Letters to the Editor

Letters to the Editor Cochlear Implants Benefit Children Provocative and lucid essays addressing legitimate questions regarding the efficacy of the use of cochlear implants with prelingually deaf children would be enthusiastically welcomed . Such essays would have to be based on complete and accurate reviews of the literature. To do otherwise would present misinformation and further cloud this very important issue. Such an essay, unfortunately, was not presented in the article written by Vernon & Alles, "Issues in the Use of Cochlear Implants with Prelingually Deaf Children" (American Annals of the Deaf, 139(5) 485-492). The League for the Hard of Hearing has utilized an auditory-oral approach within a family centered speech-language pathology and auditory program for decades, long before cochlear implants were a viable option . We favor no specific amplification device. For profoundly deaf children to develop good oral language skills, however, requires that the children be provided with the best possible auditory input. It has been our consistent and undeniable experience that many children who are prelingually, profoundly deaf and who receive a cochlear implant at a young age, make faster progress and demonstrate higher levels of performance in receptive and expressive oral language (than they were demonstrating while using conventional amplification). Specifically, they make impressive gains in auditory awareness, recognition, and perception of speech, and in speech production and intelligibility. This has been shown through subjective observation and by objective measures. Waltzman et al (1994) reported on the long-term results of early cochlear implantation in congenitally and prelingually deafened children. They report the performance on various speech perception measures of 14 profoundly congenitally or pre-lingually deaf children who were implanted before the age of three years. Data is presented for up to five years post-implant . By the end of the first year post-implant, 50% of the children demonstrated open set speech recognition ability; by the end of the second year, 13 of 14 did; and by the end of the third year, all did. On average, these children had no residual hearing above 750 Hz prior to implantation. We would expect that few, if any of them, would demonstrate open set recognition ability using only hearing aids. The reference used by Vernon & Alles to provide information about the level of performance for both groups of children, Allen, Rawlings, & Remington (1993), was published originally as a demographic description of children who are deaf and hard of hearing in Texas. The audio-logic measure of aided pure tone thresholds was used to compare hearing aid users to cochlear implant users. Aided thresholds are not accurate predictors of speech and language perception or production for either group of children . We question why this measure was chosen as the basis for comparison . It may be that the researchers were not familiar enough with these issues to choose an appropriate measure . This is precisely the reason why the research conducted by professionals directly involved in the development of new clinical procedures must not be ignored. The aided threshold is, however, useful as a quick indicator of whether or not the implant speech processor is programed optimally. Our experience is that aided thresholds for children with cochlear implants average 30 dB compared to 56 dB as was noted in that study. The benefits from cochlear implant use are achieved with very minimal risk. Vernon & Alles reviewed the possible surgical complications which were cited by Cohen et al, (1993)· Vernon & Alles omitted, however, the incidence rate of these complications. Many of the possible complications listed never occurred and the typical incidence rate of the others averaged 1%. Certainly this incidence rate must not be ignored and surgeons must strive to further minimize or eliminate these risks. However, deleting this information is misleading at best and irresponsible at worst. Vernon and Alles' call for independent , accurate, and unbiased research must be heard. However, the use of cochlear implants with profoundly deaf children is not going to stop, nor should it, while this research is making its way into the literature. We applaud Vernon & Alles' valid concern for publication of factual evidence of the benefits of cochlear implant use by children who are prelingually deaf. We also express our concern for publication of misinformation and half...