Cochlear implants are improving speech and language for many children who have severe hearing loss, but they're not without controversy.

By Jennifer Wilson
March 03, 2014

For children with severe hearing loss that can't be helped by traditional hearing aids, a device called a cochlear (KOE-klee-er) implant may be able to provide a future of speech and language development that's on par with that of their peers.

This small electronic device looks like a hearing aid tucked behind the ear; a thin wire connects it to a small receiver that attaches to the back of the head. But unlike a hearing aid -- which only amplifies sound -- a cochlear implant bypasses an ear's damaged portions and generates signals that are sent through the auditory nerve directly to the brain, which recognizes those signals as sound.

Anyone who has lost all or most of his hearing can receive an implant. Nearly 28,400 children have received them since the first child was implanted in the late 1980s, according to the FDA. Most kids receive the implants between the ages of 2 and 6, but one type of implant can be used in children as young as 12 months, according to the National Institute on Deafness and Other Communication Disorders (NIDCD).

The Implant ProcessIn a procedure that lasts two to four hours, a doctor implants parts of the device inside the skin and skull, and threads wires containing electrodes through the part of the inner ear called the cochlea. According to the American Speech-Language-Hearing Association (ASHA), this can be either an in-patient or out-patient procedure, depending on the child. After four to six weeks, the child returns to have the implant programmed and external parts fitted.

Intensive therapy often starts before the actual surgery and consists of at least two hours per week until the child enters school, and therapy continues as needed, says Anne Oyler, Au.D., associate director for audiology professional practices for ASHA. During this time, the child works with the cochlear implant to learn or relearn the sense of hearing. With enough intensive therapy, even young children can acquire speech, language, and social skills. With access to sound and appropriate therapy, most young children can acquire good listening and spoken language skills.

Low NumbersOnly about 50 percent of kids in the United States -- and even fewer adults -- who could benefit from cochlear implants are actually getting them, Dr. Oyler says. In Europe, by contrast, more than 90 percent of children who need cochlear implants have them.

The low numbers may in part be due to the fact that people don't seem to know much about the implants, she says, especially those parents who don't have a history of hearing loss in their family. At the same time, some physicians are hesitant to recommend an implant unless a child has no hearing whatsoever, even though kids with less severe hearing loss may be good candidates. The candidacy criteria created by the FDA is outdated, Dr. Oyler says, and don't take account of recent advances in the technology and of how well patients are doing as a result of the implant.

The ControversyOne drawback to implants is that the process is expensive, costing approximately $60,000 including surgery, adjustments, and training, Dr. Oyler says. This is for only one implant, but the parents who opt for the procedure frequently decide to have two implants for their child, as research increasingly supports this.

While as many as 90 percent of private and state insurance plans do cover the implants, some do not. "And a company might not cover it at the level that's fair, or cover expenses such as extra cables and batteries," says Dr. Oyler, who recommends that parents check with their insurance company about deductibles and out-of-pocket expenses.

There is also some protest within the deaf community, stemming from a fear that cochlear implants might encourage a move away from American Sign Language (ASL) and deaf culture. ASL allows those who are deaf to communicate using signs, gestures, and facial expressions.

A majority of families choose listening and spoken language for their children with cochlear implants, but some may decide to incorporate ASL to support communication when needed.

Hopeful FuturesCochlear implants are very sophisticated tools that have improved over the years. When a child is helped early and receives implants in the first three years of life -- when speech and language development is so crucial -- and has a good team working with him, he usually has a great outcome. "If all those stars line up, and they do for many kids," says Dr. Oyler, "they're able to develop speech and language skills on par with those of their hearing peers."

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