XVII. John Niparko, M.D.

John Niparko, M.D., Professor in The Johns Hopkins School of Medicine and Director of The Listening Center, The Johns Hopkins Cochlear Implant Program, noted that cochlear implant programs attract individuals with a range of hearing histories and levels of hearing loss. These individual differences need to be kept in mind when communicating procedures and obtaining consent as the preferred method of communicating can vary markedly. Due to the relatively low level of open-set speech recognition sometimes achieved by adult recipients of implants deafened prior to the age of 5, expectations and predicted benefits should be examined carefully in this population. Thus, the mode of communication that is most informative to the candidate must be adopted in such discussions. Discussions with a peer-group recipient of an implant are generally viewed as extremely valuable. Quality-of-life studies on this adult population indicates that, on average, persons who became deaf early in life do not view deafness as a severe disability when compared to persons who lose hearing later in life. Such beliefs should be carefully examined as they can greatly aid discussions of whether an implant is truly indicated and likely to be of benefit. The Listening Center Program is able to use hospital-based interpreters and also recommends the use of peers to explain procedures and to maintain compliance after the implant.

In response to a query about how the project recruits children, obtains informed consent for their participation, and explains to the parents the expected results, Dr. Niparko described the use of parents as proxy for the child. To Dr. Niparko's knowledge, no program advocates that children be actively recruited for evaluation of their cochlear implant candidacy. Such an approach would be immediately self-defeating, as the family's commitment to a prolonged period of rehabilitation should be strong and sincere. Since the Hopkins program has found better results for implants in congenitally deaf infants who receive an implant by 24 months of age, the parents must serve as proxies for the decision to pursue implantation for a child. Niparko noted that prospective client families can benefit immensely from meeting with other families whose children have received an implant. This is a procedure that is widely used in his program. Referrals for alternative approaches to facilitating communication can be made within the Hopkins environment. In the past year several children have been judged as poor candidates for a cochlear implant and have been referred to the Maryland School for the Deaf to pursue language acquisition through visual modalities. This example illustrates that service providers must be cognizant of a region's resources. Appropriate referrals for alternative services should be made when a child's best interest can be served elsewhere.

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