Nine-year-old Ryan will have his operation done in the U.S.

Quebec refuses to pay for nine-year-old's cochlear implant


Procedure to be done in the U.S.


Peter Karahalios


Nine year old Ryan Duchoeny, who resides in Chomedey with his family, will have a cochlear implant inserted into his head in Vermont, where the procedure will cost his family some 35,000 American dollars.


Ryan is profoundly deaf and relies on traditional hearing aids that do not improve his hearing significantly.


Apart from Quebec, he has been examined -said his father Frank- in three jurisdictions -Toronto, Vermont and New York- where doctors have all agreed that he is an ideal candidate for a cochlear implant and that the implantation of such a device will give him 60 percent of his hearing back.


"In fact," said Frank Duchoeny, they all told me that Ryan was a good candidate and that if the RAMQ (the Régie de 1'Assurance Maladie du Quebec -a.k.a Medicare) would pay for the procedure, they all would have performed it. But the RAMQ will not cover the costs, continued Mr. Duchoeny, because one of the Quebec doctors who examined Ryan feels that because the boy can communicate effectively in sign language, the expense that would make him hear again is not justified and therefore Ryan is not considered a good candidate. In fact, it appears that Quebec doctors and the RAMQ are among those who believe that in order for a cochlear implant to have maximum effect, profoundly deaf children should have them implanted at the age of One.


According to Dr. John Niparko of Johns Hopkins University, the first cochlear was performed in 1956 in France on a patient with a severe ear infection. After the infection was taken out, a wire was placed on the hearing nerve, which was visible due to all the destruction from the infection. The patient reported over the next three days that he heard a variety of sounds when current from a battery pack was applied to the wire. Doctors were surprised because they expected the patient would feel a sensation or perhaps some pain in the ear, but they did not expect the patient to report he could actually hear something.


The wire was left in for only a few weeks because culturally Deaf people in Paris heard about the experiment and claimed that it was a completely unethical. Nothing more happened until 1962 when a group of doctors in Los Angeles tried the same thing. They had some success, but technology was not yet available for coating a wire so that it would keep functioning over time. These early experiments showed that even in a destroyed ear, the nerve could retain its sensitivity and respond to Stimulation.


Ten years later, technology from the NASA exploration helped develop the electronics into a small package that was seated to function over a long period of time.


Currently, two different cochlear implants are approved for clinical use. Both implants consist of two parts; an internal and external component.


The internal component consists of a decoder and a magnet housed in protective easing. The electrode array extends from this casing. This component is implanted into the skull with the electrode array being inserted into the cochlea. The external components consist of a microphone, a series of cords, a transmitting coil and a speech processor. Each part must be worn in order for the device to work.


The device is powered by one "AA" rechargeable battery. Replacement batteries and a recharge are provided by each company for patients.


The internal and external components communicate through a specific radio frequency. There is no concern about interference from other radio frequencies during this transmission.


There are six steps in how the implant transmits sounds:

  1. Sound waves enter the microphone located in the headpiece.
  2. The sound is sent to the speech processor via the thin cable, which connects the headpiece to the speech processor.
  3. The speech processor converts the sound into a special signal that can be interpreted by the brain. This conversation is accomplished through sophisticated software programs.
  4. The special signal is sent back up the same cable to the headpiece and transmitted across the skin via radio waves to the implanted device.
  5. The signal travels downs to the electrode array positioned within the inner ear and stimulates the auditory nerve.
  6. The auditory nerve then transmits the electrical signal to the brain where it is interpreted as sound.


According to Statistics Canada, 2.9 million Canadians experience some form of hearing loss a number equivalent to one in ten.


But accurate statistics on hearing loss are very difficult to obtain. Most of the research and statistics gathering rely on self-identification and an inconsistent use of terminology and definitions. It is very common for people to deny their hearing loss. In addition, many hard of hearing people who have adapted well to their hearing loss, their hearing aids and other assistive listening devices may report that they have no difficulties hearing and are therefore excluded from the statistics.


Then term 'deaf is generally used to describe individuals with a severe to profound hearing loss, with little or no residual hearing. Some deaf people use sign language to communicate. Others use speech to communicate, having learned to use their residual hearing and hearing aids, technical devices or cochlear implants, and lip reading or speech reading.


The term 'culturally Deaf refers to individuals who are deaf (deafened or hard of hearing) who identify with and participate in the language, culture and community of Deaf people, based on sign language. Frank Duchoeny has set up a fund for Ryan with the help of the Jewish Community Foundation, who will manage the fund and hand out tax receipts for contributions. The target amount is $40,000 US.


Interested parties can make their contribution cheques to

"Jewish Community Foundation"

Re. Ryan Duchoeny and send them to

1114 Mill Hill Place,

Laval, Quebec,

H7W IR1,

From where they will be forwarded to the Foundation.


The operation, which can now be performed as day surgery, will be carried out at the Allan Fletcher Memorial Institute in Vermont.


With files from Johns Hopkins,

Statistics Canada, and The Canadian Hearing Society.