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Cochlear implants in children

Posted Oct 30 2008 6:02pm

On BBC Radio 4, Paula Garfield of Deafinitely Theatre argued that deafness does not require “fixing” with cochlear implants but Dr Kaukab Rajput of Great Ormond Street Hospital for Children said it’s wrong to claim they are dangerous.

I agree that we should be focusing on the social model of disability rather than the medical model. We should be ‘fixing’ people’s attitudes and the environment to assist the deaf person, rather than partially ‘fixing’ the deaf person to try to ‘fit’ them into a hearing world. Having said that, I believe there is a place for cochlear implants, where people have contracted meningitis resulting in total deafness, and have been hearing all their lives. Also, where hearing aids don’t help, a cochlear implant might be helpful - IF the patient has already acquired spoken language (he/she was previously hearing) or is young enough to benefit from a CI implantation. Some deaf people will prefer to use sign language rather than oral language. Why can’t they be offered the choice? This is the point that people keep missing, not all deaf people will benefit equally but deaf people should have the choice. Sometimes I choose not to wear my hearing aids, or I wear my iPod and shut out tinnitus and all sound except music, and that’s ok, it should be my choice. People also forget, a CI does not make a deaf person into a hearing person, it’s just another type of hearing aid, which requires a lot of effort to make it work. No wonder it’s a tough decision to get a CI. You’re damned if you do, damned if you don’t.

It’s difficult and emotive where very young children are concerned, as they will benefit much more at that age. But where do we draw the line at the blurring of the social and medical models of disability?

Here’s a transcript of the interview on the Today Programme, Radio 4, Friday 27th July

Sarah Montague – SM / Dr Kaukab Rajput – KR

SM –”Twelve Minutes to Nine”

You might have heard Paula Garfield on this programme earlier this week. She founded the Deaf theatre company, Deafinitely Theatre. She argued that being deaf is not a disability and in telling us that she wouldn’t be giving her daughter Cochlear Implants she said this.”

PG – “Well, adults and young people who make the decision for themselves is absolutely fine by me when they are able to make their own choices. But, what I am not comfortable with is babies who are implanted as early as possible because deafness is not a life threatening illness and a Cochlea Implant placed in the head of a baby has many, many risks and the Cochlea Implant is then there for life. The child doesn’t have the choice of taking it off when they have had enough, when they experience tinnitus maybe as a result of it. It’s stuck there.”

SM – “That was Paula Garfield. Well after that discussion we were contacted by a number of implant specialists who say that Paula Garfield is wrong. Dr Kaukab Rajput is consultant audiological physician at Great Ormond Street Hospital and she is here in the studio. Good morning”

KR – “Good morning”

SM – “In what way is she wrong?”

KR – “Firstly, I think we need to see this in a broader context. I think medical profession is enabling parents to make choices. Some parents may choose not to go for Cochlear Implants. I think the fundamental problem that we had with what Paula Garfield said is that it is OK for patients themselves to make choices. Unfortunately, in children who are born profoundly deaf there is a window of opportunity for these children to benefit from this technology and the medical profession has a duty of care to their patients. Now children have this window of opportunity is short and it is ultimately the parents who have to make those decisions on behalf of their children whether they put them through a Cochlear Implant and give them an opportunity to access spoken language.”

SM – “OK, so when is that window?”

KR – “The window starts from the time diagnosis. The Cochlear Implant is a perfectly safe intervention from a young age, from the age of”

SM – “How young”

KR – “10 months, 10 months, children in this country, the FDA approval is for implanting children at the age of 12 months. In this
country we are offering implantation from the age of 10 months onwards, younger if they have had meningitis”

SM – “So are there risks attached to it?”

KR – “There are risks to any operation, there are risks, the risks include the risk of general anaesthesia, the risk to the facial nerve which is minimal in experienced hands. Last year 440 children underwent this operation and none of them had any significant risks. The risks are minimal in very experienced hands and an appropriately, you know, paediatrically run hospital where there are paediatric specialists there. Certainly this operation, in the UK over 1,000 children have received Cochlear Implants and you have not heard any scandals relating to this intervention”

SR – “Dr Kaukab Rajput many thanks”

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