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Journal of Early Intervention Journal of Early Intervention http://jei.sagepub.com The Effectiveness of Cochlear Implants for Children With Prelingual Deafness Ann M. McKinley and Steven F. Warren Journal of Early Intervention 2000; 23; 252 DOI: 10.1177/10538151000230040501 The online version of this article can be found at: http://jei.sagepub.com/cgi/content/abstract/23/4/252 Published by: http://www.sagepublications.com On behalf of: Division for Early Childhood of the Council for Exceptional Children Additional services and information for Journal of Early Intervention can be found at: Email Alerts: http://jei.sagepub.com/cgi/alerts Subscriptions: http://jei.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav Citations (this article cites 31 articles hosted on the SAGE Journals Online and HighWire Press platforms): http://jei.sagepub.com/cgi/content/refs/23/4/252 Downloaded from http://jei.sagepub.com by M Peterson on May 28, 2008 © 2000 Division for Early Childhood of the Council for Exceptional Children. All rights reserved. Not for commercial use or unauthorized distribution. Journal of Early Intervention, 2000 Vol. 23, No. 4, 252–263 Copyright 2000 by the Division of Early Childhood, Council for Exceptional Children The Effectiveness of Cochlear Implants for Children With Prelingual Deafness ANN M. McKINLEY Vanderbilt University STEVEN F. WARREN University of Kansas No longer considered an experimental procedure, cochlear implantation in young children with profound hearing loss has become almost commonplace. This paper reviews the efficacy of cochlear implantation in children with prelingual deafness. First, a brief introduction to cochlear implants is provided. Second, research regarding the effects of cochlear implantation in children with prelingual deafness on speech perception, speech production, and language development is reviewed. Finally, implications for early childhood educators are discussed. The development of cochlear implants is one fessionals view deafness as a condition to be of the most significant interdisciplinary bio- diagnosed and treated, the Deaf community medical achievements to date (Clark, Cowen, sees deafness as a difference, not a deficit. Ac- & Dowell, 1997). This therapeutic break- cording to Lane and Bahan (1998), Deaf peo- through has been the subject of widespread ple have a language and are a cultural minor- media attention in recent years as its effects ity, and the world of deafness is distinctive, have been increasingly reported in scientific rewarding, and worth preserving. journals (e.g., Balkany, 1993; Bonn, 1998; Many deaf advocates consider cochlear im- Osberger, Maso, & Sam, 1993). As technolo- plants as genocidal to the Deaf culture (Lane gy continues to improve, public awareness in- & Bahan, 1998). They argue that implantation creases, and the age of implantation lowers, of children conflicts with the right of the Deaf young children with cochlear implants are be- cultural minority to exist and flourish. Al- coming common in various types of early though these issues have been raised, this pa- per is written simply to evaluate the perfor- childhood educational settings. mance of children who have received cochlear This paper reviews the empirical evidence implants. We do not wish to discredit the Deaf of the efficacy of cochlear implantation in community or the potential value of manual children with prelingual deafness. We ac- communication. Instead, we recognize that knowledge that it is almost impossible to write there are parents of deaf children who desire a paper on this topic without addressing the that their child learn verbal communication. controversy surrounding the use of cochlear With this in mind, we have provided a critical implants for children. Cochlear implant pro- review of the research literature, examining fessionals have met tremendous opposition the effectiveness of cochlear implants on the from the Deaf community. Members of the development of verbal communication skills Deaf community differentiate the term ‘‘deaf’’ in children with prelingual deafness. In addi- that is used to describe a pathology, from the tion, we addressed issues that early childhood term ‘‘Deaf,’’ which denotes a culture and a educators, who come in contact with children sense of pride. Whereas many medical pro- with cochlear implants, might face. 252 JEI, 2000, 23:4 Downloaded from http://jei.sagepub.com by M Peterson on May 28, 2008 © 2000 Division for Early Childhood of the Council for Exceptional Children. All rights reserved. Not for commercial use or unauthorized distribution. Figure 1. Internal and external components as worn by the cochlear implant recipient. A Primer on Cochlear Implants ternal components consist of a microphone, a A cochlear implant is an electronic device speech processor, and a transmitter, which providing auditory information to individuals sends the signal to the internal components who have severe to profound sensorineural (see Figure 2). Cochlear implant surgery is hearing loss in both ears and receive limited usually a 2- to 3-hour procedure, performed or no benefit from conventional hearing aids. by an otolaryngologist (ear, nose, and throat Typically, these individuals have pure-tone surgeon). The child typically spends 1 night thresholds of 100 dB HL or greater. The origin in the hospital following cochlear implant sur- of profound deafness is usually damaged or gery. Approximately 4 weeks following sur- diminished hair cells in the inner ear (Hen- gery, the child returns to the implant center derson, Salvi, Boettcher, & Clock, 1994). Be- for the initial stimulation of the device. This cause of the amount of hair cell damage, initial ‘‘tune-up’’ session usually takes 2 to 3 merely amplifying sound does not enable peo- days depending on the child’s age and level ple with profound deafness to process sound. of cooperation. An audiologist stimulates each Unlike conventional hearing aids, which de- of the implanted electrodes and determines the liver amplified sound to the ear, a cochlear child’s threshold and comfort levels. Once implant bypasses damaged hair cells and stim- threshold levels and comfort levels have been ulates the auditory nerve directly with electri- obtained for each of the electrodes, a map of cal current. Cochlear implants have been used these levels is created and programmed onto in research trials with adult patients since the the child’s speech processor. Initially, the child mid-1970s but did not receive Food and Drug will have to make frequent visits to the audi- Administration (FDA) approval for clinical ologist to fine-tune the map. After that, ad- use in children until 1989. Currently, children justments to the child’s map will be made pe- over the age of 18 months who have profound riodically as perceptual performance changes. bilateral sensorineural hearing loss and dem- Several modifications have been made to onstrate limited benefit from conventional the cochlear implant device components and hearing aids might be considered candidates speech processing strategies as the technology for cochlear implants. More than 20,000 peo- has evolved. Currently, three cochlear implant ple around the world, half of them children, devices have been cleared by the FDA for have received cochlear implants since the clinical use. The Cochlear Corporation re- clinical introduction of the device (Bonn, ceived FDA approval for clinical use of the 1998). Nucleus 22 cochlear implant in children in A cochlear implant is comprised of internal 1989. This device was subsequently replaced and external components (see Figure 1). The by the Nucleus 24 cochlear implant in 1998. internal components consist of electrodes, In 1997, the Advanced Bionics Corporation which are surgically placed in the cochlea (in- received FDA approval for the use of the Clar- ner ear), and a receiver or stimulator, which ion cochlear implant in children. A fourth de- lies beneath the skin behind the ear. The ex- vice, the COMBI 40ϩ, manufactured by the McKinley & Warren 253 Downloaded from http://jei.sagepub.com by M Peterson on May 28, 2008 © 2000 Division for Early Childhood of the Council for Exceptional Children. All rights reserved. Not for commercial use or unauthorized distribution. Figure 2. Illustration of the external device of a cochlear implant. Med. El. Cooperation, is currently undergoing onset of deafness, age of implantation, speech clinical trials. The most significant advance- processor type, number of implanted elec- ment in cochlear implant technology has been trodes, duration of deafness, communication in speech processing. Whereas the cochlear mode, and duration of implant use (Miyamoto implant devices of the early 1990s encoded et al., 1994). In addition, it is possible that only specific features of speech, the current implant success is affected by the physiolog- devices encode the entire speech signal. ical functioning of the surviving neurons in In addition to device alterations, there have the auditory nerve, the position of the elec- been changes in the demographic character- trodes in relation to excitable tissue, neural istics of children undergoing cochlear implant supply to the cochlea, the central processing surgery. Specifically, children are receiving abilities, and the child’s cognitive and linguis- implants at a younger age because research tic abilities. Furthermore, the quality of audi- has continued to suggest superior performance tory training, parental motivation, and teacher
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