Cochlear implants - more insights

A while ago, we had an interview with the founder of ONICI (lots of info on the website!), an independent information centre about cochlear implants. In stead of providing you with a long post about the topics we discussed with him, I'll just give you some interesting take home messages :-).

CI's are mostly implanted when children are about 10 months. Doing this at an even younger age is diffucult because babies' skulls are not thick enough to secure the the CI's internal part. Also, it is important for the parents to get used to communicating with their deaf child.

CI's consist of an internal and an external part. The internal part looks like a thin silicone cord with tiny electrodes at the end (see example left). This part is placed in the cochlea. On the other end of the cord, a receiver and stimulator are attached to the skull (underneath the skin). The external part consists of a microphone, a speech processor and a transmitter (attached tot he internal part via a magnet).

A lot of hospitals in Flanders are allowed to place CI's. The founder emphasizes that those medical centres who work with multidisciplinary teams (e.g. surgeons, throat, nose & ear specialists, speech therapists) are the best in that sense that they provide the best support. There are still quite some doctors who are convinced that the CI will (eventually) make deaf people hear like hearing people. Also, many of these doctors advise parents not to use sign language, since this would disrupt the spoken language development of the child (the ONICI founder fully disagrees).

Insurance companies cover for the medical costs of placing one CI (to be replaced every 5 to 10 years). Lots of parents decide to pay for a second CI (in the other ear) themselves, which costs about 10.000 Euros.

At the school, the teachers, therapists, educators, etc. all agreed to use either spoken language or sign language. Not both. This is done to teach the kids both languages in stead of a mixture. We noticed this during the Dovencultuurweek, where most hearing teachers, group leaders, etc. did not speak (sign language is the main language during this week), however most of them did move their lips as if they were speaking.

Wiki on CI's: http://en.wikipedia.org/wiki/Cochlear_implant
Simulation of hearing with a CI: http://www.hearingacademy.com/upload/De%20verschillen.swf

Onici

In my first contribution to the blog I'd like to direct your attention to Onici, an indepedent expert organization on Cochlear Implants (CI). Although the somewhat outdated website may give you the impression that clear communication is not organizations first concern, it does contain some interesting information on the current state of research on CI.

After a first glance at the presentation Onici gave at the beginning of 2009, Onici is clearly (and obviously) enthusiastic about the possibilities CIs offer to hearing impaired people. However, Onici does not shy away to also underline the limitations of the implants.

From what we have learned from the first interviews we have conducted, it seems that the presence of this kind of organization is very much needed. There is a high need for neutral information on CI, as many parents with hearing impaired children have unrealistic expectations towards CI. While the technology is continuously being modified and improved, many children still have difficulties understanding other people in groups. Cognitive issues that are typical for hearing impaired children also arise: difficulties with language comprehension and abstract thinking.

Some years ago, Belgium has introduced newborn screening hearing tests, and as a result CIs get implemented earlier, but it is unclear how this will affect the personal development of deaf people in the long run. Currently, children with CIs still have hearing difficulties in group, and those integrated in mainstream education often feel different from their peers and experience troubles with social integration. These are issues that remain important and that have to be dealt with in specific ways.

CI is also controversial as it is perceived as treathening by some people in the deaf community: they fear that CIs will make deaf and hard-of-hearing school focus solely on oral speach, ignoring sign language and thus can making deaf culture disappear.

To what extent sign language should (still) be teached is a very sensitive issue. Often parents are very reluctant to let their children learn sign language: they want their children to be as normal as possible and they are afraid that sign language will alienate their child from the world and his or her parents. On the other hand, deaf organizations and certain psychologists insist on making sign language a part of the curriculum of deaf and hard-of-hearing children. The decision to whether or not teach sign language is not only controversial, but also important as it determines the future cognitive development, mental well-being and identity of the deaf or hard-of-hearing child.

The decision making here is further clouded by audiologists telling the parents of the children that "the CI will make their child normal again" and CI companies (like Cochlear) ignoring the steps that follow CI implementation.

To avoid further confusion and to be able to make decisions irrespective of all kinds of possibly unrealistic expectations surrounding CIs, an organizations like Onici is important. Therefore, we hope to be able to add their voice to the research data.

Pieter