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International Conference Sheds Light on Cochlear Implants in Children

A recent international conference on cochlear implants in children used new research data to identify patients who can benefit from the latest breakthroughs in hearing technology. And the news that came out of the four-day meeting is promising: babies and children with significant residual hearing do benefit from implants, but early screening and intervention, experts say, is essential.

The earlier a hearing-impaired child receives a cochlear implant, the better, says Dr. Craig Buchman, medical director of Childrens Communicative Disorders Program at the University of North Carolina (UNC) Hospitals, a co-sponsor of the 11th Annual Cochlear Implant Conference that was held in Charlotte, N.C from April 11-14. All the decisions should be made in the child's first year of life. This will allow them to develop speech, language, and socialization skills early on.

The conference, attended by more than 1,150 surgeons, audiologists and hearing specialists from 26 countries, focused on cochlear implementation in young children, bilateral implantation, as well as implanting patients with auditory neuropathy, a hearing disorder in which sound enters the inner ear normally but the transmission of signals from the inner ear to the brain is impaired, resulting in poor understanding of speech.

The Earlier The Better
The U.S. has made great progress in screening newborns - 95 percent are currently tested, up from only 3 percent in 1989. According to National Institutes of Health (NIH), 39 states plus the District of Columbia and Puerto Rico have mandatory newborn screening, and additional five states have voluntary programs.
About 3.8 million infants are screened for hearing loss every year, according to the Centers for Disease Control and Prevention (CDC). In the diagnostic tests infants are presented with acoustic sounds through earphones. Electrodes measure how the sound travels from the ear to the brain to see whether the hearing nerve is functioning properly. About 2% -- roughly 76,000 babies -- don't pass and are referred for a further hearing assessment. Additional testing is needed to determine whether they are among the one to three babies per 1,000 who actually have hearing loss, the CDC says.
Why is early detection so crucial? A 2001 NIH study shows that children whose hearing impairment was discovered and treated before the age of six months scored significantly higher in language skills than those whose hearing loss was detected later. And researchers estimate that children who receive a cochlear implant early in life can save up to $200,000 in special education costs by the time they graduate from high school.

The message from hearing specialists is clear as a bell: early screening and treatment with cochlear implants do make a difference.

Wired for Sound
The National Institute on Deafness and Other Communication Diseases defines cochlear implants as small electronic devices that can help provide a sense of sound to profoundly deaf or severely hard-of-hearing people. They consist of an external portion placed behind the ear and a second portion that is surgically placed under the skin. Unlike hearing aids, which amplify sounds, the implant bypasses damaged hair cells in the inner ear and electronically stimulates the auditory nerve, sending signals to the brain, which perceives these impulses as sound. This does not give a person normal hearing, but a representation of sound that helps them understand speech. Also unlike hearing aids, use of a cochlear implant requires a surgical procedure and a habilitation or rehabilitation therapy to learn or relearn the sense of hearing, although young children, whose language and cognitive skills have not yet developed, adjust much more quickly.

According to the Food and Drug Administrations 2005 data, nearly 100,000 people worldwide have implants. In the United States, an estimated 22,000 adults and nearly 15,000 children have received them.

Although the cochlear implant technology is not new -- the FDA approved the first implant in 1984, and the first child's version in 1990 -- the devices have evolved exponentially, becoming smaller and more reliable, and the implant surgery itself is faster and easier.

Bionic Ears
One of the topics discussed at the UNC conference were bilateral implants -- cochlear implants used in both ears. The standard practice, Dr. Buchman says, has been to give children just one implant because one-ear hearing provides a good signal for learning speech and language, and cochlear implantation may destroy whatever natural hearing ability remains in that ear.

New evidence, however, suggests that in some cases bilateral implants may have a beneficial effect on the restoration of hearing. It depends on how much residual, that is to say natural hearing there is in the second ear, and whether it is worth sacrificing that hearing, Dr. Buchman says. Generally, the more residual hearing there is in the second ear, the more indication there is for a hearing aid rather than an implant.

Another subject on the conferences agenda was a discussion on whether children diagnosed with auditory neuropathy can benefit from cochlear implants. A commonly held belief has been that an implant is not recommended for this group of patients, but now experts say a baseline hearing test known as ECAP (Electronically Evoked Compound Action Potential) might help identify children who would be good candidates for implants.

One group that does not seem to benefit from cochlear implants, Dr. Buchman says, are those suffering from cochlear nerve deficiency, a condition where the acoustic nerve that conducts auditory stimuli to the brain is either small or missing. The condition is more common that previously thought and 37 children with cochlear nerve deficiency are currently being followed at UNC hospitals.

All in all, Dr. Buchman says, hearing technology continues to improve and the future looks bright. And that is music to everyones ears.

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