Currently, the United States Food and Drug Administration recommends cochlear implants for children twelve months of age or older. While many surgeons are operating on children under this age (remember, it is just a guideline, not a rule or law, and research has shown no increased safety concerns in operations before twelve months; see Dettman et. al, 2007), the possibility of detecting a hearing loss at birth still means that parents will have at least a few months of “wait time” between hearing loss identification and cochlear implantation for children with profound hearing loss. This does not have to be wasted time!
With today’s high-powered digital hearing aids, even the most severely deaf infants can gain some awareness of sound. While the sound that a CI candidate receives with a hearing aid is not enough to comprehend speech through audition alone (hence why the baby is a CI candidate), the infant may be able to perceive the pitch, intensity, and duration of sounds (the suprasegmentals, or intonation) — and that is no small thing! While it may be difficult to convince parents that wearing hearing aids all waking hours while awaiting cochlear implant surgery is worthwhile, I believe it is crucial for several reasons:
Even if the child is only able to discriminate between gross durational patterns (for example, short versus long sounds), he is building his auditory brain and establishing some great skills for later discrimination tasks between speech sounds.
Parents have a “visual reminder” to always be considering listening and spoken language enhancement in everyday life.
Children begin to alert to loud environmental sounds and build sound-object associations.
The child is establishing behaviors that will aid in later listening and spoken language learning, such as joint attention, auditory attention, cognitive, and play skills.
Parents learn to take care of hearing equipment and establish routines for daily maintenance, listening checks, and learn how to keep hearing devices on all waking hours.
Children become accustomed to having something on their ears all waking hours — it’s much easier to establish this habit from day one than to be fighting it when the cochlear implants are activated.
In her article “Empowering Parents to Help Their Newly Diagnosed Child Gain Communication Skills,” Amy McConkey-Robbins, MS CCC-SLP suggests the following ways that parents of infants can grow communication skills. Parents of CI candidates can follow this advice to make the best possible use of the wait time before implantation:
Phase I – The initial identification of hearing loss
Continue to talk, sing songs, and recite nursery rhymes to your baby
Begin a journal about your experiences, feelings, questions, and successes
Phases II and III – From receiving hearing aids to beginning communication intervention to receiving a CI
Help the child learn to alert to his name — but don’t make this a testing task. Only call the child’s name for a good reason with a real meaning or payoff.
Use the verbal cue, “Listen!” and point out sounds around your house
Monitor changes in your child’s vocalization and behavior with and without hearing aids (share this information with the professionals on your team, too — it can help them make better decisions and adjustments for your baby!)
Imitate the child’s vocalizations back to him to build the auditory feedback loop and encourage communication
Encourage and anticipatory response to sound with familiar songs, rhymes, and games. Pause and give the child a chance to participate through vocalization (For example, “We all fall… DOWN!” in Ring Around the Rosie)
Make the most of every last decibel of hearing and every last second of the time before cochlear implantation to build a the foundation for a world of sound that will open up to babies on activation day!
Elizabeth A. Rosenzweig 