Deafness is as much a challenge as blindness. Helen Keller, who was both blind and deaf said “’Blindness separates people from things; deafness separates people from people.’” Being born deaf, especially profoundly deaf will impede a child’s ability to learn spoken language and develop speech. The general, social and psychological development of the child may also be affected. It may also limit the opportunity of education and employment. If the hearing can be restored, these children can achieve everything their normally hearing peers can. They can be integrated into normal schools and join the mainstream of life.
Recently we saw a 3-year-old boy from rural Maharashtra, with bilateral profound deafness. He was brought to the hospital because he had not started speaking. The parents were shocked when we informed them that the child was profoundly deaf, and refused to accept the diagnosis. This phase of denial was overcome with patient counseling. A trial with hearing aid showed no benefit and hence the option of a cochlear implant was offered to them. The implant was successfully done, and regular auditory verbal therapy was started. Today, after one year of therapy the child is showing good progress in hearing and speech, and in another one to two years would be integrated into a normal school.
We now have sufficient evidence to show that the earlier the cochlear implant is done, the better is the outcome. Today we operate on children even under one year of age. This is possible because we now have tests to determine the degree of deafness and the need for a cochlear implant at a very early age. An otoacoustic emission (OAE) is a non-invasive test that can be performed on a new-born infant to determine whether the hearing is normal or needs further investigation. It would be ideal if this test could be done on every new-born before being discharged from the hospital (Universal New-born Hearing Screening). The incidence of congenital deafness is 4 to 5 per 1000 births. Parents need to be made aware that deafness could exist even in an apparently normal child. If a child has a delay in developing speech or appears to be inattentive when spoken to, an ENT consultation and hearing evaluation should be done at the earliest. If a hearing impairment of sensorineural type is detected, then a hearing aid trial is given with optimally fitted hearing aids. If the child has profound sensorineural hearing Loss and shows insufficient benefit with hearing aids, cochlear implant surgery is considered. Evaluation, with a CT scan and MRI, is done to study anatomy and to know if a cochlear implant is feasible. A paediatric evaluation is done to exclude any other co-morbidities. A cochlear implant is not brain surgery but an ear surgery. The procedure is like any other ear surgery and fairly safe, and requires hospitalization for just one day. After the surgery, mapping and Auditory Verbal Therapy are necessary for a minimum period of 2 to 3 years to get optimum benefit from the implant.
The basic model of the Cochlear Implant costs around 8 lakh INR including pre and post-implant therapy. Majority of the children presenting to us, come from economically weaker sections of society. Their families cannot afford such an expensive device. But there is hope for these children as there are government programs to help fund Cochlear Implants. There are also various Trusts and Donors who offer financial assistance.
The senior author has experience of close to 3000 cochlear implant surgeries. Many of these implanted children have been integrated into regular schools, attend college, have graduated, gone abroad for higher studies, procured jobs and entered the mainstream of life.