What Is the Main Idea?

This post focuses on cochlear implants and auditory brainstem implants, which are two similar medical devices that can make it possible for some people with hearing loss to hear some sounds. The post describes the differences between them, and lists the benefits and risks. It also lays out some advice for people considering such implants, especially parents of children with hearing loss. In addition, it refers to the paper “Children with Auditory Brainstem Implant: How Do They Perform in Motor and Language Skills?”, published in the journal Audiology and Neurotology, which describes a study that would be interesting to parents of children up for such an implant and for physicians working in this area.

What Else Can You Learn?

The blog post also goes into some of the objections to childhood cochlear implants, which could also apply to auditory brainstem implants. These objections are raised by members of the Deaf community, including many who received such implants as children or infants.

Hearing Aids Aren’t Suitable for Every Type of Hearing Loss

Hearing aids can help people who are hard of hearing to hear sounds by amplifying sounds they have difficulty picking up. They essentially consist of a microphone, a processor programmed to amplify specific sounds, and an in-ear speaker. However, not everyone with hearing loss can benefit from hearing aids: If the hearing loss is due to damage to the ear structure, an implant may be an option.

What Is the Difference between a Cochlear Implant and an Auditory Brainstem Implant?

A cochlear implant is an electronic medical device that can make it possible for some people with hearing loss to hear some sounds. It consists of an external microphone and processor that pick up sounds and transmit them to an implanted wire ending in small electrodes in the cochlea, which is part of the inner ear. The signals transmitted to these electrodes can then be transmitted via the cochlear nerve to the brain.

An auditory brainstem implant can provide some level of hearing to some people who would not be helped by a cochlear implant. For example, if the auditory nerve is missing, the inner ear is scarred after an infection or injury, or the inner ear has an atypical structure, a cochlear implant may not work. Auditory brainstem implants bypass any damage to the inner ear or auditory nerve because the internal wire and electrode array are implanted directly in the brainstem. The external part is similar to a cochlear implant: a microphone and processor.

Cochlear implant surgery is more common and less invasive than auditory brainstem implant surgery, because the latter requires an expertise in complex brainstem work.

After either surgery, the recipient of the implant must work with a specialist to learn how to interpret the signals, as they are not the same as the signals that the ear would generate on its own. It is possible that the recipient of either type will not benefit from the implant at all.

Currently available cochlear implants are more likely than auditory brainstem implants to provide word recognition. Both can require lip reading to gain much benefit in conversation.

Why Are These Implants Seen as Controversial?

Activists in the Deaf community have raised objections to the way these implants are seen as a way to “fix” infants and children who have limited or no ability to hear sounds. They point out that neither surgery is guaranteed to work; that neither provides the ability to hear sounds in the way people commonly understand hearing; and that the aural rehabilitation after surgery can be arduous and upsetting for infants and younger children.

What Do Deaf Adults with Childhood Cochlear Implants Say?

I’ll focus here on cochlear implants because there is more written about them and they are more spoken about within the Deaf community.1

Not all adults who received cochlear implants as infants are happy with the decision having been taken for them. This attitude is especially common if the aim was to “fix” them and put them into mainstream education, with no attempt on the part of the family to learn the national sign language, engage with the Deaf community, and look at broader education possibilities. Even with a cochlear implant, there can be issues with engaging with mainstream education, particularly if the implant is not fully successful and there is no attempt to compensate for any failings with other support (e.g., in-class assistance). Such a child can feel cut off from the Deaf community, which could otherwise provide valuable support.

Other adults who received cochlear implants as infants are happy with them because they had positive experiences. This can include feeling comfortable operating in speech- and sound-centric environments, and finding their way in mainstream education without further support. Some feel the lack of other Deaf people in their lives; some have connected with the Deaf community.

What Does This Mean for Parents?

It’s important for parents considering cochlear or auditory brainstem implants for an infant or child to engage with such information. These personal experiences of Deaf and hard-of-hearing adults can help them make a fully informed decision as well as prompting questions for the surgeons and other physicians.

Ultimately, any implant has more complicated considerations than hearing aids, glasses, mobility aids, and other external devices. It may not be possible to remove implants later and they cannot be “swapped for a better model”. Ensuring that one understands the lifelong implications of an implant is critical.

What about the Videos of Babies Who’ve Received Implants?

Beyond these experiences, objections are raised over the commonly shared videos with titles like “Baby hears for the first time”. The videos rarely show the full truth of the experience, which can involve a whole range of reactions, including infants’ fear and confusion at suddenly receiving signals that their brains don’t know how to interpret. The videos focus instead on the “inspirational” quality of the moment(s).

Within the Deaf community and the broader disabled community, there is a general skepticism about the motivation of non-Deaf and non-disabled people’s attempts to create inspirational content from our1 experiences, challenges, medical procedures, and successes.

Does This Mean That the Implants Are not Appropriate for Teenagers and Adults with Hearing Loss?

Teenagers and adults can advocate for themselves and give informed consent. As such, they can discuss the potential risks and benefits of the implants with their physicians and gain a better understanding of the post-surgical rehabilitation. This is a very different situation. It is especially important for a teenager or adult to engage with how rigorous the post-surgical rehabilitation can be.

What Are the Risks of Cochlear and Auditory Brainstem Implants?

Surgery always carries risks such as bleeding, swelling, and infection. Cochlear implants are generally well tolerated, but there are rare cases of post-surgical tinnitus (ringing in the ears), vertigo, nerve injury causing movement problems in the face, and meningitis. The same risks are associated with auditory brainstem implants, but since they are less commonly used, there is less data on their tolerance in the broader population.

What Is the Paper about?

The authors of “Children with Auditory Brainstem Implant: How Do They Perform in Motor and Language Skills?” focus on how congenital hearing loss or loss of the aural vestibule (the part of the ear between the semi-circular canals and the cochlea) can impair not only the acquisition of language, but also the development of motor skills. The described study involved ten children between the ages of 4 and 17 who had been fitted with an auditory brainstem implant on one side. The children were evaluated on their fine motor control, balance, manual dexterity, language, and sound perception using standardized tests.

The results showed a strong correlation between poor manual and balance skills and poor speech perception and language skills in the children. The group is too small to draw a broad conclusion, but it indicates the need to assess children before and after the implant surgery to establish the baseline manual, balance, and speech perception skills; and to give greater support to children after the implant surgery to ensure the best outcome.

What Does the Paper’s Conclusion Mean for the Parent(s) of a Potential Recipient of an Auditory Brainstem Implant?

The paper focuses on support. It states that an infant or child patient’s parent(s) and physician(s) should ensure the child is going to get the best support and post-surgical rehabilitation, to ensure that the benefits are the best possible. It also shows how important it is to ask for pre- and post-surgical evaluations.

Note: This post is based on an article that is not open-access; i.e., only the abstract is freely available.

1Victor Kelly has adult-onset hearing loss and uses hearing aids, lip reading, Irish sign language, and Danish sign language to communicate. They are also a wheelchair user. Victor considers themself an activist and engages regularly with various disabled communities, including the Deaf community.


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