Cochlear Implant Debate

For the motion

Introduction• The debate concerning the cochlear implantation of

babies and young children is controversial.

• A vast number of the medical community along with many others in the wider society support the use of cochlear implants to help overcome deafness in children and allow speech development and access to ‘the hearing world’.

• Implantation at an early age is thought to be fundamental in attaining a successful outcome.

Key Facts

• There are 23,000 deaf children aged 0-15 that need hearing aids

• 3 in 1000 children are born with a hearing loss and of these 1 in 1000 are profoundly deaf

• 90% of deaf children are

born to hearing parents

Summary• Speech and Language Development

• Educational Attainment

• Quality of Life

• Psychosocial Impact

• Cost Effectiveness

• Technology Improvements

• Choice

Speech & Language Development

• Long-term communication benefits when a profoundly deaf child is implanted with a cochlear implant

• In a study by Beadle, McKinley et al in 2005

• 30 children assessed consecutively over 10 years after implantation

• 87% understand a conversation without lip reading

• 60% used the telephone with a familiar speaker

• 77% used speech intelligible to

the average listener

Speech & Language Development

• Cochlear implantation has excellent language outcomes on very young children and can be performed safely.

• A study by Dettman, Pinde et al in 2007:

• Receptive and expressive language growth of children was much greater when implanted before 12 months of age

• McDonald, Conner, Craig et al in 2006

• Demonstrated stronger language outcomes for children who were implanted at an early age compared to those who were older at implantation

Group A1 – received implants before the age of 2.5 years

Group A2 – received implants between 2.5 – 3.5 years

Group B - received implants between 3.6 – 7.0 years

Group C - received implants between 7.1 – 10 years

Speech & Language Development

• A study by Moog JS (2002) :

• 17 participants aged between 5 – 11 years with cochlear implants

• Scored 90% or better on speech intelligibility test

• 65% scored within average range for language

• 70% scored within average range

for reading

Educational Attainment• 65 participants completed a questionnaire about their perception of

career opportunities after implantation:

• Employment rose from 69.2% prior to implantation to 83.9% afterwards

• Solo satisfaction rating rose from 5.56 to 6.82 after implant

• 57.7% from working group believed their hearing disibility had affected their career

• This study concluded that cochlear implantation improves chances of employment and increases job satisfaction and improved perception of their career prospects

Maisam z Fazel + Roger F Gray (June 2007)

Quality of Life• Research published in the International Journal of Paediatric

Otorhinolarynagology states that preschool children using cochlear implants rate their quality of life

• Implanted preschool children jugded their quality of life to a similar degree as their hearing peers

• Quality of life is related to how well they get on with their implants and a study showed that the ‘overall quality of life correlated inversely with cochlear implant experience’ therefore the earlier implantation occurs the more experience they have of using it

• Early implantation is vital for successful language development as brain decreases with age

Psychosocial Impact• A study was carried out in 2008 involving 101 children implanted with

cochlear implants at an average age of 4.7 years.

• This showed that 60% of parents believed their children to be socially isolated before getting their cochlear implant.

• Moreover the statistics show that the social relations have greatly improved since the surgery.

• This is reflected as 80% of parents now feel their child participates in family relationships on the same level as the rest of the family.

• Additionally 71% of parents agree that their child can now make friends easily outside the family and 58% believe that their relationship with siblings has also improved

Archibold, S., Sach, T., O’Neill, C., Lutman, M. and Gregory, S., (2008) “Outcomes from Cochlear implantation for Child and Family: Parental perspectives”,Deafness Education International, 10(3), pp. 120-142.

Psychosocial Impact• Most significantly 96% of families have observed that their child is

more sociable within the family as a whole, which is reflected as 81% believe they also have close relationships with their grandparents

Psychosocial Impact• The first 200 children in Denmark who were implanted participated

in a study of both their self esteem and well-being post implant.• The results illustrate that if the operation age was <18 months then

80% had a good social well being. This reduced as operation age increased.

• Of the children that use spoken language as their mode of communication, 82% were deemed as having good social well-being.

• Also, those children who were placed in mainstream education 72% had good social well-being

Percy-Smith, L., Jensen, J. H., Caye-Thomasen, P., Thomsen, J., Gudman, M. and Lopez, A. G. (2008) “Factors that affect the social well-being of children with cochlear implants”, Cochlear Implants International, 9(4), pp. 199-214.

Psychosocial Impact• Those children without speech and language had substandard

communication and poorer cognitive development along with insufficient social skills. Contrary to this those children with an implant could cope with a variety of social situations and were more adaptable to different environments.

Cost Effectiveness

• A study on 78 children showed that there are “net savings to society” as the total cost of a cochlear implant is $60,228 but within a child’s lifetime there are savings of “$53,198”.

Cheng, A. K., Rubin, H. R., Powe N. R., Mellon N. K., Francis, H. W., Niparko, J. K. (2000) Cost-utility analysis of the cochlear implant in children, JAMA 2000, 284(7), pp. 850-856.

Technology• CIS and SPEAK (Skinner et al 1994; Wilson et al 1991)- “80 %

correct answers on high-context sentances” the National Institute of Health Consensus Statement.

Sound processor:Small.Durable.Water resistant.Binauaral microphones.Intelligent adjustment, refinement and clarity of sounds.IPod.Adaptable.

Nucleus 5:Titanium- 3.9 mm and 2.5 times stronger.Powerful microchip- easy to upgrade.22 real platinum stimulation electrodes.Auto NRT.Non problematic magnet.

TechnologyAdvance Bionics:

• Easy upgrade.

• 90 000 updates/second, 83000 stimulation pulses/second and 120 bands of spectral info.

• Consistent signal generation and precise information delivery.

• Easier programming.

• Removable magnet.

• 10 year warranty.

• Comfort forming shape.

• State of the art integrated circuit computer technology.

Sound processor:

•Wireless connection.

•Water resistent.

•Optimal for individual.

•Easy controls.

Choice• A study involving 29 young cochlear implant

patients in 2007 found that the majority of these 13-16 year old individuals “felt positive toward their cochlear implant and the decisions made…by parents” They now state that their communication methods are “not fixed”

Alexandra Wheeler, Sue Archbold, Susan Gregory and Amy SkippCochlear Implants: The Young People's PerspectiveThe Journal of Deaf Studies and Deaf Education 2007 12(3):303-316