Cochlear Implants and Hearing Aids

EDITORIAL Cochlear hnplants and Hearing Aids In the December, 1994 issue of the American Annals of the Deaf, McCay Vernon and Catherine D. Alles published an article, "Issues in the Use of Cochlear Implants with Prelingually Deaf Children." Among the points they made were: 1. The Food and Drug Administration in 1990 approved the procedure for children as young as two years despite a lack of supporting evidence of success with congenitally deaf adults. The results with congenitally deaf adults, in fact, have been poor. 2. Most of the evaluations done have been reported by the surgeons performing the procedure, by professionals funded by implant grants, by schools with children with implants, and/or with financial sUPP0lt from those who manufacture the implant. 3. Such evaluations need validation by independent researchers . 4. An independent study by Allen, Rawlings and Remington (993) reported relatively modest gains for children with profound hearing losses with cochlear implants as opposed to those with hearing aids. 5. There are real medical risks involved. 6. There has been great variablility in results of implants and we do not understand the factors necessary for success . The article was quite timely and generated some strong reactions, as shown by letters to the editor in our March and July, 1995 issues. One writer, Dr. Luetke-Stahlman, wrote with enthusiasm of the implantation of two of her children. The children, according to Dr. Luetke-Stahlman, are fluent users of ASL and socialize with deaf adults. They use sign interpreters at school. The second writer, who asked to remain anonymous, is a teacher of deaf preschoolers who has worked with three children with implants and talks about "...picking up the parents' emotional pieces when their expectations disintegrate." She writes about parents putting off facing up to their children's deafness and unneedlessly going through pain and disappointment. She goes on to tell of audiologists who work for a cochlear implant company opposing the use of ASL with children with implants and discouraging parents from having anything to do with the deaf community. This terribly harmful VOLUME 140, NO.3 approach is a sign of ignorance at best and dishonesty at worst and brings to mind the claims of anti-manualists a generation ago that signs harm speech. The only research done with children of similar socio-economic backgrounds clearly indicate that signs, per se, have no effect-positive or negative-on speech, speechreading, or use of residual hearing. The difference lies in the fact that children using manual communication have higher academic achievement than children of similar backgrounds limited to nonmanual communication. It is time that misrepresentations against signs are refuted. Consistent with other research, in their study of children in Texas, Allen et al found great variability in the effectiveness of cochlear implants. Only 10% of the cochlear implant recipients were from racial minorities compared to 56% of a state-wide sample of non-implant recipients. Students with implants were more likely to receive educational support services as well as individualized speech and auditory training three or more times per week provided by a licensed speech therapist. Although family income and education were not reported, the possibiity is high that children with implants tend to come from families with relatively high socio-economic status. The results for children with profound hearing losses (better ear average loss greater than 90 dB) were not clear-cut. Children with inplants had an unaided threshold of 109.8 dB, which improved to 56.0 dB with the implant. Children without implants had an unaided threshold of 105.1 dB, which improved to 61.8 dB with conventional hearing aids. Clearly, both implants and hearing aids greatly reduced the hearing threshold of the children. Just as clearly, neither technique provides normal hearing in the speech range to congenital profoundly deaf children. Allen, et al stressed that the standard deviation of average reductions in thresholds for implanted children was higher than for non-implanted children. This means that some enjoyed far greater reductions and some far less. In short, we do not know what characteristics of children, families, and educational programs are related to success and failure. In summary, thousands of cases document the success of...