Transcript Cochlear Implants & Deaf Culture

Cochlear Implants
&
Deaf Culture
Medical Breakthrough, or Cultural
Genocide?
Tim Bunnell
Director, Nemours Center for Pediatric Auditory and Speech Sciences
Alfred I. duPont Hospital for Children.
QuickTime™ and a
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Tim Bunnell
Center Director
Center for Pediatric Auditory and Speech Sciences
Thierry Morlet
Lab Head
Auditory Physiology and Psychoacoustics
Linda Vallino
Lab Head
Craniofacial Outcomes Research
Rob O'Reilly
Lab Head
Balance and Vestibular Disorders
Tim Bunnell
Lab Head
Speech Research
Ear Structures
Cochlea
source: wikipedia
deafness (little ‘d’)
• Definition
– Profound hearing Impairment (threshold > 90dB)
– Unable to make use of amplifying hearing aids to
understand speech
• Assessment
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Otoacoustic Emissions (OAE)
Brainstem evoked response (ABR)
Audiogram
Funtional Hearing (Hearing In Noise Test)
Causes of deafness
• Congenital
– Genetic
• Syndromic - E.g., Waardenberg, Pendred, Usher’s
• Non-syndromic - E.g., Connexin 26
– Idiopathic (unknown origin)
• Acquired
– Presbycusis - Aging-related hearing loss
– Drug-induced - E.g., chemotherapy
– Injury - Especially head injury
Cochlear Implants
• External device and
processor
• Through the skin
transmission
• Electrode array inserts
into cochlea
• Multiple electrodes on
array
• Different frequency
bands go to different
electrodes
Cochlear Implant Outcomes
• Adults (intact auditory nerve)
– Good outcome Postlingually deaf
• short period of deafness
– Good outcome Prelingually deaf
• extremely rare
• Children (intact auditory nerve)
– Good outcome Postlingually deaf
• short period of deafness
– Good outcome Prelingually deaf
• 2 years or younger at time of first implant
– Poor outcome Prelingually deaf
• 5 years or older at time of first implant
Prosthesis not Cure
• Implantee must learn to use stimulation
– Significant (re)habilitation
– Device must be ‘tuned’
• Speech
– Stimulus known
– Stimulus unknown
• Music
– Familiar instrumental
Demo audio: www.hei.org//research/aip/audiodemos.htm (Bob Shannon, Qian-Jie Fu, John G. Galvin III)
Deafness (big ‘D’)
• First language is a signed/manual
language
• Member of ‘Deaf Community’
• ‘ Wellness’ model
– Is not handicapped
– Does not need to be cured or fixed
• Denial or healthy adaptation?
ASL
• Derived from French sign language
– Used in US & Canada
– Totally unlike British sign language
• Moderate dialectical variation in different
regions
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Toronto
Louisiana
California
Washington, DC
• VERY unlike English in structure
– Except spelling borrowed from English
– simultaneous ASL & English not possible
Education
• Oral
– Speech emphasis
– Maybe some sign or gestures
• Sign
– Sign emphasis
– Maybe some oral/aural exposure
• Bilingual
– Balanced mix of sign and oral/aural
• Schools for the deaf
– Sterck School in Delaware - ‘D’
– Clarke School in MA, PA, NY, FL - ‘d’
Gallaudet University
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Land donated by Amos Kendall
in 1862 in NE D.C.
For Deaf, Dumb, and Blind
College formed in 1864
Rubella epidemic 1960’s led to
large increase in students in late
70’s - 80’s
Deaf President Now 1988
(I. King Jordan, Ph.D.)
http://pr.gallaudet.edu/dpn/
Unity for Gallaudet - 2006
I.K.Jordan’s successor not deaf
enough.
Controversy
• If all children are implanted will there still be
deaf people and culture?
• Is deafness a cultural ‘difference’ or a
physical impairment?
• What to do with deaf children of hearing
parents?
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90% of deaf children born to hearing parents
Children identified in newborn screening
Who is the initial point of contact?
Who ‘educates’ parents of newborn deaf child?
Interesting/Useful Links
• PBS Show on Deaf Culture:
- http://www.pbs.org/wnet/soundandfury/culture/index.html
• Wikipedia article on Gallaudet University:
- http://en.wikipedia.org/wiki/Gallaudet_University
• National Association of the Deaf (NAD) statement on CI:
- http://www.nad.org/site/pp.asp?c=foINKQMBF&b=138140
• Some good websites describing CIs:
- http://www.utdallas.edu/~loizou/cimplants/tutorial/tutorial.htm
- http://www.nidcd.nih.gov/health/hearing/coch.asp