A Broader View of Pediatric Cochlear Implants Practice Perspective: An Occasional Column of Viewpoints on Clinical Practice Features
Features  |   June 01, 2006
A Broader View of Pediatric Cochlear Implants
Author Notes
  • Donald Plapinger, is the director of Clinical Audiology and the Cochlear Implant Program at the Oregon Health and Science University. Contact him by e-mail at plapinge@ohsu.edu.
    Donald Plapinger, is the director of Clinical Audiology and the Cochlear Implant Program at the Oregon Health and Science University. Contact him by e-mail at plapinge@ohsu.edu.×
Article Information
Hearing Aids, Cochlear Implants & Assistive Technology / Features
Features   |   June 01, 2006
A Broader View of Pediatric Cochlear Implants
The ASHA Leader, June 2006, Vol. 11, 5-13. doi:10.1044/leader.FTR1.11082006.5
The ASHA Leader, June 2006, Vol. 11, 5-13. doi:10.1044/leader.FTR1.11082006.5
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  • Mila O’Bryant heads off to the prom with her date. Last year’s prom gave her a headache, but after receiving a cochlear implant this year, she told family and friends that she enjoyed the music.
Since 1990, when the U.S. Food and Drug Administration (FDA) granted approval to Cochlear Americas for the use of cochlear implants in children 2 years of age and older, cochlear implants have become a standard of care for children with bilateral severe-to-profound sensorinueral hearing loss. From the initial FDA approval to the present, we have seen the accepted age of implantation drop to 18 months in 1998 to its current level of 12 months.
But over the past 16 years the one question has continued to puzzle all pediatric cochlear implant specialists: Why do some children acquire spoken language and function at age level, while others do not? Researchers have looked at a number of variables as they have attempted to isolate which factors are most important to successful cochlear implant outcomes. These include, but are not limited, to: etiology (is the loss a non-syndromic genetic loss, such as connexin 26), age of implantation; communication modality, parent involvement, and therapy model. While all of these factors contribute to a successful outcome for a pediatric implant user, the age of implantation has received considerable attention. This has been examined from a speech-language perspective as well as from an electrophysiological perspective.
Recent investigations of the cortical potentials have found that the cortical potentials return to within normal limits in children implanted at a younger age. Studies on speech and language development suggest that children implanted at a younger age will make better progress than children implanted a later age. As such, many centers have age limits for implanting children.
Although we as clinicians must look at performance or outcome data to make important clinical decisions, we also must remember that all situations are different, and must be evaluated on their own merits. This became very important when a teenager came to The Oregon Health and Science University for a cochlear implant evaluation. The intake information stated that Mila was 16 years old with a congenital, bilateral profound sensorineural hearing loss who wore hearing aids on a limited basis. Her primary language was American Sign Language (ASL), with minimal spoken language. My initial thought was, “another parent who wants her child to be hearing.” This was not the case.
Mom, who is competent in ASL and is very accepting of her daughter’s deafness, was not advocating for the implant; Mila advocated for herself. Mom made it very clear to me that they were there only to appease Mila, be told “no,” and go home.
This did not happen. Mila was able to tell me exactly what she expected for an implant. She did not expect to be able to speak, talk on the phone, or understand spoken language. She wanted contact with her environment.
After meeting another young woman, a 17-year-old that was implanted at age 8 who uses her device occasionally, Mila was not dissuaded from getting an implant. Radiographic studies found a patent cochlea. So reluctantly Mom agreed to pursue the implant.
Unfortunately, insurance denied the implant based on lack of potential benefit in terms of speech and language development. While Mom was not in favor of the implant initially, once she agreed to it, she was not going to accept the denial with out a fight. Our initial appeal was denied. Mom contacted ASHA and with materials provided, the denial was reversed, and Mila was implanted in January 2006 and had her initial activation in February. It was clear that Mila had a large support group as 10 family and friends were present for this “event.”
From the first time sound was turned on, and Mila heard her brother’s voice, there wasn’t a dry eye in the room. At each subsequent programming session, Mila reported not only hearing, but making associations to sounds in her environment. Mom reported that a shampoo container fell and Mila heard it and ran upstairs as she thought her mother fell.
In formal testing, Mila has a voice awareness level of 20 dB. She can differentiate durational cues in words and sentences, detect loudness differences, and even hear a whisper.
Does this mean we should implant all older children? No. What it does mean is that we as cochlear implant audiologists need to consider education as one of our primary roles, regardless of age or hearing status of the patient.
We also need to consider the reason a person may or may not decide to get a cochlear implant. If we limit ourselves to the narrow perspective that the purpose of implanting a child is to develop spoken language, children like Mila and her family would not have had their lives enriched.
As a result of Mila’s cochlear implant, all members of her family are experiencing sound in a new and different way.
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June 2006
Volume 11, Issue 8