Cochlear ImplantsPerry C. Hanavan, Au.D.

QuestionCochlear implants: 1. Amplify sound 2. Process sounds 3. Both A and B 4. None of the above

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QuestionWho has the fundamental right to decide whether a child should receive a CI? A. NAD B. Schools C. Parents Senteo Question D. Physicians E. The State (government)

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COCHLEAR IMPLANTSChapter 18

THE FACTS

CI Manufacturers Medel Bionics Cochlear

Who Makes the Decision for CI and When Should CI for Children with HI? Educator of the Deaf? Parents? Physician? Audiologist? Child? Team? Others? Before 1 year, 18 months, 2 years, before 5? When person is old enough to make decisions? Never?

CI Factoids About 70,000 people worldwide have cochlear implants About 25,000 people in the United States have cochlear implants About half of all CI recipients are children CIs can help an estimated 200,000 children in the United States who do not benefit from hearing aids. The demand for CIs is increasing annually by 20%. About 250 hospitals across the country perform cochlear implant procedures. A recent study on cochlear implants demonstrated that special education in elementary school is less necessary when children have had "greater than two years of implant experience" before starting school. These children are mainstreamed at twice the rate or more of age-matched children with profound hearing loss who do not have implants. The benefits of a CI to society amount to a lifetime savings of $53,198 per child. By the time a child with hearing loss graduates from high school, as much as $420,000 can be saved in special education costs if the child is identified and given appropriate early intervention.

CI Study of 181 Children Most parents had normal hearing, majority (white) and had more education and higher incomes than the general population. Families tended to be intact with both a mother and a father who involved their child with CI in family activities on a regular basis. Children enrolled in the full range of educational placements available across the United States and Canada. Fairly even distributions of children from public and private schools, special education and mainstream classes and oral and total communication methodologies were represented. Educational placement changed as children gained increased experience with a cochlear implant. They received an increased emphasis on speech and auditory skills in their classroom settings and tended to move from private school and special education settings to public school and mainstream programs. Data support the position that early cochlear implantation is a cost effective procedure that allows deaf children to participate in a normal school environment with hearing age mates.Geers A, Brenner C. (2003) Background and educational characteristics of prelingually deaf children implanted by five years of age. Ear Hear. 24(1 Suppl):2S-14S.

Study of Children in US and CA Use of a cochlear implant has had a dramatic impact on the linguistic competence of profoundly hearing-impaired children. More than half of the children in this sample with average learning ability produced and understood English language at a level comparable with that of their hearing age mates. Such mature language outcomes were not typical of children with profound hearing loss who used hearing aids. Use of a visual (i.e., sign) language system did not provide the linguistic advantage that had been anticipated. Children educated without use of sign exhibited a significant advantage in their use of narratives, the breadth of their vocabulary, in their use of bound morphemes, in the length of their utterances and in the complexity of the syntax used in their spontaneous language. An oral educational focus provided a significant advantage for both spoken and total language skills.Geers AE, Nicholas JG, Sedey AL. (2003). Language skills of children with early cochlear implantation. Ear Hear. 24(1 Suppl):46S-58S.

Canadian StudyChildren with cochlear implants have increased educational opportunities, with those children in mainstream and those who have moved toward mainstream demonstrating improved progress in speech perception ability.Daya H, Ashley A, Gysin C, Papsin BC. (2000). Changes in educational placement and speech perception ability after cochlear implantation in children. J Otolaryngol. 29(4):224-8.

British Study Age at implantation and duration of deafness were found to be significant predictors of placement two years after implantation. The duration of deafness of children in schools for the deaf or units was twice that of children in mainstream education. Fifty-three per cent of children who were in pre-school at the time of implantation were in mainstream schools two years after implantation, whereas only 6% of those who were already in educational placements at the time of implantation were in mainstream education. The results indicate that children who are given implants early, before an educational decision has been made, are more likely to go to mainstream schools than those given implants when already in an educational setting.Archbold S, Nikolopoulos TP, O'Donoghue GM, Lutman ME. (1998) Educational placement of deaf children following cochlear implantation. Br J Audiol. 32(5):295-300.

Cost Effective Children with greater than 2 years of implant experience were mainstreamed at twice the rate or more of age-matched children with profound hearing loss who did not have implants. Also placed less frequently in self-contained classrooms and used fewer hours of special education support. A cost-benefit analysis based on conservative estimates of educational expenses from kindergarten to 12th grade shows a cost savings of cochlear implantation and appropriate auditory (re)habilitation that ranges from $30000 to $200000. CI accompanied by aural (re)habilitation increases access to acoustic information of spoken language, leading to higher rates of mainstream placement in schools and lower dependence on special education support services. The cost savings that results from a decrease in the use of support services indicates an educational cost benefit of cochlear implant (re)habilitation for many children.Francis HW, Koch ME, Wyatt JR, Niparko JK. (1999). Trends in educational placement and cost-benefit considerations in children with cochlear implants. Arch Otolaryngol Head Neck Surg. 1999 125(5):499-505.

Profound vs. Severe Loss & CI Highly significant difference between the educational placement of implanted children and hearing-aided profoundly deaf children (p