Annelle V Hodges Thomas J Balkany Stacy L Butts and Shelly

CHAPTER 79

The use of cochlear implants in children in the United States was first evaluated during the mid-1980s after Food and Drug Administration (FDA) approval of the House/3M single-channel device in adults. A substantial number of children received single-channel cochlear implants during an FDA-controlled multicenter study, beginning in 1983. Also in 1983, the first child received a multichannel device in Melbourne, Australia. Initiation of a pediatric clinical trial of the Nucleus multichannel cochlear implant occurred in 1986 after FDA approval for use of the device in adults in 1985. The clinical trials in children continued over a period of approximately 4 years, with 142 children receiving the device before FDA approval was granted in 1990.1 Several upgrades of the Nucleus device, as well as several generations of the Advanced Bionics Clarion device, have undergone successful FDA trials; pediatric trials are currently ongoing with the Austrian-made Med-El. Results of these closely controlled studies indicate that cochlear implant manufacturers have made safety and efficacy claims for children that were supported by the trial data.

In addition to FDA trials, the National Institutes of Health (NIH) convened two consensus conferences on cochlear implants, one in 1988, and the second in 1995. In May 1995, nearly 200 professionals and interested parties gathered to assess the status of cochlear implants after 10 years of clinical use. As reflected by the consensus statement, the use of cochlear implants in children has been shown to "result in successful speech perception in children." In addition, it was noted that "a younger age of implantation may limit the negative consequences of auditory deprivation and may allow more efficient acquisition of speech and language."2

In spite of repeated FDA approval and NIH support for use of cochlear implants in children, a strong body of opposition to pediatric use of the device has remained. Few if any other proven treatment options for treatment of major pedi-atric health disorders have received the type and intensity of negative response which has accompanied use of the cochlear implant in children. As suggested by the title of this chapter, opposition has centered on resisting implantation of the con-genitally deafened child. That adults and postlinguistically deafened children can benefit from implants has been acknowledged by most of those who continue to oppose its use in the con-genitally deaf child. Primary opposition has come from members of the deaf world, a subset of the deaf community who hold more extreme views on the nature of deafness. They hold that deafness is not a disability, but is rather a natural human variation and therefore does not need to be treated medically.3 Support for their position has also been strong among some educators of the deaf and even among some medical and communication disorders professionals.

Initially, arguments against the cochlear implant were based on claims that congenitally deaf children do not derive benefit from cochlear implants. However, an increasing body of data supports that, given the appropriate circumstances, congenitally deaf children can indeed derive significant benefit from cochlear implants.4-7 This has led to a revision of the argument to confirm that even though cochlear implants do work for con-genitally deaf children, for other moral and ethical reasons, they should not be used in this population. Both concepts will be discussed in this chapter.

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