Cochlear implants 101
Sunday, January 21, 2007
In addition to the ups and downs of everyday life with two kids, Declan, 3, and Bennett, 8 months, both boys underwent cochlear implant surgery.
"We wanted our kids to speak so they can be a part of the speaking community given that no one in our family signs or is part of the deaf community and the cochlear seemed like the best option," says Hadley Haas, the boys' mother.
The family worked closely with Children's Memorial Hospital in Chicago. Bennett's surgery took place at the beginning of November and Declan's at the end of the month.
"There is special testing that we do from an audiology standpoint, and there are tests that are designed, depending on age, to see what kind of information the child gets from language," says Dr. Nancy Young, the head of otology and medical director of the cochlear implant program at Children's Memorial.
Although testing with children as young as Declan and Bennett can be difficult, Young likes to see cochlear implant candidates as early as possible.
"Many studies show that younger is better, in terms of optimizing the outcome," she says. "Now we're implanting infants."
In the past, if a child was able to benefit at all from hearing aids, then he was not a candidate for a cochlear implant. The guidelines continue to change, though, and more children with less significant hearing losses have been able to receive implants.
For cochlear implant candidates, the testing includes speech and language evaluation, imaging studies of the ear and a general medical assessment. After the testing is completed, the hospital waits for insurance approval before going ahead with the implant surgery.
A common misconception is that the surgery is brain surgery. In fact, the surgery only really deals with the ear. Electrodes are implanted into the cochlea of the ear (which send impulses to the brain that are heard as sound), then a small receiver and stimulator is placed beneath the skin on the skull slightly above the ear. The receiver and stimulator convert signals from the transmitter into electric impulses, which are sent to the electrodes. With incisions made only behind the ear and on the head where hair will cover, noticeable scarring is minimal. Most children who have implant surgery go home the same day.
Although any surgery involves risks, those associated with the cochlear implant are fairly minimal.
Those who have cochlear implants also have an increased risk of meningitis. Although the reason is unknown, Children's makes sure all patients receive a meningitis vaccine before surgery.
Most cochlear implant patients have only one ear implanted, but implanting both ears (bilateral) is becoming more common. Bennett became the youngest child in Illinois to have bilateral implants when he had surgery at 6 months old.
Not all insurance companies cover implant surgery on both ears, although some are beginning to change their policies.
Two to four weeks after surgery, the child returns to the hospital to have the implant turned on. This process involves actually putting on the outer cochlear device, a small magnetic transmitter that attaches to the head and the processor that fits behind the ear like a hearing aid. For younger kids, the processor also includes an ear mold, which helps keep the processor on smaller ears.
The implant is then activated. The initial activation mainly consists of making sure the implant works and adjusting the sound to comfortable levels.
Every child reacts differently to having the implant turned on for the first time. For Declan, his reaction ranged from surprise to curiosity to tears, which is not uncommon with younger patients.
For the Haas family, activation is just the beginning. Both boys go to Children's for therapy; Declan twice a week to work on listening and speech and Bennett once a week to improve sound recognition. Schooling is also an upcoming issue for Declan.
"We're working with Chicago Public Schools to see what they offer. We looked at Child's Voice and it's a wonderful program but it's a tough commute for us, so we want to see what our options are at CPS," Hadley says. The hope for Bennett is that by the time he reaches school age, he'll be able to be mainstreamed into a regular classroom.
Despite the long road the family has traveled, Hadley says it's all been worth it. They are already seeing results.
For parents considering a cochlear implant for their child, Hadley offers some advice.
"Stay on top of the process and be a strong advocate for your child," she says. "Be patient as well."