains won't make new connections. They say that bilingual should start at birth for the best suggess, and the same thing applies here. If a child is to be successful in both speech and ASL, it needs to begin from birth. The best way to do this is with auditory stimulation, i.e. hearing aids for mild/moderate/severe loss, cochlear implants for a profound loss.

Cochlear implants are by no means a perfect 'fix' for something that many believe is not broken to begin with. If you are a Deaf parent and have a child with a hearing loss, you will likely raise them to be a part of the Deaf community. Hearing parents are much less likely to choose ASL/the Deaf community over an implant (when appropriate) but some parents do see it as an opportunity to give their child a special community to be a part of.

The third group of parents of children with a hearing loss decide to see it as a problem, and want to correct it. They mean no ill will towards the Deaf community, all they know is that the baby they had waited for 9 months has 10 fingers and 10 toes, but the package is slightly different than they expected. They are grieving the loss of their 'perfect' child. They want to introduce their child to the culture they already have, not be thrown into one they were not prepared for. Please don't judge these parents so harsly, no mother gives their child over to have invasive surgery and goes out for a manicure. They sit at the hospital, worried sick, worried that they made the right/wrong decision, worried that the implant might not be a success, and worried because they have no control what so ever.

All I can say is this: As someone who became interested in Audiology because of their love for ASL, if my child was a candidate for an implant, I would not think twice about it. I know that it would give them the best start in terms of learning language, it would make their success in school greater, and if when they were 'old enough' to choose for themselves, I would let them stop wearing the implant if they wanted, and become a full member of the Deaf community. They will always be deaf, but there is only a small window of time for an implant to be the most successful it possibly can.

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Wow! What a can of worms you have opened I saw this post when it first came up and started writting a response but it is so emotionaly charged from me my husband actually took my keyboard away!!

most of what I was planning on saying is already here and I'm glad to see an audiologist pipe in who is well informed and pro-ASL not all audiologists are! I am anti-CI for children I know that spoken language is easier to learn as a baby but with no idea if the CI woud actually help my child or not I wouldn't want to take such a risk, esp. knowing there is a whole culture willing able and ready to take my child in without thinking that he/she is broken because of their hearing loss. I think that having a CI is a choice my child should make for themselves

No matter which side of the debate you are on I would suggest you rent "Sound and Fury" an amazing documentary that can sometimes be seen on PBS

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Sound and Fury is an excellent doccumentary, you can purchse it through pbs.org, but if you happen to be near a university with a speech and hearing science program, they will likely have a copy that they will let you borrow for free, or you can ask your library to obtain a copy for you.

I'm not sure if it came across in my first post, as I was a bit emotionally charged while typing, but if there was one thing I wanted for impart is that to implant or to not implant is a tough decision, and a very personal one. I feel that if I was in the situation, I would have the surgery done. Then again, I haven't had a child born with a hearing loss, so I'll cross that bridge if I ever get to it.

The final decision should be the one that is best for the individual family, and once the decision is made, everyone should be respectful of it. Then all people involved should put all of their effort into helping that child aquire language as wholly as possible.

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I am a 22 year old Mom to two hearing children. That said I was born deaf in my right ear with an impairment in my life. I spent my life in hearing aids. When I was 13 do to an auto-immune disease advanced by onset of puberty I lost my hearing, all of it. Literally in one day, it was gone. I was deaf for two years until I got my cochlear implant. This debate bothers me greatly. I understand the deaf culture is there for a reason. I understand why it's needed and would never criticize it. However, to me. Deafness and hearing impairment, is a MEDICAL problem. If we were not meant to hear we would not have ears. Most often deafness is caused by a specific problem. It is very often not a curable problem, but the reason is there. I see cochlear implants as the first step on the road to giving people the option to hear or not. It has many advantages and does have some undesirable effects as well(ie,damage to the cochlea and etc) thats why they only implant on one ear. If you've been deaf all of your life you know nothing else. I have had the unforunate expierence of both being deaf and hearing. Trust me 2 yrs is a long time. There were times that I forgot what it was like to hear. My problem is this. Why not at least give yourself the option? And your child? When they are young give them the best of both worlds.Hearing and deafness. By not giving them the implant as early as possible you are only making their lives harder later on. The deaf community says to wait and let their kids decide when they are old enough. Well my opinion is they also have the option to not use the implant when they reach of age. They CAN take it off and choose to immerse themselves in the deaf culture. But if they don't choose that wouldn't you want to make their lives easier by not having to struggle to learn spoken language?

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Wow, I am so glad to see the two (three? six?) different sides given thoughtfully, by those who live and work with this issue every day.

I have to admit I was turned off by the post itself though. Perhaps a bit more research before posting on such a heated topic would create a safer place for these discussions to be going on.

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Meghan, I know someone who got an implant during high school and it works well for him, if not better than other kids who had it earlier. I honestly don't agree with you that the earlier the implant, the better. Language acquisition IS possible...ASL. There is 100% guarantee that your child will learn ASL but there is not 100% guarantee that your child will speak.

I didn't need the implants to learn to speak and read and write. Recently, I had a discussion with my mother about all the speech therapy I took. She thinks I was able to learn speech because of my hearing aids. I told Mom that sadly, she was wrong. I had depended on lipreading 99% of the time; I was a perfect little mimic. That's just a skill I happened to have. Even now, without hearing aids, I can tell if a person is using their voice or not just by how they are moving their lips.

On another note, there is a little boy here where I live. He got a cochlear implant when he was younger than 2. At that time, his parents were not signing that much (they are not involved with the Deaf community) so as a result, he was not signing that much either. I saw him recently after maybe 5 years (he's about 7 years old now). He was talking to his mom and to be honest with you, I could NOT understand a single word he said! He seemed set apart from the group (both hearing and deaf kids). Imagine how he will feel when he gets older and no one will understand him and he will feel incompetent. He cannot even communicate with hearing AND deaf people!

I had a talk with his mother and explained to her to be prepare for the horrors of Middle school. That's when kids start clumping into cliques and that's when the Deaf kid will be more of an outsider than during Elementary school. I know this from experience and from countless of other people's experiences. It only goes downhill from there. Sure there will be one or two people who will be willing to be friends with the Deaf kid but it's not the same as being with a group and learning social skills. I didn't learn that until I went to my Deaf Boarding school. It was there that I was able to be in theatre, play sports, write for the school newspaper, etc. I wasn't able to do that in mainstream schools.

And one more thing Meghan, we cannot change our children to "fit" in our own world. We have to change ourselves to "fit" in their world for the most optimum results. We need to accept our children for who they are. This applies not only to deaf children but other challenges that children go through. It's hard work but the payoff is greater.

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Another audiologist chiming in to second Meghan's words.

As a professional whose job is to correct hearing loss, many members of the Deaf community see me as the enemy. I fully support Deaf culture, and think it is a wonderful thing for many people. However, professionally, and as a parent, there is no doubt what I would do for my OWN child.

The sad thing is that our world is not accepting or accomodating of those who are different. For social, emotional, and plain out safety reasons, I would want my child to be able to understand and use speech. this would enable him/her to choose which culture to interact it - the implant would give the child a choice as an adult. I have seen many children benefit drastically from an implant, and I have seen others who were not helped as much. But if it were my child, I would do everything to have every opportunity available to him/her. I would also introduce my child to the Deaf Community at every opportunity and teach them ASL. The unfortunate thing is, in my experience, that those with implants are ostracized by this community. I have not been accepted in many encounters with the Deaf Community based on my profession, which is another issue for another day.

The point is that techonolgy is improving daily, and while this is not a total solution it is a viable option for many children. And the earlier the better. It is an INDIVIDUAL choice for every single family and child. And one that should not be criticized either way.

Bet you never knew what a storm you were brewing up, huh, Heather?

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A disclaimer: I have devoted my scientific career to trying to improve the human condition through science and technology. To me cochlear implants are near miraculous evidence of the power of the human brain, both the brains of those who developed them, and more importantly the brains of those who learn to use them! Cochlear implants provide an opportunity for deaf children to be "doubly abled" to communicate via ASL and also in many cases via acoustical energy. Beyond speech, our environment has many other important acoustic signals --- babies crying, horns blowing, sirens ringing, etc. I think it is immoral to deprive a baby of the opportunity to utilize these cues which will enrich their lives and perhaps even save their lives, by not providing them with cochlear implants. The old struggles between the Deaf and the Hearing are really obsolete now that implants have proven their efficacy, and the generation of children who grow up both signing and using implants will lead us to a new reality for the deaf, in my opinion.

R. Lee.

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Another comment: Watching my grandchildren explore the world, I am thankful for all the cues that they can receive -- light, sound, smell, touch, taste.

R.L. Smith

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