Cochlear implants increasingly used to help kids hear

11/01/2012 12:00 AM

11/02/2012 9:31 AM

Many parents have videos of their baby's first steps. John and Kristen Scifres of Granite Bay cherish footage of the moment their baby could first hear.

Their son, Kevin, now a first-grader, was born deaf, the result of a rare recessive gene. At 9 months old, he had cochlear implant surgery, making him among the first children in the world under a year old to have the operation, and one of only a few to have both ears implanted simultaneously.

With video camera rolling, headphones were placed on Kevin, the implants were activated, and he heard his first sounds, the beeps of the hearing test.

"He immediately started smiling," Scifres said. "It was a magical, magical moment. We still celebrate his hearing birthday."

The Scifreses are among a growing number of parents choosing technology to help their deaf children hear, including cochlear implants and hearing aids. And more parents are choosing oral deaf education, also called auditory oral education, to teach deaf children to listen and talk.

The shift means children who are deaf or have profound hearing loss don't rely on sign language. They can be mainstreamed into public schools and integrated into a hearing world.

Surgical and technological breakthroughs, along with new ways of teaching, allow such children to hear and speak. Some say it could improve their chances to go to college, get better jobs and make more money, which has an economic impact on both the deaf and hearing populations.

More than 36 million Americans have some sort of hearing loss, according to the National Institute on Deafness and Other Communication Disorders.

About three children in every 1,000 nationwide are born deaf or profoundly hard of hearing, said Nikolas Blevins, director of the Stanford Cochlear Implant Center and chief of Stanford University's division of otology. Another three in 1,000 children will develop hearing problems by age 5, he said.

"There's a big societal impact there," Blevins said. "This gets to where we as a society spend our dollars in treating and educating our children."

The societal costs of educating and supporting a deaf child can exceed $1 million over the person's lifetime, including special education and lost work productivity, according to Blevins.

"If we can take some of that money and invest it early, we have the potential to integrate them into the hearing world," he said.

A cochlear implant device alone costs up to $30,000, and education and therapy afterward can cost in the hundreds of thousands of dollars, he said, but returns are healthier in terms of productivity and quality of life, Blevins said.

"We are now seeing kids with cochlear implants graduating from college, and becoming doctors and lawyers in the hearing world," Blevins said. "When you look at the decreased wages and societal costs of deaf children, this becomes a positive investment for our society."

Oral deaf education is a personal choice for families, said Laura Turner, principal of Children's Choice for Hearing and Talking in Rancho Cordova, a leading school in the field of teaching deaf and hard-of-hearing children to listen and develop spoken language. Many deaf advocates argue that deaf people already have a culture and support network, and that sign language is a valid form of communicationm, she said.

Yet, cochlear implants are surging in popularity for deaf adults and children, and even babies as young as 5 months, Blevins said.

According to the U.S. Food and Drug Administration, about 219,000 people worldwide have received the implants since they were pioneered in the 1980s. In the United States, roughly 42,600 adults and 28,400 children have received them.

Blevins said the Stanford clinic has implanted about 80 devices in the past year.

The procedure bypasses damaged portions of the ear with electronic devices that directly stimulate the auditory nerve. It can be performed on very young children, because the cochlea is full-grown at birth.

In the implantation, a tiny electrode array is surgically placed in the core of the cochlea, while a receiver is placed just under the skin behind the ear. A microphone and speech processor are positioned on the outside of the ear, picking up sounds and arranging them.

After implantation, patients undergo therapy to learn how to interpret the sounds. For very young children, there's a time crunch, Blevins said.

"There are critical periods for language development early on, where kids need auditory input to understand and learn speech," he said. "We can't go back and make up lost ground. The developing brain doesn't save space for things, so it's important to get auditory signals in early, so the brain can make sense of sound."

Turner's CCHAT group, which opened in 1996 with a dozen students, is one of only two auditory oral programs serving children in Northern California.

Now, about 70 students, fitted with hearing aids, personal FM amplification systems or cochlear implants, attend the Rancho Cordova school, with some parents making the daily commute from as far away as Redding, Chico, Reno and Fresno, said Turner, the principal.

She said deaf children relying on sign language are often cut off from hearing family members and friends who don't sign. And they can't talk on the phone, which further limits their world.

"Ninety-five percent of deaf or hearing-impaired babies are born into hearing families," Turner said. "The first thing parents think is, 'Everyone needs to learn sign language.' But with the technology available today, there's good options for allowing these children to participate in the culture of their own family. With early identification, appropriate amplification and intervention, they can speak and learn to listen alongside their hearing peers."

CCHAT's teachers and speech therapists focus primarily on preschoolers from 2 months old to 5 years of age, with the goal of transitioning them into public school kindergarten, where they can participate in regular education classes with hearing students. The school also works with some older elementary school children.

The privately funded school, operated by the nonprofit Foundation for Hearing Research, costs $35,000 a year for each student, but it's free for their families, with $25,000 coming from state education funding and $10,000 coming from school fundraising campaigns and private donations.

Turner said auditory oral learning for deaf children can save taxpayers $400,000 per child in special education costs.

"We also know that deaf adults represent a cost to society, as they have a high incidence of getting general assistance, unemployment and lower wages," she said.

While CCHAT students are taught how to listen carefully and concentrate, the school also smashes notions of deaf schools being quiet, with teachers asking questions and kids shooting up their hands to answer. The school is alive with the sound of children chattering and playing musical instruments.

Six years ago, California joined other states in making hearing tests mandatory before newborns leave the hospital. The early diagnosis allows parents to become educated and make informed decisions in a crucial time.

The mandatory test, just two weeks after implementation, caught Kevin Scifres' hearing loss, which his mother said she may not have noticed for months, perhaps years.

Kevin started attending CCHAT at 6 months, even before his implant procedure, and at 4 years graduated into regular kindergarten.

Today, he is a bright and active student in his local public school. He's at the top of his reading group, likes Spanish, riding bikes and skiing, and plays soccer, basketball and baseball.

When asked how he handles questions about his cochlear implant, he is straightforward and confident.

"I tell people I was born without hearing, and this is how I hear," he said. "I usually try to explain it. I don't feel bad about it. It actually helps me hear good."

Krista Rey, a Lodi native who graduated from CCHAT, is a sophomore at George Fox University in Newburg, Ore., pursuing a teaching degree. She was fitted for hearing aids at 15 months old, and learned to speak and listen at CCHAT.

Rey said her world would be completely different if her parents had chosen a sign-language option for her instead of sending her to CCHAT.

"If I were to sign, I wouldn't be able to enjoy sports like I do," said Rey, 19. "I would have needed more help. Honestly, I don't think I would have made it to college. Now, I'm able to live a fairly normal life. I live in the dorms, I have a lot of friends who are great people. I don't need a translator in class. I love being independent and on my own."


RESOURCES

Children's Choice for Hearing and Talking is a Rancho Cordova school that teaches deaf and hard of hearing children to listen and develop spoken language. www.cchatsacramento.org, (916) 361-7290.

The National Organization for Hearing Research Foundation funds research into causes, prevention, treatments and cures of hearing loss and deafness; nohrfoundation.org

Oral Deaf Education is a clearinghouse for matters regarding one schooling approach for deaf and hard-of-hearing children; www.oraldeafed.org.

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