CIPRIAN

Age 17 years

General data on the case:

  • Biographical and case identification data – Ciprian is the third child of a hearing family. His mother, father, older sister, and older brother are all hearing.
  • Case history (Anamnesis):

– Significant medical data – Ciprian was born at 41 weeks through natural birth, following a normal pregnancy without complications. He received an APGAR score of 9 but no neonatal hearing screening was performed at birth because it was not available in Romania at the time (2004).

At 14-15 months he was using a few words such as “mama” and “tata”, but by age 2 his parents noticed that his speech was not progressing, and he was not reacting to loud noises. After seeking medical help, they received the news that Ciprian had profound bilateral neuro-sensorial deafness.

Following his diagnosis, he received bilateral hearing aids, which he wore for 6 months with no positive results, so it was decided that a cochlear implant was needed. After a waiting period, when he was 4 years and 6 months old Ciprian received a cochlear implant in his left ear. He never received a CI for his right ear because by the time it was an option, he was no longer eligible due to his age.

At 12, Ciprian had to undergo a re-implantation surgery because of a malfunction in his first cochlear implant (some of the electrodes were short-circuiting).

  • Significant psychological data – Ciprian is an intelligent and creative young man. He enjoys drawing, building, and anything IT-related. He is very sociable and enjoys spending time with his close friends, however, he is also very self-conscious about his ability to effectively comprehend and communicate out loud.

While he has developed good speech and spoken language, he often finds it difficult to understand others and frequently relies on lip-reading. He is anxious about speaking with other children, preferring to converse with adults, who tend to be more understanding of his struggles. He is often worried about having a bad pronunciation, so he prefers communicating by text. Luckily, Ciprian has an incredibly good support system in his family and friends.

  • Educational setting: At around the age of 5, after getting his CI fitted and starting speech therapy, Ciprian started going to a regular kindergarten. The teachers were understanding, and the children were told about Ciprian’s situation, so it was, for the most part, a smooth process. Even so, Ciprian found it hard to integrate at first, tended to be quiet and kept to himself. In the morning he would go to kindergarten and in the afternoon, twice a week they would see a speech therapist.

He continued his education with his hearing classmates, at a regular school. Primary and middle school went well, without any significant issues.

Now Ciprian is in 10th grade and he enjoys drawing and computer science. Because he feels insecure about his comprehension and pronunciation, he prefers subjects that do not require much oral communication. He is not yet sure about his post-graduation plans, but he would like to study something IT-related.

  • Significant social data: Ciprian is the youngest of three children in a moderate-income family. He lives with his brother, sister, and parents in a 4-bedroom house. Both his parents have high school-level education.
  • Age of fitting the first hearing aids and cochlear implants: At the age of 2 Ciprian received bilateral hearing aids, which he wore for 6 months with no visible improvements. It was decided that a cochlear implant was needed, so following a waiting period, when he was 4and a half years old Ciprian received a cochlear implant in his left ear. The CI was fitted one month later. He never received a CI in his right ear because by the time it was an option, he was no longer eligible due to his age.

At the age of 12, Ciprian had to undergo a re-implantation surgery because of a malfunction in his first cochlear implant (some of the electrodes were short-circuiting).

How often and what kind of support/rehabilitation does the child/family receive?

At around 5 years of age, Ciprian started seeing a speech therapist twice a week, on Tuesdays and Thursdays. A session would last around 90 minutes and began with learning to comprehend sounds, then trying to vocalize them.

The speech therapist they were seeing was 38km away, so the only reason the family could afford the costs was the disability pension Ciprian received.

The implantation

  • age of undergoing first cochlear implantation: 4 and a half years old, left side,
    • type of implant: MEDEL both times
    • number of implants (CI and hearing aids): CI at 4 and a half years old, on his left side; no CI or hearing aid on his right side
    • current average duration of the CI use (information from the audiologists): 14 hours/day
    • other relevant information: difficult periods during early-stage development. If yes, why? In the early stages, there were no difficult periods. At age 12 Ciprian had to undergo surgery to replace the CI because of a malfunction. A few years later the processor had to be sent in for repairs and the parents ended up having to pay out of pocket for a new one.

What is the procedure for starting speech therapy after CI?

The importance of speech therapy and rehabilitation is discussed with the parents before implantation. There is no official rehabilitation program, so it is up to the parents to choose a speech therapist. The speech therapist Ciprian ended up seeing was recommended to them by the CI team and was located 38km away from their home. In Ciprian’s case, he received a disability pension which helped the family with the costs of rehabilitation.

The Speech Therapy used in rehabilitation

A few months after receiving his CI, Ciprian started seeing a speech therapist. The sessions would take place on Tuesdays and Thursdays and last around 90 minutes. They began by learning to comprehend sounds and spoken words, then training to vocalize the words. Ciprian got used to the CI very quickly and was especially driven to learn during sessions. He was extremely motivated to develop speech production and spoken language to be able to keep up with his peers. Following their speech therapist’s advice, Ciprian and his family would also work on his verbal-oral communication at home. Less than a year after starting speech therapy he began using words and later full sentences. They stopped speech therapy at age 14, even though they would have liked to continue for a couple more years. The family could not afford it after Ciprian’s disability pension was reduced.

Ciprian received regular audiological support and adjustments. He never learned sign language; however, he can read lips.

At 17, Ciprian has the vocabulary of an adult, although he still faces difficulties sometimes with comprehension and pronunciation. He often relies on lip-reading during conversations and sometimes struggles with making himself understood.

Results

SWOT analysis by Ciprian’s mother

Strengths: His parents are happy with the results. Ciprian goes to a regular school and has no problem keeping up with his peers. He can do almost anything a hearing child could do. When the first CI malfunctioned, the CI team’s response was quick, and the issue was promptly solved. Because as a child Ciprian needed to always be watched over, he has an extraordinarily strong bond with his family, especially his mother and older siblings, who spent the most time with him. His mother considers this one of the biggest strengths of Ciprian’s case.

Weaknesses: Having a hearing impaired child in the family was incredibly stressful and at times scary because they felt an immense pressure to make the best choices for their child. While they were happy to receive the CI, the waiting period between getting the diagnosis and the surgery itself was filled with worry and anxiety.

Throughout the years they have experienced a couple of device malfunctions, which again took a toll on them emotionally and financially. Their main regret, however, is that he missed the chance to get a second CI. All things considered, the family has always kept a positive outlook and supported each other, including Ciprian, through every hardship.

Opportunities: Ciprian’s parents are satisfied with the support they received from the CI team and all the opportunities the CI and rehabilitation process have offered him. They are confident Ciprian will have a bright future and never tire to support and help him feel more confident in himself and his abilities.

Threats: With the current epidemiological situation and the fact that everybody is wearing a mask, Ciprian’s parents have noticed him struggling more to understand others. This has resulted in Ciprian becoming quieter and more withdrawn, preferring to use his computer even more than usual. His parents try to be there for him and encourage him to make the best out of the situation.

SWOT analysis by Ciprian

Strengths: Ciprian is glad that he can go to school and learn along with his peers. He is also thankful for the ability to listen to music, watch movies etc. He enjoyed going to speech therapy and developing better speech and spoken language as this allowed him to feel more confident.

Weaknesses: He finds it frustrating when he cannot understand what others are saying or when he is not sure about his pronunciation. This makes him avoid verbal-oral communication as much as possible. Most of the conversations with his friends are through text messages because he wants to avoid misunderstandings.

Opportunities: He considers himself lucky to have a strong support system to help him feel better especially when he tends to be self-critical and withdrawn. He can always count on his parents and siblings, while friends cheer him up and boost his confidence. After he graduates high school his wish is to study IT, which he thinks is what he is best at.

Threats: Because of Covid-19 and people wearing masks all the time, he finds it harder than usual to communicate with others. He cannot rely on lip reading as much as he usually does. He prefers online school where he can use his computer because of this. His multiple experiences with malfunctions have made him wary of what could happen in the future.