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Cochlear Implants in Children: Ethics and Choices

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My speech got so bad [after the implant]. I felt totally cut off from everyone. But I never reached the point that I thought it wouldnít get better. I never got to the point where I was really concerned. I said, Iíll just give it 3 more weeks . . . then I said, just 4 more weeks. Also, I remember my experience with the transonic [hearing aid] and how difficult it was to adapt to that. It was horrible the first 2 to 3 months, just like the implant, then it got better.

The same college-age young woman implanted in 1995

Not all of the children initially liked wearing their implant, perhaps because they did not like the sounds they were hearing or were otherwise uncomfortable with the device. Consequently, sometimes parents had to resort to bribery to encourage their son or daughter to continue to use the implant. As one mother said: It took a lot of months of bribery and stickers and just [trying] to motivate [my son] to wear [the implant]. Another mother had to resort to similar tactics to get her daughter to use her implant, which she hated at first. In this case, the carrot was a Barbie doll. Others said that it took some getting used to and that a break was frequently needed. Even the young woman who found music so awesome on the first day said: Sometimes I just donít like to study with my implant on. I just take it off because itís so extremely quiet. I still . . . like doing that. Itís nice to have the freedom to be able to take it off and not have to hear anything. On the other hand, one child liked her implant so well, she insisted on sleeping with the external equipment attached.

Conclusions

There seems to be no one dominant type of post-implant outcome among the families we interviewed. Most young children heard some sounds, especially environmental sounds, more or less right away, whereas a few did not hear anything at all for several months. The most common description that parents offered of their childís progress with the implant was that it was quite slow and gradual, and that considerable post-implant habilitation was needed. It frequently required 6 months or more before the child was able to respond to his or her name, clearly distinguish among voices, and understand at least some speech. After time, though, most of the families we talked with said that their implanted child could clearly hear much more with the implant than they could with a hearing aid.

A lingering problem mentioned by many parents is the fact that it is often difficult for their child to hear in noisy situations, and it is hard for them to interact with strangers, with those whose voices they are not familiar with. Although these limitations are evident during the first 6 months after implantation, they tend to linger, in some cases for years, in many of the families we talked with. Clearly, few implanted children have ďnormal hearingĒ with the implant, and most of them continue to rely on lipreading to a considerable extent for communication.