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Can a baby wear hearing aids?

Absolutely. It is not only possible but necessary for babies to wear hearing aids if hearing tests suggest hearing loss. Hearing aids are recommended as early as of 3 months of age. The brains of infants function at genius levels decoding sounds, so babies will accept aids and not remove them if they are receiving any meaningful input. Wearing hearing aids does not generally cause pain or infection. If the child does not like to wear the aids it is often an indication of a hearing loss too severe for the aids to help.

Why is my doctor sending me and my baby to a geneticist?

Pediatric hearing loss often occurs with other health problems in patterns called syndromes and a geneticist is trained to recognize those patterns. If a pattern is recognized, the medical team may get a forewarning of the future behavior of the hearing loss, or of other medical problems that may not be obvious in infancy. In many cases this knowledge leads to more certainty and less testing. A visit with a geneticist can help parents understand the risk of hearing loss for subsequent children.

Can children develop normal speech and language if they can only hear with a cochlear implant?

Absolutely. Most children born with hearing loss and without other neurological or behavioral problems do develop normal speech and language with a cochlear implant, provided there is adequate follow up and auditory- verbal speech therapy after surgery, and provided speech and verbal language was sufficiently and constantly encouraged at home and at school. Most of the time, physicians are able to predict how well a child will perform with a cochlear implant but as you can tell from the long sentence above, it is a lot of work. Of course language success depends heavily on the educational environment. Children with implants belong in special Listening and Spoken Language Preschools and should be mainstreamed with supports as early as possible to have the best outcomes.

How can my doctors tell if my child is able to use hearing aids or will need a cochlear implant?

Although babies and young children cannot have regular hearing tests as adults do, there are other very reliable tests that can estimate the level of hearing of a child, such as the “ABR” and “behavioral audiometry”. Some of these tests can also be done while the child is using hearing aids, to see if they provide any benefit. Even with testing, it is sometimes difficult to tell if an infant or young child is hearing enough of all the speech frequencies with their hearing aids to develop speech. Children with hearing loss who use hearing aids are closely followed and re-evaluated to be sure hearing does not change and that speech is progressing. A lack of progress with hearing aids will often be the sign that dictates a child will need a cochlear implant.

How can the speech therapist tell that my child is progressing or not with hearing aids if my child is too young to speak?

Even though young children do not begin to speak for 2 years, they do begin to babble much earlier. That early babble is usually not random but is composed of individual parts of words the child hears. This is called phonemic babbling. If a child is using hearing aids and there is evidence of new meaningful babble it is evidence he is hearing those sounds with the hearing aids. If speech sounds do not develop within a few months of hearing aid use it is usually an indication that a cochlear implant will be necessary for speech and language development to occur.

Why is a CT scan necessary in the evaluation of my child’s hearing loss?

CT scans can provide invaluable information about your child’s ear anatomy. A CT scan can examine the ear canal, middle ear bones, and the inner ear as well. It can also inform the doctors of the presence of hidden fluid or infection. If cochlear implantation is contemplated, a CT scan can help detect inner ear abnormalities, plan the surgery, and help in selecting the appropriate implant.

Why has an MRI been recommended for evaluation of my child’s hearing loss?

Similar to a CT scan, an MRI can provide invaluable information about your child’s ears, auditory nerves, and brain. An MRI can pick up subtle detail about your child’s inner ear anatomy that is vital in some cases. The MRI scan takes much more time (around 40-45 minutes) than a CT to be completed and almost always requires sedation and anesthesia to put the child to sleep. An MRI scan uses a magnetic field to take pictures so no radiation is used.

Why do I need to speak with a social worker if my child has hearing loss?

Having a child with hearing loss is hard work! There are a lot of appointments to keep with doctors, audiologists, speech therapists, and schools. There is also equipment to keep in working order (hearing aids and cochlear implants). A social worker can help you to get organized and to access the support you need to make sure your child has the best hearing and speaking outcome possible.

My child is using hearing aids. Why does he need to have his hearing re-tested so often?

Children with hearing loss often lose more hearing with time, but will not be able to tell us they are not hearing well. Re-testing the hearing helps to catch changes early in order to re-calibrate  hearing aids, or to reconsider the treatment strategy.

How long after the cochlear implant surgery will my child begin to hear?

Two to four weeks after surgery, the external part of the cochlear implant is put on and the individual electrodes will be tuned. This gives enough time for the wound to heal so there is no tenderness getting in the way of the new hearing experience. At this appointment the child may hear for the first time. However, many visits and follow ups are required for the device to be calibrated adequately and used at its full potential.

How long after the cochlear implant surgery will my child begin to speak?

This depends on the age at the time of implantation and the duration of deafness. Children with natural hearing make voice sounds within months and begin to speak at 2 years. If your child is implanted at 12 months of age their ears are “born” when the implant is turned on. Be patient. It will be a full 2 years before the emergence of speech. Your speech therapists will be able to confirm the implant is working much earlier, though, because of the speech sounds that will emerge much earlier. The later the child is implanted, the longer it may take to bridge the speech gap between his/her peers in terms of speech and language skills. Most children implanted at 12 months have speech that is indistinguishable from their classmates by kindergarten.

What is a cochlear implant?

A cochlear implant is a surgically implanted device that acts as a hearing aid. Cochlear implants are considered a major breakthrough in modern medicine, that have permitted thousands of people of all ages with hearing loss to acquire or regain hearing and speech who have not benefitted from hearing aids. More than 300,000 people worldwide have received cochlear implants. The device has 2 parts: an implantable portion and an external hearing aid part. The internal device that is placed under the skin behind the ear is called the “receiver stimulator” which has a long, slender electrode array that is inserted into the inner ear. The external hearing aid portion sits behind the ear like a hearing aid and has an antenna that it uses to communicate with the implanted device.

How does a cochlear implant work?

 The external device is worn behind the ear, similar to a conventional hearing aid. It picks up sound, converts it into a code, and then transfers the necessary information to the internal device wirelessly across the skin.  The internal device (the receiver-stimulator that is surgically implanted) then sends an electrical signal to the electrode array in the inner ear where the nerves of hearing are directly stimulated. This signal bypasses the damaged or nonfunctional hair cells of the inner ear. The electrical signals from a cochlear implant can also provide a clear signal through auditory nerves that do not work well.

Are cochlear implants experimental?

 No. Although continuous research is being performed to optimize the performance of cochlear implants, they are no longer considered experimental. There is overwhelming evidence for their efficacy, and they are considered the standard of care in many cases of severe to profound hearing loss and auditory neuropathy. Most of the time, your doctor will be able to predict the extent to your child will benefit from a cochlear implant. It is imperative to discuss this with your doctor and to have realistic expectations before proceeding with surgery. Cochlear implants may be less successful or even discouraged in patients with neurological issues, psychological issues, or anatomical abnormalities in the inner ear that limit the ability to place electrodes effectively.

Is cochlear implant surgery safe?

 Cochlear implants are safe. The surgery takes around 1.5-2 hours in experienced hands. As with any surgery, there is a small risk for infection and bleeding. There is small risk of injury to the nerve that innervates the muscles of the face, but this is extremely rare as special electrical monitoring of the nerve is used and this surgery is performed only by experienced surgeons.

Is the magnet in the cochlear implant a problem for my child?

 No. The presence of a magnet under the scalp does not pose a health risk to your child and all implants are currently MRI-compatible. However, they differ in the amount of magnetism allowed to conduct the test (1.5 vs 3 Tesla MRI). If your child will require an MRI of his brain, the magnet might obscure adjacent structures in the images. Very rarely, the magnet will need to be surgically removed in order to conduct the test and then replaced.

What happens with a cochlear implant at the airport?

As with all metallic devices, the implant might activate metal detectors at the airport. Airport security staff are generally familiar with cochlear implants. Parents and legal guardians can simply explain that the child has a cochlear implant and show the Patient ID Card that is provided by the manufacturer of the implant. Neither a full-body x-ray scan nor walking through a metal detector will  cause harm to the ear or the device.

Why have I been told that cochlear implants don’t work

You might come across some people who have had negative experiences with cochlear implants. As mentioned above, this may happen in patients who are not the best candidates for the procedure, if post-operative follow-up and speech and therapy were not adequately followed, or if the child is not in a pre-school or school environment where listening and spoken language are practiced in a way that support constant implant use and practice. Please discuss this with your doctors, for they can generally predict how well your child will do with cochlear implantation and will tell you what kind of school environment will lead to success. Getting a cochlear implant is like getting a musical instrument. Just getting it without a commitment to practice is no guarantee of success.

Should my child have one or two cochlear implants?

There is now evidence that 2 implants are better than one and that early implantation is better than late implantation. Different centers have different protocols. But generally speaking, although most of the possible benefit(about 85%) will be obtained from the first implant, most centers will now perform bilateral implantation for children with congenital profound hearing loss, either at the same time, or one after the other (sequential bilateral cochlear implantation).

The decision will depend on the level of the hearing loss of your child, the status of both ears, the age of your child, the comfort and preference of your surgeon, and of course, your desire. Some parents wish to withhold implantation in one ear to leave the other ear available to possible future technologies.

What should I expect if I decide not to treat my child’s deafness with a cochlear implant and instead send him to signing school for the Deaf?

It is extremely important to understand that if your child is a candidate for a cochlear implant, the earlier the device is implanted, the better the outcome. Delaying the surgery for only a few years might miss a critical period and can cause an irreversible delay in speech and language acquisition compared to his/her normal hearing peers. This gap may be impossible to close. Leaving the option for the child until he/she is “old enough to make a decision” is an invalid argument, since he/she will most likely no longer be a candidate as the outcome of late cochlear implantation will be less than desired.

If you decide not to proceed with cochlear implantation and send your child to a Deaf school, he/she will be able to learn sign language from an early age and communicate with other children with hearing loss, and will most likely integrate very nicely into the very warm and welcoming Deaf culture. However, your child will not be able to acquire speech and language, will not be able to communicate with hearing people without the help of an interpreter, will not be able to listen to and enjoy music, and will not have the limitless opportunities of the hearing world. Because graduates of Deaf schools have an average 5th grade reading level, lifetime education and employment opportunities will be limited. It is also important to recognize that not hearing environmental sounds, such as traffic and people, changes the way your child will function in the world.

Can my child have a cochlear implant if he has recurrent ear infections and needs tubes?

Since ear infections are common in children, many patients have cochlear implants as well as tubes in the ears. In some cases, surgeons control infections by inserting ear tubes prior to cochlear implantation. It is important there is no ear infection on the day of implantation or in the few days after. This is addressed in some cases with antibiotics taken prior to implantation and for a few days after.