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Cochlear Implants in Children: Ethics and Choices

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Surgery-Related Issues

Almost all of the parents we talked with said they felt they were well aware of the potential risks of the surgery. Perhaps the most common concern was related to possible damage to the facial nerve, which lies close to the cochlea. If this nerve was damaged, some type of facial paralysis could occur. In addition, parents were generally aware of some of the limitations that would be imposed on their child because of the surgery, particularly the fact that a magnetic resonance imaging (MRI) of the head would not be an option in the future unless the implanted magnet were to be removed. Most of the parents understood that the surgery might not be completely successful. But, because they wanted to do what they could to enable their child to be able to hear as much as possible, parents said again and again that they felt the risks were acceptable.

FATHER: We realized that we were putting him in an operation, and if it wasn’t successful he might lose everything. But, we just thought that the results could far outweigh the risk.

INTERVIEWER: What did the hospital tell you about the pros and cons of the implant?

FATHER: Well, they explained what could happen if something went wrong . . . during the operation . . . . And they told us about all [the plastic] playground equipment, about static electricity [that could damage the programs in the speech processor], they went all over that. And we took the steps . . . we gave away all his toys that were plastic and might cause some static . . . . The hospital didn’t hide anything, they tried to tell us everything that might happen or could happen.

Father of a 7-year-old boy implanted in 1997

The GRI survey also dealt with the question of risk. One question asked: “When the implant surgery (initially) was performed, were you rather unfamiliar, somewhat unfamiliar, or very familiar with various POSSIBLE negative outcomes of receiving a CI [cochlear implant]?” Responses to this question are summarized in table 5.2. It should be noted that the various categories in the first column of table 5.2 were not explained (i.e., were not operationally defined) on the questionnaire. Rather, each respondent was left to his/her own interpretation of what a negative auditory, social, psychological, or other outcome might be.

Table 5.2
Awareness of Possible Negative Outcomes of Implantation

Type of Possible Negative Outcome

Percent “Rather Unfamiliar” With This Outcome

Percent “Somewhat Familiar” With This Outcome

Percent “Very Familiar” With This Outcome

Auditory or audiological




Medical or health-related
















The vast majority of parents who responded to the GRI survey also reported that they were somewhat familiar or very familiar with each of these items as possible positive outcomes of receiving a cochlear implant. In general, parents reported that they were more aware of possible positive outcomes than they were of possible negative outcomes.

Although parents generally felt that the surgery was highly desirable, this is not the same thing as saying that it was invariably seen as necessary.

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