Cochlear Implant Expert - Current & Past Questions

Current Question:

Q. I teach deaf children, some who have been implanted. The mainstreamed implanted children who I serve are missing so much classroom information when presented auditorily only. My experience tells me that their language (and speech) would only be enhanced by adding sign language. And yet I hear that implanted children should NOT use sign language. Is there any actual RESEARCH to support or refute the use of sign language with cochlear implants for academic learning? I ask this fully knowing that auditory and speech training should continue to be a primary focus.

A. Research specific to children with implants and interpreters is not available, however your questions regarding the use of interpreters with children is often asked. Children who require additional information and who use a signed system should have access to it for educational purposes. Studies of children who use sign supported English demonstrate excellent language abilities post operatively. As a group however, they demonstrated poorer production than those orally trained. For this reason many schools that use sign supported English have made a concerted effort to reinforce the speech production as often as possible. In addition, many teachers with children with implants utilize an approach that incorporates listening-only during part of the day. For material that is already known to the child, questions are asked in an auditory only mode to allow the child to practice his or her listening skills.
 

Past Questions:

Q.  I am a candidate for a cochlear implant and travel quite a bit. I would like to know the best way to get through the metal detectors with a CI.

A. Individuals with cochlear implants can travel like anyone else.  There is an identification card that they can carry with them to let the security and staff people at the airport know they have an implant.  In these days of heightened security they may have to be individually scanned with the wand. They may also ask that the implant processor be removed and sent through the X ray equipment. This will not damage the device nor will the wand create any problem.

Q. Which is the best children's hospital to get an implant? 

A. There is no best Children's Hospital for implantation. Having just finished a book that will be published by Gallaudet Press next year entitled, "The Process of Implantation: A Guide for Parents," there is a complete chapter that addresses those issues that parents should consider when choosing an implant facility. Remember ,the implant is not just surgery and that an entire team with expertise in pediatric audiology, speech, language and education needs to be in place. 

Q. How do you decide which cochlear implant device to choose for your surgery?

A. Each implant is excellently designed and effective in children and adults. However, no implant can guarantee a particular result. Each adult and child is different and bring different things to the process. You should visit all three manufacturers websites, speak with professionals in the field and read as much as possible to determine which device best suits yours or your child's needs. For links, click here: http://www.hearingexchange.com/resources/Cochlear_Implants/

Q. There has been some debate at the pediatric facility that I work at on the usefulness of  vestibular testing in children pre-implantation. What is your opinion on the worthiness of such  testing, and, if you do recommend it, can you tell me your rational and protocol? If you know of any good written resources on vestibular testing in pediatrics, I would be very interested, as well.

A. Vestibular testing for young children is not recommended since it requires a high degree of cooperation on the part of the child. In older children when there is thought to be some vestibular function some facilities may order these tests. On the average however most implant
centers do not perform them. As for references on the subject, there was a great deal of research initially conducted by Isabelle Rapin on this subject. I suggest you begin your research there.

Q. I have a son who is currently 2 years old. We found out in February that he is profoundly deaf and he was fitted with hearing aids in March. He has done very well on his hearing tests ranging around 30 to 45 with hearing aids. I want to give him a chance with the hearing aids since he is doing so well. But I fear that we might have to have a cochlear implant done if he dosn't develop speech. We are currently at LIJ in New York and the Clarke school in Manhattan as of next week. My fear is to do a cochlear implant and then some new research pans out in the future! Do you know of anything in the works that might rejuvenate the hair cells or other causes of deafness? 

A. Although hair cell regeneration has made some progress over the past few years, it has only been accomplished in lower forms of animals on a very rudimentary level. Since your child is young and needs to have access to oral language, it is important to take advantage of these early years. You should have the implant center at LIJ evaluate your child to determine candidacy. An implant is only performed in one ear in chidren and so if hair cell regeneration should become a possibility in years to come then it can be accomplished in the other ear. 

Note from HearingExchange: At 30 to 45 decibels, your child is still missing sounds within the speech banana. To better understand what he can and cannot hear with his aids at these levels, visit http://www.audiology.org/consumer/guides/uya.php.

Q. Our 13 year old daughter is scheduled to receive a cochlear implant on June 19th. Her camp program starts 6 days later. She wants to go. Are there any concerns we need to deal with if she goes? 

A. Children who receive cochlear implants require a recuperation period that oftentimes can last several days to several weeks. The incidence of post operative dizziness especially in older children and adults often precludes them from participating in activities directly after the surgery. These symptoms pass. 

If, in this case, you are talking about a day camp that is located in a local high school or college then there is no reason that, barring any problems, the child couldn't attend. However, if you are talking about a sleep away camp with outdoor activities and other possible hazards, to contemplate sending a child to camp only 6 days after surgery would not be wise. 

If the adolescent in this case is really eager to go away to camp, then just delay the surgery until after the summer. A delay of a few weeks will not substantially change the outcome. Many surgeons prefer that children do not get the area wet right away and if there is any post operative swelling one would not want the child to be far away. I would suggest that you discuss these issues with your individual surgeon to determine his/her philosophy. 

Q. I have severe hearing loss in both ears. I am told that I have about 75% loss, with the three highest tones gone. I am 48 years old male, and have worn aids since I was 20 years. I use Widex Senso BTEs. My word discrimination is below average to poor. I am getting frustrated with not being able to hear and understand. Am I a candidate for a cochlear implant?

A. The criteria for cochlear implantation has changed substantially over the past several years. Although it is difficult to determine if someone is a candidate without actually testing them, there are a few guidelines to follow. 

First, given the level of your hearing loss you will pass the first screening criterion i.e a severe hearing loss. The real question that cannot be answered without an evaluation is how much speech recognition you are able to attain with your hearing aids. Candidates are now able to receive a cochlear implant if they obtain 50% or less in the ear being considered for an implant based on special tests of sentence recognition. 

Since you report that you are missing some high frequency information, you would most probably be a candidate. My recommendation is to seek an evaluation at a local implant facility. If you do not know of one, you can contact each of the manufacturers to see if there is one in your area. A list of the manufacturers and links to their websites is available at: http://www.hearingexchange.com/resources/Cochlear_Implants/

Q. My 5 1/2 year old daughter was implanted with a Clarion in December 1997. Eleven days ago the internal device failed due to unknown reasons (no falls or blows to the head). One audiologist told me that there were a few "batches" of implants that came from Advanced Bionics with manufacturer's defects, causing the failure rate to be higher than normal. Do you know what she is talking about? How do I find out if my daughter's implant was in one of those groups?

A. There was a batch of implants very early on in the Clarion group that were manufactured with some weakened ceramic. Given the date of this child's implant I do not believe it was one of the group. Had it been, the parent would have received a letter concerning it. As for the reason for the failure it is difficult to ascertain until the device is explanted. The company will perform a full device check and send it to the center afterward. The center will then forward the report to the parent.

Q. As a Speech-Language Pathologist working with Early Intervention, I have recently had an influx of children on my caseload who are candidates for cochlear implants. I am beginning to see some of these children now and most of them have not had their implants yet. Do you have any tips for special things to work on during pre-implant stages? Parents have wanted children to learn sign language and I am also working on having children look at the face of speaker and imitate oral motor movements in mirror and other movements. The children I work with are young, around 18 mos and it is difficult to have them sit and focus on any one task. Any ideas? Good resources?

A. Although I am not a speech pathologist, many professionals that work with young children often ask the question that you raise during the pre-implant stage. First, let me begin by offering several resources to you. There is an organization known as NECCI (Network of Educators of Children with Cochlear Implants) that organizes workshops around the country to address some of the candidacy and habilitation issues. If you are interested in more information you can email mailto:CHIMELISSA@aol.com and request information on the next scheduled workshop. There are a number of books that are good resources as well. Warren Estabrooks and Nancy Tye Murray both have publications that outline some strategies to use. My co-author Mary Ellen Nevins and I also published a book, Children with Cochlear Implants in Educational Settings which is available at the HearingExchange Bookstore http://www.hearingexchange.com/bookstore/index.htm.

Now what should you do to prepare the child? This will depend a great deal on the child's abilities with his/her hearing aids. It is good to revisit Norm Erber's levels of auditory development and remember that children progress from detection to discrimination to identification and finally comprehension. Using sign language is an excellent tool to bring in language at an early age. The imitation of oral motor movements in a mirror are not at all appropriate at this age and in fact are not often used with many children. In some cases of children with additional oral-motor difficulties there may be strategies that are incorporated into the session that might include some of this work but again at 18 months this is not necessary.

I strongly urge you to seek out professional development opportunities (and there are many out there) to gain some additional information, as this topic is too expansive to completely answer in this arena.

Q. What are the risks if any associated with the implant? What is the percentage that those risks occur? 


A. The surgical risks associated with implant surgery are the same as any surgical procedure and are related to the general anesthesia. There have been no cases to date in which major complications have occurred. There are minor post-operative sequelae that may occur like post-operative vomiting and some mild dizziness that subsides. In a very small percentage of cases there may be a facial nerve weakness that might occur which also resolves over time. Since the surgeon is working so close to the facial nerve there is always the possibility of facial nerve damage although this has been extremely rare. It is best to discuss all the risks with a qualified implant team.

Q. I am a post-lingually deafened male. I became deaf at age 7 after learning speech and language. I recently received a cochlear implant. It is working well- I can hear almost everything now- BUT I still cannot understand spoken language. How can I help myself learn to identify sounds and speech?

A. There are many individuals like yourself who are now seeking implantation. This is due to the improvements in the technology and cosmetics of cochlear implants. The benefits for individual with long durations of hearing loss are still being investigated and there seems to be a wide range of performance. Therapy for this group is a must due to the long duration of deafness. I suggest that you seek out a speech language pathologist who has experience in working with children or adults who are deaf or hard of hearing so that he/she can work on the development of auditory training and speechreading skills. Your implant center should have access to such an individual. If they do not then contact your state speech and hearing association. The professional doesn't necessarily have to be someone who has had implant experience but it should be someone with experience in working with persons with hearing loss.

Q. Are children with cochlear implants allowed to participate in contact sports and if so what kind of protection needs to taken to ensure their safety with the device?

A. Children with cochlear implants participate in a very wide variety of sports.  We have had children who have played soccer, basketball, hockey, baseball, La Crosse and horseback riding to name a few.  For those sports that require a helmet then the child must be sure to wear one.  Is there a rare possibility that the child who is participating in a sport that does not require a helmet will receive a direct blow in the area of the implant? Yes, but the
likelihood is small and it is always best to look at the child's activity in the context of the socialization aspects and what they afford.

Q. I have a five year old daughter who is losing her hearing. She is considered a good candidate for a cochlear implant. How do I choose? Is there a good source of information that compares each implant company? 

A. There is no one source for this information and frankly you should never rely on only one source. You can access each of the manufacturers websites at the Resource Directory or call their 800 numbers for the written booklets. Beware however that you may get some manufacturer hype. You will need to discuss this with your implant team. The good news is that regardless of which implant you choose for your daughter, it will do the job. They are all good. My colleague Mary Ellen Nevins and I are writing a book for parents and hope to answer some of these questions. It will be published by Gallaudet Press sometime in late 2001.

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