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about its effects and likely benefits. They understood that cochlear implants do not restore nor-
mal hearing and that the benefits vary greatly. According to the audiologist, Toast could expect
improved sound awareness and, consequently, an improved ability to read lips. Optimally, he
might have improved auditory perception and might be able to comprehend the speech of others
even over the telephone. The audiologist suggested a “wait and see” philosophy about the outcome.
Toast met with the cochlear implant team, consisting of an otologist, audiologist, speech-
language pathologist, social worker, and Toast’s parents. The team discussed several types of
cochlear implants and their relative benefits. All cochlear implants include a headset, speech pro-
cessor, battery source, and a surgically implanted receiver. The audiologist described Toast’s can-
didacy for the procedure and how the pro cessor would be programmed to maximize his auditory
perception and speech discrimination. The otologist discussed the outpatient surgery using charts
and diagrams. The speech- language pathologist reviewed the speech pathology ser vices Toast
would receive. The audiologist and speech- language pathologist explored the follow-up rehabilita-
tive ser vices necessary to maximize the benefits of the cochlear implant.
The surgery began at 8:00 a.m. in the otologist’s office, and by 9:30 a.m. it was complete. Toast
had to wait nearly a month for the hookup, in which the audiologist programmed and fit the
headset to the pro cessor, a procedure that took about 2 hours. During this impor tant time, the
audiologist assessed the ability of the cochlear implant to decipher the acoustic signal into neural
impulses. This clinician instructed Toast and his family on how to maintain the system, including
changing the batteries and adjusting the controls. About a week after the initial hookup, a second
programming session reevaluated the total functioning of the device. A follow-up session occurred
several weeks later.
The results of the cochlear implant were better than anticipated. Toast could hear and under-
stand much of the speech of others at normal conversational levels. The improved hearing dra-
matically improved his speech reading ability as well. The speech sounds produced at the back of
a person’s mouth are difficult to read, and with the improved hearing provided by the cochlear
implant, Toast could either hear or speech read most of what others were saying. The most unex-
pected and positive aspect of the cochlear implant was that he could now hear his own voice. It had
been years since he could clearly hear what he was saying; now, with the implant, he could monitor
his pitch and loudness levels. The cochlear implant had returned auditory feedback and continuity
to his life. Now in high school halls, even during noisy breaks, he turned to acknowledge friends
when they beckoned him: “Yo, Toast.”
Case Study 9-5: Social Implications of Deafness and
Cochlear Implants
You feel honored to be invited to the 3- day, 2- night canoeing and camping trip. You are
also pleasantly surprised at the invitation because you are the only hearing person in the group.
Canoeing and camping in this northern state promise to be exciting, and the f ly fishing is reported
to be excellent. You will certainly catch the limit of large- mouth bass and trout each day and cook
them over an open fire at night. However, as a precaution, your friends decide to purchase freeze-
dried snacks, cans of beans, and ready- to- eat meals just in case the fishing is disappointing. You