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Do Cochlear Implants Work? Episode 25 with Dr. Lindsay Cockburn

Welcome back to the All About Audiology podcast. I’m your host, Dr. Lilach Saperstein, and in this episode we are going to be answering the question, “Do cochlear implants work?” Even that question, you already know, is a little bit of a challenge to answer because, what do we mean by work? Do they help somebody hear and have access to sound? Do they make someone have normal hearing? What does someone even mean when they ask the question, do cochlear implants work? And so I have a fabulous interview with Dr. Lindsay Cockburn, who is a pediatric audiologist and also blogs and puts out lots of great resources on Instagram and on her blog, @listenwithlindsay. So we’re going to jump in to that interview in just a minute.

Before we start that interview, I do want to let you know that the next Hope Beyond Hearing program is starting on November 3rd. The program is a six week, online support group for parents of children with hearing loss. It’s really, really important to me that there’s an integration between the medical side of things, understanding the diagnosis and feeling empowered that you know how to read the audio-gram and that you know which intervention options are available to you, and that we focus on language development. That’s all one side of learning how to navigate being a parent to a child with a hearing loss and then there’s this whole other side, the emotional side. It can really be a struggle to address the shock and the grief sometimes, to be able to feel confident and hopeful that you are going to be a wonderful parent, that you are already a wonderful parent, but to give you some tools and not to neglect your own experience within this.

So I’m an audiologist. I see many, many families both as my role in the hospital where I’m a diagnostic and clinical cochlear implant audiologist, and also during my time being an educational audiologist and lots of you that I’ve connected with online. And I really understand the importance of YOUR health, YOUR ability to understand and cope with everything that’s coming, surrounding have a child with a hearing loss. And I feel like there’s not really a place where audiologists have the time or have the opportunity to be supportive in that way for parents. So I do want to tell you that the program will be running from November 3rd for six weeks, we’ll end right before the holidays in December. You’ll have access to a private Facebook group with the other parents, and we’ll be having weekly group calls, where we discuss various topics and really address YOUR heart, how you’ve been handling this and getting some great tools, like guided imagery and meditations and other exercises that we’ll do together in order to feel more confident, feel more prepared to be the advocate that your child needs.

We’re going to be talking about how to talk to family members about the diagnosis or the needs that your child has, how to advocate for them in school, and ways of building a strong, beautiful and connected relationship with your child and everyone within the family. So I come at this from the perspective of the audiologist because there are various circumstances that really come in to play when there is a hearing loss and that’s why I’ve put together this integrated program, the Hope Beyond Hearing program. And if you’re interested in learning more about that, all you have to do is visit allaboutaudiology.com/hope. You can go to the All About Audiology website and click on hope, the link is also in my Instagram bio, and you can sign up there as well. Send me a quick DM or an email to learn more!!!

Let’s go ahead and jump in for our very interesting interview discussing, “Do cochlear implants work?”

Welcome back to the All About Audiology podcast. I’m your host, Dr. Lilach Saperstein and today I have a special guest, another audiologist with me and we’re going to be talking about, cochlear implants. Do cochlear implants really work? That is a question that I’ve gotten from a number of people and it’s not an easy answer. So here with me today is, Dr. Lindsay Cockburn, from Los Angeles. She and I are going to be talking about this today.

LS: “Welcome Lindsay, tell us more about yourself.”

LC: “Hi, I’m Lindsay Cockburn, I’m a pediatric audiologist at John Tracey Center, which used to be John Tracey Clinic. I do mostly diagnostic testing, which means I test babies and kids hearing. John Tracey Clinic/Center is really famous and they have been helping people all over the world for 75 years, helping children to listen and speak, so it’s a listening and spoken language center. We have a parent/infant program. We have a preschool with kids with hearing loss. We have telephone practice therapy with Auditory Verbal Therapists. They have little apartments set up so it simulates being at home where they do therapy one on one with the kids. They have a program every summer, where families come from all over the world and they stay in Los Angeles for two weeks with their preschool aged kids with hearing loss, where the parents are in an intensive program where they take classes and have counseling groups and see the different professionals. And the kids are in the preschool class and get AVT (Auditory Verbal Therapy) speech therapy and audiology appointments. So I work with families all over the world, all kinds of different kids and families with hearing aids, cochlear implants. I’ve actually worked with a lot of kids with Auditory Brainstem implants, which is not what we are talking about today, but that’s another kind of implant. So I’ve seen all kinds of kids from all different places all over the world with cochlear implants.”

LS: “That is amazing. Wonderful that you have such a broad range of patients and ages, where they are from, all that totally goes into how they end up doing with their hearing aids.”

LC: “Yeah, absolutely. These parents come to the center and learn all these different things. They are so amazing. They take it back to where they live and they are so motivated, so they start their own groups, their own support groups and programs that are similar to what we have. It really revolutionized how different countries help kids with hearing loss and what kind of services they offer them because these parents went back to their countries and demanded it.”

LS: “That’s so interesting. So I’m from New York and I recently moved to Israel. I started working at a cochlear implant center in Rambam Medical Center in Haifa, in the north of Israel. I’m relatively new to the cochlear implant scene so I’m very interested in learning and hearing more about your experiences, specifically with these questions, who can get a cochlear implant? Who is it for? Who can it help? And who is not a candidate? So we’re going to start with talking about candidacy, which just means who can have this and who is it good for?”

LC: “Cochlear implants are devices for people with hearing loss, who don’t get the benefit that they are looking for out of hearing aids. So if a person wants to use their residual hearing to listen and to talk, they need to have a certain amount of hearing in order to do that. You have to be able to hear the different sounds in order to say them. So if hearing aids are not powerful enough to give you the ability to hear all the different sounds of speech clearly, then you are not going to be able to speak clearly, unless you get a cochlear implant.

So cochlear implants involves a surgery where electrodes are placed into the inner ear, into the cochlea. They used to wipe out the rest of your hearing, now things have changed for a lot of people who are maintaining their residual hearing and they are no longer losing that little bit that they have left. Then they close it up and a couple weeks later, they put the outside device on. It looks kind of like a hearing aid and it takes the sound into the device and it has a little computer in it where it changes the sound into electrical impulses that electrically stimulate your hearing nerve, which is very fancy, but basically it bypasses the way that your ear normally works and helps you to be able to hear all the different sounds clearly, eventually. But, it’s not a miracle, it isn’t like glasses where you put it on and things are changed. It takes a lot of practice, especially because it’s not on just your ear, it’s working on your brain. Your brain needs to practice hearing all of the different sounds in order to make sense of the different sounds, in order to have meaning in the different sounds. It takes lots and lots and lots of rehabilitation.”

LS: “We hear with our brains that the ears are just what is bringing it in. Yep, we say that all the time. Hahaha.”

LC: “Yeah so people who can get a cochlear implant depends on where you live and what the regulations are at this point in the US. It depends on your health insurance really and how much you push. Kids can get as young as about six months old with a cochlear implant. There’s no age limit for a cochlear implant. If you are healthy enough to undergo surgery, even someone who is 100, you can get an implant.”

LS: “Yeah, and that’s also going to continue going up and up as people live healthier and longer lives. Which is such an interesting thing now. I wasn’t as aware of this but we do have a number of patients in our center who are in their 80s and they’re rockin’ it. Hahaha.”

LC: “Exactly!”

LS: “I hadn’t heard of that because so much of what we do here about cochlear implants is about kids.”

LC: “Yeah, so cochlear implants are good for people who are born without hearing or people who lose their hearing eventually. So you can be born profoundly deaf and then get a cochlear implant at six months after trying hearing aids out. Or you can, some people get meningitis and they lose their hearing. Some people have syndromes or different genetic causes of their hearing loss which causes them to lose hearing over time and they might need a cochlear implant in order to hear speech clearly. Or when you get older, the hearing loss that you get is not generally enough to make you go completely deaf for you to need a cochlear implant. You usually don’t have that much hearing loss but some people are more genetically predisposed to that and then they would need a cochlear implant if they are no longer to use hearing aids in order to hear people talk and to participate in their lives and their conversations with family and friends and do what they want to do for the rest of their lives.”

LS: “Yeah, quality of life is such a big portion of the whole conversation with hearing that it’s sometimes left out a little bit (laughs). Because if your whole world and everyone that you know speaks and talks as opposed to someone is involved in the deaf community and has another language modality, most people who are in their life and then lose their hearing throughout their life, they get older and that really isolates them. That can lead to a decrease in participating in their life, maybe even becoming isolated and/or depressed.”

LC: “It can lead to dementia too or make you more likely to have dementia if you are not participating in your life anymore.”

LS: “Right, and stimulating the brain. So that’s another part of the conversation for adults. So basically the hearing loss is the first criteria. There needs to be enough hearing loss that a person is not able to hear and because of that, learn to speak or be able to speak.”

LC: “Yeah, and that amount has been changing over the years too, so before you had to be completely and profoundly deaf. Now it’s not the same anymore. If you have better hearing in the low pitches or low frequencies but you don’t have any hearing in the high pitches or high frequencies, then you are not going to be able to hear the different consonant sounds and the differences between words. So no matter how loud a hearing aid, you’ll never hear clearly unless you get a cochlear implant. So that has been changing too, so someone could actually get a cochlear implant if they had normal or mild hearing loss in the low pitches but it went down to severe to profound hearing loss range in the high pitches or high frequencies. Another recent change is that cochlear implants just got approved for people with a profound hearing loss in one ear in the US. So that’s approved for, I believe, five years and up.”

LS: “So that really opens up the candidacy for more people to be able to get benefits from the cochlear implant.”

LC: “So in order to get a cochlear implant, another part of the criteria or the candidacy, or what you need to have, is that you have to have a cochlea. They have to be able to have a part of your anatomy to put the electrode in. Some people don’t have a fully formed cochlea. They don’t have all the little turns of the snail shell but if you have a cochlea at all, they can put an electrode in there but that’s going to change the benefit that you get with the cochlear implant. You will still be able to hear sounds but it’s going to be different than someone who has a complete cochlea, who gets a complete electrode insertion into their cochlea.

So you have to have a hearing nerve inward in order to get a cochlear implant to and not on is a little bit trickier because the hard part about that is that they can’t really figure that out. They can look at it on an MRI and see what it looks like on the MRI but there is still kind of guessing. So it can look like you have no hearing nerve or a thin nerve, but that doesn’t mean that you won’t get benefits from a cochlear implant. You wont know until you get it, how much benefit you will get.”

LS: “So one of the things that we do before someone can get the implant is of course that they have to get medical approval clearance to get the surgery, and part of that is also undergoing an MRI or CT scan, but I think MRIs more, because they want to see the bone, right?”

LC: “It depends on the surgeon and all the surgeons I feel like in the last few years have switched which scans they want and when they want it and so it depends on the surgeon and it depends on if there is more concerns about someone’s development or they have more things going on than just the hearing loss, then they are more likely to do an MRI to make sure the nerves are intact. Or to try to make sure the nerves are intact in the best way that we have right now, which is not foolproof.”

LS: “So let’s say, there is a brand new baby diagnosed with profound hearing loss at birth. They are going to get hearing aids as soon as they can. Try and see if those are giving them benefit. Then there is a bunch of testing, hearing tests, audiology exams that they go through, what do those entail?”

LC: “So for the hearing test, once the baby has the hearing aids, they play the sounds. The baby is in the sound booth and they play the sounds through the speakers to see what’s the softest level of sound that the baby can hear while wearing the hearing aids. So the hearing aids are all the way turned up or programmed to the child’s hearing loss and they see what volume are they hearing the different sounds and that way we can figure out if they are hearing all the different sounds of speech with the hearing aids, or are they not quite getting there. And most people with a profound hearing loss, you’re not going to be able to hear to the level that you need to in order to hear speech clearly.”

LS: “Another question I hear from people is, when the baby is that small, how can you even know what they hear? Has there ever been a mistake where it’s a baby that hears, but they just had a false positive on their baby screens, like when they were first born and then they had them implanted but they had good hearing? How can we account for that and make sure that that doesn’t happen?”

LC: “A lot of times they will repeat the tests. They may repeat the ABR test which the diagnostic test after the baby is born, and then you should begin early intervention or ideally Auditory Verbal Therapy or intervention as soon as you can. That’s going to depend on where you live; what country you live in, what kind of services are offered to you. There’s a teacher in the US that comes out to your house that helps to work with you and teach you how to communicate with your baby. So they are there to help you figure out, is your baby hearing with the hearing aids or not. You have months to observe the interactions, to play loud sounds, to look for a startled reaction. Eventually when they are a little bit older, a turn to a loud sound. I usually say if you have access to this, depending on what city you live in, if you close the garage door and you honk the horn, does the baby wake up or get startled, those kinds of rudimentary tests, they can give you a little bit better of peace of mind about where your baby is hearing at.

So it’s not just one person’s opinion where they say, your baby is not hearing, he needs a cochlear implant. It’s a long process with lots of tests, repeating the tests, making sure that they are very confident about the answers and that what you see at home lines up with what they see in the test booth and that it lines up with what you’re intervention provider sees and then putting all of that information together to determine that your child is a good candidate or that they would benefit from a cochlear implant.”

LS: “And I would also say that if there is anyone who really has that worry or has that concern, then they should totally, 100% go to another center, go to another clinic or hospital and do the testing with a whole different set of audiologists and get a whole different second opinion just to confirm and see that they feel more confident. Because no one want to go into it uncertain.”

LC: “Yeah, absolutely. The other important thing too, is that cochlear implants is not for only people who hear nothing. Your baby still might hear something with a cochlear implant. They may respond to your voice sometimes, but if they are only hearing your voice and it’s very loud, they are not hearing enough of the sounds of speech. They are not hearing you clearly enough to talk clearly. So just because they respond to sounds, doesn’t mean that they wouldn’t be a good candidate for a cochlear implant or that they wouldn’t benefit from one or they are sacrificing something for a cochlear implant. It’s really about the understanding and not just the hearing.”

LS: “That is a very good point. What about the family structure, family makeup, access to healthcare, that whole piece of it?”

LC: “A big part of a cochlear implant pre-evaluation process where they are deciding if someone is a good candidate is to get an idea of what the parent and family’s goal is for the child. Where do they see their child going? How do they see them communicating with other people? Do they want them to listen and to hear different sounds and to talk, then in order to do that, they are going to need to have the technology in order to hear those different sounds. Are they interested more in having them be completely involved in the deaf community and listening and talking is not only not a priority, but also something they are not interested in, that’s going to be someone who is not a good candidate obviously.

And then it’s the other really important part of counseling is that you have to have realistic expectations about what the cochlear implant can do for your child. So if you buy a treadmill, you won’t be able to run a marathon in a year. You have to actually run on the treadmill first. If you get a cochlear implant for your child, they won’t be able to talk after a year. You have to do the rehabilitation and train the brain and do all of this work so you have to be willing and able to put in the time and the effort in order to train the brain in order to listen. The good news is that if it’s a baby and you’re starting very young, then it’s a lot easier to do that brain training, because the brain is so much more flexible and changing and babies can learn languages much faster than adults. They can really make sense of the sounds pretty quickly versus someone who is older and gets the cochlear implant who has been deaf for a long time and hasn’t had the brain pathways created to those sounds. They are going to have a lot harder time making sense of the sounds and hearing the sounds clearly and they are going to struggle a little bit more with that. So all those things are important.

Other things would be regarding family dynamics. If your whole family is culturally deaf and no one uses amplification and everyone signs, and you want your child to get a cochlear implant, then you would need to figure out who is going to talk to your child if you want them to listen and to talk. And there are families out there that want that for their child so either if it’s going to be a relative or if it’s going to be a program that they are going to be in, ideally someone at home is going to talk as well as at school, they don’t have to live with that person or move or anything like that but you should have someone in your life that’s going to talk. Because if you are at home signing every day, you’re not getting that listening practice in order to make sense of those sounds.”

LS: “What about in a kind of set-up where either the main priority is listening and talking or that isn’t the priority. Is there somewhere in between where it’s not a yes or no, but if you do a total communication with both… How do you approach it if someone is kind of on the fence or wants to do both or do some kind of integrated approach?”

LC: “Yeah, absolutely. There’s a lot of people that do both and I think there is a HUGE benefit of doing both. What you would want them to understand is that if they want the child to listen and talk, what is required of the child is that they wear the implant all the time and that they have rehabilitation services, and that they are working with a specialist in listening and talking and that, most importantly, the parent is talking to the child all the time, and interacting with the child. So if you want the child to listen and talk, at any point that is so so important so you have to understand that. And if you want them to sign too, that’s great too. You can absolutely do that at the same time. That’s not going to hinder their progress and that’s not going to slow them down in their talking, but if you want them to talk you have to begin right away or it’s going to be much more difficult if you wait for years and they wear the implant inconsistently, and then when they are five or seven or nine, then you want them to talk, that’s going to be a lot more difficult to get them.”

LS: “Did you hear the episode with Kimberly Sanzo that was all about sign language and the bias against sign language and the medical model?”

LC: “That was the only one I didn’t listen to I feel like. I listened to the other ones with the girl who is in her twenties who was deaf, who was having the baby. I listened to the other episode with the woman with two kids with hearing loss. I feel like that’s the only one I didn’t hear.” (Laughs)

LS: “Wow, you listened to the whole catalog,

LC: “I try to…”

LS: I’m honored. Thank you so much. Okay so that was basically our one controversial episode and Kimberly Sanzo is an SLP who works very closely with students who are ASL (American Sign Language) dominant, she’s a huge advocate for language over speech, and you know, teaching the brain language, the issue with language deprivation. That is her whole shtick. I just gave you the rundown of what that episode was about and that there is a lot of bias in the medical model and in hospitals, audiologists and cochlear implant centers, where they would like to convince everyone, persuade, I don’t know, that CIs (cochlear implants) are right for them, that CIs are right and that they are not right for everybody. So if you can just talk a little bit about that.”

LC: “That’s okay I like it. It’s funny because I work at a place that specializes in listening and talking and I’m always trying to persuade these hearing families to sign. I’m trying to talk them into signing. And they might not be interested in that at all for various reasons. A lot of times when parents have had a few years for everything to sink in and they are really submerged with all the therapies and all the services, it becomes their whole life. And the kid is a few years older and that’s when they maybe meet someone who is in the deaf community, they understand it a little bit better and then they get more interested in it. But people with babies, it’s hard to convince them to be interested in sign language. I give them the resources but a lot of the families, that is what they want for their children. I tell every family, if I do the ABR (Auditory Brainstem Response) on the baby and they have profound hearing loss, they have especially a “No Response ABR” which means there was no response from the brainstem at the loudest level the ABR will go to, and tell them all that they need to use some kind of visual communication and at least be doing some signs with the baby because they won’t know until the baby is older what the anatomy looks like and if the baby has a cochlea or a hearing nerve. So it’s so important to start then. All the families should start, if your child has a severe to profound hearing loss, all the family should start from birth using at least some signs because your child is not hearing words, they are not hearing language. They are not getting access to language so it’s absolutely correct.

But the main issue is if you do both of them half way, that’s when it’s a struggle and you have no real language and you struggle to communicate with people. That happens for a lot of different reasons with families, whether they didn’t understand the kind of dedication that it takes in order to get their child to listen and talk and now they are not able to do that and they need sign language as a supplement so they can communicate. Or people who wanted to just do sign language and their child hasn’t been listening for years and they want their child to listen and to speak…If you do it half way like that, it’s going to be much more of a struggle and it’s going to be harder to establish that native language or that initial language learning.

The other thing is that you’re in therapy from 1-3 hours a week, but your child is mostly spending time at home with you. So what kind of language model are you providing for the child? For a baby or an infant, they don’t go to school, so if you can learn signs and use signs with your baby, that’s amazing and I would definitely encourage that. But you’re not going to become fluent with a newborn infant. You may be able to have a preschool language level but someone who is not a native English speaker, I would advise them against using spoken English with their baby. I would advise them to use their native language. We want families to use the language that they are the most fluent and comfortable in in order to establish a strong language basis for their child in order to develop and grow, because once you have one language it’s a lot easier to learn and develop the other languages. But if you aren’t fluent in sign language, how is your child going to be able to become as fluent as someone who uses spoken language?”

LS: “Exactly!”

LC: “The other biggest issue is, how realistic is that? There are amazing, mostly mothers, out there, let’s be honest, who dedicate themselves to being a part of the deaf community, who go take their children to deaf events, who have deaf friends and deaf mentors. They do all these amazing things for their kids. who are learning sign, who are working so hard to learning sign and do all these different things and that is so incredible and I think that it’s definitely amazing what they are doing for their children but let’s not forget that that takes a lot of privilege. That takes time which means money, which means it’s not something that everyone has the ability to do. Not everyone has the time in order to learn a new language.”

LS: “And access, you’re talking about people in urban environments where they have a 100 different classes in different libraries all over, versus someone who is in a rural environment and even to get to a hospital is a two hour drive, let alone, a deaf event that is like once a year that they can access.”

LC: “Absolutely, it’s resources. Are you able to fly out for the deaf expo or are you in the middle of nowhere with no deaf people. Don’t forget that there are people out there with no email address, there are people with little to no internet access that I meet every day in Los Angeles. People forget where they are at and not everyone is at the same level as them. And the other thing that is really different that people don’t think about is if you speak English or Spanish and you want to learn sign language, in Los Angeles we can try to find the services for you. They are available for someone to help you learn sign language. But what if your native language is Mandarin or what if it’s Korean? Because those are the families that I’ve diagnosed. Then what, how do you learn sign language? That makes it a lot more difficult for those people to access those classes. And then, you know, people want their children to not only be able to communicate with themselves and the community, but grandparents are important parts of the family, sometimes a huge part of the family and sometimes they don’t speak English either, so getting them to learn sign language in addition to that, I mean, that is a real challenge and definitely, I highly recommend the book “Far from the tree”, by Andrew Solomon. Have you heard of that book?”

LS: “NO.”

LC: “It’s awesome. It’s about children who have different identities than their parents, so deaf children of hearing parents is the first chapter in it. So it talks about the biggest variety of families and experiences that I’ve ever seen presented all at once and it really helps me to round out my perspective. Because I used to think, ‘Why can’t these people just learn to sign? What’s wrong with them? Why won’t they just take the class? Why won’t they just use the app, it’s free? Why won’t they just do this or that?’ When I was listening to that and they were talking about these parents who move and try so hard to learn sign language, and completely submerge themselves and still couldn’t do it, still could not become fluent in it and not have a real, deep conversation with their child and connect with them, you know, that made me realize that even families who are really trying, that is still very difficult. So, yes, your child is always going to have access to that visual language, unless they start to lose their eyesight, that is their natural language. But who is their language model? That is my question honestly. If we’re talking about older kids, I totally understand if they are three years old, great, but what about when they are six months old???”

LS: “I loved this tangent (laughing) because language is the whole goal of everything that we’re doing basically. To try and get access to language in whatever way it is, but you know, with the cochlear implant, we’re trying to give people access to speech, the spoken language so that they can also become speakers, I don’t know how to say that otherwise. (Hahahaha) So that’s a very interesting perspective, I’m glad you are helping me out with that.”

LC: “Thanks!”

LS: “It’s really funny how the pendulum has swung in the younger generation of audiologists and also as the technology has gotten better, it’s saying wait, don’t forget about sign language. It’s like everyone is kind of graveling with this thing.”

LC: “Absolutely, it is a difficult decision to make, because we can talk about the idea about it so much but what is real for a real family right now, what’s real for you because, right now more mothers than ever are going back to work. So is learning a new language and becoming fluent a real goal that you can achieve?? Maybe. If you are really good at that and maybe if you’re a real good language learner but maybe not everyone is able to do that even when they try really hard. And that’s something to really keep in mind before people judge others who aren’t able to learn sign language. And I would say the other thing that the young adults who are cochlear implant users, who communicate with listening and speaking, a lot of them say that they want to learn sign language, they want to learn ASL and want to be able to communicate with the deaf community a little bit better but mostly because they are super high achievers and having more than one language is always useful and important. They want to be doctors and lawyers so of course if they are fluent in sign language, they would have something else as another really great skill. And then of course it’s going to connect you to the deaf community which is so important to connect to that history and to connect to people who are similar to you but it’s going to be a different experience for everyone and it’s never black and white like that.”

LS: “Yeah, and we talked about that with Toby in the episode where she said she had one foot in one world, one foot in the other world, which is like, let’s say there is a young adult who you are describing that wants to learn and maybe they are excluded from things because maybe their sign isn’t as advanced. You’re 25, why are you signing like a five year old? And they say, I don’t know I just started learning. So there could be some of that too.”

LC: “I mean luckily I found that most people are so nice and so patient and are willing to help people learn and grow. I mean, that has been my experience at least, which is so awesome and so nice.”

LS: “So you brought up when we were preparing for this interview to talk about music and dance classes for children with hearing loss. And I’m so interested in what was the direction you were going with that?”

LC: “I recommend music and dance class to all families to all families to children with hearing loss because when you move your body with music and you’re singing and dancing and you have the visual, that connects all of the different parts of your brain at the same time and really gives you such a great really cognitive input. It has social skills when you are learning to dance with other kids, you’re learning to stay on the beat. It’s great listening practice for the kids. Moving your body is part of communicating with people. Being able to follow directions and follow along with the other kids. We recently had a parent that was concerned that it was too loud, and that’s not something I’d be concerned about for a kid with hearing loss. I think that they can absolutely take a dance class and that they should be just fine, especially if they have a cochlear implant. But it’s never going to be too loud for them unless it’s behaviorally too loud, it’s never going to be too loud for it to cause damage to them like the other kids in the class that have regular hearing. Music class is a great idea to connect all those different parts of the brain together.”

LS: “So earlier we talked about how important it is to have intensive therapies, a lot of effort goes into having to learn how to use the implant, learn how to listen in order to learn how to talk. So children get speech therapy, they are going to get oral rehabilitation, rehabilitation, what are some of the services that kids need or that kids get in order to develop with their cochlear implants?”

LC: “So kids that have cochlear implants, they can work with listening and spoken language specialists, which are also called Auditory Verbal Therapists, who specialize in helping kids to use their hearing in order to listen and speak. All therapies have really shifted for the past few years, even in speech therapy too. Now the emphasis is so much on play and real life. So before they were, you know, holding your cheeks and pinching your mouth and having you stick out your tongue and you are sitting in a chair for hours. It’s so completely different now. I was saying at my work, we have these amazing studio apartments, there’s a kitchen, they are always cooking together and doing recipes and it’s a great language lesson because you are following directions and what goes next. Let’s pour, let’s add more too, how does it taste? Yum, yum. There’s so much language in things like cooking and routines and what can you do when you are changing your baby’s diaper to help with their speech and language development. So it’s so different than sitting in a chair and being poked and having to do the articulation drills over and over again, like the poor kids had to go through in years past, even 15 or 20 years ago. Young, deaf adults had to go through this really difficult therapy where they were just trying to get those sounds clear by repeating them over and over again. It’s so completely different now. I feel for those young, deaf adults who had to sit through hours of articulation drills and trying to say their “R” sounds and “S” and “Sh” and “T” and “Th” and “k”. I totally feel for them, therapy was so different then. Now it’s so much more play based. Now it’s so much more about the parents being the main people who are facilitating the therapy for their children. It’s about teaching the parent so they can use the skills at home. The parent isn’t going to sit there and they should not sit there with flash cards or with articulation drills, that is really not the way to go about it. That’s a way to make your kid hate therapy. They should just be using it in their every day or finding ways to incorporate more language and speech in their everyday life and their everyday world, when you’re walking around or driving in the car, when you’re changing the diapers, or when you’re going to a doctor appointment or walking in the park. How can you incorporate speech and language and listening and learning into all those different things that you are doing anyways.”

LS: “Children with typical hearing, how they learn language is exactly that. Through incidentally learning, it’s my favorite expression ever. Which means that you didn’t know you were learning, haha! Gotchya! Just by being around you are learning. By example they are watching and listening and taking everything we are doing and talking. It’s overwhelming being a parent sometimes. Everything you would say and do is being recorded, hahaha, by these children even the young babies. You can’t get past those little ones. So the kids who are having all those therapies, we just gotta model it after typical life. That’s the way to go.”

LC: “I think it’s so much more fun for kids now and that they enjoy so much more than kids used to which I totally understand why it was not enjoyable before. I think that that experience is just so different for kids now and if your child is starting to hate to go therapy, or have behavior issues with therapy, then you should look at your schedule and think about how much you are putting your child in every week, maybe you can back down a little bit depending on where they are at with their skills with listening and spoken language development. If they are already really thriving and doing amazing, maybe you don’t need to go quite so much and you can spend that time with them and do something fun instead and that could help with that. Because there are those parents who take it a little too far and then you can see the kid reacting and pushing back and communicate in the only way they can and that it’s too much and then you need to pull back a little bit.”

LS: “So I have an upcoming episode of an interview that I’ve done with the person that brought Auditory Verbal Therapy to Israel.”

LC: “Oh wow!!”

LS: “Yeah, she’s an amazing mom of twin girls that are deaf and I think they are in their early 20s now. She brought this when they needed it when they were little and really built up everything that’s basically in this country in Auditory Verbal Therapy. One of the conversations we had was about was the word normal and do we want our kids to be normal? Well it’s like, on one hand, they are not normal, they are not typically hearing. And then on the other hand, it’s like, who even is normal ever, what does that even mean? In some of their marketing material they used the expression, and they really grilled her on it, where you can’t say that the kid quoted something. It was like a seven year old who said, “I’m just like a normal kid because I did AVT” or something like that. And I was like, that like didn’t hit right for me, it was the wrong note. Because is the point to be normal? No. The point is to help them be able to communicate and listen and speak and be part of their family and part of their community. Then I felt like they were taking away that deaf identity. It’s tough!”

LC: “I will say that kids and young adults with hearing loss have been some of the most confident people I have ever met in my life. When a parent is so dedicated to spending that one on one time with that child, that face. You have to be face to face, you have to be close to them. You have to be talking to them all day, every day. That’s something that parents who have typically hearing kids don’t have to do, they don’t have to go to therapy together, they don’t have to do all the activities together. They are also involved but don’t have to be so direction-ally involved with a child with hearing loss. So spending all that time getting them to that point I think that gives these kids such amazing confidence in themselves and they do think of themselves as just another kid. So it’s not necessarily that they are normal, but they think, of course they are just like everyone else.”

LS: “That’s such a great, indirect outcome. That’s beautiful for their relationship between the parent and the kid. One of the things that people do a lot when they have a child with hearing loss or even therapies to say, what’s this and what is this called? Constantly quizzing the child to see if they are able to hear. Can you hear me? Asking all these very direct questions. I know you are a big advocate of not doing that so tell us more.”

LC: “Yes, I learned that the hard way when I told a parent of a child that had typical hearing loss and speech delay, I said, “You know you can try to talk in sentences with them like I was just doing.” And they responded by asking the child, “What color is that?” To be fair that is a full sentence but it’s not what I meant. So having the child label over and over, what color is that, red, blue, green…Which animal is that? What sound does this animal make? That’s not a conversation. That’s not how we talk to each other. Yes, I’m glad you are practicing, you are seeing what kind of language or speech they are understanding, great. But most of your conversation should not be that. It should be talking more naturally. How you would talk to a typically hearing child, you would talk in sentences, you would have back and forth communication. And ideally, you want them saying more than one word too.”

LS: “Instead of saying this one is blue and this one is green, and you just hold the third one and don’t say anything, there isn’t the pressure of saying what color is this next color. It’s like we are doing a pattern and we are talking about all the colors and maybe they will come out and say it on their own…”

LC: “That’s the other thing, it’s not always fun to do that and then kids stop talking and that’s not effective either. So if it’s a quiz all the time, just kind of be aware of that and it should be fun. It should be a conversation.”

“Right. Isn’t that interesting, that you are trying to connect and make a report with someone and say, “Wow, Mickey Mouse, I love Mickey Mouse in a knapsack, look how cool the bow is.” And then it’s like, wow, this lady likes my things, which is such a nicer interaction and immediately builds you some sort of connection with them as opposed to this one with the questions. (laughing)”

LC: “Definitely. Make sure you aren’t only asking questions and that you’re having back and forth communication. If you are only asking questions, you are not interviewing your child. You’re having a conversation. Like you shouldn’t be asking and then they answer and then they ask and then you answer. You want the back and forth and it could be hard when you are not saying anything, I would definitely encourage more pausing. Sometimes it takes a long time for the kid to process the information that you said to them or to come up with what they are going to say. Sometimes you just have to be very patient in order to wait for that answer or for that response.”

LS: “I’ve heard of the count to ten method and it’s the longest ten seconds. (Both laughing) because you want to give the answer and help them out. Anyway, so let’s go back to the question at the top of the hour, do CIs work, do cochlear implants work? What is your answer for this?”

LC: “My answer for this is yes, they work. They are amazing and incredible and actually work better than ever. The technology, even in the last five to ten years is different. So it’s really incredible what these people who are getting implants are doing with them. Kids who are getting cochlear implants young, who are getting the rehabilitation, they are talking and speak clearly. The way they talk is different from kids who got implants when they are older. You can hear it in their speech and in their voice. They do sound like the other kids, they don’t have that speech difference than kids who got the implants later have and you can hear the difference in their voice. And they don’t have to struggle as much. It’s easier for them. Yes, it’s a little bit harder when it’s noisy but they don’t have to focus on the person so much. It doesn’t have to be just the one on one conversation. They don’t have to be lip reading as much. It comes easier and more natural and all of that hard work and that stress and pressure and that therapy and the poking and prodding that these poor adults had to go through, who had hearing loss as a child. It’s so different now. So yes, cochlear implants work, they are amazing and people can learn to listen and talk and speak more than one language, which is more than I can do. So yes, I would say they work pretty well.”

LS: “Nice. I think a big part of that is like when all the stars are aligned and everything is going well, then they can have those incredible super duper outcomes, those super stars. I think also a big part of the question is coming from well, what about these device failures, what about these kids with multiple disabilities, or these kids with language disorders. There are people who are going to get a cochlear implant and not be “successful”, not be able to develop spoken language and that’s not necessarily the whole story, you know. It’s not about the cochlear implant but about the whole case.”

LC: “Absolutely, that’s so true. You can do everything that you can and you can still have a different outcome than you expect and again that comes onto having realistic expectations. If you implant a child at six months and then at two and a half, realize they have autism, that’s going to be a different experience than someone who doesn’t have that other language difficulty to contend with. So everyone is going to be different. Device failures do happen but they are pretty rare. A lot of times they can re-implant and people who get re-implanted can have a lot of good benefit from the cochlear implant. There is always risk with surgery and with the device. It’s a man made device and it’s not going to be perfect every single time. We can all do the best that we can in order to set someone up for success. You have to understand that success is never promised to you, as part of the realistic expectations, but you should definitely keep the expectations high for your child and that’s the only way you’re going to know if they can do it or not, or if they are doing it. You can’t guess or predict. We’re audiologists, we’re not psychics. We can give you all the tools and we can help you and we can give you the knowledge and information and access. But then it’s up to YOU and it’s up to your circumstances and to lock at the end of the day, we can only control so much.”

LS: “Dr. Lindsay, thank you so much for this incredible conversation. Tell our listeners where they can find you or more of some of the blog posts you have written and some more information about you.”

LC: “Thank you so much. This has been really fun. I have a blog called listenwithlindsay.com. My Instagram is @listenwithlindsay so come join me there if you want to hear more about audiology and listening and cochlear implants and all about the field if you are a student studying. Send me a message and let me know that you heard me on this podcast so that we can chat too.”

Thank you so much again to Dr. Lindsay Cockburn for joining us on this episode, do cochlear implants work? I hope that you have a better understanding of how complicated and complex the journey is and that it isn’t really a yes or no question. It’s very micro factorial and a lot of things come into it. I want to remind you that you can always DM me or send me any messages about anything, any questions, or comments. Leaving a review on Itunes melts my heart and if any of you are interested in the Hope Beyond Hearing program, do check out the link allaboutaudiology.com/hope.

Thank you so much for listening. I’m Dr. Lilach Saperstein and this is the All About Audiology podcast.

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