Screening for deafness.

Eskander and Papsin1 may be somewhat disingenuous in their plea for neonatal screening for deafness. Underlying this notion is the unspoken concept that, having detected a hearing impairment in an infant, it is required that we treat him or her with a cochlear implant. Although early placement of cochlear implants may well foster acquisition of the spoken language of the larger community, as implied by the authors, it is incorrect to suggest that children with hearing impairments lack language skills per se. The battle between the hearingimpaired community, which has a distinctive culture and a rich manual language, and a paternalistic hearing community, which feels the need to “fix” the “defective” individuals, has been ongoing for decades. Infants with hearing impairments babble with their hands, just as hearing infants do so orally. Given the opportunity, they then acquire language skills just as hearing infants do; it is simply a different language, expressed in a different mode. This manual language reflects a culture foreign to the hearing community, and many in the hearing-impaired community argue that the insistence on cochlear implants is both unjustified, and, in the extreme, a form of cultural annihilation. I would suggest that the bland assumption that early detection is necessary and beneficial may not be as simple and obvious as Eskander and Papsin1 suggest.