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20 Robert WoodJohnson
example, schools for the deaf and school systems that
have programs for children who are deaf or hard of
hearing--to identify children who may benefit from
cochlear implants, as well as provide further support to the
child post-procedure.
Improving the Chances of Success
here was a real need in Central Jersey for this type of
service," Dr. Chee says.
As many as three out of every 1,000 children in the United
States are born with a detectable level of hearing loss in one
or both ears, according to the Centers for Disease Control
and Prevention. Nine out of 10 babies born with hearing loss
are born to hearing parents.
"In the past, some kids wouldn't be identified with hear-
ing issues at all until they were 3 or older," says Dr. Chee.
"That number has gone down with the universal newborn
hearing screenings, but even now we see children being iden-
tified at 3, 4, and even 5 years old."
The earlier that children are identified, the better the
chance of success, say Dr. Chee and Dr. Kwong.
For children who are born deaf or with profound hearing
loss, there is some limit on the maximum age at which cochlear
implants can be performed--usually 5 or 6 years old--because
the brain can only go so long without any aural stimulation, Dr.
Kwong explains: "At that late stage, they may have sound
awareness as a result of the implant, but it would not be mean-
ingful enough to have normal speech recognition."
As a result, the best possibility of success is with children
who are between 1 and 2 years old, says Dr. Chee, because
they will be exposed to sounds during an optimal period to
develop speech and language skills. In fact, a growing body
of research has shown that when children receive a cochlear
implant followed by intensive therapy before 18 months of
age, they are better able to hear, comprehend sound and
music, and speak than their peers who receive implants when
they are older, according to the National Institute on
Deafness and Other Communication Disorders.
In addition, children who receive bilateral cochlear
implants--that is, cochlear implants in both ears, such as
Annabella--benefit from the ability to have directionality of
sound, improved hearing quality, and improvement in distin-
guishing sounds in noisy environments, says Dr. Kwong.
Bilateral cochlear implants are performed sequentially, ideal-
ly less than six months apart, because the brain is better able
to handle both signals if the surgeries are performed closer
together, he adds.
Finding the Right Candidates
ike most medical procedures, cochlear implants are
not a good fit for everyone. Individuals whose hearing
is improved by hearing aids, or who have conductive hearing
loss, which results from problems with the ear canal, ear-
drum, or middle ear and its ossicles, would not be candidates
for cochlear implants, for example. The amount of work
needed afterward by the child and family also requires com-
mitment and a strong support system to be in place. The
Robert Wood Johnson Pediatric Cochlear Implant Team
conducts an intensive process to determine which individuals
would be most appropriate and reap the largest benefit from
the procedure.
"We meet every month with all members of the team to
discuss prospective cases. It's not always a straightforward
decision. Family support is critical," Dr. Kwong says.
The team also meets with family members to discuss
what they hope the results of the implantation will be, so
the team can set realistic expectations, he says. For exam-
ple, speaking fluently following the surgery may be possible
for some children but not all, and many factors--physical
and otherwise--can affect the success of cochlear implants
for each child. As a result, Dr. Kwong says, the team devel-
ops an individualized plan and goals and shares them with
the family so that everyone is on the same page with regard
not only to the possibilities for their child, but also to the
work needed to help the child make the most of the implant.
Besides expanding access to cochlear implants for chil-
dren in the area who are deaf or have profound sen-
sorineural hearing loss, the team hopes to add to the
research being conducted on this technology. They have
proposed additional research with the Institute for the
Study of Child Development to explore such issues related
to pediatric cochlear implants as the development of hear-
ing and/or speech and a comparison of outcomes based on
the different ages at which a child has the procedure, says
Dr. Kwong.
They also hope to focus on increasing general awareness,
Dr. Chee says. "We follow children who are very border-
line--they're developing some language, but are very hard
of hearing, even with hearing aids--or those whose hearing
loss might progress to the point they might benefit from
cochlear implants, to be sure they don't just fall through the
cracks. With the advent of universal hearing screening,
there should be no reason for a child to have profound
hearing loss and not at least be offered a chance for hear-
ing," he says.