Grendel’s Kitchen

We’ve got a dilemma.

Do we schedule a second implant now and reap the near term benefits of localization and better hearing in classrooms?  Or wait 5, 7, or possibly 10 years until medical technology offers less invasive surgery, better approaches to stimulating or even regrowing the nerve?

We want Li-Li to receive every opportunity that we can make possible when it comes to her language development. She’s in ASL (American Sign Language) class at home and gets wonderful ASL immersion at school and our parent-infant program every day. She has a cochlear implant on the right side and takes auditory rehabilitation sessions four times a week both at school and with our early intervention program. And at home we reinforce both language models with a whole lot of interaction.

We are interested in proceeding with implant #2, given the truly amazing results we’ve seen with #1. There are benefits to having a second implant: among these are the ability to localize sound, better hearing in noisy environments. The drawbacks are considerable, though, and we’ve identified two big issues:

• Risks inherent in any surgery: Although we are confident that our surgical team does everything possible to mitigate those risks and has a spotless record, we are, of course, terrified of putting Li-Li through surgery yet again — it’s a gruesome thing to consider for a little one. We know that there are always risks with surgery, there’s no getting around that.
• Future Technology: There are so many new approaches to implant technology and surgical methods for implantation that are currently in research stages. Research being done at Vanderbilt University describes its minimally invasive surgical methods as the ‘LASIK of cochlear implants’. According to the Economist, researchers have developed a prototype “thin film” electrode that can stimulate the cochlea in up to 128 different places (beyond the 22 - 24 electrodes in current CIs), they are working on technology that penetrates the auditory nerve and stimulates the nerve fibers directly, and devices that secrete drugs to encourage nerve growth and even ones that stimulate nerves using an infra-red laser. Implant manufacturers are working on new electrode designs with high electrode counts, so we’ll soon see a new generation of implant technology.

I wonder if we should consider holding off on #2 to receive the next generation implant later.

With the first implant, the urgency was clear to us: as a profoundly deaf child in a hearing home (even with ASL as her primary language), to have the most effective shot at spoken language acquisition during that critical window of time between 0-3 when babies’ brains are most elastic and they develop communication, we needed to make it possible for her to hear as quickly as possible. But I’m not clear if there’s an urgency to getting a second implant.

I’m researching every study I can get my hands on to determine what we would be giving up (in terms of language development, auditory stimulation, ability to adapt to a second implant, etc.) by not getting the second implant for what may be years until the new approaches are available to the public. Current CI surgery is less certain to damage the cochlea than in years past, but I also want to know if there’s any risk that a second implant would damage parts of the cochlea that would otherwise be utilized by newer technology.

Li-Li has her 6 month evaluation coming up in a month — can medical technology keep up with us?

Sounds like a good idea

Mar 6th 2008 From The Economist print edition

Biomedical technology: As cochlear implants improve, people who use older versions of the technology could face a difficult choice

Michael Chorost

YOU could call it the upgrader’s dilemma. When it comes to buying a new mobile phone, computer or DVDplayer, should you buy the latest and greatest model now, since it offers new features that your old model lacks? Or should you wait for the next version of the technology that will be along next year and threatens to make today’s gear seem suddenly old-fashioned? Now imagine that upgrading the item in question requires you to have surgery. That, in a nutshell, is the predicament that people with cochlear implants may soon be in.

Read the full article.