Running
head: New Hearing Technology vs. Age
Cochlear Implants and the Effects of Age
ALHE 4060 Research in Allied Health
East Tennessee State University
Joshua R. Wilmeth
Abstract
Objective: The purpose of this study is to analyze and discuss the findings relating to cochlear
implanting at younger ages. A brief discussion of cochlear implant history and
the controversies surrounding its use lead to more challenging theories. Method: A quantitative research design is used to describe results
and procedures so that the reader may understand the importance of the issue at hand.
This study is an examination of methods used to relay information to audiologists, physicians, and the public regarding
the uses of cochlear implants. Many of these studies are done in quantitative
research designs that use graphs to show results and compare to past studies. Results: Promising results show that
a younger person, less than the age of five, when receiving a cochlear implant has more positive results than an elderly person. Some of the studies that have been previously proposed are longitudinal studies, meaning
that they follow the progress of the recipient over a certain amount of time. In
conclusion to cochlear implanting at younger ages, one should understand the term “deafness” that plagues our
society today. The improvements in modern technology lead to more capable individuals
in society who are more able to contribute to everyday life.
Cochlear Implants and the Effects of Age
Hearing loss is any degree
of impairment of the ability to comprehend sounds (FDA, 2004). Many people suffer
from this condition and some are not even aware of it. Years of medical research
has brought about changes in technology, which can be used to help hearing impaired and deaf individuals live out normal lives. Hearing aids, auditory trainers, and cochlear implants are the next generation methods
of artificial sound. Deafness can be congenital or caused by some external source
such as noisy work environments. Many people choose not to do anything about their deafness and suffer the consequences of
their choices. Luckily, in today’s society there are qualified individuals
who want to help those who suffer this condition. The purpose of this study examines the use of cochlear implantation and the issues surrounding the
variables, such as age, that are involved.
Technology has evolved
the hearing aid to a much newer system that tries to enable those who suffer from hearing loss to function at more normal
levels. In the 1950s, research began on a device known as the cochlear implant. It was not until the mid 1980s that the Food and Drug Administration finally approved
of the device for public use (FDA, 2004). Today, the cochlear implant is available
to all those who wish to undergo surgery to try out the next best thing in hearing technology.
All ages are also able to be recipients of the device if he or she meets insurance protocols, physician’s requirements,
and hearing tests done by audiologists. This is a pre-requisite for the cochlear
implant because not everyone is eligible. The qualifications are based upon the individual’s present hearing loss and
the individual’s healthcare services.
One must understand the
science behind the cochlear implant in order to better grasp the controversial topics associated with the device. Cochlear implanting involves a surgical procedure that regenerates hair cells in the cochlea of the inner
ear (Euteneur S). The surgery allows an electrode to regenerate hair cells, but
must reinnervate the peripheral axons of the spiral ganglion neurons. The scientific
logic reveals that the spiral ganglion neurons can be electrically stimulated, which gives rise to the purpose of the implant
(Euteneuer S). Once this is complete, a magnet is placed beneath the skin on
the parietal portion of the skull above the auricle to relay the electrical signals to the processor to be interpreted as
sound. The processor is worn on the auricle like a hearing aid and it also requires
high power batteries. The cochlear implant recipient is turned on by a process
called “mapping” after surgery of about six months due to the healing process.
Time and rehabilitation help the patient to evolve and learn to hear sounds all over again. Sometimes the process is overwhelming and can cause the patient to be overly stressed and worried. Eventually, most recipients begin to notice vast amounts of improvement in hearing. Upgrades and new processors are available through the company known as Cochlear. Cochlear is the organization responsible for the marketing and creation of advanced
hearing technology. This is fairly significant information for the lay person so that understanding can be achieved easily. It is necessary to understand the purpose of the cochlear implant and the nature of
being deaf in order to obtain a full circle of significance.
With each new technological
advance, there are always debates and controversies regarding better methods of treatments.
The cochlear implant is a prime example because it revolves around issues such as speech perception, age, and successful
daily living. Daily living has been a topic with families, audiologists, and
occupational therapists because normal functioning is impaired. There are even
schools that the deaf may attend and live in order to be in a world that they supposedly cannot function in. Age is a more common experimental phenomenon with the cochlear implant and its results vary among the populations. Research about implantation and age has paved new roads for more successful implantation,
and the results are extraordinary.
What Age?
Problem Statement
Cochlear implanting has
been in testing for over a decade, and yet there is still much to be learned. One
issue that seems open to debate is what age should an individual be in order to receive a cochlear implant? Some limitations to the study include little research on the age topic because it is such a new field,
and there is a lack of age comparative graphs. There have been various subjects
tested such as the Nottingham University Hospital. This university provided a
longitudinal study of thirty children who suffered from hearing loss and obtained the implant.
This hospital tested children whose ages ranged from 2.5 to 11 years old at the time of implantation (The Lancet, 1991). This study only proved that a cochlear implant improves the quality of life for those
with severe impairments. As time has revealed that implantation is successful,
one must begin to question detailed components that might improve the use of an implant even more. The question of what age still lingered after the Nottingham study, and more research was done in various
parts of the world. In this present study, the hypothesis states the fact that
earlier implantation is a much better method. It also creates a doorway for all
researchers to view and to be able to implement certain experimentational schemes to find desired results.
Previous case studies and
journals have examined what ages implantation should be done. In this research
methodology, a dependent variable has been assigned. The dependent variable is
identified as children who receive an implant before the age of five years old. On
the other hand, there is an independent variable that is without manipulation, the children who receive the cochlear implant
later in life at any age. The independent variables who receive the cochlear
implant can vary in ages all the way up to the elderly years (Brodsky, 2007). One
must realize there is an obvious anatomical and physiological difference between the elderly and children. Cochlear implantation has several variables such as age, health, speech perception, and education. These variables are all mentioned in the literature used for the present study and
they help influence the outcome of successful implantation.
Literature Review
I.
Brodsky, Irene Taylor. Hear and Now. Vermilion Films, 2007.
“Hear and Now” is a documentary released in 2007 by Sundance Festivals. The film follows the life of a married couple that has been severely deaf all of their
lives. The film is written, directed, and portrayed by the couple’s daughter,
Irene Taylor Brodsky. The purpose of the documentary is to examine the elderly
couple’s advancement with the cochlear implant. It also portrays interactions
with audiologists, physicians, and the actual surgery of each person. It is meant
for all varieties of viewers and hopes to help them understand the rise of technology in hearing conditions. The film relates to this study mainly because it analyzes the elderly and new technology. It also shows that it is much harder for an elderly person who has been deaf all of their life to cope
with sound. It is a strange phenomenon to experience, especially after sixty
years of silence. A young person such as a child would be able to better cope
physically and physiologically with more extraordinary results. The documentary
is useful in this research study, in that it lets the researcher know the effects of implanting in the elderly and that it
is much more beneficial in children. In hopes to prove implanting is more beneficial
in children, this film accurately supports the hypothesis.
II.
Ching TY.“Should children who wear cochlear implants wear hearing aids in the
opposite ear?” Ear Hear 2001 Oct; 22(5).
Peer reviewed articles can sometimes lead a researcher to other articles that help to better understand the issue at
hand. For instance, this particular article examines the effects of hearing aids
with cochlear implants. As Bailey stresses in her research, a researcher must
have a problem that needs to be answered (Bailey, 25). The purpose of this particular
study is to examine the negative and positive effects of hearing aids worn in the opposite ear with the cochlear implant. The experiment consisted of sixteen children with a Nucleus 22 and/or 24 cochlear
implant, and two procedures were used to test the effects. A frequency response
and a loudness balancing technique were used to accurately measure the results. Like
any researcher conducting an experiment, Ching states four controlled conditions to help maintain internal and external validity. These conditions involved testing with a cochlear implant alone, hearing aid alone,
cochlear implant with a hearing aid, and a cochlear implant with a hearing aid adjusted to normal requirements. The results show that the children preferred a hearing aid that is adjusted to the loudness of the implant. This study is important to the research question of age because it proves children’s’
brains are able to learn much faster and thus improvements are quickly recognized. Elderly
patients tend to be slower physiologically with a hearing aid and a cochlear implant, thus proving the issue with age requirements. These sixteen children will be able to function in society much easier because of
the balanced sound from the hearing aids.
III.
Peters Br.“Importance of Age and Postimplantation Experience on Speech
Perception Measures in Children with Sequential Bilateral Cochlear Implants.”
Otol Neurotol 2007 May 9.
In the search to prove implantation at an earlier age is best, clinical trials are the most effective in helping with
research. The objective of the Dallas, Texas US MultiCenter, was to analyze the
effects of bilateral implantation “offered on a number of measures.” This
includes age which is the focus of the present study. Thirty children were tested
pre-implantation and post-implantation, ages ranging from 3 to 13 years old. “However,
children younger than 8 years do have a higher level of speech perception ability after 12 months than older children/adults.” This quote is a gold mine in itself because it proves that age does conflict with
implantation, and that younger children do benefit more than older people. The
results proved children with bilateral or unilateral implantation increased in speech perception and noise, which are all
tested individually with different methods of instrumentation. This study greatly
enhances the future of cochlear implantation of younger children, especially concerning bilateral implanting.
IV.
Profant, M. “From hearing screening to cochlear implantation: cochlear implants in
children under 3 years of age.” Acta Otolaryngol. Vol
4, 2008, pp 369-72.
“Hearing screening help diagnose faster and open doors to implant younger patients.” A good researcher covers all of his or her bases before beginning their analysis. This article relates to the present study indirectly, because it analyzes the anatomical and physiological
components of cochlear implantation. This type of information helps a researcher
understand the “what” and “how” questions. The idea of
studying clinical trials is used to help a researcher “see the big picture.”
This article is useful because it explains what can be done in order to implant at younger ages.
Methodology
The proposed study reflects on the use of cochlear implants and why society should consider this procedure at younger
ages. The study will be put into motion at the University of Tennessee at the
Speech and Hearing Center in Knoxville, Tn. In order to achieve the desired results,
I will submit my information gathered to the IRB. I will also fill out the required
information given to me by the IRB, and take the educational program. This will
help me to be able to understand the steps that I must take and how to go about the guidelines of the study. In order to abide by HIPPA standards, I will have all participants fill out information regarding their
patient privacy rights. It is extremely important that patients feel confident
in knowing that their personal information and results are kept confidential, and it also helps the reliability of the study. The study will consist of thirty individuals that suffer from severe hearing loss
to complete binaural deafness. The thirty individuals will be divided into three
groups. Ten of these individuals are candidates that have received a cochlear
implant before the age of five, another ten will have had an implant later in life, and the third group will be those who
only wear hearing aids. The purpose of the third group will be to examine the
difference between cochlear implants and hearing aids as a sub study. An
outside person that views this study will be able to see potential differences in each category and be able to draw his or
her own conclusions regarding cochlear implantation. This will be a quantitative
longitudinal study that involves testing with language perception, spoken language ability, Hearing in Noise Tests for children,
and Multisyllabic Lexacal Neighborhood Tests. The study will be a difference
analysis according to the Scale of Measures, in which there are two or more groups.
Results will be measured and submitted for peer review. This is so the
study will be repeatable (reliability) and maintain randomization. We also want
to make sure that there is a measurable amount of variation between the three groups. The study will consist of periodic testing
every six months and observations will be recorded by computer. During the quantitative
portion of the study, I will use graphs to compare each group to show the correlational differences in hope to support the
hypothesis. This is a data collection method that can be used later to write
the proposed thesis or journal. This analysis will be able to show the differences and direct healthcare officials to consider mandatory implanting at younger ages in order to
help increase the quality of life in the future for each patient. After the study
is completed, the results will be submitted for peer-review. It is a great effort
to educate the public about new technologies and support the proposed hypothesis. Parents
of deaf and hearing impaired children should be made aware about implanting as soon as possible in order to assist the child’s
daily living skills later in life.
Analysis and Discussion
The results from
the studies involving cochlear implants are shattering. The implant itself from
a study of children ranging from age 2.5 to 11 who wore the device from five to ten years revealed that there are long term
communication benefits (Beadle EA, 2005). From the results of that study one
can correctly assume that the earlier an implant is given, the better the outcome will be for the recipient. There is however, no significant difference between children who receive the device in their very early
lives such as twelve months to twenty-four month when compared (Holt RF, 2008). In
order to view comparable results, a study must portray a vast difference in age and health.
This is greatly comparable to the elderly couple in “Hear and Now,” and is an example of the progress expected
(Brodsky, 2007). From personal experience having received a cochlear implant
at the age of sixteen, there are noticeable changes in speech perception, spoken language, and academic progress. Had I been implanted at a much earlier age, I may have progressed even faster. This study supports the proposed hypothesis and needs no alterations.
Results from several previous studies and films prove the theory that younger people will benefit greater with cochlear
implants. They also show that when compared with age, there are other factors
that influence the outcomes. These factors include present hearing levels in
decibels, health, and daily life. The significance of the study is greatly stressed
because there are many families that do not know about the alternatives to hearing technologies. In conclusion, cochlear implant technology is steadily climbing the success ladder. The public should be made aware of the different issues such as when to implant and what to expect concerning
results. The importance of research will enable a person to find the best method
of treatment and yield more satisfactory results such as in this study. Any child
that is diagnosed as deaf should be given the alternative to choose a cochlear implant earlier in life, so that others will
be able to see the significant increases in their lives. In the next ten years,
greater results than the present will be shown through binaural cochlear implantation (Peters BR, 2007). This method of technology will remain to be a signal of hope to those who suffer from deafness.
References
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3.
Brodsky, Irene
Taylor. (2007). Hear and Now [DVD]. Capital Hill, Seattle: Vermilion
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C., Hill M., Dillon H., Incerti P. (2001 Oct). Should Children wo use
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MA. (2008 Aug). An exploratory look at pediatric cochlear implantation: is
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8.
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J. (2007, May). Importance of Age and
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Cochlear Implants. Otol Neurotol, volume n/a. 10 June 2008.
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