Thursday, April 23, 2009

Hearing Aids or Cochlear Implants for Deaf Children

The recent AFA story of a hearing parent opting out of a CI for her child and Dianrez’s comment on a previous blog show that the function of CIs as opposed to hearing aids is still not very well understood.

The child in AFA’s story can hear at 30 dB with hearing aids, which means she has access to spoken language (at around 30-60 dB). From an auditory perspective, this child is not deaf but hard of hearing, which means she would be able to benefit from hearing aids. By “benefit” I mean the hard of hearing child is able to access to spoken English through the use of hearing aids only. No parent would willingly put their child through surgery if that can be avoided.

In the case of a profoundly deaf child (with a dB of 90 and up), hearing aids provide access to environmental sounds. With intensive auditory and speech training, a few can lipread and use residual hearing to communicate in spoken English. Most hearing aids, even digital aids, provide some profoundly deaf children access to sounds at the 60 dB level, which is not within the range of spoken English.

With cochlear implants, profoundly deaf children can hear at the 20 dB level, which gives them access to spoken English. This is with auditory and speech training, but at a much less intensive level than with hearing aids.

For example, I had the opportunity to observe the language development of two four-year old profoundly deaf children. Both signed ASL at an age appropriate level. One wore hearing aids all the time and had auditory/speech training, and the other wore a cochlear implant and also had auditory/speech training. The hearing aid user was able to produce vowels and was able to identify some environmental noises (e.g., door bell, phone ringing). The child with a cochlear implant was almost at age appropriate level for spoken English, and was able to understand sentences in spoken English without visual cues. The difference between the children is dramatic, and only underscores the benefits that cochlear implants can provide some profoundly deaf children.

Again, to be crystal clear here, hearing aids provide a greater benefit to hard of hearing children. Cochlear implants levels the playing field for profoundly deaf children.

41 comments:

Candy said...

Thank you for posting this. You have made a very valid point.

There are so many degrees of hearing and because of that, there are so many choices and options for parents to make.

This is why I don't feel comfortable classifying myself as deaf, although my parents and friends would say "Yes, Candy is deaf (or Deaf)"

The reasoning is simply because my db is not in the range of 'deaf' classification. Technically I am hard of hearing and like that girl, a hearing aid benefited me at the time I was six. This is why some parents decided to implant some children when their hearing loss have progressed over time. I can't speak for many, but, I can imagine how someone would have heard at one point to want to continue to hear when their hearing have progressed to a deafened state, thus some would go from a hearing aid to an implant later in life.

Which is why, parents should explore all options based on the degree of hearing loss. No one child/person is the same.

drmzz said...

"By “benefit” I mean the hard of hearing child is able to access to spoken English through the use of hearing aids only. No parent would willingly put their child through surgery if that can be avoided."

ci industries are going after Deaf babies with severe to profound hearing loss above 70dbs. In this sense, a hard of hearing child does not qualify so your mere suggestion for surgery is moot.

"In the case of a profoundly deaf child (with a dB of 90 and up), hearing aids provide access to environmental sounds. With intensive auditory and speech training, a few can lipread and use residual hearing to communicate in spoken English."

I disagree. It is pointless even for a severe to profound hearing loss person to use a hearing aid and even more so to spend so much on speech training and the likes. They need visual language. This is the population that ci industries are going after and from my perspective, very unethical.

If a child is that Deaf in that severe to profound range, they need visual language like ASL rather than speech or hearing. This is the main gripe I have with this industry cuz I grew with many severe to profound hearing loss people and as a hoh person with decent hearing and speech, I always see how irrelevant hearing aids and speech training (and now ci) are for them. Visual language, not ci, are compatible for this population. If ci are designed for hoh children then I'll be OK with it but it's not.

Anonymous said...

drmzz

You are a little confused.

The person who wrote this basically said:

CI are for PROFOUNDLY Deaf children.

Hearing aids are for HOH children (because they have residual hearing).

The AFA vlog about the deaf child using hearing aids was misleading - the deaf child they supposedly "market" is actually hard of hearing, that's why hearing aids are successful for her.

Come to think of it, AFA is as bad as AGBell.. parading around "success" stories that cannot be applied to the rest of the population.

Anonymous said...

AFA is as extreme as AG Bell Association. AFA frowns the use of cochlear implants with young children, pointing out to the audism behind cochlear implants and hearing aids. AG Bell is opposed to the use of ASL with the young children.

The ASL-Cochlear Implant Community is in the middle between these two opposite poles.

Candy said...

drmzz,

You said: "It is pointless even for a severe to profound hearing loss person to use a hearing aid and even more so to spend so much on speech training and the likes."

Which I do agree somewhat, because for a profoundly deaf person, the hearing aid isn't really helping with the spoken language, although it might help them with the environmental sound. For some speech training might help, but shouldn't be used as a model. To that exent, it is a quality of life issue and a personal choice.

I guess the question I'm wondering is, are there incidents currently ongoing where we have a deaf child with no residual hearing that is being speech trained? My thinking is that, that is not happening anymore because of technology and parents are opting for an implant if they choose the spoken language route. If there deaf child with no residual hearing being speech trained without any technology, that is definitely ridiculous to even try that route.

So, if the parent is well informed and still shuns ASL and opts for CI, so be it. Fact is that the more you have, the better and easier it is for one to forge on in life. For example, we wouldn't have had issues with being selected over in job interviews, for one. Truth hurts. It is a fact. Raising awareness about deaf people and their ability to be able to do anything but hear is just something we all need advocate to others.

As always, ASL is a great language for any deaf child to have.

I do agree with the author of this post that there are so many misconception going around. People need to get facts from a reliable source.

Someone told me that if one had an implant and had an heart attack. The AED would blow up the implant. I asked a AED certified instructor, and she said no. The electrodes do not go anywhere except between the two points.

So, you see, this is one of the many misconceptions people have by word of mouth.

drmzz said...

Anon, little confused? You funny. I chose to offer my perspective instead of responding to this finger pointing agenda.

AL said...

About speech training with profoundly deaf children with hearing aids, this is being suggested as an alternative to cochlear implants by many in the deaf community (e.g., see Dianrez's comment in a previous blog).

Speech training with hearing aids only sets up the deaf child for failure and frustration, as many of us who are profoundly deaf remember all too well from our childhood.

The surgery itself can be scary and this turns off hearing parents as well as deaf parents of deaf children, and many of them would prefer hearing aids. Unfortunately, hearing aids only offer a very limited benefit to profoundly deaf children. It is very misleading to tell parents and other members of the deaf community that profoundly deaf children can do just as well with hearing aids as they can with cochlear implants.

K.L. said...

Great post AL.

It needs to be recognized that giving a cochlear implant to a profoundly deaf 1 year old, with appropriate speech/language therapy afterwards works. There are many, many children out there now who can easily show that they have age appropriate verbal language. It is no longer a debate among the doctors who see the results. Implants work.

The goal now should be, how can we insure that kids who get implants ALSO get ASL. ASL can help in earlier language acquisition, a safety net for if the implant fails or doesn't work as well as hoped, and for making important connections with the Deaf Community.

The implant is not going away. Most parents are hearing, and can see the value of giving their children as much hearing as possible. The Deaf Community can continue to debate its merits, but that debate should not be allowed to get in the way of starting programs to help parents learn how to provide BOTH implants and ASL.

Dianrez said...

Thanks for picking up on something I said that could be misinterpreted.

I didn't mean that hearing aids were an equal alternative to the CI, only that it still remained as one of several tools.

I should have said it was a less effective tool for profoundly deaf people, based on what others have said here.

We all know of its many failures, but we also know of a few successes profoundly deaf people have had with hearing aids.

What was not obvious in this discourse is that many hearing people think of hearing as paramount, an end goal in itself.

Many Deaf people on the other hand put intellectual development as the end goal, considering hearing of any type to be merely a tool, but not a goal in itself.

AL said...

Dianrez, thank you for keeping an open mind and for commenting here clarifying your previous statements. You might be relieved to know that through my interactions with hearing parents of deaf children with CIs, a large majority of them chose to go both routes- ASL and CIs as a tool to acquire auditory skills. They want to be sure that their children have access to a language, and ASL guarantees them that.

I liked what John Egbert said during his presentation at the EDHI conference about ASL as an opportunity, just like cochlear implants, instead of having to choose between the two. Choosing to teach a deaf child ASL does not mean that one cannot also choose to provide them with access to an auditory language.

Anonymous said...

"We all know of its many failures, but we also know of a few successes profoundly deaf people have had with hearing aids."

Yes, true, I'm one of a few successes but also recognize that there are many profoundly deaf people who could not utilize hearing and speech training very well due to x number of factors.

Dianrez puts it very well that "many hearing people think of hearing as paramount, an end goal in itself" when deaf people know very well that intellectual development is a far more important goal.

A profoundly deaf person can be just as intelligent and articulate as a hearing person, given all the language acquisition tools available, including ASL and technology with AVT/speech training.

One key thing to a deaf person's success is this: The EARLIER the hearing loss detection and the EARLIER the language acquisition, the better. That is a piece of information that shouldn't be twisted and messed with.

Ann_C

Dianrez said...

Thanks, Ann. "I liked what John Egbert said during his presentation at the EDHI conference about ASL as an opportunity, just like cochlear implants, instead of having to choose between the two."

It seems that we are moving on to the next stage in developing a more cohesive d/Deaf community. DBC's leader is saying he is not against the CI, but in favor of making sure d/Deaf children have access to ASL from the beginning.

Neither is AFA against the CI, although it appears to be against what the CI symbolizes: an overemphasis on hearing to the detriment of developing other skills.

Once we understand that the Deaf activists are advocating for acceptance of ASL as equally important as the CI, we can then discuss the next stage: united action to combat audism that affects both signers and nonsigners.

Anonymous said...

This info seems somewhat out of date.

I'm profoundly deaf. I have 110 dB loss in one ear, 100 in the other. My Phonak Naidas add a gain of about 80 dB to both ears. When tested, I'm at the lower end of the 'speech banana' - 20 in one ear, 30 in the other.

Mine are two generations old. More recent models are, I believe, more powerful.

Anonymous said...

To add to my message above - the Phonak Naidas also have several other CI-like features, such as beeping when the battery is low, moderating environment volume, bluetooth for my blackberry so I can play music etc. etc. Digital aids are for everyone now.

The problem is these are more expensive than the cheap, less-helpful kind. I used to get the most basic sort for several hundred; my family hadn't the money for more expensive ones. CI's cost several tens of thousands, more over one's lifetime. These HA's are around 3,500-4,000 - but most insurance plans won't cover them while the CI industry has the health insurance gig locked up and will be fully covered. (My current employer reimburses me up to $500 for the cost of HA's, so I had more help than most people.)

The REAL truth is that most parents can't afford the best hearing aids and have no help in the process of obtaining them. (Mine are only one of several dozen top-notch digital aids available.)

K.L. said...

Hearing aid trials are REQUIRED before a person can become a candidate for a cochlear implant. If hearing aids work well enough to bring hearing into the 30 db range, then the person is not a candidate.

The problem is usually that for the profoundly deaf, there is not enough residual hearing across the entire pitch range to make hearing aids work as well as they need to.

Gaps in any portion of the pitch range cause incomplete understanding of sound in the brain during the brain development window (birth to three).

Anonymous said...

If that is true what K.L. said then why is it that cis are being pushed for 6-12 months old babies since they haven't even tried hearing aids at first?

Anonymous said...

DianRez, I hope you're thinking about CI for yourself.

Anonymous said...

Interesting-- just how young can young go as far as babies wearing hearing aids? Three months, six months, what?

Ann_C

Anonymous said...

These babies start wearing hearing aids as young as three months old.

Miss Kat's Parents said...

They ARE having a trial of hearing aids, it is required. I believe the youngest child in America to get a CI was 6 months, and they were post meningitis, so there was a hurry because of the ossification issue. The "average" is still over 12 months old. That is 12 months to try hearing aids.

Miss Kat's Parents said...

I've seen kids as young as 6 weeks with hearing aids.

Dianrez said...

Nope. No CI...too set in my ways for the hassle of maintaining electronics in my skull. And for an imperfect result.

If in the future stem cell treatments were proven more effective than the CI along with less side effects, I'd consider it.

Joseph Pietro Riolo said...

I am a little surprised that Dianrez would even consider stem cell treatments if they are proven effective beyond doubts.

For those who consider the symbolism of cochlear implant as audism (their rhetoric is totally meaningless but I will go along with their language for a moment), stem cell treatments carry exactly the same symbolism. Stem cell treatments originate from the desire to correct the diseases and disabilities including deafness. Given that the desire to "fix" the deafness is considered as audism, the symbolism of stem cell treatments is therefore audistic.

It would be double standard if one says that the symbolism of cochlear implant is audistic and then, hold to a different standard when he or she comes on the symbolism of stem cell treatments or any other technologies that improve hearing.

Joseph Pietro Riolo
josephpietrojeungriolo@gmail.com

Public domain notice: I put all of my expressions in this post in the public domain.

Dianrez said...

Joseph, you'd be surprised how many Deaf people think the way I do. They feel the cochlear implant, as an invasive treatment with less than optimal results, is audistic in that it is an extreme response to deafness that requires a large degree of accommodation.

To go through all that to give hearing society one less problem?

That was meant as a rhetoric question, aside from the stated advantages of the CI.

Anonymous said...

'Scuse me if I'm going off topic but Dianrez and Joseph raised this subject up...

Dianrez, I don't know the particulars of how stem cell treatments work, but say, it is considered a non-invasive procedure with few side effects. However, say hypothetically, if a prelingually deaf adult were to receive such treatment and develops intact cochlear hair cells which enables him to hear, he would still need to take some kind of audio training to understand speech, if not speech training. The ears are wired, but the adult brain would take time and training to comprehend human speech.

So, would such treatment and training be considered "audistic" if the the formerly deaf person who hears again chose to hear? I'm sure the treatment would be an irreversible procedure, unlike the CI which can be left off if a deaf person desired.

Ann_C

Joseph Pietro Riolo said...

I am not really sure where the leaders and members of AFA stand in respect to stem cell treatments. Their position on the technologies that improve hearing continues to be vague and seems to be confusing sometimes.

If it is accurate that many Deaf people do embrace stem cell treatments in spite of their opposition to the symbol of cochlear implant, they really need to provide strong rationales for treating the technologies differently even though they carry the same symbol. The stem cell treatments have great potential in wiping out deafness (as well as other disabilities). I don't think that this will sit well with the members of Deaf culture.

Ann_C is correct that stem cell treatments still do require therapy beyond simple placement of stem cells in cochlear. Brain needs to create new neural pathways to interpret the new sound inputs and this will take a while for the recipients to develop the listening skills. Sounds much like cochlear implant.

Joseph Pietro Riolo
josephpietrojeungriolo@gmail.com

Public domain notice: I put all of my expressions in this post in the public domain.

Anonymous said...

Joseph,

Stem cell treatment of deafness, if successful on a large scale, actually will have far more serious repercussions on the deaf community than CIs ever will. Cochlear implants and hearing aid technology will pale in comparision to the impact that successful stem cell treatment will create.

I'm sure also that stem cell treatment will raise moral implications about the issue of "disability" and the diseases/disorders that cause disability in the near future. It will raise questions about whether a cure for all kinds of physical disabilities will make society a more compassionate one or not. It will raise questions about the wisdom of man's interfering with the natural processes of disease and aging, as well as other questions we may not have thought of yet.

Ann_C

Dianrez said...

That's true, even if stem cells work optimally, we likely would need extensive auditory rehabilitation to go along with it and depending on age at stem cell treatment, it may succeed only partially.

Purists would condemn it as obliterating Deaf Culture, but it would be shouting into the wind because hearing people cannot understand Deaf Culture as anything but a response to an abnormal condition.

In that way, all treatments are audistic in upholding the superiority of a Hearing lifestyle.

What will be the real loss here? Is it actually a loss, or an improvement? Again, rhetorically.

Anonymous said...

Children having problems in hearing let treat them special. It is better to have hearing aid to those deaf children. So that they will hear what people say and easily for them to understand. Children will not ashamed facing people when having conversation. It is also easily boost their confidence.

Miguel said...

hi,
I think you are doing human trials, at least with children (see the web cordbloodregistry -->> http://www.cordblood.com/regenerative-medicine/hearingloss.asp ).
In this blog http://deafdude1.blogspot.com/2009/08/stem-cells-for-deafness-begins-human.html you can also stay informed on human trials.
greetings!

Anonymous said...

My daughter has ossification in both ears and was implanted in her left...her doctor says "Addison would never be a candidate for hearing regeneration due to her altered cochlear anatomy," I understand that she is implanted, but what about her right ear? Has any one heard anything that contradicts this statement. Any help would be greatly appreciated I am really against having to make her go bilateral if we can someday get her hearing back through hearing regeneration.

Miguel said...
This comment has been removed by the author.
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Children with some hearing problems should be treated special since they can't live their life normally.

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