Implants in Children: Ethics and Choices
discussed in detail in chapter 2, mapping is a complex process that involves
establishing appropriate levels of sound for each of the implanted electrodes
and making sure that the electrodes “work together” to enable the user to
perceive sounds as clearly as possible. Under ideal conditions, the implantee is
able to inform the audiologist doing the mapping when the sounds (including pure
tones at different decibel levels and frequencies) are too soft, too loud, or
just right. Of course, there are other ways, such as closed- or open-set word
tests or even simple conversations, to determine the extent to which the mapping
for the cochlear implant is appropriate.
child, it is often difficult to achieve a good initial cochlear implant map
because it is sometimes hard for the audiologist to know exactly what the child,
especially a very young child, can hear. Many of the parents we talked with said
that, although it was clear their child heard something at the first
mapping session it was not always clear exactly how much was heard.
Consequently, it was often necessary for them to return to the implant center
quite frequently during the first 6 months or so to “fine-tune” the map.
asked parents about their child’s first reaction at the initial mapping
session. The vast majority of parents said that their child did in fact respond
in some way to sound at the first mapping session; only three families said that
there was no response at all. The most common initial reaction was crying, and
about half of the parents said that their child appeared to be scared or
frightened when sounds were first heard with their newly activated implant. A
couple of parents said that their child was overwhelmed at the initial
activation, whereas another parent said that their child signed weird
when asked to describe what the sound was like. Not all of the children
necessarily cried because they were frightened, however; as one parent said, her
child cried and, at the same time, apparently loved it. About a quarter
of the families we talked with said that the initial mapping session was
uneventful; there was no dramatic scene at all, although it was clear that their
child did perceive at least some sounds with the implant. And about another
quarter said that their child was surprised or excited, or even laughing, at
their first mapping session after hearing sound with the implant.
took [my son] into the bathroom [halfway through the first mapping session] and
he . . . reached up and flushed the toilet and he jumped, he was scared . . . .
And then I went and I flushed the toilet again [and] he was scared. And then he
looked up and it was almost like he was afraid of the handle on the toilet,
[but] he finally grabbed it and pulled. And it made the same noise and he
jumped. Then he grabbed it again and pulled it and he started laughing. And I
couldn’t get him out of there.
Father of an 11-year-old boy implanted in the mid-1990s
What follows is a short sampling of some other “first-day” reactions to implant activation:
think it was a bit scary, too, because when she got home [the first day] she
didn’t like the garage door opener when it opened. She cried, said not to open
it. But she liked to run water and put my high heels on and click my high heels.
Mother of a 7-year-old girl implanted at age 4