Cochlear Implants and Adults with Congenital Hearing Loss –
It's worth considering!
My previous blog post described the process of expanding the boundaries of CI candidacy to include teenagers and adults who communicate with sign language, have minimal use of oral language, and little functional use of their residual hearing. The experience of providing cochlear implants to congenitally deaf adolescents refined our understanding of the different ways in which people benefit from cochlear implantation including subjective benefits that need to be evaluated using quality of life measures rather than more typically applied measures of language perception.
When the first congenitally deaf adult candidates arrived at our clinic, we already had experience in providing CIs to adolescents with congenital deafness. Although sometimes the motivation for teenagers was at least in part to please their parents, the interest of adults with congenital hearing loss in cochlear implantation was typically derived from a desire to improve their quality of life. Some of these adults had typically hearing spouses and/or children. Many struggled with academic and career issues related to their hearing loss. They wished to improve their ability to communicate with people with typical hearing—mainly by enhancing their speechreading. They wished to be able to perceive environmental sounds to a greater degree and to be more independent in their daily activities. Some expressed hope for understanding speech without speech reading, to be able to talk on the phone, and to enjoy listening to music. Some wanted to improve their speech intelligibility. They were excited about the benefits they might gain from the new technology and didn't want to miss the possibility to experience improved access to sound.
Some of those adults who expressed interest in CI had experienced important benefit from conventional hearing aids when they still had usable residual hearing; they hoped CI would advance access to sound as they remembered it. Most of these adults were involved in the Deaf community; however, unlike their teen counterparts, most were not concerned about social acceptance (or rejection) by the Deaf community.
While teenagers usually received ongoing support from their families (who attended mapping and auditory rehab sessions with them), adults were generally accompanied by a family member at the candidacy phase only and negotiated the post surgery rehabilitation process post implantation alone. Moreover, their ability to commit to a long intensive rehabilitation process, which might involve the loss of working hours among other things, was difficult.
Auditory stimulation prior to cochlear implantation is an important issue for adults with congenital hearing loss if they have not used amplification recently. The long-term lack of auditory amplification has to be taken into account when determining the appropriateness of CI, communicating realistic expectations, and providing appropriate rehabilitation.
Adult CI recipients with congenital hearing loss have benefited importantly from auditory rehabilitation provided weekly by an auditory rehabilitation professional. In my experience, some patients require support starting at the early stage of adjusting to the new auditory signal since they may experience the new sound as strange, unfamiliar or even unpleasant. The rehab professional can help determine whether the unpleasant sensations are within the normal range for a recipient's process of adaptation. In addition, s(he) can document progress and consult with the audiologist and surgeon.
Auditory training helps CI recipients learn to identify the differences between environmental and speech sounds and improve their listening skills. As recipients become more experienced, they often report hearing new environmental sounds, which is thrilling for auditory therapists as they witness the gradual development in their patients' listening attentiveness! Learning to recognize environmental sounds is an exciting experience that extends one’s world knowledge and improves a sense of involvement and orientation.
Adult CI recipients with congenital hearing loss can also learn to recognize some speech sounds. Recognition of specific speech sounds enables them to gradually acquire an auditory inventory of dozens of words and phrases. It is important to note that most of these recognition skills are restricted to structured and quiet rehabilitation settings. After a period of time, some of these recipients excitedly report that they are able to identify certain words and common phrases in real life situations (e.g., when their child calls Mom or Dad, when someone calls their given name, when co-workers greet them "good morning" or ask "What's up?" in a relatively quiet acoustical environment).
Another important achievement is continuous use of the sound processor. Many people with congenital hearing loss did not use their hearing aids consistently prior to the CI and others haven't amplification for years. The experience of continuous connection to the world of sounds can be an important benefit.
After several months, many CI recipients report enhanced speech reading and easier communication. They may report fewer requests for clarification, fewer misunderstandings, and an improved ability to understand people with imperfect or unclear speech. For example: "Suddenly I realized that I could speak with my young daughter's friends, who until recently had to seek my daughter's help when talking to me. Now they could communicate with me directly".
From my experience, CI rehabilitation goals for adults with congenital hearing loss typically do not include the improving the recipient’s own speech intelligibility nor achieving complete auditory speech understanding (based solely on the auditory modality). The rehabilitation of adults with congenital hearing loss focuses on:
- Taking advantage of basic acquired auditory skills in order to improve the perception of environmental sounds
- Facilitating oral communication
- Modifying old habits that often result in someone ignoring auditory stimulation, changing the pattern of behavior to more auditory attentiveness
It is my feeling that post CI rehabilitation of adults with congenital deafness is like adding rungs to a ladder. In some instances, it can make the ladder more accessible for those who could have never before have climbed it. In other cases, it can make the climbing more pleasant and comfortable, thereby improving the climbers' opportunity to reaching even higher levels.
Good luck to you all.