Editorial: Cochlear Implants: An Update

In the interest of full disclosure, I should note that I have expressed strong reservations about the practice of implanting very young children. I continue to believe that introducing a foreign object into the head of a child with today's life expectancy of around 80 years is fraught with uncertainty, especially when there is no clear evidence that the procedure is more effective than the present generation of powerful hearing aids. I have also believed that much of the research reported must be taken with a grain of salt to the extent that results have been reported by scientists directly involved with implants themselves, raising the possibility that, either consciously or unconsciously, the results have been influenced by expectations. On the other hand, it is clear that, with miniaturization and improved technology, the procedure will become less intrusive and more effective.

This publication marks the third straight issue in which an article on cochlear implants has appeared, testifying to the importance attached to the procedure in our field today. Of course, the interest did not develop overnight. For example, Kluwin and Stewart (2001) reported on the process and outcomes of parental decision making regarding implants and Johnston (2004) identified implants as one possible factor in the apparent decline in the Australian Deaf signing population, estimating that perhaps 45% of young Australian children with severe and profound hearing losses have cochlear implants. Taken together, the three articles printed in 2005 issues of the Annals to date provide some unique insight because of their geographic diversity and their research foci. Reflecting the internationalization of the Annals, Preisler, Tvingstedt, and Ahlstrom (2005) interviewed Swedish deaf children about their experiences using cochlear implants; Burger, Spahn, Richter, Eisele, Lohle, and Bengel (2005), in a German study, reported on parental distress related to their children's cochlear implant fitting; and Ben-Itzhak, Most, and Weisel (2005) studied the knowledge and expectations of Israeli teachers of the deaf, audiologists, and speech therapists regarding cochlear implants. Taken as a whole, information is provided on children, parents, and professionals serving deaf children, thereby addressing the three populations most concerned with implants. The three countries themselves represent very different philosophies concerning educational placement and the role of signs in instruction. They share a widespread and growing incidence of cochlear implants among the young deaf population, a phenomenon that apparently is global in nature.

Preisler et al. studied the real consumers of cochlear implants themselves, 11 deaf children, ranging in age from 8.5 to 10.5 years of age, who had from 5 to 7.5 years of experience with implants. Six of the children attended special schools in which Swedish Sign Language was the language of instruction and 5 were enrolled in regular classes with hearing children with spoken Swedish the language of instruction, although there was some access to sign language. Unlike some research reported in other countries to the effect that parents choose cochlear implants for their children in the hope that they would function as hearing children, Swedish parents hoped that their children would become bilingual in spoken Swedish and Swedish Sign Language. This may reflect the Swedish philosophy that parents should utilize all possible means of communication to establish communication with their children. For children in both educational settings, sign was the basis for family communication in the first stages of the study, but later much of home communication was in spoken language. On balance, the children's responses were positive; 10 of the children used their implants regularly and considered them natural parts of their lives. Those in regular classes were able to participate in one-to-one conversations, but reported problems in following teachers and class discussions. The children seemed to have a nuanced view of cochlear implants, with a consensus that there were both advantages and disadvantages. Implants provided at least environmental sounds to the entire sample, but for children in regular classes communication with teachers and classmates in class and during breaks was limited. Preisler et al. report that both parents and children in regular classes are aware that they need sign language, which they do not get, to fully understand what...