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Cochlear Implants in Children: Ethics and Choices

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Most of the other complications or unexpected outcomes cited by parents were fairly minor and usually disappeared in a day or two. Some of the children experienced nausea, and in one or two cases postsurgical problems appeared to be exacerbated because, in this era of managed care, the hospital was in a rush to discharge the patient. Some parents were not completely prepared for what would happen after the surgery or what their child would look like.

The scar, the actual incision, is so much bigger, there is so much more hair that went, than I ever imagined.

Mother of a 9-year-old girl implanted in 1994

Most parents, however, were surprised at how quickly their child bounced back after the surgery. Some children were outside playing the next day and others returned to school within a few days after the surgery.

Most of the parents said that the surgery went smoothly and that all of the electrodes were successfully inserted in the cochlea. In the GRI survey, 95% of the respondents said that the electrodes were successfully inserted. Over time, however, some of the electrodes may stop working, either because they fail internally or because unpredictable interference among them can make it difficult for the user to interpret sound. About a fifth of the respondents in the GRI study said that some of the inserted electrodes were inactive, either through hardware failure or voluntary shut off. Another 10% said they were not sure whether or not any electrodes were inactive.

One issue that many people, including parents of children with implants as well as adult implant users, have concerns about is the question of re-implantation. That is, do the internal components have to be replaced periodically, or is it expected that they will remain implanted in the cochlea for the implantee’s entire life? In general, the expectation, both from the implant center’s perspective and from the patient or the patient’s family, is that the internal components will not need to be replaced even though new developments in implant technology continue to be made. Rather, it is expected that any changes that occur will take place in the external components, particularly the speech (sound) processor. Indeed, many of the parents we talked with hoped that their child would be able to take advantage of new speech processing technology, including behind-the-ear (BTE) models that would make the implant more cosmetically appealing. Many parents said they hoped to purchase this new technology even if their insurance carrier refused to pay for it.

Concerning this issue, the GRI survey asked parents if their child’s “device (internal or processing components)” ever had to be “upgraded or replaced.” Virtually all of the respondents said that some upgrading or replacement was necessary. The vast majority of these responses focused on upgrading the external components, or even replacing cords that had been broken or lost, rather than replacing the internal equipment.

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