Cochlear Implant Debate

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Cochlear Implant Debate For the motion
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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.

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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

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Summary

• Speech and Language Development
• Educational Attainment
• Quality of Life
• Psychosocial Impact
• Cost Effectiveness
• Technology Improvements
• Choice

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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

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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

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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
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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

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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)

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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

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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., ONeill, 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.

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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

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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 lt18 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.

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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.

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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 childs
  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.

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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.
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Technology

• Advance 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.

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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 madeby
  parents They now state that their communication
  methods are not fixed
• Alexandra Wheeler, Sue Archbold, Susan Gregory
  and Amy Skipp
• Cochlear Implants The Young People's Perspective
• The Journal of Deaf Studies and Deaf Education
  2007 12(3)303-316