For very young, cochlear implants can make a huge impact

Discovering that your child is deaf can be overwhelming—how will his language skills develop? How do you communicate? One increasingly common option is a cochlear implant. Between an external speech processor (roughly the size of a hearing aid) and an internal receiver (surgically implanted in a child’s inner ear), a cochlear implant can provide a child with the sensation of hearing. With 97 percent of deaf children born to hearing parents, this surgery can be life changing for the whole family.

But when should parents make the decision about this major surgery? A recent Boston Globe article looks at the rate at which deaf children under 3 are getting cochlear implants. At Children’s Hospital Boston, which has one of the largest cochlear implant centers in the country, this age factor is already something that physicians Greg Licameli, MD, FACS, and Margaret Kenna, MD, MPH, FACS, FAAP, have encountered. They routinely see patients who are 3 or younger.

“The FDA recommends surgery for patients 1 and older,” Licameli says. “It’s not unheard of for even younger children to have surgery for medical necessity, but we find that a year provides parents enough time to make major decisions about surgery. Also, by age 1, patients can better respond to sound stimuli, which is extremely helpful in the rehab process.”

In 1998, a law was passed in Massachusetts that requires all newborns to have their hearing tested prior to hospital release in order to catch hearing loss as early as possible. For this test, an infant wears a set of headphones; the result is either a ‘pass’ or ‘refer.’ If an infant doesn’t pass, further diagnostics are required. However, the testing isn’t perfect.

“False positives do happen, and hearing loss can occur over time,” Kenna says. “Also, there’s no mandatory retesting after birth. You can’t just assume that a child will have normal hearing.”

Since hearing loss can be gradual, there is no upper age limit for cochlear implant surgery. If a child is absolutely deaf by birth, by age 3 the benefits of surgery go down. However, if a child’s hearing stops working over time, he is still an implant candidate .

If one implant is successful, parents often consider a second implant in their child’s other ear. Although these bilateral implants can help a child localize sound better and potentially hear music more richly, the cost of multiple surgeries can be a major issue for parents and insurance providers. However, Licameli argues that the benefits that come with the second surgery can outweigh the price. “Allowing a child to become hearing can provide better educational and employment access,” he says. “In this era of health care reform, it’s important to look at these factors as opposed to just the initial cost.”

At Children’s, Licameli and Kenna attribute the high success rate for cochlear implant patients on the variety of individuals involved in the program—from surgeons to audiologists to educators. Each patient has multiple visits and consultations before surgery. “You need to have a whole support system to serve the child,” Kenna says.

In the Globe article, one doctor describes cochlear implant surgery as “close to a miracle.” Kenna and Licameli would agree. Even though the implant isn’t perfect—background noise makes hearing difficult, music can sound mechanical, etc.—it gives children the ability to hear, and to give parents the opportunity to communicate with their child.

“Usually kids start by speaking very simple words, like ‘mama’ or ‘daddy,’” Licameli says. “It’s very moving to see parents hear those words for the first time.”

For more about children with cochlear implants, read Hannah Harrington’s story and watch a video about her journey to hear.

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