Cochlear implants have been approved by the FDA for use as a treatment for severe and profound deafness in children.
Cochlear implants work by converting sound into electrical signals which are transmitted to electrodes placed inside the cochlea. The electrical signals from the electrodes directly stimulate the auditory nerves, bypassing damaged or missing "hair cells" in the cochlea.
There are both external parts and internal parts for a cochlear implant. The internal parts are implanted during surgery. In the future, implant systems may be completely implantable.
The external parts include a microphone, a speech processor to translate the signals from the microphone into a series of electrical signals to represent sound, and a transmitter for sending the FM signals across the skin. A magnet holds the transmitter in place on the head. The speech processor comes in body-worn models, and also in models that are worn behind-the-ear that resemble a large behind-the-ear hearing aid.
Internal parts include the receiver to receive the FM signals from the transmitter and send the corresponding electrical signals into the electrode array placed inside the cochlea.
There are currently three companies that provide cochlear implants for children in the United States, listed below:
Cochlear Corporation 61 Inverness Drive East Suite 200 Englewood Colorado 80112 USA Toll Free: 1 800 523 5798 Telephone: 1 303 790 9010 Facsimile: 1 303 792 9025 e-mail: info@cochlear.com Materials avaialable: video: Nucleus 24, The Art of Hearing Nucleus 24 folder Parents' Guide
Advanced Bionics Corporation 12740 San Fernando Rd. Sylmar, CA 91342 800-678-2575 Materials available: video: Clarion, the Link Between Silence and Sound Clarion folder
Med-el Corporation med_el_corp@compuserve.com 2222 East NC Hwy 54, Suite B-180 Durham, North Carolina 27713 1-919-572-2222
The implant companies offer implants that differ in such things as number of electrodes, stimulation rates, and speech processing strategies.
Multiple-channel implants have been used for children for about fifteen years now, and have been approved for use in children by the FDA since 1990. Implants have evolved from the early single-channel implants to the current multiple channel implants.
One common misconception about cochlear implants is that a child can hear normally as soon as their implant is activated. This is not true. While most implanted children can hear most sounds of speech, for the child to process that sound and make sense of it requires countless hours of practice and therapy. Also, the sound a child hears with a cochlear implant is still not normal hearing - implanted children still typically show a 20 to 40 db hearing loss, and the speech processing strategy used by the implant is able to extract and represent only certain key elements of speech.
There have been numerous studies of cochlear implant use by children A summary of results of eight of these studies was presented in Annals of Otology, Rhinology, & Laryngology Supplement 177-April 1999 Vol. 108, Number 4, Part 2, "Meta-Analysis of Pediatric Cochlear Implant Literature" by Cheng, Grant, & Niparko. Among their findings:
A five-year study currently underway at Central Institute for the Deaf, sponsored by the National Institute of Health, is examining the factors contributing to successful use of the implant in children. Dr. Ann Geers of CID has written a mid-project summary that appears in Appendix C of this document.
You can search abstracts of articles about cochlear implants and many other topics related to deafness using Medline and ERIC (Educational Resources Information Center).
-or-ERIC
Only if a parent or other caretaker is ready to commit to the continual work required with a child with a cochlear implant can such a child receive full benefit from an implant. Speech recognition and speech intelligibility of implanted children vary considerably. Research into implant use by children attributes this variation to a variety of causes.
Cochlear implant surgery can be a stressful experience for both parents and child. Typically the surgery lasts from two to four hours. There are always slight risks associated with any surgery; one has to weigh the risks with the possible benefits. The overwhelming majority of cochlear implant surgeries occur without complications.
There are various other concerns with cochlear implants. Some implant systems are incompatible with having a MRI. Static electricity has been known to damage both the internal and external parts of an implant, so cautionary steps to prevent static electricity problems are needed. Periodic "mapping" sessions with the audiologist are also required to adjust and fine-tune the speech processing programs.
Some implant centers may provide only the basics of surgery and mapping. Other centers may include educational consultants or other professionals who work to optimize results for your child.
Complete lists of cochlear implant centers and cochlear implant surgeons can be found at the web sites of the various implant companies.
There are many factors that go into picking an implant center - such as insurance considerations, availability of follow-up care and mapping, comfort with the surgeon, and references from other parents. Some implant centers do same-day surgery, others keep the child overnight. For peace of mind of the parents and for having someone available if anything comes up such as nausea or the dressing coming loose, keeping the child overnight in the hospital may be preferred.
Parents considering implantation should also be aware that the internal parts of implants can physically fail, either totally or partially. For failed implants, reimplantation can usually be performed without problems. Implant companies claim 99.9% one-year cummulative survival rate for their implants (meaning the implants are still functioning one year after implantation). A possible figure for long-term use of implants without physical device failure is probably around 90%.
Implant companies can make available to you "package inserts" that give exact figures on device failure during their FDA clinical trials.
You can also check the "Maude" FDA database of implant failures at:
Some advocates (who can hear) for the Deaf culture community and some in the Deaf culture community are actively opposed to implants for children. For their reasons, read the writings of Harlan Lane. But even the National Association of the Deaf has softened their once vehement opposition to implants in children with a new position paper on cochlear implants issued October 2000. For example, in the position paper they state that "While there are some successes with implants, success stories should not be over-generalized to every individual." The position paper can be viewed at:
Even Gallaudet's elementary school is opening a center for children with cochlear implants.
You may encounter misinformation about cochlear implants from those opposed to cochlear implants. You may also encounter some marketing hyperbole from implant companies. Just try to separate the hyperbole, the myths, and the misinformation from the facts and reality of implants.
For example, a statement one sometimes sees is that the parents should wait until the child is old enough to make the decision for themselves about whether to get a cochlear implant. However, numerous studies have shown that the earlier a child is implanted, the better the child's hearing performance will be. By delaying the decision until their child is old enough to decide for themselves, the parents have in effect decided that their child will not get the optimal benefit from an implant and have tilted the options for their child.
The House Ear Institute has a list of possible questions you may want to ask the implant center on their website at: HEI CI questions
Some additional questions you may want consider asking the implant center are given in Appendix B.
Some questions you may want to ask yourself when considering a cochlear implant for your child are listed in Appendix A.
References:
Children with Cochlear Implants in Educational Settings, Mary Ellen Nevins and Patricia M. Chute, Singular Publishing Group, San Diego, 1996
Cochlear Implantation for infants and children, Advances, Graeme M. Clark, Robert S.C. Cowan, Richard C. Dowell, Singular Publishing Group, San Diego.
Cochlear Implants for Kids, Warren Estabrooks, Editor, A.G.Bell Assoc. for Deaf, 1998.
Cochlear Implants, Principles and Practices, by John Niparko, Karen Iler Kirk, Nancy Mellon, Amy Robbins, Debra Tucci, Blake Wilson, ISBN 0-7817-1782-5, c. 1999.
Cochlear Implants by Susan Waltzman and Noel Cohen
Cochlear Implant Rehabilitation in Children and Adults, Dianne Allum, editor
Cochlear Implants - Audiological Foundations - Richard Tyler, editor
NIH Consensus Statement on Cochlear Implants in Adults and Children, Vol. 13, Number 2, May 15-17, 1995, National Institutes of Health 1-800-644-6627; see: NIH CI consensus statement
The Sound & The Fury - a movie released Fall 2000 - see: Sound and Fury
See following website for further information about implants: Listen-Up