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Cochlear Implants in Children: Ethics and Choices

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It often took some time for the child to get used to new voices.

[My daughterís] first reaction, and actually for a long time [after that] was, Iím waiting for it to be a real voice. Itís not a real voice yet. To her, I think, the sound that she had gotten from her hearing aids was real voice sound, and this wasnít a real voice yet. And thatís what her reaction was.

Mother of an 11-year-old girl implanted in 1996

Almost invariably the progression was from hearing something to making an identification of the sound to, months, or sometimes even years, later, understanding speech. Moreover, this progression usually did not happen naturally. Rather, parents repeatedly acknowledged that hours and hours of work, including regular speech and auditory therapy after the surgery, was necessary for their child to benefit from the implant. As one mother said: Detection of sound doesnít mean comprehension. So we still had a lot of work to do [after the first day].

Part of the development of speech discrimination involves the ability to hear high-frequency consonants that the child was usually unable to hear with a hearing aid. For some families, this development came rather quickly after implantation, whereas for others it was delayed for months or even longer.

The difference we see [that] the implant makes are things like, he never heard the Ďsí sound or Ďtsí before and now he not only hears them but he is producing them. And that is a big difference. He now hears up into the 6000 hertz [cycles per second] frequency range whereas before he was only up to 2000 hertz, and he hears better at lower decibels, too.

Father of a 2-year-old boy implanted in 1998

MOTHER: One night [2 months after the implant was activated] we turned off all the lights and I was whispering a few words and [my daughter] was receiving everything I was saying.

INTERVIEWER: She was repeating everything?

MOTHER: Everything.

Mother of a 3-year-old girl implanted in 1998

[My daughter] could hear nothing for, I would say, for 3 weeks; we went back four times for mappings. This is unheard of . . . they couldnít figure out where she was . . . . She didnít hear tones, she heard nothing. Three or 4 weeks later she thought she discerned a beeping . . . . Weíve gone from . . . understanding speech and understanding stuff [with a hearing aid] to hearing beeping . . . . I mean, I was just beside myself; she had many, many mappings . . . . [My daughter] was all over the map, literally, in her mapping. Now she is doing quite well with the implant but it required 6 months to a year to differentiate between tones and, ultimately, understand speech. Now she is functioning better than she did with the hearing aids.

Mother of a college-age young woman implanted in 1995