If the choice is CI and it's early and bi-lateral

Cloggy

Cloggy

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If the choice is CI and it's early and bi-lateral......

Found an interesting article...


As stated in the last sentence of the summary:

"It opens the debate of the ethics of not implanting a deaf child in the first few months of life."
 
For myself, I have never had the feeling that it should be forced. The choice for a CI is one that is for the parents. There should not be any pressure. But what should be there is GOOD INFORMATION !!

What I want to show with this research paper is that that the results are real.
What I would like to see is very early screening of newborn. Because the earlier the diagnosis, the earlier parents can be informed, start looking into the possibilities etc.
Information should be available straight away. Good information, from medical institutions, but also from deaf organisations.
 
I think if more infants are implanted bilaterally, the need for an oral-only approach is more likely to be pushed on the parents. See what happens in the future.
 
shel90 said:
I think if more infants are implanted bilaterally, the need for an oral-only approach is more likely to be pushed on the parents. See what happens in the future.
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You might be right. But in the case of Lotte, she uses less and less sign. BUT she is a master in reading lips. It goes almost unnoticed by us, until we find out that her CI was not on for example. Her voice when she speakes without hearing herself is normal. We do not notice a difference.
(Just to add... I do believe that using sign has helped us tremendously in Lotte's development. I would recommend it to any parent.)

My worry would also be that follow-up would decrease. (But then again, how much follow-up would be needed for an implanted 1-year old compared to a 4-year old??)
We can see that many institutes think that when the child has been implanted with CI, they can hear and therefore speak.
Follow-up of these children (and adults) is very important in order to get the best benefit.

We had to go through great lengths to get 5 hours (which in fact is 4 real hours) of speech therapy for Lotte. My wife fought hard for that and had to argue a lot. She did not become popular with the local government with all the letters she wrote, but in the end it worked.
But it worked because all involved would be educated on how CI's work and how the children should be followed up afterwards.

We all have to think of CI as a system that involves the technology for a small part, but an organisation around it that is crucial. The person with CI, the parents, the teachers, the local government, the speech therapists. All are a vital elements in the concept of CI.
 
Cloggy, I think that bilateral implantation is going to probaly reach its crest in a few years, and then, the numbers are going to fall.
Like I think that a lot of the people who are getting implanted, are ones with uneven losses...like they can hear REALLY well with hearing aids in one ear, but no benifit with the other ear.
One thing that makes me kind of uncomfortable about CI, is that with the exception of auditory nereopathy, it's VERY hard to tell exactly how well a dhh baby hears and how hearing aids might be able to help that. Yes, I know there's ABR, but I've heard that can be inaccurate.
I'm 100% pro early implantation, if it has been established firmly that the child cannot benifit at all from hearing aids or other alternative methods, like a body worn aid (might be able to get more power in some cases) or one of those high frequncy transponder things.
 
deafdyke said:
Cloggy, I think that bilateral implantation is going to probaly reach its crest in a few years, and then, the numbers are going to fall.
Like I think that a lot of the people who are getting implanted, are ones with uneven losses...like they can hear REALLY well with hearing aids in one ear, but no benifit with the other ear.
Click to expand...
I doubt if that person would be a candidate. Apart form that, thresholds are lowered all the time.
Another note. There are people with Ci on one side and HA on the other side that do really well with that combination.
deafdyke said:
One thing that makes me kind of uncomfortable about CI, is that with the exception of auditory nereopathy, it's VERY hard to tell exactly how well a dhh baby hears and how hearing aids might be able to help that. Yes, I know there's ABR, but I've heard that can be inaccurate.
I'm 100% pro early implantation, if it has been established firmly that the child cannot benifit at all from hearing aids or other alternative methods, like a body worn aid (might be able to get more power in some cases) or one of those high frequncy transponder things.
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I'm no specialist eather, but I can imagine that there's a relationship between a bad ABR and the degree of hearing loss. Also, the decision should not be based on 1 ABR, and probably is not. Lotte had two, one before the CI-procedure started and 1 during the procedure..
 
Since ABRs do not test low frequency hearing, a newborn (or adult) may be tested using ASSR (Auditory Steady State Response) since this tests high, middle *and* low frequencies.

If a person can hear *really* well with one ear aided, chances are very likely that they will not be considered a CI candidate. While it is true that CI candidacy criteria have been relaxed over the past several years, a CI candidate must have bilateral severe, severe-profound or profound hearing loss as well as speech discrimination that falls within a certain percentage for the "better" and "poorer" ear.

With more insurance companies paying for bilaterals, I think they will become standard practice.
 
DD, Contrary to popular belief, ENT doctors will not implant anyone that wants a CI and passes the CT scan. I sat through a very informative forum in which the leading ENT docs, speech pathologists, and several others, discussed bilateral implantation. The person you spoke of with good use of 1 ear with CI ond other with HA, was discussed. They were discusseing how many, many with binaural hearing (CI and HA) want a bilateral, but they will not do the surgery because they HA ear still gets good use from the HA. The conclusion of the entire forum was that getting hearing from each ear was the main issue, NOT getting a CI in each ear. They even showed results of studies they did in which the results showed the people with CI and HA scored remarkably well, in fact the scores were incredibly similar to that of a person with bilateral CI.
Now, if a person with CI and HA is hell bent on getting bilateral CI, they can shop doctors until they find one that will do it, or lie on the tests of the HA ear. But that then would not be the doctors responsibilty, it woul dbe on the patient.
 
No....I wasn't advocating for bilateral implants with uneven losses. Just saying that the sudden popularity of implants, is probaly due to doctors relaxing the implantation criteria. Before, if you had good ha use in one ear, there was no hope for getting an implant in the other ear. There's a whole subpopulation who get aidable hearing, but who have "dead" ears on their other ears.
 
deafdyke said:
........ Just saying that the sudden popularity of implants, is probaly due to doctors relaxing the implantation criteria. Before, if you had good ha use in one ear, there was no hope for getting an implant in the other ear. ........
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It's still like that !!!
 
deafdyke said:
No....I wasn't advocating for bilateral implants with uneven losses. Just saying that the sudden popularity of implants, is probaly due to doctors relaxing the implantation criteria.
Click to expand...

I think there are several things going on here that can lead one to believe that the medical community is just "relaxing" the criterion for a CI for reasons that are "willy nilly". First, CIs have finally arrived at the point where the benefits of one are such that it begs the question...where do you draw the line between "limping" along with a HA and having what a CI can provide? It isn't as simple as it seems. My last 5 years or so with a HA prior to my CI weren't the greatest years in hearing for me. It was getting harder and harder to use what I was losing. The hand writing on the wall was there but I "plugged" along knowing it wasn't going to be much longer until I was forced to do something drastic. The rest is as they say is "history".

Secondly, the factors that favor success is getting easier to determine as the technology gets better and the knowledge gleaned from prior surgeries. In another words, it is much less of a "crapshoot" than it was say five years ago. They tested me and saw how I functioned with my HA and they had absolutely no doubt that I would be off and running from the beginning. Sure enough, that happened and it was even better than I thought possible. Yes, there are things one can't predict and less than optimal results occur but it is less and less.

deafdyke said:
Before, if you had good ha use in one ear, there was no hope for getting an implant in the other ear. There's a whole subpopulation who get aidable hearing, but who have "dead" ears on their other ears.
Click to expand...

That described my situation very well for eons. It is still very much the case if you got a decent ear aid, they won't touch you. If I had decent hearing in my aided ear, I wouldn't have had a CI in March of '05. I don't know where you are getting your information from...
 
sr171soars said:
........ CIs have finally arrived at the point where the benefits of one are such that it begs the question...where do you draw the line between "limping" along with a HA and having what a CI can provide? ........
Click to expand...
Good point.
 
deafdyke said:
No....I wasn't advocating for bilateral implants with uneven losses. Just saying that the sudden popularity of implants, is probaly due to doctors relaxing the implantation criteria.
Click to expand...

Numerous research studies have been conducted over the past 4-5 years which demonstrate the benefit people with higher amounts of residual hearing (severe or severe-profound loss) experience with a CI. It was discovered that CI users function significantly better than those with HAs and severe or severe-profound loss. Once people with higher degrees of residual hearing were activated, the results indicated that they performed just as well (if not better) than CI candidates who were profoundly deaf or did not have any residual hearing before implantation.
 
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