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Online EHDI Case 2 (Part 2 With Answers)

Online EHDI Case 2: A Child with Profound Hearing Loss

Part 2

Ismael returns for evaluation at 4 months of age. He has been fitted with hearing aids, and has worn them for one month. He shows minimal response to sound even when the aids are in place. His father, who has read extensively since the last visit, wants to proceed immediately to cochlear implantation. He is unconvinced that Early Intervention with hearing aids in place will benefit Ismael given the severity of the hearing loss. He declines the recommendation for genetic testing.
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1. How do you respond to Ismael’s father’s interest in cochlear implantation for his son?

• Ismael’s father has correctly concluded that his son may be a candidate for cochlear implantation.
[https://www.ihsinfo.org/IhsV2/Hearing_Professional/2005/010_January_February/030
_Practical_Aspects_Cochlear_Implantation.cfm]
• Cochlear implant is a device to allow detection of sound usually reserved for individuals, adults and children, with severe to profound hearing loss.
    o The device includes an external component and an internal component.
    o The internal component requires a surgical procedure to introduce the device into the inner ear.
• However, the protocol for cochlear implantation requires that the child receives a 6-month trial period of hearing aid amplification before the decision about cochlear implantation is determined.
• In the USA, the FDA has approved cochlear implants for children 1 year of age or
older.
• You can offer information on cochlear implantation:[http://www.babyhearing.org/HearingAmplification/Cochlear/index.asp] Refer the child to a specialty center in your area.

2. What is your current advice?

• The father’s difficulty waiting most likely represents his response to worry as well as his interest in receiving the best care for his son.
• One strategy that often works well when families are anxious is to speak directly about the emotions underlying the statement. In this case, you might say, “Wow, I see how worried you are about Ismael. I know how difficult it must be to wait until we have had time to assess how Ismael is able to use his ‘residual’ hearing. However this is an important aspect of the process. The whole team—the audiologist, the early intervention team and I--will be here to help you through this process.”
• A second strategy is to inquire about how the family has dealt with stress, anxiety or uncertainty in the past. Because they are in a foreign country, they may not have available to them the usual methods or people they use for support. Helping them to problem solve about getting emotional support might take the focus off the struggle to wait and see.
• While waiting, the family can concentrate on what stimulation encourages their son to learn. Whether or not he is a candidate for cochlear implantation, this information will be useful for his future.
• Commit to staying on top of the situation, and moving to the next stages as soon as it is wise. Make an appointment for 2 months.
• Suggest that the cochlear implantation center may help them appreciate the value of genetic testing. Once the family develops a strong relationship with the team, they may reconsider the recommendation for genetic testing.

Additional Info

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