A Retrospective Look at Cochlear Implantation in Adults with Prelingual Hearing Loss
Part 1: Introduction
Today’s post takes a retrospective look at CI in adults with prelingual hearing loss. This has been informed by the experiences of of implanted adults with this type of hearing history and my personal and professional experience as an educational audiologist at schools and as an auditory rehabilitation therapist on a CI team in Bnai-Zion Medical Center in Haifa, Israel.
During the late 1980s, when CIs were first approved for use in the US, there were two major groups of recipients. The first group was people with post lingual hearing loss, those who previously had normal or near normal hearing and lost their hearing later in life. The second group encompassed young children (and later, infants) with prelingual profound hearing loss.
Adults with prelingual deafness differ from these two groups in many aspects. This group was included in expanded FDA guidelines beginning in 1998.
A Change in Perspective
How did we get to the point of considering CI as an appropriate, beneficial option for adults who had never heard before? Why consider CI for adults and adolescents whose communication required visual information rather than auditory information? What benefit might people who rely upon sign language as their preferred and dominant language derive? How did it come to pass that in spite of the well-documented advantages of early implantation and shorter periods of deafness that there are now so many prelingually deaf CI users who have gone through implantation at a later age?
The current reality results from nearly a decade of clinical experience and research. The accumulated knowledge, both theoretical and clinical, altered the perceptions, both among professionals and among people with congenital hearing loss regarding the potential benefits of CI for adults who were deaf at birth but opted to pursue CI as adults.
Pressure for Change Based on Parent Advocacy and Clinician Support
This change in candidacy criteria was supported by persistent parents advocating for their older children and teenagers as well as by determined adult CI candidates with prelingual hearing loss. These people have recognized the limited benefit of conventional hearing aids for those with profound hearing loss and pressed for an opportunity to experience the potential advantages of CI. Such parents and adults were aware of the fact that CI cannot provide the same benefits for these individuals that it offers young children and postlingual adults; nonetheless they chose to pursue this path.
This candidacy expansion process was encouraged and facilitated by CI professionals who foresaw the likely benefits of CI for this population. The complexity of CI rehabilitation for these candidates was recognized and professionals developed intensive, customized rehabilitation programs. Implantation of "challenging" candidates not only broadened CI criteria boundaries, it also extended the definition of CI success. Implantation of prelingually deafened older children and adults provides examples of the diverse ways in which cochlear implantation contributes to quality of life.
My next post on this topic will address the process of learning to listen with a cochlear implant as a prelingually deafened adult or adolescent.
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