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Cochlear Implants

Until the 1970s there was no medical or surgical method to cure deafness. Since then, the new technique of cochlear implantation has been developed. It can briefly be described as a hearing aid surgically implanted in the inner ear to transmit sound signals, via an external microphone and a processor, to a receiver and electrodes placed in the cochlea.

When cochlear implantation was introduced in the early 1980s the first patients were post - lingually (i.e. after language acquisition) deaf adults. The first operations on children were also carried out on post - lingually deaf. In 1990, the cochlear implant was approved by the United States Food an Drug Administration (FDA) for use on pre-lingually (i.e. before language acquisition) deaf children over the age of two.

The Council of Europe Committee on the Rehabilitation and Integration of People with disabilities (CD-P-RR) has been studying the advantages and disadvantages of cochlear implants and has reviewed current implantation practice in its member and observer States since 1996. The differences between the States concerned call for intensified exchange of information in the light of the genuine common interest of the States to capitalize on each other’s experience in the best interest of the deaf persons and their families.

There is convincing evidence that post-lingually deaf adults and children benefit from cochlear implantation. Speech perception is considerably improved since many patients recover substantial ability to respond to sound and recognize words by ear. However, implant surgery on young pre-lingually deaf children is still an area of controversy.

On the one hand, parents welcome this technological development as an opportunity for their child to improve the chances of acquiring spoken language and hence of easier communication with the environment.

On the other hand, there is consensus that children with cochlear implants remain severely hearing-impaired. There is no case reported of a deaf child being able to acquire spoken language as a result of implant surgery alone. Consequently, the children need special education, such as extensive and specific speech and auditory therapy and training, and special provisions, such as intensive long-term rehabilitation and parental guidance. This rehabilitation and after-care is crucial to the success of the implantation.

In May 2001 the Council of Europe published the report “Cochlear implants in deaf children”, which analyses the psychological and psychosocial consequences of cochlear implantations in children. It also provides an overview of the current policy and practice in 10 European countries. In most countries the minimum age for an implant operation is 2 years. The rationale for an early implantation is that early exposure of the child’s auditory system is seen as means of stimulation its speech perception and production. However, speech is not synonymous with language. Language learning is about understanding symbols and understanding that something can be represented by something else. The language learning process is more effective when preceded by a successful linguistic experience, e.g. the learning of sign language. Studies have clearly shown the positive effects of sign language learning in deaf children, not only for communicative, social and emotional development but also for language learning in general. There is concern that cochlear implant surgery may delay the child’s acquisition of sign language and therefore the child’s command of a full-fledged natural language. And if children are not fluent in any language their intellectual, psychological and social development may be hampered. Consequently, cochlear implantation should be combined with the learning of a sign language.

If deaf children can become bilingual – in sign language as well as in reading and writing – and gradually also be able to use speech, the cochlear implant can become an asset for them. But if their ability to take part in social interaction will only be based on auditory perception through the implant, their future emotional, social and also cognitive development may be at risk.

There is a clear need for more research in the long-term effects of cochlear implantation in children, since there is not sufficient information available on the linguistic, socio-emotional, educational and cognitive development of congenitally (by birth), pre- or peri - lingually (i.e. before or during language acquisition) deaf children and the long-term psychological, pedagogic and ethical consequences.

The study was drawn up by Professor Gunilla Preisler from Stockholm University, Sweden, for the Council of Europe’s Committee on the Rehabilitation and Integration of People with disabilities (CD-P-RR). It is based on governmental contributions from member and observer states of the Partial Agreement in the Social and Public Health Field, as well as contributions from non-governmental organizations, such as the European Union of the Deaf (EUD).

The report concludes that intensive rehabilitation is needed to guarantee a successful outcome and that the use of cochlear implants in children should be combined with the learning of a sign language.

The publication is available in English and French from:
Council of Europe Publishing, F-67075 Strasbourg Cedex,
Fax: +33 3 88 41 27 80
E-mail: publishing@coe.int
Web site: http://book.coe.int
(Cochlear implants in deaf children, Council of Europe Publishing, Strasbourg
May 2001, 39 pages, ISBN 92-871-4628-4, Price: € 8.00 / US $ 12.00)

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