Impact of a Cochlear Implant on Job Functioning (2001)

Multichannel cochlear implants were first approved for use in adults with acquired profound hearing loss by the Food and Drug Administration (FDA) in 1985. Since that time patient selection criteria has been expanded by the FDA and manufacturer's recommendations to include adults with severe hearing loss, with limited benefit from hearing aids, and children with profound hearing losses. Cochlear implant devices are designed to electronically stimulate the auditory nerve to provide sound and speech information. Over 25,000 persons worldwide have received multichannel cochlear implants (Kirk, 2000). It is estimated that from 360,000 to 700,000 persons in the United States have profound hearing loss (Reis, 1982; Schow, Mercaldo, & Smedley, 1994). If persons with severe hearing loss are included in these estimates, these numbers are greatly increased. The Nucleus mulitchannel cochlear implant system is the most commonly used system in the United States. It consists of an external headset with a microphone and transmitter, a battery-powered body worn speech processor approximately the size of a small beeper, and an internal receiver sugerically imbedded in the mastoid bone and electrode array that is implanted in the cochlea. The microphone picks up sound information and sends it to the speech processor that encodes the sound information into a digital signal. This digital signal is then sent back to the headset, and the transmitter sends the electrical signal through the skin via radio frequency waves to the internal receiver in the mastoid bone. The receiver sends the electrical impulses to the electrodes implanted in the cochlea thus stimulating the auditory nerve, and the person receives sound sensations (Estabrookes, 1998; Koch, 1996; Staller, Beiter, & Brimacombe, 1994). Studies have shown cochlear implants to be successful in providing some auditory information to persons who receive minimal benefit from traditional hearing aids (National Institute of Health, 1995). Adults with post-lingual deafness have the best prognosis for success with cochlear implants. Post-lingual deafness is defined as having its onset after the development of speech and language (after approximately age six years). A wide range of benefits have been noted among patients, ranging from sound awareness and minimal help in speechreading to open-set speech perception without visual cues (National Institute of Health 1995; Skinner, et al., 1994; Skinner, Fourakis, Holden, Holden, & Demorest, 1996; Skinner, Holden, Holden, Demorest, & Fourakis, 1997). One of the suggested benefits from the use of cochlear implants with adults is improvement of job satisfaction and placement. Dowler and Walls (1996) investigated 392 job-accommodation cases for individuals with hearing loss. The primary concerns of employers listed in these cases were in the areas of communication (62%) and safety (24%). The purpose of cochlear implants is to aid in both these areas by providing some auditory awareness and understanding. Studies have indicated that individuals with hearing impairment tend to have lower aspirations for vocational placements, higher unemployment rates, to be more underemployed and be paid less than their counterparts with normal hearing (Farrugia, 1982; MacLoed-Gallinger, 1992). Zain and Kelly (1996) found that attitudes about the employability of persons with hearing loss could be improved with prospective employer training. Their finding is positive in that employers may change their attitudes towards workers with hearing loss after they see successes with interventions such as the cochlear implant. Saxon and Holmes (1996) completed a pilot study to determine the impact of a cochlear implant on the job functioning of a 60 year-old adult with profound hearing loss. A 20-item questionnaire was given to the cochlear implant patient and his two immediate work supervisors. The questions were designed to elicit information about the patient's performance prior to and after receiving his cochlear implant. …