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Deaf Education: The Impact of Cochlear
Implantation?
Sue Archbold
The Ear Foundation, Nottingham, UK
Connie Mayer
York University, Toronto, Canada
This paper reviews the impact that cochlear implantation has had on the prac-
tice of deaf education in terms of educational placement, communication
choices, and educational attainments. Although there is variation in
outcome, more children with implants are going to mainstream schools,
and using spoken language as their primary means of communication, and
the evidence to date suggests that cochlear implantation early in life has led
to improved levels of spoken language and educational attainments.
However, there is also evidence that providing an appropriate educational
environment for these learners remains a challenge –from parents making
choices in the early years to students managing the complexity of the second-
ary and post-secondary setting. Managing the technology effectively in the
classroom remains an issue in many schools, and ongoing training of teachers
and other educational workers needs to include its management. While the
positive benefits of cochlear implantation are clear, we must also be mindful
of the attendant challenges in providing flexibility of choice in meeting the
needs of this increasingly diverse population.
keywords cochlear implantation, deaf children, deaf education
Introduction
Cochlear implantation, in providing useful hearing across the speech frequencies for
profoundly deaf children for the first time, is having an educational impact in ways
that no changes in pedagogy or communication approach have previously achieved
(Archbold, 2010; Mayer & Leigh, 2010). In this paper, we will consider the nature
of this educational impact from the perspective of change. We will review some of
the major studies in the area and describe shifts in educational placement,
deafness & education international, Vol. 14 No. 1, March, 2012, 2–15
© W.S. Maney & Son Ltd 2012 DOI 10.1179/1557069X12Y.0000000003
communication choice, educational attainment, and parental/student perspectives.
We will conclude by summarizing the implications of these changes for educational
policy and practice and teacher training in the era of the cochlear implantation.
Impact of cochlear implantation on educational decisions
The educational management of deaf children has long been controversial, often with
little evidence to support practice and ideology. In part this is due to the fact that deaf
children and young people are a challenging group for researchers to consider. They
are a particularly heterogeneous population with many variables to account for,
including aetiology, age at diagnosis and amplification, cognitive ability, socio-
economic status, parental support, communication preference, and educational
history. Cochlear implantation has added yet more variables: age at implantation,
type of implant, pre-implant hearing levels, processing strategy, and programming/
management of the system. Defining homogeneous groups in order to implement tra-
ditional research methodologies may be appealing, but does not represent the popu-
lation that educators work with, and it is unlikely to produce research that will
influence educational policy and practice in a meaningful way (Leigh, 2008; Arch-
bold, 2010). However, there is a tendency to view children with cochlear implants
in this way. Cochlear implantation, set in a medical and surgical context, has been
the subject of a great deal of research (for a discussion see Thoutenhoofd et al.,
2005), and, 20 years on, there are numerous studies that have explored the impact
of cochlear implantation on language development, educational attainments, and
the educational decisions of placement and communication choices.
Cochlear implantation and educational placement
In step with a world-wide movement to inclusion and the education of all children
with a disability in a mainstream setting, children with cochlear implants are increas-
ingly being educated in mainstream schools (Uziel et al., 2007; Geers et al., 2008;
De Raeve et al., 2012), even when compared to those children using hearing aids
(Archbold et al., 2002). This shift in educational placement has brought with it a
new set of issues, particularly in the later years. When questioned about their experi-
ences of being mainstreamed in a secondary school setting, young people, their
parents and teachers described the challenges of handling increasingly complex
language and concepts, poor acoustic conditions, greater number of teachers and
teaching styles, and the increased use of group work (Wheeler et al., 2007; RNID,
2008). These combine to make access to the curriculum and classroom language
increasingly difficult. Additionally, the excellent levels of speech intelligibility typi-
cally achieved by those implanted early may mask the young person’s language
delay or difficulty in the more subtle pragmatic communication skills required in
the classroom, particularly at the high school level.
Damen et al. (2006, 2007) investigated the performance of children with cochlear
implants in mainstream classrooms using the assessment of mainstream
DEAF EDUCATION: THE IMPACT OF COCHLEAR IMPLANTATION? 3
performance (AMP; Chute & Nevins, 2006) and the screening instrument for target-
ing educational risk (SIFTER: Anderson, 1989) to compare them with their hearing
peers. Their studies revealed a wide variation in functioning, and although the results
are encouraging, the group using cochlear implants scored significantly less well than
their normal-hearing peers on areas of both the AMP and the SIFTER. The most
important variables impacting on the outcomes in this study were age at implantation
and duration of deafness. Mukari et al. (2007) also used the SIFTER, and found that
children with implants were rated poorly in the communication assessments. They
conclude that children with implants continue to need specialist support in main-
stream classes, and that linguistic delay may be one of the causes, in spite of the
levels of hearing provided by the implant. When interviewed, young people reported
that listening in groups and noise in school was extremely challenging, and resulted in
missing important parts of the lessons or instructions (RNID, 2008).
Cochlear implantation and communication mode
In addition to educational setting, the other major educational decision made relates
to communication mode. Oral communication has often been linked with improved
outcomes from implantation (Geers et al., 2003, 2011; Geers, 2006; Spencer &
Oleson, 2008; Wiefferink et al., 2008). In the large-scale study Geers et al. (2011)
reported that of 112 adolescent users of cochlear implants, those who relied on
spoken language at an elementary level evidenced higher levels of language and lit-
eracy at high school.
Studies comparing outcomes from implantation in children using oral communi-
cation and those using signed communication often suggest that communication
choice is a ‘once and for all’decision, that communication does not change over
time, or that differing communication modes may be used in differing situations.
However, children with cochlear implants do change communication mode after
implantation, particularly if implanted early (Watson et al., 2006; Tait et al.,
2007). Parents were asked if their child had changed communication mode follow-
ing implantation, and if so, how and why (Watson et al., 2007). The trend was mark-
edly towards an increase in oral communication, even for children who had initially
used signed communication. Parents’views were that this shift was largely driven by
the change in access to audition provided by the implant and was led by the child’s
changing needs and own choice. Those implanted younger were more likely to
change communication mode from sign to oral and did so more quickly than
those implanted later, with 83 per cent of those implanted below the age of three
using oral communication exclusively 5 years after implantation. In another
study, the majority of those implanted at one moved from signed communication
to oral within 6 months of implantation (Tait et al., 2007).
In interviews parents have described this as a communication journey (Wheeler
et al., 2009). While clearly the goal of cochlear implantation for parents was the
development of spoken language, parents were also pragmatic about the
4SUE ARCHBOLD and CONNIE MAYER
communication that was crucial to family life. Prior to implantation they wanted the
most effective form of communication, which, for hearing families who make up 95
per cent of parents of deaf children, was likely to be a spoken language, with or
without some signed or gestural support. Following implantation parents reported
a reduction of signed support as spoken language developed through increasing
access to audition via an effective implant system. Later, parents and young
people showed interest in the use of some signed support or Sign Language (e.g.
BSL) itself, once spoken language had been established. Thus, while cochlear
implantation offers increased opportunity for the development of oral communi-
cation, parents recognize that differing approaches may be appropriate at differing
times, and this might include the use of signed communication. The concept that
parents have to make a ‘once and for all’decision about communication mode,
shortly after diagnosis, may have been changed by cochlear implantation: while
cochlear implantation may have brought about new opportunities for spoken
language, the decision may not be as clear cut as once was predicted.
However, obtaining appropriate provision and flexibility in educational services
has often been a source of tension between parents and local teachers (Sorkin &
Zwolan, 2004; Sach & Whynes, 2005; Wheeler et al., 2008). Sach and Whynes
reported that parents had to ‘fight’for the provision they felt appropriate for their
child, and Sorkin and Zwolan found that 30 per cent of parents described being
unable to obtain the educational provision they wished for their child.
Cochlear implantation and educational attainments
It has become standard practice to compare the educational progress of children
with implants to that of normally hearing children. This was not as common
prior to implantation, and is significant in considering the educational implications
of cochlear implantation. Comparison to (and achieving) age appropriate outcomes
has become the new benchmark. For example, Dettman et al. (2007) looked at nine-
teen infants implanted below age of one (mean age at implant 0.88) and found that
language growth was significantly greater in these infants than in a matched group
implanted between 12 and 24 months. Their growth rates matched the growth rates
of normally hearing infants. Nicholas and Geers (2007) used the Pre-School
Language Scales with 76 children aged 3.5 and 4.5 years of age, implanted below
the age of three. They found that those implanted between 12 and 16 months
were more likely to achieve age-appropriate spoken language. Ching et al. (2008)
reported that children implanted below the age of 12 months developed normal
language skills at a rate comparable to hearing children. Tait et al. (2007) compared
the pre-verbal communication skills of children implanted before the age of one,
with normally hearing children. They found that normally hearing children pro-
gressed faster, but the difference was not significant.
Investigation into educational attainments following implantation is still in its
infancy, given the long time frame from implantation to school entry to graduation.
DEAF EDUCATION: THE IMPACT OF COCHLEAR IMPLANTATION? 5
That said, early reports are encouraging with studies to date focusing primarily on
reading outcomes. A review of reading studies by Marschark et al. (2007) reported
improved reading skills in those with implants, but not on a par with their hearing
peers. Archbold et al. (2008a) found that age at implantation was a significant factor
in the development of reading skills. Those children implanted before the age of 42
months, and with a non-verbal IQ in the normal range, had age-appropriate reading
scores both 5 and 7 years after implantation. In their study of fifty deaf children
with at least 3 years of implant use, Vermeulen et al. (2007) found that those with
implants had significantly better reading comprehension scores than those with
hearing aids, but remained substantially behind hearing peers. Other researchers
(Geers et al., 2003, 2008, 2011; Spencer et al., 2003; Spencer & Oleson, 2008)
have also reported encouraging reading results in children after implantation.
However, it is still an open question as to whether these encouraging results hold
as the children move into adolescence, with the more demanding and subtle skills
required to achieve age-appropriate reading levels (e.g. inferencing). In spite of
reports of age appropriate language development in early implanted children
(Ching et al., 2008; Dettman et al., 2007), reports of progress in educational attain-
ments in the longer term are more cautious. Geers et al. (2008) reported long-term
outcomes from a large study of children implanted in the pre-school years. When
assessed at ages 8/9 years, reading levels were within normal levels. However,
when retested at ages 15/16, while speech perception scores improved over the
long term, and average language scores improved at a faster than normal rate,
reading scores did not keep pace over time. They concluded that early cochlear
implantation impacted positively on auditory and verbal development in the
group of eighty-five adolescents they tested, but age-appropriate reading levels in
high school were not found for the majority of students. In a further study, Geers
and Hayes (2011) also reported that there were significant delays in spelling and
written expression in their group of 112 adolescents compared with hearing
peers. Harris and Terlektsi (2010) compared the reading skills of a group of 12–
16 year olds with implants with those with hearing aids, and found that the
reading ages of all groups were several years below that of their hearing peers.
Thoutenhoofd (2006) in his study of deaf children in Scotland showed that those
with implants had better educational attainments, particularly in mathematics, than
those with hearing aids, but scored more poorly than their hearing peers. Stacey
et al. (2006), in an investigation of a large group of cochlear implant users in the
UK, found paediatric cochlear implantation to be associated with reported improve-
ments in some aspects of educational achievements and quality of life, provided that
children receive implants before 5 years of age.
Cochlear implantation and parent/student perspectives
Parents reported that implantation had influenced their educational decisions, sup-
porting a move towards spoken language and mainstream provision (Archbold
et al., 2006). Over half of the parents were concerned about their child’s future
6SUE ARCHBOLD and CONNIE MAYER
education, with one-third of parents expressing the opinion that their child was not
keeping up educationally with their hearing peers (Archbold et al., 2008b). Another
major concern for parents was the management of the technology in the classroom.
This is not a new concern: Geers & Moog (1995) pointed out that the long-term
management of cochlear implants resides with teachers.
To get a sense of the student perspective, Wheeler et al. (2007) interviewed twenty-
nine young people with cochlear implants. Their responses indicated a reliance on
the technology, and a dislike of being without it; one young person refused to go
to school if his implant was not working. A majority felt that their implant helped
them understand lessons. The majority of the group interviewed saw themselves
as either ‘deaf and hearing’,oras‘deaf’, recognizing that without their implants
they were deaf. Comments such as ‘some days deaf, some days hearing’may indicate
different levels of functioning in different situations. Identity for these students may
not be a fixed concept; the notion that these young people must see themselves as
deaf or as hearing may be outdated. For most (69 per cent) speech was the chosen
mode of communication, with the others using Sign Supported English. Wheeler
and Archbold (2009) reported that the group appeared pragmatic about choice of
communication mode and were flexible in its use, using signed support or speech
as appropriate. In this group, a positive view of implantation is given, and a flexible
view of communication and identity is reported (see also Wald & Knutson, 2000;
Christiansen & Leigh, 2004; Percy-Smith et al., 2008; Moog et al., 2011).
Variability in outcomes
Outcomes from paediatric implantation have surpassed expectations, even of those
who were sceptical at the outset. The major predictor of positive outcomes appears
to be early implantation (e.g. Dettman et al., 2007; Tait et al., 2007; Archbold et al.,
2008a, b); however, there are some provisos noted in the literature. Holt and Svirsky
(2008) queried whether earliest is always best and found that although earlier
implantation favourably influenced language outcomes, there were few differences
in those implanted before the age of 12 months and those implanted between 13
and 24 months. The advantage in implanting before the age of one was only appar-
ent in receptive language development, not in expressive or word recognition devel-
opment. Leigh (2008) noted that the empirical evidence base for early implantation
is ‘incomplete and equivocal’. He challenged studies that do not take account of the
influence of early intervention itself, known to be a positive factor (Yoshinago-Itano,
2004), and which do not highlight the inter-subject variability that is revealed in
many studies where at least some of the later implanted children do well (Svirsky
et al., 2004; Dettman et al., 2007; James et al., 2008).
The other major finding has been that of diversity of outcomes, and the variability
and uncertainty as to predictive factors for positive outcomes (Thoutenhoofd et al.,
2005; Leigh, 2008; Pisoni et al., 2008). Assessment batteries to measure outcomes
following cochlear implantation were often established in cochlear implant centres
DEAF EDUCATION: THE IMPACT OF COCHLEAR IMPLANTATION? 7
and designed to demonstrate benefit and safety in the prevailing climate of contro-
versy. They looked at ‘end points’, rather than how the children achieved the goal,
and usually at the child’s functioning in the clinic, where some of the variables could
be controlled and where more specific abilities (e.g. listening in differing conditions)
were measured (Archbold, 2010). When looking at outcomes in the home and in
educational settings, the complex interaction of the many influences on progress
increases the likelihood of variability. In addition, cochlear implantation has
increased diversity in an already heterogeneous group. For educators, this variability
combined with the corresponding uncertainty about predictive factors, makes advis-
ing parents about educational decisions and providing appropriate educational
support for deaf children with implants especially challenging.
Discussion
Cochlear implantation is changing the choices for parents and educators for their
deaf children. It is engendering a shift in the old arguments about communication
choice as profoundly deaf children now have access to spoken language via this
new technology. With very early implantation, communication mode is unlikely
to be well established prior to surgery; the development of effective communication
skills after early diagnosis, combined with early implantation, is likely to bring
together vision and audition in the development of spoken language in a natural
way, as with hearing babies, reducing the need for hearing parents to make a com-
munication choice early in life. Research and practice in this controversial area needs
care in the use of terminology; the use of British Sign Language, with its own
grammar, and without the use of voice, has very different language learning and edu-
cational implications, than that of using Sign Supported English, using English
grammar and simultaneous voicing (Mayer, 2009; Mayer & Leigh, 2010). To
report in research only the comparison of sign and speech masks this. Similarly, edu-
cators, in planning educational provision, must be very clear about their terminol-
ogy and what is provided if the benefits of access to speech through hearing are
to be maximized in the development of spoken language.
Cochlear implantation has also changed educational placement options, with
increased access to mainstream provision, particularly for those implanted early.
However this engenders a new set of considerations. Because learners with cochlear
implants appear to hear well and speak intelligibly, teachers, particularly main-
stream teachers, may fail to realize the impact of profound deafness, even with
the advantage of cochlear implantation, and do not realize students’needs,
especially in secondary and post-secondary education (Wheeler et al., 2007;
RNID, 2008). Most children implanted in the past, and the subjects of research
reported here, have only one implant, and the effect of a unilateral hearing loss in
education is well known. Bess et al. (1986) showed that children with a unilateral
hearing loss were ten times more likely to fail a grade, and twice as likely to have
8SUE ARCHBOLD and CONNIE MAYER
behavioural difficulties, and even a mild, unilateral hearing loss can affect a child’s
performance in the classroom (Most, 2004).
Children with implants who evidence intelligible, age-appropriate language are
still not hearing as their hearing peers in the classroom. They are receiving a degraded
auditory signal, and have had a period without auditory stimulation, however early
implanted. They are likely to experience difficulty particularly in noise and in groups,
and are more likely to be dependent on visual clues in order to access language in a
busy mainstream class, and to miss some information or mishear (Hauser &
Marschark, 2008). Their communication needs are likely to be more subtle than
those of profoundly deaf children in the past and easily overlooked. Managing the
rapidly changing technology in the classroom is challenging –particularly in the
mainstream classroom with non-specialist teaching staff. Young people and
parents highlighted the reliance of implanted children on the technology, and the
necessity of long-term technical support, with links to the cochlear implant centre.
There are also those who do not do as well as expected prior to implantation and
those with additional needs. Up to 40 per cent of deaf children are likely to have
another difficulty (Fortnum et al., 1996), and are increasingly being considered
for implantation. Prior to implantation, it was difficult to diagnose some additional
difficulties, such as autism, or a language learning difficulty in the presence of pro-
found deafness. Following implantation, some difficulties may be identified which
were not known prior to implantation and for teachers of the deaf, working with
teachers with other specialist areas, such as those working with autistic children,
is now increasingly important.
Cochlear implantation has changed the potential for profoundly deaf children to
increase the level of educational attainments compared to outcomes commonly
accepted in the past. Their language, reading, and other educational outcomes are
now being compared with those of their hearing peers. Evidence does indicate
that their educational attainments are better than their peers with hearing aids,
but not yet as good as those of their hearing peers in the long term. However to
date there is little evidence to show what type or level of educational support
leads to improved educational outcomes for these children.
From parents and young peoples’perspective, education is a major issue and one
where cochlear implantation has made a major impact. While the majority of
parents are satisfied with outcomes from implantation, concerns remain with
respect to certain aspects of education. Parents expressed concerns about the man-
agement of their children into adulthood, and of the technology in the long term.
They wanted local educators to be trained in the management of the technology;
better liaison between implant centres and local educational services; choice and
flexibility in educational provision and communication methodology; and recog-
nition of their child’s changing needs and abilities over time. The young people
valued their implants in school, wanted them fully functioning at all times, had a
pragmatic view of communication choices, and generally saw themselves as both
deaf and hearing.
DEAF EDUCATION: THE IMPACT OF COCHLEAR IMPLANTATION? 9
It may be that cochlear implantation demands more of deaf education, rather than
less. Deaf children remain a heterogeneous group; it appears that cochlear implan-
tation has added further to the factors producing variability rather than reducing it.
For educators, cochlear implantation has provided new opportunities, but also new
challenges to address:
•Providing flexibility in educational provision over time.
•Providing effective support in mainstream, inclusive educational settings.
•Supporting a more diverse population with more subtle communication needs.
•Monitoring subtle changes in progress over time, and identifying difficulties which
may impede progress, whether these originate in the child, the environment, or in
the technology.
•Providing appropriate education for those who have an additional learning
disability.
•Providing appropriate support for the increasing demands in the secondary,
school setting.
•Managing complex, changing technology in a busy educational environment.
•Collaborating effectively with a greater number of professionals Providing
peer-group support for the psycho-social needs of the increasing numbers of those
in mainstream settings (Archbold, 2010).
There remains the challenge of long-term management in education for this new
group of children, who are deaf but functioning with levels of hearing provided by
implantation not previously possible for profoundly or severely deaf children, and
who are increasingly using two implants. They are not functioning as profoundly
deaf children of the past, but neither do they function as hearing children. If the
changing needs of this new group of deaf children and young people are to be
met, changing practice needs to be evidence based and to be informed by rigorous
and reliable quantitative and qualitative research (Hauser & Marschark, 2008),
and preferably in the classroom (Archbold, 2010). Such research into the ‘real-
world’functioning of deaf pupils should influence service planning and teacher
training as well as the decisions made about appropriate educational support for
individual children.
Implications for teaching and teacher education programmes
As the education of deaf learners has become increasingly complex, teachers of the
deaf are challenged to meet the needs of an increasingly diverse group of learners.
As Leigh (2010) has suggested, ‘there is currently more knowledge and skill
required of a teacher of the deaf than at any time in the history of the field’.
Cochlear implantation has served to expand the range of this diversity within the
student population, and of the competencies teachers require in meeting learner’s
needs. As noted above, this has implications for both teachers and teacher education
programmes.
10 SUE ARCHBOLD and CONNIE MAYER
For students with cochlear implants, learning is predicated on being able to access
information via audition. Equipment must be worn and working. Teachers of the
deaf need to know how to manage this equipment, and be able to teach others
how to manage it: parents, classroom teachers, educational assistants for
example. This can be a challenge given the range of technologies they will encounter,
and the rapid pace at which the technology changes. Therefore a heightened empha-
sis on technology in teacher education is warranted, yet only 13 per cent of respon-
dents reported including instruction in troubleshooting cochlear implants as part of
their programme (Harrington & Powers, 2004). Ongoing professional development
to teachers of the deaf already in the field is also vital.
It is also the case that the majority of children with cochlear implants are educated
in inclusive settings in their local school. This means that, in contrast to having their
own class of deaf learners in a self-contained setting, most teachers of the deaf will be
working as part of a collaborative team to provide the appropriate programme in a
mainstream setting. A major aspect of this role is to be able to work and communi-
cate effectively with a range of individuals (e.g. classroom teachers, administrators,
speech language therapists, audiologists, and support workers such as teaching
assistants, interpreters, tutors, and notetakers). In addition, it often falls on the tea-
chers of the deaf to co-ordinate this team as they have the most direct contact with
the student; yet less than 50 per cent of teacher education programmes report any
focus on collaboration with general educators or other professionals as part of
the curriculum (Harrington & Powers, 2004).
Along with these changes in educational setting come shifts in expectations for
educational outcomes. As learners with cochlear implants evidence language out-
comes that are near age-appropriate, it has been anticipated that grade level per-
formance in reading, writing, and other academic areas will follow. While the
current evidence is not unequivocal, research does indicate a variable but overall
positive shift in literacy outcomes for learners with cochlear implants (Marschark
et al., 2010), and research reported here is likely to be conservative, being based
on children implanted later than currently the practice, with only one implant,
and with older technology. Teachers of the deaf will require a better understanding
of the reading and writing processes in typically hearing children and of the main-
stream curricula for literacy education. Rather than teaching a separate curriculum
or one designed for deaf learners, teachers of the deaf need to know how to appro-
priately differentiate the mainstream programme for learners with cochlear
implants. Familiarity and expertise in administering a range of assessment and
evaluation tools will also be key in monitoring progress in language and literacy,
and in ensuring that students are being educated in the most appropriate setting.
In addition to the even greater focus on the mainstream setting, teachers of the
deaf will be working with greater numbers of infants, toddlers, preschoolers, and
their families as implantation is routinely being done by 12 months of age in
many countries. They will also be working with more children with cochlear
implants who have additional disabilities as this group is being implanted in
DEAF EDUCATION: THE IMPACT OF COCHLEAR IMPLANTATION? 11
increasing numbers. Most teachers of the deaf do not have expertise in providing
support to these groups of children, or their families, as the focus in teacher edu-
cation programmes has historically been on the impact of hearing loss, and not
other disabilities, on learning.
Clearly teachers and teacher educators face a myriad of challenges, and exciting
possibilities, as the population of learners with cochlear implants continues to
grow. Teacher educators will be challenged to review their existing programmes
and curricula in light of the changing context (e.g. Millett & Mayer, 2010), and it
will also be paramount to provide professional development for practising teachers
of the deaf.
Conclusion
The impact of cochlear implantation in children has not turned out as either the
critics or the supporters predicted. It is more complex than anyone could have
been anticipated. It has changed educational choices for parents and led to improved
levels of spoken language and educational attainments. However, cochlear implan-
tation has served to make an already diverse group, even more heterogeneous,
increasing demands on teachers of the deaf, and continuing to make educational
choices for their children a major issue for parents. If practitioners in deaf education
are to work with parents, students and researchers to identify the best possible long-
term support for this changing and diverse group of deaf learners, it may be possible
to utilize the opportunities afforded by cochlear implantation to enable the field to
move on from some of the old arguments and fulfil the predictions of Marschark and
Spencer:
Spoken language development of deaf children may be more possible today than
ever before. …..we are now presented with the opportunity to learn from earlier
mistakes and misunderstandings and to synthesize the best ideas of the past with
the technological, programming and social advances of today. …….we may
finally be able to fulfil the promise of effective support for speech and spoken
language with hearing loss. (Marschark & Spencer, 2006: 17)
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Notes on contributor
Correspondence to: Sue Archbold, The Ear Foundation, Nottingham, UK. Email:
sue@earfoundation.org.uk
DEAF EDUCATION: THE IMPACT OF COCHLEAR IMPLANTATION? 15
