Understanding Hearing Loss - Part 1
By Professor W.P.R.Gibson. AM MD FRACS FRCS.

As presented at the Sydney Opening of Hearing Awareness Week, 26 August 2002 and reproduced with the kind permission of Professor Gibson and Irene Truscott, President of Deafness Council of New South Wales

Hearing Awareness Week is an important annual event which makes us all appreciate how important hearing is in our everyday lives. Loss of effective hearing later in life can be devastating as hearing loss can make work difficult, or even impossible. Hearing loss limits family and social life. Lack of hearing during childhood can prevent the acquisition of speech and hamper education. Although Deaf people do develop their own means of communication by using ‘sign’, they face immense challenges in gaining employment and when trying to communicate with hearing people.

So what has happened during the last 20 years, and what can we expect to happen in the next 20 years?

In the early 1980's, when I came to Australia and began at The University of Sydney, there was little that could be done to rectify a profound hearing loss. For children, the outlook was limited. Even the National Acoustic Laboratories (now Australian Hearing) advocated the use of total communication for children with a profound hearing loss (worse than 90dBHL). The problem was hearing aids could only provide some amplification for profoundly deaf children and they had to be taught by lip reading to say the sounds that they could not hear. Typically high frequency sounds or consonants could not be heard and the children would omit the consonants, such as ss, sh, f, t, from their speech. Instead of saying ‘ she goes shopping’, they would say ‘ he go hopping’ and hearing people would be unable to understand. A few children, with a dedicated parent, might succeed in gaining intelligible speech but others would fail and could be left with no means of communication.

Thus, it was policy that deaf children should learn ‘total communication’. This allowed the use of ‘signed English’, together with attempts to teach oral skills. In reality this approach was doomed. Few of the children developed any useable oral communication, and most relied on sign. For those who signed, ‘signed English’ was a clumsy form of communication and they preferred the use of ‘Auslan’.

When I began my job in Sydney, the work of Professor Graeme Clark had already stirred great interest. He had designed a cochlear implant which had 22 electrodes which could be placed inside the inner ear to provide hearing. Previous cochlear implant research had shown that it was safe to put electrodes inside the cochlea but many felt that the cochlear implant could only provide a buzzing noise which could only be used as an aid to lip reading. A single channel implant had been developed in the USA which performed well but did not give the user the ability to recognise speech. Many leading researchers wrote that multiple electrode devices would never provide any better results than these single channel devices. Many leading surgeons, audiologists and researchers felt Professor Clark was crazy to pursue the goal of using a cochlear implant to hear speech.

In 1984, I performed the surgery to install the first multiple channel cochlear implants in Sydney on two young women. The results were spectacular as both women were able to distinguish speech without the need to lipread. The first young woman was Susan Walter, now Susan Foster, and I was able to have a telephone conversation with her. The early adult recipients were the pioneers who provided the knowledge needed to advance the programme.

In 1987, I began to provide cochlear implants for children. The publicity aroused by performing this controversial surgery on young children was immense. Professional colleagues were upset. The Deaf community was upset so I received adverse mail from surgeons, audiologists and teachers of the deaf. The sustaining factors were the quality of the results and the support of the parents.

The cochlear implant team soon realised that, the results were better than anyone could have expected. Most children were able to hear enough to be able to learn to speak by listening and the voice production was clear enough for them to be able to go to a regular school situation.

It was soon realised that the earlier, the child received a cochlear implant, the better the outcome. Already several children aged less than 1 year have received cochlear implants in Sydney and within the next month a child aged 5 months will receive a cochlear implant.

The world has changed over the past 20 years. In the past parents who had a deaf child who chose that their child should speak had to spend countless hours teaching their child to say sounds they could not hear. For many parents the struggle was too great and the children never achieved useable speech. These children only learnt to communicate using sign and as Deaf adults have limited social and job opportunities. 60 per cent of adults who can only communicate by using sign are either unemployed or under employed.

The world has changed.

We now have computers, mobile phones and digital hearing aids. Technology is changing everything and technology has changed the world for deaf children. Now parents have a true choice for their deaf child. They can chose that their deaf child will learn to listen and to speak and have every reason to expect success providing that child is given the technology to be able to hear at a young enough age. Providing there is early intervention, and providing there is no other major disability, there is no need for a deaf child to learn to sign.

Currently in NSW, over 90 percent of children born deaf who cannot hear sufficiently using a hearing aid receive a cochlear implant. Over 80 per cent of these children are integrated into regular schools, albeit with itinerant support. These children can look forward to educational and employment opportunities beyond the dreams of deaf children 20 years ago.

Part 2 >>

This article posted to this web site on 11 September 2003