Cochlear Implants in Young Children: Informed Consent as a Process and Current Practices

Abstract

Audiologists are the only nonsurgical professionals always represented on the cochlear implant team. In order to best prepare audiologists for this role, graduate audiology programs need to address more extensively the Deaf culture and perspective, as well as genetics of hearing loss. Increased attention to educational audiology and evidence-based research regarding best age to implant and bilateral implantation needs to be included in the discussion with parents. Audiologists play a crucial role in informing parents and coordinating care, and should therefore carefully consider their role in the informed consent process.

The language development of a deaf child with a cochlear implant

“…This makes results hard to interpret or generalize (Schauwers et al, 2008;De Raeve, Loots, 2008;Weisel et al, 2007). Moreover, despite the fact that Flemish Sign Language (Vlaamse Gebarentaal or VGT) was acknowledged as an official language for the deaf by the Flemish government in 2006, we find that Universal Neonatal Hearing Screening (UNHS) referral centres in Flanders dealing with hearing parents of deaf children either do not mention signed language (and Deaf culture) or mention it only in function of the spoken language development (Berg et al, 2000(Berg et al, , 2007 on the situation in the United States; Hardonk et al, 2011a, b and c and Matthijs et al (forthcoming) on the situation in Flanders). It is our opinion that language is not defined by modality, in this case, the auditory-vocal modality.…”

“…Thus, hearing parents of deaf children run the risk of 'becoming worn down due to excessive rational decisions' (Papousek, Papousek, 1987;Koester, 1992, Waxman & Spencer, 1997. These issues of insecurity are not automatically resolved by CI (Hyde et al, 2010;Christiansen & Leigh, 2002;Weisel et al, 2007;Zaidman-Zait & Most, 2006), as discussed by Weisel et al (2007), who state that 'at the beginning of the process [of cochlear implantation], parents' expectations from implantation tend to be high (Kampfe et al, 1993), accompanied by anxiety experienced by both parents and child (Bray, Neault, & Kenna, 1997;Russell, Coffin, & Kenna, 1999). Later on, facing the demanding rehabilitation process, the family's level of stress increases (Beadle, Shores, & Wood, 2000) especially if their high expectations are not met.'…”

“…This focus on auditory perception and spoken language in research taken together with the clearly medical point of view of treating the deaf ear by means of CI constitutes what is called the medical discourse concerning language development of deaf children. Although this intensive interest in spoken language development has rendered important insights into the linguistic development of young deaf children with a CI (Berg et al, 2007), we would like to point out that by excluding signed language development one presents only half a story. When Stokoe in 1960 published his paper Sign Language Structure, this was the beginning of many studies acknowledging signed languages as equal to spoken languages (Armstrong 2005).…”

The Role of Multidisciplinary Teams: A Focus on Communicating Bad News

“…One of the bases is paediatric-neonatology care. In our opinion, the main ideological pillar is care focused on achieving optimal health of the new-born and cooperation with other experts [20].…”

Cyborgization: Deaf Education for Young Children in the Cochlear Implantation Era

“…However, what is most problematic with these discussions (or lack thereof) is that they ignore or undermine the physical and emotional costs of this highly invasive surgery while also underutilizing or excluding the expertise of the Deaf community, particularly those who have received implants. This has the effect of making the decision about cochlear implants only a medical issue and at the same time devaluing social, cultural, and linguistic perspectives, especially counter standpoints that do not support implantation (Berg, Herb, & Hurst, 2005;Berg, Ip, Hurst, & Herb, 2007;Hyde & Power, 2006;Okubo, Takahashi, & Kai, 2008;Young et al, 2006). Researchers have also found "fewer than half (45%) [of the cochlear implant teams] presented Deaf culture and emerging autonomy/identity issues to parents" (Berg et al, 2007, p. 13).…”